Delayed Patterns of Food Allergy - Case Examples
Mysterious Flu-Like Illness
A 34 year old woman presented with an illness of 10 months
duration. A consultant's medical history stated that she was well
until 10 months previously when she developed a flu-like illness
with cervical lymph node swelling, fatigue, aching, and sore throat.
When she did not recover as expected, extensive were inconclusive.
Her 10 month debilitating illness featured chronic rhinitis,
recurrent pharyngitis, generalized aching, stiffness, abdominal
bloating, dyspepsia and fatigue. She had quit work 4 months
previously and spent most of her days in bed. The impression of the
illness, on casual review was that it was a new event, but on closer
examination of her history, a different story emerged. She revealed
that she had chronic "sinus problems" for 15 years (chronic
rhinitis, mucus in her throat, maxillary and frontal sinus pain).
Muscle pains, tension and stiffness had been occurring for over 10
years but were limited to her shoulders and upper back. She treated
this discomfort with exercise, massage, and aspirin, keeping it
under control. As a child she had episodes of mysterious illness
with fevers, middle ear infections, rhinitis, and eczema.
She described increasing work "stress" for a year prior to her
collapse. The "stress" translated into a series of relevant
behavioral and diet changes-she worked longer hours, she stopped
exercise classes, increased her cigarette consumption from 10 to
over 20 per day and increased her coffee consumption from 2-3 to
8-10 cups per day. She took more aspirin for headaches and muscle
pain and ate more fast foods, muffins, crackers, cheese, and yogurt;
70% of her daily calories were supplied by milk products, wheat, and
eggs, and the 10% vegetable fraction was mostly potato.
What really happened was not a sudden new illness in an otherwise
healthy, professional woman, but an avalanche effect from a
cascading series of negative events over many months to years. Her
history suggested that she had delayed pattern food allergy since
childhood in a mild and intermittent form. She existed in an
adaptive dysfunctional state and perceived herself to be "well" even
during the hectic year which shifted her food intake, smoking, and
other habits into a maladaptive range. This perception, "I am OK",
while in the ADS is typical of highly-motivated, goal-oriented
people. Many ADS people may totter on the brink of collapse for
months to years. Their suffering is associated with denial of
increasing dysfunction. Physicians, operating conscientiously in the
medical model, permit and even encourage this sort of
self-deception. When the doctor reassures an ADS patient, who
presents with symptoms too early, that everything is OK because the
tests are normal, the patient is really encouraged to continue
working on the illness until it is a fully-expressed, finished
product. When you go too far out of range, you can expect a sudden,
dramatic collapse-the avalanche-but you never know when it will
occur.
Similar Illness in a Child
If we amplify the details of her childhood history, we would
reveal more convincing evidence that she had chronic symptoms from
food allergy, perhaps even beginning in early infancy. A similar
illness is often seen in children. For example, a 9 year old girl
presented with an illness, apparently of 4 months duration which
left her bed-ridden and unable to attend school for 3 months. She
had nose congestion, sore throats, lymph node swelling, coughs,
muscle aching, and extreme fatigue. She felt tearful, despondent,
and could not concentrate on her school assignments nor remember
what she had learned the day before. She had been carefully studied
with many tests, and her mother had been told that the cause was "a
virus; there is nothing to do but wait". Her mother described an
unusual eating pattern; she craved milk and yogurt and consumed
these foods with toast, often with the exclusion of all other foods,
especially on her worst days. On careful review of her history, it
was obvious that she had symptoms since infancy, and her mother knew
that she was allergic to milk during the first year when she had
relentless colic, bloating, continuous colds, and severe diaper rash
while on a milk formula, and complete remission of symptoms after
cow's milk had been replaced with a soya formula. Her symptoms
seemed to clear after 2 years and her physician advised resuming
dairy intake, telling mother that "infants outgrow their milk
allergy". The child went on to display chronic respiratory symptoms,
and had odd "mysterious" illnesses with fevers, aching, headaches,
and occasional abdominal pains for the past 5 years. Although none
of the prior illnesses were as severe as her present illness, the
pattern was well-established before the avalanche effect occurred.
The myth that "children outgrow their food allergy" has been
perpetuated by pediatricians who do not notice how the food allergy
pattern shifts and evolves over time and who do not study the slow,
logical progression of food allergy over decades.
The 9 year old girl and the 34 year old woman are proceeding down
the path of a disease-making process that continues until the
problems in their food supply are corrected. Both experienced
complete remission of symptoms on an oligoantigenic diet and
recurrence of symptoms when they again ate reactive foods. Neither
had an atopic history and neither had positive skin tests. The
symptom expressions are the result of many factors combining at any
given time. I have referred to this illness pattern as type III
pattern food allergy - in my opinion one of the most prevalent and
least diagnosed forms of food allergy. Both improve dramatically
with complete diet revision. Both do better if they continue their
revised diet. The 34 year old woman must stop smoking before she is
well again.
Continuous Since Infancy
A 16 year old girl presented with a chronic flu-like illness that
had been investigated repeatedly for over three years with no
definitive diagnosis. She complained of constant sore throat,
epigastric pain with abdominal bloating, daily headaches, and
chronic rhinitis with recurrent otitis media. Her left tonsillar
node was conspicuously enlarged and would fluctuate in size from a
small to large grape size. Repeated hematology testing and mono
antibody screens were negative. In her first year she was fed a cows
milk formula and, suffered from colic, constipation, chronic
rhinitis, and recurrent otitis media. In years 2 to 5 she continued
to have rhinitis and otitis media with repeated antibiotic
prescriptions, headaches, neck, back and limb pains, recurrent
abdominal pains and bloating. She had episodes of hyperactivity, was
moody and had frequent sleep disturbances, waking often with night
sweats and complaints of pain. She preferred to eat dairy products,
bread, cereals and had chocolate cravings. Her favorite food was
yogurt which she consumed every day. A similar pattern of food
preference and symptoms persisted into adolescence; the increased
sore throats and lymphadenopathy attracted more medical attention.
This is a typical type III food allergy pattern, easily recognized
from the medical history.
Gastrointestinal symptoms as the central feature of a chronic
illness
Often gastrointestinal tract symptoms are the central feature of
a chronic illness with evolving features of immune-mediated disease.
The illness may be mild or intermittent, but may flare-up
occasionally with manifestations of target organ dysfunction. The
examples to follow show the polysymptomatic, multisystem features of
the type three pattern.
A 40 year old woman had GI symptoms for many years associated
with hyperthyroidism, migraine headaches, arthralgias, and a
recurrent flu-like syndrome. When asked to keep a daily food-intake
and symptom record, she scored symptoms on a spread-sheet over a 4
week period as she followed the Core Program method of diet
revision. Her total daily symptom score (using a 0 to 3 scale)
started over 60 and reduced to 17 on day 28 of diet revision. By
following patients with a daily food-symptom journal and spreadsheet
scoring of symptom occurrence and intensity, typical patterns of
response to diet revision have emerged and must be understood by
physicians who seek to treat these patients.
She had just retired from a stressful job as a school
Vice-Principal, stated that she had been pushing herself to the
limit everyday and had been progressively unwell. She described
passing 4 to 5 "cigar-size" stools per day, daily bloating, and
episodes of epigastric pain, occasionally severe. A one month course
of ranitidine relieved the pain but had no effect on the other GI
symptoms. Stool cultures, UGI series and ultrasound of the abdomen
were all negative. She reported a mixed headache pattern with
frequent tension headaches and less frequent morning migraines which
were incapacitating and kept her in bed. Hyperthyroidism was
diagnosed 9 years previously and treated successfully with
propylthiouracil; but recurred 6 years later and was treated with
radioactive iodine; she had been on thyroxine replacement 100 ucg
/day since then. She reported chronic rhinitis with frequent
nosebleeds, aphthous ulcers, pharyngitis, and flu-like symptoms -
aching, fatigue, sore throats, general malaise. She was concerned
about slowly progressive cognitive dysfunction and noted difficulty
concentrating, recent memory drop-outs and difficulty recalling
familiar information ( names, phone numbers). A typical day's food
intake ( before diet revision) was recorded as:
Breakfast: Oatmeal with raisons and a little milk; 1 mug of
coffee.
Lunch: 2/12 eggs scrambled with asparagus, butter, whole-wheat
toast and margarine.
Snacks: Chocolate bar, candy-coated popcorn, hot chocolate.
Dinner: McLean Burger at MacDonalds, small fries.
Symptoms: "feel yukky", cold sores, nasal stuffiness, cough,
rough voice, joint-aches and backaches ( went for therapeutic
massage).
