Unorthodox
Techniques for Diagnosing & Treating Asthma & Allergy
for Professionals
Allergy is a science-based specialty
Conventional allergy practice and testing relies upon an understanding
of the immune basis of diseases such as food allergy, allergic
rhinitis, stinging insect allergies, drug allergies and asthma.
Allergy practice is underpinned by the reliable detection of "allergic"
(IgE) antibodies to a specific substance by the standardised techniques
of skin prick testing or blood specific IgE testing.
Philosophies underlying unorthodox medical practice
Many unorthodox allergy practices claim that common symptoms
such as headaches, migraine, irritable bowel, muscle tension,
aches and pains, addiction, PMS, fatigue and depression are either
due to "hidden allergies" or secondary to noxious external
triggers.
Blurring the meaning of the word "immunity" with that of "energy", allergic and other disease is often described as a result of disturbed / imbalanced vital life force or energy, or secondary to noxious external triggers such as environmental toxins and chemicals, food allergens or chronic Candida infection.
Conventional allergy testing is of little use in these situations, as these conditions do not have an allergic basis.
It is stated that the body can generally cure itself if only given the opportunity to correct these imbalances, if only environmental toxins or allergens can be eliminated or avoided. Blending concepts of immunity, neurology and eastern mysticism, claims are usually accompanied by quasi-religious and pseudo-scientific jargon, and emotive language designed to encourage unrealistic expectations.
The following is a summary of the most common alternative techniques used. They have not been subject to reliability testing in the same way as conventional tests. No Medicare rebate is available in Australia for these tests. Reliance on the results of such tests to guide medical treatment is inadvisable.
INAPPROPRIATE TESTING
Cytotoxic testing (Bryans' test)
Use: Diagnosis of food sensitivity / allergy. Method:
A suspension of patient white cells is dropped onto a slide coated
with dried food extract. The slide is then examined under the
microscope to detect changes in appearance and movement of cells,
and whether they look alive or dead. Significant changes are interpreted
as representing a sensitivity or "allergy" to that food.
Evidence: Studies have shown results to be poorly reproducible
when duplicate samples have been submitted to the same laboratory
for testing. Furthermore, patients may be given positive results
to foods for which no symptoms occur, and negative results for
foods allegedly triggering symptoms. There is no correlation between
the results of cytotoxic food testing and any immune mechanism
thought to play a role in allergic disease. The ALCAT test is
essentially a variation of the same test, with the exception that
a mixture of patient blood cells and food extracts is placed into
a Coulter counter.
Oral provocation and neutralisation
Use: This technique is commonly promoted for the diagnosis
and treatment of sensitivity to foods, inhaled allergens as well
as environmental chemicals. Method: The patient is "provoked"
by administering dilute allergen or chemical extracts, usually
as liquid drops under the tongue. The dose required to trigger
symptoms is assessed, then further dilute extracts prepared. Symptoms
are then expected to disappear when the more dilute extract is
administered. If so, the patient is instructed to use this "neutralising
dose" before exposure to the offending environmental chemicals
or foods. Evidence: Blinded provocation studies have shown that
patients are unable to distinguish between placebo controls and
food extracts. Furthermore, studies of doctors practising this
technique have shown that they are also unable to discriminate
between reactions to placebo or active extracts. Subcutaneous
provocation and neutralisation is a variation of the above technique,
with the exception that extracts are injected rather than administered
orally.
Vega testing (electrodermal testing)
Use: Diagnosis of food sensitivity / allergy. Method:
This test is based on the concept that pathological changes in
the body due to disease will be reflected in alterations in electrical
charge. Vega machines claim to measure changes in the resistance
to flow of electric charge between acupuncture points over fingers
and toes. The patient holds one (negative) electrode in one hand,
and then the positive electrode is applied to acupuncture points
over fingers or toes. The machine is then adjusted until a reading
of 80 to 100 scale units is produced. A food extract in a sealed
glass container is brought into the electrical circuits. If a
reduction in current is observed, the patient is told that they
are sensitive to that substance. If a child is tested, then the
parent is initially assessed, and then reassessed while holding
the child's hand. Evidence: Vega testing has been promoted
as being useful for diagnosing a range of diseases from allergy,
sinusitis, chronic Candidiasis through to cancer. There is no
evidence that it is reliable in diagnosing allergic or other disease.
Results are not reproducible in blinded studies, and do not correlate
with results from conventional allergy or other scientific testing.
Kinesiology
Used: Diagnosis of food sensitivity / allergy. Method:
This technique is based on the concept that the body itself can
recognize what is provoking symptoms, and that it can be used
as a "divining rod" for testing. Patient muscle strength
is measured at rest, and then repeated after exposure to food.
"Provocation" to food occurs by having drops of food
extracts given under the tongue or by holding a vial of food extracts
in one hand. Onset of weakness is interpreted as indicating a
food "allergy" or sensitivity. If a child or infant
is being tested, the parent's strength is assessed first, and
then re-measured while holding the child's hand. The two test
results are then subtracted to give the final results. Evidence:
This technique is subjective by its very nature, and there is
no evidence that results are useful for diagnosing any disorder,
including allergies.
Pulse testing
Use: Diagnosis of food sensitivity / allergy.
Method: This test is based on the rationale that allergic
reactions are mediated by nerve impulses transmitted by the sympathetic
nervous system. Promoters of this test state that sensitivity
to a food will result in a temporary increase in heart rate after
exposure. Evidence: This technique is subjective by its
very nature, and there is no evidence that results are useful
for diagnosing any disorder, including allergies. The auricular
cardiac reflex test is a variation, in which food sensitivity
is attributed based on changes in pulse waveform.
Hair analysis
Use: Diagnosis of food sensitivity / allergy and other non-specific
symptoms
Method: Trace elements are measured from samples of hair, and
nutritional deficiencies or excesses are related to the patient's
symptoms. Evidence: There is no evidence that vitamin or mineral
analysis from hair samples is useful for diagnosing disease. There
is no evidence that treatment based on results of such analysis
has any clinical benefit. Blinded studies have shown that testing
laboratories frequently report variable and non-reproducible results
from the same samples.
Radionics (psionic medicine, dowsing)
Use: Diagnosis and treatment of food sensitivity / allergy,
infections and various medical conditions Method: Radionics
is based on the concept that all life forms are submerged in the
electro-magnetic energy field of the earth, and that disease will
be reflected by changes or "imbalances" in an individual's
electromagnetic field that are said to lie outside the normal
electromagnetic spectrum. Practitioners of radionics claim to
be able to detect changes in energies and vibrations arising from
internal organs affected by disease using a pendulum-like device.
Such "dowsing" is said to detect energies and force
fields through subtle vibrations that are then amplified by the
device. Sometimes more sophisticated instruments are used that
purport to "tune in" to disease-specific energies. Practitioners
claim that by focusing their own thoughts and energies, they can
treat disease by restoring normal energy balance in patients in
order to heal. Sometimes the operator is with the patient, and
sometimes the practitioner "connects" with the patient
at a distance using an object such as lock of hair, blood sample
or even a photograph. Evidence: This technique appears
to combine concepts of kinesiology, reflexology, vega testing
and eastern mysticism. There is no evidence that it is effective
for the assessment of treatment of any disorder, including allergies.
Iridology
Use: Diagnosis of various disorders Method: Iridology is based
on the concept that each area in the iris represents a corresponding
part of the body. As such, this shares a similar conceptual framework
with those of reflexology and acupuncture. A person's state of
current and past health can therefore be diagnosed from the color,
texture, and location of pigment flecks in the eye. Detection
of imbalances can be treated with dietary supplements or herbal
medicines. Evidence: There is no published evidence that this
technique is useful for the diagnosis of any allergic disorder.
Furthermore, studies have shown iridologists to be unable to distinguish
patients with visceral disease from healthy controls, and for
results to be not reproducible when iris photographs from the
same individuals taken a few minutes apart were examined.
INAPPROPRIATE USE OF CONVENTIONAL TESTING
Food specific IgG, IgG4. IgE
Use: Diagnosis of food sensitivity / allergy.
Method: Antibodies to food are measured using standard
laboratory techniques. Evidence: Antibodies to food can
be detected in healthy adult patients and children, regardless
of whether or not these foods provoke symptoms, and independent
of the presence of absence of allergy. There is no credible evidence
that measuring IgG antibodies is useful for diagnosing adverse
or allergic reactions to food, nor that IgG antibodies cause symptoms.
Low levels of food-reactive IgE are also found in some healthy
individuals without clinical sensitization or evidence of clinical
reactivity. Inappropriate use of food allergy testing in patients
with inhalant allergy, for example, may lead to inappropriate
and unnecessary dietary restrictions, with particular nutritional
implications in children. These are examples of the inappropriate
use of a conventional diagnostic tests.
Lymphocyte subset analysis
Use: Conventionally used for the assessment of patients with
suspected immunodeficiency or lymphoid malignancy. Also used by
some unorthodox practitioners to assess patients with suspected
"chemical sensitivity" or chronic fatigue syndrome or
"environmental allergies".Method: Lymphocyte
subsets are measured using standard laboratory techniques. Evidence:
The normal range is very wide, varies from day to day and will
be influenced by such factors as time of collection, exercise,
infection and the presence of chronic end-organ disease, and even
depression. Misinterpretation of minor changes in the absence
of evidence of immune deficiency or malignancy can misleadingly
reinforce patient's concern that they are suffering from an immune
disorder, a common concern when the distinction between concepts
of "energy" and "immunity" are blurred.
UNORTHODOX TREATMENTS
Homeopathy
Use: Treatment of various disorders including allergies
Method: Based on the concept of "like cures like",
proponents argue that if a particular substance or toxin can trigger
symptoms in large amounts, extremely dilute extracts of the same
substance can relieve the same symptoms, regardless of cause.
Disease is thought to result from a disturbance in the body's
ability to heal itself, and that only a small stimulus is needed
to start the healing process. Extracts of plant, mineral or animal
origin (eg. adrenal gland, thyroid, thymus, spleen) are first
prepared. These are then serially diluted, with vigorous agitation
at each step to a point where not a single molecule of the original
extract remains. Proponents claim that these extremely dilute
extracts retain the "memory" or "spirit" of
the original extract that will revive the body's "vital force"
and provide relief when taken orally. Evidence: While there
is a superficial resemblance between homeopathy and conventional
immunotherapy, only the latter has been shown to have a clear
dose-response relationship between administered dose clinical
efficacy and changes in immune response. As extracts are diluted
beyond the limit by which a single molecule of the original extract
will remain, they are effectively placebos. Homeopaths often consider
that the more dilute the extract, the more potent is its effect,
the opposite to the conventional view of pharmacology. There is
no convincing evidence that homeopathy benefits patients with
allergy or asthma beyond that of placebo, and no evidence of a
physiological or therapeutic effect. While toxicity from homeopathy
has only been demonstrated in a few cases of accidental contamination
with heavy metals, the promotion of so-called homeopathic "vaccines"
is of particular concern when considering the risk of transmissible
disease in children when used instead of conventional vaccination.
Nambudripad's Allergy elimination
technique
Use: Treatment of food, inhalant and chemical sensitivity
/ allergy Method: This treatment is based on the concept
that allergen is perceived by the brain as a threat to the body's
well being, and that exposure to allergen disrupts the flow of
nervous energies from the brain to the body via "meridians",
and that blocked energy flow results in allergic symptoms. The
technique seeks to "re-programme" the brain by applying
acupressure applied to both sides of the spinal column (where
energy flowing along meridians intersects with nerve roots) while
the patient is in direct contact or close proximity to purported
allergen. Evidence: This technique, which appears to combine
concepts of kinesiology, reflexology, acupuncture and radionics.
Proponents claim to be able to cure almost any allergy or sensitivity.
This is a particularly dangerous technique, particularly when
considering potentially dangerous food allergies.
Clinical Ecology/ Environmental Illness
Use: Treatmemt of a variety of illnesses, usually attributed
to exposure to dietary or environmental toxins, and sometimes
electromagnetic radiation. Method: Promoters of clinical
ecology claim that much illness results from exposure to dietary
or environmental toxins and sometimes Candida. These concepts
arose in the first half of the 20th century, when many ill-defined
conditions were attributed to "allergy", and well before
the key components of the immune system were identified or their
function understood. A variety of "diagnostic tests"
are used to confirm "sensitivity" such as those alluded
to above. Patients with this diagnosis usually display physical
and emotional symptoms (particularly fatigue) involving multiple
organ systems. Conventional medical tests are generally normal,
showing no evidence of organ dysfunction, and objective examination
generally fails to confirm objective evidence of organic disease.
Patients usually complain that a number of distinct and chemically
unrelated substances may trigger symptoms, such as smells, natural
foods, food additives, environmental chemicals and even electromagnetic
radiation. Treatment involves major environmental avoidance strategies,
dietary changes, sometimes elimination of Candida using antifungal
agents or special diets, and "neutralization" of chemicals
in order to minimize exposure and strengthen the immune system.
Evidence: There is no evidence of immune dysfunction in
these patients. Similar symptoms may also be found in some patients
suffering from anxiety and depression, and there is evidence that
a substantial proportion of patients suffer from psychiatric disorders
and benefit from appropriate treatment. Major lifestyle changes
can impact on employment, social functioning and nutrition.
Chronic Candidiasis/
Use: Treatment of a variety of ailments including allergy,
irritable bowel, food allergy and intolerance, autoimmunity, arthritis
and psychological conditions. Method: This approach is
based on the concept that imbalance of gut flora results in overgrowth
of Candida albicans within the gut. Release of fungal toxins results
in a variety of symptoms including fatigue, arthritis, irritable
bowel, food intolerance as well as psychological symptoms. These
toxins weaken the immune system further, predisposing to further
symptoms from ingested foods. Treatment centres on dietary supplements,
administration of antifungal drugs such as nystatin, and restriction
of "Candida friendly" foods such as those contain sugars,
yeast or molds. Evidence: Given that Candida is a normal
gut organism, immune responses (antibodies, cell mediated responses)
to this organism are both expected and observed in healthy controls
as well as those allegedly suffering from this condition. There
is evidence of neither overgrowth of Candida nor altered immune
responses to this organism in patients complaining of this syndrome.
There is neither a scientific rationale nor published evidence
that elimination of Candida with diets or anti-fungal therapy
is useful for the management of any disorder including allergies.
Reflexology,
Chiropractic, Acupuncture
There is limited evidence that these techniques are
useful for analgesia, but controlled studies have found evidence
of neither subjective nor objective evidence of their use in asthma
or allergic rhinitis.
Adverse consequences may arise from unorthodox testing and
treatments
Treatment based on inaccurate results is not only misleading,
but can lead to ineffective, expensive and sometimes harmful treatments,
and delay more effective therapy. False positive results can also
be misleading. For example it can lead to unnecessary dietary
avoidance, with risk of malnutrition, particularly in children.
Unnecessary environmental and chemical avoidance can impact on
employment and social functioning. Moreover, creating a perception
of illness where none exists, or when psycho-social factors are
to blame, is particularly unhelpful. Some practices, such as use
of homeopathic "vaccines" and claims of being able to
"cure" food allergies have potentially dangerous consequences
for those with true life-threatening allergies.
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