Who is Looking After Our Kids?
CHAPTER 14
Food Allergies and Childhood Behavior
The subject of food allergies has been controversial in the medical field. Conventional wisdom holds that food allergies are relatively unimportant in health problems of children, the exception being the relatively infrequent instances when children break out in hives or some other allergic manifestation immediately after ingesting an offending food (technically known as Type I allergic reaction).
Other physicians, predominantly those schooled in the Held of environmental medicine, believe that food allergy problems are relatively common. They may manifest as delayed reactions in many forms including asthma, hay fever, eczema, irritable bowel, seizures, headaches, behavioral problems, hyperactivity, and some forms of mental illness.
Probably the single more important study confirming the widespread role of food allergies in childhood health problems was conducted by Joseph Egger, MD, of Munich, Germany. (1) The study involved 76 children specially selected because of severe hyperactivity and behavioral problems, as well as a high proportion with other problems including headaches, abdominal pains, and seizures. In the study, the children were placed on an "oligoantigenic diet" from which all foods with high allergic potential were removed from the diet. The restrictive diet was continued for several weeks during which time 82% of the children showed significant improvement in behavioral problems and hyperactivity. Most of the associated symptoms (headaches, abdominal pains, and seizures) improved as well. Previously eliminated foods were reintroduced after several weeks, one at a time in intervals as long as five days. In this way offending foods were identified by reappearance of symptoms. It should be noted that reactions were often delayed two or three days after reintroduction of the allergy-causing food, proving the prevalence of delayed-type reactions (Type IV allergic reaction).
A well-designed study at Cornell Medical Center, Manhasset, New York, has confirmed that "foods and additives are common causes of the attention deficit hyperactive disorder in children." (2)
One of the better known figures in food allergies is the pediatric allergist, Doris Rapp, MD of Buffalo, New York. Dr. Rapp has been a frequent guest on popular television shows where she has shown videos made in her office of hyperactive children during treatment. In these demonstrations, the child would be given sublingual (under the tongue) drops containing extracts of a food which, by previous testing, had been found to be offending to the child. The child then went into wild, uncontrolled behavior until neutralization drops were administered, also based on previous testing. The child then returned to normal behavior. As explained by Dr. Rapp, this Jekyll- Hyde behavior could be turned on and off, almost like a light switch, by administering the offending food, followed by sublingual neutralization. It should be mentioned that this pattern has been confirmed by double-blind studies in her office.
As with other types of allergies, the incidence of food allergies appears to be increasing in children. The causes appear to be chemical in nature. Patients with multiple chemical sensitivities, the result of volatile organic compound exposures, usually have digestive impairments. These are caused by damage to intestinal mucous membranes by the volatile organic compounds. (3)
Chemical food additives may also play a role. As a result of this mucosal damage there may be increased intestinal permeability with large-scale leakage of incompletely digested food molecules into the bloodstream. These food molecules are foreign to the human system and, therefore, are prone to induce allergies and sensitization. This, in lay terms, is the probable explanation for the increasing incidence of food allergies.
The digestive process is regulated by an intestinal immune system (the secretory IgA system). (4-11) This immune system, sometimes referred to as "antiseptic paint," coats the surface of intestinal mucosa. The secretory IgA antibodies work by adhering to undigested food particles and preventing their absorption before digestion is complete. It is a system of almost inconceivable intelligence, because each food particle of untold billions of food particles must be recognized and intercepted in this way. In Chapter 10, it was pointed out that many published studies show the suppressive effects of antibiotics on the systemic immune system. Although we are not aware of comparable studies of antibiotics on the intestinal system, it can be safely assumed that antibiotics have the same suppressive effects here, thus also contributing to "the leaky gut" or increased intestinal permeability.
Several options are available in identifying offending allergenic foods in an individual. The first and perhaps the best is the elimination-rechallenge diet. Guidelines for this diet are provided in Dr. Doris Rapp's books (listed at the end of this chapter). It is conducted in the home. Its success, however, depends on rigid control of the diet during the elimination and reintroduction phases. Problems commonly arise when the child is visiting with friends or when at school where the youngster may be able to obtain unauthorized foods.
Another approach to identifying problem foods is blood testing. There are several types performed by physicians. Finally, there are skin tests, commonly done by physicians whose practices include treatment of allergy.
Treatment depends on the severity of the food allergy. In milder cases, the elimination of several of the major offending foods from the diet, once they have been identified, may be sufficient to relieve symptoms. More serious cases may require further measures. In addition to removing the worst of the problem foods from the diet, a four-day rotation diet may be beneficial, where a given food is not eaten more than one out of four days. In the field of environmental medicine, sublingual food neutralization drops may go far in relieving symptoms. Neutralization doses are determined by skin tests using the technique of serial dilution titration, in which differing dilutions of a given food extract are injected into the skin to find which dilution first gives a skin reaction. This is then used to determine the "neutralizing dose." Experience has shown that a majority of children are significantly helped by these drops. When they fail, as they sometimes do, other causes must be sought.
Note: Guidelines for the rotating diet are found in the books of Dr. Doris Rapp (see end of chapter).
Breast feeding an infant will go far in protecting against allergies. Maternal milk contains antibodies and other factors that cannot be reproduced in infant formulas.
References
1. Egger J, et al. Controlled trial of oligoantigenic diet treatment in the hyperkinetic syndrome. Lancet. 1984:540-545.
2. Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy. 1994;72:462-468.
3. Finn R. Interaction between allergy and chemical sensitivity. Environ Med. 1991 ;8(3):92-95.
4. Walker WA. Antigen absorption from the small intestine and gastrointestinal disease. Pediatr Clin North Am. 1975;22:713-746.
5. Walker WA, Hong R. Immunology of the gastro intestinal tract. Part I. I Pediatr. 1973;83:517-530.
6. Walker WA, Wu M, Isselbacher KJ, Bloch KJ. Intestinal uptake of macromolecules, 111, studies on the mechanism by which immunization interferes with antigen uptake. J Immunol. 1975; 115:854-861.
7. Walker WA. Antigen handling by the gut. Arch Dis Child. 1978;53:527-531.
8. Walker WA, Isselbacher KJ. Uptake and transport of macromolecules by the intestine, possible role in clinical disorders. Gastroenterology. 1974;67: 531 -550.
9. Walker WA, et al. Intestinal uptake of macromolecules, IV, the effect of pancreatic duct ligation on the breakdown of antigen and antigen-antibody complexes on the intestinal surface. Gastroenterology. 1975;69:1223-1229.
10. Coldstine GB, Heiner DC. Clinical and immunological perspectives in food sensitivity, a review. J Allergy. 1970;46:270-291.
11. Tomasi TB Jr. Secretory immunoglobulins. N Engl J Med. 1972;287:500-506.
Recommended reading for parents
Rapp D. ls This Your Child? (Discovering and Treating Unrecognized Allergies). New York: William Morris and Company; 1991. (Availa61e from Practical Allergy Research Foundation PO Box60, Buffalo, NY 14223-0060, (716-875-0398 or 800-787-8780).
Rapp D, Bamberg D. The Impossible Child, in School - at Home. Buffalo,NY: Practical Allegy Research Foundation. 1986.
Rapp D. ls This Your Child's World? New York NY. Bantam. 1996 (716- 875-0398)
Recommended reading for professionals
Brostoff J, Challacome Sl, ed. Food Allergy and Intolerance. London: Bailliere Tindall; 1987.