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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).
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