Questions for Andrew T. Weil, MD

Best ways to battle allergies
My daughter, 14, is suffering from slight hyperthyroidism and vitiligo. Her doctor recommends low-dose allergen shots. She does have allergies, and he believes getting them under control will help her immune system and relieve her of the thyroid problem and vitiligo. What do you think?

In vitiligo, areas of the skin lose their natural pigment, melanin, resulting in white spots and patches. Vitiligo is likely the symptom of an underlying autoimmune disorder and tends to run in families. It is also more common in people with other autoimmune diseases, particularly Hashimoto’s thyroiditis and type-1 diabetes. Some people trace the onset of their vitiligo to an illness or to emotional trauma and stress, although there’s no clinical proof that such events can act as triggers. Hyperthyroidism (an overactive thyroid) speeds up the body’s metabolism. One of the most common causes is Graves’ disease, another autoimmune disorder that tends to run in families.

I discussed your question with Randy Horwitz, M.D., an allergy specialist and medical director of the Arizona Center for Integrative Medicine. He noted that there are a number of methods of allergy desensitization available. Conventional immunotherapy has the most published data supporting its effectiveness. It carries a very slight risk of severe (anaphylactic) reactions, but thankfully these rarely occur. Dr. Horwitz says that in his opinion, sublingual (under the tongue) immunotherapy is safer. He adds that this has been used in Europe for many years and that there is a body of published data supporting its use. The method is slowly gaining acceptance in the United States.

Dr. Horwitz also tells me that the low-dose allergen (LDA) therapy you ask about is an offshoot of an older method called Enzyme Potentiated Desensitization (EPD) developed in England. Although EPD was imported and used for several years under an investigational review, the F.D.A. denied application for investigational study of EPD as an approved drug in 2001 on the grounds that it isn’t licensed in the United States and that its labeling gave inadequate directions for use.

LDA adds a small amount of an enzyme to a mixture of allergens. There is very little published data to support its use, and Dr. Horwitz does not recommend it. He adds that there is no evidence that “immune boosting” in this manner will alleviate your daughter’s vitiligo or hyperthyroidism (both of which are caused by an already overactive immune system). I urge you to get a second opinion for treatment of your daughter’s conditions from a qualified integrative allergy specialist.

Overcoming adult food allergies
I have some pretty extreme food allergies. They started with fish, then oranges, then most nuts. Now I can’t eat most meats and have trouble breathing when I eat many of these foods. My doctor has prescribed an EpiPen. Is there a way to cleanse my body so I can eat some of these foods again?

Your question is timely. In May 12, 2010 the Journal of the American Medical Association published a review of research on food allergies that clearly indicated these disorders are problematic to diagnose and treat. However, the reviewers also determined that only a small minority of adults, less than five percent, have true food allergies.

I discussed your question with Randy Horwitz, M.D., medical director of the Arizona Center for Integrative Medicine and an expert on allergy and immunology. Dr. Horwitz told me that the problems that most adults regard as allergies are actually food intolerances or sensitivities. He noted that with a careful history and testing an allergist can differentiate between a “true” food allergy and what may be an intolerance or sensitivity.

What’s the difference? True allergies involve immediate, measurable reactions from the immune system, which can become life-threatening in some cases. Food intolerance or sensitivities also appear to be rooted in the immune system, but reactions to them can be subtle, are more variable, and while some can certainly interfere with activities of daily living, they tend to be annoyances rather than dangerous.

Dr. Horwitz explained that some problems with food will resolve if you strictly avoid the ones that cause you trouble for a period of time and then reintroduce them slowly one by one to see if you can handle them. If and when your physician approves this strategy, Dr. Horwitz said he would recommend clinical hypnotherapy as an adjunctive treatment. He added that emotions have been shown to play a role in the body’s responses to allergens and irritants and that in one published study, laughter was shown to reduce the reactivity of skin when testing for allergies.

Dr. Horwitz and I agree that there is no body cleanse that will eliminate residual allergens – the only potential solution is avoidance. What’s more, there are not many proven complementary or alternative therapies for true food allergies, especially those that have potentially life-threatening consequences such as the breathing problems you describe. Consulting a practitioner of traditional Chinese medicine might be helpful, and Dr. Horwitz noted that a research team in New York City is testing a very promising traditional Chinese formulation that has proven to be remarkably effective in treating and preventing peanut allergies in animals.

I hope this helps and will set you on a course to overcome your problems with so many foods.

Natural treatments for seasonal allergies
This year I’ve found that my allergies can’t be controlled with stinging nettle and quercetin. Are there any other remedies I can try? (The non-drowsy prescription antihistamines are not effective for me.)

I’m sorry to learn that my favorite natural allergy treatments aren’t helping your seasonal allergies this year. As you may know, I’m not a great fan of antihistamines, which don’t change the allergic process but merely block its expression. Steroid nasal inhalers used for treatment of hay fever and other seasonal allergies can be very effective, but some of the steroids are bound to get into the rest of the body and these hormones weaken the immune system. My preference among conventional treatments is the non-prescription drug cromolyn sodium (Nasalcrom Nasal Solution). It works and is non-toxic. If that doesn’t help, you may have to try a steroid nasal spray such as Vancensae, preferably for a limited time.

You don’t mention what type of allergy you have, but I’m assuming it is seasonal pollen allergy. If so, you might try nasal douching with a warm saline solution to rinse pollen grains off nasal tissues and soothe irritated mucus membranes. I would also recommend trying some lifestyle modifications. All allergies have the potential to disappear if you make changes in both lifestyle and your mental state. Here are my suggestions:

• Follow a low-protein diet and try to eliminate milk and milk products. Excessive protein can irritate the immune system and keep it in a state of overreactivity. The protein in cow’s milk is a frequent offender.

• Try hypnosis, which can lessen or completely prevent allergic reactions and facilitate the immune system’s unlearning of its pointless habits (in this case, an inappropriate response to pollen, dust, mold or animal hair or other substances that cannot really hurt us).

• Consider whether stress impacts your allergy and, if so, take steps to reduce it. I’ve seen long-standing, severe seasonal allergies disappear when people switched jobs, left a relationship or otherwise eliminated a source of stress.

• Dust-proof your bedroom by eliminating wall-to-wall carpets, down-filled blankets, feather pillows and other dust catchers.

• Substitute window shades for Venetian blinds, which can trap dust; be sure to wash curtains regularly in hot water to kill dust mites.

• Encase your mattress in an airtight, dust-proof plastic cover; dust your furniture with a damp cloth; and damp-mop floors regularly to pick up dust.

• Consider buying an air filter. I recommend a HEPA (high-efficiency particulate air) filter, which removes particles in the air by forcing it through screens containing microscopic pores. These devices work well and aren’t too expensive. Get one for the main rooms in your house, or move one from room to room regularly. Avoid air-filtering equipment that generates ozone (HEPA filters don’t).

“Questions for Andrew Weil, MD” were previously published at www.drweil.com and have been posted on this blog with permission by the author.

Andrew T. Weil, MD is an internationally acknowledged physician and author best known for his work in the field of integrative medicine. He is the founder and Director of the Center for Integrative Medicine at the University of Arizona. For more information, please visit http://www.drweil.com

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

Connect with us on FacebookTwitterGoogle+PinterestLinked InYouTubeRSS