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Title: ADHD and Food Allergies
Author: Anthony Kane, MD
Website: http://addadhdadvances.com
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ADHD and Food Allergies
Part 1
by Anthony Kane, MD
Introduction
There are a number of controversial areas in medicine when it
comes to ADHD. Food allergy is certainly one of them.
The classic allergic reaction, which is classified as the type-1
hypersensitivity reaction, can be elicited by food, but this is
fairly uncommon. When we discuss food sensitivities in ADHD
we are discussing a different, not well-defined, mechanism.
One of the main progenitors of the food allergy/ADHD connection
is Dr. Doris Rapp. Dr. Rapp was a pediatric allergist who
noticed that many children in her practice had significant
physical and behavioral changes when exposed to certain foods.
They may have red ear lobes, dark circles under their eyes, or
glazed eyes after eating certain foods. These children could
have tremendous swings in behavior. They can be calm one minute
and wildly hyperactive a few minutes later.
To make it more interesting, children with food allergies usually
crave the food that affects them negatively. That means a child
who is allergic to peanuts will demand peanut butter and jelly for
lunch everyday, and for the rest of the afternoon you have to peel
him off of the ceiling.
What is Food Allergy?
The classic allergic reaction operates through a very specific
mechanism. The reaction is caused when a specific type of antibody,
called IgE, reacts with a specific provoking substance
called an allergen. The result of this interaction
is an allergic response and the person is deemed allergic to that
allergen.
The specific type of antibody involved in classic allergy is
called IgE. The proposed antibody mechanism for this type of food
allergy does not involve IgE, but a different antibody called IgG.
This is significant because standard allergy testing tests only for
IgE antibodies. If your child has IgG mediated sensitivity, his
allergy test is going to miss it. That means that your child may
have a severe allergy to a specific food, but your allergist will
tell you he is not allergic to it.
Why the Controversy?
Reason 1: Diagnosis
I said this was a very controversial area of medicine and here is
one of the reasons why. Food allergies are very difficult to
diagnose. One reason is that the symptoms wax and wane. When a
child has a classic allergy, for example to bee stings, then
every time a bee stings him, he will have a reaction. Food
allergies don’t work that way. There seems to be a threshold
that must be exceeded before there are any symptoms. In
addition, this threshold seems to vary from day to day. On some
days a food will affect the child, and on other days it won’t.
Dr. Rapp explains this phenomenon using the analogy of a barrel.
We can view each allergic child as if he has a barrel. As long
as the barrel is empty or only partially full, your child will
have no problems. Your child won’t become hyperactive until his
barrel is overflowing.
Various things will fill your child’s barrel. Let’s say your
child is sensitive to chocolate, cats, and peanut butter. Each of
these things all can partially fill his barrel. As long as he
only has peanut butter or only plays with the cat, his barrel is
only partially full. That means that there are no symptoms and
that his behavior is fine. Then, one day he has a peanut butter
and jelly sandwich, has chocolate ice cream for dessert and plays
with the cat all afternoon. These things in combination make his
barrel overflow, and by evening he is out of control. Your child
has food allergies, but sometimes they affect him and sometimes
they don’t.
The barrel can change sizes. If your child has a cold or is upset
his barrel gets smaller. It takes less to make it overflow. If
he is happy his barrel is bigger. It takes more to make it
overflow. If he isn’t eating well and that day he is low on
certain nutrients his barrel gets smaller.
Many traditional allergists find this barrel concept ludicrous.
It doesn’t fit into the pattern of how other allergies work.
Reason 2: Method of Diagnosis
The next problem is the way in which you test for food allergies.
Dr. Rapp describes a technique called provocation-neutralization
testing. This method works as follows: Say that a child
frequently has headaches after eating eggs. The practitioner will
give an intradermal injection of egg extract. If this elicits
the child’s headache, then the child tests positive for egg
allergy. Other signs of a positive test include an increase in
pulse rate of 20 points, a large skin reaction (this indicates a
classic IgE reaction), a change in the child’s handwriting, or
some other physical or emotional complaint.
This last criterion “some other physical or emotional complaint”
is problematic. It is too vague. The result is that when studies
compared how several physicians evaluated the same group of
patients, their results didn’t agree. For each patient if there
were twenty different doctors with twenty different sets of
findings. None of their diagnoses matched.
Reason 3: The Mechanism
As I mentioned before, the proposed mechanism is an IgG mediated
response. Some food allergists diagnose specific food allergies
by measuring IgG levels. This runs counter to all of modern
allergy practice.
Allergists give allergy shots to treat allergy. The way this
works is they give a low level of allergen, which is not enough
to elicit an IgE reaction. The dose is slowly increased until
eventually the patient can tolerate a significant exposure to the
allergen.
This is how it works. The repeated low-level exposure to the
allergen induces the body to make a different antibody to the
substance. This antibody attaches to the allergen and
deactivates it before IgE can cause the allergy reaction. What
is this antibody that allergists try to induce to cure their
patients of their allergies? You guessed it, IgG. So the very
antibody the traditional allergists have been inducing for
decades to successfully treat allergies, the food allergy people
claim is the antibody guilty of causing allergies.
For a traditional allergist this is nothing short of heresy.
IgG has been used for decades to treat allergies successfully.
Comes along Rapp and her friends and they claim that IgG causes
allergy? This is a little hard for some people to accept.
Just how strongly do allergists reject this idea? I once tried
to contact an Israeli physician who was a food allergy specialist
to discuss with him provocation-neutralization testing. I called
the hospital where he is on staff and asked to speak with him.
For some reason the operator instead put me through to the head of
the Department of Allergy.
I began discussing with him the theory of food allergies,
provocation-neutralization testing and IgG testing. He told me
that he was the head of a committee of allergists who were in
the process of testifying before the Israeli Knesset to get
legislation passed to make IgG testing illegal in Israel.
Can you imagine? You visit a prison in Israel. In one cell
there is car thief. In the next cell there is a mass murderer.
And in the next cell there is a guy who tested someone for food
allergies. Now that’s pretty strong opposition!
(Continued in Part 2)
Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com
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Anthony Kane, MD is a physician, an international lecturer, and
director of special education. He is the author of a book,
numerous articles, and a number of online programs dealing with
ADHD treatment (http://addadhdadvances.com/childyoulove.html),
parenting issues (http://addadhdadvances.com/betterbehavior.html),
ODD, and education.
You may visit his website at http://addadhdadvances.com.
To sign up for the free ADD ADHD Advances online journal send
an email to: subscribe@addadhdadvances.com?subject=subscribeart
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