ABC OF ALLERGY
    Three factors determine who suffers from allergy and how much:
A.    Allergy genes.
B.    Food and environmental triggers.
C.    The status of the health of the bowel, blood, and liver in allergic patients.

A. ALLERGY GENES
    Allergy runs in families. When both parents are allergic, the child has a nearly 90% chance of developing clinical allergy sometime during life. Several specific genes are now known to cause allergy and lead to a large number of immune diseases. There are two important issues here. We cannot do anything about genes at this time. Some gene enthusiasts talk about taking out allergic genes to cure allergy. I have serious reasons to doubt that. However, it is very important to recognize the role of genes.
    Allergy genes alone do not make most people sick. That, from the clinical standpoint, is the most important issue in this matter. It is possible for persons with allergy genes to live healthy and symptom-free lives without any treatment. People who live in deserts (little or no molds) and away from industry (no pollutants) rarely suffer serious allergy symptoms. Mothers who learn to rotate foods for their babies prevent many troublesome food reactions in their children. And, of course, hives sufferers recognize the relationship between skin rashes and itching with stress.
    I have cared for a large number of allergic children with asthma, eczema, recurrent throat and ear infections, and abdominal problems. The presence of allergy as the underlying cause of those disorders had not been suspected before I saw them. Allergy tests revealed the underlying food, mold, and pollen allergies. The mothers of such children were dismayed that allergy tests had not been performed while the children were administered repeated courses of antibiotics and steroids and, in many cases, were subjected to ear tubes and tonsil operations. They were pleased when the children regained health with appropriate treatment. Forearmed with that knowledge, they managed the allergic symptoms of their babies differently by rotating foods, avoiding some items, and, when necessary, undertaking some environmental controls and doing allergy tests and treatment without unnecessary delay.
    My colleagues at the Institute and I have seen over 5,000 patients with chronic immune disorders, including chronic fatigue syndrome and fibromyalgia. Almost invariably, such patients were allergic, but their allergies had been ignored.2-5 Instead, they had received multiple courses of antibiotics, antianxiety drugs, antidepressant, and, in many cases, steroid therapy. All such patients learned the lesson about allergy the hard way. And all of them became advocates of early allergy diagnosis and treatment.

B. FOOD AND ENVIRONMENTAL TRIGGERS
    The need for control of food, mold, and other environmental triggers of allergy is recognized by allergic persons as well as doctors. However, total elimination of those triggers for most allergic persons is very difficult, if possible at all. For example, molds (also called fungi and yeast) are present in our air, water, and foods as well as in the human bowel and other tissues.
    Genes are like hidden codes that remain unrecognized until some environmental trigger sets them off. Here is a simple example to illustrate the relationship between allergic genes and allergic triggers. In Sweden, people do not suffer from ragweed allergy because the ragweed plant does not grow in that country. Swedes with allergic genes who travel to the United States become sensitized during the first year ragweed season and suffer hay fever symptoms during the next year.

The Roles of Genes and Stress in Asthma
    Several years ago, a 52-year-old woman consulted me for asthma that developed after a mild case of a viral infection. Not unexpectedly, she was very puzzled as to why she should develop asthma at age 52. She vigorously denied a history of nasal, sinus or skin allergy. Unable to uncover a history of allergy, I also expressed my puzzlement. Toward the end of my consultation, I asked her about stress at home. She stiffened visibly and then told me she had lost her husband of 33 years some months before she developed asthma.
    "You were close to your husband, were you not,?" I asked.
    "Yes," she replied, hiding her hurt.
    "Very close?" I asked.
    "Very, very close," she replied, then asked, "How did you know?"
    "Because that is where your asthma came from."
    "But that was almost six months aftee he died," she said, baffled.
    "That's not that unusual. People call up their full reserves after shocks like that, appear in control for months, and then break down," I explained.
    "But why asthma?"
    "Because you have asthma genes."
    "How do you know?" She looked at me suspiciously.
    "Because you're allergic."
    "But I'm not allergic," she insisted.
    "Is your mom alive?"
    "Yes, but what does that have to do with anything?" She grew distrustful.
    "Please ask her if you had been a colicky baby or had suffered eczema as a child. Those are sure clues to allergic genes."
    "I will and we'll see," she smiled.
    The next day I received her message. She learned from her mother that she had been a colicky baby and had suffered from eczema. Eczema and recurrent colics in babies are considered signs of allergy.
    The lesson of this case history is simple: in many persons, asthma genes remain dormant for years until some stressor activates them.

Hyperactivity Triggered By Paint
    Some years ago, I saw a boy with a severe form of ADHD (hyperactivity/attention deficit disorder). He had been assigned to a special class for children with learning disabilities in school. Like almost all children with ADHD l have seen, the tests showed allergy to molds and other inhalants and sensitivity to several foods. His mother, an intelligent woman fully committed to doing the best for her son, assured me that she was going to follow rigidly our program for her son. The boy responded well and within some months he was readmitted to regular class.
    Then one day I received a distress call from his mother telling me that there had been a complete breakdown and her son was back to where he had been when I first saw him. I asked the usual questions looking for the usual answer in sugar overload, straying off his prescribed diet, viral or bacterial infections, and exposure to dust during renovation work at home. The mother assured me that she had diligently looked for all those factors but had failed to identify the culprit.
    I prescribed liquid Nystatin for the boy because that had worked well in the past in similar situations. The mother called two days later and said he was 90% better. I asked one of our nurses to call the mother to see if she had any clues to what had triggered the relapse. There were none.
    The next week the mother called and told me of her discovery.
    "I know what caused Tommy's [not his real name] relapse," she said excitedly.
    "What?" I asked, my interest piqued.
    "House paint," she replied.
    "Paint? But didn't I ask you last week if he had been exposed to any chemicals?"
    "Yes, you did. But I didn't know then."
    "Where was it?"
    "Tommy was at his grandparents for the weekend and slept in a freshly painted room."
    "How do you know it was the paint?," I expressed doubt.
    "I called to tell you he was 90% better in two days. Well, he went there again last weekend and had another relapse, though not so bad. He slept in the same room. You know they kept the windows in the room closed during the week. Interesting, isn't it?"
    "Yes. Very interesting!" I concurred.

    The lesson in this case history is that chemicals can trigger hyperactivity in children with hyperactivity and attention deficits syndrome. Furthermore, such chemical exposures are frequently not recognized by parents.

C. THE STATUS OF THE HEALTH OF THE BOWEL, BLOOD, AND LIVER IN ALLERGIC PATIENTS
    The roles of the bowel, blood, and liver in the production of allergy symptoms are seldom, if ever, addressed in books and articles on allergy. That, in my view, is a serious omission. In the treatment of serious allergic conditions—such as asthma and severe forms of colitis, such as Crohn's colitis and ulcerative colitis —ignoring the health of the bowel, blood, and liver can create life-threatening situations.
    I consider it essential to assess and restore the health of the bowel, blood, and liver ecosystems in the management of every allergic person.
    During the last few decades, we have learned many new things about the cause and treatment of allergy. Hundreds of research papers are published each month showing the types of:
1.    Immune cells that are involved in allergy reactions.
2.    Immune molecules that trigger chain reactions.
3.    Immune reactions that cause symptoms.
4.    Immune-suppressing drugs that are used to control symptoms.
5.    Allergy injections (immunotherapy) for desensitizing allergic persons.

    However, there is another face of this problem of allergy that is not adequately addressed. Many basic questions concerning allergic disorders remain unanswered. For example:
1.    Skin rashes of eczema flare more in some weeks than in others in the same person.
2.    Wheezing and air hunger is worse on some days than others in the same person.
3.    Symptoms of Crohn's colitis and ulcerative colitis remit and relapse for no apparent
        reason in most instances.
4.    Food sensitivity reactions vary over a broad range in the same individual.
5.    Allergic rhinitis becomes more intense on some days when pollen count is low and abates
        on days when pollen counts are high.
6.    Lifestyle stressors exaggerate bronchospasm more on some days than on others in the same
        asthma sufferer.
7.    The phenomenon of "spreading sensitivity reactions" is increasingly recognized in chronic fatigue
        syndrome, fibromyalgia, and multiple chemical sensitivity syndrome.

    The scientific basis of all of the above cannot be explained by any of the advances in immunology of allergic reactions. However, there is a direct relationship between allergic symptoms and the health of bowel, blood, and liver.
    Mold allergy and food sensitivity cause many allergy reactions that are directly related to events taking place in the bowel, including ovegrowth of disease-causing microbes and poor digestion. The symptoms include abdominal bloating, flatulence, cramps, poor digestion, and episodes of diarrhea and constipation. Allergy reactions also lead leaky gut syndrome and blood toxicity. Liver is the primary detox organ of the body, and is adversely affected by events in the bowel and blood of persons with allergic genes.

   THREE PROBLEMS WITH ALLERGY DIAGNOSIS:
The False Negative Test Results

    There are three main problems with diagnosis of allergy: (1) Allergy is not suspected even when the presence of immune disorders is known; (2) Diagnostic tests are used that are not sufficiently sensitive; and (3) Even when allergy tests are positive, the treatment is limited to allergy injection therapy, while the critical issues of the damaged bowel, blood, and liver ecosystems are completely ignored.
    Proper allergy diagnosis and treatment, I regretfully recognize, continue to be a low priority for some doctors. Amazingly, that happens in the majority of disorders which they themselves consider immune in nature. The main reason for that is that most family practitioners, pediatricians, and internists have neither the necessary training nor the inclination to diagnose allergy in those patients. Indeed, many of them seem convinced that allergy has no role to play in such immune disorders as lupus, scleroderma, rheumatoid arthritis, vasculitis, multiple sclerosis, autoimmune thyroiditis, fibromyalgia, chronic fatigue syndrome, and others. That seems especially odd in the face of spreading epidemics of fibromyalgia (eight million Americans affected) and chronic fatigue syndrome (another estimated five million Americans).
    Even when those physicians consider the possibility of allergy, they often fail to use optimal tests. The commonly used RAST test is simply inadequate for the diagnosis of mold allergy. In a paper published in 1981 in American Journal of Clinical Pathology, my colleague, Madhava Ramanarayanan, and I showed that the RAST test misses almost one half as many mold allergies as detected by the micro-ELISA test. Even though the RAST test since then has been improved, I still many allergic persons who are told they not allergic simply becuase the insensitive blood test employed gave false negative results.

   SUMMARY
    There are growing epidemics of asthma, eczema, fibromyalgia, and other serious immune disorders. The flames of those epidemics are fanned by undiagnosed food and mold allergies, functional nutritional deficiencies, and the ever-increasing total body burden of environmental pollutants.
    For good results, persons with allergy need to address three primary issues: (1) recognize the underlying role of genes (allergy runs in families); (2) recognize food and environmental triggers; (3) Assess the health status of the bowel, blood, and liver.
    Three main problems with allergy diagnosis are identified: (1) Allergy is not suspected when it exists; (2) Insufficiently sensitive diagnostic tests are used; and (3) the issues the bowel, blood, and liver health are not addressed. Clinical allergy can be optimally managed with ecologic and integrative thinking.

References
1.    Holgate ST. The epidemics of allergy and asthma. Nature 1999;402:B2-B4.
2.    Ali M. Recent Advances in Integrative Allergy. Current Opinion in Otolaryngology. 2000; 8:260-266.
3.    Ali M. Ali M: Fibromyalgia: an oxidative-dysoxygenative disorder (ODD). J Integrative Medicine 1999; 3:17-37.