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Added July 20, 2004
ADHD and Food Allergies
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,
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
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!
(Go to Part 2)
Anthony Kane, MD
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