Allergy is very common in Western countries. It affects at least 30% of adults and can manifest itself in many different ways, from itchy, runny nose and eyes, sneezing, snoring, throat discomfort, tongue and lip swelling, to cough, asthma, stomach and bowel upsets, irritable bowel syndrome (IBS), diarrhoea, general irritability, skin disease etc.
The vast majority of adults with allergy have never been tested – so out of a possible 20 million or so allergy suffers in the UK, it is thought that 200,000 or less have been properly diagnosed – <1%. Trying to find the cause for allergic reactions can sometimes feel like looking for a needle in a haystack. This is especially true when symptoms and case history are inconsistent, the patient is multi-sensitized or shows unsatisfactory response to the treatment.
In treating these patients, Mr. Mike Dilkes provides the most current, optimal testing and treatments based on medical research and consultations with leading experts in the USA and Germany.
A small number of foods are believed to cause the majority of reactions. The top eight food allergens: eggs, fish (including cod and salmon), shellfish (including crab, prawn and lobster), tree nuts (including walnuts, almonds and cashews), peanuts, cow’s milk, soy and wheat. A food allergy can result in sensitivity to similar foods (crab, prawn, lobster, for example). This is called “cross-reactivity.” In some cases, individuals with strong reactions to certain pollens will experience cross-reactivity with certain fruits and vegetables.
It is important to be tested, because some allergens, especially food allergens, can be relatively easily avoided. The question is – what is the best test? These range from medically unproven type tests, available widely, performed by a non-medically qualified practitioner and fairly cheap.
Applied kinesiology and VEGA testing are examples of these, which seem to have no scientific evidence that they are in any way useful. More proven tests are skin prick and blood testing. There is no doubt that the best way to properly diagnose this condition is to test for specific component blood allergen IgE.
IgE is an immunoglobulin, or antibody. Antibodies bind to antigens. Allergens are antigens. Allergens (things you can be allergic to), like pollen, bind to their own “lock and key” specific antibody. If you take antibody from a patient’s blood, which is just a blood sample, you can find out what antibodies (IgE in this case) are present for a range of possible specific allergens – so we can diagnose almost irrefutably what patients are allergic to.
Component IgE testing is even more specific, as it identifies the exact part of the allergen that the patient is allergic to. For example, BetV1 is a component allergen found in Birch pollen. It is useful to test for this as the standard Birch pollen allergen has a similar structure to other allergens, such as shellfish (prawn in particular). This a specific IgE test in the face of marked Birch pollen sensitivity (hay fever), may also show up as a prawn sensitivity.
However, if the BetV1 component of Birch is highly positive, this means the prawn sensitivity is probably not significant / real. If the patient tells us that he or she eats prawns without trouble, then that positive result can be refuted.
Skin prick tests, total IgE
Other tests, like total amount of IgE, are not particularly useful. Neither are the skin prick tests as accurate since they are very user dependent, and the actual process is quite difficult to maintain complete specificity. Skin prick tests have the added problem of potential anaphylactic shock being induced by administering the substance that the patient is allergic to – a potentially life-threatening problem.
This is a British invention, and uses a modification of enzyme-linked immunosorbent assay, called Immunocap ISAC. This is based on biochips, which use tiny amounts of serum (200 microlitres) to test for specific component IgE where possible.
We test for 26 of the most common food and inhaled allergens, along with latex and bee venom, are tested, with results available in 48 hours – then emailed to patients. This test costs £200, which is markedly less than prices from pathology labs, which are around £25 – 30 per allergen – sometimes over £600.
Treatment is mainly for symptom relief. However, some patients who are severely allergic may need to carry an adrenaline pen with them in case of anaphylaxis (a life-threatening allergic reaction).
Rule #1: Once you know what you are sensitive to a substance, avoid it!
Make effort to prepare your environment to minimise contact if it can’t be avoided completely – this particularly relates to house dust mite sensitivity.
If you continue to have symptoms, you will need medication. We can prescribe various treatments — steroids, whether sprays, creams, tablets, inhalers or injections, antihistamines, anti-leukotrienes and mast cell stabilisers. Treatment should be carried out under the supervision of an experienced doctor, such as an Ear, Nose and Throat specialist or a Dermatologist.
Sometimes a course of desensitisation (immunotherapy) can also help, although this is reserved for the most severe cases as it is expensive and can be dangerous.