A letter dated 27 February 2011 from Ir. Tan Seng Khoon to a certain David was received by me. The content is below:
David,
Are you saying you are allergic to MeeTeh?
As a matter of scientific curiosity, what was the cause?
Are you diabetic? Or was the MeeTeh polluted? I am just doing research.
Dr Lim Ju Boo and myself had a dear friend named John Batzer. One day John came to my house for Astro Society business. He told me that he had suddenly for no rhyme or reason, developed an allergy to BREAD.
He said that to anything that had wheat, he developed skin problem. So I was immensely astounded and dumbfounded. Because it was so strange and illogical.
Regards,
Khoon
My comment to Ir. Seng Khoon follows:
Dear Ir Tan,
Thank you for your letter to David, a copy I have received. Allow me to comment on this.
I understand your confusion with Mr. Batzer’s case when he said he suddenly developed an allergy to bread. I know you are an engineer, I don’t expect you understand medical issues.
It is possible for any person to suddenly develop an allergy to certain foods. This is true for anything he applies to his body, he smells or inhales.
Let me briefly explain this in a very simple way that would be reachable to everybody. When a foreign substance especially proteins, but not necessary, enters the body, two things can happen
The Scenarios:
1. Nothing happens
2. The body reacts violently to the foreign body or agent.
In the event when nothing happens, it either means his immunological defenses are either:
1. Clinically unresponsive
2. Serologically positive
This means antibodies were produced, but was not clinically apparent. There was no symptoms (asymptomatic). This stage was a sub-clinical stage due to the very low presence of antibodies.
Blood samples taken may show the presence of antibodies like IgE on mast cells and basophils. In short, it is already sero-positive. But it has not peaked yet. The body was challenged repeatedly by the antigen (foreign protein) in previous exposures until it goes into exhaustion. Serologically it may also be negative. In other words it was tested to be sero-positive, but clinically it was unresponsive and has no symptom (asymptomatic).
In the event the body reacts violently as in scenario 2 above, this means the body has been challenged repeatedly by very small doses of a foreign protein in the past (example: wheat protein in bread, cow’s milk, shellfish, peanuts, legumes, serums, vaccines, etc), but the body tolerated them without showing any signs of ill effects or moderate clinical events (example urticaria, known as welts, beehives and flares).
The presentations:
Other events are vasodilatation, hypotension, flushing, headache, tachycardia (increased heart rates), and bronchoconstriction (mimics bronchial asthma in presentation).
This means the built up of antibodies against the antigen is now sufficient to evoke or elicit a serious and life threatening event such as angiooedema (swelling of the face, body, or more seriously, asphyxiation (airway obstruction and suffocation), and subsequent respiratory arrest.
This is a medical emergency and requires instant medical and pharmacological interventions (example: injection of sub-cutaneous adrenaline, airways intubation, and supplemental oxygen.
Sub-clinical, but sero-positive:
In Mr. Batzer’s case as you described, it was very possible that he was tolerant to bread (wheat protein or gluten to be more technically correct) for some time in previous dietary or medical history. Meantime, his body did not response clinically to the allergenic challenge but there was a serological built up of serum antibodies titers (amount or levels in blood).
The antigen (allergen) evolves the body to produce specific antibodies (normally, IgE immunoglobulins) against the antigen to form antigen-antibodies complexes. Antigen-antibody complexes are mediators of immune responses, sometimes called an immune complex.Thus even if a patient did not show presentations of an allergic reaction clinically, a blood sample drawn from such a patient may show the presence of specific antigen-antibody complexes in his serum.
In short he is asymptomatic, but he is sero-positive. In other words, there was a sub-clinical serological response. This scenario of events is well known to us in physiology or medicine, in immunology or in nutrition.
The parable:
Let me give you a simple parallel analogy, Jesus always likes to illustrate with parables. Suppose there was a country that has no army (antibodies). One day enemies (antigen) start to invade. The country was without defense. It remained silent and let the enemies come in without any struggle.
Meantime the country was repeatedly challenged. It became necessary to fight. It initially only can afford to build up a small one. It was challenged again. The army began to gather in numbers strength (the titer). One day another attack came. This time it has sufficient strength to put up a resistance. If it is just a small one there is only minor casualties (pruritus or itchiness, urticarial rash, weal and flares).
But if it has sufficient built-up, it would be an all out war with tremendous casualties (angiooedema, asphyxiation, anaphylaxis or anaphylactic shock. There may also may also a possibility of angioneurotic and haemodynamic shocks).
So it was not surprising that Mr. Batzer suddenly develop an allergy to bread (gluten intolerance). I have a few patients in the past with this problem. They went to their doctors previously, but it did not help with the medicines their doctors prescribe.
If you have an allergic problem, you should always be seen by an allergist or an immunologist. He is a doctor who specializes in allergic diseases. He is able to determine the causes of the allergy by skin or patch tests This most effective way is based on the patient's history. The sensitivity and specificity of skin testing methods may be compared with skin prick testing alone.
This is often sufficient to identify or exclude immunoglobulin E (IgE)-mediated hypersensitivity, including food allergy.
The Right Doctor:
An immunologist, an allergist or an occupational therapist is the right doctor to consult in an allergic reaction. He should be able to explain in detail to the patient the nature of the condition, and from various skin tests, he may be able to identify the specific antigen or allergen he is sensitive to.
Sufferers of an allergy may be a life-long condition each time his immunological surveillance is challenged by the allergen. Although this can be treated with drugs each time it flares up, treatment with drugs is not the long term solution. Allergies are life-style or occupational diseases, hence modifications of life-style, dietary habits and environment exposures, and not drugs, is the only answer. A holistic approach need to be taken in its management. Always, treat the root causes, not suppress the symptoms with drugs
Consult the correct physician:
Thus it is not advisable to go to an ordinary doctor or a GP for consultation for life-style diseases. All they know and can do is to give you some anti-allergic medication, and a 1-2-day medical certificate. You will be back to square one after the episode is over with the antihistamine. The root causes may still be there. These anti-allergic drugs are called antihistamines, or pharmacologically called histamine antagonists or blockers. There are a large numbers of them. Examples are: Cetirizine, Chlorpheniramine, Diphenhydramine, Pheniramine, Promethazine, etc, etc.
The Pharmacodynamics:
These agents act pharmacologically as H1 antagonist or a histamine antagonist of the H1 receptor whose role is to reduce or eliminate effects mediated by histamine. Histamine is an endogenous chemical mediator released during allergic reactions. Agents where the main therapeutic effect is mediated by negative modulation of histamine receptors are termed an antihistamine.
Antihistamines are drugs that compete with histamines for their receptor sites, known as H1 and H2 receptor sites. When the antihistamine binds itself to the H1 receptor site, it prevents histamine from doing the same, which effectively eliminates histamine action. Histamine is produced by basophils and by mast cells found in nearby connective tissues
Mast Cells & Antigen-Antibodies Complexes:
Mast cells release histamine and other substances that control local blood flow and attract other cell types of the immune system to the area. Mast cells can be activated by a variety of mechanisms. IgE antibodies are a special class of antibody that attaches itself to receptors on the mast cell. If a foreign substance (an antigen) attaches itself to the bound IgE antibody, the mast cell becomes activated leading to histamine release and initiation of an allergic
Antihistamines attach themselves to histamine receptors on cell surfaces. This competitive inhibition prevents histamine molecules from attaching to the receptors consequently inhibiting activation of the cell and interrupting the sequence of the allergic reaction. Histamine is a messenger substance released by the mast cell.
With these antihistamine agents may cause a patient to become drowsy and have xerostomia (dry mouth) among other side-effects reaction.
The Choice of Therapy:
What you need if you have an allergy is to consult an allergist who is a doctor specializing in this area. He should be able to educate the patient about this problem, conduct skin and sensitivity tests to identify the allergen, perhaps even the source, and explain to him. He may institute a therapeutic regimen to desensitize him to the allergen (the agent that causes allergic reaction). This form of therapeutic approach is called allergen immunotherapy.
There are several ways of doing this. One approach is through vaccination with increasing doses of the allergen with the aim of inducing the body to go into exhaustion, namely increasing immunological tolerance
Allergen Immunotherapy:
Allergen specific immunotherapy is the only treatment strategy which treats the underlying cause of the allergic disorder. It is a highly cost-effective treatment strategy which results in an improved quality of life,
Since most allergies are food-related another simpler approach in desensitizing is to reintroduce the offensive food bit by bit in very, small amounts that are not sufficient to elicit an acute allergic event.
Challenge the body slowly this way until they body goes into total exhaustion, or becomes resistant to the offending food. I have used this dietary approach on a number of my patients previously with excellent results.
Dietetic & Nutrition Therapy:
Another alternative approach is to keep a record on all the foods which a patient is sensitive to. Keep a log book to identify the foods over 3 months, and apply the desensitizing therapy, or avoid list of foods completely. I believe this is the best approach.
However, you need to consult a qualified dietician familiar with this approach, or a qualified and registered clinical nutritionist to assist you. He should be professionally competent to administer this dietotherapeutic modality as a permanent solution to patients with food allergies.
Don’t go to a GP for this problem. All he knows is to give you one of those antihistamines I have already named above. Consult other appropriately trained and qualified health-care professionals who are more familiar and competent to handle this problem.
Drugs not the solution:
Drugs can never, never solve life-style health problems. Only education, modification of dietary, occupational and exposure habits and rehabilitation can, and permanently also. Use antihistamines only as an immediate and short-term measure only in an acute attack.
Although the aetiology (causes) is usually attributable to food, there are also many non-food allergens. They can also be cosmetics, perfumes, rubber, toiletries, drugs, nickel, copper, plastics, pollens, fur of animals, flowers, plants, grass, carpets, bed-bugs, excreta of insects, etc, etc
Rehabilitative Medicine:
Education is the proper way to treat a patient. It is not merely dishing out the medicine and tell the patient ‘satu biji, tiga kali sehari, sebelum or selapas makan’. (one tablet 3 times a day, before food, after food). That’s not the way to treat a patient. Nor is it for the management of chronic diseases.
Maybe at best in this case with antihistamines, the doctor will tell you to take the medicine at night before sleep, and don’t drive or operate a machine. But they will not tell you about how these drugs affect urination, vision, confusion and other ADR (adverse drug reactions).
Rudeness and Discourteous:
I have 4 patients previously with allergic reactions to certain food. They went to see their doctors many times without much effect. They were only given antihistamines. They found out that they were even allergic to antihistamines. They told their doctors this. Instead of helping them find other ways of managing the cases, the doctors became angry and very rude to them.
They told them 'Apah! U doktor atau saya doktor, Apah U tahu? (What! are you the doctor or Am I the doctor? What do you know?').
They told the patients what did they know about the medicine he prescribed?
This was very rude and discourteous to their patients, amounting to be very egoistic and self-centered.
Intolerance to Antihistamines:
Sometimes patients get arrogant and ignorant doctors who get angry when patients tell him that they are allergic even to the anti-allergic medicine itself which was supposed to protect them against allergies? This is not surprising as there area many documented cases of drug intolerance including antihistamines themselves.
In the practice of medicine we are dealing with people with varying biological systems and makeup. There are no two persons who are alike like mechanical robots. Our reactions to drugs vary quite widely from patient-to-patient. Adverse drug reaction or ADR is very common phenomena among drug users. This is an area in pharmacology, and it is outside our scope here to discuss this further.
The Complaints:
I have heard from own patients many times that a lot of arrogant and egoistic doctors will reply back by asking the patient ‘apa, u doktor, atau I doktor’ (What! are you a doctor, or am I the doctor?). This is very conceited, conceited to the highest degree!
Very conceited and egocentric some of them are. They only think only they know, and that the patient knows next-to-nothing. The ‘consultation’ was just a one way street. The patient is just there to follow like a machine. . But fortunately most doctors are courteous and do listen to their patients. But there are also quite of them who are egoistic. This is wrong, very unprofessional, and socially very repulsive.
A doctor should never, never be rude or discourteous to his patient. A patient calls his physician ‘doctor’ because this is only a courtesy title given to him out of respect, and not because the physician, essentially a clinician, is technically or academically entitled to it. A physician or medical doctor is technically and legally not a doctorate holder. It is just a courtesy title given to him. He must respect that. So a medical doctor or a physician should never be rude or discourteous to his patients if he wants his patients also to be courteous to him so as to retain that title.
The Meaning of Doctor:
The original meaning of the word ‘doctor’ means ‘teacher’ – someone who teaches others (example a patient), and not someone who just give out the medicine and merely ask the patient to follow his orders. The patient has every right to ask, to question, and to refuse a treatment. This is ethics a doctor needs to observe and respect. The doctor cannot just ask a patient to do as he is told, and just take the medicine as he prescribes and ask no question. A lot of my own patients complain to me about the rudeness of some doctors.
Technically the real doctor is a holder of a doctorate degree, the highest degree a university can bestow on someone with the highest learning. He is a teacher so that he can teach others. That’s the original Aramaic word to mean a doctor, a philosopher, a teacher, a sage, or someone with great learning.
The History of Medicine:
A medical doctor is just a courtesy title given to a physician. That is why a surgeon in the UK is addressed as ‘Mr.’ and not ‘Dr’. Historically a surgeon in England was a physician who decided to cut. Hence he is called a ‘barber physician’ – someone who cuts and not a physician or a medical doctor who treats with medications. You need to read the History of Medicine to understand this. You may check this out with the Medical History Section of The Royal Society of Medicine where I am a Life Fellow.
The address is:
The Royal Society of Medicine
1 Wimpole Street
London
So, I hope I am able to answer your question about Mr. Batzer sudden allergy to bread. It was a medical possibility and a logical one.
Kind regards.
lim ju boo
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