Food sensitivity or self-deception

Article Abstract:

Food intolerance, or food sensitivity, is a general term applied by clinicians for adverse reactions resulting from eating specific foods. However, even highly experienced clinicians have difficulty linking specific clinical manifestations with particular foods. Various testing methods have been endorsed by clinicians. Restrictive diets and provocative testing are two methods that have come in to accepted use. An article in the August 16, 1990 issue of the New England Journal of Medicine explores the efficacy of provocative testing, injecting a measured extract of a specific food to elicit a symptom from the patient. Members of the medical community and general public have become convinced that food intolerance and other environmental factors induce a large number of symptoms including the following: headache, insomnia, tinnitus (ringing in the ears), breathlessness, bodily swelling, fatigue, and behavior problems in children. In this study, 18 patients who had previously been tested for food intolerance and reported consistent symptoms were studied. These patients were again tested with specific agents or with an inert ineffective, placebo injection, in a double-blind study (neither the administrator of the test nor the patient knew the contents of the injection). Under these conditions, as opposed to when the patients and clinician knew the contents of the injection, there was no difference in symptoms produced by active or the placebo agents. Provocative testing symptoms are usually relieved by the injection of a 'relieving-dose', which was also administered in the double-blind study to diminish symptoms. In this case, the relieving-dose was as effective eliminating symptoms caused by the placebo as it was for the active injection. The medical literature also indicates that many food sensitive patients are suffering from psychiatric conditions, and that long-term relief is best achieved through psychotherapy. Provocative testing and the subsequent relief of symptoms by injection appear to be placebo effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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A double-blind study of symptom provocation to determine sensitivity

Article Abstract:

Food intolerance, or food sensitivity, is a general term used by clinicians for adverse reactions that occur after eating specific foods. However, even highly experienced clinicians have difficulty linking specific clinical manifestations with particular foods. Various testing methods have been developed and endorsed by clinicians. Provocative testing is a highly controversial method in which allergens (chemicals which invoke allergic reactions) are injected into the patient to provoke symptoms. Patient reports of symptoms and the findings of the test administer are used to determine which allergen is responsible for a particular allergic reaction. The present study was organized by several medical societies to formally test the value of provocative testing, along with the use of additional injections of allergens to 'neutralize' the effects of the provocation. Eighteen patients who previously gave consistent responses at provocative testing were included in the experiment. These volunteers were subjected to 20 testing sessions administered by the same technician using the same extracts that had previously elicited response; the patients were also given injections of a placebo (a biologically inert material, or 'sugar pill'). The experiment was carried out in a double blind manner; neither the patient nor the technician knew the content of any injection. No differences were observed between the reactions evoked by the active and placebo agents. A neutralizing injection was also administered in the double-blind study to diminish symptoms; the injection was effective in eliminating symptoms caused by the placebo and by the active injection. It was concluded that the method of symptom provocation to determine food sensitivities, as well as the efficacy of neutralizing injections, lack scientific validity. Patient response to injected extracts are mostly likely the result of chance and suggestion. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Lethal food allergy in children

Article Abstract:

Food allergies in children and adolescents may cause an anaphylactic reaction that is fatal or nearly fatal. A research study examined the circumstances surrounding a fatal or nearly fatal anaphylactic reaction to a food among 13 children and adolescents with food allergies and asthma. None of the children or their parents knew that they had eaten a food with ingredients they were allergic to. Most of the children who died were in a public place during their reaction, but all of the children who survived were in a private home. Fatal anaphylactic reactions may be prevented by identifying all the foods children are allergic to and educating them and their caregivers about anaphylactic reactions. When these children eat away from home, they or their parents should request information about the ingredients of foods. More school personnel should be authorized to use epinephrine, the drug used to treat anaphylactic reactions.

Care and treatment, Editorial, Anaphylaxis, Food allergy in children, Pediatric food hypersensitivity

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