Allergies were first recognised in the 1920s. As is usual with illnesses, the problem was recognised, but at first no mechanism was known for why some people react adversely to things that don’t seem to bother other people. In the 1960s one mechanism was discovered, which involved the immune system, and in particular antibodies called IgE.

Tiny amounts of allergen could trigger a reaction. In many cases this could be just a nuisance, like hay fever, but occasionally it was life threatening. Doctors decided that only this mechanism counted as allergy. I used to live with some Americans, and realised that we were divided by a common language. It is the same when patients and doctors try to communicate. The patient uses the 1920s language, and says he has an allergy.

The doctor uses the 1960s language, and says there is no IgE issue, and so no allergy. Doctors often tell people they have no problem, when they do have a real problem. It is just not an immune system problem. They still need help.

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The language I use is different. If it is known to have an immunological mechanism, IgE or something else, then it is an allergy. If it is an inability to break down milk sugar, it is lactose intolerance. If it is an inability to process fruit sugar, it is fructose intolerance. If it is an inability to absorb all the fruit sugar you consume, it is fructose malabsorption.

If you have specific positive antibody tests, or a positive biopsy, then you have coeliac disease. If you have a problem with foods, other chemicals, or electromagnetic frequencies, then I call that sensitivity. You may not have an allergy, but you do still have a problem with wheat, a food dye, a disinfectant, or a microwave.

We do not have identical body chemistry, and a chemical that one person can detoxify can overwhelm the less efficient enzymes of another person. You may be able to tolerate only a very small amount of the chemical, but larger amounts cause symptoms in more people. Much larger amounts can be expected to cause symptoms in anyone: because of this it is important to test safely for allergies.

The European Union has made a list of common problems in foods.

If these are present, they must be labelled. They are:

1. Gluten containing grains, like wheat, rye, barley and spelt, and avenin containing grain, which is oats. The main worry with oats is that they may have been contaminated with gluten from wheat when they were milled. Oats with a very low level of contamination can be labelled gluten-free.
2. Crustaceans like prawns, crabs, lobster and crayfish.
3. Eggs.
4. Fish.
5. Peanuts. Peanuts are legumes not nuts.
6. Soya.
7. Milk.

list of common allergies
8. Nuts, like almonds, hazelnuts, walnuts, cashews, pecans, Brazils, pistachios, and macadamias.
9. Celery and celeriac.
10. Mustard.
11. Sesame.
12. Sulphur dioxide or sulphite preservative, above a certain level.
13. Lupin, which is in some bread, pastry and pasta.
14. Molluscs like, clams, mussels, whelks, oysters, snails or squid.

The trouble with trying to choose the fourteen worst problems for an area the size of the European Union is that problems vary from place to place. The biggest issue in the Southern United States is said to be maize, because it is a major food there. Areas of Africa and Italy that rely on polenta may well have the same problem. Sesame is said to be the worst problem in Israel.

This list is interesting, because it contains allergens, like peanuts, but it also includes sulphite, which causes chemical sensitivity. So even official policy is beginning to recognise that sensitivity exists. It is important to know whether you are dealing with allergy or sensitivity, because the list of common allergens is different from a list of foods most likely to be involved in food sensitivity.

If you have a problem with a food, you may still be able to cope with a related food. For example, you may have a problem breaking down the sugar in milk. Butter is mainly fat, and some water, with only a trace of protein or sugar. It is often well tolerated by those who cannot cope with milk or cheese. Hard cheese is mainly fat and protein, with only a trace of sugar.

Lactose intolerant people can often tolerate milk. However, some people tolerate milk, but have a problem with mature cheese, because it contains amines that can trigger a migraine. Some people cannot tolerate wholemeal bread or bran, but can tolerate refined wheat, as the lectins in the bran layer of the grain cause a problem. Some cannot eat modern bread, but can eat sourdough, because the souring process makes the bread easier to manage.

Life-threatening allergies?

Deaths from anaphylaxis are rare. More die of lightning strikes in the UK than of anaphylaxis. If you do have a problem with IgE which could lead to fatal anaphylactic shock, there are simple things you can do to minimise the danger. It is all very well having an Epipen, but you do need to be taught how to use it properly, by someone who knows the pitfalls.

Moreover, it will not help you if you leave it at home. If you use an Epipen you still need to call an ambulance, even if you think you are recovering, as you could suddenly worsen. Most deaths from anaphylaxis could have been avoided if simple measures like these were always followed.

The UK Fatal Anaphylaxis Registry in Manchester studies these deaths in order to try and prevent future tragedy. The publicity given to the few dramatic deaths is worrying to the many, whose problems are life disrupting rather than life threatening. Much can be done to help those who are sensitive to foods.

Most food sensitive people do not make enough sulphate, so bathing in magnesium sulphate (Epsom salts) is beneficial. Don’t confuse sulphate, which we need, with sulphite preservatives, that cause reactions including asthma.

Allergy and sensitivity are complex. People need to be looked at as individuals, and given advice specifically designed for them.

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