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Unorthodox Testing and Treatment for Allergic Disorders

Unproven allergy testing provides misleading results, delays correct diagnosis and lead to unnecessarily ineffective treatment. These approaches are not regulated in Australia and New Zealand.

pdf AER Unorthodox Testing and Treatment for Allergic Disorders 132.59 Kb

Allergy is a science-based speciality

Modern allergy practice relies on understanding the biological mechanisms underlying allergic disorders, such as asthma, allergic rhinitis (hay fever), food allergy and insect sting allergy. Accurate diagnosis is underpinned by standardized allergy testing (skin prick testing or blood allergen specific IgE (RAST) testing. 

Advice needs to be “evidence based”

When considering testing and treatment, advice needs to be “evidence based”. In other words, there needs to be evidence that a particular test or treatment is reliable, based on studies of other patients with the same condition. Reliable tests need to be able to distinguish between those with illness and those without. Therapeutic trials are designed to show that any improvement seen is due to the treatment, and not just due to chance or coincidence. Such studies also examine whether a particular treatment may also cause harm as well as benefit. So-called “levels of evidence” have been developed to rate the quality of published evidence, with Level I being the highest quality of evidence, and level IV being of lesser quality. The aim rationale that doctors are able to more readily select a treatment for their patient that is most likely to help. An example of the 2006 Australian NHMRC Levels of Evidence is shown below, and Levels of Evidence for the unorthodox approaches to allergy testing and treatments are also listed in the text.

Click on image to view a larger size.

Levels evidence

Use of unproven “allergy tests” is common in Australia

Despite advances in scientific knowledge about allergic disorders, 50-70 per cent of adults and children with allergic disease consult alternative practitioners yearly for diagnosis and treatment. Some will undergo unproven diagnostic “allergy testing” or treatments. Incorporation of traditional Eastern health care philosophies into Western culture and uncritical media attention to claims of new “cures” for allergy may all contribute to uptake.

Unproven allergy testing and treatments are not regulated

Unlike claims to “cure” cancer, unsubstantiated claims to be able to detect or “cure” allergic or immune disorders are only stringently regulated by government, medical boards or advertising regulators if the practitioner is a registered medical practitioner. There is also currently no stringent regulation of unproven diagnostic techniques or devices. These devices and tests can be “listed” in Australia without having to prove that they work.

Allergy redefined

Some unorthodox practitioners claim that conventional allergy testing only detects some types of allergies. They state that conditions such as headaches, migraine, irritable bowel, muscle tension, pain, addiction, premenstrual syndrome, fatigue or depression are due to “hidden allergies”, a claim for which there is no evidence. Instead of relating allergy to IgE, or an inflammatory response mediated by the immune system, disease is attributed to either (a) a disturbance of vital life force or energy (“Qi”, yin-yang), or (b) are secondary to noxious external triggers such as environmental toxins and chemicals, food allergens / additives, or chronic infection with organisms like Candida albicans. It is stated that the body can generally cure itself if given the opportunity to correct these imbalances on the one hand, or avoid/eliminate environmental toxins, allergens or occult infection on the other. These philosophies use terminology loosely, blur and confuse the distinction between the terms “fatigue” and “immunity”, and blend concepts of immunology, neurology and spirituality to explain the nature and causes of disease.

There are many types of unproven tests

A multitude of tests have been proposed to detect “hidden allergies”, based on concepts of disease pathogenesis very different to those underlying Western medicine. These have no scientific rationale, and have not been shown to be reliable or reproducible when subjected to formal study. Not only are such tests unreliable in diagnosing allergic disease, they are also increasingly being promoted for the diagnosis and management of disorders for which no evidence of immune system involvement exists. ASCIA strongly advises against the use of these tests for diagnosis or to guide medical treatment. No Medicare rebate is available in Australia for these tests, and their use is not supported in New Zealand.

Vega (electro-diagnostic) testing (Evidence Level II: inaccurate test)

Vega testing claims to detect disease by measuring changes in body electrical currents using a “Vega machine”. The patient holds one (negative) electrode in one hand, and the positive electrode is applied to acupuncture points over fingers or toes. An allergen (such as food extract) in a sealed glass container is brought into the electrical circuit. An alteration in current is interpreted as sensitivity to that substance. Formal examination of this technique, shows it is unable to distinguish between healthy and allergic individuals, between control and allergen extracts, and results do not correlate with those obtained using conventional testing.

Cytotoxic testing (“Bryan’s test”) and the Alcat test (Evidence Level II: inaccurate test)

In cytotoxic food testing (“Bryan’s test”), the size and shape of white cells is assessed after incubation with food extracts on a microscope slide. These results have been shown to not be reproducible, give different results when duplicate samples are analysed blindly, don’t correlate with those from conventional testing, and “diagnose” food hypersensitivity in subjects with conditions where food allergy is not considered to play a pathogenic role. The Alcat test is a variant on a theme; the results are analysed on a Coulter counter instead of under the microscope.

Iridology (Evidence Level II: inaccurate test)

Iridology claims to diagnose disease by examining iris patterns. Its theoretical basis, however, is undermined by the fact that iris patterns (like fingerprints) are so unique and unchanging, that they can be used as biometric identification markers to distinguish one person from another. Furthermore, blinded studies of iridology have also demonstrated that practitioners are unable to distinguish healthy from diseased individuals, and even give different diagnoses using iris photographs from the same patients taken minutes apart.

Kinesiology (Evidence Level II: inaccurate test)

Kinesiology is based on the concept that exposure to exogenous toxins or allergens will be reflected in a reduction in muscle strength. Muscle strength is measured before and after exposure to food. “Provocation” to food occurs by having drops of food extracts given under the tongue or by holding a vial of food extracts in one hand. Children are assessed by testing the parent’s strength first and again while holding the child's hand. The two test results are then subtracted to give the final results. Controlled study has shown that kinesiology results are not reproducible and are no more accurate than guessing. Unfortunately, kinesiology and other unproven diagnostic techniques are used as the basis of unorthodox treatment techniques as well.

IgG food antibody testing (Evidence Level II: inaccurate test)

IgG antibodies to food are commonly detectable in healthy adult patients and children, independent of the presence of absence of food-related symptoms. There is no credible evidence that measuring IgG antibodies is useful for diagnosing food allergy or intolerance, nor that IgG antibodies cause symptoms. In fact, IgG antibodies reflect exposure to allergen but not the presence of disease. (The only exception is that gliadin IgG antibodies are sometimes useful in monitoring adherence to a gluten-free diet in patients with histologically confirmed coeliac disease). Despite studies showing the uselessness of this technique, it continues to be promoted in the community, even for diagnosing disorders for which no evidence of immune system involvement exists.

VoiceBio©TM (Evidence Level: no evidence)

This technique is based on the concept that internal organs communicate with each other via sound waves, with each organ vibrating at certain frequencies, and with organ dysfunction being detectable by analysis of such frequencies using a computer assisted analysis of the patient’s voice. There is no scientific rationale for this technique, and no evidence that results are useful for diagnosing any disorder, including allergies.

Other techniques

Other techniques such as pulse testing, stool or hair analysis or oral provocation/neutralisation have no scientific basis and no proven role in the diagnosis or management of any medical condition.

Unorthodox therapies are unproven

Claims of “breakthrough treatments” continue to appear at regular intervals, generally variations of other unorthodox treatments. These treatments have either not been subject to careful study or shown to be unhelpful when subject to formal evaluation. Unorthodox treatments sometimes pander to the common but unrealistic desire of patients to cure disease rather than simply control symptoms.  Unfortunately, there are actually few cures for disease, other than those that can be eliminated with antibiotics, the surgeon's knife or sometimes cancer chemotherapy.  Treatments usually centre around one or more of (a) dietary manipulation, (b) oral supplements (eg.   herbal remedies, anti candida supplements) to strengthen the immune system, or (c) techniques to “cure” or “eliminate allergy”, even when the patient has no evidence of immune mediated disease. 

Allergy elimination techniques (Evidence Level: no published studies)

At the present time, the only proven “allergy elimination technique” is allergen immunotherapy, when there is clear evidence of an immune mediated allergic reaction to inhaled allergen, or to stinging insects.  Both sublingual/oral (Immunotherapy) and systemic/injectable immunotherapy (Immunotherapy) have been shown in controlled studies to reduce the severity and frequency of symptoms in the majority of patients.  This form of therapy is the closest thing to cure for proven allergic disease.  In recent years however, unorthodox “allergy elimination techniques” have also become popular. Also known as advanced allergy elimination and Nambudripad’s allergy elimination in some countries, practitioners claim to treat a range of conditions (not necessarily with evidence of an immune basis), as well as symptoms attributed to inhalant allergens, or perceived chemical or environmental triggers. 

This treatment is based on the concept that “allergen” is perceived by the nervous system as a “threat” to the body’s well being. Exposure to allergen disrupts the flow of nervous energies from the brain to the body via “meridians”, resulting in symptoms. The technique seeks to “re-programme” the brain by applying acupressure applied to both sides of the spinal column (where energy flowing along meridians intersects with nerve roots) while the patient is in direct contact or close proximity to purported allergen. While proponents claim to be able to “eliminate” almost any allergy or sensitivity, the approach lacks any scientific rationale or physiological basis, and there is not a single published study demonstrating its effectiveness for any medical condition.

Adverse outcomes from unorthodox testing and treatments may arise

The potential for adverse outcomes following some unorthodox diagnostic techniques and treatment is insidious, but potentially more serious than those commonly debated issues surrounding adverse reactions to herbal medicines (Adverse Reactions to Alternative Medicines). 

  • Misleading results may result in advice to undergo major dietary restrictions. These have the potential to impair growth and even cause malnutrition, particularly in more vulnerable groups such as young children.
  • Access to more effective diagnostic techniques and treatments may be delayed, with lost productivity from inadequately controlled disease.
  • Substitution of homoeopathic vaccines for those with proven effectiveness (or even discouragement to undertake vaccination at all), has individual and public health implications.
  • Unnecessary environmental and chemical avoidance, creating a perception of allergic or other organic illness when there are other explanations for their symptoms, can impact on employment and social functioning.
  • So-called “allergy elimination techniques” have the potential to cause particular harm, if those with a potential dangerous allergy consider themselves protected from exposure.

Unproven diagnostic techniques and treatments are not inexpensive

The costs incurred are not insignificant, and amount to over $600 million per year in consultations, and over $1.5 billion per year in complimentary medicines in Australia alone, greater than the out of pocket contribution by the community to the PBS system.  While it can be argued that this is a cost borne by individuals rather than the public purse, this claims undermined by the cost implications of:

  • Adverse outcomes with assessment by the conventional medical community, resulting in costs borne by the community,
  • Lost income and productivity results from inadequately controlled disease,
  • Private funds are directed into non-productive areas and are not available for more useful activities, and

Evidence, claims and counterclaims

There are only two types of therapies for disease; those that have been proven to be effective, and those that are unproven.  The plural of anecdote or testimonial is not good clinical evidence.  The medical literature is littered with the corpses of treatments previously claimed or thought to be effective on theoretical grounds, later discarded as unproven when subjected to careful study. 

Questions to ask unorthodox practitioners

In the absence of effective advertising or government regulation for unsubstantiated claims for unorthodox allergy testing or treatments, patients should ask the same questions they pose for any form of treatment before going ahead:

  • What is the evidence it works?
  • What are the risks and benefits?
  • What might happen if I do not undertake this form of treatment?
  • How much does it cost?
  • Are there any side-effects?
  • Why doesn’t my own doctor suggest this type of treatment?
  • What are the qualifications of the practitioner recommending the treatment?
  • Why can this one test of treatment detect or treat so many different problems?

Further Reading

References

  1. Becker EL. Elements of the history of our present concepts of anaphylaxis, hay fever and asthma. Clin Exp Allergy 1999; 29: 875-895.
  2. Chinen J, Shearer WT. Advances in Asthma, Allergy and Immunology Series 2004: Basic and clinical immunology. J Allergy Clin Immunol 2004; 114: 398-405. 
  3. MacLennan AH, Wilson DH, Taylor AW. The escalating cost and prevalence of alternative medicine. Preventative Med 2002; 35: 166-173.
  4. Andrews L, Lokuge S, Sawyer M, Lillwhite L, Kennedy D, Martin J. The use of alternative therapies by children with asthma: a brief report. J Paediatr Child Health 1998; 34: 131-4.
  5. Wilkinson JM, Simpson MD. High use of complementary therapies in a New South Wales rural community. Aust J Rural Health 2001; 9: 166-71.
  6. Simon A, Worthen DM, Mitas JA. An evaluation of iridology.  JAMA 1979; 242: 1385-1387.
  7. Ludke R, Kunz B, Seeber N, Ring J. Test retest-reliability and validity of the kinesiology muscle test. Complem Ther Med 2001; 9: 141-5.
  8. Lewith GT, Kenyon JN, Broomfield J, Prescott P, Goddard J, Holgate ST. Is electrodermal testing as effective as skin prick tests for diagnosing allergies? A double blind, randomised block design study. BMJ. 2001; 322 :131-4.
  9. Benson TE, Atkins JA. Cytotoxic testing for food allergy; evaluations of reproducibility and correlation. J Allergy Clin Immunol 1976; 58: 471-6.
  10. Markham AW, Wilkinson n JM. Complementary and alternative medicines (CAM) in the management of asthma: an examination of the evidence. J Asthma 2004; 41: 131-9.
  11. Ernst E. Serious adverse effects of unconventional therapies for children and adolescents: a systemic review of recent evidence. Eur J Pediatr 2003; 162: 72-80
  12. Niggemann B, Gruber C. Side-effects of complementary and alternative medicine. Allergy 2003; 58:707-16.
  13. Goldrosen MH, Straus SE. Complementary and alternative medicine: assessing the evidence for immunological benefits. Nature Reviews Immunology 2004; 4: 912-21.
  14. Holgate ST. The epidemic of asthma and allergy. J R Soc Med. 2004; 97: 103-10.
  15. Becker EL. Elements of the history of our present concepts of anaphylaxis, hay fever and asthma. Clin Exp Allergy 1999; 29: 875-895.
  16. May CD. Food allergy – lessons from the past. J Allergy Clin Immunol 1982; 69: 255-259.
  17. Schafer T. Epidemiology of complementary alternative medicine for asthma and allergy in Europe and Germany. Ann Allergy Asthma Immunol 2004; 93: S5-10.
  18. Bielory L. The science of complementary and alternative medicine: the plural of anecdote is not evidence. Ann Allergy Asthma Immunol 2004; 93: S1-4.
  19. Ernst E. Serious adverse effects of unconventional therapies for children and adolescents: a systemic review of recent evidence. Eur J Pediatr 2003; 162: 72-80
  20. Niggemann B, Gruber C. Side-effects of complementary and alternative medicine. Allergy 2003; 58:707-16.
  21. Robertson DAF, Ayres RCS, Smith CL, Wright R.  Adverse consequences arising from misdiagnosis of food allergy. Br Med J 1988; 297: 719-720.
  22. Liu T, Howard RM, Mancini AJ, Weston WL, Paller AS, Drolet BA, Esterly NB, Levy ML, Schachner L, Frieden IJ. Kwashiorkor in the United States: fad diets, perceived and true milk allergy, and nutritional ignorance. Arch Dermatol. 2001; 137: 630-6.
  23. Ernst E. Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination. Vaccine. 2001; 20 (suppl 1): S90–S93
  24. Wilson K, Busse JW, Gilchrist A, Vohra S, Boon H, Mills E. Characteristics of pediatric and adolescent patients attending a naturopathic college clinic in Canada. Pediatrics. 2005; 115: 338-43.
  25. Eysink PED, de Jonge MH, Bindels PJE, Scharp-van der Linden VTM, de Groot CJ, Stapel SO, Aalberse RC. Relation between IgG antibodies to foods and IgE antibodies to milk, egg, cat, dog and/or mite in a cross-sectional study. Clin Exp Allergy 1999;29:604-10
  26. Aalberse RC, van der Gaag R, van Leeuwen J. Serologic aspects of IgG4 antibodies. J Immunol 1983; 130;2:722-6 6
  27. Wüthrich B. Specific IgG antibodies as markers of adverse reactions to food. Contra! Monograph Allergy 1996;32:226-7

 

© ASCIA 2010

The Australasian Society of Clinical Immunology and Allergy (ASCIA) is the peak professional body of Clinical Immunologists and Allergists in Australia and New Zealand.

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ASCIA Education Resources (AER) information is reviewed by ASCIA members and represents the available published literature at the time of review. Information contained in this document is not intended to replace professional medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.

Content updated January 2010

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