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Unorthodox Techniques for the Diagnosis and Treatment of allergy, Asthma and Immune Disorders

ASCIA Position Statement

November 2007

Based on the October 2004 version published online

Keywords: vega testing, advanced allergy elimination, cytotoxic testing, iridology, kinesiology, Alcat test, allergy testing, IgG antibody testing, allergy, allergy elimination technique, VoiceBio ©TM

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

While our ability to accurately diagnose and treat allergic disease has benefited from scientific understanding of what happens during an allergic reaction, a number of tests and treatments have been promoted in the absence of any scientific rationale. Some non-conventional approaches to disease also claim that various disorders unrelated to allergy have an immune basis. These tests and treatments have been shown to be unreliable when subjected to careful study. ASCIA advises against use of these tests for diagnosis or to guide medical treatment.

Table of Contents

Allergy is a science-based specialty

Use of unproven “allergy tests” is common in Australia and New Zealand

Unproven allergy testing and treatments are not regulated

Philosophies underlying unorthodox practice

Advice needs to be “evidence based”

Inappropriate testing

  • Cytotoxic testing (Bryans' or Alcat testing)
  • Oral provocation and neutralisation
  • Vega testing (electrodermal testing)
  • Kinesiology
  • Radionics (psionic medicine, dowsing)
  • Iridology
  • Pulse testing
  • Hair analysis
  • Tests for “dysbiosis”
  • VioceBio

Inappropriate use of conventional testing

  • Food specific IgG, IgG4, IgE
  • Lymphocyte subset analysis
  • Allergen specific IgE (RAST, ImmunoCap testing)

Inappropriate use of conventional treatments

Allergen immunotherapy

Treatments used by conventional and unorthodox practitioners

  • Buteyko Breathing Technique
  • Elimination diets

Unorthodox treatments

  • Homoeopathy
  • Acupuncture
  • Reflexology (zone therapy)
  • Autogenous urine therapy
  • Physical Therapies: Chiropractic therapy, Osteopathy, Cranial therapy
  • Allergy elimination techniques (also known as “Advanced Allergy Elimination”, “Nambudripad’s Allergy Elimination”)
  • Vega MRT (Matrix Regeneration Therapy)
  • Clinical Ecology/ Environmental Illness
  • Chronic Candidiasis
  • Enzyme potentiated immunotherapy
  • Insulin resistance / allergy

Conclusions

  • Adverse outcomes from unorthodox testing and treatments may arise
  • Unproven diagnostic techniques and treatments are not inexpensive
  • Evidence, claims and counterclaims

References

Position Statement

Allergy is a science-based specialty

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

Use of unproven allergy tests is common in Australia and New Zealand

Despite advances in scientific knowledge about allergic disorders, 50-70 per cent of patients 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.

Philosophies underlying unorthodox practice

Some unorthodox allergy practices claim that common conditions such as headaches, migraine, irritable bowel, muscle tension, pain, addiction, premenstrual syndrome, fatigue or depression are expressions of a disordered immune system, a claim for which there is no evidence. Allergic and other diseases are attributed to either (a) disturbance of vital life force or energy (“Qi”, yin-yang), or (b) 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.

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. Levels of Evidence for the unorthodox approaches to allergy testing and treatments are listed in the text. Comments provided assist the interpretation of levels of evidence. For example, Level I evidence of a test being unreliable represents high quality evidence. When NO published evidence exists, this is listed as “No evidence”.

Evidence Levels

The following is a summary of the most common unorthodox techniques and practices used to treat or diagnose allergy and asthma. ASCIA strongly advises against the use of these tests for diagnosis or to guide medical treatment. 

Inappropriate Testing

Cytotoxic testing (also known as Bryans' or ALCAT testing)

Use: Diagnosis of food sensitivity / allergy.

Method: A suspension of patient white cells is incubated with dried food extracts on a microscope slide. Changes in the appearance and movement of cells are interpreted as representing a sensitivity or “allergy” to that food. The ALCAT test is a variation, whereby a mixture of blood and food extracts is analysed in an automated Coulter counter.

Evidence Level: Level II

Comment: 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.

Oral provocation and neutralisation  

Use: This technique is promoted for the diagnosis and treatment of sensitivity to foods, inhaled allergens and environmental chemicals. 

Method: Drops of dilute extracts are administered under the tongue. The dose required to trigger symptoms is assessed, and further dilutions prepared. Symptoms are expected to disappear with exposure to more dilute extracts, in which case the patient is instructed to use this “neutralising dose” before exposure to the offending environmental trigger. Subcutaneous provocation and neutralisation is a variation, except that extracts are injected rather than administered orally.

Evidence Level: Level II

Comment: Blinded provocation studies have shown that neither patients nor practitioners are able to distinguish between reactions to placebos and food/chemical extracts.

Vega testing (electrodermal testing)  

Use: Vega testing has been promoted as being useful for diagnosing a range of diseases including allergy, sinusitis, chronic candidiasis and malignancy. 

Method: This test is based on the concept that pathological changes in the body will be reflected in alterations in electrical charge, changes that can be detected by Vega machines. The patient holds one (negative) electrode in one hand, and the positive electrode is applied to acupuncture points over fingers or toes. A food extract in a sealed glass container is brought into the electrical circuit. A reduction in current is interpreted as sensitivity to that substance. Children are assessed by testing the parent first, and repeated with the parent holding the child’s hand.

Evidence: Level II

Comment: 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.

Kinesiology  

Use: Diagnosis of food sensitivity / allergy.

Method: This technique is based on the concept that exposure to exogenous toxins or allergens will be reflected in a reduction in muscle strength. 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.

Evidence: Level III

Comment: This technique has no physiological basis, and interpretation is innately subjective. Formal studies have shown poor reproducibility between duplicate testing, and poor correlation with the results of conventional allergy testing.

Radionics (psionic medicine, dowsing)

Use: Diagnosis and treatment of food sensitivity / allergy, infections and various medical conditions.

Method: Radionics is based on the concept that all life forms are submerged in the electro-magnetic energy field of the earth, and that disease will be reflected by changes or “imbalances” in an individual’s electromagnetic field that are said to lie outside the normal electromagnetic spectrum. Practitioners of radionics claim to be able to detect subtle changes in energies and vibrations arising from internal organs affected by disease using a pendulum-like device to amplify these changes. Sometimes more sophisticated instruments are used to “tune in” to disease-specific energies. By focusing their own thoughts and energies, practitioners claim to treat disease by restoring normal energy balance. Sometimes the operator is with the patient, and sometimes the practitioner “connects” with the patient at a distance using an object such as lock of hair, blood sample or photograph.

Evidence: No evidence

Comment: This technique combines concepts of kinesiology, reflexology, vega testing, “ESP” and the paranormal. This technique has not been subject to formal study, and there is no published evidence that it is effective for the assessment or treatment of any disorder.

Iridology

Use: Diagnosis of various disorders.

Method: Iridology is based on the concept that each part of the body is represented by a corresponding part of the iris. A person's state of current and past health is diagnosed from the color, texture, and location of pigment flecks in the eye. Imbalances are treated with dietary supplements or herbal medicines.

Evidence: Level II

Comment: Iridology shares a similar conceptual framework with those of reflexology and acupuncture. Studies have shown that iridologists are unable to distinguish patients with disease from healthy subjects, and to give varying diagnoses when examining iris photographs from the same individuals taken a few minutes apart. Furthermore, iris patterns are unique and remain constant throughout life, enabling them to be used for reliable personal (‘biometric’) identification. This calls into serious question the theoretical basis of iridology. 

Pulse testing

Use: Diagnosis of food sensitivity / allergy.

Method: This test is based on the rationale that allergic reactions are mediated by nerve impulses transmitted by the sympathetic nervous system, and that allergen exposure will result in a temporary increase in heart rate. The auricular cardiac reflex test is a variation, in which food sensitivity is assessed by changes in pulse waveform.

Evidence: No evidence

Comment: This technique is subjective by its nature, and there is no evidence that results are useful for diagnosing any disorder, including allergies.

Hair analysis

Use: Diagnosis of food sensitivity / allergy and other non-specific symptoms

Method: Trace elements are measured from samples of hair, and nutritional deficiencies or excesses are related to the patient's symptoms.

Evidence: No evidence

Comment: While hair analysis is employed for toxicological/forensic use, there is no evidence that vitamin or mineral analysis from hair samples is useful for diagnosing disease or that treatment based on its results has any clinical utility. Blinded studies have shown variable and non-reproducible results from the same samples sent to the same and different laboratories.

Tests for ‘dysbiosis’

Use: Diagnosis of food sensitivity / allergy and other non-specific symptoms

Method: Some laboratories offer pathology tests including stool bacterial/chemical analysis, urine metabolite profiles, intestinal permeability assays, trace metal analysis, Candida antibody / cellular proliferation assays and blood / urine fatty acid and amino acid profiles for assessment of “dysbiosis”. The concept of ‘dysbiosis’ states that there is a balance of ‘good’ versus ‘bad’ bacteria in the bowel of each person,  that imbalances result in disease, and that this can be assessed by various metabolic and bacteriological measurements. Such tests are often used by unorthodox practitioners as a rationale to guide (a) megadose nutritional supplementation; (b) ‘probiotic’ and/or antibiotic therapy; or (c) dietary modifications. These treatments are promoted as a means of restoring a ‘healthy’ balance of bowel flora.

Evidence: No evidence

Comment: There is no sound evidence to support the notion of ‘dysbiosis’ as a cause of allergic diseases or related clinical conditions.  The clinical validity of the tests involved or treatments advocated has not been demonstrated.

VoiceBio

Use: Diagnosis of various disorders.

Method: 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.

Evidence: No evidence

Comment: There is no scientific rationale for this technique, and no evidence that results are useful for diagnosing any disorder, including allergies.

Inappropriate use of Conventional Testing

Adverse consequences may also arise if conventional laboratory tests are used in inappropriate clinical situations, or where results are presented in a manner amenable to misinterpretation.

Food specific IgG, IgG4

Use: Diagnosis of food sensitivity / allergy.

Method: Antibodies to food are measured using standard laboratory techniques. 

Evidence: Level II

Comment: 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 exception is that gliadin IgG antibodies are sometimes useful in monitoring adherence to a gluten-free diet patients with histologically confirmed coeliac disease. Otherwise, inappropriate use of food allergy testing  (or misinterpretation of results) in patients with inhalant allergy, for example, may lead to inappropriate and unnecessary dietary restrictions, with particular nutritional implications in children. 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.

Food specific IgE (RAST, ImmunoCap testing)

Use: Diagnosis of food sensitivity / allergy.

Method: Antibodies to food are measured using standard laboratory techniques. Some laboratories may present data inappropriately as raw counts or as “response factors”.

Evidence: will depend on the clinical scenario

Comment: Inappropriate used may be divided into three areas. (1) Inappropriate patient selection. As with any diagnostic test, use in patients where there is no evidence that food allergy plays a role in pathogenesis increases the likelihood of irrelevant false positive results. Use of food allergy testing in patients with inhalant allergy, for example, may lead to inappropriate and unnecessary dietary restrictions, with particular nutritional implications in children. (2) Misinterpretation of results. Low levels of food-reactive IgE are found in some healthy individuals without clinical reactivity. Challenge studies have shown a correlation between allergen-specific IgE and then likelihood of reactivity to some (such as cows milk, egg and peanut) but not all foods. In the absence of a history of clinical reactivity, low levels of allergen-specific IgE are usually of little diagnostic significance. (3) Inappropriate data presentation. Presentation of data as “raw counts” has no scientific or clinical rationale, has not been shown to correlate with clinical reactivity and renders results more liable to misinterpretation.

Lymphocyte subset analysis

Use: Conventionally used for the assessment of patients with suspected immunodeficiency or lymphoid malignancy. Also used by some unorthodox practitioners to assess patients with suspected “chemical sensitivity”, chronic fatigue syndrome or “environmental allergies”. Method: Lymphocyte subsets are measured using standard laboratory techniques.

Evidence: Level II for investigation of immune deficiency, but many illness will result in temporary alteration of results. No evidence that this test has a role to play in investigation of patients with non-specific fatigue or to monitor response to immunotherapy.

Comment: Lymphocytes in the blood are in transit between the various lymphoid organs and tissues where they perform their functions. Their numbers and proportions in the blood vary from day to day and are influenced by a wide range of physiological and pathological factors, including: time of collection, exercise, pregnancy, cigarette smoking, alcohol, medications, allergen exposure, infection and the presence of a variety of chronic disease states, including anxiety and depression. Misinterpretation of minor changes in the absence of evidence of immune deficiency or malignancy can be very misleading and may reinforce a patient’s concern that they are suffering from an immune disorder. This commonly occurs when the distinction between concepts of “energy” and “immunity” are blurred, and when health professionals offer ill-informed and unsubstantiated opinions about “immune dysfunction”.

Inappropriate use of Conventional Treatments

Allergen immunotherapy (injectable)

Conventional Use: Treatment of severe allergic reactions from inhalant allergen or venomous insect stings.

Unconventional use: Treatment of food allergy, or treatment of inhalant/stinging insect allergy using inappropriate protocols.

Method: Conventional immunotherapy involves the graded injection of commercial allergen extracts to which the patient is sensitive using standard protocols.  Unconventional use involves administration of food allergen extracts to treat food allergy, or the use of very short courses of injected inhalant allergen to treat allergic rhinitis and asthma.

Evidence: Level I for injectable immunotherapy for treatment of insect venom and inhalant allergy.

Comment: The clinical effectiveness of injected immunotherapy to treat inhalant and stinging insect allergy has been demonstrated in a number of double-blind placebo-controlled studies with long-term follow-up. By contrast, there is no convincing published evidence to date of an effective treatment to for food allergy in humans using injectable immunotherapy (but there is published evidence of lack of efficacy), although research in this area is ongoing.  The changes in immune response to allergen immunotherapy require a long-term commitment to regular maintenance injections once a therapeutic dose is achieved, to reduce the risk of relapse once treatment is ceased. Very short courses of immunotherapy (or commencement of immunotherapy for seasonal allergens over the warmer months) exposes the patient to the risk of adverse reactions from treatment without the likelihood of substantial short or long-term benefit. There is no proven role for immunotherapy to reduce the severity of symptoms related to “food intolerance” or any perceived adverse reactions to food chemicals, additives, preservatives, artificial colours or “smoke”. At this time, immunotherapy to switch off food allergy is the subject of research, but is yet to enter routine clinical practice. There is no proven role for the additional of bacterial extracts to allergen extracts for immunotherapy, or for the use of bacterial extracts to treat any allergic disease at this time.

Allergen immunotherapy (sublingual/oral)

Conventional Use: Treatment of severe allergic reactions from inhalant allergen, with limited published studies of its use for induction of tolerance in some patients with food allergy

Unconventional use: Routine treatment of food allergy, either validated food allergy, or “food sensitivity” as “diagnosed” using unorthodox techniques.

Method: Unconventional use involves administration of low concentrations of food allergen extracts to treat food allergy

Evidence: Level I for treatment of inhalant allergy; level II for some food allergy (but status is research, not routine clinical practice at this stage); no evidence for food “sensitivity” diagnosed with unorthodox techniques.

Comment: Recent studies suggest that the administration of oral or sublingual allergen may also have a beneficial effect in patients with inhalant allergy. As the magnitude of the benefit and its effectiveness in comparison to injected immunotherapy remains undefined, sublingual immunotherapy is currently considered as an option for treatment of inhalant allergy (particularly in young children), rather than as routine treatment of allergic respiratory disease in Australia or New Zealand. By contrast, the published evidence to date that this approach is useful to treat food allergy (or at least induce tolerance of a known food allergen) is very limited, although research in this area is ongoing. Until further work determining safety and efficacy is determined, such treatments should not be performed outside of well-defined research protocols. Use for treating “food sensitivity” as assessed by unorthodox techniques or using “raw counts” of specific IgE in patients without clear evidence of food allergy (eg. to treat rhinitis) has no scientific basis.

Treatments used by Conventional and Unorthodox Practitioners

Buteyko Breathing Technique

Use: The Buteyko Breathing Technique is promoted as a drug-free asthma therapy. It is sometimes used to treat rhinitis, snoring and sleep apnoea.

Method: The technique is based on the concept that carbon dioxide is a natural bronchodilator.  Slowing the rate of breathing will raise carbon dioxide levels, resulting in symptomatic improvement. 

Evidence: Level III-2

Comment: Controlled studies have demonstrated symptomatic improvement and reduction in medication use in some patients, but no changes in carbon dioxide levels or measurements of lung function.  Not only are there are similarities between symptoms of hyperventilation and asthma, but the prevalence of chronic hyperventilation is relatively high in this patient population. At this time it is unclear whether symptomatic improvement is experienced due to reversal of bronchospasm, by improvements in disordered breathing and asthma perception, or both. There is no evidence that there is any impact on the inflammatory components of asthma.

Unorthodox diet modification

Use: Used for the diagnosis and treatment of various disorders, whereby food is considered to play a pathogenic or aggravating role.

Method: The type of diet employed reflects the underlying philosophy of the practitioner. All share advice to avoid some individual foods or food groups. One category of ‘alternative’ diets is based on beliefs about the role of particular foods, such as wheat, dairy, yeast (including Candida), or toxins (e.g. additives, pollutants). Individual CAM practitioners usually focus one of these approaches, and recommend it for all patients regardless of their complaint. Other individualise dietary modification, basing their advice on one or more of the testing methods described above. The following are some of the most common diets used by unorthodox practitioners:

Wheat/dairy free: These diets are commonly advised for management of respiratory, gastrointestinal and skin-related disorders.

Anti-Candida diet: Treatment concentrates on avoidance of “Candida friendly” foods such as those contain sugars, yeast or molds, dietary supplements, and administration of antifungal drugs. 

Liver cleansing diet: Liver dysfunction due to unhealthy diet, dietary additives and environmental toxins is considered to lead to ill health, immune dysfunction and leakage of food complexes and toxins across the bowel lining.  Patients are advised to consume an essentially healthy diet, with or without various herbal supplements to improve hepatic function.

Blood group diet: Practitioners claim that illness can be reduced if one eats an “appropriate” diet for one’s blood group. Blood group is reflected in an individual’s personality, constitution and immunity. Some groups are advised to consume meat, nuts and fruit and avoid cereals, others advised to avoid these, and others still told to stick to cereals, fruit and vegetables.

Evidence: no evidence

Comment: There is neither a scientific rationale nor published evidence that elimination of Candida with diets or anti-fungal therapy is useful for the management of any disorder. Wheat and dairy free diets may benefit the small proportion of infants with eczema allergic to these foods, and may assist patients with other disorders such as lactose intolerance,  coeliac disease or irritable bowel syndrome. There is no published evidence that dietary restriction has a role to play in allergic respiratory disease, but good evidence that unnecessary prolonged dietary restrictions may impact on nutrition, particularly in young children.  The Liver Cleansing Diet is essentially a healthy diet, but there are no publications supporting its utility in treating any medical disorder, nor that liver dysfunction exists in those in whom it is diagnosed. The Blood Group Diet is irrational, has no scientific basis and is contrary to standard dietary advice to obtain nutrition from a wide variety of food sources. Extensive changes in diet may nonetheless result in clinical improvement in some patients with genuine food intolerances, even if the underlying rationale was unsubstantiated.

Conventional diet modification

The major factors distinguishing conventional from unorthodox dietary approaches is that the former are (a) always characterized by an individualized approach, (b) based on conventional medical testing when an immune mechanisms is involved, (c) conducted short-term under close dietetic and medical supervision to minimize the risk of malnutrition, and (d) followed by challenges to identify avoidable triggers.  There are three broad clinical groups in which this approach is used:

Food allergy: Avoidance of specific food protein allergens is based on conventional diagnostic testing of each individual for specific IgE, interpreted in the context of the clinical history. Since not all positive allergy tests are clinically relevant, supervised open and/or double-blind food challenges may also be required. Furthermore, not all immune reactions to food are IgE mediated. Delayed cellular responses to food allergen resulting in delayed atopic dermatitis or food induced colitis, enteropathy, or eosinophilic oesophagitis generally require elimination of suspect foods (or temporary substitution of an elemental diet), followed by deliberate challenge.

Coeliac disease: Avoidance of gluten-containing foods is based on conventional diagnostic criteria for coeliac disease (small bowel biopsy changes with improvement after gluten exclusion; with or without prior screening for antibodies to EMA and/or tTG). Occasionally a gluten-free diet is used for management of the related condition, dermatitis herpetiformis (diagnosed conventionally by skin biopsy).

Food intolerance: Widely practiced in private and public allergy services in Australia and abroad, these diets are most commonly used to obtain symptomatic control of chronic urticaria, as well as non-immune-mediated disorders (that are nevertheless commonly seen in allergy services) such as migraine headaches, irritable bowel syndrome, recurrent aphthous ulceration and sometimes, for rhinitis or behavioral disorders. Elimination diets involve a three stage diagnostic process: (a) avoidance of specific food substances (additives and/or natural chemicals) to determine whether a broadly restrictive diet will result in symptomatic improvement followed by (b) oral challenges (blinded or open) to identify avoidable aggravants, and (c) an individualized long-term modified diet based on the results.

Evidence: Level II for food allergy; Level III for celiac disease; Level IV for food intolerance

Comment: Dietary restriction followed by challenge in patients with immune-mediated food allergy intolerance is based on a number of published studies.  When considering “low chemical diets” for food intolerance, results sometimes vary from study to study, vary according to patient selection, testing methodology, and the condition examined. Many older studies are observational. Of more recent published studies that have used double-blind placebo controlled challenges  (DBPC) methodology, limited (and at times conflicting) evidence of aggravation of some conditions (such as urticaria, migraines, aphthous ulceration, irritable bowel syndrome or behavioral problems) by some artificial or naturally occurring food-derived chemicals. When considering dietary modification for asthma, there is no convincing evidence that elimination of naturally occurring food chemicals, wheat or dairy products is useful for the management. Controlled provocation studies have demonstrated a very low prevalence of aggravation of rhinitis by dietary additives, and no published evidence that ingestion of wheat or dairy products aggravates rhinitis or mucus production. There is limited evidence that low salt diets and fish-oil derived dietary supplements (but not vitamin E) may be of some benefit to asthmatics.  Controlled provocation studies have demonstrated asthmatic responses to dietary tartrazine, metabisulphite and monosodium glutamate.  Of these chemicals, sensitivity to metabisulphite is by far the most prevalent whilst sensitivity to tartrazine and monosodium glutamate is very low. Overall, the structured approach to elimination diets allows an individual to determine whether diet plays an aggravating role. The potential for referral bias, however, makes it difficult to be certain of the applicability of results of studies from tertiary referral units, to a broader patient population with similar problems.

Unorthodox Treatments

Some non-conventional approaches to disease claim that various disorders unrelated to allergy have an immune basis. 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 they have. The following is a summary of the most common techniques used.

Homoeopathy

Use: Treatment of various disorders including allergies.

Method: Disease is thought to result from a disturbance in the body’s ability to heal itself, and that only a small stimulus is needed to start the healing process. Extracts of plant, mineral or animal origin (eg. adrenal gland, thyroid, thymus, spleen) are first prepared, and then serially diluted, with vigorous agitation at each step to a point where not a single molecule of the original extract remains. Proponents claim that these extremely dilute extracts retain the “memory” or “spirit” of the original extract that will revive the body’s “vital force” and provide relief when taken orally. Based on the concept of “like cures like”, proponents argue that if a particular substance or toxin can trigger symptoms in large amounts, extremely dilute extracts of the same substance can relieve the same symptoms, regardless of cause.

Evidence: Level I

Comment: While there is a superficial resemblance between homoeopathy and conventional immunotherapy, only the latter has been shown to have a clear dose-response relationship between administered dose, alterations in immune response and clinical efficacy. As extracts are diluted beyond the limit by which a single molecule of the original extract will remain, they are effectively placebos. Homeopaths consider that the more dilute the extract, the more potent is its effect, the opposite to the conventional view of pharmacology. There is no convincing evidence that homoeopathy benefits patients with allergy or asthma beyond that of placebo (as described in a recent Cochrane review), and no evidence of a physiological or therapeutic effect. While toxicity from homoeopathy has only been demonstrated in a few cases of accidental contamination with heavy metals, the promotion of so-called homeopathic “vaccines” is of particular concern when considering the risk of preventable transmissible disease in children when used instead of conventional vaccination.

Acupuncture

Use: Treatment of a variety of ailments including musculoskeletal ailments, addictions (eg. smoking), post-operative nausea, and various medical conditions including allergy and asthma.  Method: Acupuncture arose from Chinese concepts of the aetiology of disease. Illness is considered to arise from imbalance between nature’s two opposing forces: Yin (representing the feminine or passive), and Yang (the masculine or aggressive qualities). Treatment of disease aims to re-establish “balance” between these opposing forces, by stimulating the flow of energies along “meridian” lines by inserting needles into parts of the body. Acupuncture points were assigned to "meridians" on the surface of the body, in turn corresponding to channels through which "Ch'i" or "Qi” life force flows. Variants include the application of low voltage currents to inserted needles (electro-acupuncture).

Evidence: Level II

Comment: Controlled studies have found neither subjective nor objective evidence of benefit in patients with asthma. One recent study combining acupuncture and Traditional Chinese Medicine (with sham arms for both), showed conflicting evidence of efficacy, with significant improvement in visual analogue scales and overall quality of life, but no difference in allergy-related symptoms scores or medication use. One recent Australian study (2007) demonstrated significant improvement in symptoms scores (but without a significant change in medication use) in a 20 week study, although the absence of blinding of the acupuncturist and the lack of control for medication use makes the study difficult to interpret. Furthermore, treatment involved twice weekly treatments for several months.

Reflexology (zone therapy)

Use: Treatment of a variety of ailments including musculoskeletal pain and various medical conditions including allergy and asthma. 

Method: Reflexology is based on the concept that each part of the body is represented on specific areas of the hands and feet, sharing a similar conceptual framework with those of iridology and acupuncture. Proponents state that practitioners can diagnose internal disease by feeling the hands and feet, and that pressure or massage will stimulate the flow of healing energy to the corresponding organ in that zone.

Evidence: Level II

Comment: Some unblinded studies have shown some subjective improvement in asthma symptoms. Blinded studies using sham and active treatments have shown no significant clinical benefit and no objective improvement in lung function.

Autogenous urine therapy

Use: Treatment of various medical disorders including asthma, eczema, urticaria and other ailments.

Method: This approach is based on the concept that therapeutic antigens (“Proteose”) are excreted in the urine of allergic patients, and will have a clinical benefit if swallowed or injected. 

Evidence: no evidence

Comment: Urine therapy lacks scientific rationale, and there is no published evidence of efficacy in any disorder. This approach also carries with it a theoretical risk of inducing autoimmune renal disease by injecting   urine-derived glomerular antigen.

Physical Therapies: Chiropractic therapy, Osteopathy, Cranial therapy

Use: Treatment of a variety of ailments including musculoskeletal pain and various medical conditions including allergy and asthma. 

Method: Chiropractic is a manual therapy based on the principle that the nervous system is the main controller of internal organ function and health. Misalignment of the spine and musculoskeletal system can impair nerve function, and thus health. Manipulation aims to restore normal nerve functioning and thus health. Osteopathy is based on the principle that the body has the ability to heal itself, as long as there is no impediment to flow of fluids to and from tissues.  Cranial therapy is a related treatment, whereby manipulation of the spine, skull or jaw is thought to correct internal organ dysfunction by restoring normal fluid flow.

Evidence: Level II

Comment: There is limited evidence that chiropractic is useful for musculoskeletal pain, but controlled studies have found neither subjective nor objective evidence of benefit in patients with asthma or allergic rhinitis. There is no evidence that the other physical techniques have any clinical benefit.

Allergy elimination techniques (also known as advanced allergy elimination and Nambudripad's  allergy elimination in some countries)

Use: Treatment of food, inhalant and chemical sensitivity / allergy.

Method: This treatment is based on the concept that “allergen” is perceived by the brain 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.

Evidence: No evidence

Comment: This technique combines concepts of kinesiology, reflexology, acupuncture and radionics. Proponents claim to be able to cure almost any allergy or sensitivity. This approach lacks scientific rationale or published evidence of efficacy. It is also a potentially dangerous technique if used for to treat dangerous food, drug or venom allergy. The only proven “allergy  elimination” techniques are those of conventional injectable (add WEB LINK) and  sublingual/oral immunotherapy (add WEB LINK) for treatment of allergic respiratory  disease and stinging insect allergy. At this point in time, proven standardised methods for curing food allergy have not been established, but  research is ongoing.

Vega MRT (Vega Matrix Regeneration Therapy)

Use: Treatment of a variety of illnesses including injury, musculoskeletal pain, asthma, allergies, fatigue, skin disorders, environmental toxicities and cancer.

Method: A cup-like device is applied to the skin, which generates negative pressure and designed to draw tissue toxins and waste products to the surface, where they can be eliminated by the lymphatic system. Simultaneously, low grade current is applied to the tissue via a contained electrode, designed to stimulate the body’s immune system, neutralise the effect of body toxins on neural tissues and enhance the ability of damaged tissue to heal itself.

Evidence: No evidence

Comment: This technique combines concepts of cupping, acupuncture and allergy elimination techniques. As with similar methods, the technique lacks scientific rationale or published evidence of efficacy.

Clinical Ecology/ Environmental Illness

Use: Treatment of a variety of illnesses, usually attributed to exposure to dietary or environmental toxins, and sometimes, electromagnetic radiation.

Method: Promoters of clinical ecology claim that much illness results from exposure to dietary or environmental toxins and sometimes Candida. These concepts arose in the first half of the 20th century, when many ill-defined conditions were attributed to “allergy”, and well before the key components of the immune system were identified or their function understood. A variety of “diagnostic tests” are used to confirm “sensitivity” such as those alluded to above. Patients usually complain that a number of distinct and chemically unrelated substances may trigger symptoms, such as smells, natural foods, food additives, environmental chemicals and even electromagnetic radiation. Treatment involves major environmental avoidance strategies, dietary changes, and elimination of Candida using antifungal agents or special diets, and “neutralization” of chemicals in order to minimize exposure and strengthen the immune system.

Evidence: Level III-2

Comment: Patients with this diagnosis usually display physical and emotional symptoms (particularly fatigue) involving multiple organ systems. Conventional medical tests are generally normal, showing no evidence of organ dysfunction or disease. There is no evidence of immune dysfunction or immune deficiency in these patients. Similar symptoms are found in some patients suffering from anxiety and depression, and there is evidence that a substantial proportion of patients suffer from psychiatric disorders and benefit from appropriate treatment. Major lifestyle changes can impact on employment, social functioning and nutrition.

Chronic Candidiasis

Use: Treatment of a variety of ailments including allergy, irritable bowel, food allergy and intolerance, autoimmunity, arthritis and psychological conditions.

Method: This approach is based on the concept that imbalance of gut flora results in overgrowth of Candida albicans within the gut. Release of fungal toxins results in a variety of symptoms including fatigue, arthritis, irritable bowel, food intolerance as well as psychological symptoms. These toxins weaken the immune system, predisposing to further symptoms from ingested foods and toxins. Treatment centres on dietary supplements, administration of antifungal drugs such as nystatin, and restriction of “Candida friendly” foods such as those containing sugars, yeast or molds.

Evidence: Level II

Comment: Candida is a normal gut organism, and immune responses (antibodies, cell mediated responses) to this organism are both expected and observed in healthy controls as well as those allegedly suffering from this condition. There is no evidence of overgrowth of Candida or altered immune responses to this organism in patients complaining of this syndrome. There is neither a scientific rationale nor published evidence that elimination of Candida with diets or anti-fungal therapy is useful for management.

Enzyme potentiated immunotherapy

Use: Treatment of food and inhalant allergy as well as migraine, urticaria and other conditions. Method: A minute dose of allergen is placed in a suspension of freshly drawn patient blood and mixed with the enzyme beta glucuronidase. After mixing, the solution is injected intradermally. The rationale is that the addition of enzyme as an “immune modifier” activates suppressor lymphocytes, switches off the allergic response and that this method is more effective with fewer injections than conventional immunotherapy.

Evidence: Level III-3

Comment: There are a few published studies with small patient numbers, with conflicting claims of efficacy. This approach should be considered experimental and unproven at this time.

Insulin resistance / allergy

Use: Treatment of allergic disorders.

Method: Proponents argue that insulin is a pro-inflammatory peptide and that high levels of insulin in response to a glucose load aggravate allergic disease.

Evidence: No evidence

Comment: Insulin resistance is a well-accepted medical concept. There is no published evidence, however, that metabolic resistance to insulin plays a role in the pathogenesis of allergic disease, or that low carbohydrate diets ameliorate the severity of allergic disease.

Conclusions

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

  • 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. For example, Rona and Chinn found that around one half of parents who thought that their child was food allergic or intolerant altered their child’s diet, but only one third sought medical advice, and that some children were 4cm shorter than controls.
  • 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

Private health insurance funds being similarly misdirected into unproven endeavours, diverting resources away from cost-effective medical treatments and indirectly, raising the cost of private and publicly funded health care.

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. 

ASCIA recommends against the use of unproven diagnostic treatments and treatments

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.

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?
  • Has such evidence been published?
  • If so, can I find it on Medline/Pubmed?
  • 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?
  • What are the qualifications of the practitioner recommending the treatment?
  • Why doesn’t my own doctor suggest this type of treatment?
  • Why can this one test of treatment detect or treat so many different problems?
  • Why don’t I get any Medicare (Australia) rebate for this type of test or treatment?

Further reading on evidence based medicine

Evidence based Medicine http://www.cebm.net/index.asp

Cochrane Reviews (via Australian National Institute of Clinical Studies) http://www.nicsl.com.au/

Medline/PubMed database of published medical articles  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

ASCIA Position Statement and Review of Unorthodox Allergy Testing and Treatments http://www.allergy.org.au/pospapers/unorthodox.htm

Quackwatch http://www.quackwatch.org/index.html

Disclaimer

The content of this article has been reviewed by ASCIA members, represents the available published literature at the time of review and is not intended to replace professional medical advice. Any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.

For further information on allergy, asthma or immune diseases, visit www.allergy.org.au - the web site of ASCIA is the peak professional body of Clinical Allergists and Immunologists in Australia and New Zealand.

Contact details

PO Box 450
Balgowlah NSW Australia 2093

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

© ASCIA 2007

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Acupuncture

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Steurer-Stey C, Russi EW, Steurer J. Complementary and alternative medicine in asthma: do they work? Swiss Med Wkly. 2002 Jun 29; 132(25-26): 338-44. Review.

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Malmstrom M, Ahlner J, Carlsson C, Schmekel B. No effect of chinese acupuncture on isocapnic hyperventilation with cold air in asthmatics, measured with impulse oscillometry. Acupunct Med 2002; 20: 66-73.

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Gruber W, Eber E, Malle-Scheid D, Pfleger A, Weinhandl E, Dorfer L, Zach MS. Laser acupuncture in children and adolescents with exercise induced asthma. Thorax 2002; 57:222-5.

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W, Peake MD. Acupuncture in treatment of stable asthma. Respir Med 1998; 92: 1143-5. 

MacPherson H, Thomas K, Walters S, Fitter M. A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists. Acupunct Med 2001; 19: 93-102.

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Chronic Candidiasis / Candida hypersensitivity syndrome

Lacour M, Zunder T, Huber R, Sander A, Daschner F, Frank U.  The pathogenetic significance of intestinal Candida colonization--a systematic review from an interdisciplinary and environmental medical point of view.  Int J Hyg Environ Health.2002; 205: 257-68.

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Dismukes WE, Wade JS, Lee JY, Dockery BK, Hain JD. A randomized, double-blind trial of nystatin therapy for the candidiasis hypersensitivity syndrome. N Engl J Med. 1990 Dec 20; 323: 1717-23.

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Autogenous urine therapy

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Conventional Immunotherapy 

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Insulin resistance

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Chiropractic/manipulation therapy

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Alcat testing

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Provocation/neutralization

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Vega testing

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Food IgG antibodies

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W Atkinson 1,T A Sheldon 2,N Shaath 1and P J Whorwe . Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut 2004 53: 1459-1464

Iridology

Cockburn DM. A study of the validity of iris diagnosis.  Aust   J Optometry1981;  64: 154-157.

Munstedt K, El-Safadi S, Bruck F, Zygmunt M, Hackethal A, Tinneberg HR. Can iridology detect susceptibility to cancer? A prospective case controlled study.J Altern Complement Med. 2005 Jun;11(3):515-9.

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Stark DJ.  Look into my eyes. Iridology exposed. Med J Aust. 1981 Dec 12-26;2(12-13):676-9.

Simon A, Worthen DM, Mitas JA 2nd. An evaluation of iridology. JAMA. 1979 Sep 28;242(13):1385-9.

Kinesiology

Garrow, J. S. Kinesiology and food allergy.  Br Med J (Clin Res Ed) 1988; 296: 1573-4.

Ludtke, R., B. Kunz, et al. Test-retest-reliability and validity of the Kinesiology muscle test. Complement Ther Med 2001; 9: 141-5.

Schmitt, W. H., Jr. and G. Leisman (1998). Correlation of applied kinesiology muscle testing findings with serum immunoglobulin levels for food allergies. Int J Neurosci 96(3-4): 237-44.

Pothmann R, von Frankenberg S, Hoicke C, Weingarten H, Ludtke R. Evaluation of applied kinesiology in nutritional intolerance of childhood Forsch Komplementarmed Klass Naturheilkd. 2001 Dec;8(6):336-44.

Pulse testing

Coca AF. The Pulse Test.  Easy Allergy Detection. Arco Publishing Inc, New York, 1982.

Hair analysis

Barrett S. Commercial hair analysis: science or scam?  JAMA 1985; 254: 1041-1045.

Fletcher  OJ. Hair analysis. Proven and problematical applications.  Postgrad Med  1982; 72:79-88.

Rivlin RS.  Misuse of hair analysis for nutritional assessment. Am J Med 1983; 75:489-493.

Hambidge KM. Hair analyses: worthless for vitamins, limited for minerals. Am J Clin Nutr 1982; 36:943-949.

Seidal S et al. Assessment of commercial laboratories performing hair mineral analysis. JAMA 2001; 285: 67-72.

Deeming SB,Weber CW. Hair analysis of trace minerals in human subjects as influenced by age, sex, and contraceptive drugs.  Am J Clin Nutr 1978; 31:1175-1180.

Radionics

Wilcox J. Alternative medicine: radionics.   Nurs Times 1976; 72: 568-70.

Radionics  and the black box judgement for defendant.  Br Med J. 1960; 5195: 398-9.

Radionics and the black box. Action for fraud against Mr. de la Warr. Br Med J. 1960; 5192:156-8.

McCarney R, Fisher P, Spink F, Flint G, van Haselen R. Can homeopaths detect homeopathic medicines by dowsing? A randomized, double-blind, placebo-controlled trial.  J R Soc Med 2002; 95:189-91.

Skrabanek P. Paranormal health claims. Experientia 1988; 44: 303-9.

Reflexology

Barlow,J, Cullen L. Increasing touch between parents and children with disabilities: preliminary results from a new programme." J Fam Health Care 2002; 12: 7-9.

Blanc, P. D., L. Trupin, et al. Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis : data from a population-based survey. Chest 2001; 120: 1461-7.

Brygge, T., J. H. Heinig, et al.Reflexology and bronchial asthma. Respir Med 2001; 95: 173-9.

Field, T., T. Henteleff, et al. Children with asthma have improved pulmonary functions after massage therapy.J Pediatr  1998; 132: 854-8.

Maa, S. H., M. F. Sun, et al. Effect of acupuncture or acupressure on quality of life of patients with chronic obstructive asthma: a pilot study. J Altern Complement Med 2003; 9: 659-70.

Brygge T, Heinig JH, Collins P, Ronborg S, Gehrchen PM, Hilden J, Heegaard S, Poulsen LK. Reflexology and bronchial asthma.  Respir Med. 2001; 95:173-9.

Hondras, M. A., K. Linde, et al. Manual therapy for asthma. Cochrane Database Syst Rev(1): 2001; CD001002.

Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med 2003; 138: 898-906.

Kober A, Scheck T, Schubert B, Strasser H, Gustorff B, Bertalanffy P, Wang SM, Kain ZN, Hoerauf K. Auricular acupressure as a treatment for anxiety in prehospital transport settings. Anesthesiology 2003; 98:1328-32.

Petersen L, Faurschou P, Olsen O, Svendsen U. Footzone therapy and bronchial asthma - a clinically controlled investigation. Ugeskr Laeger 1992;154:2065-8.

Oleson, T. and W. Flocco. Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstet Gynecol  1993; 82: 906-11.

Robertson, A., K. Gilmore, et al. Effects of connective tissue massage in subacute asthma. Med J Aust 1984; 140: 52-3.

Yan, S.  14 cases of child bronchial asthma treated by auricular plaster and meridian instrument. J Tradit Chin Med 1998; 18: 202-4.

Homoeopathy

Ernst E. Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination. Vaccine 2001; 20 (Suppl 1): S90-3; discussion S89.

Lehrke P, Nuebling M, Hofmann F, Stoessel U. Attitudes of homoeopathic physicians towards vaccination. Vaccine  2001; 19: 4859-64.

Sulfaro F, Fasher B, Burgess MA. Homoeopathic vaccination. What does it mean? Immunisation Interest Group of the Royal Alexandra Hospital for Children. Med J Aust 1994; 161: 305-7.

Livartowski A, Toulotte K, Reinert P. The practitioner and vaccination (results of a sample survey. Pediatrie 1987; 42: 483-7.

White A, Slade P, Hunt C, Hart A, Ernst E. Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial. Thorax 2003; 58:317-21.

White A, Slade P, Hunt C, Hart A, Ernst E. Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial. Allergy 2002; 57: 694-700. 

Schafer T, Riehle A, Wichmann HE, Ring J. Alternative medicine in allergies - prevalence, patterns of use, and costs. Allergy 2002; 57: 655-8.

Lewith GT, Watkins AD, Hyland ME, Shaw S, Broomfield JA, Dolan G, Holgate ST. Use of ultramolecular potencies of allergen to treat asthmatic people allergic to house dust mite: double blind randomised controlled clinical trial. BMJ 2002 ; 324: 520.

Aabel S. No beneficial effect of isopathic prophylactic treatment for birch pollen allergy during a low-pollen season: a double-blind, placebo-controlled clinical trial of homeopathic Betula 30c. Br Homeopath J.2000;  89: 169-73.

Linde K, Jobst KA. Homeopathy for chronic asthma. Cochrane Database Syst Rev 2000; (2): CD000353.

Reilly D, Taylor MA, Beattie NG, Campbell JH, McSharry C, Aitchison TC, Carter

R, Stevenson RD. Is evidence for homoeopathy reproducible? Lancet 1994; 344:1601-6.

Reilly DT, Taylor MA, McSharry C, Aitchison T. Is homoeopathy a placebo response? Controlled trial of homoeopathic potency, with pollen in hay fever as model. Lancet1986; 2: 881-6.

Schmidt K, Ernst E. MMR vaccination advice over the Internet. Vaccine 2003; 21(11-12):1044-7.

Audicana M, Bernedo N, Gonzalez I, Munoz D, Fernandez E, Gastaminza G.  An unusual case of baboon syndrome due to mercury present in a homeopathic medicine. Contact Dermatitis 2001; 45: 185.

Barquero Romero J, Redondo Lopez JM, Galeano Diaz F, Perez Miranda M. Fatal acute pancreatitis in a patient who received an homeopathic treatment. Med Clin (Barc) 2004; 122:318-9.

Cardinali C, Francalanci S, Giomi B, Caproni M, Sertoli A, Fabbri P. Contact dermatitis from Rhus toxicodendron in a homeopathic remedy. J Am Acad Dermatol 2004; 50:150-1.

Bellavite P, Ortolani R, Pontarollo F, Piasere V, Benato G, Conforti A. Immunology and homeopathy. 4. Clinical studies-part 2. Evid Based Complement Alternat Med. 2006 Dec;3(4):397-409. Epub 2006 Jul 31.

Loudon I. A brief history of homeopathy. J R Soc Med. 2006 Dec;99(12):607-10.

Vickers AJ, Smith C. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Database Syst Rev. 2006 Jul 19;3:CD001957. Review.

Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B,

Pawankar R, Price D, Bousquet J. ARIA update: I--Systematic review of complementary and alternative medicine for rhinitis and asthma. J Allergy Clin Immunol. 2006 May;117(5):1054-62. Review.

Shang A, Huwiler-Muntener K, Nartey L, Juni P, Dorig S, Sterne JA, Pewsner D,

Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005 Aug 27-Sep 2;366(9487):726-32.

McCarney RW, Linde K, Lasserson TJ. Homeopathy for chronic asthma. The Cochrane Database of Systematic Reviews 2004, Issue 1.

Clinical Ecology/ Environmental Illness / Multiple Chemical Sensitivity / Idiopathic environmental intolerance

Terr AI. Environmental sensitivity. Immunol Allergy Clin North Am 2003;  23 : 311-28. 

Guglielmi RS, Cox DJ, Spyker DA. Behavioral treatment of phobic avoidance in multiple chemical sensitivity. J Behav Ther Exp Psychiatry 1994; 25: 197-209. 

Staudenmayer H, Selner JC, Buhr MP. Double-blind provocation chamber challenges in 20 patients presenting with "multiple chemical sensitivity". Regul Toxicol Pharmacol 1993; 18: 44-53. 

Clinical ecology. Executive Committee of the American Academy of Allergy and Immunology. J Allergy Clin Immunol 1986; 78: 269-71. 

Terr AI. Environmental illness. A clinical review of 50 cases. Arch Intern Med. 1986; 146: 145-9. 

Caress SM, Steinemann AC, Waddick C. Symptomatology and etiology of multiple chemical sensitivities in the southeastern United States. Arch Environ Health 2002; 57: 429-36. 

Bornschein S, Hausteiner C, Zilker T, Forstl H. Psychiatric and somatic disorders and multiple chemical sensitivity (MCS) in 264'environmental patients'. Psychol Med 2002; 32: 1387-94. 

Caccappolo-van Vliet E, Kelly-McNeil K, Natelson B, Kipen H, Fiedler N. Anxiety sensitivity and depression in multiple chemical sensitivities and asthma. J Occup Environ Med 2002; 44: 890-901. 

Tarlo SM, Poonai N, Binkley K, Antony MM, Swinson RP. Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder. Environ Health Perspect 2002; 110 Suppl 4: 669-71. 

Levallois P, Neutra R, Lee G, Hristova L. Study of self-reported hypersensitivity to electromagnetic fields in California. Environ Health Perspect 2002; 110 Suppl 4: 619-23. 

Black DW, Okiishi C, Schlosser S. The Iowa follow-up of chemically sensitive persons. Ann N Y Acad Sci 2001; 933: 48-56. 

Otto T, Giardino ND. Pavlovian conditioning of emotional responses to olfactory and contextual stimuli: a potential model for the development and expression of chemical intolerance. Ann N Y Acad Sci. 2001; 933: 291-309. 

Bornschein S, Forstl H, Zilker T. Generalization of acquired somatic symptoms in response to odors: a Pavlovian perspective on multiple chemical sensitivity. Psychosom Med 2000; 62: 751-9. 

Devriese S, Winters W, Stegen K, Van Diest I, Veulemans H, Nemery B, Eelen P, Van de Woestijne K, Van den Bergh O. Psychological treatment of psychogenic idiopathic environmental intolerance. Occup Med. 2000; 15: 627-46. 

Staudenmayer H. A nine-year follow-up of people diagnosed with multiple chemical sensitivities. Psychosomatics 2000; 41: 253-61. 

Elimination diets for food intolerance

IRRITABLE BOWEL SYNDROME

Niec AM, Frankum B, Talley NJ. Are adverse food reactions linked to irritable bowel syndrome? Am J Gastroenterol 1998;93:2184-90.

Zwetchkenbaum J, Burakoff R. The irritable bowel syndrome and food hypersensitivity. Ann Allergy 1988; 61: 47-9.

Jansen SC, van Dusseldorp M, Bottema KC, Dubois AE. Intolerance to dietary biogenic amines: a review. Ann Allergy Asthma Immunol  2003; 91:233-40

URTICARIA/ANGIOEDEMA

Zuberbier T, Pfrommer C, Specht K, Vieths S, Bastl-Borrmann R, Worm M, Henz BM. Aromatic components of food as novel eliciting factors of pseudoallergic reactions in chronic urticaria. J Allergy Clin Immunol  2002; 109:343-8.

Ehlers I, Niggemann B, Binder C, Zuberbier T. Role of nonallergic hypersensitivity reactions in children with chronic urticaria. Allergy  1998; 53: 1074-7.

Fuglsang G, Madsen G, Halken S, Jorgensen S, Ostergaard PA, Osterballe O. Adverse reactions to food additives in children with atopic symptoms. Allergy  1994; 49:31-7.

Goodman DL, McDonnell JT, Nelson HS, Vaughan TR, Weber RW. Chronic urticaria exacerbated by the antioxidant food preservatives, butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT). J Allergy Clin Immunol.  1990 Oct;86(4 Pt 1):570-5. 

Malanin G, Kalimo K. Henz BM, Zuberbier T. The results of skin testing with food additives and the effect of an elimination diet in chronic and recurrent urticaria and recurrent angioedema. Clin Exp Allergy  1989; 19: 539-43. 

Wilson N, Scott A.A double-blind assessment of additive intolerance in children using a 12 day challenge period at home. Clin Exp Allergy 1989; 19: 267-72. 

Supramaniam G, Warner JO. Artificial food additive intolerance in patients with angio-oedema and urticaria.  Lancet  1986; 2:907-9. 

Kemp AS, Schembri G. An elimination diet for chronic urticaria of childhood. Med J Aust 1985; 143: 234-5. 

Genton C, Frei PC, Pecoud A. Value of oral provocation tests to aspirin and food additives in the routine investigation of asthma and chronic urticaria. J Allergy Clin Immunol 1985; 76:40-5. 

Allen DH, Van Nunen S, Loblay R, Clarke L, Swain A. Adverse reactions to foods. Med J Aust 1984;141(5 Suppl):S37-42. 

Minford AM, MacDonald A, Littlewood JM. Food intolerance and food allergy in children: a review of 68 cases. Arch Dis Child  1982; 57(10):742-7. 

Gibson A, Clancy R. Management of chronic idiopathic urticaria by the identification and exclusion of dietary factors. Clin Allergy 1980;10:699-704. 

Freedman BJ. A dietary free from additives in the management of allergic disease. Clin Allergy.  1977;7:417-21. 

Ros AM, Juhlin L, Michaelsson G. A follow-up study of patients with recurrent urticaria and hypersensitivity to aspirin, benzoates and azo dyes. Br J Dermatol  1976; 95:19-24.

BEHAVIOUR

Schmidt MH, Mocks P, Lay B, Eisert HG, Fojkar R, Fritz-Sigmund D, Marcus A, Musaeus B. Does oligoantigenic diet influence hyperactive/conduct-disordered children—a controlled trial. Eur Child Adolesc Psychiatry 1997; 6:88-95.

Krummel DA, Seligson FH, Guthrie HA. Hyperactivity: is candy causal? Crit Rev Food Sci Nutr 1996; 36: 31-47.

Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 1994; 125(5 Pt 1):691-8.

Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy. 1994;72: 462-8.

Kanarek RB. Does sucrose or aspartame cause hyperactivity in children? Nutr Rev 1994; 52: 173-5.

Dengate S, Ruben A. Controlled trial of cumulative behavioural effects of a common bread preservative. J Paediatr Child Health.  2002; 38:373-6.

Wolraich ML, Lindgren SD, Stumbo PJ, Stegink LD, Appelbaum MI, Kiritsy MC.  Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. N Engl J Med 1994 ;330(5):301-7.

Carter CM, Urbanowicz M, Hemsley R, Mantilla L, Strobel S, Graham PJ, Taylor E. Effects of a few food diet in attention deficit disorder. Arch Dis Child 1993;69:564-8.

Egger J, Carter CM, Graham PJ, Gumley D, Soothill JF. Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet 1985; 1:540-5.

Kavale KA, Forness SR. Hyperactivity and diet treatment: a meta-analysis of the Feingold hypothesis. J Learn Disabil 1983;16:324-30.

Hughes EC, Weinstein RC, Gott PS, Binggeli R, Whitaker KL.  Food sensitivity in attention deficit disorder with hyperactivity (ADD/HA): a procedure for differential diagnosis. Ann Allergy 1982; 49:276-80.

Salamy J, Shucard D, Alexander H, Peterson D, Braud L. Physiological changes in hyperactive children following the ingestion of food additives. Int J Neurosci 1982; 16(3-4):241-6.

Mattes JA, Gittelman R. Effects of artificial food colorings in children with hyperactive symptoms. A critical review and results of a controlled study. Arch Gen Psychiatry 1981; 38:714-8.

Bateman B, Warner JO. The effects of a double-blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Arch Dis Child 2004; 89: 506-11.

PA Eigenmann and CA Haenggeli. Food colourings and preservatives-allergy and hyperactivity. Lancet 4 Sep 2004 364(9437): p. 823.

APHTHOUS ULCERATION

Hunter IP, Ferguson MM, Scully C, Galloway AR, Main AN, Russell RI.  Effects of dietary gluten elimination in patients with recurrent minor aphthous stomatitis and no detectable gluten enteropathy. Oral Surg Oral Med Oral Pathol.  1993;75:595-8.

Nolan A, Lamey PJ, Milligan KA, Forsyth A. Recurrent aphthous ulceration and food sensitivity. J Oral Pathol Med.  1991 Nov;20(10):473-5.

Hay KD, Reade PC. The use of an elimination diet in the treatment of recurrent aphthous ulceration of the oral cavity. Oral Surg Oral Med Oral Pathol  1984;57:504-7.

RHINITIS

Asero R. Food additives intolerance: does it present as perennial rhinitis? Curr Opin Allergy Clin Immunol.  2004 Feb;4(1):25-9.

Pacor ML, Di Lorenzo G, Martinelli N, Mansueto P, Rini GB, Corrocher R. Monosodium benzoate hypersensitivity in subjects with persistent rhinitis. Allergy.  2004 Feb;59(2):192-7.

Hassoun S, Sabbah A, Bouchereau JL. Non-allergic rhinitis or intrinsic rhinitis? Unusual features of nickel Allergy Allerg Immunol (Paris).  1999 Feb;31(2):57-9. Int Arch Allergy Immunol.  1996 Aug;110(4):397-400. 

Ogle KA, Bullock JD. Children with allergic rhinitis and/or bronchial asthma treated with elimination diet: a five-year follow-up. Ann Allergy.  1980 May;44(5):273.

ASTHMA

Vally H, de Klerk N, Thompson PJ. Alcoholic drinks: important triggers for asthma.  J Allergy Clin Immunol  2000; 105:462-7.

Wantke F, Hemmer W, Haglmuller T, Gotz M, Jarisch R. Histamine in wine. Bronchoconstriction after a double-blind placebo-controlled red wine provocation test.

Fuglsang G, Madsen G, Halken S, Jorgensen S, Ostergaard PA, Osterballe O. Adverse reactions to food additives in children with atopic symptoms. Allergy.  1994 Jan;49(1):31-7.

Rosenhall L. Evaluation of intolerance to analgesics, preservatives and food colorants with challenge tests. Eur J Respir Dis.  1982 Sep;63(5):410-9.

Ardern KD, Ram FS. Tartrazine exclusion for allergic asthma. Cochrane Database Syst Rev.  2001;(4):CD000460.

Freedman BJ. A dietary free from additives in the management of allergic disease. Clin Allergy.  1977 Sep;7(5):417-21.

Pearson PJ, Lewis SA, Britton J, Fogarty A. Vitamin E supplements in asthma: a parallel group randomised placebo controlled trial. Thorax.  2004 Aug;59(8):652-6.

Ram F, Ardern K. Dietary salt reduction or exclusion for allergic asthma. Cochrane Database Syst Rev.  2004;3:CD000436.

Oddy WH, de Klerk NH, Kendall GE, Mihrshahi S, Peat JK. Ratio of omega-6 to omega-3 fatty acids and childhood asthma. J Asthma.  2004;41(3):319-26.

Woods RK, Walters EH, Raven JM, Wolfe R, Ireland PD, Thien FC, Abramson MJ. Food and nutrient intakes and asthma risk in young adults. Am J Clin Nutr.  2003 Sep;78(3):414-21.

Mickleborough TD, Murray RL, Ionescu AA, Lindley MR. Fish oil supplementation reduces severity of exercise-induced bronchoconstriction in elite athletes. Am J Respir Crit Care Med.  2003 Nov 15;168(10):1181-9. Epub 2003 Aug 06.

Nafstad P, Nystad W, Magnus P, Jaakkola JJ. Asthma and allergic rhinitis at 4 years of age in relation to fish consumption

in infancy. J Asthma.  2003 Jun;40(4):343-8.

Wijga AH, Smit HA, Kerkhof M, de Jongste JC, Gerritsen J, Neijens HJ, Boshuizen HC, Brunekreef B; PIAMA. Association of consumption of products containing milk fat with reduced asthma risk in pre-school children: the PIAMA birth cohort study. Thorax.  2003 Jul;58(7):567-72.

Woods RK, Thien FC, Abramson MJ. Dietary marine fatty acids (fish oil) for asthma in adults and children. Cochrane Database Syst Rev.  2002;(3):CD001283.

Ardern KD, Ram FS. Tartrazine exclusion for allergic asthma. Cochrane Database Syst Rev. 2001;(4):CD000460.

Yazicioglu M, Baspinar I, Ones U, Pala O, Kiziler U. Egg and milk allergy in asthmatic children: assessment by immulite allergy food

panel, skin prick tests and double-blind placebo-controlled food challenges. Allergol Immunopathol (Madr).  1999 Nov-Dec;27(6):287-93.

Woods RK, Weiner JM, Thien F, Abramson M, Walters EH. The effects of monosodium glutamate in adults with asthma who perceive themselves to be monosodium glutamate-intolerant. J Allergy Clin Immunol  1998;101: 762-71.

Woods RK, Weiner JM, Abramson M, Thien F, Walters EH. Do dairy products induce bronchoconstriction in adults with asthma? J Allergy Clin Immunol.  1998 Jan;101(1 Pt 1):45-50. 

Hodge L, Yan KY, Loblay RL. Assessment of food chemical intolerance in adult asthmatic subjects. Thorax  1996; 51:805-9.

Sanz J, Martorell A, Torro I, Carlos Cerda J, Alvarez V. Intolerance to sodium metabisulfite in children with steroid-dependent asthma. J Investig Allergol Clin Immunol.  1992; 2:36-8.

Wilson N, Scott A. A double-blind assessment of additive intolerance in children using a 12 day challenge period at home. Clin Exp Allergy. 1989; 19: 267-72.

Moneret-Vautrin DA. Monosodium glutamate-induced asthma: study of the potential risk of 30 asthmatics and review of the literature. Allerg Immunol (Paris).  1987 Jan;19(1):29-35.

Pinnock CB, Arney  WK. The milk-mucus belief: sensory analysis comparing cow's milk and a soy placebo.  Appetite 1993 Feb;20(1):61-70

Arney WK, Pinnock CB. The milk mucus belief: sensations associated with the  belief and characteristics of believers. Appetite 1993 Feb;20(1):53-60

Pinnock CB, Graham NM, Mylvaganam A, Douglas RM. Relationship between milk  intake and mucus production in adult volunteers challenged with rhinovirus-2.  Am Rev Respir Dis 1990 Feb;141(2):352-6

Nguyen MT. Effect of cow milk on pulmonary function in atopic asthmatic patients.  Ann Allergy Asthma Immunol 1997 Jul;79(1):62-64

MIGRAINES

Jansen SC, van Dusseldorp M, Bottema KC, Dubois AE.  Intolerance to dietary biogenic amines: a review. Ann Allergy Asthma Immunol. 2003 Sep;91(3):233-40;

Hering-Hanit R, Gadoth N. Caffeine-induced headache in children and adolescents. Cephalalgia. 2003 Jun;23(5):332-5.

Strong FC 3rd.  Why do some dietary migraine patients claim they get headaches from placebos? Clin Exp Allergy. 2000 May;30(5):739-43.

Marcus DA, Scharff L, Turk D, Gourley LM.  A double-blind provocative study of chocolate as a trigger of headache. Cephalalgia. 1997 Dec;17(8):855-62;

Peatfield RC.  Relationships between food, wine, and beer-precipitated migrainous headaches. Headache. 1995 Jun;35(6):355-7.

Guariso G, Bertoli S, Cernetti R, Battistella PA, Setari M, Zacchello F.  Migraine and food intolerance: a controlled study in pediatric patients. Pediatr Med Chir. 1993 Jan-Feb;15(1):57-61.

Littlewood JT, Gibb C, Glover V, Sandler M, Davies PT, Rose FC.  Red wine as a cause of migraine. Lancet. 1988 Mar 12;1(8585):558-9.

Hasselmark L, Malmgren R, Hannerz J.  Effect of a carbohydrate-rich diet, low in protein-tryptophan, in classic and common migraine. Cephalalgia. 1987 Jun;7(2):87-92.

Salfield SA, Wardley BL, Houlsby WT, Turner SL, Spalton AP, Beckles-Wilson

NR, Herber SM.  Controlled study of exclusion of dietary vasoactive amines in migraine. Arch Dis Child. 1987 May;62(5):458-60.

Diamond S, Prager J, Freitag FG.  Diet and headache. Is there a link? Postgrad Med. 1986 Mar;79(4):279-86.

NUTRITION IMPACT OF DIETARY RESTRICTION

Henriksen C, Eggesbo M, Halvorsen R, Botten G. Nutrient intake among two-year old children on cows’ milk-restricted diets.  Acta Paediatr 2000; 89: 272-8.

Tarnow Mordi WO, Moss C & Ross K. Failure to thrive owing to inappropriate diet free of gluten and cows' milk. Br Med J 1984; 289: 1113-1114.

Roberts IF, West RJ, Ogilvie D, Dillon MJ. Malnutrition in infants receiving cult diets: a form of child abuse. Br Med J 1979; 1:296-298.

Scarlett Salman, Lynn Christie, Wesley Burks, Mccabe-Sellers. Dietary Intakes of Children With Food Allergies: Comparison of the Food Guide Pyramid and the  Recommended Dietary Allowances 10th Ed. J Allergy Clin Immunol 2002; 109 (1: Part  2): Abstract 643.

Buteyko Breathing technique

McHugh P, Aitcheson F, Duncan B, Houghton F. Buteyko Breathing Technique for asthma: an effective intervention. N Z Med J. 2003 Dec 12;116(1187):U710.

Cooper S, Oborne J, Newton S, Harrison V, Thompson Coon J, Lewis S,

Tattersfield A.  Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial. Thorax. 2003 Aug;58(8):674-9.

Thomas M, McKinley RK, Freeman E, Foy C. Prevalence of dysfunctional breathing in patients treated for asthma in primary care: cross sectional survey. BMJ. 2001 May 5;322(7294):1098-100.

Al-Delaimy WK, Hay SM, Gain KR, Jones DT, Crane J. The effects of carbon dioxide on exercise-induced asthma: an unlikely explanation for the effects of Buteyko breathing training. Med J Aust. 2001 Jan 15;174(2):72-4.

Opat AJ, Cohen MM, Bailey MJ, Abramson MJ. A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video. J Asthma. 2000;37(7):557-64.

Bowler SD, Green A, Mitchell CA. Buteyko breathing techniques in asthma: a blinded randomised controlled trial. Med J Aust. 1998 Dec 7-21;169(11-12):575-8.

Holloway E, Ram F. Breathing Exercises for Asthma. The Cochrane Database of Systematic Reviews 2004;3.

Adverse outcomes from unorthodox treatments

Robertson DAF, Ayres RCS, Ssmith CL & Wright R Adverse consequences arising from misdiagnosis of food allergy. Br Med J 1988; 297: 719-720.

Ernst E. Serious adverse effects of unconventional therapies for children and adolescents: a systematic review of recent evidence.  Eur J Pediatr 2003; 162:72-80. Epub 2002 Dec 04. Review.

Steenkamp V, Stewart MJ, Zuckerman M. Death due to use of traditional medicines in Africa: a preventable cause of neonatal and infant mortality. J Pediatr Gastroenterol Nutr 2003; 36: 294-5. 

Tagwireyi D, Ball DE, Nhachi CF. Poisoning in Zimbabwe: a survey of eight major referral hospitals. J Appl Toxicol 2002; 22: 99-105.

Knepper K.  Withholding medical treatment from infants: when is it child neglect? J Fam Law. 1994-1995 Winter; 33:1-53.

Christie L, Hine RJ, Parker JG, Burks W. Food allergies in children affect nutrition intake and growth. J Am Diet Assoc 2002; 102: 1648-51.

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Golbert TM. A review of controversial diagnostic and therapeutic techniques employed in allergy.  J Allergy Clin Immunol 1975; 56: 170--190.

Lowell FE. Some untested diagnostic and therapeutic procedures in clinical allergy. J Allergy Clin Immunol 1975; 56: 168-169.

American Academy of Allergy. Position statements-controversial techniques. J Allergy Clin Immunol 1981; 67: 333-338.

Ali NS, Azam SI, Noor R. Women's beliefs regarding food restrictions during common childhood illnesses: a hospital based study. J  Ayub Med Coll Abbottabad 2003 ; 15: 26-8.

Van Metre TE Critique of controversial and unproven procedures for diagnosis and therapy of allergic disorders. Pediat Clin N Am 1983; 30:807-817.

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Quackwatch web site: http://www.quackwatch.org/ 

 

Content updated February 2010

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