Posts Tagged ‘Psychological’

Alka-Seltzer
We used to think that Alka-Seltzer was one of the more irrational remedies in the drugstore trileptal peidatric . That is because it contains both aspirin and bicarbonate of soda requip corporation . In the original edition of The People’s Pharmacy, published more than 30 years ago, we-said, “If you have indigestion or upset stomach, the last thing you want is aspirin included in the tablet percentage caffeine content in tea . That is like trying to put out a fire with gasoline too much testosterone .”
We may have been wrong effexor and alcohol . It’s not just that millions of people have used this product successfully for decades natural alternative for spironolactone . This tablet of aspirin (325 milligrams), bicarbonate of soda (1,916 milligrams), and citric acid (1,000 milligrams) is converted into sodium citrate when it fizzes in a glass of water clindamycin dosage for feline toxoplasmosis . This antacid seems to provide fast and effective relief of “acid indi-gestion, upset stomach, and heartburn syrup ranitidine .” What we don’t know is whether Alka-Seltzer is any more effective than a half-teaspoon of baking soda in 4 ounces of water when it comes to
heartburn symptoms lexapro high snorting .
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G orgasm dj caffeine . Allow me to tell you about my experience with heartburn, which I have had for a very long time what is digoxin poison arrows . Last year I started using a toothpaste which contains baking soda clomid and breast tenderness . Since then my heartburn is gone medication and tramadol hcl and information . If I change toothpaste the heartburn comes back, so it’s not a coincidence tablet viagra .
I brush my teeth three times a day online steroids nolvadex . Even though I don’t swallow the toothpaste I think a little of it gets into my stomach and the baking soda neutralizes the stomach acid loratadine condition . Could that be true?
A lithium breast feeding . Baking soda (half a teaspoon in 4 ounces of water) is a tried and true remedy for heartburn lithium overdose . Alka-Seltzer, long used for stomach upset, contains sodium bicarbonate, the compound in baking soda accutane and pearly penile papules . Whether you’d get enough baking soda from your toothpaste to actually neutralize stomach acid is hard to tell, but thanks for sharing your success clarisa nora doctorovich viagra .
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Antacids
For the occasional bout of heartburn, antacids work surprisingly well jeff johnson viagra . In fact, they may be better than pricey acid suppressors digitek 0.25 mg . That’s because it takes hours to shut down acid production zoloft duration of side effects . If you go to the ballpark and gobble down two chili dogs, chase them with beer, and have Cracker Jack for dessert, you don’t want to wait hours for your acid suppressor to go to work insulin resistance glucophage diet . Popping a Turns E-X, Maalox Quick Dissolve, or Rolaids Extra Strength can be safe and effective lexapro message board side effects . That’s because they all contain calcium carbonate, which neutralizes stomach acid lithium polymer batter prices . There are lots of such products to choose from, so pick something that tastes tolerable and isn’t too pricey lithium metal mining .
Calcium Carbonate
Calcium carbonate is inexpensive, fast-acting, and effective addiction and wellbutrin . In addition, you get extra calcium allera with augmentin 875 mg .
Downside: Constipation is fairly common if used regularly beneficial facts about lithium . Cost: A bottle containing 160 tablets of Turns Ultra (1,000 mg calcium carbonate per pill) costs $8 to $10 chloroquin chloroquine . That should be enough to last 2 to 3 months or much longer if used occasionally viagra and heart medicines .
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0 better for gps lithium or nimh .1 have never seen you recommend calcium carbonate for heartburn order avapro . Why? You keep suggesting sodium bicarbonate, even though it introduces too much sodium into the body kamagra in berlin . Calcium carbonate, on the other hand, provides much-needed calcium depakote for headaches . What is your problem?
A propecia cost . We agree that calcium carbonate (Caltrate, Titralac, Turns, etc generic equivalent of lipitor 10mg .) is an excellent, inexpensive antacid that can quickly ease heartburn and supply extra calcium adverse side effects of premarin . We’ve recommended it for decades demeclocycline .
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Don’t forget Pepto-Bismol kroger pharmacy price cialis . We think the familiar pink liquid also has some benefit caffeine free unsweetened tea . The active ingredient, bismuth subsalicylate, can be found generically in store brands and in Maalox Total Stomach Relief Liquid butalbital apap caffeine tabs drug . While not a very powerful antacid, Pepto does seem to calm the fire of heartburn through mechanisms we may not understand very welt dosage of amoxil for young child . Perhaps it coats the esophagus and helps reduce the irritating effects of nid reflux will help the prozac work quicker . There are even decent data to suggest that bismuth subsalicylate can help against traveler’s diarrhea topamax eating . When it is combined with antibiotics, Pepto-Bismol can help fight infection by the bacterium Helicobacter pylori, which leads to gastritis and stomach ulcers tetracycline antibiotcs .
Acid Suppressors
The mainstays for treating indigestion or heartburn are acid suppressors celexa patient ratings . That’s because pharmaceutical companies have become extremely adept at creating such drugs ibuprofen side effects on liver . In the 1960s a team of scientists led by an extraordinary researcher (Sir James Black) hypothesized that if they could block specialized histamine receptors (H2 receptors) in the stomach, they could reduce acid production toprol vs metoprolol .
Histamine2 Antagonists
When drug companies thought about antihistamines, they focused on relieving allergy symptoms in the nose cialis cheapest price . But Sir James thought he could come up with a new kind of antihistamine that would work primarily in the stomach tetracycline and antacids studies . In 1972 the breakthrough was announced, and in 1977 cimetidine (Tagamet) became the first H, antagonist launched in the United States dosing amounts before surgery promethazine . It went on to become one of the most successful drugs in history caffeine drink energy in . Like its successor ranitidine (Zantac) new zealand pharma amitriptyline . Tagamet was one of the first billion-dollar babies (with annual sales of greater than $1 billion) antiobiotics for people allergic to penicillin .
Although these acid suppressors were initially prescribed to help heal stomach ulcers, they rapidly became popular as super antacids xenical online pharmacy phentermine meridia . Any amorphous abdominal pain was treated with an H, antagonist clomid and ovulation test kits . Their success was noted by other drug companies, and “me-too” drugs like famotidine (Pepcid) and nizatidine (Axid) soon appeared benzoyl peroxide tinted acne lotion . Such drugs were perceived as so safe that once they lost their patent protection, the FDA approved them for over-the-counter sale ultram online prescriptions . Although these drugs can relieve heartburn by making stomach contents less acidic, they are not as fast-acting as antacids advantages of wellbutrin .
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Q zyrtec swelling feet . 1 had two hip replacement surgeries in my mid-forties ramipril dosage color . I was given cimetidine (Tagamet) to prevent stress ulcers post-op for the first one and it gave me very nasty hallucinations what is the drug carvedilol . I had already withdrawn myself from the pain medications, and the staff assured me nothing I was taking could induce these things generic alternitive for vytorin . When the surgeon stopped the Tagamet, the nasties went away abilify prescribing .
For the second operation, I listed cimetidine as a drug problem, but they gave it to me anyway boniva alert . I knew within an hour something was seriously wrong and fortunately didn’t have to take any more wellbutrin generic names .
I was assured that the incidence of problems is low, but I’d hate for others to go through what I experienced danger zocor .
A eli lilly cialis tadafil . Cimetidine (Tagamet) has been linked to hallucinations, depression, confusion, and disorientation ciprofloxacin and the oral mucosa . Such psychological side effects are relatively rare, but people need to know that they can occur nitrix interaction with cialis .
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There are not enough data to recommend one H2 antagonist over another chloramphenicol 1 equine eye medication . They are all roughly comparable in effectiveness building muscle testosterone . Side effects are generally uncommon pregnant on paxil . Cimetidine may cause a slightly higher incidence of headache, sexual difficulties, and mental confusion or disorientation than some of the other drugs in this class maxalt info . This usually only happens at high doses or in older or sicker patients trane lithium bromide chillers . Other possible side effects associated with HZ antagonists may include dizziness, fatigue, diarrhea, and constipation asprin and pregnancy .
Interactions are a bigger issue with medications like Cimetidine norethindrone acetate pregnancy test . This acid suppressor can cause mischief when combined with many other drugs, including alcohol atrovent arachides . It is crucial that anyone using such acid suppressors check with both a physician and a pharmacist for any incompatibilities claritin million .
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Q zoloft reaction fatigue . I have been on either Tagamet or Zantac for years warfarin effects mood . I have a hiatal hernia that causes severe heartburn does omeprazole help in stopping rebleeding .
Over the last 2 years I find that ( start to feel “tight” after a single beer prozac overnight no prescription . I used to drink two or even three beers on a hot day after 18 holes of golf with no problem penicillin and without prescription . Now with just one beer I feel too impaired to drive fortamet glucophage lawsuit .
Could these heartburn medicines have that effect? I used to be able to hold my booze with the best of them dystonic reaction to geodon . Because of this I am loath to even take a drink at a party medication warfarin .A using expired asprin . You have raised a fascinating issue tetracycline neomycin bacitracin and prednisolone infusion . More than a decade ago, alcohol expert Charles Lieber, MD, reported that cimetidine (Tagamet) and ranitidine (Zantac) could increase blood alcohol concentrations in susceptible people singulair cramps . He told his colleagues that such interactions “may result in unexpected impairment to perform complex tasks, such as driving maggi santarlasci vitro desloratadine . Thus, patients treated with these drugs should be warned of this possible side effect nortriptyline withdrawal symptoms .”403
More recently Dr treatment for amoxicillin rash . Lieber warned, “Under conditions mimicking social drinking, ranitidine increases blood alcohol to levels known to impair psychomotor skills needed for driving high blood pressure wellbutrin .”404
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If we had to pick one over-the-counter (OTC) acid suppressor to relieve heartburn, we would probably opt for Pepcid Complete allegra d xr .The reason is that this medication combines the H, antagonist famotidine (10 milligrams) with calcium carbonate (800 milligrams) and magnesium hydroxide (165 milligrams) astrazeneca atacand . Putting these three ingredients together means that you get the immediate benefit of fast-acting antacids (calcium carbonate and magnesium hydroxide) plus longer-acting acid suppression with famotidine antihistamines claritin .
Proton Pump Inhibitors (PPIs)
The most powerful acid suppressors available are called proton pump inhibitors (PPIs) diflucan and amoxicillin 500 .This class of medications has been
*** Pepcid Complete
Pepcid Complete combines immediate action with longer-lasting acid cQMv6 is feldene an nsaid .
Downside: Side effects are uncommon but nevertheless, be vigilant for allergy, jaundice, headache, constipation, dizziness, or diarrhea seroquel withdrawals weakness .
Cost: $17 to $20 for 50 pills sinemet crushing tablet with applesauce . Should last several months using motrin and tylenol for kids . Short-term use should be safe apri bondurant . Long-term use should be approved and monitored by a physician mining of lithium .
incredibly successful for the pharmaceutical industry, which has done well with graphic commercials featuring a cartoon stomach or “The Purple Pill chlorpromazine hcl .” Over 70 million prescriptions are written annually for these drugs at a cost of almost $10 bil lion high testosterone test in women . 40
Starting with omeprazole (Prilosec), drug companies have created a series of compounds that are capable of dramatically changing the acid environment of the stomach viagra medi tabs . Such action is extremely helpful for curing ulcers depo provera injection weight gain . It can also help relieve reflux has anyone tried smoking prozac . But there is growing concern that long-term acid suppression may have some unexpected and potentially unpleasant consequences is prednisone acidic .
Acid is important in the stomach does fosamax cause dementia . For one thing, it creates an inhospitable environment autoimmune hepatitis azathioprine . Germs have a hard time surviving in acid metronidazole cat conditions . Studies published in the Journal of the American Medical Association have suggested that constantly suppressing stomach acid may increase the risk of pneumonia and severe infectious diarrhea generic allegra .”-407 Presumably, this is because bacteria not killed by stomach acid can work their way up through the esophagus and get into the lungs or work their way down and infect the lower digestive tract dilantin alcohol . Such serious infections can be life threatening lithium manganese battery charging high temperature .
PPIS AND CANCER
The really big elephant in the room with the PPIS is a fear of cancer atenolol hydrochlorot interactions . For years there has been a quiet controversy brewing regarding a possible relationship between acid suppression and the risk of cancer amiodarone hcl . In 1985 we wrote: “Scientists fear that if bacteria set up housekeeping in your stomach, they can go to work converting nitrate to nitrite prednisone two parent dose . drug side effects ultram er . what is nifedipine er . effexor and wiehgt loss . Nitrate is a chemical which can come from food, water, or even saliva; by itself it
PROTON PUMP INHIBITORS
• Esomeprazole (Nexium)
• Lansoprazole (Prevacid)
• Omeprazole (Prilosec)
• Pantoprazole (Protonix)
• Rabeprazole (Aciphex)
probably does little harm amoxicillin dosage treatment course for pneumonia . But if nitrate is turned into nitrite by bacteria, all hell can break loose, because the end product can be something very bad indeed—nitrosamines vytorin muscle cramps . Nitrosamines are among the most potent cancer-causing chemicals
known musc nexium protocol .
Over the last several decades there has been an alarming increase in what was once a rare kind of esophageal cancer atrovent nasal . Adenocarcinoma of the esophagus has turned into an epidemic cheap order prescription ultram .’ Gastroenterologists are mystified about the causes of this deadly condition lithium battery rechargers . Some have told us that it’s brought on by the American diet buy discount buy flomax online . Others blame it on reflux and insist that PPIs can solve the problem by reducing acid exposure to delicate tissues apcalis erectalis kamagra plus . Has reflux really increased that much in the last couple of decades, and if so, why’?
A provocative editorial that appeared in the American Journal of Gastroenterology entitled “Acid Suppression and Adenocarcinoma of the Esophagus: Cause or Cure?” lays out the confusion and the contradictionS interaction of amiodarone and zorcor .410 Thomas Schell, MD, points out that “decreasing acid reflux by the use of PPIs
*** Prilosec OTC (omeprazole)
For years Prilosec was the most prescribed drug in the country clindamycin medication 25mg . The active ingredient, omeprazole, did not lose its effectiveness when it went over the counter synthesis of paroxetine .
Downside: Side effects are uncommon, but headache, diarrhea, rash, cough, and upper respiratory tract infections have been noted chemical make-up of augmentin . Rare but very serious side effects may include blood disorders, inflammation of the pancreas, liver problems, and severe skin reactions warfarin and vitamin d .
Special Cautions: Use Prilosec OTC for only 2 weeks at a time loratadine breastfeeding . According to the information on the label, you can repeat another 14-day course alter 4 months have elapsed u 2899 viagra . Prolonged use of prescription proton pump inhibitors may require vitamin 8,2 supplementation (up to 1 milligram daily) canada health advisory prozac . Extra vitamin C (500 milligrams) and vitamin E (200 IU) may reduce the possible formation of carcinogens (nitrosamines) simvastatin oral gavage .
Cost: $30 to $40 for 42 pills (1 year’s supply)
might help to slow or halt this deadly progression zoloft and buspar free .” But he also reminds his colleagues that lack of acid in the stomach (achlorhydria) “is a known risk factor for adenocarcinoma of the stomach claritin health alternative .” Dr caffeine in youth . Schell notes that nitrosamines formed by bacteria in the stomach “would also expose the esophagus to these carcinogens andriol for low testosterone in women .”
There are three other disconcerting problems linked to long-term use of PPIs tablissement services sp cialis s . When the stomach ceases to produce acid, it senses that something has gone terribly awry and it tries desperately to get acid-producing cells working again taking flagyl and consuming alcohol . It does so by making a compound called gastrin, which aids in digestion and also triggers the production of stomach acid dizziness after taking cymbalta . When acid levels do not rise, gastrin production continues indefinitely, often at very high levels chemical properties of asprin .
Imagine that the float device in your toilet was stuck in the “on” position ovral l vietnam . The water would keep running forever, which is what happens with gastrin in your stomach lasix intramuscular . There is no acid “float” to turn off the gastrin supply breast paint after getting off effexor .
Too much gastrin is not a good thing buspar sexual dysfunction . In fact, there is increasing concern that gastrin may stimulate abnormal cell growth throughout the digestive tract, increasing the risk of cancer-, of the stomach, pancreas, and colon, as well as the esophagus cipro thompson ct .411,412
Another concern about long-term treatment with PPIs has to do with nutrient absorption digoxin toxcicity . It is harder to absorb vitamin BQI iron, and calcium when there is not enough acid in the stomach what is telmisartan . Older people may have some trouble getting enough vitamin B12 2 or iron under normal conditions antimicrobial properties of ampicillin . With a PPI on board, this may be an even greater challenge levofloxacin renal impairment . 413 A vitamin B12 deficiency can lead to some very serious consequences fosamax and contraindications . Symptoms may include anemia, fatigue, nerve damage (burning, tingling, weakness, or numbness in the hands and feet), difficulty in sensing vibration, unsteadiness, shortness of breath, and psychological side effect’S, Depression, confusion, and poor memory may be mistaken for early-onset Alzheimer’s disease definition hydroxyurea .
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Q valtrex and edema . 1 have taken Prilosec and then Prevacid for years to treat severe heartburn legal issues paxil . When I began to suffer weakness and confusion, I started taking 1,000 micrograms of vitamin B,, daily drug-resistant gonorrhea spreading rapidly cipro . Within a relatively short time, the horrible symptoms began to subside fda reports strattera vision loss .
My doctor does not really see the relationship, but I sure do! What can you tell me about this side effect?
A acyclovir and constipation . Long-term suppression of stomach acid can sometimes interfere with efficient absorption of vitamin B12 high blood pressure medicine norvasc tab . This nutritional deficiency can cause nervous system problems, which may show up as insomnia, memory problems, depression, burning tongue, sore mouth, difficulty walking, and tingling or numbness in feet or fingers fda lipitor .
One reader reported a conversation with a nurse who noticed an amazing improvement in a woman with dementia after a vitamin B12 deficiency was discovered and treated pennsylvania exelon carin anders .
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This vitamin deficiency often appears very gradually zoloft and sweating . Patients may describe complaints such as mental fuzziness, a sensation of burning on the tongue, or poor coordination for months or even years before a proper diagnosis is made warfarin country origin . Anyone who has been on PPIs for many months (or years) should request a blood test for iron and vitamin B,2 synthesis metronidazole . It’s not enough to just look for vitamin B,,, though tougera clindamycin phosphate . Be sure to be tested for serum cobalamin (that is vitamin B,2) and methylmalonic acid (MMA) fosamax and heart attack . When MMA is elevated and cobalamin is low, that is an indication of a probable vitamin B,, deficiency homemade cialis .
PPI ADDICTION?
Another unspoken concern among some gastroenterologists is PPI-induced “physical dependence lipitor celecoxib combo limits cancer .”414 That’s a nice way of saying addiction isotretinoin for ichthyosis treatment . Now, no one is getting high on PPIs ranitidine tachycardia . But some pcgpke dysreflexia after ditropan . may tl)d it difficult to quit taking such medications once they start down the long and winding road of acid suppression montelukast side effects .
Here’s the sad story leukopenia and sporanox . Proton pump inhibitors like omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid) are so effective at shutting down acid production that the body seems to rebel diflucan treatment length . As previously noted, gastrin is produced in large quantities, and it stimulates cell growth augmentin cheap . These are cells that want to make acid, but PPIs prevent them from doing their job inability to smell and testosterone levels . They proliferate, though, and if the PPI is stopped, they start churning out acid to is higher dose of effexor better . make up for lost time zyrtec and dose and weight . The consequence is something called “rebound acid hypersecretion cipro plue bactrim for diverticulitis .” This means the body really starts generating excess acid when these drugs are discontinued low cost flomax .
What’s so insidious is that it takes several days for the effect to show up using strattera with fluoxetine . So someone might be fine for a while, but within 2 weeks of stopping a PPI there is maximal acid production from stomach cells dexamethasone drug dosage . 5 And here’s the kicker prepare tramadol for injection . This rebound hyperacidity effect lasts for more than 2 months could amoxicillin cause hives .416
Dear reader, this is nothing short of astonishing try prilosec $20 coupon . Think about it for just a moment bupropion marijuana . Tens of millions of people have spent billions of dollars on acid-suppressing medications for years and years to soothe the fires in their upper gastrointestinal tract meloxicam side affects and dangers . But Mother Nature does not forgive or forget zocor bottom feet hurt . No sooner are the drugs discontinued than she turns on the acid-making machinery and puts the pedal to the metal for months metoprolol succinate tabs .
Within a few days of stopping the medicine, someone with indigestion or heartburn is likely to feel the effect lotensin aciphex phentermine pharmacy chicago . Not surprisingly, the first thing people experiencing rebound hyperacidity are likely to do is reach for their PPI dr mercola and synthroid . According to Norwegian researchers, “Discontinuing treatment may prove difficult in some patients even if the dose of proton pump inhibitor is slowly tapered kamagra jelly pharmacy . melatonin amlodipine . talking clozapine chat . natrural viagra . In these cases the use of high doses of 1-12-receptor antagonists or antacids should be considered stopped taking clomid .”‘ 17 From a drug company’s perspective, PPIs could be the perfect pills lamictal and bi-polar side effects . As long as people take them, they feel pretty good prescriptions lexapro and effexor . But if they stop, they could be punished for a very long time lithium formate amino acids . That’s strong motivation to beg the doctor for more medicine—indefinitely equine testosterone and estrogen levels .
So, what’s a person to do? Well, our recommendation would be to be cautious half-life of ibuprofen . These drugs are great for short periods of time kaufen levitra . They control symptoms of heartburn quite well and have relatively few side effects caffeine free coca-cola . If a doctor recommends that you take a PPI for longer than 2 or 3 months, though, be prepared for rebound hyperacidity when you stop the medicine analytical methods caffeine .418
Conclusions
Persistent symptoms of pain, burning, or pressure behind the breastbone should be investigated by a doctor to rule out a seri-ous condition synthroid atrial flutter . For an occasional attack of indigestion, however, there are lots of things you need to consider amaryl generation . Before pulling out the heavy artillery of acid-suppressing drugs, there are many options to contemplate caffeine 50mg . Here is a quick snapshot:
• Avoid foods or drugs that might make the lower esophageal sphincter lazy and let gastric juice creep back into the esophagus side effects of duricef . There are few good studies, but some possible culprits include chocolate, carbonated beverages, smoking, diazepam, and progesterone can taking effexor cause anxiety .
• Cut back on Garbs the history of pseudoephedrine . Although the data are preliminary, there is some suggestion that the typical high-carbohydrate American diet may be contributing to reflux wellbutrin sr 100mg discussion boards .
• Keep your eyes on itopride cheap rimonabant without a prescription . This prescription drug works differently than acid-suppressing drugs to relieve indigestion and heartburn dexamethasone mode of action . Its success in Japan and India and a fascinating report in the New England Journal of Medicine (February 23,2006) have us looking forward to FDA approval lipitor bilirubin . •Saliva is the body’s natural buffering agent and fire extinguisher for heartburn lithium levels affected by dehydration . Chewing gum or sucking on hard candy can help relieve symptoms prescription sildenafil .
• Chamomile or ginger tea also can wash acid out of the esophagus and back into the stomach where it belongs hydrocodone tramadol carisoprodol . These traditional remedies also may help calm an upset stomach penile discharge flagyl .
• Home remedies such as sipping diluted apple cider vinegar or even swallowing yellow mustard may help side effects on lamictal . Each person is different, though, so trial and error will be the only way to find out if a home remedy will work for you p1p synthesis of pseudoephedrine .
• Baking soda remains a time-honored solution for occasional heartburn inhalation dexamethasone . Dissolve ‘47 teaspoon of powder in 4 ounces of water bose wave radio testosterone . For those on sodium-restricted diets because of congestive heart failure or high blood pressure, this is not an option amitriptyline lansoprazole .
• If you need an antacid, calcium carbonate remains one of the cheapest and most effective in the pharmacy decongestant with atenolol . Turns Ultra contains 1,000 milligrams of calcium carbonate and is a cost-effective option clomid vitex .
• In our opinion, a sensible first choice for an OTC acid-suppressing drug is Pepcid Complete ketoconazole used for . It combines the immediate action of antacids (calcium carbonate and magnesium hydroxide) with the longer-acting H2 antagonist famotidine how to increase free testosterone . Short-term use should be safe how much clonidine should i take .
• If you feel you must take a powerful acid-suppressing PPI, we would opt for Prilosec OTC safer alternitives to ibuprofen . If you have great insurance coverage, you might save money if your doctor prescribes generic omeprazole instead used to make testosterone . We think a little vitamin insurance is appropriate whenever acid-suppressing drugs are taken for any length of time (vitamin B12, vitamin C, and vitamin E) wellbutrin xl and weight lose .

The simplest and most certain test for any sensitivity reaction is to expose the person concerned to the substance under suspicion and see what happens. This is known as a

challenge test. With true allergies, challenge tests are powerful tools, but they are also alarmingly close to reality. The risk of provoking a severe reaction requires a very

cautious approach.
By comparison, an indirect test – a roundabout way of seeing how the body responds, such as the skin-prick test (see p. 91) – has the advantage of rarely producing dangerous

reactions. The downside is that indirect tests can be misleading, precisely because they are not like the real-life situation. No indirect test is perfect – there are always

false positives and false negatives (see box on p. 91).
Challenge tests
If you undergo a challenge test with food or an airborne allergen, you will also be given dummy challenges with an innocuous substance which is indistinguishable from the item

being tested. Neither you, nor the tester who is scoring the reaction, should know which is which. This is called a double-blind trial because, to eliminate all possible bias,

both of you are in the dark. (The full name is a ‘double-blind placebo-controlled trial’ – the dummy challenge is also called a ‘placebo challenge’ or ‘control challenge’.)
The double-blind trial is a standard medical procedure and does not imply that the doctors think you are faking symptoms. Psychological forces are powerful things, and just

thinking that you might react to a test can be enough to produce a reaction – the process that generates the symptoms is largely unconscious.
Food challenge
A food challenge – eating the food that is under suspicion – is a key test for food intolerance (see p. 197). It is sometimes used for food allergy and other forms of food

sensitivity too, as a follow-up to skin tests. Some allergists use a food challenge only if the skin test is at odds with actual events reported by the patient. Other allergists

use food challenge more readily, to confirm skin-test results, and to assess the severity of the reaction.
Extreme caution must be exercised with immediate food allergy, because of the considerable risks involved. The test must be done under medical supervision with resuscitation

equipment to hand. A challenge test should never be done for true food allergy without some careful preliminary tests on the face and the lips (see box on p. 23). Even if these

tests produce no reaction, only tiny amounts of the food should be eaten to begin with.
Bronchial challenge
This type of test involves inhalation of an airborne allergen – such as pollen – suspected of causing asthma. Bronchial challenge carries the risk of provoking a severe asthma

attack, and few doctors use it unless there are compelling reasons to do so – such as demonstrating that someone’s asthma is due to an allergen encountered at work.
Skin-prick tests
This is an indirect method of detecting true allergic reactions. It is one of a family of skin tests that use a similar approach. The three different tests in this family are

known as: skin-prick tests or prick tests, puncture tests, and scratch tests.
For the skin-prick test – the technique used in Britain – a small drop of liquid containing an allergen, such as grass pollen, is placed on the arm. The doctor makes a small

prick in the skin, under the drop of liquid, allowing a minuscule amount of the allergen to get into the skin. A positive reaction is recorded if a red bump develops soon

afterwards. For accuracy, the bump must be compared to positive and negative controls (see below).
The puncture method is very similar to the skin-prick test but uses a slightly different technique for breaking the skin. The term prick-puncture test covers both techniques.
With the scratch method, the skin is scratched lightly, and the allergen solution is then applied over the scratch. This method gives less consistent results than prick-puncture

testing.
It is important to include a negative control in the test – a skin-prick test with plain salt water (saline). This should not produce much of a bump – if it does, the skin is

clearly over-reactive and the tests more difficult to assess. The doctor should also include a positive control – a skin-prick test with histamine, the substance that plays a

central role in allergic reactions. This should always produce a bump. If it does not, the skin is decidedly under-reactive, and the tests are invalid.
Taking antihistamines will make the skin under-reactive, and you should stop taking them before the testing, for a period ranging from a day to several weeks – it varies

depending on the particular antihistamine. Ask your doctor for specific instructions about stopping these and other drugs before testing.
Skin tends to be over-reactive to testing in people with dermatographism (see p. 52). Blood tests for specific IgE,
such as RASTs (see p. 92), are needed for anyone who has this condition. Eczema sufferers with a rash over large areas of the body may also require blood tests, if there is too

little clear skin for testing.
Skin-prick tests can produce both false positives and false negatives (see box below). Some allergic diseases will give a lot of false negatives and relatively few false

positives, while for others the reverse is true. The allergen itself influences the rates of misleading reactions: for example, tests for soya allergy are notoriously

unreliable, whereas those for peanut are far more accurate. The age of the person being tested also makes a difference. With all these influences at work, interpreting the test

responses is a real art, and the doctor’s experience counts for a lot.
All sorts of people offer skin-prick tests, including alternative practitioners. Get them done by a qualified doctor, preferably by an allergist, who will know how to make sense

of the reactions.
Note that the purpose of these tests, and of blood tests for specific IgE, is to identify the allergens that are bringing on your symptoms, not to predict how strongly you will

react to those allergens. The tests may give some Indication of the intensity of your reaction, but they cannot be regarded as a good guide to how you will respond to the

allergen in the future.
The safety record of skin-prick tests is very good. Occasionally a systemic reaction (anaphylaxis) occurs with these tests, but there are no records of any deaths. Nevertheless,

if you suffer from severe asthma or have experienced anaphylactic shock in the past, it is advisable for the doctor to have adrenaline and resuscitation equipment available.

Those with strong allergic reactions to latex may also react badly if they are tested with an allergen that cross-reacts with latex (e.g. cypress pollen), not just when tested

with latex itself. Taking beta-Mockers (see box on p. 150) increases the risk of a life-threatening reaction for anyone in these higher-risk categories.
False positives and false negatives
Apart from challenge tests, none of the tests used for allergy works with 100% accuracy. Most give both false positives and false negatives.
A false positive means that there is a positive test but no actual reaction when the allergen is encountered (e.g. eaten or inhaled). A false negative means that there is a

negative test result despite a genuine reaction (as shown by a challenge test, for example).
A test that gives relatively few false positives has good positive predictive value – in other words, if it suggests you are allergic to something, you probably are.
A test that gives relatively few false negatives has good negative predictive value. If it comes up negative, you are probably not allergic to that allergen.
Some tests for allergic reactions show good positive predictive value but poor negative predictive value, while for other tests the reverse is true.

Homeopathy
`We believe that a serious effort to research homeopathy is clearly warranted despite its implausibility.’ That was the conclusion of a group of German and American scientific

researchers who, in 1997, looked at every study of homeopathy they could find. This prestigious trans-Atlantic team carefully assessed the scientific validity of each study, and

then considered the data from studies that were of reasonably good quality.
This kind of study, in which all the available research data on a topic are combined, is called a meta-analysis. There were 119 research studies which were good enough to be

included in this meta-analysis and, taken together, these studies suggested that homeopathy does indeed have some real effects. In other words, it produces significantly more

benefits than simple placebo effect – the psychosomatic improvement which tends to occur with any treatment, even a dummy pill (see p. 233).
Some of the most convincing scientific studies included in the meta-analysis were those relating to homeopathic remedies for allergic conditions (see p. 217). But what exactly

does this mean for allergy sufferers? Is homeopathy a treatment that is worth a try? Unfortunately, it is difficult to say.
Firstly, the evidence from the homeopathy meta-analysis is far from overwhelming, as the researchers themselves point out. The observed improvements – the overall differences

between the placebo and the homeopathic remedy – are not huge. Secondly, even if there are some homeopathic treatments that have real effects, it does not mean that every kind

of homeopathic treatment works. Homeopathy is a very broad field, with a multitude of different approaches. The types of homeopathy that have been tested, and appear to help,

may bear little or no relation to the homeopathic remedies that are generally available (see p. 217).
`Let like cure like’
The central idea in homeopathy – often known as the principle of similars – is that a substance which causes a particular set of symptoms can also, if handled in the right way,

cure symptoms of
a similar kind. In the words of Samuel Hahnemann, the German doctor who invented homeopathy at the beginning of the 19th century, ‘Let like cure like.’
The natural substances that form the basis for homeopathic remedies are mostly derived from toxic plants or minerals. (Sometimes extracts from diseased tissue – called nosodes –

are used instead, but this is a relatively recent development. So is the use of allergen extracts, such as pollen, described on p. 217.) Hahnemann himself began with the

standard drugs of his own day, such as belladonna and arsenic compounds. His innovation was to use them in very much smaller doses than his fellow physicians, and to apply them

to entirely different diseases.
Hahnemann worked by first discovering what the effects of the drugs were, when taken by a healthy person (he experimented on himself and his family for this). Then he tried to

match the symptom pattern produced by the drug with the symptoms of a particular disease. For example, he observed that belladonna produces hallucinations and a hot, dry skin –

symptoms that were also seen in children with scarlet fever. He claimed that, by giving belladonna in very small doses, much less than was normally used, he could stimulate the

body to heal itself of scarlet fever.
Hahnemann, unlike his medical contemporaries, also advocated a good diet, fresh air and exercise. And he was heartily opposed to the conventional medicine of his day, a brutal

business that involved a great deal of blood-letting and large doses of very toxic medicines. Considering how useless, and indeed dangerous, the orthodox medicine of the time

frequently was, Hahnemann’s successes were not really surprising.Less is more’
Homeopathy today is the ultimate version of the ‘less is more’ philosophy. A homeopathic remedy is prepared by taking the basic ingredient, dissolving it in water, and then

diluting that solution over and over again. Imagine pouring a bottle of wine into the Pacific Ocean, and you have a rough idea of how dilute homeopathic remedies are. Making

extreme dilutions was an idea introduced by some of Hahnemann’s followers, after his death.
Dilution is only part of the story, however. With each dilution, homeopaths apply a special shaking-and-tapping technique known as percussing. This was originally done by hand,

but now is often done mechanically. Homeopaths believe that percussing makes the active substance more powerful, despite the dilution. The term used by homeopaths is potency,

and a homeopathic remedy of the highest potency is the one that has been most thorDughly diluted and percussed.
In fact, a simple calculation, using the basic laws of physics, shows that there is nothing there at all but water – many homeo pathic remedies are watered down so thoroughly

that not one Jingle molecule of the active substance is likely to remain. It is  which leads medical researchers to use words such as ,nplausibility’ (see p. 216) when talking

about homeopathy.
Nhat homeopaths do
\ homeopath starts by considering all your symptoms (not just allergies, but any other symptoms as well) and various other characteristics that conventional doctors do not

usually consider, including physical appearance and psychological traits. The homeopath then chooses a substance which, if taken at full strength, would produce a comparable set

of symptoms and characteristics. This approach is called classical homeopathy.
In addition, homeopaths often give advice on diet, sleep, exercise and allergen avoidance. As in the early days of homeopathy, this may be the most important part of the

treatment.
Like many other complementary therapists, homeopaths will listen if you need to talk about personal problems and emotional difficulties, and will offer reassurance or advice.

This can be valuable, though not everyone would agree that a homeopath is the best source for such help. There are two distinct traditions within homeopathy – a scientifically

inclined tradition (represented today by experiments with homeopathic immunotherapy – see right) and a highly metaphysical tradition. Among the many ideas floating about within

the metaphysical tradition is the notion that all illness is a result of psychological or moral failings. Attitudes of this kind, which are quite common among complementary

therapists, can be very damaging (see p. 209).
Sometimes homeopaths recommend avoiding certain foods, on the assumption that the patient suffers from food intolerance, though they rarely use an elimination diet (see p. 194),

the only way to achieve accurate diagnosis.
In addition to all this, some homeopaths also give herbal remedies where they think it will help. This approach is called complex homeopathy.
A much more recent development within homeopathy is homeopathic immunotherapy or HIT, which uses an extreme dilution of an allergen (such as pollen or dust mite) to treat people

who are allergic to that substance. While homeopathic immunotherapy was inspired by conventional immunotherapy, the relationship between the two is a very distant one indeed.

The extensive dilution process means that the liquid used for homeopathic immunotherapy is unlikely to contain even one molecule of the allergen. This puts it in a completely

separate realm from conventional immunotherapy, where the presence of the allergen, and the steadily increasing dose with successive injections, is what produces the beneficial

effect (see p. 166).
Does it work for allergy?
Two scientific trials suggest that HIT makes a difference, albeit a small one, for hayfever and pollen asthma. In the meta-analysis described on p. 216, one of these trials was

given a good rating for scientific reliability, and the other was considered fairly good.
Another type of homeopathic treatment that appeared to be effective for patients with allergic asthma was one using a nosode – an extract of the asthmatic airway itself. A small

sample of the airway was taken from each asthmatic patient, diluted and per-cussed, then given to the patient as a treatment. It seemed to work, and the scientific rating of

this trial was very high.
The third homeopathic treatment that appeared to have an effect in valid scientific studies was Galphimia, used for symptoms in the eye caused by pollen allergy.
If you go to a local homeopath, it is very unlikely that you will be given either of the first two treatments – these are only used experimentally, in large research centres.
The Galphimia treatment might be available from a local homeopath, but it will not necessarily be in the same form as the treatment used in the scientific trial.
Note that all the studies described above are trials with a positive outcome. If you are trying to assess homeopathy overall, you should also consider the many trials that found

no effect. For example, a very careful study of homeopathy for children with asthma, carried out at the University of Exeter and published in 2003, found no benefit from

individualised homeopathy treatment.

Acupuncture
Acupuncture shot to fame in the West in 1972, when James Reston, a correspondent for the New York Times, fell ill with appendicitis while covering President Nixon’s historic

trip to China. Following the removal of his appendix, he received acupuncture treatment for pain, and was highly impressed with its effects.
His Chinese doctor invited Reston to witness the use of acupuncture in anaesthesia, and he reported the remarkable fact that patients undergoing surgery could be free from pain

with just a few tiny needles inserted into carefully chosen points on the body. They remained alert and talkative throughout the operation.
Traditional Chinese medicine has enjoyed a good reputation in the West ever since, but what few people realise is that acupuncture anaesthesia is a very new invention. Surgery

was not traditionally practised in China and it was only in the 1950s, after Chairman Mao had urged Chinese doctors to unify Western and Chinese medicine, that the anaesthetic

potential of acupuncture was discovered.
The remarkable effects of acupuncture anaesthesia made a huge impression on doctors in the West – a high-profile success that has had both good and bad results. On the positive

side, conventional medicine has been prepared to take acupuncture seriously, and to undertake some research into its effects. On the negative side, most
of that research has concerned pain control – the effects of acupuncture on the endorphins. These are natural painkilling compounds produced by the body (their effects are

mimicked by opiate drugs such as morphine and heroin).
Western researchers have paid little attention to how acupuncture affects most other aspects of health, including the immune system and allergic diseases. One exception to this

is asthma, where certain nerves do play a large part in producing the symptoms (see box on p. 235).
Treating the person
Diagnosis and treatment are far more orientated towards the individual patient-, in traditional Chinese medicine, and diagnostic labels such as ‘allergy’ or `hayfever’ are less

important than the particular character of a person’s Qi (see box on p. 215), as detected by the acupuncturist. A traditional Chinese acupuncturist pays great attention to the

quality of the different pulses and takes them at the start of every appointment, and at intervals during treatment, to check how the Qi flow has changed. Each treatment session

is unique and tailored to the individual’s condition at that particular moment.
This makes it very difficult to carry out conventional scientific research into traditional acupuncture.
In an effort to make acupuncture accessible to research, a more Westernised and formulaic approach has been developed, using orthodox medical diagnosis and needling a set of

acupuncture points that are prescribed for that medical condition. Experts in traditional acupuncture feel that this approach – first name the disease, then apply a standard

remedy – will often fail, and is missing the whole point of acupuncture.
That is not the only problem with Westernised acupuncture, as Dr David Eisenberg of Harvard University, a leading expert on acupuncture, points out. He describes a typical

acupuncture session in China: ‘Each time the acupuncturist inserts a needle, he or she asks the patient, “Do you have it or not?” referring to the patient’s “obtaining the Qi”

(de Qi). The question asks whether the patient has felt a sensation of fullness, distension, pins and needles, or the like, from the insertion of the needle in the spot being

used… Most Chinese have experienced acupuncture and they understand the phenomenon of de Qi… By contrast, most Western patients seeking acupuncture therapy know nothing of

the phenomenon of de Qi. Not knowing what sensations they should anticipate, they cannot tell the acupuncturist whether a needle is in the right place. When both therapist and

patient know little about de Qi, as frequently occurs in Western acupuncture clinics, the result is bound to be disappointing.’ Fortunately it is possible to find acupuncturists

who have been properly trained, and the sensation of ‘obtaining the Qi’ is perfectly detectable, even to a sceptical Westerner, so look for someone who pays attention to this.
There can be emotional and psychological reactions to acupuncture, so make sure that you also feel relaxed with your acupuncturist and that there is a certain empathy between

you.
Does acupuncture work for allergies?
According to Chinese theories, acupuncture can have some benefits in any illness – if you are ill, your flow of Qi must be disturbed, and it will help to put that right. Indeed,

most people do feel a sense of well-being after an acupuncture session.
To look at this from a Western scientific perspective, acupuncture can stimulate your body to increase its production of endorphins (see p. 214). This gives you a mild high,

similar to that you’d get from running for a couple of hours. Feeling relaxed and confident helps most people to cope better, and gives them a new perspective on life’s

problems. Since the mind plays some part in almost all illness (if only to aggravate the effects of an underlying physical problem), inducing a more positive state of mind can

be of benefit.
As regards more specific effects, several studies show that acupuncture can have a small, short-term effect in opening up the airways of asthmatics. This is not surprising

because acupuncture affects the autonomic nervous system, the ‘auto-pilot’ section of the nervous system (see box on p. 235) which can tighten or relax the muscles around the

airways. A short-term effect is just that – it doesn’t treat the real problem. What matters more in asthma is the long-term impact of any treatment on the underlying

inflammation of the airways (see p. 36). Although some studies of acupuncture treatment have found a reduction in inflammation, other studies have not. However, only one study

to date used an individualised approach to acupuncture, as opposed to a same-for-everyone formula. It is interesting that this study did find good long-term effects on airway

inflammation.
The larger picture
Acupuncture is just one element of Chinese medicine, which has several other techniques available. In China (and in some Chinese clinics in the West) these techniques are used

together, as different ways of tackling the same problem. No traditional Chinese doctor would dream of trying to treat every patient with acupuncture alone and, in the case of a

patient with allergies, herbal remedies would usually be a central part of the treatment.
A recent and very careful scientific study from Germany took this combined approach with hayfever, and showed some benefit. The patients were treated with both acupuncture and

herbal treatment, using a standardised regime but with additional acupuncture points and herbs chosen to suit the individual. Those treated reported a substantial improvement in

how they felt generally –but not in the specific symptoms of hayfever.
The flow of energy
Acupuncture is rooted in ancient Chinese ideas of the human body. which are radically different from those of Western medicine:
•    Vital energy. called Oi or Chi (and always pronounced ‘thee’). is what distinguishes living bodies from dead ones. It should flow easily and harmoniously thrOLIC11011i

the body nourishing and protecting the organs. When the flow of Qi is blocked, or becomes unbalanced. then illness develops. - Channels called meridians are the conduits for Qi

in the body. They mostly run vertically (i.e. from head to toe) and the points where acupuncture needles are inserted all lie on these meridians.
•    The flow of Qi can be measured by carefully taking pulses — not just one pulse as in Western medicine, but several different kinds of pulse.
•    By detecting disturbances in the flow of Qi, and correcting them, existing illness can be cured, and incipient illness prevented, before there are any obvious symptoms.
The nature of the meridians and the acupuncture points remains a mystery to Western doctors. Some parts of the meridians run roughly along the lines of certain nerves or blood

vessels, but they do not follow them exactly. The acupuncture points have no anatomical reality — there is nothing to see either on the surface or under the skin. However, many

are located near major nerve endings or over deep pressure receptors.

Suffering from a long-term illness, especially if it is severe and sometimes limits activity, can easily make a child feel different from other children, and ‘not good enough’. Children with allergies, especially those with severe asthma or food allergies, may also be very frightened and anxious. At the same time, such children often feel that they have to protect their parents by not revealing their fears.
Children may also think that their illness is a punishment for something they have done wrong. Their guilty feelings can be so powerful that they may not confide in you unless you spend time talking with them about their illness, and encourage them to share their feelings with you.
One of the most valuable things you can do for children with allergies is to build up their self-esteem. This is especially important when they first start school, because they have to adjust to other children there, and learn how to deal with questions about their illness, as well as some unkindness.
For children whose allergies limit what they can do physically, or restrict some normal activities, try to find other interests and hobbies that the child can do well. When talking with the child, always emphasise the positive things – the difficulties that you have overcome together in the past, the measures that the child can take to keep the symptoms under control (such as stopping scratching, applying creams, or using a preventer inhaler) and the areas of Iife where he or she is particularly successful. As the child gets older, introduce the idea that coping with illness makes you a stronger, kinder and more resolute person, one who can cope with any of life’s challenges. Show the child how much you value their maturity and perseverance.
Pay attention to what the child’s friends are
saying – a bit of eavesdropping is allowed – and be prepared to counteract any negative messages. Teach your child to be strong and self-confident about choosing their friends, and to prefer those who are sensible, understanding and supportive. Ask casually about what schoolteachers and other adults say when you are not around, because they can, without meaning any harm, undermine a child’s confidence with thoughtless remarks.
For children with problems that are potentially life-threatening, such as true food allergy, your natural anxieties as a parent can lead you to be overprotective. This can make the child feel smothered, but letting go is far from easy. You somehow have to find a middle path that works for you both.
With asthmatic children, focus on letting them live as normal a life as possible. Avoid saying ‘no’ automatically to things that might induce an asthma attack – such as running around outdoors in cold weather. Take some small risks, and let the child make the decision sometimes – he or she will gain a lot from taking the responsibility, especially if the decision is the wrong one.
This is the only way for children to learn how to manage their own condition. The sooner you can begin letting go, the better the child will cope in his or her teenage years, when it really will be necessary to make some difficult decisions without your help.
A pitfall for parents
In bringing up a child with allergies, remember that there should never be any ’secondary gain’ from illness – absolutely no advantages to having the eczema get worse (easily done by scratching) or starting an asthma attack (some children can bring one on by breathing in a particular way).
If your child has to take time off from school because of ill-health, ask the teacher for work that can be done at home, and check that it really is done. Children who are allowed to benefit from being ill can establish an unhealthy pattern for dealing with life’s difficulties (see pp. 94-5), which may be long-lasting. Such a mind-set can seriously limit a child’s development.
Incidentally, the ’secondary gain’ from illness may be quite altruistic in nature. It can include stopping parents from arguing, or from nagging a naughty brother or sister, as well as more obvious things such as getting a parent’s attention – so be aware of all the circumstances in the family that are affecting the child.
Sometimes a child realises, unconsciously, that attending to illness gives a parent welcome distractions from emotional problems and a comforting feeling of being needed and useful. The allergies can become part of the structure of a family, the glue holding everyone together.
Conversely, long-term illness can tear families apart: according to recent research carried out in the United States, divorce is more common in families where a child suffers from severe asthma.
Doctors frequently notice that severe eczema also can create a lot of tension in the home.
If you feel that a child’s illness is affecting the family badly – in whatever way – talk to your doctor, or someone else who you trust. You may need the help of a counsellor or family therapist to sort things out.
Children and medicines
Parents often feel very anxious about all the medication an allergic child uses. On the whole, the drugs prescribed for allergy are very safe, and only children with severe disease are at risk of significant side effects. These children will be carefully monitored by the doctor.
Needless to say, if you can cut down on the drugs by reducing allergen exposure, avoiding irritants (e.g. tobacco smoke) and implementing some of the other measures described in this book, you should do so. But if the child still needs drugs to control the symptoms, it is far better to accept them than to let the child struggle with all the discomfort, limitations and distress that the illness imposes.
Parents who are very concerned about drugs should talk openly to the doctor about their fears. If there are differences of opinion about drugs within the family, try not to expose the child to the disagreements. Sort out a joint policy in advance and always present a united front to the child. Be consistent and reassuring about drug use, otherwise the child may feel confused and anxious about the situation – or may even learn to manipulate it.
The asthmatic child
Children with asthma should have a management plan (see p. 96) and may benefit from using a peak-flow meter (see p. 97). Once your child is old enough to comprehend the difference between preventers and relievers, explain that using the preventer regularly keeps asthma under control, which means no sudden attacks and less need to use the reliever in public — something which most children find intensely embarrassing. You should oversee the child’s treatment closely until the age of seven or eight, then gradually let the child take over some of the responsibilities.
Coping with food allergy
The following concerns true food allergy (see p. 62), which can be life-threatening, not idiopathic food intolerance (see p. 74).
Protecting a child with severe food allergies is a major task. You will find it enormously helpful to be in contact with other parents who are facing the same challenge. The practical details are everything here, and you can benefit from other people’s ingenuity in solving day-to-day problems. Several support groups exist (see p. 255), offering a wealth of advice.
For very small children, the main task is to ensure that everyone who looks after the child understands exactly what can and can’t be eaten. Child-minders and baby-sitters should spend time with you as ‘apprentices’ seeing what is involved in preparing food for the child – this is far better than just giving verbal instructions. Also make sure that everyone knows how to use the adrenaline auto-injector (see pp. 98-9).
Once children start going to parties, you should always stay at the party for the whole time, and supervise your child closely. Take food that your child can safely eat, but which other children can also share. Some parents put a label on toddlers warning other adults that certain foods are taboo – for children under reading age this is probably acceptable, and does allow you to relax a little, but with older children the dangers of being teased or stigmatised should always be borne in mind.
Plan ahead all the time. Keep a snack box in the car containing food that the child can safely eat. Whenever you go on a trip, however short, have some safe foods with you, in case you get stuck somewhere and the child gets hungry. If you go out to eat, exert maximum caution about the restaurant food (see p. 111). Some parents take along a guaranteed-safe, but super-delicious sandwich or burger, and ask the restaurant to warm it up in a microwave (where appropriate) and serve it at the same time as the other food. If you do this, be sure the staff understand that the food must not touch any other food.
At home, some parents opt for everyone eating the same allergen-free food, on the basis that this makes for being ‘a real family’. Others, finding this too problematic or expensive, make a virtue out of the allergic child having a different meal. ‘I try to make her feel special about having her own food. The allergen-free dinner or cake always looks and tastes really good.’
As children get older, and more independent, you need to educate them thoroughly about avoiding the offending food. Equip them for difficult situations by role-playing. Act out being offered a tempting item of food by another child, and being jeered at for refusing. Act out suffering an allergic reaction to food and getting help quickly, even though people around don’t understand and are uncooperative.
Allergies and schools
When your child starts at a new school, creche, or kindergarten, request a meeting with staff and teachers to talk about the child’s allergies if there is any likelihood of these becoming a problem. Do this well before your child starts at the school, so that any necessary changes can be made. If your child has a serious food allergy or severe asthma, you may have to make several visits because there are usually a number of different people you should meet, and follow-up sessions may be needed with some staff. If all this sounds daunting and ‘not my style’ then you need, for the sake of your child, to develop your skills in dealing with people and being assertive. Talk to a counsellor, or look for suitable training courses.
In addition to ensuring that the school takes good care of your child’s health (see below), you should also discuss wider issues of adjustment to school life. Teasing or bullying can be a problem for children with any kind of health problem. Ask the teacher to keep an eye on your child and ensure that he or she is coping well – for example, that there is no difficulty about using an inhaler in front of other children when necessary.
Eczema
Ensure all staff realise that the skin rash is not infectious, and that they are aware of the need to communicate this to other children. The appearance of the skin can create a lot of problems with class-mates, and teachers need to be alert for taunting remarks or hurtful nicknames.
Unfortunately, children with eczema are very susceptible to infections caught from others, such as impetigo (see p. 44), but you can’t really protect children from such infections without isolating them socially. The best way to tackle this problem is to deploy all the available treatments so that your child’s skin becomes stronger and more resistant.
Food allergy
If your child has food allergy, go and see the catering manager personally. It may be helpful to take some printed material on food allergy with you, plus lists of synonyms for food ingredients (see pp. 172-4) where appropriate. Concentrate on building up a good relationship with catering staff, while ensuring that they understand how dangerous certain foods can be to your child.
Many parents feel more relaxed if they supply their child with a packed lunch that they know is allergen-free. This is often a good strategy, but don’t be complacent. Most allergic reactions in schools involve food given or traded by another child with entirely good intentions. Some schools with food-allergic children have set up a ‘no trading food’ policy, which seems to work well. Other schools establish milk-free or nut-free tables in the canteen, so that friends can sit together and trade food safely. (The mothers of the other children sitting at these tables need to be well versed in food avoidance, of course, so that their packed lunches are as safe as your own.) In the United States, schools have sometimes tried banning nuts or peanuts altogether, where there is a nut-allergic student, but this does not work well.
Some parents prepare a printed information sheet about their child’s food allergy, with a photograph of the child, and put these up at strategic points around the kitchen and canteen area. This information can include instructions on how to deal with anaphylactic shock (see below) and who to contact in an emergency.
Finally, include the art teacher in your rounds – foodstuffs are often used in art and craft projects.
Anaphylaxis
For children with severe food or insect-sting allergies which can lead to anaphylaxis, check that everyone at the school understands the potentially fatal nature of this condition. Key staff must know how to recognise anaphylactic shock and exactly what to do: show them how the adrenaline injector kit works. You could take along an old one, so that they can practise (see p. 150). Injector kits and adrenaline inhalers must be within easy reach, never locked in a cupboard.
Repeat this educational process at the beginning of each new school year, and before school trips. As an additional precaution, your child should wear a bracelet or pendant (see box on p. 95) that informs medical personnel about his or her allergies –this is also vital for children with latex or drugs allergies.
Asthma
If your child has asthma, ask what arrangements are made for inhalers. Children who can take responsibility for their own treatment should keep their inhalers with them. For younger children, the inhaler should be in the classroom, somewhere that is easily accessible (never locked away) and should be taken along during breaks and mealtimes. The child must always be able to get to the inhaler quickly: even a small delay in using it when an attack occurs can have dire consequences. Make sure everyone at the school understands this, that they know how to recognise an attack, and how to react. Assure the teacher that there is little danger of an asthmatic child overdosing, and if other children take a few puffs they will come to no harm.
If the teacher seems to believe that asthma is a psychological problem (some still do), go and see the head. Suggest that a local asthma nurse or doctor comes in and talks to the staff and pupils about asthma.
Ensure that the teacher knows about the effects of cold air and exercise on asthmatics. Talk to the games teacher or sports coach, and the playground attendants. It is vital that the games teacher is encouraging but understanding towards asthmatic children. They should never be told to continue exercising if they feel breathless.
Allergens and irritants in school
Schools today often have soft furnishings and carpets – these may be full of dust mites. If your child is allergic to mites, and if allergy symptoms are frequent at school, have a look around the classroom and see if this might be the cause. Before discussing the problem with the school, learn all you can about dust mites (see p. 114-117) so that you can assess whether proposed solutions to the problem would actually work.
Pets are common in classrooms and they can cause allergic reactions in sensitised children. Moulds flourish in many school buildings, and will affect a child with mould allergy. Poor ventilation is sometimes a major problem in school buildings, especially those where windows cannot be opened.
Irritants in school air include glue, paint, the solvents from felt-tip pens, disinfectants, air fresheners and the fumes produced during science lessons. Make sure the science teacher is aware of the risks and always uses a fume cupboard if irritant gases such as nitrogen dioxide or sulphur dioxide are likely to be given off during an experiment.
Applying sunscreens to children’s skin is now routine in many schools and preschools. Teachers probably won’t think to ask permission, so if your child is sensitive to any common ingredients of creams or sunscreens, let them know in advance.

The days when doctors wanted their patients to obey orders and ask no questions are largely gone. Patients with allergies and other forms of sensitivity - or their parents -

have to play a key role in managing the disease. Most doctors now recognise this, and encourage their patients to learn about their illness, its diagnosis and treatment, and to

be partners in their own medical care.
Quite apart from this, there are aspects of allergy management where few doctors can afford the time to become experts. The nitty-gritty details of dust-mite avoidance or food

labelling practices are good examples. You can usefully supplement your doctor’s treatment here, by informing yourself.
But where should this process stop? That is a difficult question which doctors are increasingly forced to consider. One modern phenomenon, being discussed in many medical

journals at present, is the abundance of medical information on the Internet. Some doctors dread the arrival of patients who have logged on the night before their appointment

and are armed with a huge number of facts about their illness -some accurate, some utterly wrong and some highly debatable. But other doctors welcome the fact that patients are

actively interested in their health problems.
The reactions of doctors to ‘Internet patients’ highlight an issue that also runs right through this
book - that of medical orthodoxy. Who decides what is true and what is false in medicine, and how do they do it? Make no mistake - this is a deep and abiding problem which

afflicts not just scientific medicine, but science in general.
If a doctor, confronted with a web-page claiming that allergies are caused by space aliens intent on
destroying Western civilisation, snorts ‘Rubbish!’, he or she is not, strictly speaking, taking a scientific approach. In science, you should consider all the different

hypotheses.
In theory, science works by questioning everything and taking nothing on trust - but you can’t make much practical progress if you stick rigorously to that approach. Neither

scientists nor doctors start their careers by running experiments to establish the truth of everything they were ever taught. At some point in science, and in scientific

medicine, you have to assume that certain things are probably true, and proceed accordingly. If you make significant progress working on those assumptions, then the chances are

they were correct. But a good scientist always remembers that they are only assumptions.
Scientific medicine rests on a huge number of assumptions. Some of these are clearly accurate - for example, that eating wheat triggers coeliac disease -and it would be

time-wasting to argue about them. But this ‘fact’ about coeliac disease began as just a theory (see p. 70), and a highly debatable one. It has taken time for it to become

substantiated by more and more evidence.
Some medical assumptions become enshrined as facts rather too quickly. Fifty years ago, orthodox medicine accepted as a ‘fact’ that many asthmatic children had ‘intrinsic

asthma’, which was psychological in origin. Research since then has shown that there is almost always an allergy underlying childhood asthma. Many other examples could be given

of medical ‘facts’ that are overturned by subsequent research.
Doctors thirst for certainty, something that is quite understandable when they are faced with so much human need. A significant part of the healing power of medicine comes from

placebo effect (see p. 233), and that relies on patients having faith in the doctor. The traditional way for doctors to cultivate that faith was by assuming an air of absolute

certainty - about their diagnosis of the patient’s illness, about the treatment, and about medicine in general. This need for certainty has always hastened the transformation of

assumptions into facts.
The fatherly authoritarian attitude of old-fashioned doctors was, in large part, a reflection of how little they had in the way of useful treatments, and how much they relied on

placebo effect. Modern doctors have far more genuinely effective remedies to offer and can afford to take a different approach. Many now rely on a different kind of authority,

one based on intelligence, good information, flexibility, curiosity and openness. It’s a form of authority that allows a doctor to say ‘I could be wrong…’ or, ‘Let’s try this

and see what happens…’ without losing face.
Unfortunately, there is another powerful force at work in this complex situation, and that is quackery -the age-old business of selling phoney cures (see p. 209). Official

bodies within the medical community try to curb quackery by weighing the evidence about novel treatments and coming to decisions on their validity. This can be very useful. But

in deciding what is, and what is not, good scientific medicine, medical organizations always run the risk of mistaking their own unverified assumptions for facts.
Establishing criteria for good treatment is essential in medicine, but when this develops into dogmatism, that is decidedly unhealthy. Among the treatments that are being

dismissed as valueless today, there are
several that deserve a fairer hearing.
Some of these treatments have been shown to work by the most excellent of scientific methods. The use of elimination diets in Crohn’s disease is a good example - for some

patients, there is a huge and sustained improvement, suggesting that their disease was caused, at least in part, by food sensitivity. The tactic used by those who want to reject

this evidence is simply to ignore it. When scientific review papers (summaries of all the current knowledge and latest research) are written about Crohn’s disease, the research

on diet is usually not mentioned. Evidence that is routinely ignored in this way slips into oblivion because most doctors only have time to read the review papers, not the

original research reports.
Occasionally - and this is even more shameful -good scientific evidence that goes against the grain of current orthodoxy is actually misreported in review papers. This happened

with an impeccable scientific study showing the benefits of an elimination diet for some patients with rheumatoid arthritis. By missing out certain key facts, a review author

managed to give the impression that the results of this study supported the conventional view on the subject (that diet makes no difference to rheumatoid arthritis), whereas

they actually disputed the conventional view.
Unthinking rejection of new treatments often occurs with currently untreatable diseases such as autism and Chronic Fatigue Syndrome (CFS). Such medical problems always attract

experimental treatments, just as they always attract sheer quackery, and sorting out one from the other is not easy - it takes time, and a clear-headed approach, not knee-jerk

dismissal.