Allergic diseases are among the most common (with rising prevalence) chronic disorders, particularly in childhood and adolescence where they are important causes of suffering.
Diagnostic tests & Treatment procedures that are of proven efficacy in allergy are readily available today. Tests like the skin prick tests, RAST (blood test), Immuno CAP RAST (newer, more accurate than RAST) and Treatments, like Antihistamines and Immunotherapy are based on scientific well-established principles, basic research, and controlled clinical trials. In spite of this, some practitioners adhere to certain non-scientific theories that give rise to diagnostic tests and therapeutic strategies of unproven efficacy.
Many Alternative practitioners claim that "food allergy", "candida" or "Multiple Chemical Sensitivity" is responsible for virtually any symptom a person can have. In support of this false claim, they promote various – some even bizarre unproven tests, none of which has any scientific basis. Their evidence is usually based entirely on anecdotal case reports and "clinical experience".
Definition of an Unproven Procedure
An unproven procedure for the diagnosis and treatment of allergic & immunologic diseases is defined as any specific procedure for these purposes that has not been proven effective by proper trials
An unproven procedure can be proven effective, since it is possible to prove a positive end point. However, under most circumstances it is not possible to prove that a procedure is ineffective, because one cannot prove a negative point. Therefore, the medical community should require proof of effectiveness of a procedure before the procedure is accepted for routine use, but should not demand proof of ineffectiveness before discarding the unproven procedure.
Applied kinesiology is the application of an unfounded and scientifically illogical theory that an allergic reaction, especially to a food, causes weakening of skeletal musculature. The method consists of a subjective estimate by a technician of the muscle strength in an extremity before and after exposure of the patient to an allergen. The exposure consists of placing a vessel such as a glass vial containing allergen extract on the patients skin. Even though there is no pathophysiologic rationale to this "test" and no basis whatsoever for its diagnostic efficacy, it is widely used because of simplicity
For testing infants and small children the procedure is done by proxy by having a parent hold the hand of the child during the testing!
Cytotoxic Food Testing – ALCAT
The cytotoxic test for food allergy consists of applying one drop of diluted whole blood to a microscope slide that was previously coated with a dry film of a food extract. The slide is examined microscopically for swelling or other distortion of white blood cells. Any such change indicates a food allergy.
Based on the current knowledge of the immune pathogenesis of allergic disease there is no theoretic basis for this test.
Electrodermal Skin Test – VEGA test
This test is again based on the false theory that allergy produces a change in electrical resistance in the skin. In general food extracts are placed in containers that are connected to an electric circuit, which makes contact with the patient's skin with a galvanometer for measuring the electrical resistance of the skin.
Ketelaris et al in Australia found no diagnostic validity to the use of this procedure.
The ELISA/ACT is performed by culturing the patients lymphocytes and seeing how they react to 300 foods, minerals, preservatives, and other environmental substances. After the test is completed, the practitioner recommends dietary modification and supplements. Although the test can assess the level of certain immune responses, these are not necessarily related to allergy and have nothing whatsoever to do with a persons need for supplements. It might have something to do with the sale of the supplements however.
Hair analysis is a test in which a sample of a persons hair is sent to a lab for measurement of its mineral content. Although hair analysis has limited value as a screening device for heavy metal exposure, it is not reliable for evaluating the nutritional status of individuals.
Most commercial hair analysis labs have not validated their analytical techniques by checking them against standard reference materials.
Various substances, such as shampoo, bleaches, and hair dyes, can affect hair mineral content.
Normal range of hair mineral has not been defined.
Hair grows slowly (1cm/month), so even hair closest to the scalp is several weeks old and thus may not reflect current body status for health diagnosis.
Hair analysis as a method of detecting allergies was quite a popular in the 1980s, but seems to be less popular now. The test supposedly noted toxic levels of heavy metals or low levels of selenium, zinc, chromium, manganese, and magnesium in hair samples which apparently indicated allergy. Double-blind studies failed to show any diagnostic value to this test.
Several reporters have sent hair samples from the same person to different labs for hair analysis. The reports varied considerably between identical samples sent to the same lab, and from lab to lab.
Most of the reports contained computerized interpretations that were voluminous.
A recent study published in January 3, 2001 issue of JAMA entitled "Assessment of Commercial Labs Performing Hair Analysis" concluded "hair mineral analysis from these labs was unreliable, and we recommend that health care practitioners refrain from using such analyses to assess individual nutritional status or suspected environmental exposures. Problems with regulation and certification should also be assessed".
This is sometimes referred to as iris diagnosis. It is based on a bizarre belief that a corresponding area in the iris of the eye represents each area of the body. A naturopath developed this idea 70 years ago.
The iridology chart relates various sots on the iris to about 50 parts of the body. The innermost part for example, is said to reflect the stomach, the topmost quadrant is said to represent the brain and other parts of the head.
According to the viewpoint, a persons state of health and disease can be diagnosed from the colour, texture, and location of various pigment flecks in the iris. Iridologist claim to diagnose "imbalances," that can be treated with herbs, vitamins and minerals.
This procedure consists of "testing" the patient with a small amount of substance in liquid form administered by either intradermal injection or by sublingual drop. The patient records any symptoms or sensations for a period of 10 minutes thereafter, and any symptom, regardless of its nature or intensity, is taken as an indication that the test is "positive". If the patient fails to report a symptom, the test is repeated using the same substance at a different concentration until there is a "positive" result by these criteria. Next, the same substance is tested at lower concentrations until the patient again fails to report a symptom, at which point the allergy (i.e. the symptom) is said to be "neutralized". The neutralizing dose of the substance is then prescribed as a form of treatment.
Substances used in this procedure are numerous and include common atopic allergens, food extracts, chemicals, drugs, and hormones. Because each substance has to be tested separately, testing to multiple substances is extremely time-consuming.
It has been shown, however, that patients cannot distinguish test extracts from placebo controls by this procedure, so the basis of a positive test is merely the power of suggestion. This procedure is therefore worthless for diagnosis and treatment.
A theory that allergy causes a change in pulse has led to the so-called pulse test for food allergy. An increase in the pulse rate of 10 beats per minute or more after a test dose of a food is eaten is considered a positive test. Some proponents for this bizarre theory consider either a rise or a fall in pulse rate to be equally diagnostic. A frightened patient is as likely to be allergic as a calm patient! There is no prescribed time interval in performance of the test.
These unproven diagnostic procedures, no matter how bizarre and incredible, may impress suggestible and gullible patients when presented by enthusiastic practitioners along with assurance of success in alleviating illness.
Serum IgG Antibodies
Although some have postulated that IgG antibodies to specific foods may be responsible for delayed symptoms or vague intolerance to foods, there is yet no proof for this. The RAST and similar technology are capable of detecting minute quantities of such antibodies, and it is likely that low levels of IgG antibodies to foods circulate normally. IgG antibodies to foods are found in allergic and non-allergic individuals. It is of no pathologic significance.
Acupuncture is an ancient form of "healing" and has no scientific or logical basis. It is usually combined with other forms of treatment such as homeopathy, naturopathy, and psychotherapy.
No controlled trial has shown efficacy and safety in the treatment in any form of allergic disease.
Homeopathy is an alternative medical practice in which exceedingly minute quantities of substances believed to cause disease are administered to the patient to "cure" the disease. These substances are referred to as "remedies", and they are usually given orally. Patients will sometimes take as many as 50 different extracts daily. The extracts are made from plant and animal origins. The basic theory of homeopathy is that "like cures like" although current-day homeopathists often claim that they cure diseases by inducing immunity.
There is only superficial similarity between homeopathy treatment and allergen immunotherapy. However, the latter procedure requires that specific environmental allergens be identified objectively for each allergic patient, and successful immunization against the allergic or anaphylactic allergic disease requires injection of allergens over a period of time and at sufficient dosage to alter favourably the specific immunologic hypersensitivities. Clinical effectiveness of allergen immunotherapy in hymenoptera venom anaphylaxis has been repeatedly demonstrated in double-blind trials, with efficacy always in excess of 90%. No such evidence exists for homeopathic remedies.
Many plants have therapeutic properties and one only has to remember that digoxin comes from Foxglove, salicin from the bark of the Willow tree and opiates from poppy. Herbal remedies such as Ma Huang plant (Ephedra sinica), which contains ephedrine, have been used to treat asthma for 5000 years but there is very little evidence that herbal medicines in general confer any major benefit. In some cases they may even be hepatotoxic. Chinese herbal medicine was found to be effective in treating eczema but after testing the extracts it was found that they contain potent steroid properties. This just reminds us that if the herbal medicine is effective there is a good chance, that like all effective drugs it will have some side effects.