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Federal law dictates that dates and many other dried fruits must be fumigated with a chemical called methyl bromide before they are shipped across state lines. Thus, almost all of the dates eaten in this country contain a small but often troublesome residue of this chemical.

Many people have noticed that dates and figs are laxatives and even eat them for this purpose. However, in my experience, it is not mainly the fruit itself which exerts this laxative effect but the chemical contamination. Unsprayed figs or dates can usually be eaten with impunity, even in one- or two-pound lots, without causing any laxative action at all. An exception would be a person who is allergic, or sensitive, to dates or figs per se and reacts by getting an upset stomach.

The same problem can be observed with nuts, dried peas, beans, and lentils, all of which are heavily fumigated. Many people believe that they simply cannot eat these foods without having a reaction, but when they try “organic” varieties of the same foods, or nuts in the shell, they do not have the reactions.

Health-conscious people often try to protect themselves by buying unsulfured dried fruit. Such apricots, pears, peaches, and so forth may indeed be unsulfured, but they are generally not uncontaminated. Most of the so-called “health food” dried fruit has been sprayed and fumigated and will often cause the same problems (or chemically susceptible people as the commercial variety.

In the early 1960s, I conducted a test among my patients to determine the possible effects of chemical contamination of wheat and com—the two leading causes of food allergy. Both foods were avoided for five days prior to the test feedings. Patients were then given commercially available wheat and corn, and reactions to these were compared to those to cereal grains from a farm on which no commercial fertilizers and sprays had been used for thirty years. Although the frequency of food allergy to wheat and corn is approximately the same, more persons reacted to commercial corn products than to commercial wheat products. This difference may have been due to the fact that corn is often soaked in sulfur dioxide for several days in order to separate different parts of the kernel. Most manufactured corn products start from such chemically contaminated sources.

A similar problem is posed by bleaching agents used to whiten flour. It is difficult to separate the contribution of the bleach in white bread from the host of other chemicals which go into the loaf.

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Some doctors use short courses of corticosteroid tablets for patients with chronic urticaria, to allow the irritation to settle down before other treatments are tried. In very severe cases of rheumatoid arthritis, corticosteroid tablets are sometimes used (see Section 5). A corticosteroid injection into an affected joint can reduce inflammation for some time.

In eczema, corticosteroid creams or ointments are used when other forms of treatment (see Section 6) have failed. The creams, ointments and other preparations are classified into four groups: mildly potent, moderately potent, potent and very potent. In general, only preparations in the first two groups are prescribed for children, since there is a risk of stunting and other side-effects when corticosteroids are absorbed into the bloodstream (see p319). Even in adults, the potent and very potent preparations are generally only used for a few weeks, to control an acute outbreak of skin irritation; a less potent preparation is then substituted.

The amount absorbed depends on certain other factors, besides the potency of the cream or ointment. More will be absorbed from the face and genitals, and creams should be used sparingly in these areas. Damaged skin will also absorb more.

If corticosteroids have been applied to the skin for more than a few weeks, treatment should not end abruptly, or there may be a flare-up of the eczema. The cream should be withdrawn gradually, a little less being applied each day. The corticosteroid cream can be used alternately with an emollient (see Section 6) to ease withdrawal.

In general, treatment with mildly potent corticosteroid preparations can be continued for as long as necessary. Provided there is good medical supervision, such treatment can safely continue for several years if needed.

The corticosteroids most commonly used in creams and ointments for eczema is hydrocortisone.

Creams and ointments used for eczema often contain other drugs, besides the corticosteroid. Some include antibiotics and/or anti-fungal drugs, to treat secondary infections. Others contain substances that help to reduce itching, soothe the skin, or restore its water content. Preparations containing a mixture of coal-tar (which reduces itching! and hydrocortisone (eg Carbo-Cort) are often very effective, the coal tar helping to make the hydrocortisone effective, even at a low dosage.

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This is also known as intradermal neutralization therapy, or the Miller technique, after Dr Joseph Miller of Alabama who has spent many years developing it and investigating its potential. The treatment can be applied in two ways – either using injections of food extracts under the skin, subcutaneous injections, or giving food extract drops under the tongue, sublingual drops. In both cases, the doctor establishes a particular dose of the food extract that will ‘turn off or ‘neutralize’ the symptoms caused by that food.

To test for the correct dose, intradermal injections, which put food extracts into the skin, are used. Intradermal injections place food extracts deeper in the skin than skin-prick tests (see p30). A tiny amount of food extract is used – 0.05 millilitres. If the body does not react to this extract it simply produces a small raised area, known as a wheal, which begins to go down soon afterwards. If the body does react, then the wheal grows slightly, and takes on a characteristic appearance – it is white, hard and raised, with a sharp edge. This is known as a ‘positive wheal’ At the same time, the patient may experience symptoms similar to those that are normally produced by the food – this is the ‘provocation’ part of the test.

The ‘neutralization’ part of the technique is based on the finding that a particular concentration of the same food extract will put a stop to those symptoms. Such a dose also produces a ‘negative wheal’ – one that is white, hard and raised but does not grow larger. It is usually the same size ten minutes after the injection.

The neutralization dose is usually the strongest solution that fails to produce a positive wheal, so it is determined by starting with a solution that does produce a positive wheal and then working gradually downwards. Using this method, the neutralizing dose can be determined even though the patient has no symptoms at the time – the wheals alone show when the right dose has been reached.

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As soon as you can, start keeping a daily record of your symptoms. This might seem rather unnecessary at this stage, but it will prove very useful later. The main purpose is to give you a detailed picture of how you felt before you began the diet – a base-line to which any later state of health can be compared. It is remarkable how quickly the memory fades – especially the memory of illness. If you only make a partial recovery, as some people do, you may later forget how ghastly you felt at the outset, and begin to think that the improvement is very small. Looking back at your symptom-record is often a startling reminder, and it can help strengthen your resolve to persist with the diet. It is also valuable if friends or relatives start to question the usefulness of what you are doing – you may need to prove to yourself that you really are better.

At the same time, you could also make a record of what you eat. Some people are more conscious of what passes their lips than others, and when you come to plan your diet you need to be aware of what foods you eat very regularly. Keeping a food-diary for a week or two can be quite an eye-opener. It will also get you into the habit of reading ingredients labels and watching out for synonyms.

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With breast-fed babies who are thought to have food sensitivity, the first step is to check that it is not something other than breast milk causing the problem. Think about what else the baby consumes, and if possible eliminate everything except breast milk, including medicines (with your doctor’s approval), vitamin drops (which often contain artificial colouring), fruit juices and any solids. If the baby needs to go on taking medicines or vitamins, ask the doctor to prescribe something that does not contain any colouring or other unnecessary ingredients. You may need to give boiled water to compensate for fruit juices or other extra liquids that you have withdrawn.

If this has no effect, the next step is to compile a list of suspect foods from those that you are eating. Keep a record of everything you eat, recording the quantities and times of eating as well. Make a separate record of your baby’s symptoms, with the time, duration and intensity. Continue this for a week or two, and compare the two records to see if there are any likely suspects. The time interval between the mother eating the food and the baby suffering symptoms can vary from one day to several days.

Don’t make the mistake of thinking that it must be cow’s milk, just because this is the food problem that we hear about most often in babies. For the exclusively breast-fed baby, it could be any food. However, babies who have received supplementary bottle-feeds are more likely to react to cow’s milk than anything else. Even if you have never given a bottle feed yourself it is possible that the baby received one from a nurse while in the maternity ward.

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Are antigens and allergens fundamentally different from each other? This is a question that causes a lot of confusion and it is worth spending some time looking at what these two words actually mean.

An antigen is any molecule that can provoke the body into producing antibodies to it. To do this the molecule must be above a certain size, because the B cells and their colleagues in the immune system are programmed to ignore very small molecules. So simple chemical molecules such as water or salt cannot act as antigens. However, some quite small molecules, that are too small to act as antigens on their own, may combine with proteins in the body, thus producing molecules that are large enough to be recognized by the immune system. Small molecules of this sort are called haptens.

Living organisms are composed of a great variety of chemical compounds, and some make more effective antigens than others. The important point about an antigen is that it should have at least one distinctive chemical structure on its surface – a chemical ‘handle’ that the antibody can grab hold of. This structure, which the antibody fecognizes, is called the epitope.

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Avoid doing DIY, car maintenance, using garden chemicals or other tasks yourself unless it is imperative. Avoid newly decorated or treated buildings if you can. Do not use newly dry-cleaned clothes or bedding – hang them up to air for a few days before use (or else avoid dry-cleaning totally). Buy washable clothes whenever possible. trouble). If you retain gas appliances, get them and inlet pipes serviced and checked to be sure that they are operating properly.

Take care with barbecues, bonfires and solid fuel appliances. Some people find these no problem, but others are badly upset by them. Do not burn food – charring and burning give off chemical fumes known to upset people. Watch the toast!

Avoid tobacco smoke as much as you can. If you or your housemates have been smokers, but have now stopped, or if you move into a house where smokers lived before, it helps to try and clear out the residues of tobacco fumes which impregnate carpets, furniture, curtains, even walls.

Most hard plastic – used for radios, audio equipment, televisions and computers – does not give problems with fumes, once aired off, unless it gets hot. Some audio equipment is made of a type of hard plastic that can give off persistent fumes, however. It is usually distinguished by a sweet, aromatic smell – stronger than other types of audio equipment – and often has a black/greyish, metallic finish. Sniff equipment carefully before buying to try and avoid this problem.

Avoid situations where any spraying is being done – spray polish, agricultural spraying, gardening, hairdressing. The location of your home may expose you to heavy levels of fumes from vehicles or industry. You are best to live away from heavy traffic if you can, and upwind of local industry. Upper storeys of buildings are usually affected less by vehicle pollution; living in upper storeys of a high rise building may help you cope in a city centre. The eastern side of the UK is generally less favourable for people sensitive to industrial fumes than the western side; the prevailing westerly winds carry pollution eastwards across the country.

Chemical pollution can be aggravated by low, damp, cloudy weather that holds down fumes and discharges. You may be better to restrict going outdoors on such days if you can manage it, or to take extra care if you cannot avoid going out.

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Parents often describe children who are subsequently found to be sensitive to foods and chemicals, or to have multiple allergies and sensitivity, as being very restless, demanding, irritable, difficult to manage children, with unpredictable moods, tempers quick to flare and readily tired.

Other low-level symptoms which subsequently clear up when allergens or troublesome foods and chemicals are identified and avoided can include a constantly runny nose, persistent catarrh, and blocked ears. Children do pick up colds and viruses easily at school or elsewhere, but colds and viruses have a clear onset, and tail off and go away. No child should have the symptoms of a head cold permanently or for weeks on end.

Glue ear, and ear, nose and throat infections, and tonsillitis, are not always caused directly by allergy or sensitivity, but they can be aggravated and sustained by them. These conditions often clear up spontaneously when allergy or sensitivity is dealt with.

Constant urination, waking at night, general aches and pains, puffiness, excessive hunger or thirst, mood swings, sudden excitability, are all low-level symptoms which often accompany allergy and sensitivity in children.

Hyperactivity in children has been linked in some cases to food and chemical sensitivity.

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Skin and laboratory tests for food and other allergies are not always practicable or helpful for babies and very young children. Nor will they identify food intolerance or chemical sensitivity.

For detecting the causes of reactions to milk (breast and bottle) and foods.

If you see seasonal variations in your baby’s symptoms, the causes may be seasonal allergens, such as pollens or moulds. .

If your baby or toddler gets reactions only at night, these can be delayed reactions to allergens inhaled during the day, such as moulds, pollens, or pets and animals. Food reactions in very young children are very rarely delayed, but waking in the night, discomfort and restlessness are often due to food sensitivity continuing into the night. The most common causes, however, of night time reactions are house dust mites in bedding or soft toys, fibres or chemicals in bedding.

Symptoms can sometimes develop some months after a change in the baby’s environment, so look back a few months and see whether there was a recent change, such as a new soap powder, new childminder, new pet or new bedding.

If there is no obvious potential cause of reactions, try investigating foods first, and then follow the avoidance measures below for chemicals and inhalants to see if they make a difference.

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Much of the advice commonly given to people with house dust mite allergy is unhelpful or impracticable in everyday life. The basic advice often given by doctors – to vacuum as much as possible to remove allergens and use plastic covers on mattresses – usually make things worse. Vacuuming actually increases the level of airborne allergens, and plastic covers trap damp and condensation in the mattress, making things worse when you come to change covers or air the mattress. At the other extreme, people often receive a long list of things which are very desirable to do, but which are totally overwhelming. You would need most of your life to carry them out, and no small amount of money. In practice, many people fail to carry through any of the measures, and are left feeling inadequate and guilty.

For some people, symptoms can last through the day, caused by heavy exposure from their bed, or other sources at home. The effects can last even when away from the source.

Some of the conditions that favour house dust mites also encourage moulds to grow invisibly in indoor environments. If you still feel unsure about how far house dust mites cause your symptoms. Reactions to house dust mites in bedding often manifest themselves in symptoms the following morning, rather than when you first lie down. If you feel worse when waking and then improve once you have left your bed, suspect house dust mites. > Reactions to dusty old attics, storerooms, or to old dusty books are often caused more by moulds than by house dust mites.

The advice that follows focuses on things that people have found to work without massive expenditure of energy or money, and without enormous upheaval. It focuses also on improving your home environment, especially your bed and bedroom. The reason for this is that, if you reduce your exposure to allergens for a significant portion of your life (especially in bed where you have intense exposure to house dust mites), your tolerance to them when you meet them somewhere else will generally be much better. You will not react so severely when you meet them elsewhere (in other people’s homes, at work, or at school) if your home environment is reasonably clear.

How far you go to eliminate house dust mites depends ultimately on how badly affected you are, and on what investment of time and money you feel able to make. If you are not severely affected, it may be sufficient merely to improve your bedroom environment, take care with housework, and keep the home as well ventilated and as dry as possible. If you are severely affected, particularly if you have a highly allergic child, you may feel the need to make substantial changes.

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