Anyone prone to allergy spends a lot of time asking —and trying to answer—such questions as, Are allergies all in my head? Does my child deliberately make himself wheeze? Why does my nose always get stuffy when I’m nervous? Allergic diseases are not figments of the imagination. Once a person becomes disposed to allergic disease, however, many factors may be involved in aggravating the individual’s physical problem. People with asthma have overly sensitive and reactive muscles in the bronchial tree, just as patients with allergic rhinitis have overly sensitive blood vessels and mucous-secreting cells in the nose. When these individuals are faced with such stresses as exposure to allergens, irritating fumes, or viral infections, their allergic problems may well increase. This is not a deliberate turning on of reactivity, but rather a manifestation of increased reactivity to various stimuli by the allergic end-organ. Just as a man with an ulcer can aggravate his difficulties by eating spicy foods or allowing the pressure of work to upset him, an asthmatic who breathes in pollen or who has a stressful work situation can suffer bronchospasm. The physical raw material re­sponsible for the ulcer or the asthma, however, existed before the stressful situation and determined the course the stress would take. The extent to which an allergic individual can control reactions to external factors has a lot to do with the individual’s coping mechanism —how secure the person is, whether he enjoys his job, how much pleasure he derives from daily chores, and so on. It is important that the physician explain this interaction of physical disease and environment (both psychological and physical) to the allergic person. That way, the link between what the person thinks and feels, and his or her physical problems, is less likely to be mis­construed as a psychosomatic, attention-getting mechanism. The allergy sufferer should not lose sight of the tremendous psy­chological impact a person with a significant allergy problem has on the people around him. Someone with severe eczema may be viewed as ugly and unfortunate, as someone to be avoided. People may misunderstand the medical problem and consider it infectious and dangerous to their health if they associate too closely with the allergy sufferer. A person with asthma may be considered an invalid who cannot participate in normal activities. The person’s family or spouse may be annoyed, or even angry, because of coughing fits that disturb sleep, physical limitations that force daily lives to be altered, medical costs that prohibit other spending. Allergic individuals undoubtedly can encourage negative feelings in people around them if these people remain ignorant of allergy problems. With education comes understanding that can help the allergic patient, as well as the patient’s friends and family, cope with allergy problems. Knowledge of allergies helps them understand that allergic disease is not a will-o’-the-wisp but a physical ailment that can be affected either positively or negatively by the environment. For example, exposure to cigarette smoke, paint fumes, or freshly mowed grass can exacerbate an individual’s control, and avoidance of compounds known to be noxious or threatening can subdue al­lergic reactivity. There are several ways of correcting negative ways of coping with difficulties (for example, a bad experience always provokes wheez­ing). One is to observe the cause-and-effect relationship between an event and a negative result. Sometimes a friend or a physician merely has to suggest such a relationship to someone for them to understand their behavior and correct it. In the case of a complex allergy prob­lem the allergy victim may not admit a problem or may not be able to correct an annoying reaction pattern. Counselling by a professional psychiatrist, a psychologist, or a primary-care physician can some­times correct the behavioral pattern. Behavioral modification and biofeedback methods can also alter reaction patterns in some situa­tions.

Certain methods of testing for and treating food allergies have failed to receive adequate scientific scrutiny. One example is the leukocytotoxic test, which involves putting antigen and serum from an allergic person on a slide with white blood cells. Killed white cells are thought to indicate allergy, but this has not been proved. Other inadequately documented methods are subcutaneous provocation testing and sublingual (under the tongue) provocation testing. In both tests, small amounts of antigen are administered and such side effects as respiratory problems, gastrointestinal problems, irritability, and drowsiness are noted. Because these responses are difficult to relate immunologically to the initial challenge, their validity is questionable. End-point intracutaneous test titration is an immunotherapy method for determining proper dosage on the basis of the lowest concentration of antigen that produces a specific wheal. Essentially, the technique is low-dose immunotherapy. It differs from conven­tional immunotherapy only in that, instead of giving as large an antigen load as is feasible to produce immunologic protection, the smallest feasible dose is given. This method was recently compared with conventional immunotherapy for ragweed hay fever, and was found less effective.

Urine immunotherapy is another controversial area of allergy research. Clinics that use it as a treatment have sprung up around the United States. In the therapy, patients bring their own urine to the clinic, where it is filtered and injected back into them. This procedure is purportedly beneficial, but to trained allergists, it is a sham, for which gullible people pay large sums of money despite the lack of evidence supporting the therapy. Belief in such treatment indicates that people have chosen a form of medical treatment without regard for research —the scientific procedures by which medical practices are substantiated and theories verified.

One research area that has stimulated great interest among parents ш recent years is the effect of food consumed by children on their behavior. Dr. Ben Feingold, for example, maintains that significant amounts of food dyes and preservatives in a child’s diet can con­tribute to hyperactivity and other types of negative behavior. This claim met with great criticism from the medical community, members of which replied that Dr. Feingold’s statements about behavior were sweeping, suggesting that a large proportion of children were being adversely affected; that his observations were not supported by con­trolled trials, but rather seemed to suggest biased reporting; that the diets recommended by Dr. Feingold were restrictive and difficult to follow, raising the possibility that sacrifices in daily life would be greater than the rewards; and that the term allergy had been adopted by followers of the Feingold diet who claimed that children were "allergic" to the dyes and additives, when, in fact, no specific aller­gens had been noted. While Dr. Feingold’s claims continue to require clarification, and while the criticism remains valid, some investigators have documented that additives and preservatives do increase aberrant behavior in a small group of children considered hyperactive. The mechanism by which these additives work is not an immune or an allergic mecha­nism, but a toxic one: large doses of the chemicals in additives and preservatives seem to modify nerve function, and certain dyes have been shown to change the releasing of neurotransmitters from the nerves. Some investigators have reported that the Feingold diet has been effective in a small group of hyperactive children. At the same time, however, research has rejected allergy as the mechanism by which dyes, preservatives, and other chemicals modify behavior. A word of caution is in order. Parents attempting to impose a restrictive diet on their children (or themselves) should be aware of the nutritional deficiencies that can result from the proposed regimen and of the nutritional supplements that should be taken to correct the de­ficiencies. In a diet that goes beyond simply eliminating "junk food," Dr. Feingold advocates omitting dyes and preservatives; certain fruits, vegetables, and spices; and extracts containing salicylates.

Whether it is in the field of epidemiology, the research laboratory, or the clinical laboratory, progress is being made in increasing the fund of scientific knowledge about allergy problems and what to do about them. The various facets of research are of more or less equal importance. Population studies are done to increase awareness of the dimensions of allergy problems. While investigators in the laboratory study the molecular basis of the mechanisms that cause problems, clinicians observe and suggest possible pharmacological adjustments to correct them. Both animals and humans are tested. There is, in­deed, a research chain; each link must be strong if knowledge is to be expanded. Ultimately, research must be translated into practical results. Scientists, physicians, patients, and their families must be able to use the products of research. One of the ways to make sure that this happens is through education and dissemination of information about research, treatment, and new products. For that purpose, The Asthma & Allergy Foundation of America offers reference materials, trained physicians to answer questions, and literature such as this book. Community lung associations offer courses designed to increase understanding of allergic diseases. Summer camps and residential services exist for allergic children; they are designed to teach the children about their problems and help them lead more normal lives. Thanks to research and its application in everyday life, allergic disease, albeit often chronic, can be better understood, modified, and controlled. References Frick, O. L. "Controversial Concept s and Techniques, with Em­phasis on Food Allergy." In Allergic Diseases of Infancy, Childhood and Adolescence, ed. С W. Bierman and D. S. Pearlman. Phila­delphia: W. B. Saunders, 1980. Furukawa, С . Т ., and Roesler, T. A. "Psychological Aspects of Allergic Disease." In Allergic Diseases of Infancy, Childhood and Adolescence, ed. С W. Bierman and D. S. Pearlman. Philadelphia: W. B. Saunders, 1980. General Considerations for Clinical Evaluation of Drugs. FDA publication 77-3040. NIAID Task Force Report. Asthma and the Other Allergic Diseases. NIH Publication No. 79, 387, May 1979. Van Metre, Т . Е ., et al. "A Controlled Study of the Effectiveness of the Rinkel Method of Immunotherapy for Ragweed Pollen Hay Fever." Journal of Allergy and Clinical Immunology, 65:288, 1980.