A Broad Introduction
Rhinitis & Hay Fever
Children & Infants
Allergy to Animals
IBS, Migraine, and skin reactions due to nail reviver, milk, and
Beverley was aged fifty when she was referred because of swelling of
her eyelids, especially on the right, which was worse at weekends.
She was using two types of finger-nail ‘revivers’, she was
right-handed, and she tended to scratch her right eyebrow,
explaining why the right eyelid was worse. It seemed probable that
the nail-revivers were the cause, but why it was worse at weekends?
Reading the labels revealed that the nail-reviver she used at the
weekend contained toluene sulphonamide resin, a well-known sensitiser. The skin of the eyelids is very thin, explaining why
there was no effect on the thick skin of the fingers, which may be
Since she was sixteen she had suffered about once a month from
severe migraine, once requiring hospitalisation because of incessant
vomiting,. Her warning of an impending attack was unique, as it
consisted of uncontrollable burping!. She also had had irritable
bowel syndrome for many years, improved since she had tried avoiding
Skin tests were definitely positive for milk and slightly positive
for wheat. Although skin tests for these foods are not reliable it
seemed worth while introducing a diet consisting of only foods which
rarely cause problems. This was continued well past the time when
she was due to have another migraine, and she had no attacks until
she had cheese. Her “IBS” also vanished on the diet, but deliberate
challenges with a glass of milk reproduced the wind, bloating, and
diarrhoea on several occasions, leaving no doubt that milk was the
major cause of her problems.
Flapjacks made using one make of margarine caused a gut upset, but
not using another sort. Comparison of labels revealed that the
colourings annatto and circumin were in the margarine which upset
her, and this has been avoided. She now kept very detailed diaries
of foods and symptoms, and established that any trace of any sort of
milk could not be tolerated, and also the nitrite preservatives in
Thus the causes of all three problems were identified as a result of
her meticulous cooperation, as she has had no problems for the last
five years except when she has had a trace of milk. One tummy upset
was triggered by using a cream cheese substitute, and another by
eating two Thorntons milk chocolates at Christmas.
Some time later she noticed patches of eczema under her collarbones
and could not understand what was causing them until, when standing
in the shower, she realised that she was folding her arms in such a
way that the ends of her fingers were over the symmetrical patches
of eczema. This cleared after she ceased to apply any hand creams at
Beverley is obviously very easily sensitised and will have to take
great care, but her quality of life is much better than for many
years as long as she avoids the known causes of her problems.
However, if she had not cooperated to the full and been a willing
partner in the investigation she would not have been helped.
A case of Multiple Inhalant and Food allergies
Joan had been on continuous oral steroids in quite high dosage for
five years, and showed all the usual side-effects. The main cause
was her cat, which was always sat on the end of the bed and glared
at her GP when he called to see her. After the cat was banished and
the house cleaned she was able to reduce the dose of steroids to a
low level. She was then found to be allergic to pencillium mould
which was coming from the dahlia bulbs in the cellar which had gone
very mouldy. She improved even more when they were thrown out.
She was also sensitive to house dust, and was improved after
desensitisation injections, but she still had chronic asthma.
Attention was then directed to her diet, and she was found to be
allergic to milk, all milk products, and plain chocolate. Stopping
her bedtime cocoa stopped her attacks of asthma in the early hours.
She had also been found to be allergic to wool, and improved with
removal of woollen blankets, but it was only after a course of
desensitisation to wool that she was finally able to stop her oral
This case was investigated and treated before Becotide inhaled
steroid became available, at a time when desensitising injections
offered the only possibility of stopping oral steroids. Today
nothing could have been done for her because this treatment is taboo
for asthma in the UK.
It is interesting that her skin tests were
positive for house dust but negative for mites, suggesting that
something in the home environment other than mites, such as wool and
cat, was responsible for her continuing problems.
The wool allergy
was positively diagnosed by a nasal provocation test, because the
skin test for wool is always negative, but this investigation would
be unethical today because desensitisation is no longer available.
A Fishy Tale “Bloodworms” cause Swollen Face and Conjunctivitis !!
Grace was thirty-four years old, and had had six episodes when her
face became very swollen, mainly round her right eye which was
sometimes almost closed for up to a week, and with intense
irritation of the eyes. These attacks occurred any time, but always
started at home, and because she looked as if she had been beaten up
she could not carry out her part-time job as barmaid at a local
hotel. Skin tests were negative for a wide range of possibilities,
including her son’s pet cat, rabbit, and hamster. Although no cause
could be found the possibilities were discussed in general terms,
and she was asked to get in touch at any time if she had any ideas
regarding a possible cause.
A year later she phoned to ask if feeding tropical frogs and fish,
which she had not mentioned previously because they were looked
after by her small son, could be the cause, because her last attack
began a few hours after she fed the frogs when he was away on a
school trip. I asked her to come and bring the fish food, and to my
surprise she brought samples of deep frozen, freeze dried, and gamma
radiated fish food all labelled as “Bloodworms” Fortunately one
sample was accurately labelled as mosquito larvae.
I skin tested her with all three by sticking the test needle into
the fish food samples, and then pricking her arm with the same
needle. All three produced very large wheals, the biggest nearly 2
inches in diameter, which lasted for two days. Questioning revealed
that she only fed the frogs and fish when her son could not do so
for some reason. She used her right hand, explaining why the right
eye was most affected, and she admitted that she did not always wash
her hands after feeding the frogs and fish. Blood tests (RAST)
confirmed that she was very allergic to mosquito larvae by finding
specific IgE against larvae. She was advised never to touch
“bloodworms” again, and I put her samples in my freezer for future
She had no further attacks by avoiding the fish food, but she could
not really accept the diagnosis until she had carried out a
deliberate test (on her own initiative), by touching the fish food
and then her eye. She provoked an attack lasting three days! The
thick skin of the fingers would prevent a reaction on the hands, but
traces of mosquito larvae carried on her hand would easily penetrate
the very thin skin round the eye and cause the reaction.
Enquiries at the pet food shop revealed that the young man who sold
the fish foods had noticed his hands itched for some time after
handling ‘bloodworms’, and he had a very large positive skin
test and also a positive blood test.
Three years later a thirty three year old taxi driver was referred
from the eye department having had conjunctivitis so severe that he
could not see to drive for six weeks. This problem was not
responding to treatment, and he also had occasional lip swelling,
sneezing attacks, and sometimes a severe attack of asthma. Again all
the usual tests were negative, but because he had kept tropical fish
for twenty years the first patient’s sample was taken out of the
freezer and used for a skin test, producing a very large immediate
and delayed skin reactions.
He was asked to bring samples of his fish food, and he brought
samples labelled “Fish Flakes” and “Tubifex”. When these were used
for tests, only the Tubifex produced a skin reaction. He admitted
that he did not wash his hands after feeding the fish, so he stopped
using “Tubifex” and has had no further problems.
With the increased popularity of aquaria allergic problems caused by
food for fish or frogs may become a more common cause of severe
allergies. However, as in the first case, an intelligent and
observant patient can pin-point the cause, and avoidance can effect
a complete cure.
Another case was reported recently where a fish fancier had been
grinding up mosquito larvae (picture at left) to feed his exotic fish. He accidentally
inhaled some of the powder, causing immediate swelling of the face
and wheezing which soon subsided, but was followed two days later by
severe inflammation of the kidneys. Skin tests using the powder he
had inhaled caused a very large skin reaction, and IgE antibodies to
mosquito larvae were found in the blood. This case illustrates how
any part of the body can be affected by allergy. Rarely kidney
problems recurring every summer can be caused by grass pollen, the
clue being the seasonality of the complaint.
This dust allergic patient was given a peak flow meter for the first
time, and told that he must always blow it if he had an asthma
attack, and that it was very important to to make a note of what he
was doing at the time.
He took these instructions absolutely literally, with the results
I refrained from asking for further details, so it will never
be known if it was the dust from the mattress or the exertion that
triggered the attack, or for details regarding the even lower
reading the next night.
Allergy to Alcoholic Drinks
|| One Gin & Tonic
Alcoholic drinks quite often contain allergens which will affect
allergic patients. Obviously yeast is one of the commonest, but
there are also additives, preservatives such as sulphites, clearing
agents like egg white and isinglass derived from fish and many
others.Obviously if the subject is drinking every day he will
always be in trouble, so the cause may not be obvious.
A local GP phoned one day to ask if I would see a patient of his
“because he was sick and tired of getting up in the wee small hours
of Sunday morning to deal with his asthma” Apparently this happened
with remarkable regularity in the last six weeks, so there had to be
As usual the personal history provided the solution, which was that
he only drank on Saturday nights, and that the asthma had only
occurred since he had changed his club from one that served Home
Ales to one that served Worthington E. I never found out whether the
difference was in the yeast, or in an additive, but going back to
his old club solved the problem.
I have seen only one case where
pure alcohol produced an attack of asthma, as shown below. I tried
to carry out a provocation test as often as possible, and the
results I have obtained are shown here.
When I was a student I was taught that asthma was often emotional,
and even after the war that was a common opinion in teaching
hospitals in London. For example when patient I knew well was
admitted to a famous hospital in the sixties with asthma,
arrangements for a consultation with a psychiatrist were routine. In
my experience emotion as a significant trigger for asthma has
usually been due to complete frustration with their medical advisers
but two instances where there was a dominant emotional factor are
The first was when a boy aged 13 was referred with asthma
which got worse through the week, but improved dramatically at
weekends. All sorts of treatment, including oral steroids and
tranquillisers, had been ineffectual. It transpired that he was very
bad at maths, the first lesson every morning, and the teacher made a
fool of him. The GP was a school governor, and when the teacher, who
should have known better, was removed his asthma vanished
A young Asian girl had well controlled asthma while at University
which became difficult to control after she got her degree and
returned home. All summer she had severe attacks requiring treatment
at the Emergency department, and was admitted several times for a
few days. She was no sooner discharged than she developed another
attack, but if she went to her grandmother’s house she was well. The
home environment was considered as a significant factor as she was
very sensitive to dust mites, and a visit to the home was arranged.
The home was very clean indeed, but her father, an impressive Sikh
gentleman, appeared on the scene and it became obvious that he was
the trigger for her asthma. The background was that she wanted to
marry someone who was not considered suitable.
A Complex case of Asthma and Dyslexia due to Milk and Moulds
Bruce was 12 years old, with a family history very suggestive of
milk sensitivity in no fewer than five generations and extending as
far as cousins. His mother was also a patient and was found to be
allergic to milk and the moulds aspergillus and penicillium which
were prevalent in her house. Even 1% milk solids in margarine would
provoke intense rhinitis for a week. She also improved with
desensitisation to moulds and was able to tolerate the house after
an old well was found under the kitchen floor and was filled in.
He was at the bottom of the class at school, and had been diagnosed
as dyslexic, but with avoidance of milk and desensitisation against
aspergillus there was a vast improvement in his general condition
and attitude. Before long he was at the top of the class and the
reading difficulties had disappeared.
Yeast Allergy and Intolerance
Yeast is ubiquitous, and it is seldom realised that it can be a
potent allergen. The following anecdotes may help in recognition,
the skin test being always negative.
Eustace was 48, with a positive family history for allergies. His
complaint was that for some months if he had a few drinks in the
evening he would wake with abdominal pains, followed by a widespread urticarial rash. All sorts of tests had been done, all with negative
results, and had dental abscesses removed without benefit. Avoidance
of beer and yeast containing foods brought about so much improvement
that he did not require any treatment. Pints of beer caused a rash
in a few hours, ordinary bread caused slight urticaria, but soda
bread had no effect. The answer was there in his story, but nobody
had asked the right questions.
Susan was 39, with a family history of allergy on father’s side. She
had had perennial asthma for 16 years, better in frost and snow
suggesting moulds. Beer, shandy, sherry, and yeast tablets brought
on worsening asthma in half an hour. She was also allergic to house
dust and penicillin. Avoidance of yeasty foods was very helpful.
Beryl was 49, with family history of asthma.
She had had asthma for 16
years, and rhinitis and polyps which recurred several times, over 26
years. She had noted that milk ”clogs me up doc” ( as so many say )
Sherry, whisky, and wine cause sneezing and wheezing but not gin.
She had worked in the Marmite factory as a teenager and had been having
Bovril for her morning break for years, both made from yeast. A short steroid course
followed by Becotide and avoidance of milk and yeasty foods and
drinks resulted in regression and finally disappearance of the
polyps. Stopped all medication without relapse of the asthma or the
polyps. Took 100 mls of milk and peak flow dropped from 420 to 220
Edward was 65, with history of asthma in mother and an uncle who
died of asthma. He was well until age 62, when he had sudden asthma
after drinking three pints of bitter, and found that if he had a
pint of beer each evening he would have severe asthma by the third
day. Then found that sherry caused wheezing, and even a little
whisky or brandy would cause confusion and dizziness lasting 12
hours, but gin had no effect. Discovered that in France wine had no
effect at all. Avoidance brought about complete remission of the
asthma, but a test with a little beer caused wheezing. It is curious
that yeast in foods did not have any effect. All tests were
Kay was 13, and
had had chronic rhinitis and mild asthma since infancy.
There were no clues from skin testing, but a nasal provocation test
with yeast caused a positive reaction. Further enquiry revealed that
father was a very enthusiastic home brewer. After this was closed
down and yeast removed from her diet her asthma and rhinitis ceased
within a week. An unexpected bonus was that her personality changed
to being more extrovert and lively, and her school performance
improved beyond recognition. She had been so difficult at school
that when aged 7 she had been assessed by a child psychologist as
backward. Two years later got good maths and English A levels.
Accidental exposure to yeast caused irritability and bad temper as
well as wheezing. One such occasion was when exposed to an in-store
bakery in a supermarket, and another being near a room at school
where baking was being carried out.
Blair was 6 when first seen, with a family history of allergies and
eczema. Infant feeding had been very difficult, with projectile
vomiting and suspected pyloric stenosis, followed by chronic
indigestion, abdominal pains, large floating stools, chronic cough
and rhinitis. He was almost impossible to examine, with temper
tantrums and stamping his feet. There were no skin test reactions to
a wide range of allergens, but on the basis of the history milk was
removed from his diet. Within a month the cough, and the rhinitis
had disappeared, and his stools and behaviour became normal. To me
he seemed to have been transformed from a little horror to a lovely
cheerful child who would not stop talking. His mother commented that
after he had had some milk in a pudding his behaviour had become as
foul as his stools. It was found that trace of milk, a small
quantity of bread, or egg would produce severe abdominal pains in
half an hour, with misbehaviour and heavy shadows under the eyes
which would be red-rimmed. He resented very much having his bread
stopped, as he had a positive craving for it. On one occasion he
took a piece of stale bread from the bird table in the garden, and
one mouthful produced an episode of dreadful behaviour. Seen aged 16
the situation was unchanged, and having spaghetti in defiance would
still produce misbehaviour, misery, and shiners. His mother became
very reluctant to introduce any foods to find out if his intolerance
had subsided, but when seen aged 23 he could eat anything without
Inger had escaped from Norway by boat at the beginning of the war,
got married, and established a business in Burton on Trent making
hats. She noticed that whenever a brewery nearby was brewing a new
batch of beer and the smell of yeast was strong she began to wheeze,
but not at home in the countryside unless she went to the local pub
and drank beer, On stopping her beer the asthma disappeared, but
when she went on holiday in late August to the east coast in the
autumn she found that if the weather was damp she had asthma. The
only way she could get relief was to hire a rowing boat and row
about a mile off shore, where the asthma vanished, only to return
when she rowed back again. This was almost certainly due to allergy
to the very high counts of yeast spores at that time of year,
The next year she went back to Norway on
holiday for the first time since 1940, and had no trouble whatever
when there, as her relatives were total abstainers. On arriving back
in Newcastle on the boat she took the train to Derby, and asthma
returned in full force on the journey. I doubted if yeast spores
could account for this, and asked her if she had had anything on the
train. She confessed that she had gone to the bar and had a “Double
Diamond,” which was a popular brand of beer at the time. She took to
gin and tonic and had no trouble except when the smell of yeast was
in the air in Burton was strong.
A Reaction to a Herbicide used round the School
Richard was a fifteen in 1985, and was a very allergic subject
already well known to me because when he was changed from breast to
bottle he became seriously constipated, which ceased when I advised
Aged four I found that he was sensitive to dust feathers
and wool, and it was repeatedly established that if he was exposed
closely to wool he reacted by aggression and misbehaviour.
remarkable effect of wool was firmly established, and persisted, so
that being in a small car with people in thick sweaters would cause
misbehaviour. His mother was a tireless and intelligent
investigator, and was quite objective. Aged ten he reacted to
coloured foods and drinks with headaches and tummy aches.
milk challenges resulted in eczema within a few days, but this time
the eczema persisted after avoiding milk again, so he was seen for
He had ++ skin tests for mites, housedust, and wool, a
total IgE of 127 units which is about three times normal, but had no
The rash was associated by his mother with the fact that the school
authorities had been treating the playing fields with Atrazine, a
herbicide which has since been found to have many possible
It was difficult to be sure that the herbicide had
anything to do with the skin rash, which subsided on school
I instructed that some treated grass should be obtained
from the playing field, and noted that so much Atrazine had been
used that white powder was easily seen on the grass.
forearm with this grass and the other with grass from my garden
produced no immediate results, but after an hour and a half the
appearances were as shown ion the photographs.
Unfortunately it was not possible to follow up this preliminary
investigation, but Atrazine was not used again at the school.
Obviously much more intensive investigation would be desirable.
Allergy to Legumes in a small boy
George was three, and he was having attacks of abdominal pain and
diarrhoea which were clearly associated with eating a remarkably
wide variety of foods. He was very fond of tomato sauce, and
spaghetti with tomato sauce. Prick Skin testing using the soups
indicated clearly confirmed his specific allergies, as shown below