A Broad Introduction
Rhinitis & Hay Fever
Children & Infants
Allergy to Animals
Wheat is eaten by almost everyone in the west, so it is not
surprising that some people react adversely to it. Wheat contains
gluten which causes Coeliac disease by triggering a reaction which
damages the lining of the small bowel (and also a skin problem
called Dermatitis Herpetiformis). The lining of the gut is
seriously damaged, food is not properly absorbed, and gluten has to
be avoided for life. Since more sensitive tests were introduced
and are available from GPs through the NHS many of the less severe
cases have been identified, often explaining unaccountable
ill-health for many years.
A wide range of gluten-free products are
available now from a variety of sources, but allergy to wheat is
directed towards the wheat proteins rather than the gluten, so
gluten free products are totally unsuitable for wheat sensitive
Irritable Bowel Syndrome is very common, especially in women, and
usually regarded by the medical profession as all in the mind. This
may well be true in some cases, but there is also an unknown number
of cases where the cause is intolerance of wheat, which is such a
common item of diet that it would be surprising were it not to upset
some people. Because this possibility is seldom taken seriously and
a wheat-free diet tried out, we simply do not know how often wheat
causes IBS and other digestive problems.
In recent years blood tests have been advertised which promise to
tell you what food to avoid to get better,, but there has never
been a properly conducted trial of any of these very expensive
tests. The food antibodies detected are of the IgG group, which can
also be found in many normal people.
An Embarrassing Problem caused by Wheat
The most striking case ever seen was a thirty-four year old lady who
had had severe unpredictable intermittent diarrhoea for five years.
Although she had been fully investigated by barium enema and
colonoscopy at the local hospital no cause had been found, so her
problem had been dismissed as IBS or psychosomatic. Her quality of
life was seriously disturbed as abdominal pain and urgency could
occur at any time, even when driving. She would not get married lest
she had a sudden call during the ceremony, and sometimes even 6
capsules of Imodium had no effect.
She was referred by a locum doctor who had asked for a blood count
which had revealed a high number of eosinophil cells which suggested
allergy. There were no clues or positive skin tests except to a
grass extract from my own lawn, but no positive tests to grass
pollen or any foods. As usual the answer was in the history, as
she had recently observed that she had had a very severe attack on a
day when she had had Weetabix, a pure wheat breakfast cereal, for
breakfast, followed by more for lunch. As she had eaten nothing else
that day wheat seemed to be a likely answer, supported by her
observation that pasta, bran flakes, and a high fibre preparation
prescribed for her “IBS” all made the diarrhoea much worse.
Her occupation involved shift work, so any special diet was
impossible, but because of the very suggestive history total
avoidance of wheat was advised as a first approach. To her delight
the diarrhoea ceased totally after a few days, and a week later she
phoned saying “ Doctor, I don’t know what to do! I’m Constipated!!!”
Weetabix was reintroduced, and every time caused acute pain and
diarrhoea, but on a wheat free diet she has remained well, got
married, and now has a daughter.
This is an extreme example, but the diagnosis is seldom so
Wheat as a cause of Asthma
Dora had been quite fit as a child, but in her twenties she
developed bronchiectasis, a problem where the bronchial tubes become
grossly enlarged and chronically infected, so that huge amounts of
infected sputum are produced, and the patient has to tip up every
morning to get rid of it. Because it was mainly her left lung that
was affected she had this lung removed when aged thirty, but the
result was very disappointing and she became virtually bedridden
because she was so short of breath from asthma. She was referred by
the thoracic surgeon who had removed her lung, but there were no
clues in the history and all tests were negative. I admitted her to
hospital where a milk free diet was tried out but she actually she
got worse, so she was sent home.. When she came to the out-patient
clinic she was wheezing so loudly that I still remember hearing it
through the door of the consulting room before she came in.
My only positive suggestion, as I was just at the beginning of my
interest in food allergy, was to try a very limited diet of meat,
fish, and vegetables, and to everyone’s amazement she stopped
wheezing in a few days. Reintroduction of bread cause wheezing every
time, so wheat was avoided completely and she remained well.
reason why she got worse in hospital was because she was so hungry
on the milk free diet that she ate more bread! In spite of all the
negative skin and blood tests she was shown to be very sensitive
indeed to wheat, because she found that Ryvita, which is was
supposed to be pure rye and nothing else, caused wheezing. Enquiry
from the makers revealed that the white dusting on the bottom of the
Ryvita to stop it sticking was actually wheat flour, showing very
clearly just how intensely allergic she was to wheat..
The next time her doctor came to visit her at home he was astonished
to find the patient who had been a chronic invalid for six years
scrubbing the floor and singing! She became very fit in spite of
having only one lung, and became an enthusiastic walker. She also
became an expert in avoiding wheat, which turns up in all manner of
foods and is often not declared on the label.
Of course this is an extreme example of wheat allergy causing very
severe asthma, but her case does suggest that perhaps this
possibility should be considered as a background allergy in severe
cases of so-called ‘brittle’ asthma which are very unstable and
difficult to treat even with all available drugs.
This lady had been suffering from ulcers in the mouth on and off for
some years. Her son had serious behaviour problems which disappeared
on avoiding wheat.
He had such a craving that he ate the stale bread
off the bird table and then became violent again.
Her ulcers cleared
completely when I suggested that she also avoided wheat, and her
blood test for Coeliac disease was negative.
Presumably he had
inherited his wheat intolerance from his mother.
A Multiple Food Allergy
Janet is now 52, and had been attending the Dermatology Clinic since
she was eleven with Scleroderma, a disease of connective tissue
which causes thickening and contraction of the skin and other
problems. From the age of about 46 she also developed severe eczema
which the skin department did not appear to be able to control.
had a Vega test which suggested so many food allergies that
avoidance would have led to malnutrition, but she tried avoiding
wheat and milk products resulting in considerable improvement for
two months. She then had an acute skin reaction to prawns, and a
RAST test was carried out which showed that the Total IgE was 68
times normal, which the Dermatologist could not explain, and further
investigation revealed Milk 3+, Soya 1+, Potato 1+, banana 2+, wheat
2+. This result was correct for milk, but reactions to eating the
others were much more severe than the RAST test would indicate, and
it was clear that immunological tests were only partly relevant to
She then developed such a severe attack of eczema that I had to give
her a course of oral steroids in high dosage Her food problems was
so complicated that she had to be prescribed Elemental Diet 028 to
live on while the steroids were tapered off. This special product
contains a complete diet which has been processed to such an extent
that it will not turn on any allergies. This liquid diet will also
supply sufficient calories and essential nutrients to maintain
health, so it is also used in treating colitis and other severe gut
problems. This product can be prescribed on NHS in suitable cases or
as a test, but is not often used.
Having been weaned off the steroids on 028 without relapse
of the eczema occurring the next step was to introduce a few foods
diet, and as long as her skin remained in reasonable condition
further foods were introduced one by one to find out which she could
Four years later she has found out exactly what she can and cannot
tolerate, and as long as she adheres to this diet she remains well.
She still has to have very occasional courses of oral steroid to
control a flare-up of the eczema as a result of inadvertent
consumption of a forbidden food.
Her list includes anything containing a trace of milk or milk casein, potato, celery, grapes, palm oil, and especially anything
containing corn (maize). She can take a little bread, but she is so
sensitive to corn that she gets eczema if she eats a chicken which
has been fed on corn, or eggs from that chicken.
She can eat both
chicken and eggs from barley fed chickens without a flare-up of the
eczema. It has been reported from the USA, where corn is used to
make alcohol, that some patients react to corn whisky, but not to
Scotch as it is made from barley.
The list of foods which can
contain corn is a very long one, and can be obtained from the
internet or a supermarket. Milk fed pork causes trouble in milk
allergic people, so she would be well-advised to enquire about the
feed when purchasing pork products. Of course sausages are taboo.
She has now been discharged from the skin clinic, and is able to
control her condition by careful attention to her diet. She is an
example of a successful allergist/patient partnership which could
not have been achieved without her complete cooperation and
A Complex Case of chronic Cough
Shiela was forty-nine when she was referred for help with her severe
chronic cough. Her mother had asthma, which she had found was
related to milk and beef, and her fathers family had many allergic
members. She started wheezing when aged three with intermittent
eczema, and she could not go to school from May to September because
of hay fever and asthma which was often so severe that she was
either in bed or in a chair. This was a clear indication that she
was allergic to both grass and tree pollens, and also mould spores
later in the season. From September she could go back to school for
the winter, and although her education was disrupted she was a
studious only child and became a librarian from age nineteen. The
seasonal asthma had subsided considerably by age thirty when she
went to university to study informatics.
From the age of about twenty-two onwards her asthma had been
reasonably controlled with becotide rotahalers, where the active
drug is mixed with micronised lactose powder, plus occasional
courses of oral steroid when essential. About two and a half years
before she was seen for the first time this particular formulation
of inhaled steroid was discontinued.
She was changed over to a
similar inhalers using a different steroid, but all were in lactose
powder inhalers not only for the steroid, but also for the
long-acting and short-acting bronchodilators. Thus she was having
three powder inhalers instead of one and because the asthma got
worse the dose was increased until she was inhaling fifteen doses of
lactose powder a day when first seen.
Shortly after this change in inhaled treatment she had a sudden
attack of asthma and a severe cough all night. This cough persisted
and became a serious problem because it continued night and day,
keeping everyone awake. The cough was accompanied with sputum, which
was unusual for her, and the cough was described as explosive and
incessant, causing serious concern. At the first consultation.,
surprisingly, her lung function tests were 112% of the predicted
figure for her age and height, and the sputum did not contain
eosinophil cells. These findings indicated that her asthma was
totally under control, except for the loud explosive cough, and
indeed her peak flows in the past had seldom been below 400l/min.
She gave the significant history that she had always disliked milk,
but her mother, who also reacted to milk, insisted that she must
have because it was good for her! She stated that if she had milk
she got a tickling sensation on the front of her neck, and felt
‘clogged up’----a statement which is always a strongly suggestive of
milk allergy or intolerance—and dairy products always caused
diarrhoea. She had a craving for potato, which also caused a tickly
neck, and tomato caused an even more definite tickle. Curiously, her
mother also has a similar allergy detector which reacts to milk, but
at the back of her neck!
On this evidence she was advised to avoid milk, beef, potato, and
tomato, and changed to Qvar, Serevent, and Ventolin inhalers, so
that she was no longer inhaling lactose powder. There was remarkable
improvement in a week, and the cough almost disappeared. She stopped
her antihistamines because they had blocked the skin tests, and when
retested she had a large reaction to wheat, grass pollen as
expected, and potato juice. This reaction to wheat was the largest I
have ever seen to this extract, which is unreliable, so she was to
avoid wheat as well as the reaction seemed genuine
The result was that she feels so rejuvenated that she is resuming
her Phd studies, and the only time that she had coughed was when she
had eaten forbidden food accidentally or on purpose. A small amount
of beef caused coughing all night, bread a cough in a few minutes,
and a trace of cream diarrhoea. She also had a severe obesity
problem which resulted from ineffective courses of fertility drugs
fourteen years before. She weighed 266 lbs (19 stones) at the first
consultation, and 12 weeks later she had lost 21 lbs in weight, many
previous attempts at dieting being unsuccessful.
The RAST immunological tests were negative for specific IgE against
potato and milk, a slight positive for wheat, and a definite
positive for grass pollen. The Total IgE was only slightly over the
normal. This scientific test could have been most misleading, but
this has been a common experience in patients with food
Now the Qvar is being gradually withdrawn under peak flow monitoring
to find out the minimum dose for the winter. She will almost
certainly need treatment in the summer, although the removal of the
food factors should lead to great improvement. The unanswered
question is if the lactose contained traces of milk protein
sufficient to trigger the cough, or if it was simply the irritant
effect of fifteen lactose inhalations a day. This is possible
because when lactose powder encounters the moist mucosal lining of
the bronchi it will draw moisture from it producing a strong
solution of the sugar which is very hypertonic, and irritating. She
now requires only two puffs of Q-Var a day, and has not used her
Ventolin for months.
and/or Corn Intolerance
Jane was aged 59, and had had perennial allergic rhinitis for
twenty-six years, beginning while pregnant, and had had polyps
removed twice but they soon recurred. In the last five years her
nose had been completely blocked and she had begun to develop
asthma. Skin tests were all negative, but the nasal smear and a
sputum sample were crowded with eosinophil cells characteristic of
allergy. She was given a short sharp course of soluble oral steroid
to clear the blocked nose, which was tapered off and a local steroid
aerosol given instead.
All her problems vanished with the course of steroids, and this
improvement was maintained with the steroid aerosol. The next step was
to try a few foods diet, and then to slowly stop the spray to find
out if it was necessary. The result was that she stopped all
treatment without relapsing, and the eosinophil cells disappeared
from her nasal smear.
Challenge tests with wheat on three occasions
caused a feeling as of pressure on the chest, a feeling of being
“clogged up “, and audible wheezing which came on in two hours and
lasted for twelve. The last test kept her awake with sneezing and
wheezing until five in the morning. The RAST test was, as expected,
negative. She is very happy, requires no medication whatever, and
has also solved her obesity problem.
Geraldine was sixty-one, with a history that when aged 45 she
developed such severe joint pains that she was placed on the
disabled register and moving to a bungalow or installation of a
stair lift was seriously considered. She attended the Rheumatology
Department for some time but all findings were negative.
The turning point was when she had mashed potatoes three days
running and her joint pains became very severe, but were better on
avoiding potato, so the idea that her troubles could be due to food
intolerance was considered for the first time. Her husband, who was
a science graduate, sorted her dietary intolerances out over the
next five years without any medical help, and demonstrated that
pains in the joints were repeatably triggered within a few hours by
corn of any kind, corn syrup, or anything containing corn products
Her sensitivity to corn was really extreme, as he discovered that
Paracetamol tablets and Tenormin blood pressure tablets caused pain,
and found that they contained corn starch as a bulking agent in the
Paracetamol in capsules and Tenormin syrup
caused no problem at all. He found that chocolate, onion, tea unless
decaffeinated, grapes, banana, all cheese, and most breads (except
one white sliced loaf which was tolerated for no obvious reason), and potato had to be
avoided. All skin and blood tests were negative as would be expected
in a case of intolerance.
The most difficult food to avoid is corn because it is in so many items, the latest incident being most interesting.
A nasal steroid spray was prescribed for nasal catarrh, and
over the course of a week her joint pain became progressively worse. On stopping the nasal spray the pain
disappeared in about a day.
It was found that the contents list included dextrose,
which is derived from corn, explaining her reaction.