One of the important questions scientists ask about allergies is: ‘why did these responses develop in the first place?’

Surprisingly, some of the latest theories suggest that the allergic response initially evolved to help humans cope with parasites. We have known for some time that there are more allergies in advanced, developed countries where hygiene measures are more likely to have reduced exposure to these micro-organisms.

Eric Ottensen, head of the Clinical Parasitology Section at the National Institute of Allergy and Infectious Disease in Maryland, USA, studied the native population of a Polynesian island, Makue, where there is a high incidence of filarial worm infestation. When he first started, in 1974, he found that hardly anyone suffered from allergies. When he returned to the island in 1992 he found the levels of parasitic infestation considerably reduced. The population, however, had suffered a considerable increase in the incidence of allergies. Could it be, Ottinger speculated, that when a change in someone’s lifestyle caused a greatly reduced exposure to parasites, the immune system starts to respond to other substances that are, in themselves, non toxic? After all, house dust and pollens are not poisonous to the body. Why does the body make such a fuss in the first place? Because the specific immunological response to parasites is mediated by immunoglobulins E (IgE), the very ones that are usually involved in allergic responses to inhalants such as pollens and dust. Ottinger speculates that once humans reduce their contacts with parasites through more hygienically prepared foods and other measures, the IgE immune reaction is ‘all dressed up with nowhere to go’. It then directs, or misdirects, its attention to otherwise innocuous factors, and all of a sudden, we have an allergy. (‘Life Death and the Immune System’, Scientific American, September 1993, and Discovery, August 1993)

A number of clinicians and researchers, notably Dr Leo Gallant in New York, Dr Tom Borody in Sydney and Dr Jeff Bland in Seattle, have indeed noted that different types of intestinal micro-organisms can cause a variety of symptoms associated with different conditions, ranging from asthma to chronic fatigue. All have reported cases in which the presenting condition has been cured once the intestinal problem was successfully resolved.

So what do we do if it is not a food allergy or intolerance or a Candida infection? Call it what you like, when your digestive system does not work properly the symptoms can vary from constipation or diarrhoea, migraine headaches, skin rash and vomiting. You would be surprised to learn that digestive infections by a number of organisms can so profoundly alter our biochemistry that they can trigger or contribute to a wide number of illnesses, especially asthma, mood swings and emotional instability. Depression, anxiety and aggravated premenstrual symptoms are also common in people with poor digestive function.

In spite of what many people believe, the problem is not always caused by a food intolerance. We are often confronted with patients who appear to react to so many different foods that any elimination regimen would leave them unable to eat a balanced diet. Then there are those who are already so underweight that diets pose a danger. Finally some people cannot tolerate any food. They will experience abdominal swelling, indigestion, stomach discomfort, loose bowels or constipation, no matter what food they ingest. Many will also find their asthma symptoms get worse. Some of those people do not have a Candida problem and many of them do not suffer with a food allergy but with ‘dysbiosis’. This is a condition in which the normal gut flora is unbalanced, perhaps because of too many antibiotics during childhood, often as a result of micro-organisms such as giardia, camplylobacter, enteroviruses or helicobacter pylori. The gut ‘leaks’, allowing undigested particles to enter the circulation. These polypeptides, as they are known, may then cause an allergic-like reaction. And here lies the problem. Treating the allergy will not cure the problem simply because another, and then another, and then another food will cause the same problem sooner or later. The gut linings of these people are so sensitive that they react to almost anything. If you have a sore boil on your back and someone slaps you vigorously on the back, it will hurt! And it won’t make any difference whether the person who pounded your back is a friend or an enemy. Similarly, it is often irrelevant whether one is allergic to a food or not. Eating it will cause problems anyway. We call these ‘pseudo-allergies’. So what may the underlying cause of all these problems be?

We are now able to diagnose, treat and reverse the majority of these problems. To our delight, we have found that when some asthmatics with digestive problems have these cured, their asthma improves greatly.

When the digestive tract is assailed by some organisms, for example, Candida, Campylobacter, helicobacter pylori and others, two things are likely to happen. First the body can make antibodies to these organisms and thus we can ascertain their presence with a simple blood test. When this is not possible, other tests and special investigative procedures can identify the responsible mechanism.

Secondly the liver detoxification system will be either overworked or incapable of keeping up with the load because of a pre-existing malfunction. This can happen in the case of past alcohol or drug abuse, previous viral infections or the earlier use of many pharmaceutical drugs, including some antibiotics, which affect liver function. In this case a new test (a liver detoxification profile) will warn us of the existence of a problem. This in turn enables us to take appropriate measures to increase the liver detoxification (Cytochrome P-450) ability and to devise a personalised nutritional programme that will assist in minimising the burden on the liver.

Furthermore, special techniques devised by Dr Borody may allow us to actually rebuild the gut flora by re-colonising it with a mixture of friendly flora, introduced directly into the gut via the rectum.

For example, we have now seen and cured cases of suspected ulcerative colitis, duodenal and gastric ulcers, chronic constipation and irritable bowel syndrome. When properly diagnosed, the ulcers turned out to be caused by helicobacter pylori. This bacterial organism can probably be acquired through poor hygiene. Its presence can be accurately diagnosed with a simple blood test and confirmed with a special breath test or a stomach biopsy. Helicobacter pylori invariably causes chronic active gastritis and is found in 95 per cent of cases of duodenal ulcers and some 60 per cent of gastric ulcers. This organism is also implicated in the development of gastric cancer, so that its eradication is also a useful preventative measure. Helicobacter can release toxins that play havoc with one’s health.

Unfortunately the presence of helicobacter pylori does not exclude other digestive pathologies and we often find that patients infected with it also have other digestive pathological abnormalities. The tests and investigative procedures which we use look for those as well as the possibility of cancer.

The success of this new diagnostic and treatment procedure is evident from recent statistics which show a recurrence rate of less than one per cent (0.7 per cent) four years after treatment.

Even more interesting is the fact that, while Dr Galland had already reported several cases in the USA in which patients were cured of Chronic Fatigue Syndrome following treatment of their intestinal parasites, we in Australia have also found that several of our patients have been completely cured of chronic fatigue after successful treatment of their gastrointestinal problems, whether these were due to parasites, intestinal Candida or helicobacter pylori. Asthmatics as a whole tend to respond well to treatment, and most report not only a general improvement in well-being, but also a reduced need for medications.

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Intramuscular morphine injections should be given for the relief of acute or severe pain when intravenous access is not available. There is no place for continued intramuscular injections and either oral or subcutaneous treatment should be used for continuing therapy.

Rectal morphine-Morphine suppositories are available in some countries and can easily be manufactured by a pharmacist. The recommended dose is the same as for oral administration although absorption may be slower and variable. Oral controlled-release MS Contin tablets are effective when given rectally but absorption is less predictable than by the oral route. They can be used to tide a patient over a short period of vomiting, but are not otherwise recommended.

Spinal morphine-Spinal morphine therapy provides improved pain control for selected patients with severe pain. The indications for this treatment and the optimal mode of administration for patients with advanced cancer remain to be defined.

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It’s beyond me why anyone would still want to smoke after knowing how unhealthy it is for every organ in the body. Perhaps I can appeal to our vain side by stating that it can also do a destructive number on your skin.

Formally, there are varying opinions on the effects of smoking on the skin. Some studies have demonstrated that smoking doesn’t harm the skin that drastically, while others dispute those claims. My personal and professional opinion is that smoking adversely affects the skin in many ways. In fact, I can spot a smoker’s skin immediately, as it tends to develop a very sallow appearance. Smokers also get a lot more blackheads, because the pores are so dilated due to the decrease of collagen in the skin. Smokers also don’t heal as quickly as non-smokers, a consideration that has prompted many plastic surgeons to refuse to operate on smokers.

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