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How many people have started to sneeze, cough, tear or scratch itchy skin blotches only to be told by the allergist that they have no allergies. Unfortunately this happens to many people. Every day we come into contact with people who have all of the typical symptoms of allergy but no evidence of IgE type reactions in their blood.
IgE's, or immunoglobulin E, are the antibodies that were discovered in the 60's by the doctors Ishizaka with which allergies have been catalogued for many years. Without a doubt, the study on the IgE's is useful and usually all immediate, acute reactions are linked to these antibodies. However, when we're confronted with chronic inflammation or persistent allergies, or phenomena linked to allergy and food intolerance, we almost always find a situation in which these antibodies are absent and we're left with some serious doubts.
As Brandt demonstrated in his wonderful study published in 2006 on the Journal of Allergy and Clinical Immunology(Brandt EB et al, J Allergy Clin Immunol 2006 Aug;118(2):420-7), food intolerances often cause reactions that are identical to those of allergies, even when the classic mechanism that we have known of up to now is absent. Before a diagnosis can be performed, a doctor must look for antibodies or cellular reactions that are different from the IgE's.
For years, we have been dealing with this situation by way of non-conventional tests, such as the ALCAT and DRIA. These tests investigate the reaction that occurs between a food extract and a white blood cell group (ALCAT) or the reaction that occurs between the entire neuro-immunological system and food (DRIA test).
But over the past few weeks, a new scientific discovery that was published in one of the most authoritative journals of Allergology has caused turmoil in the academic world. The American scientist Fred Finkelman discovered that there are at least two different activation routes for allergy. According to the study described in the latest number of the Journal of Allergy and Clinical Immunology (Finkelman FD. J Allergy Clin Immunol ), the reaction that was evident in laboratory mice (whose immunological characteristics are similar to those of human beings) should be applicable to humans as well.
What this means is that all of the allergological analyses that have been performed up to now were partial at best. The many people who weren't diagnosed because they were only tested for IgE type reactions, can realistically think that the information that they have been given up now has been incomplete, to say the least.
The description of this allergy with two routes, the classic one and the alternative one, is too close to the classic model of delayed food hypersensitivities (intolerances) to not make us think that this is (as Sampson has already suggested) a model that is always present within the body , more or less side by side with the IgE type reaction.
Accordingly, the two types of reactions depend on:
- Classic route, modulated by the IgE's, histamine, stimulated by small quantities of antigen, even in the presence of small quantities of antibodies.
- Alternative route, modulated by the IgG's, by a group of white blood cells (macrophages), stimulated by large quantities of antigens, repeated over time, in the presence of considerable quantities of antibodies.
We‘re faced with an extraordinary discovery that should make us completely reevaluate the way in which allergies develop or are regulated. We also need to remember that the IgG's are able to create tolerance phenomena with regard to classic allergy and as such should not be considered totally detrimental.
As far as the management of allergies is concerned, today allergists will have to take into consideration an additional scientific reality and they will not be able to avoid the patients' request to go beyond the immediate diagnostics of the IgE.
With regard to the study of delayed food allergies (intolerances), we can only reemphasize the need for a diagnostic study that evaluates cell reactivity ALCAT , DRIA . The results that we have obtained up to now, together with the scientific evidence of this new discovery, confirm that we were right.
Doctor Attilio Speciani
Clinical Allergist and Immunologist
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