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Intriguing Cases


Dr David L. J. Freed, MB, MD, MIBiol

Intriguing Case 7

A seven-year old girl was brought as a tertiary referral from another allergist. She had been well while breast-fed until 13 months of age. On weaning she developed a night cough, which was eventually diagnosed as asthma and led to her receiving inhaled steroids. As she was about to be ‘promoted’ to oral steroids a homoeopath suggested a trial of dairy elimination and this abolished the cough and the asthma.

As she grew, mother (an ex-nurse) now noted other food reactions causing more subtle problems, behavioural abnormalities and failure to thrive (weight around the 20th centile). She was particularly sensitive to apple (to the extent that she could detect the traces of apple cider frequently added to commercial breads) but many other foods were also problematic and her diet was gradually dwindling. She had been to a top-class allergist and had been well managed (which probably explains why she was still alive), and he had now referred her on for neutralisation.

She didn’t like the intradermals much but mother bribed her with 50p a shot and she recognised a good deal when she saw one. She submitted without excessive demur and eventually I covered her for 34 foodstuffs. There were large weal-and-flare skin reactions to several foods, in spite of which she was then (after neutralisation) able to eat many of them in safety. Fruits, however, clinically her worst problem (especially apple) stubbornly refused to neutralise and she couldn’t eat those.

Fruits contain a number of pan-allergens – chemical/antigenic moieties that occur widely across the Vegetable Kingdom, and are recognised by their major sources. Natural salicylates are one such major grouping [6], and I often neutralise for sodium salicylate – the simplest of the group - in the hope of covering those. Another major grouping is the latexes, as exemplified by rubber latex [7]. A third major grouping is recognised by its cross-reactivity with birch pollen [8]. When I neutralised this girl for sodium salicylate, on top of neutralising the specific fruits, she suddenly surged ahead. She now consumed the danger foods, including her worst allergen apple, in safety. Her behaviour normalised and she grew fast. Within six months her weight and height rose from <20th centile to >50th.

As in Case 6 (see separate report), this girl showed the problematic phenomenon of delayed skin reactions, albeit visible the following day, several of which contradicted the neutralising end-points of the first day. Cheddar cheese, for example, gave a clear neutraliser on the third dilution, but next day the site of the third dilution was juicy red and throbbing. The fourth dilution however was fine.

Someone asked Joe Miller about this phenomenon during his workshop at the Harrogate meeting. He replied that the only important datum is the immediate (10-20 minute) end-point. I was (and am) unconvinced, and I have never been able to bring myself knowingly to administer as treatment a dilution that I know will cause delayed inflammation. Indeed, doing that inadvertantly, as in Case 6, almost led to disaster.

Again I adjusted the neutragen to reflect the delayed reactions, but mother was still unhappy. True, the adjusted neutragen stopped reactions the following day, but the child was still reacting on the same day of eating the foods! Mother now realised that the child was getting two distinct types of reaction. “Same-day reactions”, coming on between a few minutes and two hours, were characterised by a bright red face (with, paradoxically, a background pallor and grey bags under the eyes), headache, tearfulness and extreme emotional lability. I observed these reactions myself while testing. “Next-day reactions” were somewhat different, comprising depression, aggression and poor concentration.

I therefore dispensed two sets of neutragen drops, one containing the same-day end-points and another containing the next-day dilutions, and this strategy proved to be effective at neutralising both types of reaction. This child answered my unsettled problem about what to do when the delayed reactions contradict the immediate ones. Which end-point is the true end-point? Both!


1) Prausnitz C, Küstner H (1921) Studies on supersensitivity.
Centrallblatt fur Bakteriologie, 1 Abt Origin 86: 160-9,
translated and printed as appendix to
Clinical Aspects of Immunology (eds Gell PGH, Coombs RRA) 2nd ed,
Blackwell, Oxford 1968, pp 1298-1306.

2) Freed DLJ, Waickman FJ (2002). Laboratory diagnosis of food intolerance In Food Allergy and Intolerance 2nd edn
(eds Brostoff J, Challacombe SJ) Elsevier, London, pp 837-856.

3) Freed DLJ (2002) False-negative food challenges.
Lancet, 359: 980-1

4) Egger J, Carter CM (1983), Wilson J et al. Is migraine food allergy?
Lancet, ii: 865-8

5) Jones VA, McLaughlan P, Shorthouse M et al (1982),
Lancet ii: 115-7

6) Anthony H, Birtwistle S, Eaton K, Maberly J. Environmental Medicine in Clinical Practice,
1997, BSAENM Publications, Southampton, p B40.

7) Frankland AW. Latex allergy (1999).
J Nutr Environm Med, 9: 313-321.

8) Goldman AS, Kantak AG, Ham Pong AJ (2002).
Historical perspectives: clinical presentations, pathogenesis and diagnosis of food hypersensitivities.
In (eds) Brostoff J, Challacombe SJ, Food Allergy and Intolerance, Elsevier, London p811.

9) Freed DLJ (2002). Dietary lectins and disease In Food Allergy and Intolerance, 2nd edn
(eds Brostoff J, Challacombe SJ) Elsevier, London, pp 479-495.

10) Sharon N. Carbohydrate-lectin interactions in infectious disease (1996).
Adv Exp Med Biol, 408: 1-8.

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