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Clinical Ecology

Also called Allergy Environmental & Nutritional Medicine (AEN)

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

Lob a canister of CS gas into a crowded room, and everyone there will start to feel mighty ill pretty quickly, but not everyone will feel exactly the same.Some will be affected only slightly, with maybe some stinging of the eyes and nausea, while others will be affected very badly indeed, perhaps dangerously so.This variety of responses is seen with all poisons. Since the modern environment is getting more and more polluted with poisons, both natural and artificial, it is not surprising that people at the very sensitive end of the spectrum are suffering more and more from environmental toxins.

A typical example is the gas formaldehyde.This gas is a natural exhalation of all living bodies, so there will always be some formaldehyde in the air of a crowded room.On the other hand it is also used extensively to treat fibres in the fabric industry, and it gradually outgases over the months, so that a shop selling curtains (or clothing, or furniture) will be much more heavily contaminated with formaldehyde. That is what gives the air in these shops its tangy smell. Most people can smell it but are not badly affected. Some people - the more sensitive ones - will feel positively ill after going into such environments.

Surprisingly, a good many foods also contain small doses of toxins, both natural and artificial. These range from pesticides and anti-sprouting agents sprayed onto potatoes, to natural alkaloids like the solanine contained in the green portion of potatoes.Once again, most people are not affected by these things and are usually unaware of their existence, whereas others can be made dangerously ill. Added to this, some people also react to foods, inhalants or chemicals with an immunological reaction - that is, they are allergic.

Clinical Ecology consists basically of knowing all about these possible poisonings and allergies, and therefore knowing either how to avoid damaging agents, or how to protect oneself against them. For historical reasons, this expertise is most often acquired by allergists and toxicologists; there is considerable overlap of interests between these two specialities and sometimes confusion also.

Clinical Ecologists or Allergists therefore offer two basic skills to the Health marketplace: (1) a detailed knowledge of the environment and diet and of the various ways in which they can be damaging (especially to more susceptible individuals), and (2) one or more methods with which to strengthen the defences of those individuals. These methods usually entail a nutritional programme plus one or more forms of "desensitisation".

The most contentious area, and the one that generates the hottest controversy amongst doctors, is diagnosis. Exactly how does the practitioner know what is causing the problem? Is it a food, or a pollen, or a dust, or furry animals, or chemicals, or germs such as Candida albicans? Or some combination of these or none of these? Methods of diagnosis vary widely, from relatively conventional methods like blood tests and skin tests, which are still used by conventional doctors, through to electrical devices, muscle-tone testing (kinesiology), and dowsing.

The controversy is hot because no-one can prove that his testing technique gives reliable accurate results (see Reference 2).Speaking for myself, in my 30-plus years of experience as an allergist (I first joined the Immunology Clinic staff at Manchester Royal Infirmary in 1970), I have never yet acquired the knack of making a confident advance diagnosis of allergy. The best I can do is proceed on the basis of probabilities, that is to say, I may have a pretty good idea of what the trouble is, but I will not be completely sure until the patient gets better. If in my experience a problem of this sort usually responds to allergy techniques, that is the way I will go. If not, not. If the patient gets better, there is a reasonable probability (though not proof) that my presumptive diagnosis was correct. For cases of chronic urticaria, asthma, fibromyalgia and irritable bowel syndrome (IBS) I find that 80% of patients improve, but I can never promise in any individual case that this one will be a success. In cases of partial success I will often call upon parallel specialists, in nutrition, acupuncture or osteopathy- or even a conventional medical speciality!- for their input. Some patients do better if they are treated with two or more modalities at once.

Allergists and Clinical Ecologists in the UK do not have to be medically qualified, although many are. Many practitioners in the private sector tend to suspect each other of quackery, but I have yet to meet a real rogue. All I can say is that some of the methods on offer have been validated by scientific studies and others have not. I personally restrict myself to the former category, but that is only because I am conservative by temperament. I do not permit myself the luxury of holding opinions on the latter group.

Because there are so many unqualified enthusiasts offering allergy tests and treatments in the marketplace, medically-qualified allergists have banded into learned societies with postgraduate specialisation.

The British Society for Allergy and Clinical Immunology (020 8859 6118) maintains a list of allergists within the NHS.

If you are looking for an additional expertise in chemical sensitivities and/or modern desensitisation techniques, the British Society for Allergy and Environmental Medicine (01547-550380) maintains a Register, a copy of which can be obtained either from the Society or from the Institute of Biology (020 7823 9409).

Other lists are held by Allergy UK (01322 619898),
and Action Against Allergy (020 8892 4949).

Suggested Reading

'Diet-Related Diseases; the Modern Epidemic'.
Seely S, Freed DLJ, Silverstone G, Rippere V.Croom
Published by Helm, London, 1985.

'Food Allergy and Food Intolerance'.
Brostoff J, Challacombe S.(eds)
Published by Bailliere Tindall, Eastbourne, 1987.
(see especially Chapter 50 for diagnostic methods)

'Food Intolerance'.
Dobbing J.(ed)
Published by Bailliere Tindall, Eastbourne, 1987.

'The Complete Guide to Food Allergy and Food Intolerance'.
Brostoff J, Gamlin L (eds)
Published by Bloomsbury Publishing, London, 1990.

'Health Hazards of Milk'.
Freed DLJ (ed)
Published by Bailliere Tindall, Eastbourne, 1983.

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