Asthma Management in a ‘Clean’ Environment: 2. Progress and Outcome in a Cohort of Patients

Abstract

A cohort of I 9 consecutive asthma patients, stable prior to admission, were investigated in the 'clean' atmosphere of the Airedale Allergy Centre, starting with a therapeutic fast. The peak expiratory flow rate (PEF)fell initially, whether medication had been reduced or not (withdrawal), but by about the sixth day most patients were symptom-fiee on less medication; by the last week of admission the reduction in medication was very highly significant (p < 0.0005). All patients gave positive wheals on intradermal injection of inhalant allergens (4 prick-test negative). Bronchoconstriction was provoked by open food challenge in 18 patients, and by sublingual challenge with chemicals in ten patients.The implications of the findings were discussed with the patients at each stage of the investigation. They were discharged on 'vaccines' containing their Miller endpoints f I]for prophylaxis, and an individually designed rotation diet (including most trigger foods), and advised how to reduce exposure to relevant inhalants and chemicals. At follow-up >6 months after discharge, patients had more control over their asthma: 13/19 (68%) claimed to be at least 'definitely better': 5 'well' or 'almost well'. Symptoms were significantly reduced, and medication was lower at follow-up than on admission (p<O-OI). Compliance correlated with outcome (tau=O-37, p<0.05): outcome was not related to inhalant prick-test reactivity. The study underlines the need for a randomized trial testing this management against conventional management of asthma.

Multiple Chemical Sensitivity: Phased Initiation by Anaesthetics and a New Building

“…From experience of many patients, symptoms graded as 3 or more are accepted as evidence of a reaction (although lesser reactions may occur consistently on retest or be accompanied by signs, and may require desensitization). Symptom provocation is commonly supported by signs, namely, a gain in body weight of 2 lbs (1 kg) over the day [8], a change in pulse rate of $ 10 beats/min (usually but not always a rise) [9] or a fall in peak expiratory ow rate (PFR) of $ 30 L min 2 1 [5,6]. Foods provoked gains in weight, changes in resting pulse rate (but no signi cant changes in PFR) and a variety of symptoms (Table 1), but on some occasions she thought that she was unaffected until she got off the bed at the end of the hour and discovered that her legs would not support her; the surprise on her face was memorable.…”

“…The staff adhered to strict standards so that nothing perfumed or giving off VOCs was allowed into the building. In the 14 years since then, many patients with medically unexplained illness have been admitted [3][4][5][6], have discovered that their symptoms were of environmental origin, and have learnt how to keep well.…”

Adverse Reactions to Foods: What is the Gold Standard?

“…This means that highly sensitive patients may have to avoid most of the environmental and food incitants to which they are sensitive before challenge, and that observations must cover at least the succeeding 48-hour period. One of our patients with brittle asthma showed no bene t from a therapeutic fast in an ordinary hospital ward but improved dramatically when she fasted in a comprehensive environmentally controlled inpatient facility and developed severe bronchospasm on food challenge [9]. The other source of error is that challenge with a food that has been avoided for more than a month may not provoke a response because of the development of temporary tolerance: symptoms may, however, follow repeated testing or a return to regular consumption [6].…”

“…Our experience is similar to that of Pelikan and Pelikan-Filipek. We looked in detail at the sensitivities found in 19 patients with asthma admitted to an environmentally controlled unit (ECU), some admitted because of severe asthma, others primarily for other conditions [9,28]. The low morning peak ow rate thought to be characteristic of asthma disappeared during the therapeutic fast [9] and, during the food challenge phase, was noted on some mornings after a positive challenge the previous day, but not otherwise.…”

“…We looked in detail at the sensitivities found in 19 patients with asthma admitted to an environmentally controlled unit (ECU), some admitted because of severe asthma, others primarily for other conditions [9,28]. The low morning peak ow rate thought to be characteristic of asthma disappeared during the therapeutic fast [9] and, during the food challenge phase, was noted on some mornings after a positive challenge the previous day, but not otherwise. In 18 out of 19 patients bronchospas m was provoked by food challenge and con rmed by recovery of the peak ow rate when the appropriate therapy dose of that food (but not another food) was found using the neutralization technique [28].…”