Asthma Management in a ‘Clean’ Environment: 1. the Effect of Challenge with Foods and Chemicals on the Peak Flow Rate

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?

“…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]. The remaining patient would not accept this technique or the role of foods and demanded bronchodilator drugs as the only management; in contrast to the others, she was not better on discharge.…”

“…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.…”

“…They included the foods which are most likely to produce immediate allergic reactions and anaphylaxis but were not limited to them, and usually involved a number of different foods, occasionally very many foods [17,26,28]. The best clinical results were obtained in studies in which the methods used allowed detection of all, or almost all, of the foods responsible.…”