MONDAY
Monday morning at my London clinic, and a flustered-looking woman in her 40s arrives complaining she is allergic to her new puppy.
Whenever she gets close to or even sees the dog, she says her chest tightens and she can’t breathe. She has no history of allergy and when I test her for dog allergy — with a blood test and a skin-prick test, where a small amount of each suspected allergen is placed on her skin and then punctured with a lancet — she is clear.
She does reveal she has a history of anxiety disorder, but when I suggest that the route of her symptoms could be psychological, she becomes angry and defensive and ends our session.
But is it real?: A leading specialist in the field of allergies reveals many of us don't have the allergies we think we do
The following week, I receive a letter from her saying she went to an alternative practitioner subsequently, who told her she does have a dog allergy. She has got rid of the dog and feels much better.
This is frustrating but not unusual: a number of patients I see have self-diagnosed an allergy mistakenly and then had it supposedly confirmed by an alternative practitioner.
This bogus allergy testing causes a lot of unnecessary anxiety and can be very dangerous if a real allergy is missed. The fact this woman feels better after getting rid of her dog just shows what a strong psychosomatic component there can sometimes be to supposed allergic reactions.
Next, a man in his early 40s comes in with severe hay fever. He is typical of the profile for this condition: it isn’t understood why, but this allergy is more common in men from affluent backgrounds.
His itchy eyes, runny nose and sneezing are making life a misery and his medication isn’t working. He’s also noticed that certain foods including apples, celery and hazelnuts make his mouth itch.
A skin-prick test shows he has a strong allergic reaction to birch pollen. I’m not surprised: apples, celery and hazelnuts all contain a protein that’s similar to the pollen he is allergic to.
However, I reassure him he is simply ‘sensitive’ to these foods rather than highly allergic (it’s a matter of degree), and he can safely eat them in cooked form.
I recommend a non-sedating antihistamine tablet and nasal spray, to be used regularly during tree pollen season from March to April. I’m convinced his current medication isn’t working properly because he isn’t using it regularly enough.
TUESDAY
In the past 40 to 50 years, childhood allergies have risen sharply — in the Sixties, peanut allergy was unheard of, whereas now it’s fairly commonplace.
Some experts, myself included, believe this is due to the ‘hygiene hypothesis’. This says the higher up the social chain you are, the more protected you are from bacteria — as a result, your immune system starts to fight harmless substances such as dust mites.
Certainly, most of my child patients come from middle-class families and spend a lot of time indoors. When my children were growing up, I was careful to encourage them to muck around outdoors, and put our family cat in their cots occasionally.
Today, at my Surrey clinic, I see a three-year-old girl with severe eczema, asthma and food allergies, with her parents. Peanuts cause her an anaphylactic reaction: fast swelling of her face and throat, affecting her breathing.
At our last appointment, I sent off a blood test. On the NHS it can take up to three weeks to receive these test results back, but private patients can get them back in a few days.
The results confirm she has a severe peanut allergy. We discuss how they can avoid peanuts in food. I also prescribe an EpiPen for them to carry, which will administer a shot of adrenaline in case of a severe reaction, and advise her parents to use her hydrocortisone cream more consistently, for seven days at a time on her eczema.
These creams are safe to use long term, but seven-day continuous therapy followed by a break seems most effective.
It’s a bad sign her allergies to milk and eggs are also still present at three — most children would have grown out of these by this age, as the immune system matures. Half of children with allergies outgrow them by their teens.
WEDNESDAY
In London, a 36-year-old man comes to see me with a red and itchy rash around his nose, cheeks and forehead. He also suffers with the irritation around his bottom. I can tell it’s seborrhoeic dermatitis, a common fungus-related rash (but not an allergy).
He’s so embarrassed about it that he’s never been to his GP and instead suffered in silence for years. I prescribe an antifungal cream which, he tells me a week later, clears the problem.
Many men wait years before consulting anybody with symptoms, hoping they will go away — and often a short course of treatment is all that’s needed.
Wheat and dairy are 'trendy allergies' says Dr Morris. A wheat allergy could simply be mild IBS
Later, a mother and teenage daughter arrive who both say they have been suffering lethargy and exhaustion.
They’ve used a High Street allergy test called a Vega — where a practitioner uses a computer to ‘measure’ your response to different foods and substances, held in glass vials, without the substance touching the skin.
It diagnosed them both with allergies to a host of foods including wheat, yeast, sugar and dairy. And so they’ve cut them out — unsurprising, then, that they’re lacking in energy.
Wheat and dairy have become ‘trendy’ allergies that celebrities are often reputed to suffer from.
In fact, only three per cent of the population have a genuine food allergy — while 30 per cent believe they have one.
This mother and daughter don’t have an allergy; they probably have mild irritable bowel syndrome.
THURSDAY
Some good news at my afternoon clinic in Guildford. I’m pleased to be able to tell the parents of a seven-year-old boy that he no longer has an egg allergy (in the past, eggs had caused a rash around his mouth, hives all over his body, and a swollen tongue).
We observe as he eats a piece of hard-boiled egg, then a soft-boiled egg and, finally, an almost raw egg — the most allergic because heat and cooking reduce the level of allergens present in foods. He is all clear — he has simply grown out of it. The relief of his parents is palpable.
Next is a one-year-old girl with a severe case of eczema all over her face, arms and legs. Asian and Afro-Caribbean people have a higher incidence of allergies such as eczema, and her father, who is Asian, also suffers from it.
Children with eczema have a sensitivity to the staphylococcus bacteria we all carry on our skin. I prescribe a short course of oral antibiotics to clear the staph bacteria and a steroid/antibiotic mixture cream.
I also recommend an oil-based emollient. Misguided GPs are still often prescribing aqueous cream, which is great as a soap, but shouldn’t be used as a treatment — left on the skin it can exacerbate eczema.
The rest of the day brings the usual mix of red herrings and genuine allergies. I see more allergies to tropical fruits like mango and kiwi, reflecting our more diverse eating habits — these allergies never would have been a problem before we started eating exotic fruit.
Sulphite allergies are also on the rise because it’s used as a preservative in processed foods and ready meals, and can trigger hives and asthma.
FRIDAY
Pseudo-science? Many companies have convincing arguments that mercury fillings are toxic. Probably not, says Dr Morris
A woman comes for her appointment at my London clinic, convinced her low mood, tiredness and difficulty sleeping is down to a ‘toxic reaction’ to the heavy metals present in her body.
This is all thanks to a visit to an alternative practitioner, who said she has dangerously high levels of mercury, titanium and aluminium in her system.
As a result, she has been recommended to have all her metal fillings removed and replaced with new ‘non-toxic’ ones. This is the sort of thing that makes me really angry.
Truly ‘toxic’ levels of heavy metals in the body are in reality highly unusual: there is likely to be no danger in mercury fillings, for example.
However, many companies have very convincing, pseudo-scientific websites and vulnerable people like this woman, whom I believe is probably clinically depressed, are their prey.
I do my best to convince her of this. But, no doubt, she will pay an unscrupulous dentist thousands of pounds to do the job.
And finally, a 31-year-old man whose hay fever is so bad he has to take time off work, and avoids going anywhere green. As steroid and antihistamine treatments seem ineffective, he is a good candidate for desensitisation treatments such as Grazax.
This is a new approach in which a small amount of the allergen (in this case grass pollen) is given in tablet form, starting a couple of months before the start of the hay fever season and throughout it. I have found this to be effective for around 70 per cent of my severely grass-pollen allergic patients.
Unfortunately, the NHS will rarely fund this treatment, but many patients are happy to pay for it privately (around £400 for a six-month treatment course) as the benefits can be impressive. ( dailymail.co.uk )
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