Alcohol plus allergies can cause mealtime conundrum

Dear Dr. K.: Please don’t think I’m drunk when I ask this this peculiar question: Is it possible that alcohol makes one allergic to food? It seems that the only time I react to certain foods is if I also have some alcohol.

Intoxicated or not, your question is quite apt. Alcohol has been known for some time to be an allergic facilitator.  First, alcohol allows quicker absorption of all food. Thus, if you quickly absorb the food, the resultant higher blood level can lead to a greater release of histamine. This can trigger an allergic response that might not otherwise occur with slow absorption and lower histamine response.

Also, alcohol is a direct releaser of stored histamine; therefore, this additional release compounds the histamine release by the allergic response.

Finally, certain types of alcohol – especially wines – actually contain natural histamines. Hence, you can be in histamine overload by the triple hit from allergic reaction, direct histamine release and ingested natural histamines.

You can lighten this overload by eating some food first, prior to any alcohol.

Many unpleasant symptoms mimic allergy to fish

Not all acute reactions after eating seafood are allergic. In fact, there are three common syndromes that are allergy-mimics, but are non-allergic: Scramboid, Ciguatera and Anisakis.

Ciguatera fish poisoning (CFP) is the most common with an estimated half-million people affected yearly. CFP is caused by the ingestion of toxins that invade tropical and subtropical fish, especially in the Pacific and Caribbean. More than 400 species of fish are known to carry this toxic organism. Because of global warming and international food commerce, the toxin is going to become a more frequent problem. Also, affected fish appear normal in appearance and taste, and the toxin is not inactivated by cooking. The symptoms that occur are intense pruritis (itchiness), followed by nausea, vomiting and diarrhea. In severe cases blood pressure and pulse can drop, leading to fainting and loss of consciousness.

Scromboid toxicity occurs from fish that have a high innate histidine content, such as tuna and mackerel. Histidine is readily converted to histamine once the fish is digested and this sudden load of histamine accounts for the symptoms of flushing, hives, respiratory symptoms and nausea and vomiting. The implicated fish are typically “past prime,” and the histidine is high because the fish is decomposing. Also, this “old fish” contains two other bio-active amines that can add to the histidine effect: putrecine and cadaverine.

Anisakis is a nematode worm found in many fish. This syndrome is actually a true allergy, but to the worm and not to the fish. The problem only occurs for people who eat raw or lightly cooked fish. Symptoms include wheezing, hives, generalized itching and nausea and vomiting.

Treatment for Ciguatera is primarily in the form of hydration – by mouth or IV – if nauseous. For Scramboid and Anisakis, it’s antihistamines and hydration.

Prevention? For Scramboid, ensure the freshness of tuna or mackerel. For Anisakis, cook the fish. An antibody test kit for Ciguatera is being developed so one can test fish purchased at a market or restaurant before eating it.

Pasta Loading? Maybe not . . .

WDEIA is a newly recognized condition called wheat-dependent, exercise-induced anaphylaxis. Basically, it’s a condition that requires two “hits” to lead to symptoms.

The patient must ingest wheat and then partake in aerobic exercise. Wheat by itself or exercise without prior ingestion of wheat does not lead to any symptoms. Put the two together and the individual experiences allergic shock.

Omega-5-gliadin seems to be the molecule in wheat that causes the allergic symptoms. Some of the first medical observations of this condition were made by Harvard physicians who were lending medical support to the Boston Marathon.

Perhaps the traditional pre-race “pasta-loading” will go by the wayside for runners.

Pre-baby house pets play a role

Ever since the Hygiene Hypothesis was proposed in 1989 as the reason for burgeoning allergy in the modern world, more and more research tends to confirm this idea. By way of reminder: The Hygiene Hypothesis posits that modern man is “too clean” and, therefore, his idle immune system looks for “work,” and ends up causing allergic mischief.

One of the supporting observations: It seems that if pets are present before a child is born, the child is less likely to be pet-allergic than if the pets appear after the child has lived in the home for a while. A recently published childhood allergy study done at Detroit’s Henry Ford Hospital supports this view and adds new insight. This longitudinal study, initiated in 1987, has tracked 555 children to adulthood.

Sure enough, as investigators had suspected but never scientifically proved, the presence of a cat or dog prior to birth led to reduced cat or dog allergy later in life, as compared to introducing the animal after birth. The pet-specific allergic reduction was better for dog than cat by 61 percent to 37 percent. Of perhaps even greater interest was that pre-birth pets also led to a global reduction in all allergies.

The Henry Ford researchers feel this is because the gastrointestinal flora that is established early in life is healthier when pets are present. Healthy gut flora alter immune response, so as to promote tolerance to common allergens.

Statin drugs come with bonus positive prevention attributes

The recent Journal of Allergy and Clinical Immunology had an article about statins and asthma. The attention was not just for these drugs’ cholesterol-lowering properties, but also their immune-modulatory and anti-inflammation effects.

You might remember that several years ago there was concern for a possibly highly lethal global flu pandemic. The Center for Disease Control and Prevention recommended stockpiling not only anti-flu medication, but also statins. This is because they can prevent death from an otherwise lethal flu infection thanks to these bonus effects they include.

Well, apparently these same benefits are leading to better asthma outcomes.

A longtime study comparing two asthma groups, one of which was on statins, showed reduction in both rescue inhaler and steroid-burst use and fewer ER visits for the group on statins.

Also of interest are new guidelines for statin use. These new recommendations are to use lower doses, as it seems a large part of the benefit of statins in heart disease is owing to their reducing blood vessel inflammation, not just cholesterol levels. This anti-inflammation effect occurs with lower doses, which are less likely to lead to side effects.

Q – Tips: Sneezes

  • The Greek Goddess Demeter is said to control fertility of the Earth. It must be for this reason that the ancient Greeks dedicated sneezes to her, in the same fashion that we now say, “God bless you.” However, the ancient Greeks believed that Demeter may have had oracular motives in sending sneezes during discussions of ideas. Maybe she prompted the saying, “not to be sneezed at.”

Heads up: Cashew nut’s apple “cousin” deserves attention

Cashew nuts are not new to the American diet, but cashew apple is.

Cashew trees native to Brazil and the West Indies also grow in Central America, Asia and Africa. People in these countries have long eaten not only the cashew nut, but the apple itself.

The cashew apple has a fibrous juicy pulp which can be eaten directly or squeezed to make cashew apple juice – a rich source of vitamin C and antioxidants.

This juice is starting to appear in American health food stores. Despite its healthy nature, it can be a source of allergic difficulties.

As it turns out, the cashew tree is a member of the Anacardiaceae Family, which includes poison ivy and oak, poison sumac, mango, lacquer tree, Indian marking tree and rengas tree.

The common allergen found in all these plants is urushiol and hence, there can be cross- reactivity with all the plants.

In the case of the cashew, the apple has a higher concentration of urushiol than the nut. Hence, it has greater likelihood to lead to allergic problems. These can occur via contact with the skin, resulting in the typical poison ivy-type rash of itchy bumps and blisters. Ingestion can cause irritation of the lips, tongue, mouth and GI tract.

Of special interest is that ingestion of cashew nut or cashew apple can lead to reappearance a previously healed case of poison ivy/oak. It seems the area of the skin that broke out from contact with urushiol has immunologic memory that can cause the same area to redevelop the rash from ingestion of urushiol.

Researchers concentrate on this unwelcome gut bacteria

Dear Dr. K: I’ve read several articles by you about the immune health benefits of probiotics. In a recent Wall Street Journal (WSJ) article I read that gut flora could lead to colon cancer. Can you tell me more?

Yes I can. You are actually touching on a subject of cutting-edge research. There have been three recent publishings (probably the fodder for the WSJ piece) on this subject: New England Journal of Medicine, Genome Research and Cell Host Microbe.

The bacterial species that seems to be the culprit is Fusobacterium nucleatum. This unwelcome gut bacteria is not considered part of the normal flora. It seems to create its mischief by producing a unique protein called FadA, which is a sticky protein called an adhesion antigen. This molecule “sticks” to colon cells and causes both inflammation and eventually cancerous changes in the cells.

Studies done in mice models demonstrate that blocking adherence of this protein, even without removing the Fusobacterium, protects the mouse colon from inflammation and cancer. Thus, human research is looking at ways to accomplish the same thing in people, and also ways to eradicate the bacteria.

This research shouldn’t come as too big a surprise in view of the discovery about 15 years ago that another bad gut bacteria called helicobacter pylori is the cause for most stomach ulcers (inflammation) and stomach cancer.

Priming the immune pump – deposits to the health bank

My paternal grandparents had no indoor plumbing. When I visited them as a child I was put in charge of bringing in water for coffee and breakfast oatmeal. I would run to the well and pump hard — with no result.

Then I’d remember the priming glass of water kept inside. Pouring it in the pump first always led to bountiful water.

The dramatic aspect of priming happens with many vaccines, which is one reason many are given as a series. Examples are DPT and polio. Priming also can occur with the flu vaccine, even though each year’s vaccine is different.

The reason I bring this up is because in the past few years many people — who previously received annual flu shots — have chosen not to.

What the media fail to report is that it is precisely that older population who have received flu shots over many years, who have the best chance of getting better “bang for the buck” via priming from all their previous vaccines.

And the strategy the CDC (Centers for Disease Control and Prevention) is now considering is to give two identical flu vaccines in the same season, with the first one being the priming dose for the second.

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