Food intolerance: an unrecognised cause of chronic fatigue

Brenda was a forty-year-old housewife with all the symptoms of a Chronic Fatigue Syndrome. Her trouble started, two years ago, with a viral infection of the thyroid gland. She was perfectly well before this, but never right since. In particular, she complained of bouts of extreme fatigue, recurrent sore throats, pains in the arms and legs, stiffness across the shoulders, swollen glands in her neck, headaches and unrefreshing sleep. She had not been symptom-free for a single day in the past two years. She consulted her doctor frequently, first with one thing and then with another. She found this hard to cope with for, as she said of herself, she took pride in the fact that she hardly ever 'bothered the doctor'.

Everything was normal on physical examination. The blood tests were also normal; and so, in view of the ongoing symptoms, her doctor referred her to the Allergy Clinic. Brenda went on the Low Allergy Diet and within ten days all of her symptoms abated. Two years of abject misery came to an end simply by changing her diet! Subsequent food challenges revealed that she had multiple food intolerance. She reacted very badly to wheat, especially, but also to a host of 'otherwise harmless' foods, including bananas, onion, yeast, mushrooms, rice and oats. Because it would have been very difficult to avoid all of these foods, and to prevent the development of other food intolerance, she was offered a course of desensitisation. She has never looked back.

I would also like to introduce you to Gerry. He was a young lad in his early teens who complained of constant fatigue. His mother told me that he had never really recovered from a glandular fever three years previously. She described him as lethargic, always sitting down, with no real energy or interest in anything. For his part, Gerry also complained of frequent bellyaches, recurrent sore throats, and dizzy spells. He too was placed on the Low Allergy Diet, and he too lost all of his symptoms. He reacted badly to wheat, rye and oats — all gluten-containing foods. He had a biopsy test to exclude coeliac disease, and this was negative. We can safely say, therefore, that Gerry had a post-glandular fever fatigue prolonged by food intolerance — in his case, non-coeliac gluten intolerance.

In both of these cases there is a clear history of viral onset. One had a thyroid infection; the other a glandular fever. In each case, the patient slid imperceptibly from a state of viral infection into one of food intolerance. Patients have been known to develop IgE allergies, such as hay fever and asthma, in the wake of viral infection; but the development of food intolerance under similar circumstances has received less attention. This is a pity because, as these cases so clearly demonstrate, postviral food intolerance can cause years of suffering.



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Crohn's disease

Aideen was a 33-year-old business executive. She had always enjoyed the best of health, but then her bowels started 'acting up'. She first noticed that she was passing slimy stuff, like raw egg white, from the back passage. This could happen on its own or with the stool. She then developed abdominal cramps, and the stools became looser. Within weeks she was feeling quite unwell with loss of appetite, fatigue and joint pains. Finally, blood started to appear with every bowel motion. She was admitted to hospital and a biopsy of the intestine confirmed that she had Crohn's disease. She was treated in hospital with medication, and given instruction on how to administer the medication to herself at home on an ongoing basis. That worked well but Aideen still had symptoms, and besides, she wasn't happy with the notion of taking medication for any length of time. In fact, when I saw her she had stopped her medication entirely and her symptoms were beginning to flare up again. She started the Low Allergy Diet and came back for review ten days later. She was able to report a reduction in all symptoms, although they hadn't cleared completely as yet. In view of her improve­ment, she was willing to stay on the diet for another few days, and this time her symptoms were virtually gone. Subsequently, we challenged her intestine with various foods and, in so doing, identified which foods were safe for her, and which ones were not. It was clear that Aideen had food intolerance and that this was playing a significant part in her Crohn's disease.



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A word about chemically induced food intolerance

Nancy worked as a technical assistant in a chemical plant. One day, she smelt something funny corning from one of the vents. She didn't recognise the smell, no one else seemed bothered by it and no alarm sounded. She continued working. One by one the laboratory personnel became ill. They started to cough, one of them vomited, and several developed headaches. Meanwhile the smell was getting stronger. They put two and two together, realised that they were dealing with a chemical accident and left the premises smartly. Nancy was admitted to hospital, and discharged a few days later without treatment. That was last year, and Nancy has never been right since. In particular, she still had headaches, muscle pains and dizziness. She was also tired, and could not manage much outside of her routine work. On closer questioning, Nancy admitted to other symptoms, including bloating of the abdomen, bouts of diarrhoea and the occasional tummy cramp. She also complained of an increased sensitivity to chemical smells, such as bleach, polish, perfume, and the like. We put her on the Low Allergy Diet and all of her symptoms disappeared within twelve days. She was pain-free for the first time since the accident. One by one we reintroduced foods and identified which ones were causing her trouble and which were safe. She is now well into a course of desensitisation to allow her to eat a wide and nutritious diet without suffering the ill effects of food intolerance. Nancy had developed multiple food intolerance as a complication of chemical toxicity at work.



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Contact Allergic Stomatitis Case history

Anne Marie had her first set of dentures fitted by the dentist some eight months ago. Everything was going well until she developed a stinging sensation on her tongue. She also complained that her sense of taste was altered, and that her mouth was 'generally sore'. She removed her plate for a few days and her symptoms gradually settled. She then returned to the dentist, and was given a new plate in the hope that this would solve her problem. It didn't. All of her symptoms returned within a week. Inside her mouth, one could see only a mild redness together with a few blisters on her palate — where she had most contact with the dental plate. In spite of the paucity of visible disease, Anne Marie had a contact allergic stomatitis.



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A word about oral infection

Patricia also thought that she was allergic to 'something used by the dentist'. The day after her last visit she developed a crop of mouth ulcers. Her mouth was also generally sore and a bit swollen. The ulcers healed spontaneously within nine days, and she had completely recovered by the time I saw her. Her clinical history was fully consistent with a diagnosis of herpes (viral) infection in the oral mucosa and gums. We call this acute gingivostomatitis. Nevertheless, she was nervous about future dental treatment, so we patch-tested her anyway. The results were negative, suggesting once again that she had experienced a non-allergic event.



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Anaphylaxis Case history

The 8th of November 1994 is for ever etched in our minds. It was the end of another busy day as we sat around with our three children, eating what was left of the Halloween nuts, and catching up with each other's news. Our eldest daughter, Aisling, was then aged five. She started to cough, and complained of a sore throat whilst eating. I looked in her mouth and, finding nothing amiss, clapped her reassuringly on the back as doctors sometimes do. She then went upstairs to brush her teeth in preparation for bed, still complaining of pain. Her protests on the stairs were put down to another attack of the 'Shirley Temples'! By the time she reached the bathroom, her face was peppered with enormous hives, and her tongue was swollen with angry lumps. I threw a blanket around her, lifted her into my arms and rushed downstairs to the car. I was headed for hospital. On the way, she started to wheeze, and then slumped to one side in the back seat. I shouted at her: 'Aisling! Stay with me now, baby, stay with me!' But she could hardly speak. She was weak, very weak. I drove like a lunatic, one eye on Aisling, the other on the road; hazard lights, headlights and horn flashing and sounding as I weaved my way dangerously in and out of traffic. I thought I would lose her. But I knew that if I could just get her there alive she would have a chance. Adrenaline, that's what she needed now, and nothing else would do. I ran into the emergency department, trembling; by now her eyes were swollen like balloons, her breathing was noisy and distressed, and hives were spreading to the rest of her body. I handed her over to the medical staff and prayed. Aisling was in the throes of anaphylaxis.

I would estimate that her symptoms began within three or four minutes of eating nuts, and that another five minutes had: elapsed before we reached hospital. Her symptoms were dramatic, and they developed at a terrifying pace. This was, without doubt, a potentially life-threatening situation. To our great joy, Aisling pulled through. But, sadly, others like her have been less fortunate. Each year, some six to eight people die from this sort of allergy in the British Isles.

The blood tests came back a few weeks later. They confirmed a definite allergy to Brazil nut. The other nuts, including peanut, did not show up in the blood. However, the skin test to peanut was most certainly positive. Aisling, for her part, was unable to sleep for about a month. She had got an awful fright. There is no doubt, however, that she now fully understands her situation. Thank you, Lord Jesus, that I didn't die when I ate the nuts,' she prays. Brian was just a babe in arms at the time, and remained oblivious throughout; but Fiona, who was only three years old, became wonderfully protective of her older sibling. She wouldn't let her eat anything — and I mean anything — before I asking us if there were nuts in it! Thankfully, Aisling is a very I sensible young lady, and never eats a new food without first asking us whether it is safe to do so. She also carries an adrenaline syringe at all times: in her schoolbag, in the car and in the home. She is brought to friends' parties with a present in one hand and a syringe in the other. The hosts at each and every event are discreetly taken to one side for a brief but very clear instruction: no nuts! And if a 'hidden' nut is eaten accidentally: use the adrenaline!



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A word about dental allergy

Susan is an eighteen-year-old student nurse. She was referred to the Allergy Clinic by her dentist because of a rather frightening reaction she had in the dental chair. She told me that one of her cheeks started to swell just as the dentist completed a filling. Her tongue was also swollen, so much so that her speech was slurred. The dentist packed her off to the hospital, where she was admitted for observation. Her blood pressure was low, her heart was racing and she felt a bit faint. She was put on a drip to support her blood pressure, and she was given an antihistamine injection to reduce the swelling. This treatment was quite successful, and she was discharged the following day with no ill effects. Susan had a reaction to dental material(s). We now had to find out what it was that caused her such grief, lest she suffer it again. There were several possibilities. She could have been allergic to the dentist's latex gloves, the local anaesthetic, the mouthwash, or indeed any other material used during her treatment. It was also possible that she had a non-allergic reaction to the local anaesthetic. Such reactions can cause swelling, low blood pressure, fast heartbeat and even fainting.



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