Food allergyBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7140.1299 (Published 25 April 1998) Cite this as: BMJ 1998;316:1299
All rapid responses
For many years I suffered from classical Ulcerative Colitis. Although
aware of the work of Truelove and Witts milk avoidance was only partially
helpful. The colitis remitted instantly in Germany and Spain and relapsed
on return to UK.7 years ago after many years of uncontrolled IBD, except
on high doses of steroids, I had a total colectomy and temporary
ileostomy. Shortly after this I developed a highly irritating very fine
rash on my legs and trunk. On Ileostomy reversal I obstructed and was on a
drip for a week with nil by mouth. My first drink was a milky Mars drink
and within an hour I developed a reccurence of the rash. Scrupulous
avoidance of all cow's milk protein will keep me free. I therefore seem to
have a type 1V hypersensitivity. I feel sure that the UC was a result of
this. However I can drink Goats Milk and Ewe's milk and eat Goats Cheese
and Sheep cheese with impunity. I wonder what component of the protein
unique to a cow causes this?
Competing interests: No competing interests
Professor Bindslev-Jensen dismisses the potential use of oral sodium cromoglycate in the management of food allergy as being " generally unhelpful" and that clinical trials have given " conflicting results". These comments may result form early trials that either did not select patients with food allergy or an inadequate dose was used.
Oral sodium cromoglycate can often be a useful support to diet in the management in two ways, by giving improved symptomatic control when diet alone is inadequate and by allowing small amounts of the foods to which the patient is sensitive to be consumed. Thes uses do the correct diagnosis to have been made and the main causative foods to have been identified. Adequate doses must be used. In his original case study report Kingsley (1) showed that single doses of up to 400 mg may be required to give adequate protection against reasonable amounts of food.This was confirmed in a double-blind trial by Basomba et al. who showed that to be sure of providing good protection against food challenge doses of between 400 - 800 mg are needed. In the one case of anaphylaxis reported in this latter trial a dose of 800mg did not provide complete protection which indicates that this use of the drug should not be contemplated if anaphylactic reactions are involved. Doses of 400-500 mg were used in trials reported by Dahl (3), Papageorgiou et al. (4) and by Carini et al (5). All of these trials reported positive results but trials in which lower dose were used were more likely to give negative results.
Recent positive trials of the beneficial uses of continuous treatment in irritable bowel syndrome due to food allergy have used daily doses of 1600-2000mg/day (6,7). Positive results have been in patients who have a psoitive history of foods exacerbating symptoms and who demonstrate positive skin tests or RAST to foods.
Whilst an elimination diet remains the primary management of food allergy, this has become increasingly difficult at a time when many foods hae multi-ingredients. In these circumstances the selected use of oral sodium cromoglycate can be very beneficial.
Alan M Edwards
19 May 1998.
1.Kingsley PJ. Oral sodium cromoglyate in gastrointestinal allergy. Lancet 1974; 2: 1011.
2. Basomba A, Campos A, Villalmanzo IG, Pelaez A. The effect of sodium cromoglycate (SCG) in patients with food allergy. Acta Allergol; 1977; 32(Suppl13): 96-101.
3.Dahl R. Disodium cromoglycate and food allergy. Allergy 1978; 33:120-124.
4.Papageorgiou N, Lee Th, Nagakura T, Cromwell O, Wraith DG, Kay AB. neutrophil chemotactic activity in milk-induced asthma. J Allergy Clin Immunol 1983;72: 75-82.
5. Carini C, Brostoff J. Evidence for circulating IgE complexes in food allergy. Ric Clin Lab 1987; 17(4):309-322.
6. Lunardi C, Bambara LM, Biasi D, Cortina P, Peroli P, Nicolis F, Favari F, Pacor M. Double-blind cross-over trial of oral sodium cromoglycate in patients with irritable bowel syndrome due to food intolerance. Clin Exp Allergy 1991;21: 569-572.
7. Stefanini GF, Saggioro A, Alvisi V, et al. Oral cromolyn sodium in comparison with elimination diet in the irritable Bowel Syndrome, diarrhoeic type. Scand J Gastroenterol 1995; 30: 535-541.
Competing interests: No competing interests