Published on June 27, 2014
milk and eggs, to which patients are most frequently sensitive. 4. Skin reactions especially by the cutaneous scratch method are frequently negative in pollen,3 animal emanation and especially, in my opinion,4 in active food allergy. 5. Determination of sensitization of foods therefore must depend on dietary trial. Such dietary trial is even necessary when skin reaction to foods are positive Table 1.—Ages of One Hundred Seventy-Five Food Sensitive Patients Age Total -«-, l':¡- Major Diagnosis Aver. 0-5 6-10 10-21) 20-30 30-50 50-SO tients AbdomiDal allergy. 37 0 2 4 6 29 9 50 Urticaria. 11 84 2 3 2 1 20 Angioneurotic edema... 380 0 2 2 7 3 H ]>/.a. 23 51 2 2 33 18 Migraine. 37 0 1 2 5139 30 Asthma. 27 8 ß S 5 14 4 45 Total. 31 21 14 20 2368 29 175 since such reactions, as stated by Alexander,5 may indicate a localized allergy in the skin and not in the affected tissues. 6. The diagnosis and treatment of allergy and especially of food allergy are not laboratory procedures but demand a most careful history, supervision of the diet, and a control of concomitant types of allergy. They also demand thorough diagnostic study with laboratory and roentgen-ray investigations to determine all existing pathologic conditions. For comparative and statistical purposes, a series of 175 food-sensitive patients have been grouped according to their chief allergic manifestation. The ages of patients in this series are given in table 1. The average age was 31 years, though the series contained patients of all ages. Family history, as shown in table 2, was positive for allergy in 68 per cent of the cases in comparison with 56 per cent in a former series of asthmatic patients.7 Females were in slight excess. A single manifestation of food allergy was present in 51 per cent of the cases. In the remaining patients one or more associated allergic conditions not necessarily due to food were present. Food dislikes and especially known disagreements were complained of in 57 per cent of the patients. ABDOMINAL ALLERGY Abdominal allergy manifesting itself in abdominal pain, colic, gastric and intestinal distress, distention, nausea, vomiting, constipation or diarrhea is of frequent occurrence. Laroche8 has described many of the results of abdominal allergy in his monograph on the subject. Duke - especially has emphasized food allergy as a cause of abdominal pain and other gastro-intestinal symptoms and has pointed out the danger of unneces- 3. Lamson, R. W., and Miller, Hyman: Pollen Allergy: Genesis of the Skin Hypersensitiveness in Man, Arch. Int. Med. 40:618 (Nov.) 1927; Kern, R. A.: The Interpretation of Skin Tests, Atlantic M. J. 30: 290 (Feb.) 1927. 4. Rowe, A. H.: Allergy in the Etiology of Disease, J. Lab. & Clin. Med. 13:31 (Oct.) 1927; Food Allergy: A Common Cause of Abdomi- nal Symptoms and Headache, Food Facts 3: 7, 1927; Abdominal Food Allergy: Its Treatment with Elimination Diets, California & West. Med., November, 1928. 5. Alexander, H. L.: Localized Allergy, M. Clin. North America 11: 399 (Sept.) 1927. 7. Rowe, A. H.: The Treatment of Bronchial Asthma, J. A. M. A. 84:1902 (June 20) 1925; Bronchial Asthma in Children and in Young Adults, Am. J. Dis. Child. 31:51 (Jan.) 1926. 8. Laroche, Richet; and Saint Girons; L'anaphylaxie alimentaire, Paris, 1919. sary surgery. Andresen9 has discussed the general digestive symptoms due to food sensitization. I 4 have also described, in recent publications, the gastro¬ intestinal symptoms of food allergy. The abdominal symptoms and danger of unnecessary surgery were emphasized by Osier 10 in an article on the "Erythema Group of Skin Diseases," the probable cause of which was food allergy. In this series are included fifty cases, presenting various symptoms due to abdominal food allergy. Other allergic manifestations were present in 70 per cent of the cases. Food disagreements were «specially frequent in 80 per cent. Generalized or definitely localized abdominal pain or distress, especially in the lower abdomen, discomfort over the liver region sug¬ gestive of biliary tract disease, nausea, vomiting, gastric or intestinal distention and uneasiness, pyrosis, mucous colitis,11 proctitis 12 and sigmoiditis, frequent constipa¬ tion and diarrhea are manifestations of food allergy complained of by these patients. Such symptoms are probably due to muscular spasm or mucosal congestion and edema from the allergic reaction. Pain over the liver region due to sensitization to definite foods has occurred in twelve different cases and may be the result of a local edema of sensitized liver cells. The hepatic reaction occurring in the anaphylactic dog 13 and the outstanding demonstration of Walzer " of whole food proteins in the normal blood stream lends credence to such an hepatic allergy. Lintz 15 has commented on the occurrence of pain simulating that of appendicitis and on the frequency of gastro-intestinal bleeding due to food sensitization. Severe abdominal pain even with symptoms of obstruction may lead to unnecessary Table 2.—Incidence of Family History of Allergy and Asso¬ ciated Allergic Manifestations in One Hundred Seventv-Five Food Sensitive Patients Posi- Associated Allergic Conditions Nura- tive ,-*-, ber Family Cuta- Abdom- Major ot Fe- His- Hay- neous Mi- inai Diagnosis Cases Male male tory Asthma Fever Allergy graine Allergy Abdominal allergy. 50 13 87 37 8 14 17 12 50 Urticaria. 20 7 13 113 2 20 1 2 Angioncurotic edema. 14 3 11 6 2 2 14 5 4 Kczema. 16 8 8 11 3 1 16 0 5 Migraine. 30 11 19 26 3 2 11 30 11 Asthma. 45 19 26 28 45 4 7 0 3 Total. 175 61 114 119 64 2585 48 75 S5% 65% 68% 37%14% 49% 27%43% surgery and is probably due to smooth muscle spasm or to localized angioneurotic edema.16 Such cases have been reported by Harrington 17 and Bogart.18 Briggs 10 9. Andresen, A. F. R. : Gastro-Intestinal Manifestations of Food Allergy, M. J. & Ree. 123:271 (Sept. 2) 1925. 10. Osier, William: On the Surgical Importance of the Visceral Crises in the Erythema Group of Skin Diseases, Am. J. M. Sc. 137: 751, 1904. 11. Hollander, E. : Mucous Colitis Due to Food Allergy, Am. J. M. Sc. 174: 495 (Oct.) 1927. 12. Wynn, J.: Senile Pruritus Due to Hypersensitiveness, J. Lab. & Clin. Med. 13: 16 (Oct.) 1927. 13. Auer, John: The Functional Analysis of Anaphylaxis, George Blumer Edition of Billings-Forchheimer's Therapeusis of Internal Diseases 2: 80-160, 1925. 14. Walzer, M.: Studies in Absorption of Undigested Proteins in Human Beings, J. Immunol. 14: 143 (Sept.) 1927. 15. Lintz, W.: Appendicitis in Three Hundred Cases of Asthma and Other Forms of Allergy, New York State J. Med. 25:368 (March 6) 1925; Gastro-Intestinal Bleeding in Asthma and Other Forms of Allergy, Boston M. & S. J. 190:980 (June 5) 1924. 16. Morris, R. S.: Angioneurotic Edema: Report of Two Cases with the Histology of a Portion of the Gastric Mucosa Obtained by the Stomach Tube, Am. J. M. Sc. 128: 1812, 1904. 17. Harrington, F. B.: Angioneurotic Edema: Report of a Case Oper- ated on During an Abdominal Crisis, Boston M. & S. J. 152: 362, 1905. 18. Bogart, A. H.: The Surgical Significance of Intestinal Angioneurotic Edema, Ann. Surg. 61:324, 1915. 19. Briggs, W. A.: Fulminating Pelvic-Abdominal Edema Simulating Rupture Tubal Pregnancy, J. A. M. A. 50: 528, 1908.