Have you ever noticed that we humans have a tendency to "solve" a problem--and the solution only gives birth to an even bigger problem?  Examples abound.  For instance, the development of the A-Bomb helped to end WWII...and then nuclear proliferation ensued.  Or, to take another case, we've developed a superior mode of 20th century transportation (i.e., the automobile), only to give birth to massive pollution problems.  And then...we developed antibiotics to end the scourge of infectious diseases, and...?

In my last journal entry, I mentioned that injury and the allergic patient are two things that just DON"T go together well.  Another item that can spell DISASTER for the allergic patient is recurrent antibiotics.  In this series on diagnostic synthesis, I've been discussing a taboo subject--how does a "simple" allergic patient (only one allergy+ one target organ--something which all allergists covet) end-up being a mess, with multiple complex food sensitivities?  One way this happens is through multiple antibiotic useage.  See the diagram below:

                        Let's start in the upper right corner and move clockwise.  Primary allergies such as a simple dairy allergy in early childhood, can lead to recurrent infections (such as otitis media) which in turn leads to multiple antibiotic useage.  Sadly, probiotics are often NOT given concurrently with the antibiotic administration.  Eventually, intestinal dysbiosis (imbalanced bacterial flora, usually with a predominance of commensal Candida species) ensues.  The end result?   Increased intestinal permeability, and subsequent risk for easy sensitization to any food the patient is eating alot of, especially foods with high native allergenic potential, such as wheat, soy, corn, etc.

Another common presentation on this theme is the patient with inhalant sensitivities to molds, unfortunately undiagnosed.  They have recurrent sinusitis as a result, take multiple courses of antibiotics, and present to the office with progressive food intolerances covering a wide-range of items.  Often, they feel sick with everything they eat. 

Now look at the left side of the diagram, starting with "Non-allergic infections".  Sometimes patients have NO prior history of typical allergically-related infections, but have an underlying susceptibility to allergic disease nonetheless.  They have an unfortunate non-allergic medical issue requiring repeated rounds of antibiotics, and wind up with intestinal dysbiosis and the development of multiple food sensitivities.  An example of this is the patient I saw in my office, who was in good health until having severe abdominal pain.  She was diagnosed as having a severely infected gallbladder with sepsis, and was hospitalized and on heavy doses of antibiotics, both during and after hospitalization.  Food reactions rapidly ensued for the first time in her life.

What about the dotted line you see between "non-allergic infections" and "primary" allergies, you ask?  Well, newer research has suggested that recurrent antibiotics in childhood put children at definite risk for developing an increase risk of asthmatic disease.  According to a recent article, Giving antibiotics to a child less than one for a non-respiratory tract infection greatly increases the risk of developing subsequent asthma.  Disruption of the gut flora in early childhood may accelerate/promote the development of "primary" asthma, and possibly subsequent allergy.  This is simply a reworking of the hygiene hypothesis to include the need for healthy gut flora--the so-called "extended hygiene hypothesis".  

Clinical Pearls from all this? 

1.  In the patient presenting with multiple food sensitivities, be sure to check their antibiotic use history.

2. In previously diagnosed allergic patients, try to minimize antibiotics whenever possible, and be sure to give concomitant probiotics when utilizing antibiotics for infections. 

What factor is most responsible for the intestinal permeability increase from disrupted gut flora?  Usually Candida.  But that's a discussion for another time, and another place.  Right now, I'm tired.  How about you?

Later, Dude