Treatment for Allergies in Childhood

Arizona once was considered a haven for allergy sufferers. People would move here to see if their allergies would resolve. There really isn’t overwhelming evidence to support this choice and there are a lot of factors that play into allergies. For example, many people who live in the Midwest have ragweed allergies. Unfortunately, ragweed also grows in Arizona so you would not necessarily find relief by moving here. There have been more non-native plants being transplanted to Arizona over the years increasing the pollen diversity. I still see mold allergies in Arizona even though it is a dry climate. The Arizona valley has a high level of air pollution and the smog can irritate and sensitize the airways contributing to allergies and asthma. We also see that people who have an improvement in their allergies initially by moving to Arizona will start to have allergies within a few years of living here. The problem is we need to help the person be less reactive and build up their health. Yes, reducing allergen exposure definitely helps, but allergies are an over-active response of the immune system so we also need to address and balance the immune response.

Do your children seem to have stuffy and/or runny noses all the time? Do they get itchy skin playing outside in the grass? Do they have a chronic cough? Do they suffer from asthma of trouble breathing? If so, it is a good idea to get your child allergy tested.

Our office will test for:

  • IgE Arizona desert allergens to know what your child could be reacting to (blood test)
  • IgG food allergens as these can contribute to the imbalance in the immune system (blood test)

Treatment options include:

  • Avoidance of airborne allergens (such as using quality air purifiers)
  • Nasal saline rinsing
  • Vitamin and nutrient support for the immune system
  • Avoidance of potential food allergens
  • SLIT therapy- sublingual drops to desensitize immune system to allergens (highly diluted allergen substance)
  • Homeopathy (safe and effective highly diluted plants, minerals, or other substances best suited for the patient’s individual symptoms)

Dr. Kwiatkowski has a published case study of a child with allergies who responded well to natural therapies:

IBS: Find the Underlying Cause

Is IBS Cramping Your Lifestyle? 

 

Irritable Bowel Syndrome is a common concern that I see in practice. IBS accounts for 25 to 50 percent of all referrals to gastroenterologists in the United States, and is the second highest cause for people missing work. (References 1-3)

Common symptoms of IBS include:

  • Chronic abdominal pain, commonly described as a cramping pain- this may be related to bowel movements, eating certain meals, or emotional stress
  • Bloating and gas 
  • Altered bowel habits- either diarrhea, constipation, or a combination of both

First steps by your doctor are usually to rule out other conditions such as:

  • Celiac disease- an autoimmune disease where eating gluten damages the small intestine
  • Inflammatory bowel diseases- Crohn's and Ulcerative Colitis
  • Colon cancer

-Usually your doctor will run a variety of blood tests, stool tests, and likely recommend some imaging such as a colonoscopy.


    A common scenario I see is that all of these tests come back negative, and you are left with a diagnosis of IBS and no answers about why or what may be the cause. 

    Let's find the underlying cause!

    As a Naturopathic doctor I am always trying to look for the underlying cause so we can get to the root of the problem and treat it more effectively. 

    1. Small Intestinal Bacterial Overgrowth (SIBO)

      • SIBO is characterized as abnormal overgrowth of bacteria in the small intestine.
      • Symptoms include: bloating, abdominal distension, abdominal pain or discomfort, diarrhea and/or constipation
      • A proposed mechanism of diarrhea in bacterial overgrowth is below: (4)
        1. Bacteria digest carbohydrates, producing gas and byproducts that promote osmotic diarrhea.
        2. Bacteria and fatty acid byproducts injure the mucosa and contribute to diarrhea.
        3. Mucosal injuries create lactase deficiencies, aka lactose intolerance
        4. Bacterial deconjugation of bile salts interferes with fat absorption and the absorption of fat-soluble vitamins. People may notice they can't tolerate fatty foods anymore. 
      • One study showed the frequency of SIBO among patients with IBS varied from 4% to 78% and that among controls from 1% and 40%. In most studies, frequency of SIBO among patients with IBS was higher than that among controls. (5)
    2. Post-GI infection (ex. food poisoning)

      • Recently, new evidence has emerged regarding the association of IBS with diarrhea and prior episodes of acute gastroenteritis with alterations in the intestinal bacteria. Pathogenic bacteria include: Campylobacter jejuniSalmonellaEcoli, and Shigella which all have been found to produce a toxin, CdtB. Once the immune system is exposed to CdtB it creates antibodies, and because of molecular mimicry, these antibodies create an autoimmune response to a protein called vinculin which is a cell adhesion protein. (6) 
        • Lack of cell adhesion in the small intestine leads to what we commonly refer to as "leaky gut". The tight junction between the cells that make up our intestinal lining is compromised. 
      • A study in rats showed that levels of circulating antibodies to CdtB and vinculin correlated with the levels of small intestinal bacterial overgrowth (SIBO) in these animals. (7)
        • This suggests that an episode of something such as food poisoning, may actually be a cause of SIBO as well. 
    3. Imbalances in the bacteria, or other organisms in the GI tract

      • Overgrowth or deficiencies in the normal bacteria in the intestines can be associated with IBS and other conditions. New stool testing methods are able to look at the DNA of the bacteria of our gut and find where some of these imbalances are. This could help give us insight into dietary recommendations, and as more research arises, more specific dosing of certain strains of probiotic supplements. 
      • Candida is a yeast that most people have as part of the normal flora of their digestive tract. Just as bacteria can overgrow, so can yeast. Some people may have more obvious signs of a Candida or yeast overgrowth such as oral thrush, skin rashes, or vaginal yeast infections. Clinically I see that some people have digestive symptoms similar to IBS and working an an anti-candida protocol can help resolve symptoms.
      • Parasites should not be forgotten as a possible cause of intestinal symptoms similar to IBS. Parasites can be missed with some stool samples, especially if only one sample is taken. People at more risk for parasites are those who travel internationally and contract them from contaminated food or water. 
    4. Non-Celiac Gluten Sensitivity and other food sensitivities

      • Non-Celiac gluten sensitivity is a common finding in clinical practice. People who test negative for Celiac disease still note considerable improvement of their symptoms by eliminating gluten. Vazquez-Roque, et al. (8) found that gastrointestinal symptoms can be elicited by gluten in patients with diarrhea-predominant IBS (IBS-D), in whom Celiac disease had been ruled out. They reported that patients with IBS-D had more bowel movements per day while they were on a gluten-containing diet than those maintaining a gluten-free diet. Patients on a gluten-containing diet also had higher small intestinal permeability. 
      • Food allergies and sensitivities (IgE, IgG, IgA) can also contribute to IBS symptoms. I am starting to believe that food sensitivities come later down the line after there has been some damage to the intestinal lining, such as after food poisoning and with SIBO. We have a scenario of "which came first, the chicken or the egg?" Once there is damage to the integrity of the intestinal mucosa, "leaky gut" arises as the tight junctions no longer keep out food antigens and waste products from contacting our immune system, then we start to react to these foods and create more intestinal inflammation. Eliminating these foods while we heal the intestinal lining is very important to progress towards resolution of symptoms. 

    Specialty lab testing can help us identify some of these potential causes. Once a suspected cause is found then treatment can be more focused to help you work towards healing your condition. 

    References:

    1. Schuster MM. Diagnostic evaluation of the irritable bowel syndrome. Gastroenterol Clin North Am 1991; 20:269.
    2. Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology 2002; 122:1500.
    3. Everhart JE, Renault PF. Irritable bowel syndrome in office-based practice in the United States. Gastroenterology 1991; 100:998.
    4. Sachdev AH, Pimentel M. Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance. Therapeutic Advances in Chronic Disease. 2013;4(5):223-231.
    5. Ghoshal UC, Srivastava D. Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype. World J Gastroenterol. 2014;20:2482–2491.
    6. Pimentel M, Morales W, Rezaie A, et al. Development and Validation of a Biomarker for Diarrhea-Predominant Irritable Bowel Syndrome in Human Subjects. Ro S, ed. PLoS ONE. 2015;10(5):e0126438.
    7. Pimentel M, Morales W, Pokkunuri V, Brikos C, Kim SM, Kim SE, et al. Autoimmunity links Vinculin to the Pathophysiology of Chronic Functional Bowel Changes following Campylobacter jejuni Infection in a Rat Model. Dig Dis Sci (2014); November 26.
    8. Vazquez-Roque M.I., Camilleri M., Smyrk T., Murray J.A., Marietta E., O’Neill J., Carlson P., Lamsam J., Janzow D., Eckert D., et al. A controlled trial of gluten-free diet in patients with irritable bowel syndrome-diarrhea: Effects on bowel frequency and intestinal function. Gastroenterology. 2013;144:903–911.