In the traditional history, previous medical problems will also be noted briefly, but in general there is no attempt to link seemingly unrelated “nonmedical,” past problems in the patient’s life to the present illness. Of course not— for no theoretical framework exists to make such connections. In general, symptoms and organs are neatly compartmentalized and viewed in relative isolation from one another. The history of a person’s illness is thus seen narrowly, as the history of one particular symptom or syndrome, rather than broadly, as a history of increasing ill health stemming from environmental exposures.

Although the dates of important medical changes may be indicated on the record, the reader of such a traditional medical history tends to be relatively unaware of the long-term progression of symptoms which may have preceded the current illness. In addition, traditional medical histories tell almost nothing about the environmental facts of a patient’s life. The doctor rarely asks about the details of job or hobby, about cooking or heating systems in the home, or methods of insect control used in the patient’s vicinity. To him, these seem irrelevant and outside the practice of medicine as he was taught it in medical school.

If currently available tests show no “organic” disease, the doctor is more likely to ask probing (and sometimes leading) questions about interpersonal relationships, such as problems with a spouse, children, or parents. Generally speaking, however, little effort is made to relate the “chief complaint” to other problems in the patient’s life, and the “medical” facts tend to be separated from the environmental facts.

The basic cause of a chronic illness is rarely exposed by this type of traditional history-taking. Since the doctor fails to comprehend the subtle and hidden give-and-take between the environment and the patient, with its ever-shifting balance of environmental challenge and individual response, he cannot understand the patient’s seemingly unclassifiable illness.

A patient with a long history and a thick file frequently becomes a “neurotic” in the doctor’s eyes, and this judgment is passed along from one doctor to another. In such an atmosphere, doctors tend to become cynical about many patients’ complaints, while patients bitterly reject established medicine.

I call this traditional approach the “ABCDs of modern mass-applicable medicine.” A stands for Analytical: the medical profession tends to chop problems up into neatly compartmentalized specialties, rather than seeing the broad outlines in a synthesized (unifying) fashion. B and C, in this scheme, stand for Body-Centered. The doctor looks at the body but fails to see the environment (mainly physical and nonpersonal) which impinges on that body at every step and with every breath. D stands for Drug-oriented. The traditional physician almost always uses drugs to alter or neutralize symptoms whose basic cause(s) he does not understand. Analytical, Body-Centered, Drug-oriented medicine has many achievements to its credit, but it offers little to the growing number of patients who are suffering from environmentally induced chronic illness.

The history-taking of clinical ecologists is quite different. Whereas in traditional medicine, the taking of the history (which is one of the most important portions of the diagnostic process) is usually assigned to the least experienced member of the medical team (the intern or medical student), the clinical ecologist himself usually conducts his own interviews. Some people think a doctor wastes valuable time by doing this. If important leads are to be uncovered, however, it is necessary for one experienced person to be familiar with the details of each individual case.

Because of the essentially addictive nature of many environmental problems, especially in their earlier, or stimulatory, phases, medical histories can be paradoxically misleading. For example, an untrained history-taker can overlook the significance of a patient’s remark that he “loves” or “craves” a particular food or chemical, and that eating, drinking, or inhaling that item makes him feel better. A conventionally trained doctor or nurse is likely to encourage the patient in the use of such a substance, while a clinical ecologist will immediately suspect it as a source of allergic/addictive responses.

The form of the interview which a clinical ecologist conducts is also different from that in traditional, ABCD medicine. Instead of looking at the body as a collection of various organs and parts, with medical and scientific subspecialties organized to deal with isolated problems which affect them, clinical ecology emphasizes the wholeness of the individual and the uniqueness of his experience. It thus forms part of the larger movement toward “holistic” medicine, which is gaining increasing importance.

Emphasis is put on recording events in a chronological fashion. The patient’s illness must be traced not just to the onset of the present symptom but to the beginning of his overall ill health. This, in turn, must be correlated with significant events in his life history.

Getting the medical history usually takes me about one hour. First, I generally let the patient explain who referred him and why he has come, in his own terms. If he has come because of a well-defined problem, such as headache, I ask him when he started having headaches and let him make any statement he wishes about this problem.

If the patient cannot single out any overriding problem but simply feels chronically ill, with many complaints, I ask him when he ceased being well and started feeling poorly. In other words, I try to orient the history (as the name implies) to the development of the problem in time. However, some people cannot give a chronological history. Either they do not think in those terms or their minds are too clouded by their disease. In these cases, I simply ask the patient to state all of his symptoms according to the categories explained in Chapter 8. Briefly, the categories are: physical localized symptoms: 1) upper respiratory, 2) lower respiratory, 3) gastrointestinal, 4) dermatological, 5) genitourinary. Physical systemic symptoms: 1) fatigue, 2) headache, 3) myalgia, 4) arthralgia. Mental-behavioral symptoms: a) brain-fag b) depression, with or without altered consciousness.

I gather in the data, typing whatever the patient says, without making off-hand interpretations. After about an hour, good clues usually emerge from this narrative, although the cause of the illness cannot be known for certain until actual testing is done.

The medical history is supplemented with forms and tests, such as the Chemical Questionnaire reprinted in Chapter 19. On the basis of the results of the interview, questionnaires, and tests, the patient is then assigned to one of two groups. One group, constituting about half of my referred practice, are patients who are so seriously ill that they must be hospitalized to undergo further testing and treatment. The method of helping such patients is explained in the following chapters. The less severely afflicted, or those who are unable to be hospitalized for a variety of reasons, are diagnosed and treated on an in-office (outpatient) basis.

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Many of those suffering from allergic vasculitis show sensitivity to various chemicals, so it is important to eradicate these from the immediate environment before trying an elimination diet. This may be sufficient to clear the symptoms or at least reduce their severity. Even if it has no apparent effect, avoidance of chemicals should continue during the elimination diet, as there may be dual sensitivity – complete recover)’ will only occur if both food and chemical factors are eliminated simultaneously.

It has been suggested that immune complexes can cause inflammation in much larger veins and arteries, and even in the heart itself, thus provoking a far greater range of symptoms. These include muscle spasms, irregular heartbeat, severe pain in the legs, loss of circulation to the fingers and toes (or in extreme cases to the whole limb with consequent gangrene), loss of vision, seizures and paralysis on one side of the body. It should be emphasized that food-allergic patients with symptoms such as these are probably extremely rare, and some doctors would dispute their existence altogether. Most of the reported cases appear to be sensitive to a very large range of foods and chemicals, and they have suffered serious ill-health for many years.

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The person is given either drops (to take under the tongue) or vaccine (to inject themselves) with their own endpoints which, used regularly, will protect them and control their symptoms. Multiple extracts can be included in one vial so that only one drop or vaccine is required to cover the various allergens. The neutralisation effect is not permanent – the drops or vaccine need to be taken regularly to prevent reactions. The intervals at which they need to be taken depend on the individual and the severity of their reactions. The effects of drops wear off after a few hours and are most convenient for foods eaten irregularly or substances not encountered every day. Injected vaccines have a longer lasting effect and, while most people need to inject once every two days, others need only to inject once or twice a week.

Neutralisation is most effective for inhaled allergens (such as moulds, dust mites and pollens) but it also works for food allergy and intolerance, and for chemical sensitivity. (Neutralisation for chemical sensitivity is usually done by placing drops of extract under the tongue and monitoring symptoms: when symptoms are relieved, the endpoint is found.)

When neutralisation works, the effect, like desensitisation, can be magical. Symptoms melt away and it can be a boon for people with multiple allergies and sensitivity. If on a very restricted diet, it can actually enable you to eat trigger foods with virtually no problems.

Neutralisation has its drawbacks, however. Many people do not reproduce symptoms on testing with inhalant allergens, but if you do, the process of testing can be tiring and painful. Occasionally people’s symptoms do not ‘turn off at the strongest negative dilution and for them, it is necessary to continue testing until the symptoms disappear.

It can also take a while for the endpoint to become effective. The neutralising effects of the endpoint do not always work fully at first and it can take a few weeks for the effect to build up. It can be a confusing and difficult time to experience.

Many people find that they do not need the neutralising endpoints permanently. Combined with avoidance, their system recovers sufficiently to cope without, and usually within eighteen months to two years, neutralisation is no longer necessary. In a minority of people, endpoints may shift from time to time within that period (often as the individual gets better), and the vaccines need retesting. It can be tiresome and time-consuming to retest, especially if you have many allergies, but it is worthwhile to have the endpoint right again.

Neutralisation is only available on the NHS at one or two centres in the UK. It is a relatively safe procedure – no fatal nor near-fatal reactions have ever been recorded. Like desensitisation, some people do not respond to it at all, but for those who do (particularly those with multiple sensitivity, with very severe reactions, or people intolerant of drugs), it can be one of their few means of relief.

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Suppliers will not make specific claims about the levels of contaminants which are reduced. A Which? report in August 1990 showed wide variations in the purity of results from comparable filters. But people who use them report significant improvement in their water quality and say they are worthwhile. People who use plumbed-in undersink or tap filters notice a marked improvement even over jug filters.

No AC filters kill bacteria. Filters containing silver are claimed to reduce bacterial growth in the system itself. You need to take care, particularly with jug filters, not to allow bacteria to grow in standing water. If you are concerned about bacteria in a plumbed-in system, run the tap for a few minutes each morning, or after an absence from home, to allow fresh water from the mains to flow through the filter.

Minerals are not absorbed by AC filters, so tapwater retains an acceptable taste.

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• Air intake filters

• Portable interior filters

Air Intake Filters

Air intake filters work by fitting thick fabric or electrostatic filters over the air intake to the ventilation and heating system of a car, to prevent or reduce particles, such as pollens or fumes, entering the car. Air intake filters permit you to continue to run ventilation and heating systems as normal while the filter is operating. For full effectiveness, keep windows closed. One make – the Micronair – is fitted during manufacture as standard to certain models of car, and is available as optional on others (see page 427). It cannot be fitted after manufacture. Another make – the Icleen – can be fitted on cars of any make or age.

The Micronair is made of non-woven fabric with an electrostatic charge. The charge attracts particles, and the thick fabric web prevents larger particles passing. The filter has been shown on controlled tests to be 100 per cent effective against pollens and larger particles, 70 per cent effective against virtually all smaller particles, and 50 per cent effective against the tiniest of particles. The filter medium loses its charge after one year and needs replacing. This can be done by main dealers as part of a yearly service, or separately. The cost of replacement (including parts and labour) would be between £19 and £25 at 1992 prices, depending on the dealer.

The Icleen filter is made from a thinner fabric web than the Micronair, without electrostatic charge. No test information is available on performance, but reports from users say it makes a noticeable difference, especially in heavy traffic. The filter is simple to fit – a competent DIYer or any garage can do it – and needs changing every six months. A pack of two filters costs £43 (at 1992); available from SBP Limited (address below). A garage would charge about £15-20 to instal or change the filter.

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Flavourings (such as menthol or thymol) and active ingredients in toothpastes can cause reactions. Herbal toothpastes can equally give you trouble. Here are two alternative toothpowders:

• Mix one part salt with two parts sodium bicarbonate. Apply to brush with a little water and use as usual.

• Use sodium bicarbonate on its own in exactly the same way.

If you have young children and want to give them fluoride, you can give it to them in the form of drops made up with distilled water. These are available from dentists or chemists.

For cleaning dentures, mix up the salt and sodium bicarbonate powder as above, and clean the dentures thoroughly with a brush. You can use sodium bicarbonate on its own just as well if you prefer.

Soaps

Use soap sparingly. You only really need it to remove grease or severe dirt.

Two soaps that are tolerated well by people with sensitive skins and other allergies are Kays’ Vegetable Oil Soap (available in Superdrug and most supermarkets), and Simple Soap by Simple (available in most chemists). Most supermarkets also sell their own brand of ‘pure’ soap or ’simple’ soap. These are worth trying. Beware of fragrance-free soaps and look for unperfumed . Health food stores sell pure olive oil soap. Wash E45 is tolerated well by some sensitive people; ask your pharmacist.

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You may be allergic or sensitive to the materials used to make the furniture – feathers and horsehair in upholstery are common allergens, especially in older furniture. Chemicals are also a common cause if you are chemically sensitive. People are often sensitive to fumes from synthetic foams and fillings, to synthetic fibres and fabrics, and to chemical treatments on fabrics, although all of these are much less troublesome on older furniture which has aired off. Most veneered furniture is based on chipboard, also used in fitted kitchens and bedroom furniture. It gives off free formaldehyde for some time after manufacture. If you are exceptionally sensitive, it may bother you even for years if you have a lot of chipboard furniture in your home. Office furniture and surfaces in shops are often made of coated chipboard. Melamine veneers and sheets give off fumes initially but usually air off fast. Adhesives on veneered furniture can also be troublesome at first, but well tolerated in the long term.

Solid wood furniture rarely gives problems. Some people react to resinous woods, such as pine or cedar, but these are rarely a problem once they are polished or varnished. If you think you react to wood, it is extremely rare. It is more likely that you are sensitive to the actual varnish or polish that has been used on the wood.

Reactions to metal furniture are also extremely rare. Some people are sensitive to the enamel paints used on metal surfaces, but these are usually only a problem when new, or if the furniture becomes warm for any reason.

Glass and marble furniture, mirrors, stone, slate and ceramic tiles or surfaces do not cause reactions.

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If you are vegetarian, you will have realised by now that it is difficult to undertake an exclusion diet and to stick to a vegetarian regime. Some of the most common problem foods – eggs, cow’s milk, cheese, grains, nuts, beans, soya, pulses – are the building blocks of a vegetarian diet. Many vegetarians have, in food sensitivity terms, a high-risk and repetitive diet with a heavy load of potential troublemakers.

You may have to renounce your vegetarian diet for at least the period of exclusion dieting. Use unusual cereals such as sago, tapioca and buckwheat. Use pulses and nuts sparingly and only eat types that you rarely eat. Introduce fish if your principles permit, but take care as fish can be allergenic.

If You Have an Ethnic or Religious Diet

If you eat a particular diet because of your religion or because of your ethnic background, add to the list of the potentially most allergenic foods any foods that you eat a great deal as part of the diet. Do not forget spices, or flavourings such as monosodium glutamate.

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Hair analysis is inaccurate in diagnosing allergies and sensitivity and has little value. Other diagnostic tests available often involve measuring energy flow or electro-magnetic fields, such as dowsing, Vegatest electrical devices, or energy boxes. Applied kinesiology is based on measuring muscle strength. Such tests are often attractive as a means of diagnosing allergy or sensitivity, in that they are relatively quick and easy and it is tempting to think that they can do no harm, but they can do harm in that they are often inaccurate.

People whose allergies have already been identified and who know what they react to, report that they get different or varying results from such methods and that they do not find them reliable. So, if you use any of these methods, keep an open mind, use them to corroborate your own detection work, but do not allow them to send you off on wild goose chases.

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When reading brochures from any of the suggested suppliers, check the materials of each garment carefully. Some firms selling pure untreated cotton, for instance, also sell polycotton or other materials. Read brochures carefully and check with the supplier yourself if you need to.

Baby Clothes

Here’s some advice on finding clothes, especially untreated pure cotton clothes, for babies and toddlers.

Avoid cotton winceyette if you or your baby are very sensitive. Winceyette clothes, especially sleepwear, are often treated with fabric finishes. If you buy cotton poplin or denim clothes, wash them very well before using. If you or your baby are very sensitive to resins, avoid them altogether. Look for clothes made of:

• cotton jersey

• cotton tracksuit fleece

• cotton plush velveteen jersey

• 100 per cent cotton corduroy

• brushed cotton

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