San Diego Dr. Milan Brandon is San Diego's longest-practicing allergist. Since leaving the Navy in 1959, he has treated more than 30,000 patients. His son, Donald, also a physician with an interest in allergies, practices with him at their Third Avenue office in Banker's Hill. Brandon has seen a good deal of innovation in treating allergies over the years, but he doesn't quite buy the popular belief that allergies are on the rise.
"There's not necessarily a rise in the instances of allergies, but there is more awareness. Because of the media, the public has learned a lot that they wouldn't have otherwise learned. The problem now is that we're emphasizing food allergies and not putting enough emphasis on toxic allergic reactions."
According to Brandon, toxic allergic reactions are commonly mistaken as food allergies. "Take shellfish, for instance," he explains. "They're a very common cause of hives and other allergic reactions, but a lot of times the reaction is not to the shellfish, but to the shellfish being tainted. So a person will come in with a severe hives reaction, and if you just treat that patient as an allergic problem, they will take a long time to get over it. If it were a true shellfish-allergy reaction, it would clear up in 24 hours. So if you get a reaction to food that hangs on, be suspicious. It's because it's been tainted with bacteria, or some kind of degradation has taken place."
Discerning true allergic reactions from toxic reactions is usually measured by the patient's response to treatment. "If you buy some peanuts and you get an acute allergic reaction with hives and it comes on very quickly and you treat it as an allergic reaction and the patient gets over it quickly -- that's an allergy. Now, let's pretend those peanuts had a lot of aspergillus mold on them. The mold is in the powder, and that mold causes a toxic allergic reaction, which takes longer to get over. When you go buy popcorn in a theater and you get a severe reaction, you might think you're reacting to the popcorn, when you're really reacting to whatever oil was used in popping it. Some of these oils are old, and you never know how long that popcorn has been sitting around before it was popped. Don't always think that every reaction is an allergy. When we skin-test these people to these things, very often the skin-test is negative because they have a toxic reaction to other things. So someone will have a reaction to shellfish, and we'll skin-test them, and if they break out, we know that they're allergic to it. But if they have that toxic-allergic reaction and we skin-test them and find out it's negative, you can be pretty sure that they were reacting to something else."
Mistaken reactions are not limited to toxic reactions. Allergies can easily be misidentified. "Soybeans are a common offender. Soybeans are in so many foods, and people will eat stuff that has soybean in it, and they'll think they're reacting to another ingredient, when, in fact, they are reacting to the soybean. When they go eat something else that doesn't have the ingredient they thought they were allergic to and break out in hives, they don't think of looking at the label and seeing what the ingredients are in that product. If soybeans are near the top, you should be very suspicious that it's the soybeans. The most common offender is milk and dairy products."
The problem children have with milk and dairy products is usually the development of antibodies that lead to an allergic reaction. "It's primarily a problem with children. Let's say a mother is unable to nurse right away, and cow's milk is given to the baby. So the baby has no antibodies, at the time, against the cow's milk and has no allergic reaction. Then the mother is able to produce and starts nursing the baby. After she stops nursing and gives the baby milk, the baby reacts immediately to the cow's milk because it's had this long interval to develop the antibodies to the cow's milk. So even though the cow's milk did not bother it in that first week of life, the antibodies have since been developing against that milk. So when the baby is exposed to the cow's milk later on, it immediately reacts. The longer the interval between exposures, the more time there is to develop antibodies and the more risk of allergy."
Allergic reactions are one of the ways the body has to get rid of a foreign "offender." The runny nose, sneezing, and watery eyes associated with breathing in pollen are just the body's way of trying to dispose of the pollen. The problem is, allergic reactions can get a lot stronger -- to the point where the body seems at war with itself. "A lot of patients notice that if they cough up mucus from their lungs, the asthma will go away. So maybe they got rid of the allergen by coughing it up. Some doctors feel that hives occur because you haven't had enough liquids, and you're trying to eliminate the allergen through the skin. But there's no proof -- that's a hypothesis. Or you get rid of it through the kidneys or digestive tract. So if a person has a gastrointestinal food allergy and consumes that food, if they feel a reaction in their mouth, the first thing they should do is to try to spit it out. That's particularly true with peanuts, because peanuts can cause reactions so quickly that you can feel it when it hits your tongue. If it does get as far as the stomach, you'd get a lot of gas cramps, digestive upset, and diarrhea. Whether it's through vomiting or diarrhea, the body's trying to get rid of it. The allergic mechanism is partly a disposal mechanism, even though you seldom hear that concept."
If milk is one of the most common allergies for children, the myth of breast-milk safety is one of the most common misconceptions. "People have always talked about how breast milk is much safer than cow milk. Now, finally, La Leche League [an organization dedicated to promoting breast feeding] is not working as hard as it used to. After all this time, people are coming out with evidence that shows cow's milk is better than breast milk. Of course, the reason is that with breast milk, your diet changes. If mom is eating a lot of corn, then doesn't have any corn for a number of weeks, then goes on another corn binge, the baby's had time to build antibodies against the corn. So now, when the baby starts drinking mom's milk, the baby starts reacting to corn. A skin-test would be positive for corn. There are a lot of misconceptions that we've passed on because of our bias and trying to look for facts and scientific explanations."