ADHD and Food Allergies, Part I
by Anthony Kane, MD
Anthony Kane, MD is a physician,
an international lecturer, and director of special education.
He is the author of a book, numerous articles, and a number
of online programs dealing with ADHD
treatment, ODD, parenting issues, and education. You
may visit his website, ADD
ADHD Advances, and sign up for the ADD ADHD Advances
There are a number of controversial areas in medicine when
it comes to ADHD. Food allergy is certainly one of them.
The classic allergic reaction, which is classified as the
type-1 hypersensitivity reaction, can be elicited by food,
but this is fairly uncommon. When we discuss food sensitivities
in ADHD we are discussing a different, not well-defined,
One of the main progenitors of the food allergy/ADHD connection
is Dr. Doris Rapp. Dr. Rapp was a pediatric allergist who noticed
that many children in her practice had significant physical and
behavioral changes when exposed to certain foods. They may have
red ear lobes, dark circles under their eyes, or glazed eyes after
eating certain foods. These children could have tremendous swings
in behavior. They can be calm one minute and wildly hyperactive
a few minutes later.
To make it more interesting, children with food allergies usually
crave the food that affects them negatively. That means a child
who is allergic to peanuts will demand peanut butter and jelly
for lunch everyday, and for the rest of the afternoon you have
to peel him off of the ceiling.
What is Food Allergy?
The classic allergic reaction operates through a very specific
mechanism. The reaction is caused when a specific type of antibody,
called IgE, reacts with a specific provoking substance called
an allergen. The result of this interaction is an allergic response
and the person is deemed allergic to that allergen.
The specific type of antibody involved in classic allergy is called
IgE. The proposed antibody mechanism for this type of food allergy
does not involve IgE, but a different antibody called IgG. This
is significant because standard allergy testing tests only for
IgE antibodies. If your child has IgG mediated sensitivity, his
allergy test is going to miss it. That means that your child may
have a severe allergy to a specific food, but your allergist will
tell you he is not allergic to it.
Why the Controversy?
Reason 1: Diagnosis
I said this was a very controversial area of medicine and here
is one of the reasons why. Food allergies are very difficult to
diagnose. One reason is that the symptoms wax and wane. When a
child has a classic allergy, for example to bee stings, then every
time a bee stings him, he will have a reaction.
Food allergies don't work that way. There seems to be a threshold
that must be exceeded before there are any symptoms. In addition,
this threshold seems to vary from day to day. On some days a food
will affect the child, and on other days it won't. Dr. Rapp explains
this phenomenon using the analogy of a barrel.
We can view each allergic child as if he has a barrel. As long
as the barrel is empty or only partially full, your child will
have no problems. Your child won't become hyperactive until his
barrel is overflowing.
Various things will fill your child's barrel. Let's say your
child is sensitive to chocolate, cats, and peanut butter. Each
of these things all can partially fill his barrel. As long as
he only has peanut butter or only plays with the cat, his barrel
is only partially full. That means that there are no symptoms
and that his behavior is fine. Then, one day he has a peanut butter
and jelly sandwich, has chocolate ice cream for dessert and plays
with the cat all afternoon. These things in combination make his
barrel overflow, and by evening he is out of control. Your child
has food allergies, but sometimes they affect him and sometimes
The barrel can change sizes. If your child has a cold or is upset
his barrel gets smaller. It takes less to make it overflow. If
he is happy his barrel is bigger. It takes more to make it overflow.
If he isn't eating well and that day he is low on certain nutrients
his barrel gets smaller.
Many traditional allergists find this barrel concept ludicrous.
It doesn't fit into the pattern of how other allergies work.
Reason 2: Method of Diagnosis
The next problem is the way in which you test for food allergies.
Dr. Rapp describes a technique called provocation-neutralization
testing. This method works as follows:
Say that a child frequently has headaches after eating eggs.
The practitioner will give an intradermal injection of egg extract.
If this elicits the child's headache, then the child tests positive
for egg allergy. Other signs of a positive test include an increase
in pulse rate of 20 points, a large skin reaction (this indicates
a classic IgE reaction), a change in the child's handwriting,
or some other physical or emotional complaint.
This last criterion "some other physical or emotional complaint"
is problematic. It is too vague. The result is that when studies
compared how several physicians evaluated the same group of patients,
their results didn't agree. For each patient if there were twenty
different doctors with twenty different sets of findings. None
of their diagnoses matched.
Reason 3: The Mechanism
As I mentioned before, the proposed mechanism is an IgG mediated
response. Some food allergists diagnose specific food allergies
by measuring IgG levels. This runs counter to all of modern allergy
Allergists give allergy shots to treat allergy. The way this
works is they give a low level of allergen, which is not enough
to elicit an IgE reaction. The dose is slowly increased until
eventually the patient can tolerate a significant exposure to
This is how it works. The repeated low-level exposure to the
allergen induces the body to make a different antibody to the
substance. This antibody attaches to the allergen and deactivates
it before IgE can cause the allergy reaction. What is this antibody
that allergists try to induce to cure their patients of their
allergies? You guessed it, IgG. So the very antibody the traditional
allergists have been inducing for decades to successfully treat
allergies, the food allergy people claim is the antibody guilty
of causing allergies.
For a traditional allergist this is nothing short of heresy.
IgG has been used for decades to treat allergies successfully.
Comes along Rapp and her friends and they claim that IgG causes
allergy? This is a little hard for some people to accept.
Just how strongly do allergists reject this idea? I once tried
to contact an Israeli physician who was a food allergy specialist
to discuss with him provocation-neutralization testing. I called
the hospital where he is on staff and asked to speak with him.
For some reason the operator instead put me through to the head
of the Department of Allergy.
I began discussing with him the theory of food allergies, provocation-
neutralization testing and IgG testing. He told me that he was
the head of a committee of allergists who were in the process
of testifying before the Israeli Knesset to get legislation passed
to make IgG testing illegal in Israel.
Can you imagine? You visit a prison in Israel. In one cell there
is car thief. In the next cell there is a mass murderer. And in
the next cell there is a guy who tested someone for food allergies.
Now that's pretty strong opposition!
here for part 2