|
|
|
Autism - Is it an Allergic Disease |
|
JENNIFER WORTH reports on a conference of the Allergy Research Foundation held at the Medical
Society of London, 18th November 1999.
Chairman: PROFESSOR JONATHAN BROSKOFF
Speakers:
MICHAEL TETTENBORN
Consultant Paediatrician at Frimley Park Hospital, Surrey.
STEPHAN STROEBEL
Professor of Paediatric Immunology, Great Ormond Street Hospital, London.
STEPHEN CHALLACOMBE
Professor of Oral Medicine, Guy's Hospital, London
JOHN
RICHER
Consultant Paediatric Psychologist, John Radcliffe Hospital, Oxford.
ANDREW
WAKEFIELD
Reader in Experimental Gastroenterology, Royal Free Hospital, London.
GLENN
GIBSON
Professor of Food Microbiology, Reading University.
ROSEMARY WARING
Reader in Human Toxicology, Birmingham University.
Autism is a condition of retrogressive
brain damage occuring in children whose development had previously been normal.
The increasing
incidence of autism in the past 30 years coincides with the increase of allergic diseases. Are the
two conditions linked to a common cause?
The onset of autism relates to a number of identifiable
factors: food allergy and intolerance, immuno-deficiency, infections, antibiotics, and vaccinations.
Whether these stimuli are enough in themselves to produce autism is not known. Possibly some underlying
metabolic problem triggers all the above factors.
The autism/allergy link is strengthened by
family history. Five of the speakers had treated several hundred children who showed signs of allergic
diseases, and came from atopic families. But none of the families had a history of neurological disorders.
Dr. Tettenborn gave an encouraging talk on the success in treating autistic children with anti-fungal
diet and treatment, I.e a low-sugar, low-yeast diet which most children can follow. The regime must
be guided by a dietician and continued for a minimum of six weeks, and preferably six months, to assist
the result. If it is effective the diet should be continued indefinitely.
Anti-fungal treatment
consists of oral Nystatin, adjusted according to response, and, if effective, continued for at least
four months. Sometimes Fluconazole can be given initially for three weeks before the Nystatin.
The
alternative option of a gluten/casein free diet is more difficult to follow, but may be appropriate.
When children have not responded to an anti-fungal diet, Dr. Tettenborn said that more than half the
children managed in this way showed definite improvement, and many returned to main-stream schooling.
The other doctors in clinical practice all supported Dr. Tettenborn's anti- fungal regime, saying
that they had similar success. However, the difficulty of setting up double blind control trials meant
that it would not be acceptable to most orthodox assessments. For this reason parents may meet reluctance
from GPs
and paediatricians to support this regime.
Professor Stroebel, a member of the
International Committee on Toxicity of Chemicals in Foods, spoke of multi-systematic disorders resulting
from infant sensitisation to allergens. Physical changes in gut mucosa can lead to physical changes
in all systems of the body. The central nervous system can be affected, but it is not known how, nor
whether there is a genetic predisposition in individuals so affected.
The intestinal tract consists
of about 400 metres (1000 feet) of mucosal surface, and allergens enter the body easily via the mucosa.
The foetus will encounter allergens which pass the placenta from the mother's blood; during delivery,
new allergens will be in the delivery room; the new-born baby may be given cow's milk, which in some
babies causes milk-allergy; the growing baby will encounter household allergens and toxins, the roles
of which are unknown in the sensitisation process; after weaning, the child's food may contain chemical
toxins, and be low in minerals and vitamins; a cough or mild infection may be treated with antibiotics,
which disrupt the equilibrium of the gut flora, encouraging fungal overgrowth.
A picture was
built up of children greatly at risk to allergenic exposures. Most children are not affected, but a sizeable
minority are.
Professor Stroebel said that most cases of autism were first manifested in children
around 16-24 months old who previously had no neurological impairment. Several triggers may have
come together in the child's body to tip the balance of normal development to abnormal.
Professor
Challacombe spoke on the immunological processes in oral tolerance. He said that many children with
autism have shown a disruption of the gut flora, and proliferation of gut fungi, so a stool analysis
should routinely be carried out on autistic children.
He was critical of sedatives and mood altering
drugs, like Ritalin, which have no long-term benefits, and many dangers. He also spoke of the many
foods and drinks that affect mood and behaviour - coffee, chocolate, coca-cola, - saying that no autistic
child should consume them.
Professor Challacombe said that many autistic children have a low
mineral blood count, of zinc, manganese and magnesium, which affect the digestive processes and impair
secretion of pancreatic enzymes. Dietary supplements of these minerals will help in the treatment of
autism, but will not, alone, be a cure.
He said that secretin infusion, (an enzyme), has greatly
benefited some children, but others have shown no improvement. More data is needed.
Dr. Richer
has worked with autistic children for over thirty years, and was an early advocate of the connection
between diet and autism. He said that no diet will benefit all children. Each child must be treated
individually. He stressed that taking foods out of the diet one by one is seldom effective, because
usually several foods affect the child, and removing only one will not help. The only method of investigating
food intolerance was as described by Dr. Tettenborn, with proper supervision to ensure adequate nutrition.
Dr. Richer spoke of the importance of attachment and security and discussed communication, social
behaviour and acquired culture, in which a paediatric psychologist can yield much information. He spoke
of the need for specialist training of health workers to help autistic children but emphasised that
psychological treatment and education will be more effective if the physical state - e.g. food - has
been dealt with first. He said that, in his long experience, about two thirds of the children investigated
benefited from dietary change.
Dr. Wakefield works on inflammatory gut disorders, and
regressive developmental disorders of childhood. In 1998 he and twelve other researchers published a
paper in the Lancet.* The paper also referred briefly to a possible link between the MMR vaccination
and the onset of autism, stating it was unproven, and further studies are required. The media jumped
on this, and led the public to believe that the MMR vaccination is the cause of autism. This, Dr. Wakefield
said, is misleading , and does no service to serious clinical research.
He said that autism is
not new. Disintegrative psychosis has been recognised as a sequel to measles encephalitis since 1901.
In 1961 Asperger first described a disfunctional intestinal disorder linked to behavioural psychosis.
Viral encephalitis and the rubella virus have been known to give rise to autistic symptoms since the
1980s . A link between the measles virus and vaccine and Crohn's disease was first described in 1993.
A possible link with the MMR vaccine and autism was described in Germany and America in 1995 and 1996.
Dr. Wakefield described a pattern of colitis and ileal-lymphoid nodular hyperplasia in children with
developmental disorders, the uniformity of which, together with the historic findings, suggests that
the connection between gut and brain is real and reflects a specific disease process.
He showed
slides of endoscopic findings in autistic children, including:
Chronic inflammatory changes
in the colon;
Loss of vascular pattern, and patchy erythema;
Granularity of colonic
mucosa;
Enlarged lymphoid nodules;
He said that the 'opoid-theory' of autism dating
from 1979 imputes excessive absorption of peptides which may exert central opoid effects, leading to
disruption of normal neuro-regulation and brain development by encephalins and endorphins generated from
within.
Autism has many contributing factors, all of which require further research. Dr. Wakefield
said that excessive attention given to the possible link with autism and MMR is particularly unfortunate,
because it diverts attention from the findings of the research team at the Royal Free Hospital that
there is a link between gut and brain function. The MMR does not cause autism. However, a child with
a genetic disposition to asthma, eczema or hay fever, with food allergy or intolerance, with chemical
sensitivity, with digestive problems, with deficiency of minerals or vitamins, or with a fragile immune
system, would be at risk. For such a child the MMR could be described as the last straw that breaks
the camel's back, after which a retrogressive state of development might be observed.
* The Lancet,
28 February 1998, Vol. 351.
Professor Gibson analysed the exquisite state of equilibrium
in which the gut microflora exists, and the dangerous effects of disequilibrium. "If it goes wrong,
it goes wrong in a big way," he said.
There are many hundreds of different species of bacteria
in the gut, most of them residing in the colon. When gut dysbiosis is suspected, attempts have been
made to restore the balance by giving probiotics. Bifidobacteria and lactobacilli in yoghurt are usually
recommended. However, they have limited benefit, because most probiotics die in the upper alimentary
tract and may not even reach the colon, which is where they are mostly required.
Professor Gibson
spoke of prebiotics. These are non-digestible food ingredients that pass directly into the colon, where
they can selectively stimulate the growth of a limited number of bacteria, and alter the colonic flora
towards a healthier composition.
Experimental work is underway in combing pro- and pre-biotics,
known as synbiotics, which may prove beneficial throughout the entire alimentary system.
Many
children with autism have gut dysfunction, and parents may already be giving pro-biotics to their children.
They may wish to try prebiotics as well.
Food supplements are fructo-oligosaccharides and inulin
(natural sweeteners which can replace sugar) obtainable from Bio-care, 180 Lifford Lane, Kings Norton,
Birmingham, B30 3NT tel: 0121 433 3727.
Dr. Rosemary Waring is a biochemist researching
the sulphate levels in autistic children.
Sulphates in the blood help rid the body of waste products
by making them water soluble and therefore easily excreted. Low levels of sulphate can lead to retention
of toxins, which can lead to bio-chemical effects on the central nervous system.
232 children
with autism, matched with 86 control children, were found to have reduced levels of sulphate in blood
, and to excrete higher levels of sulphate in urine, as compared with the control group. Loss of sulphate
in urine may partly explain low blood sulphate levels, since once the process had started it would continue
on a slow, but steady, downward spiral.
Sulphation capacity affects the gastro-intestinal tract.
The mucins which line the gut are sulphated glycoproteins which rely on sulphation to maintain their
structure. Reduced sulphation has been associated with inflammation,gut dysfunction, and increased
permeability.
Proteins and peptides were found in urine from autistic children. Peptides can
show 'opoid' activity, crossing the gut wall, and penetrating the blood barrier. Such findings tend
to confirm theories on peptide transfer across the gut, into the blood stream, and then into the brain.
The balance of gastro-intestinal hormones seems to be altered in children with autism, possibly due
to the inter-action between sulphation and digestive peptide hormones. Gastrin is active when sulphated,
and so is cholecystokinin (CCK), a peptide active in both the gut and the brain. The secretion of CCK,
liberated by gastrin, releases another hormone - secretin, which stimulates the release of digestive
enzymes from the pancreas. A cascade process is started which can be blocked at any stage.
As
children with autism often have low sulphate levels, the consequence may be reduced levels of secretin,
and therefore a blocking of the essential pancreatic enzymes.
Recently, it has been reported that
some children with autism respond well to infusions of secretin . However, this is controversial, and
adverse reactions have been reported.
It might be possible to stimulate the cascade process
at an earlier point, by giving sulphated gastrin. But this has not yet been tried.
Dr. Waring
said that parents may wonder if their own child is affected by low sulphate levels, and what can be done
about it, and she gave the following advice: The Department of Bio-Sciences at Birmingham University,
Edgbaston, Birmingham, B15 2TT, tel: 0121 414 5621, will test for sulphite oxydase. If the level is
low, she advises tiny amounts (a pinch or two) of magensium sulphate (Epsom Salts) given in drinks several
times a day. Skin absorption is effective - ie Epsom Salts in the bath - or made into a thick paste,
and plastered on the child, and held in place with a bandage. She advises increased supplements of Vitamin
B6 and Vitamin C, also increased minerals, zinc and magnesium, and molybdenum, (a co-factor of sulphite-
oxydase), obtainable from Lamberts, 1 Lamberts Road, Tunbridge Wells, TN2 3EQ.
Dr. Waring
said that many children with autism showed a marked neurological improvement when their blood sulphate
level improved.
FURTHER COMMENTS
Secretin is not available on the NHS, but
treatment can be obtained privately. The Autism File, Box 144, Hampton, TW12 2FF, can advise.
Secretin
can be given homoeopathically; The British Homoeopathic Association, 27a Devonshire Street, London W1,
tel: 0171 935 216, will advise.
Paul Shattock, Autism Research Unit, University of Sunderland,
SR2 YEE, tel: 0191 510 9822, has been researching autism for twenty-five years. He can offer advice
and guidance to parents, including urine and stools analysis.
Jennifer Worth, SRN,
SCM
May 2000
This report was commissioned by Action Against Allergy, PO Box 279,
Twickenham TW1 4XQ.
Jennifer Worth is a retired ward sister and midwife. She is the author of:
"Eczema and Food Allergy", ISBN 1 872560 02 4, price £7.95 (+ £1.20 p.&p.)
"Neonatal Sensitisation
to Latex", price £2.50
"The Allergy Volcano", price £3.50
"The Treatment of Allergic Disease
by Immunotherapy", price £2.00
All available from Merton Books, Box 279, Twickenham, TW1 4QQ
Allergy Research Foundation, Middlesex Hospital, London W1N 8AA
|
|
|
