By Darin Ingels, ND

Allergies and asthma affect more than 50 million people living in the United States and comprise the sixth leading cause of physician office visits. Children with autism often have impaired immune function and may be predisposed to allergy symptoms.[i]^,[ii] Studies also show that children with autism have multiple defects in immune function and that the severity of immune dysfunction is proportional to the severity of autism.[iii] Unfortunately, allergies are often underdiagnosed and undertreated due to lack of verbal skills of the child or the lack of understanding by parents of what symptoms may be caused by allergy. The immune system produces five different antibodies (also known as immunoglobulins) in response to substances that are recognized as being foreign (e.g., bacteria, viruses, allergens, etc.). Immunologists refer to them as IgG, IgM, IgA, IgD and IgE. Each immunoglobulin serves a primary role in our normal immune function, and IgE is the one most associated with allergies. Common symptoms of allergy, including runny nose, itchy eyes, sneezing, and asthma, are often precipitated by IgE, which triggers the cascade of events leading to allergic symptoms. However, there is good evidence that many allergic reactions do not involve IgE at all and can be mediated by different immune mechanisms. Non-IgE reactions have been identified as causing neuropsychiatric symptoms such as irritability, hyperactivity, mood disorders, or cognitive deficits; gastrointestinal or motility problems; skin rashes; and sleep disturbances.[iv] Conventional allergy testing specifically looks mostly at IgE reactions (whether by blood test, intradermal, or scratch testing), so it is not uncommon for a child with autism to get allergy testing and be told they do not have any allergies. However, IgE testing excludes most non-IgE reactions and, therefore, has limited value in diagnosing these types of allergies.

Treatment of allergies usually consists of over-the-counter or prescription oral antihistamines (e.g., Benadryl®, Zyrtec®, or Claritin®), leukotriene inhibitors (Singulair®), or steroids. Nasal and inhaled steroids may also be prescribed to prevent inhaled allergy reactions. While medications may be used to suppress symptoms, they do not treat the underlying cause of allergies. Subcutaneous immunotherapy (SCIT), commonly referred to as “allergy shots” may be used to help desensitize the immune system to specific allergens, such as pollen, mold, or house dust mites. It is rarely used in the United States to treat food allergy due to its risk of triggering life-threatening (anaphylactic) reactions. However, children with autism who suffer from allergies and asthma now have a viable alternative to conventional injection immunotherapy in treating their symptoms. Although injection immunotherapy has been the gold standard for allergy desensitization for almost 100 years, over 300 published studies show that sublingual immunotherapy (SLIT) is equally or more effective than allergy shots in reducing allergy and asthma symptoms.[v]^{,[vi],[vii],[viii]} The allergy extracts used in SLIT are identical to those used in injection immunotherapy, but rather than receiving a shot on a weekly or monthly basis, oral drops are administered under the tongue, often on a daily basis.

Recent research shows that during SLIT, the allergen is absorbed into the oral mucosa. The underlying dendritic cells, which are part of the immune system, produce a series of chemicals that ultimately result in a decrease in IgE and other molecules that produce allergy symptoms as well as decreasing inflammation in target tissues.[ix]^,[x] This mechanism of action is similar to that observed in conventional immunotherapy.

Although SLIT seems relatively new in the United States, it has been used clinically for more than three decades. Its use has increased steadily in the past 15 years but mostly in other countries, especially those in Europe. There are many advantages to SLIT over injection immunotherapy. SLIT may be used in children who are not eligible to receive conventional allergy injections or who may have sensory issues that would prohibit using injections. There are no reports of SLIT causing anaphylaxis, making it a safer alternative to injections. SLIT is more convenient than injection immunotherapy, since the drops are administered at home by the parent, meaning fewer office visits and no needles. There are no significant medical disadvantages of SLIT treatment; however, many insurance companies in the United States do not reimburse for SLIT, which may be financially limiting for some individuals.

The practical application and successful use of SLIT is dependent on accurate assessment of a child’s allergies and sensitivities. Since conventional allergy tests only pick up on the serious types of allergic reactions, other assessment tools may be helpful in identifying more subtle allergic triggers. Environmental medicine physicians have specialized training in some of these alternative methods. Provocation/neutralization is a technique where a small amount of a food substance is injected just under the skin. If a child is allergic or sensitive to the food, then an area of redness will appear on the skin and the child may start to exhibit physical signs of reaction, including red ears, irritability, screaming, head banging, etc. When the neutralizing dose is subsequently injected, the area of redness goes away and the physical symptoms stop. It can be a very powerful tool for the parent to observe how specific foods affect their child. A similar technique is used to test for inhalant allergies, such as mold, pollen, or dust mites.

However, testing most children with autism with a needle technique is difficult and time consuming. Other noninvasive methods may be more suitable for these children. Electrodermal screening (EDS) is an effective method of determining a child’s sensitivities. Although there has been little research comparing EDS to conventional allergy testing, many practitioners have found it to be an invaluable tool in identifying hidden sensitivities. EDS is a noninvasive technology that allows the practitioner to measure energy patterns in the body. Dr. Alfred Gilman and Dr. Martin Rodbell won the Nobel Prize in Physiology and Medicine in 1994 by discovering that cells communicate electrically before they communicate chemically. This means we have a way of measuring how the energy of different allergens affects the energy of our own bodies.

EDS has the capacity to assess for sensitivities to foods, molds, pollen, animal dander, and even more subtle triggers, such as chemicals, hormones, and neurotransmitters. While conventional allergy testing looks specifically at IgE or IgG antibodies, EDS looks at the broader scope of immune reactions, particularly delayed reactions. It is not uncommon for a child with autism to go through allergy testing and be told that they do not have any allergies. Since the term “allergy” has a strict definition of IgE reaction, this may very well be true. However, this does not necessarily mean that the child does not react to various allergens. EDS is an effective means to measure delayed or subtle sensitivities that are often missed through conventional allergy testing.

The author of this article and other physicians has successfully treated thousands of children with autism with SLIT and has not observed any significant side effects or severe reactions to the treatment. Some children do get hyperactive or agitated during their initial course of treatment, but this usually resolves after a couple of weeks. Sometimes the dose has to be adjusted down for very sensitive children. Although injection immunotherapy can take a year or longer to begin controlling allergies or asthma, SLIT will often diminish symptoms within weeks. The combination of EDS and SLIT has enabled our practice to successfully treat children with autism for their various allergies and sensitivities. SLIT is a safe, effective treatment that should be considered as a first line therapy for the treatment of allergies and asthma in children with autism.

[ii] Careaga M, Van de Water J, Ashwood P. Immune dysfunction in autism: a pathway to treatment. Neurotherapeutics. 2010 Jul;7(3):283-92.

[iii] Trottier G, Srivastava L, Walker CD. Etiology of infantile autism: a review of recent advances in genetic and neurobiological research. J Psychiatry Neurosci. 1999;24(2):103-15.

[iv] Jyonouchi H. Autism spectrum disorders and allergy: observation from a pediatric allergy/immunology clinic. Expert Rev Clin Immunol. 2010 May;6(3):397-411.

[v] Incorvaia C, Masieri S, Berto P, et al. Specific immunotherapy by the sublingual route for respiratory allergy. Allergy Asthma Clin Immunol. 2010 Nov 9;6(1):29.

[vi] Frati F, Scurati S, Puccinelli P, et al. Development of a sublingual allergy vaccine for grass pollinosis. Drug Des Devel Ther. 2010 Jul 21;4:99-105.

[vii] Scala G, Di Rienzo Businco A, Ciccarelli A, Tripodi S. An evidence based overview of sublingual immunotherapy in children. Int J Immunopathol Pharmacol. 2009 Oct-Dec;22(4 Suppl):23-6.

[viii] Pham-Thi N, de Blic J, Scheinmann P. Sublingual immunotherapy in the treatment of children. Allergy. 2006;61 Suppl 81:7-10.

[ix] Akdis CA, Barlan IB, Bahceciler N, Akdis M. Immunological mechanisms of sublingual immunotherapy. Allergy. 2006;61 Suppl 81:11-4.

[x] O’Hehir RE, Sandrini A, Anderson GP, Rolland JM. Sublingual allergen immunotherapy: immunological mechanisms and prospects for refined vaccine preparation. Curr Med Chem. 2007;14(21):2235-44.

The latest edition of Cutting Edge Therapies for Autism has just been released and I am one of the contributing authors! My chapter on Allergy Desensitization: An Effective Alternative Treatment for Autism is the first chapter of the book and discusses how allergies and sensitivities to foods, mold, pollen, dust, animal dander, chemicals and neurotransmitters impact the function of the brain. The neurological and immune systems are intimately involved so that disruptions in immune function ultimately affect neurological function. By desensitizing the immune system to the offending allergens and controlling the diet, I find that a child’s neurological function dramatically improves. I will be releasing my chapter of the book coming soon! Stay tuned…

People who suffer from allergies and asthma now have a viable alternative to conventional injection immunotherapy in treating their symptoms. Although injection immunotherapy has been the gold standard for allergy desensitization for almost 100 years, over 300 published studies shows that sublingual immunotherapy (SLIT) is equally or more effective than allergy shots in reducing allergy and asthma symptoms. The allergy extracts used in SLIT are identical to those used in injection immunotherapy, but rather than receiving a shot on a weekly or monthly basis, oral drops are administered under the tongue, often on a daily basis.

Recent research shows that during SLIT, the allergen is absorbed into the oral mucosa. The underlying dendritic cells, which express high-affinity IgE receptors, produce IL-10 and TGF- β and upregulate indoleamine dioxygenase, a cytosolic enzyme that suppresses T-helper cell responses. This leads to a decrease in immunoglobulin E (IgE) and a reduction in recruitment and activation of proinflammatory cells in the target tissue. This mechanism of action is similar to that observed in conventional immunotherapy.

Although SLIT seems relatively new in the United States, it has been used clinically for more than three decades. Its use has increased steadily in the past 15 years, but mostly in other countries, especially those in Europe. Some critics of SLIT have argued that there is a lack of research documenting its efficacy. However, two recent meta-analyses showed that SLIT significantly reduced symptoms of allergic rhinitis and asthma, as well as decreased use of rescue medication. Studies show SLIT effectively treats allergies to pollen, mold, dust mites, animal dander, foods and latex. A 3-year study found SLIT plus allergy medication led to significant reductions in allergy symptom scores and airway hyperreactivity by 73% and 61%, respectively, while no improvement was observed in the group taking allergy medications only. Other shorter studies suggest SLIT can start to reduce allergy symptoms and asthma within weeks to months.

There are many advantages to SLIT over injection immunotherapy. SLIT may be used in
patients who failed to respond to injection immunotherapy or had an anaphylactic reaction to their injection. There are no reports of SLIT causing anaphylaxis, making it a safer alternative to injections. SLIT is more convenient than injection immunotherapy, since the drops are administered at home by the patient, meaning fewer office visits and no needles. This is ideal for children and others who may have a fear of needles. There are no significant medical disadvantages of SLIT treatment; however, many insurance companies in the United States do not reimburse for SLIT, which may be financially limiting for some individuals.

Myself and other physicians have successfully treated thousands of patients with allergies and asthma with SLIT and have not observed any significant side effects or severe reactions to the treatment. Although injection immunotherapy can take a year or longer to begin controlling allergies or asthma, SLIT will often diminish symptoms within weeks. Like any treatment, not everyone responds to SLIT and some patients do feel better with allergy injections. Nonetheless,
SLIT is a safe, effective treatment that should be considered as a first line therapy for the treatment of allergies and asthma.

In the new study, sleep habits from 32 children aged 2 to 18 years who attended a pediatric sleep center with chronic sleep initiation and maintenance problems were reviewed. Bedtime, rise time, awakenings in the night and resistance to sleeping were documented, as well as the frequency, duration and amount of melatonin taken. Melatonin was routinely given one hour before bedtime and the average amount given was about 2 mg per night. The average duration of melatonin treatment was approximately two months.

More than 90% of the children taking melatonin reported improvement in falling or staying asleep. Only three of the children reported no benefit with melatonin supplementation. However, the parents these three children were unwilling to increase the amount of melatonin, so it is unclear whether they would have improved by taking higher amounts. Parents reported that their children fell asleep faster soon after starting melatonin treatment, but it took 1 to 2 weeks until sleep patterns completely normalized. Sleep onset decreased from 90 minutes down to 25 minutes and awakenings in the night also dropped from 19 times per week to once per week. No adverse side effects with melatonin therapy were observed.

The authors also found that the effective amount of melatonin differed between age groups. Children between the ages of 2 to 6 required 1.4 mg per night of melatonin, compared with 2 mg per night in children between the ages of 7 to 11 and almost 3 mg per night in those in the 12 to 18 year-old group. Despite the increased amount of melatonin used with increased age, reductions in sleep onset and night awakenings were similar between all age groups.

Melatonin is a hormone produced by the pineal gland in the brain and plays a key role in regulating sleep patterns. Studies have shown that melatonin is effective in treating sleep disorders, jet-lag, some neurological diseases, migraine headaches and psychiatric disorders in adults. Poor quality of sleep and sleep loss has been associated with behavioral problems, hyperactivity, daytime sleepiness, fatigue and poor concentration in children. In the new study, parents reported their children were more attentive, less hyperactive, performed better in school and had better moods. This suggests melatonin may play a role in the development of ADHD in children and may be related to poor sleep habits. More research is necessary to clarify this issue. However, melatonin has been shown to be safe in children at the appropriate amounts and can help restore normal sleep patterns.