THE ALLERGY RESEARCH FOUNDATION CONFERENCE
THURSDAY 18 NOVEMBER 1999
AT THE MEDICAL SOCIETY OF LONDON

DR MICHAEL TETTENBORN
Consultant Paediatrician at Frimley Park Hospital

Dr Tettenborn has treated a number of autistic children with anti-fungal and dietary intervention. In a study on 57 children at an average age of four and one month, with a average onset of autism at

• 16 months, he completed the following treatments
• 13 Had no treatment
• 24 Had anti-fungal therapy
• 9 Were put on a gluten/casein free diet
• 11 Had anti-fungal therapyand gluten free diet
• Of those treated 28 showed a marked improvement

He found that when using anti-fungals the child can often get worse before they start to improve. His cases were completed on children who fell within the following classifications:

• A clear history of onset of regression in the second year of life
• Good eye contact and finger pointing prior to regression
• A history of altered bowel habits
• A history of illness at the onset of regression
• Nasal congestion
• Increased thirst – craving milk and wheat
• Very pale face, dark shadows under the eyes
• Distended abdomen and increased flatus

My comments: These are children that, due to their physical conditions and health history are ‘perfect’ cases for anti-fungal and dietary modifications. They are probably allergic to a number of foodstuffs and have a gastro-intestinal yeast overgrowth. I need to enquire of Dr Tettenborn whether he completes organic-acid and urinary peptide tests to confirm the presence of yeast overgrowth before using this treatment protocol.
Anti-fungal Therapy
Low diet in refined sugars, yeasts and fermented products
Oral nystatin (anti-fungal) or amphotericin in a sugar free suspension if possible,
for four months
He then adjusts the dose according to response
Treatment with floconazole, a systemic antifungal (2–3 mg/kg once daily for three weeks also helps)
My comments: Using anti-fungals is great. In Billy’s case I completed a liver function test before treatment and will do another test mid treatment to see if his liver is stressed by such treatment, especially if using systemic anti-fungal therapy. The Great Smokies Laboratory’s comprehensive stool analysis also looks at the type of fungal/yeast overgrowth and advises which anti-fungal is the most appropriate to eradicate it.

DR JOHN RICHER
Consultant Clinical Psychologist in Paediatrics at the John Radcliffe Hospital in Oxford

Dr Richer suggested we give our children attachment security through holding to make them feel as secure as possible. We must interact at a basic level and try to involve them as much as possible in simple tasks. Always redirect aggression and try to introduce different tasks or items.
He suggested avoiding the following foods:

• Cow milk products
• Chocolate
• Wheat and other grains – not rice
• Sugar
• Yeast
• Additives
• Citrus
• Corn

DR ANDREW WAKEFIELD
Reader in Experimental Gastroenterology in the Departments of Medicine and Histopathology at Royal Free University College Medical School

Dr Wakefield has found that 52% of the autistic children tested have lymphoid nodular hyperplasia. This is seen in the colon and terminal ileum and not higher up in the gut. Immunologically, he noted that their IgG1 levels in these children were raised suggesting a TH2 elevation and that their CD3 were lower than normal. He feels that this lymphoid hyperplasia is antigen driven.

PROFESSOR STEPHEN CHALLACOMBE
Professor of Oral Medicine and Chairman of the Division of Oral Medicine, Pathology, Microbiology and Immunology at the new Guy’s, King’s and St Thomas’s Medical and Dental school.

Why aren't we all allergic to food? The reason is that we have developed an intolerance to foods. Oral tolerance is caused by specific immunological unresponsiveness induced by feeding antigens.This can cause intestinal hypersensitivity to food allergens and may also provide vital clues for the treatment of many inflammatory disorders. The mucosal epithelium is protected predominantly by IgA antibodies and oral tolerance can lead to an inhibited production of IgE and IgG antibodies. If there is evidence of allergens then all will be elevated. The induction and effector sites on the mucosal immune system are:

Induction sites
Tonsils, adenoids +NAL
NALT
GALT (peyers patches in ileum)
Rectum

Effector sites
Nasal
Saliva
Upper respiratory tract
Lungs
Breast
Gastro-intestinal tract

T and B cells carry IgA antibodies to all mucosal epithelial sites to protect. TH1 is suppressed by oral tolerance especially if there is a high dose of allergens and TH2 is increased. Therefore the risk of more allergens produced is higher. T cells are important for producing cytokines IL2,3,4,5,10 and interferon-y. These, especially IL4 and 10, are important cytokines in making us tolerant against allergens.

PROFESSOR GLEN GIBSON
Professor of Microbiology at University of Reading

It was concluded that yeast overgrowth and parasitic infestation are opportunists and will soon become dominant within the gut. If there is a deficiency then the good gut flora must be replaced using probiotics to improve the gut balance. The beneficial gut flora are:

• Lactobacillus acidophillus
  
• Bifidobacterium infantis
  
• Bifidobacterium langum
  
• Enterococcus faecum
  
• Lactobacillus caseo
  

He is developing a prebiotic that is a non-digestible food ingredient that boosts the already present bacteria. Probiotics have to be taken in large quantities if they are to reach the gut. Acid resistant forms are the best. More information is available from Bio Care in Birmingham (see advert on inside back cover for contact details).
When using anti-fungals especially nystatin, bifidobacteria numbers are suppressed so use a probiotic to supplement the gut.

PROFESSOR STEPHAN STROBEL.
Professor of Clinical Paediatric Immunology at Great Ormond Street Hospital for Children

Professor Strobel mentioned the ‘great 8’ food sources from which allergies generally come:

1. Milk
2. Wheat
3. Soy
   
4. Fish
5. Eggs
   
6. Peanuts
7. Tree nuts
   
8. Shellfish
   

Normal oral tolerance is when the food enters the gut and primes the immune system to respond by producing a mucosal response. When a food enters the gut and there is an immune exclusion or deviation then there is antigen exposure. If this is inherited genetically then there will already be exposure to these antigens and therefore the child remains allergic to the foods that enter its gut.
There are immediate responses to some antigens. These can be seen on the skin where a skin test is positive. Some take longer through abdominal pain, bloatedness, diarrhoea etc when a skin test is negative. Other responses may cause a multitude of disorders which affect the skin, lungs, GI tract and the central nervous system. These allergens can create havoc with the balance of the immune system with the TH2 cells in particular being elevated. Due to these allergens irritating mucosal surfaces IgA levels also increase.
If the mother already has a high number of allergens then the child may, through pregnancy, be exposed to TH2 immune disregulation during their foetal stage.
If this is the case the child may be a late birth and be more susceptible to increased risk of allergy.

DR ROSEMARY WARING
Reader in Human Toxicology at the School of Biosciences, University of Birmingham.

There is an altered biochemistry in autism seen in
abnormalities in:

• Catecholomines/neurotransmitter levels
  
• GI tract function
  
• GI tract permeability
  
• Appetite control
  
• Immune system function
  
• Reaction to drugs

Sixty per cent of autistic children come from parents with dyslexia, development disorder, eczema and asthma, learning difficulties, hyperactivity and migraine.
Dr Waring sees the sulphur transferases as not working properly. This affects the neurotransmitters and therefore brain function, thought pattern etc. Autistic children have little or no sulphation due to low sulphur transferase enzyme levels or the inability to activate them. Foods that inhibit these enzymes are: oranges, spinach, radishes, grapefruit, beetroot, peppers, pumpkins and tomatoes. Other foods that inhibit sulphation are bananas, cheese and chocolate.
Cysteine amino acid, along with sulphur containing foods, is important as a sulphate provider for the body to utilise. Cysteine oxidase is the enzyme that produces sulphate and the ratio of cysteine/free sulphate in blood plasma should be tested. In normal children the ratio is 1-100 and in autistics it is 1-500, so there seems to be a definite deficiency here. The average plasma sulphate level is 4.9 in normal children but 0.49 in autistic children.
Sulphate (SO4-2) is important for the production of mucin proteins, steroids, bile acids, phenols, cholecystokinin, catecholamines and the formation of connective tissue.
Mucin protein production is very important. If there is a deficiency in sulphation there are known links with gut dysfunction and irritable bowel. There must be enough sulphur attached to these proteins otherwise the gut wall will allow peptides through.
Cholecystokinin (cck-8) protein allows the gut to be linked with the brain structure. This stimulates the secretion of enzymes, gastric acid and gall bladder contraction. It also controls food intake.
Sulphation must also be present for digestive hormones to function properly.
Gastrin must be sulphated to release active pepsin. Pepsin activates secretin release and cholecystokinin, which when sulphated, stimulates the pancreas to release pancreatic enzymes.
My question: If there is no sulphation, protein digestion will therefore be impaired making the gut more permeable. Could this be the reason why peptides are discovered in the urine?
My comment: There is a simple test to check the sulphate levels in the urine conducted at Biolab in Wimpole Street, W1. If they find sulphate then you know it isn’t being utilised properly. If the family has a history of migraine and allergy these are caused through a deficiency in sulphurtransferase and in turn this could lead to autism in children. This for me, was the most interesting of talks as it addressed the primary functioning of the body, its biochemical activity.

MR PAUL SHATTOCK
Director of the Autism Research Unit at Sunderland.

Paul Shattock again gave a very brief look at the findings in opoid peptides in the urine of autistic children and spoke of a more recent finding (trans) indoyl-3-acryloylglycine (IAG). He has discovered that 80% of autistic children have raised levels of IAG as well as elevated levels of casein and gluten.
He came up with a simple ‘to do’ list.

• Remove ‘toxic’ components
  
• Promote enzyme activity
  
• Correct pH levels, consider betaine HCL and ensure supplement levels are correct
  
• Repair gut wall (use evening primrose oil)
  
• Increase sulphate (put a cup full of epsom salts in the bath)
  
• Use methylsulphonyl methane suppl ‡ement
  
• Use low phenolic foods.
  
• Have a gluten and casein free diet
  
• Remove sulphur utilising foods

CONCLUDING NOTES

I have tried to summarise the presentations as simply as possible. It was a wonderful day and I urge those of you who are interested to attend and support these conferences. They quite possibly hold the keys to finding a solution to the problem of autism. I feel we have the experts who can find out what has caused this epidemic and if supported and managed as an interactive unit, they will succeed in finding a cure. I personally feel we are not too far away!