• Menu
  • Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Before Header

Michelle's blog

Food allergy and food intolerance, freefrom foods, electrosensitivity, this and that...

  • Home
  • Blog
  • About
  • FreeFrom Food Awards
  • Foods Matter
  • Walks & Gardens
  • Salon Music
  • Home
  • Blog
  • About
  • FreeFrom Food Awards
  • Foods Matter
  • Walks & Gardens
  • Salon Music

The importance of ‘history’ in diagnosis, especially in allergy

20/12/2013 //  by Michelle Berridale Johnson//  Leave a Comment

In a recent post on his blog Dr Briffa bemoaned the over-reliance of the modern medical profession on ‘tests’ to the exclusion of the exercise of their clinical skills. His mini rant had been set off by an article in the BMJ by Dr Des Spence accusing modern doctors of being so fearful of sticking their necks out and ‘giving an opinion’ that they had created an endless referral system that is ‘bland, thoughtless, expensive and indecisive’.

Dr Spence is a pretty regular contributor to the BMJ (with whom I have taken issue in the past – see Bad Medicine: food intolerance) but on this occasion I, too, entirely agree with him – especially in the field of food allergy. Even the keenest supporter of skin prick or blood tests will admit that they are far from perfect, turning in a worrying number of both false positives and false negatives, and that the only really reliable method of testing for allergy is a provocation test in which the patient, under medical supervision, actually ingests the allergen.

But, if tests don’t work, how is even an initial diagnosis to be reached?

Drs Briffa and Spence both suggest that the doctor draws on his/her own clinical training and experience before resorting to either a referral or a test. Dr Briffa quotes his experience with a patient who, having suffered from a month long headache, had been referred to a private neurologist and subjected to a  battery of tests including an MRI scan without any outcome, positive or negative. When she saw Dr Briffa she explained that the pain ran up the back of her head from her neck up into her skull. A cursory examination revealed, accurately, that she was suffering from muscular tension, yet none of the doctors she had seen previously had either asked in detail about the nature of her pain or given her a physical examination.

In terms of allergy, clinical training and experience is vital but possibly even more important is the ability to think outside the conventional medical box and to be prepared to delve in some depths into both the patient’s and their family’s history.

In a short presentation at a recent Anaphylaxis Campaign conference, allergist Dr Michael Radcliffe illustrated the former with a number of case histories in which testing not only failed to help but actually muddied the picture. Such as, for example:

A patient collapsed after eating spaghetti Bolognese in a restaurant but had no known allergies, and tested negative, to all of the potential allergens in the dish. However, he did have a severe reaction each autumn to the mould/fungus, altenaria. On further investigation it was found that it had been a vegetarian spaghetti Bolognese and that the meat alternative had been Quorn – a fungus which cross reacts with altenaria.

The late, and sadly missed, Dr Harry Morrow Brown, was a stickler not only for eliciting all of the circumstances surrounding each allergic reaction but for a detailed investigation into the family history of the patient. There is a lengthy (and very well worth reading) section on testing for allergy on his website, www.allergiesexplained.com, but a few of his opening remarks well illustrate his approach:

The most important part of an allergy investigation is taking a very detailed case history, always including the family history, because if many family members also have allergies then the patient’s problems are also more likely to be due to allergy. Taking an allergic case-history properly is very interactive and time-consuming, depends on the experience and knowledge of the investigator, and is an example where art of medicine still takes precedence over science. 

An experienced Allergist will know the correct questions to ask and how to elicit and detect significant clues in the patient’s answers which may suggest the most likely causes…….

….Observant patients may have noticed important circumstantial evidence relating to their sufferings, but may not mention their experiences unless asked directly by the allergist because they do not realise that their observations are important. For this reason an experienced allergist will ask essential leading questions which are always asked again later to check for consistency.

This is not to say that, even in allergy, tests are useless – Harry Morrow Brown not only used them extensively but invented many of his own. However, tests should remain an adjunct to, not a replacement for, clinical diagnosis. As Dr Radcliffe said:

Both skin prick and blood tests can be used to diagnose and, although neither are totally reliable, they are an easy and cheap guide to allergic sensitivity. However, they should only ever be used in conjunction with the patient’s history which, for an allergist, is the key to making an accurate diagnosis.

Take heed, oh ye doctors!

 

Category: Allergies, Conventional MedicineTag: Anaphylaxis Campaign, Bad medicine: Food Intolerance, blood tests for allergy, BMJ, cross reaction between Quorn and altenaria fungus, Dr Briffa, Dr Des Spence, Dr Harry Morrow Brown, Dr Michael Radcliffe, importance of circumstantial evidence in allergy testing, importance of family history in diagnosing allergy, importance of history in allergy diagnosis, referral systems, skin prick tests, testing for allergy, www.allergiesexplained.com

Previous Post: « Radiation proof nickers – and microwaves
Next Post: More steam on the vitamin front… »

Reader Interactions

Leave a Reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

Recent Posts

  • Colliding with a new reality – the hazards of low vision
  • Call for adult allergy sufferers
  • The vegan/allergy labelling issue
  • A gluten free Christmas just could be delicious – not a penance!
  • A food fad won’t kill you – an allergy will

Search this blog

ARCHIVES

Blogroll

  • Allergy Insight
  • Better brains, naturally
  • For Ever FreeFrom
  • Free From (gluten)
  • Freefrom Food Awards
  • Gluten-free Mrs D
  • Natural Health Worldwide
  • Pure Health Clinic
  • Skins Matter
  • The Helminthic Therapy Wiki
  • Truly Gluten Free
  • What Allergy?

TOPICS

A food fad won’t kill you – an allergy will

There has been a predictable outcry in the allergy world this week’s in response to Rachel Johnson’s piece in Thursday’s Evening Standard on ‘dietary requirements’ and food fads. Being charitable, I am assuming that she has never suffered from or lived with someone with a food allergy. However, I do have some sympathy with her …

Bioplastics – a solution or part of the problem?

Everyday Plastic is a social enterprise group using accessible learning and publicity campaigns to reduce the amount of plastics used daily in our society. It was founded by its current director Daniel Webb who, having moved to Margate in Kent in 2016, was horrified to discover that there were no plastic recycling options on offer.  …

FreeFrom Christmas Awards – the Winners

Since they were launched two years ago the FreeFrom Christmas Awards have been a great success. And how lucky are ‘freefrom-ers’ these days!  From Advent calendars to gifts, party food to Christmas dinner, there is no longer any need for them to miss out. Indeed, the whole family can happily eat freefrom and never know …

Do not extradite Julian Assange to the US

Julian Assange is being sought by the current US administration for publishing US government documents which exposed war crimes and human rights abuses. The politically motivated charges represent an unprecedented attack on press freedom and the public’s right to know – seeking to criminalise basic journalistic activity. Assange is facing a 175-year sentence for publishing …

What to believe – applying critical thought

For the average citizen evaluating the claims made for cure all – or even improve all – health products and procedures has always been difficult. Not only is it an area in which we have minimal expertise but most of us have a vested interest in finding a miracle intervention that will solve our health …

Could wireless monitoring devices be killing racehorses?

Regular readers may remember that back in August last year I alerted you to a posting on Arthur Firstenberg’s Cellphone Task Force site about phone masts and bird flu. Could there be a connection between the fact that the two wildlife sites in Holland and Northern France which had suffered catastrophic bird flu deaths were …

Site Footer

Copyright © 2025 · Michelle's Blog · Michelle Berridale Johnson · Site design by DigitalJen·