TES ALERGI YANG TIDAK DIREKOMENDASIKAN : PEMERIKSAAN ALERGI YANG MENJERUMUSKAN KARENA TIDAK TERBUKTI SECARA KLINIS

TES ALERGI ALTERNATIF YANG TIDAK DIREKOMENDASIKAN PARA AHLI ALERGI

dr Widodo Judarwanto SpA

CHILDREN ALLERGY CLINIC
PICKY EATERS CLINIC (KLINIK KESULITAN MAKAN)
CHILDREN ALLERGY CLINIC
Jl Taman Bendungan Asahan 5 Bendungan Hilir Jakarta Pusat
telp : (021) 70081995 – 5703646
email : wido25@hotmail.com , http://alergianak.blogspot.com/

Seorang ibu sudah demikian frustasinya dalam menangani masalah alergi yang diderita anaknya. Sudah sekian banyak dokter ahli dikunjungi sudah sangat banyak obat yang diminum tetapi tidak ada hasilnya. Akhirnya ibu tersebut datang ke terapi alternatif, karena terbuai oleh informasi dan pendapat beberapa orang yang tidak berkompeten. Akhirnya bukan menyelesaikan masalah tetapi hanya membuang biaya pengobatan secara percuma.

Hal inilah yang saat ini terjadi pada sekian banyak penderita alergi yang ahirnya jatuh pada terapi alternatif. Kemajuan informasi dan tehnologi bukan hanya mengahsilkan dampak menguntungkan tetapi sebaliknya dapat membuat menjadi bingung dan menjerumuskan bila masyarakat atau para klinisi tidak pintar dalam mencerna informasi tersebut.

Meskipun tehnologi dan pengetahuan tentang penyakit alergi telah berkembang pesat, namun banyak kasus di masyarakat dijumpai penatalaksanaan masyarakat dilakukan dengan cara alternatif. Di Austalia didapatkan sekitar 50-70 % penderita alergi berobat pada terapi alternatif. Diagnosis dan terapi alternative atau yang tidak terbukti secara ilmiah ini sering disebut “diagnosis dan terapi “unproven”

Sangat banyak jenis tes alergi unproven.
1. Vega (electro-diagnostic, Bioresonansi, Bio-E) testing (Evidence Level II: inaccurate test)
2. Cytotoxic testing (“Bryan’s test”) and the Alcat test (Evidence Level II: inaccurate test)
3. Iridology (Evidence Level II: inaccurate test)
4. Kinesiology (Evidence Level II: inaccurate test)
5. IgG food antibody testing (Evidence Level II: inaccurate test)
6. VoiceBio©TM (Evidence Level: no evidence)

Terapi alternnatif tersebut saat ini banyak dilakukan di Jakarta dan kota besar lainnya adalah terapi bioresonansi atau bio-E. Sedangkan pemeriksaan atau alat diagnosis alergi yang harus dikirim ke Amerika Serikat adalah pemeriksaan IG4 atau Alcat Test. Dimana hanya dengan pemeriksaan sejumlah darah dapat diketahui ratusan makanan penyebab alergi dan penyebab penyakit lainnya. Hal ini biasanya sering dilakukan oleh para penderita Autism atau gangguan perilaku lainnya.

Keluaran menyimpang dari pemeriksaan dan pengobatan akan meningkat tidak lazim
Dengan adanya beberapa tehnik diagnosis dan terapi yang tidak lazim mengkibatkan dampak bagi prognosis dn penyembuhan penderita. Pengaruh egatif yang diakibatkan beberapa tehnik diagnosis dan pengobatan tidak lazim berpotensi terjadi kondisi yang berbahaya dan lebih serius dibandingkan perdebatan seputar reaksi simpang terhadap pengbatan herbal.
Kesalahan intepretasi dalam menentukan penyebab alergi akan mengakibatkan kesalahan dalam pemberian rekomendasi diet. Bila hal ini terjadi akan mengakibatkan kejadian malnutrisi dan gagal tumbuh pada anak.

Bila teknik diagnosis dan terapi yang akurat terlambat, maka akan mengakibatkan penannganan penyakit alergi menajdi tidak adekuat dan menimbulkan komplikasi dan kesalahan dalam penatalaksanaannya. Rekomendasi penghindaran lingkungan dan kimiawi yang tidk bermanfaat.

Penanganan dan pengobatan terapi “unproven” tidak murah

Terapi alternatif alergi selain akan mengaburkan dalam penanganan alergi juga akan dapat meyebabkan pengeluaran biaya pengobatan yang percuma. Seperti diketahui beberapa terapi dan diagnosis alergi alternatif juga mengandalkan tehnik yang mutahir tetapi yang membutuhkan investasi dana yang tidak sedikit bagi pemilik alat diagnosis. Hal ini juga akan mengakibatkan biaya terapi alternative tersebut sangat besar dan tidak ringan, apalagi bila dilakukan berulang-ulang dalam jangka panjang.

Pertanyaan bagi praktisi klinis yang masih menggunakan terapi dan diagnosis “unproven”
Meskipun terapi dan diagnosis alergi “unproven” tidak terbukti secara klinis dan ilmiah, tetapi kenyataannya sehari-hari masih sering digunakan oleh para dokter. Tetapi justru penggunanya tidak ada dari praktisi yang kompeten di bidang alergi imunologi.

Di Indonesia saat ini praktisi klinis atau dokter yang menggunakannya sampai saat ini bukan dokter ahli alergi imunologi tetapi dokter umum, dokter penyakit dalam dan dokter ahli lain di bidang alergi imunologi. Bahkan banyak pakar dalam bidang Autism di Indonesia ikut terpengaruh oleh promosi alat diagnosis tersebut. Sehingga menjadi prosedur baku untuk penanganan penderita autism dengan mengirimkan sampel darah yang harus dikirim ke Amerika.

Mengingat investasi alat tersebut tidak sedikit maka promosi jasa layanan medis tersebut bukan hanya dari mulut ke mulut tetapi sudah langsung disampaikan lewat media masa elektronik atau cetak. Bila hal ini terjadi maka pemahaman tentang penanganan alergi akan jadi lebih menyesatkan baik bagi para klinisi maupun masyarakat awam.

Bagi klinisi atau yang berkecimpung di bidang terapi alternative mungkin melakukan berdasarkan pengalaman klinis segelintir kasus dan sebagian dokter yang pernah berhasil. Tetapi mereka tidak melihat bahwa yang tidak berhasil juga sangat banyak. Sehingga secara ilmiah hal ini harus dilihat dalam kejadian ilmiah berbasis bukti berupa penelitian atau uji klinis. Hingga saat ini penelitian ilmiah tidak ada yang pernah membuktikan bahwa diagnosis dan terapi alternative tersebut tidak terbukti. Hal ini terjadi karena metodologi alat ukur tersebut tidak berkaitan dengan kaidah ilmiah baik secara biomolekular ataupun secara biofisika.

Bila para klinisi atau para dokter saling berkontroversi maka masyarakat awam sebagai penerima jasa berada dalam posisi yang membingungkan. Sedangkan secara legal saat ini belum ada regulasi yang mengatur hal ini. Akibatnya banyak pertanyaan dan tuntutan dari beberapa pihak kepada para praktisi pengguna terapi alternative tersebut :

1. Bagaimana secara ilmiah dan rasional alat diagnosis tersebut bekerja ?
   


2. Apakah ada pengalaman klinis yang pernah di publikasikan tentang penggunaan alat tersebut. Bila ada, apakah hal itu dapat ditemukan di Medline/Pubmed?
   


3. Apakah resiko dan manfaatnya ?
   


4. Berapa banyak biaya yang dikeluarkan oleh alat dan terapi ini ?
   


5. Apakah ada efek samping dalam penanganannya
   


6. Mengapa beberapa dokter merekomendasikan penanganan tersebut ?
   


7. Apakah kulifikasi dan kompetensi dokter yang member rekomendasi penanganban penyakit ini ?
8. Bagaimana bisa satu alat bisa mendeteksi dan menyembuhkan beberapa masalah kesehatan yang berbeda ?

Dalam menghadapi kontrovesi yang berkepanjangan ini, sebaiknya pihak yang berkontroversi harus dihadapkan dalam satu forum ilmiah. Untuk memastikan bahwa semua tindakan tersebut nantinya tidak akan malah dapat merugikan penderita alergi baik secara medis ataupun secara financial. Semua pihak khususnya para klinisi sebaiknya lebih utama menjunjung etika kedokteran dan etika ilmiah. Bukan hanya mementingkan kepentingan tertentu dengan mengorbankan kepentingan atau keutamaan kesehatan penderita atau pasien sesuai sumpah dokter.

Yang pasti saat ini semua organisasi profesi alergi imunologi seperti ASCIA (The Australasian Society of Clinical Immunology and Allergy), AAAI (American Academy of Allergy Asthma and Immunology) dan WAO (World allergy Organization) dan banyak organisasi alergi internasional menentang keras dan tidak pernah sekalipun merekomendasikan pemeriksaan dan penanganan terapi alternatif tersebut.

Daftar Pustaka

Eccles M,Fremantle N,Mason J. North of England based guidelines development project:methods of developing guidelines for e .cient drug use in primary care.Eduction and debate.BMJ 1998;316 :1232 –1235.IV
Harbour R,Miller J.A new system for grading recommendations in evidence-based guidelines.BMJ 2001;323 (7308):334 –6.IV
Bandolier Library.Bias in diagnostic testing.Levels of evidence.http:// www.jr2.ox.ac.uk/bandolier/booth/ diagnosis/bias.html (accessed 12 February 2003)IV
Oxford Centre for Evidence-based Medicine.Levels of Evidence and Grades of Recommendations.Updated May 2001.www.Indigojazz.co/uk/ cebm/levels_of_evidence.asp (accessed 12 February 2003)IV
Sly RM.Changing prevalence of allergic rhinitis and asthma.Ann Allergy Asthma Immunol 1999;82 :233 –248.IV
Downs SH,Marks GB,Sporik R, Belosouva EG,Car NG,Peat JK. Continued increase in the prevalence of asthma and atopy.Arch Dis Child
2001;84 :20 –23.III
Burr MK,Butland BK,King S, Vaughan-Williams E.Changes in asthma prevalence:two surveys years apart.Arch Dis Child 1989;64 :1454 –1456.III
Magnus P,Jaakkola JJ.Secular trend in the occurrence of asthma among children and young adults:critical aparisal of repeated cross sectional surveys.BMJ 1997;314 :1795 –1799.IV
Schultz LF.Atopic dermatitis:a genetic-epidemiologic study in a popula- tion-based twin sample.J Am Acad Dermatol 1993;28 :719 –723.III
Schultz LF,Diepgen T,Svensson A. The occurrence of atopic dermatitis in
north Europe:an international questionnaire study.J Am Acad Dermatol 1996;34 :760 –764.III
Schultz LF.Atopic dermatitis:an increasing problem.Pediatr Allergy Immunol 1996;7 :51 –53.IV
Høst A,Halken S.The role of allergy in childhood asthma.Allergy 2000;55 :600 –608.IV
Wahn U.What drives the allergic march?Allergy 2000;55 :591 –599.IV
Halken S,Høst A.The lessons of noninterventional and interventional prospective studies on the development of atopic disease during childhood. Allergy 2000;55 :793 –802.IV
Trindade JC.The importance of diagnosis of allergy in early wheezing. Pediatr Allergy Immunol 1998;9 :23 –29. IV
Hattevig G,Kjellman B,Johansson SG,Bjorksten B.Clincial symptoms and IgE responses to common food proteins in atopic and healthy children. Clin Allergy 1984;14 :551 –559.II
Eigenmann PA,Calza AM.Diagnosis of IgE-mediated food allergy among Swiss children with atopic dermatitis. Pediatr Allergy Immunol 2000;11 : 95 –100.III
Silvestri M,Oddera S,Rossa GA et al.Sensitization to airborne allergens in children with respiratory symptoms. Ann Allergy Asthma Immunol 1996;76 :239 –44.III
Crimi P,Minale P,Tazzer C et al. Asthma and rhinitis in schoolchildren: the impact of allergic sensitization to aeroallergens.J Invest Allergol Clin Immunol 2001;11 :103 –6.III.
Boulet L-P,Turcotte H,Laprise C et al.Comparative degree and type of sensitization to common indoor allergens in subjects with allergic rhinitis and/or asthma.Clin Exp Allergy 1995;27 :52 –59.III
Martinez MD,Wright AL,TaussiLM et al.Asthma and wheezing in the.rst six years of life.N Engl J Med 1995;332 :133 –138.II
Haby MM,Peak JK,Marks GB et al. Asthma in pre-school children:prevalence and risk factors.Thorax 2001;56 :589 –95.II
Tariq SM,Matthews SM,Hakim EA et al.The prevalence of and risk factors for atopy in early childhood:a whole population birth cohort study.J Allergy Clin Immunol 1998;101 :587 – 93.II
Mu¨ ller UR.Hymenoptera venom hypersensitivity:an update.Clin Exp Allergy 1998;28 :4 –6.II
Salkin AR,Cuddy PG,Foxworth JW.The rational clinical examination. Is this patient allergic to penicillin? An evidence-based analysis of the likely hood of penicillin allergy.JAMA 2001;285 :2498 –505.II
Brehler R,Kutting B.Natural rubber latex allergy.Arch Intern Med 2001;161 :1057 –1064.IV
Bruijnzeel-Koomen CAFM,Ortol-ani C,Aas K et al.Adverse reactions to foods:position paper.Allergy 1995;50 :623 –635.IV
Dreborg S.Skin tests used in type I allergy skin testing.Position paper prepared by the Subcommittee on Skin Tests of the European Academy of Allergology and Clinical Immunology. Allergy 1989;44 (suppl):22 –59.IV
EAACI Subcomittee on Allergen Standardization and Skin Tests.Position Paper:Allergen standardization and skin tests.Allergy 1993;48 (suppl):48 –82.IV
Position statement.Allergen skin testing.From the Board of Directors:J Allergy Clin Immunol 1993;92 :636 –7.IV
Dreborg S.Skin testing in allergen standardization and research.Dolen WK,editor.Skin Testing.Immunol Allergy Clinics N Am 2001;21 :329 –54.
Ahlstedt S.Understanding the usefulness of speci .c IgE tests in allergy. Clin Exp Allergy 2002;32 :11 –6.IV
Yman L.Standardization of in vitro methods.Allergy 2001;56 (suppl 67):7 4.
Dolen WK.Skin testing and immunoassays for allergen-speci .c IgE:a
workshop report.Ann Allergy Asthma
Immunol 1999;82 :407 –12.IV
Sanz ML,Prieto I,Garcia BE et al. Diagnostic reliability considerations of specific IgE determination.J Invest
Allergol Clin Immunol 1996;6 :152 –61.IV
Dreborg S.Diagnosis of food allergy: tests in vivo and in vitro.Pediatr. Allergy Immunolol 2001;12 (Suppl.14): 24 –30.IV
Kjellman NM,Johansson SG,Roth. A.Serum IgE levels in healthy children quantified by a sandwich technique (PRIST).Clin Allergy 1976;6 (1):51 –59.II
Zetterstrom O,Johansson SG.IgE concentrations measured by PRIST in serum of healthy adults and in patients with respiratory allergy.A diagnostic approach.Allergy 1981;36 (8):537 –47. III
Yunginger JW,Ahlstedt S,Eggle-ston PA et al.Quantitative IgE antibody assays in allergic diseases.J
Allergy Clin Immunol 2000;105 :1077 – 84.IV
Niggemann B,Wahn U,Sampson HA. Proposals for standardization of oral food challenge tests in infants and children.Pediatr Allergy Immunol 1994;5 :11 –13.IV
Eigenmann PA,Sampson HA.Interpreting skin prick tests in the evaluation of food allergy in children.Pediatr Allergy Immunol 1998;9 (4):186 –91.III
Sampson HA.Food allergy.Part 2: diagnosis and management.J Allergy Clin Immunol 1999;103 :981 –9.IV
Sampson HA.Utility of food-specific IgE concentrations in predicting symptomatic food allergy.J Allergy Clin Immunol 2001;107 :891 –6.II
Sampson HA,Ho DG.Relationship between food-speci .c IgE concentrations and the risk of positive food challenges in children and adolescents.J Allergy Clin Immunol 1997;100 :444 –51.II
Garcia-Ara C,Boyano-Martinez T,Diaz-Pena JM,Martin-Munoz F, Reche-Frutos M,Martin-Esteban M.Speci .c IgE levels in the diagnosis of immediate hypersensitivity to cow ’s milk protein in the infant.J Allergy Clin Immunol 2001;107 (1):185 –0.II
Boyano-Martinez T,Garcia-Ara C, Diaz-Pena JM,Martin-Esteban M. Prediction of tolerance on the basis of quanti .cation of egg white-speci .c IgE antibodies in children with egg allergy. J Allergy Clin Immunol 2002;110 (2):304 –9.
Medillo G,Aas K,Cartier A, Davies RJ,Debelic M,Dreborg S, Kerrebijn KF,Lassen A,Pinto Mendes J, Rizzo A, Rosenthal RR, Tateishi S, Corsico R. Guidelines for the standardization of bronchial provocation test with allergens.Allergy 1991;46 :321 –329.IV
Dreborg S.Conjunctival Provocation Test (CPT).Allergy 1985;40 (Suppl 4):66 –7.IV
Silvestri M,Oddera S,Rossa GA et al.Sensitization to airborne allergens in children with respiratory symptoms. Ann Allergy Asthma Immunol 1996;76 :239 –44.III
Crimi P,Minale P,Tazzer C et al. Asthma and rhinitis in schoolchildren: the impact of allergic sensitization to aeroallergens.J Invest Allergol Clin Immunol 2001;11 :103 –6.III
Boulet L-P,Turcotte H,Laprise C et al.Comparative degree and type of sensitization to common indoor allergens in subjects with allergic rhinitis and/or asthma.Clin Exp Allergy 1995;27 :52 –59.III
Martinez MD,Wright AL,Taussig LM et al.Asthma and wheezing in the first six years of life.N Engl J Med 1995;332 :133 –138.II
Haby MM,Peak JK,Marks GB et al. Asthma in pre-school children:prevalence and risk factors.Thorax 2001;56 :589 –95.II
Tariq SM,Matthews SM,Hakim EA et al.The prevalence of and risk factors for atopy in early childhood:a whole population birth cohort study. J Allergy Clin Immunol 1998;101 :587 – 93.II
Mortz CG,Lauritsen JM,Bindslev-Jensen C et al.Prevalence of atopic dermatitis,asthma,allergic rhinitis and hand and contact dermatitis in adolescents.The Odense Adolescence Cohort
Study on Atopic Diseases and Dermatitis.Brit J Dermatol 2001;144 :523 –32.III
Annus T,Bjorksten B,Mai Z_ XM et al.Wheezing in relation to atopy and environmental factors in Estonian and Swedish school children.Clin Exp Allergy 2001;31 :1846 –53.III
Brehler R,Kutting B.Natural rubber latex allergy.Arch Intern Med
2001;161 :1057 –1064.IV
Bruijnzeel-Koomen CAFM,Ortol-ani C,Aas K et al.Adverse reactions to foods:position paper.Allergy 1995;50 :623 –635.IV
Dreborg S.Skin tests used in type I allergy skin testing.Position paper prepared by the Subcommittee on Skin Tests of the European Academy of Allergology and Clinical Immunology. Allergy 1989;44 (suppl):22 –59.IV
EAACI Subcomittee on Allergen Standardization and Skin Tests.Position Paper:Allergen standardization and skin tests.Allergy 1993;48 (sup-pl):48 –82.IV
Position statement.Allergen skin testing.From the Board of Directors:J Allergy Clin Immunol 1993;92 :636 –7.IV
Dreborg S.Skin testing in allergen standardization and research.Dolen. WK,editor.Skin Testing.Immunol Allergy Clinics N Am 2001;21 :329 –54.IV
Ahlstedt S.Understanding the usefulness of speci .c IgE tests in allergy. Clin Exp Allergy 2002;32 :11 –6.IV
Yman L.Standardization of in vitro methods.Allergy 2001;56 (suppl 67):70 –4.III
Dolen WK.Skin testing and immunoassays for allergen-speci .c IgE:a workshop report.Ann Allergy Asthma Immunol 1999;82 :407 –12.IV
Sanz ML,Prieto I,Garcia BE et al. Diagnostic reliability considerations of specific IgE determination.J Invest Allergol Clin Immunol 1996;6 :152 –61.IV
Dreborg S.Diagnosis of food allergy: tests in vivo and in vitro.Pediatr Allergy Immunolol 2001;12 (Suppl.14): 24 –30.IV
Kjellman NM,Johansson SG,Roth A.Serum IgE levels in healthy children quanti .ed by a sandwich technique (PRIST).Clin Allergy 1976;6 (1):51 –59. II
Zetterstrom O,Johansson SG.IgE concentrations measured by PRIST in serum of healthy adults and in patients with respiratory allergy.A diagnostic approach.Allergy 1981;36 (8):537 –47. III
Yunginger JW,Ahlstedt S,Eggle-ston PA et al.Quantitative IgE antibody assays in allergic diseases.J Allergy Clin Immunol 2000;105 :1077 – 84.IV
Niggemann B,Wahn U,Sampson HA. Proposals for standardization of oral food challenge tests in infants and children.Pediatr Allergy Immunol 1994;5 :11 –13.IV
Eigenmann PA,Sampson HA.Interpreting skin prick tests in the evaluation of food allergy in children.Pediatr Allergy Immunol 1998;9 (4):186 –91.III
Sampson HA.Food allergy.Part 2: diagnosis and management.J Allergy Clin Immunol 1999;103 :981 –9.IV
Sampson HA.Utility of food-specific IgE concentrations in predicting symptomatic food allergy.J Allergy Clin Immunol 2001;107 :891 –6.II
Sampson HA,Ho DG.Relationship between food-speci .c IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997;100 :444 – 51.II
Garcia-Ara C,Boyano-Martinez T, Diaz-Pena JM,Martin-Munoz F, Reche-Frutos M,Martin-Esteban M.Specific IgE levels in the diagnosis of immediate hypersensitivity to cow ’s milk protein in the infant.J Allergy Clin Immunol 2001;107 (1):185 –0.II
Boyano-Martinez T,Garcia-Ara C, Diaz-Pena JM,Martin-Esteban M. Prediction of tolerance on the basis of quantification of egg white-speci .c IgE antibodies in children with egg allergy. J Allergy Clin Immunol 2002;110 (2):304 –9.
Medillo G,Aas K,Cartier A, Davies RJ,Debelic M,Dreborg S, Kerrebijn KF,Lassen A,Pinto Mendes J, Rizzo A, Rosenthal RR, Tateishi S, Corsico R. Guidelines for the standardization of bronchial provocation test with allergens.Allergy 1991;46 :321 –329.IV
Dreborg S.Conjunctival Provocation Test (CPT).Allergy 1985;40 (Suppl 4):66 –7.IV
American Academy of Allergy: Position statements -- Controversial techniques. Journal of Allergy and Clinical Immunology 67:333-338, 1980. Reaffirmed in 1984.
Chambers VV and others. A study of the reactions of human polymorphonuclear leukocytes to various antigens. Journal of Allergy 29:93-102, 1958.
Lieberman P and others. Controlled study of the cytotoxic food test. JAMA 231:728, 1974.
Benson TE, Arkins JA. Cytotoxic testing for food allergy: Evaluations of reproducibility and correlation. Journal of Allergy and Clinical Immunology 58:471-476, 1976.
Lehman CW. The leukocytic food allergy test: A study of its reliability and reproducibility. Effect of diet and sublingual food drops on this test. A double-blind study of sublingual provocative food testing: A study of its efficacy. Annals of Allergy 45:150-158, 1980.
New York Academy of Medicine Committee on Public Health. Statement on cytotoxic testing for food allergy (Bryan's test). Bulletin of the New York Academy of Medicine 64:117-119, 1988.
Lessof MH and others. Food intolerance and food aversion. A joint report of the Royal College of Physicians and the British Nutrition Foundation. Journal of the Royal College of Physicians of London 18(2), April 1984.
Saywer CE, Adams AH. The cytotoxic leukocyte test. A position statement of the ACA Council on Nutrition. ACA Journal of Chiropractic 21(2):59-61, 1987.
Hecht A: Lab warns cow: Don't drink your milk. FDA Consumer 19(6):31-32, 1985.
Bartola J: Cytotoxic test for allergies banned in state. Pennsylvania Medicine 88:30, Oct 1985.
Proposed notice: Medicare program; Exclusion from Medicare coverage of certain food allergy tests and treatments. Federal Register 48(162):37716-37718, 1983.
Cytotoxic testing for allergic diseases. FDA Compliance Policy Guide 7124.27, 3/19/85.
Becker EL. Elements of the history of our present concepts of anaphylaxis, hay fever and asthma. Clin Exp Allergy 1999; 29: 875-895.
Chinen J, Shearer WT. Advances in Asthma, Allergy and Immunology Series 2004: Basic and clinical immunology. J Allergy Clin Immunol 2004; 114: 398-405.
MacLennan AH, Wilson DH, Taylor AW. The escalating cost and prevalence of alternative medicine. Preventative Med 2002; 35: 166-173.
Andrews L, Lokuge S, Sawyer M, Lillwhite L, Kennedy D, Martin J. The use of alternative therapies by children with asthma: a brief report. J Paediatr Child Health 1998; 34: 131-4.
Wilkinson JM, Simpson MD. High use of complementary therapies in a New South Wales rural community. Aust J Rural Health 2001; 9: 166-71.
Simon A, Worthen DM, Mitas JA. An evaluation of iridology. JAMA 1979; 242: 1385-1387.
Ludke R, Kunz B, Seeber N, Ring J. Test retest-reliability and validity of the kinesiology muscle test. Complem Ther Med 2001; 9: 141-5.
Lewith GT, Kenyon JN, Broomfield J, Prescott P, Goddard J, Holgate ST. Is electrodermal testing as effective as skin prick tests for diagnosing allergies? A double blind, randomised block design study. BMJ. 2001; 322 :131-4.
Benson TE, Atkins JA. Cytotoxic testing for food allergy; evaluations of reproducibility and correlation. J Allergy Clin Immunol 1976; 58: 471-6.
Markham AW, Wilkinson JM. Complementary and alternative medicines (CAM) in the management of asthma: an examination of the evidence. J Asthma 2004; 41: 131-9.
Ernst E. Serious adverse effects of unconventional therapies for children and adolescents: a systemic review of recent evidence. Eur J Pediatr 2003; 162: 72-80
Niggemann B, Gruber C. Side-effects of complementary and alternative medicine. Allergy 2003; 58:707-16.
Goldrosen MH, Straus SE. Complementary and alternative medicine: assessing the evidence for immunological benefits. Nature Reviews Immunology 2004; 4: 912-21.
Holgate ST. The epidemic of asthma and allergy. J R Soc Med. 2004; 97: 103-10.
Becker EL. Elements of the history of our present concepts of anaphylaxis, hay fever and asthma. Clin Exp Allergy 1999; 29: 875-895.
May CD. Food allergy – lessons from the past. J Allergy Clin Immunol 1982; 69: 255-259.
Schafer T. Epidemiology of complementary alternative medicine for asthma and allergy in Europe and Germany. Ann Allergy Asthma Immunol 2004; 93: S5-10.
Bielory L. The science of complementary and alternative medicine: the plural of anecdote is not evidence. Ann Allergy Asthma Immunol 2004; 93: S1-4.
Ernst E. Serious adverse effects of unconventional therapies for children and adolescents: a systemic review of recent evidence. Eur J Pediatr 2003; 162: 72-80
Niggemann B, Gruber C. Side-effects of complementary and alternative medicine. Allergy 2003; 58:707-16.
Robertson DAF, Ayres RCS, Smith CL, Wright R. Adverse consequences arising from misdiagnosis of food allergy. Br Med J 1988; 297: 719-720.
Liu T, Howard RM, Mancini AJ, Weston WL, Paller AS, Drolet BA, Esterly NB, Levy ML, Schachner L, Frieden IJ. Kwashiorkor in the United States: fad diets, perceived and true milk allergy, and nutritional ignorance. Arch Dermatol. 2001; 137: 630-6.
Kenyon JN. Food sensitivity, a search for underlying causes. Case study of 12 patients. Acupunct Electrother Res 1986; 11: 1-13.
Ernst E. Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination. Vaccine. 2001; 20 (suppl 1): S90–S93
Wilson K, Busse JW, Gilchrist A, Vohra S, Boon H, Mills E. Characteristics of pediatric and adolescent patients attending a naturopathic college clinic in Canada. Pediatrics. 2005; 115: 338-43.
Eysink PED, de Jonge MH, Bindels PJE, Scharp-van der Linden VTM, de Groot CJ, Stapel SO, Aalberse RC. Relation between IgG antibodies to foods and IgE antibodies to milk, egg, cat, dog and/or mite in a cross-sectional study. Clin Exp Allergy 1999;29:604-10
Aalberse RC, van der Gaag R, van Leeuwen J. Serologic aspects of IgG4 antibodies. J Immunol 1983; 130;2:722-6
Wüthrich B. Specific IgG antibodies as markers of adverse reactions to food. Contra! Monograph Allergy 1996;32:226-7
Evidence based Medicine http://www.cebm.net/index.asp
Cochrane Reviews (via Australian National Institute of Clinical Studies) http://www.nicsl.com.au/
Medline/PubMed database of published medical articles http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
ASCIA Position Statement and Review of Unorthodox Allergy Testing and Treatments http://www.allergy.org.au/pospapers/unorthodox.htm
Quackwatch http://www.quackwatch.org/index.html
(http://www.allergy.org.au/aer/infobulletins/alternative_medicine.htm ).
http://www.allergy.org.au/pospapers/unorthodox.htm