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 A Role for Food Intolerance in Childhood Migraine  
The following is one in an ongoing series of columns entitled Dr. Galland's Integrated Medicine by . View all columns in series

avoided during the treatment period. Three weeks after the third injection, foods shown to provoke symptoms during the open trial were again reintroduced. The outcome was assessed by a single criterion: the ability of each child to resume a full normal diet without recurrence of migraine. The results of this experiment, which involved forty children, are shown in Table 3. Eighty per cent of children receiving active treatment, but only twenty-five per cent of those receiving placebo, were able to resume a normal diet without recurrence of headache (p=0.001).

The adjuvant role of beta-glucuronidase in enhancing hyposensitization was discovered by McEwen in 196755. Uncontrolled case reports of the usefulness of EPD for hyposensitization of adolescents and adults with immediate hypersensitivity responses to specific foods were first published in 197556. Double blind placebo-controlled trials have demonstrated the effectiveness of EPD in decreasing the symptoms of seasonal allergic rhinitis provoked by grass pollen56 and in hyposensitization of children with food-induced hyperkinetic syndrome54. The mechanism by which EPD reverses food intolerance is not known. Its effectiveness in the treatment of hayfever57 implies an immunologic effect. Nonetheless, unlike conventional pollen desensitization, which elicits production of blocking antibodies58, EPD treatment of patients with allergic rhinitis does not induce blocking antibody (MS Starr, personal communication). Antigen-induced

leukocyte migration inhibition demonstrates in vitro a cell-mediated immune response which is present in IgE-mediated hayfever59. The leukocytes of cow's milk-sensitive patients with atopic eczema are also inhibited by cow's milk in this test. Brostoff showed that after successful EPD for milk allergy this inhibition disappeared (J. Brostoff, personal communication). This finding suggests that EPD hyposensitizes by reducing cellular responsiveness to allergens. The effectiveness of EPD in the treatment of childhood migraine gives weight to the hypothesis that the basis of migraine for most children is a non-atopic immunologic response to foods or other antigens.

A parallel to the combined immunologic/metabolic hypersensitivity of migraineurs can be found in atopic asthma. It is now widely accepted that atopic asthma has multiple mechanisms of pathogenesis. Contact with specific allergen (e.g. house dust mite) triggers immunologic hypersensitivity60,61, but hyper-responsiveness of the airway to pharmacologic mediators (e.g. histamine62) is also extremely important. Prolonged allergen avoidance not only decreases the frequency of allergen triggered asthmatic attacks but also decreases non-specific bronchial reactivity to histamine challenge63. Asthma is thus an excellent model of the immunologic priming of pharmacologic responsiveness. We believe that lessons learned from asthma research are relevant to migraine and that, for migraine, altered intestinal permeability may be a link between humoral/metabolic and immunologic reactivity.



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22 Litflewood J, Glover V, Sandler M. Platelet phenolsulfotranferase deficiency in dietary migraine. Lancet 1982; 2: 983-986

23 Glover V, Littlewood J, Sandler M. et al. Biochemical predisposition to dietary migraine: the role of phenolsulphotransferase. Headache 1983; 23: 53-58

24 Littlewood J.T., Glover V, Davies PTG et al. Red wine as a cause of migraine. Lancet 1988; 1: 558-559

25 Unge G, Malmgren R, Olsson P et al. Effects of dietary-protein restriction upon 5-HT uptake by platelets and clinical symptoms in migraine-like headache. Cephalalgia 1983; 3: 213-218

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31 Marteletti P, Sutherland J, Anastasi E et al. Evidence for immunemediated mechanism in food-induced migraine from a study of activated T-cells, IgG4 subclass, anti-IgG antibodies and circulating immune complexes. Headache 1989; 29: 664-670

32 Marteletti P, Stirparo G, Rinaldi C et al. Disruption of the immunopeptidergic network in dietary migraine. Headache 1993; 33: 524-527

33 Marteletti P, Bussone G, Centoze V et al. Prophylaxis of food-induced migraine with cromolyn sodium: efficacy of short- and long-term use. Cephalalgia 1989 (suppl 10): 441-442

34 Mansfield L.E., Vaughan T.R., Waller S.F. et al. Food allergy and adult migraine: double blind and mediator conformation of an allergic etiology. Ann Allergy 1985; 55: 126-129

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37 Paganelli R, Levinsky R.J., Brostoff J. et al. Immune complexes containing food proteins in normal and atopic subjects after oral challenge and effect of sodium cromoglycate on antigen absorption. Lancet 1979; 1: 1270-1272

38 Doering P. Drug therapy of food allergies. In: Perkins J. E. (ed) Food Allergies and Adverse Food Reactions. Aspen Publishers, Gaithersburg, Maryland. 1990. pp 69-79

39 Egger J. Psychoneurological aspects of food allergy. Europ J Clin Nutr 1991; 45 (suppl 1): 35-45

40 Dupont C. Barau E., Molkhou P. et al. Food-induced alterations of intestinal permeability in children with cow’s milk-sensitive enteropathy and atopic dermatitis. J Pediatr Gastroenterol Nutr 1989; 8: 459-465

41 Barau E., Dupont C. Allergy to cow’s milk proteins in mother's milk or in hydrolized cow's milk infant formulas as assessed by intestinal permeability measurements. Allergy 1994; 49: 395-398

42 Andre C. Andre F, Colin L. Effect of allergen ingestion challenge with and without cromoglycate cover on intestinal permeability in atopic dermatitis, urticaria and other symptoms of food allergy. Allergy (Denmark) 1989; 44 (suppI 9): 47-51

43 Andre C, Andre F, Colin L, Cavagna S. Measurement of intestinal permeability to mannitol and lactulose as a means of diagnosing food allergy and evaluating therapeutic effectiveness of disodium crornoglycate. Ann Allergy (US) 1987; 59: 127-130

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45 Egger J, Soothill J.F., Carter C.M. et al. Is migraine food allergy? A double-blind placebo-controlled trial of oligoantigenic diet treatment. Lancet 1983; 2: 865-869

46 Egger J. Soothill J..F., Carter C.M. et al. Controlled trial of oligo antigenic treatment in the hyperkineti. syndrome. Lancet 1985; 1: 540-545

47 Carter C.M., Urbanowicz M, Mantilla L. et al. Effects of a few food diet in attention deficit disorder. Arch Dis Childh 1993; 69: 564-568

48 Egger J. Carter C.M., Soothill J.F., Wilson J. Oligoantigenic diet treatment of children with epilepsy and migraine. J Pediatr 1989; 114: 51-58

49 Galli V, Ciecarone V, Venuta A, Ferrari P. Hemicrania and food in the child. Pediatr Med Chir 1985; 7: 17-21

50 Lucarelli S. Lendvai D, Frediam T et al. Emicrania e allergia alinientare nel bambino. Minerva Pediatr 1990; 42: 215-218

51 Mylek D. Migrena. Jako jeden z objawow alergii pokarmowej. Polski Tygodmk Lekorski 1992; 47: 89-91

52 Guariso G, Bertoli S, Cemetti R et al. Emicrania e intolleranza alimentare: studio controllato in eta evolutiva. Pediatr Med Chir 1993; 15: 57-61

53 McEwen L.M.. Hyposensitization. In: Bristoff J, Challacoimbe S.J. (eds) Food Allergy and Intolerance. Balliere Tindall, London. 1987. pp 985-994

54 Egger J, Stolla, A, McEwen L.M. Controlled trial of hyposensitization in children with food-induced hyperkinetic syndrome. Lancet 1992; 339: 1150-1153

55 McEwen L.M., Starr M.S. Enzyme-potentiated hyposensitization. I. The effects of pre-treatment with B-glucuronidase, hyaluronidase, and antigens on anaphylactic sensitivity of guinea-pigs, rats and mice. Int Arch Allergy l972;42:152-158

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 About The Author
Leo Galland, M.D. has received international recognition as a leader in the field of Nutritional Medicine for the past 20 years. A board-certified internist, Dr. Galland is a Fellow of the......moreLeo Galland MD, FACN
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