THE INFLAMMATORY RESPONSE:
IS THERE A LINK BETWEEN IGAN AND ALLERGIES?
I recently came across a valuable book,
Dr. Michael T. Murray's Natural Alternatives to
Over-the-Counter and Prescription Drugs (William
Morrow & Co., Inc., 1994). Murray, a naturopathic
physician, gives lucid explanations of how certain drug
therapies work, from headache and heartburn remedies to
anti-hypertensive and cholesterol-lowering drugs. He even
has a chapter on corticosteroids, which IgAN patients
commonly know as prednisone, the most frequently
prescribed oral corticosteroid.
Prednisone works by blocking "key
steps in the allergic and inflammatory response, including
the production and secretion of the so-called inflammatory
mediators such as histamine, prostaglandins, and
leukotrienes by white blood cells." As Murray points
out, disrupting the normal defense reaction of white cells
stops the inflammatory response, but "essentially
cripples the immune system."
Long-term use of prednisone has many
side-effects. At doses higher than 10 mg per day, some of
the common side effects of long-term use are depression
and other mental or emotional disturbances, high blood
pressure, diabetes, peptic ulcers, acne, excessive facial
hair in women, insomnia, muscle cramps and muscle
weakness, thinning and weakening of the skin,
osteoporosis, and increased susceptibility to blood clot
formation. Since long-term use also suppresses the adrenal
glands' production of natural corticosteroids,
discontinuing the drug suddenly can result in collapse and
According to Murray, "virtually
every condition treated with corticosteroids has responded
to a diet that has eliminated food allergies." Murray
cites studies done on patients with Crohn's disease,
ulcerative colitics, rheumatoid arthritis, asthma, and
eczema, all disorders commonly treated with
corticosteroids of various types.
While Murray does not refer to IgAN,
there have been studies showing some success with a
gluten-free diet in treating IgAN. Not all patients are
allergic to wheat gluten; but in some areas, Ireland being
one, IgAN commonly is secondary to another disease,
namely, celiac sprue, which involves an absolute
intolerance to gluten. Cow's milk is another food that is
highly allergenic (which is one reason IgAN patients
should consider going off all dairy products for a
six-month period to see if it helps).
A recent Italian study reported that all
but one of a dozen IgAN patients with heavy proteinuria
had their protein loss markedly reduced (or even
disappear) while on a low-antigen diet (that is, one that
is virtually free of allergenic foods). Perhaps even more
important, subsequent biopsies showed that the deposits of
IgA in patients' mesangial tissues was "significantly
reduced," along with a reduction in fibrinogen and
Many of our patients report having
allergies of various types, and some have developed
allergies after developing IgAN. Food allergies are
somewhat difficult to trace, however, for you don't
necessarily have an immediate reaction to what you're
eating. A delayed reaction is quite possible. Sometimes,
too, people actually crave the very foods to which they
are allergic. And some foods known to be highly
allergenic, such as corn, are difficult to eliminate from
the diet because they're everywhere.
There are laboratory tests for food
allergies. Serammune Labs in Reston, Virginia, performs an
ELISA/ACT that tests a single blood sample for reactions
to 235 substances, including oils, sugars, additives,
preservatives, certain pesticides and chemical compounds
as well as foodstuffs. The test is very expensive, and not
all health insurance may cover it. But it is useful for
identifying delayed hypersensitivity.
A cheaper way of doing this is to use an
elimination diet, for which Murray's book gives
instructions. After a person has been off all allergenic
foods for a period, they are rotated back into the diet,
one at a time, to see what reaction, if any, develops. One
problem with this method, however, is that it is slow and
does not account for confounding factors, such as food
coloring, or preservatives, or flavoring agents, or other
In addition to eliminating food
allergies, Murray suggests following a vegetarian diet,
because the essential fatty acids found in vegetable oils
contribute to the formation of prostaglandins that inhibit
inflammation. Fruits and vegetables are also rich sources
of such anti-oxidant compounds as beta-carotene,
bioflavonaoids, vitamins C and E, selenium, and
sulfur-containing amino acids, which are needed to protect
the body from the tremendous increase in free radicals
that takes place during an inflammatory process.
Murray also notes that pancreatin [proteolytic
enzymes isolated from fresh hog pancreas] and bromelain
[the protein-digesting enzyme of pineapple] have been
shown to be effective anti-inflammatory agents. Pancreatin
has reduced levels of circulating immune complexes, with a
corresponding clinical improvement in many cases;
bromelain appears to inhibit the formation of
pro-inflammatory compounds and block the production of
kinins, compounds that increase swelling.
A third natural anti-inflammatory agent,
curcumin (the yellow pigment of the spice turmeric), shows
anti-inflammatory effects similar to, though weaker than,
cortisone's, but without the toxic side effects, according
to Murray. This triggered a memory in me: one of the
treatments used successfully on my son was an extract of
khella/turmeric prepared by Herb Pharm in Williams,
Oregon. Now I understand why.
1. Dr. Michael T.
Murray, Natural Alternatives to Over-the-Counter and
Prescription Drugs (New York: William Morrow &
Co., Inc.), 155.
2. Ibid., 156.
3. Ibid., 157.
4. C Ferri, et al.,
"Low-Antigen-Content Diet in the Treatment of
Patients with IgA Nephropathy," Nephrology,
Dialysis, Transplantation, v. 8 (11) (1993), 1193-8.
[Reprinted from Network News, No.
6 (April, 1996)]