Adrian Morris, MBChB, DCH, MFGP, Dip Allergy(SA)2 Burnham Rd, Constantia, Cape Town, South Africa

Many unconventional allergy tests are available whichpurport to diagnose a number of maladies. Tests rangefrom electrodermal tests to trace metal estimation inhair samples.1 These unvalidated tests are promoted bycomplementary and alternative medicine (CAM) practi-tioners. Superficially many of these tests sound plausi-ble, but are based on unproven theories and explainedwith simplistic physiology. Most of these tests diag-nose non-existent illnesses,2,3 are a waste of money,and divert attention from actual allergies, thus delayingconventional treatment that may offer genuine allergyrelief. CAM practitioners base their allergy tests on contro-versial theories about what might cause allergies.Examples include:• Chemical fumes from cleaning solvents, petrol,

paints and perfumes• Electromagnetic radiation from power lines and elec-

tronic devices• Food with traces of colourings, antibiotics, pesticides

and preservatives• Micro-organisms such as Candida albicans and exot-

ic parasites• Prescription and over-the-counter medication• Multiple foods such as wheat, yeast, sugar and cof-

fee• Endogenous hormones particularly progesterone.

WHO 'TESTS' THEIR TESTS?

CAM practitioners cite anecdotal case reports and clin-ical studies published in fringe medical journals.Individuals may well develop non-specific irritant reac-tions and side-effects to medication or vaso-activeamines occurring in foods but this is of a non-allergicnature. Environmental or multiple chemical sensitivi-ties, systemic candidiasis, attention deficit disorder(ADDH) and chronic fatigue are commonly diagnosedas resulting from 'allergies' to various environmentalchemicals and naturally occurring fungi and parasites.Although Candida can cause vaginitis and oral thrush,there is no convincing evidence that systemic infec-

tions are related to allergy.4,5 Exotic parasite infesta-tions are diagnosed on a droplet of blood with no con-vincing supportive evidence. Few of these tests areever validated, checked or run with control samples.None is routinely recalibrated or appraised with recog-nised scientific checks of equipment. A recent article in Britain's Daily Mail newspaper(19/11/05) reported on an adolescent girl who tested'positive' to 33 toxic chemicals found in householdcleaners, foods and the modern 'environment'. Thiscaused enormous consternation to her caregivers butwhen one considers the accuracy of these tests andwhether traces of chemicals in hair samples or otherbody fluids have any health implications at all, theunnecessary anxiety generated by these 'tests'becomes apparent. Once many of these fictitious conditions are diag-nosed, the naïve patient is then put onto various elimi-nation diets, rotation diets and many unnecessaryvitamin and trace element supplements. Herbal reme-dies such as ephedria (now banned in USA), spirulina,grape seed oil, nettle, vitamin C and more recently flaxseed oil are prescribed and symptom improvementmay be related to undisclosed 'salting' with steroids inthese so-called natural remedies.6 The illegal addition ofcorticosteroids to these 'natural and traditional' reme-dies gives them obvious therapeutic effect but mayresult in dangerous side-effects if used for prolongedperiods of time.7

Warner8 is of the opinion (and I agree with him) thathealth journalists are unlikely to investigate or exposethese pseudoscientific tests as fallacious for fear ofalienating their 'complementary medicine' readership.Some of these CAM allergy tests may someday beproved to be safe and efficacious, but to date no con-vincing studies have proved any of their efficacies indiagnosing allergies.This article reviews the common 'allergy tests' used bycomplementary and alternative medical practitioners.

SOME COMMON TESTS

The leucocytotoxic test (Bryan's test)

Bryan's leukocytotoxic test was originally developed in1956 by Black, and further elucidated by Bryan in 1960.The basis of the test is that if the patient's white bloodcells are mixed with the offending allergen, they swell.The test then measures any swelling of the leukocytesand if a certain threshold of swelling is measured, usinga Coulter counter, a positive result is recorded. Studiesto date have shown poor correlation between this testand clinical allergy. The marketers, who rely on anec-dotal evidence of efficacy, do not mention these disap-pointing clinical studies. A large number of allergensare tested for and patients are usually positive to anumber of foods, additives and other agents. Personalcommunication with Katelaris in Australia andSteinman in South Africa plus Lieberman's study9 inUSA confirm that preliminary studies on the ALCATtest found no diagnostic accuracy. At present the testis also marketed under the name 'Nutron'. Despiteclaims to the contrary, no large studies have evershown the test to be accurate despite its having beenavailable for over 50 years!

COMPLIMENTARY AND ALTERNATIVEALLERGY TESTS

ABSTRACT

This article reviews the common tests employed bycomplementary and alternative medical practitionersto diagnose allergies and intolerances. These testsinclude VEGA, applied kinesiology, hair analysis,auriculo-cardiac test, stool and live blood analysis,leucocytotoxic tests and IgG ELISA tests. None ofthese tests has proven to be as accurate as specificIgE measurement in allergy diagnosis and they can-not be recommended.

Correspondence: 2 Burnham Rd, Constantia 7800. Tel 021-797-7980,fax 021-683-5335, email adrianm1@telkomsa.net

22 Current Allergy & Clinical Immunology, March 2006 Vol 19, No.1

The original protagonists of theALCAT test (which includes theleucocytotoxic test and Nutrontest) could only cite a few non-peer-reviewed congress abstractsas evidence that it worked, whilethe antagonists (personal commu-nication with the leading opinionleaders in the field of food allergysuch as Bindslev-Jensen, Potterand Katelaris) have substantial

data on record to show a poor diagnostic accuracy. Thelack of mainstream acceptance of these tests is oftenblamed on 'a conspiracy' by the larger multinationaldiagnostic companies trying to remove the defencelessopposition from the market. This perception is not atrue reflection of the situation.

The IgG ELISA allergy test

Another allergy test of questionable accuracy is IgGELISA test. This test measures IgG antibodies to vari-ous foods which should not be confused with IgE anti-body testing in conventional RAST and UniCAP. Mostpeople develop IgG antibodies to foods they eat andthis is a normal non-specific response. There is no con-vincing evidence to suggest that this test has any aller-gy diagnostic value.10,11 In fact, the IgG response mayeven be protective and prevent the development of IgEfood allergy! IgG4 antibodies produced after high levelcat allergen exposure in childhood confer cat allergyprotection and not sensitisation.12

Applied kinesiology (muscle testing)

Applied Kinesiology was developed in the USA byGoodhart in 1964 and relies on energy fields within thebody to diagnose allergy and intolerance. Kinesiology ispopular among chiropractic practitioners in the South

Africa. In this test, the practitionertests the patient's musclestrength when the allergen isplaced in a vial in front of them.The shoulder strength (deltoidmuscle) is usually tested forweakness. The patient holds outan arm and the practitionerapplies a counter pressure - if thepatient is unable to resist thecounter pressure, the test is con-sidered positive to that allergen.The antidote to the allergy is then

also held in front of the patient and if their weakness isreversed - this indicates it is the correct antidote. Thereare a number of variations to the technique of muscletesting and many practitioners complement the test byholding a magnet in front of the patient. There is noconvincing evidence that this test has any useful role toplay in allergy diagnosis.1,13

VEGA testing (electrodermal testing)

This test was developed by German physician DrReinhold Voll in 1958. The VEGA test (or electrodermal

test) involves measuring electro-magnetic conductivity in the bodyusing a Wheatstone bridge gal-vanometer. The patient has oneelectrode placed over anacupuncture point and the otherelectrode is held while a batteryof allergens and chemicals are

placed in a metallic honeycomb. A fall in the electro-magnetic conductivity or a 'disordered reading' indi-cates an allergy or intolerance to that allergen. Newer

transistorised/computerised versions of the originalVEGA or Voll test are called Dermatron, BEST,Quantum and LISTEN Systems which have a similarapplication and give more rapid results. Some claim totest for 3 500 allergens in 3 minutes! Katelaris et al.14and Lewith et al.15 performed independent double-blindtesting, comparing VEGA testing with conventionaltesting in known allergy sufferers, and the VEGA testshad no reproducibility or diagnostic accuracy at all.1 Themanufacturers aggressively promote the test and offerfree training courses for potential 'allergy' diagnosti-cians.

Hair analysis testing in allergy

Hair is analysed for allergies in two ways. First of all,the hair is tested for toxic levels of heavy metals suchas lead, mercury and cadmium and then deficiencies ofselenium, zinc, chromium, manganese and magne-sium.There is no scientific evidence to support thehypothesis that these heavy metals have any bearingon allergic diseases. Hair samples are usually sentaway for analysis and numerous studies have failed tofind any accuracy in hair analysis diagnosing allergies.1

Another hair test is called dowsing. The dowser swingsa pendulum over the hair and an allergy is diagnosed ifan altered swing is noted.

Auriculocardiac reflex

Suspected allergens are placed in filter papers over theskin of the forearm. A bright light is shone through theear lobe or back of hand. At the same time the pulse isassessed. If the filter paper contains an allergen towhich the patient is allergic, the pulse increases by 12or more beats per minute. To date, no scientific dataare available to validate this test.1

Provocation-neutralisation tests

The allergen is applied sublingually, or by skin injection.Increasing test doses are given until a wheal appearson the skin (provocation dose); the dose is thendecreased until the wheal disappears. This is the neu-tralisation dose which is used to treat the allergy and'desensitise' the patient. This test has also not beenvalidated by studies and has no diagnostic reliability inallergy or treatment.1

Nampudripad's allergy elimination tech-

nique (NAET)

NAET has to be the most unsubstantiated allergy treat-ment proposed to date. It consists of a combination ofmethods of diagnosing and treating allergy such askinesiology, Vega testing and acupuncture. It was pro-posed in 1983 by American chiropractor DeviNampudripad, hence its name. The premise is thatallergy (contrary to our current understanding) is due tosome form of internal energy blockage triggered byabnormal energy fields in the brain. Nampudripad pro-posed that after 20 or so treatments she can repro-gramme the brain and body energy flow and eradicateall allergies and many other diseases affectingmankind. However, as a cause of allergies, energy flowand electrical fields in the body have not ever beenproven.

Live blood analysis

With the aid of a simple microscope and a short coursein microscopy, many CAM practitioners are now pro-fessing to be able to diagnose all sorts of chronic ail-ments including allergies. The finger is pricked and afresh blood specimen is examined under the lightmicroscope for blood cell 'deterioration', rare parasites,

Current Allergy & Clinical Immunology, March 2006 Vol 19, No. 1 23

or coagulation disorders. It is impossible to determineparasitaemia, bacteraemia or coagulation abnormalitieson a drop of blood, without specialised stains and test-ing methods.

Stool analysis and microscopy for yeasts

and parasites

Fringe laboratories in the USA operate a postal service,analysing stool samples for bizarre metabolites and anarray of exotic parasites and organisms that are pur-ported to cause non-specific symptoms supposedlyrelated to lifestyle allergies. Great SmokiesLaboratories in the USA will do a full assessment ofexotic micro-organisms, bizarre biochemicals and pro-teins on a stool sample and send a 'comprehensive'report of these.

BEWARE OF ANECDOTAL AND UNSUB-

STANTIATED ALLERGY TESTS

There are a plethora of so-called tests for 'intolerances'including urine, stool and saliva as well as bioresonance(vibrational medicine) and iridology. These tests areoften promoted as 'wonder' diagnoses and anecdotalstories of lifelong allergies finally being accurately diag-nosed abound. It would be naïve for any medical prac-titioners to accept these individual anecdotal reports ofdiagnostic efficacy without any scientifically validatedstudies to prove their worth. We often read about sim-ilar tests in the media and unsuspecting patients flockto part with their hard-earned money. Conventionalmedical practitioners may be accused of bias againstthese supposedly simple and 'cheap' tests and feelpressurised to try them out. On the other hand, a con-vincing CAM practitioner armed with an impressiveallergy-diagnosing 'contraption' can talk even the mostsensible patient into believing their pseudo-scientificexplanations and anecdotal reports of allergy cures.Once patients realise that they have been incorrectlydiagnosed, they may feel embarrassed, put the matterdown to bad experience and hardly ever complain

about the treatment or costs involved. For more infor-mation on these dubious tests visit the Quackwatchwebsite at www.quackwatch.com .

REFERENCES

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4. Crook WG. The Yeast Connection. Jackson, Tennessee:Professional Books, 1984.

5. Candidiasis hypersensitivity syndrome. Executive committee ofthe American Academy of Allergy and Immunology. J. Allergy ClinImmunol 1986; 78: 271-273.

6. Niggemann B, Gruber C. Side effects of complementary and alter-native medicines. Allergy 2003; 58: 707-716.

7. Ramsay HM, Goddard W, Gill S, Moss C. Herbal creams used foratopic eczema in Birmingham, UK, illegally contain potent corticos-teroids. Arch Dis Child 2003; 85: 1056-1057.

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9. Lieberman P, Crawford L, Bjelland J, et al. Controlled study of cyto-toxic food test. JAMA 1974; 231: 728.

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11. Atkinson W, Sheldon TA, Shaath N, Whorswell PJ. Food elimina-tion based on IgG antibodies in irritable bowel syndrome: a ran-domised controlled trial. Gut 2004; 53: 1459-1464.

12. Kihlstrom A, Hedlin G, Pershagen G, Toye-Blomberg M, Harfast B,Lilya G. Immunoglobulin G4-antibodies to rBet v 1 and risk of sen-sitisation and atopic disease in the child. Clin Exp Allergy 2005; 35:1542-1549.

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14. Katelaris CH, Weiner JM, Heddle RJ, Stuckey MS, Yan KW. Vegatesting in the diagnosis of allergic conditions. Med J Aust 1991;155: 113-114.

15. Lewith GS, Kenyon JN, Broomfield J, Prescott P, Goddard J,Holgate ST. Is electrodermal testing as effective as skin prick test-ing for diagnosing allergies? A double blind randomised blockdesign study. BMJ 2001; 322: 131-134.

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