The end of the NHS? CCGs - Power to the People?

There have been many articles, headlines (I'm thinking The Independent, Cover story 2nd April) and Blog posts deploring the end of the NHS with the Health and Social Care Act which this week become Law. Our local newspaper had a large NHS advertisement published on the same day entitled "Shutdown of NHS Suffolk", likely to have scared the living daylights out of a large percentage of its readership. I even found myself succumbing to the inner panic such propaganda aimed to ignite, fearing an end to the healthcare my children currently rely on. So widespread has the panic been that surely it *had* to be the beginning of the end of our NHS?

My biggest fear was that encouraging GPs to commission services was an ideal about forty years out of date. What practice has a stable and unchanging group of GPs these days? Every time I visit our surgery there has been a turnover of approximately a third of the GPs, some of them only GP Registrars. Long gone are the days of a "Family Doctor", a local GP who knows his or her caseload and looks after families for years, getting to know them and their needs. Just HOW are an ever-changing group of professionals, several only locums, going to have any inkling as to what services may be required in a particular area? It might have worked beautifully in bygone days, when the NHS was in its infancy and demand was substantially lower but I was slightly alarmed at the premise that today's society could support such change.

I am however a true Liberal, in the old sense of the world. I abhor Big Government, prefer self determination and am rather scathing of men in suits with little or no experience of my life making decisions which impact on me at every turn. Any semblance of decentralisation was bound to grab my interest.

So I took my head out of the sand, and decided to read. I'm barely past the first few pages but I am already feeling considerable reassured. Take Ipswich and East Suffolk. I visited our GP Clinical Commissioning Group page, and clued myself up.... breathing a huge sigh of relief. Here at least, I can see this revolutionary overhaul might just actually work. On the Clinical Executive, and the Governing Body, were names I recognised. People I knew. Most importantly professionals I respect and admire. GPs who are senior partners at the best practices in our area. There are two or three extremely successful large medical centres in our CCG. These have bought in services to support their community which have taken considerable pressure off local hospitals (ECGs done at Hadleigh for example) and speeded up routine testing. The Senior Partners for these Centres are now involved in making the new system work, and after 14 years watching at least two of them have such positive impacts on their own surgeries I am considerably more enthusiastic.

The best "bit" of the new changes, which really are revolutionary, is that the Men in Suits are almost obsolete. Politicians and Civil Servants now have less say in local healthcare, which is in the hands of the health professionals. I'm not sure there is an ideal, but I certainly wish someone had a similar idea for Education. How many teachers are sick and tired of being dictated to by Westminster and Whitehall? Politicians and Civil Servants Hell bent on "making their mark" in a Department they will have four years in at best, and in an area they have little expertise. I totally support the concept at least of devolving power to local areas to commission healthcare as they see fit. Obviously you don't want to subdivide areas into such tiny blocks that their bargaining power is reduced to little more than a whisper, but cutting out the middle man so to speak, or reducing his influence has to be a good thing. Too much money is wasted on management within the NHS and almost every area of the public sector. It's not only saving money (hopefully!) it's placing the purse strings and decision making in the hands of the professionals.

The cynic in me doubts it can be accomplished without a variety or problems, not least the apparent incompetence of almost every government in history to effect such sweeping change without making a few catastrophic miscalculations. I and the rest of the country live in hope this isn't one - and reading between the lines I suspect the Labour party actually wish this too. Overturning such a far reaching Act would be politically, financially and practically  challenge of enormous magnitude.

My biggest current concern is over data sharing, resolving the current mostly appalling communication lines between primary, secondary and tertiary care. Between community and hospital professionals, and above all from and to GPs. Hospitals like Great Ormond Street get their clinic letters typed in India - and some of ours have been sent to Ipswich Australia when a well intentioned typist googled "Ipswich Hospital"! Excellent communication is vital, it's the key which will make or break this new system. Because if GPs are not aware of 100% of a patient's healthcare they will NOT be best placed to commission appropriate services.

So I hold my breath and wait, and watch. I sincerely hope this is the major step forward it has been flagged up to be - because the NHS certainly needs to evolve from the elephant wading through custard   experience most of its users have.

Knowledge is Power, right?

You know the saying "Knowledge is Power"?  However it seems the opposite is true at times and my experiences of the NHS over the past fortnight would sadly concur. What is happening in our society and particularly in the area of the public sector which works with children and young people chills me to the bone. The rights of parents are being eroded, invalidated and belittled, and professionals even at the lowest levels are being given an overly elevated status and level of influence, their views weighted above those who know their own children best.

It is - and always has been in this country - the right of every parent to decide their child's education. Parents are RESPONSIBLE for their child's education  - which is compulsory. School, however, is not. How parents choose to deliver that education is NOT subject to State dictat and it is a fundamental liberty we should be extremely protective of. In the wake of Victoria Climbie there was a huge backlash against Home Education, purely because the press chose to advertise the fact that the poor child was "Home Educated" and did not attend school. From that moment the previous government (and  Ed Balls in particular) led an insidious campaign against the Home Educating sector and attempted to removed the rights of parents to decide their children's education. The most important point which the press, past government and campaign groups like the NSPCC (who have little to do with child protection and more to do with making profit) chose to ignore and/or keep quiet was that Victoria Climbie was not educated in any sense of the word. She did not attend school but was not Home Educated. The failings of Social Services/CYPS/Whichever trendy anachronism currently in favour were hushed up and the finger pointed at libertarians seeking to meet their children's needs as they saw fit. Very convenient. Big Government interfering as only Labour know how...

But it didn't stop there. We now have all Children's Services under CYPS (Children and Young People's Services) and Social Services is enmeshed in Education and community support. We have Children's Centres and CAFs, Health Visitors and Safeguarding, all over hyped, over zealous, and all - most worryingly - run by public sector workers who barely scraped a "C" grade in English at GCSE. They do indeed support some but a part of their remit is to watch, observe and advise on the basic premise that we can't do it alone and without their help we would be lost. Big Brother is most definitely watching you and parents have never been under such a degree of scrutiny before.

This trend towards Big Government and public sector interference in family life is subtly becoming  entrenched in society. There are manuals for everything, and more so for new parents than any other group. I utterly despise books like Gina Ford's "Contented Little Baby", written by an "expert" who had no children of her own and attempted to reduce the fundamental, organic and intuitive relationship between mother and baby to a cold science. It causes new mothers, awash with emotions and often struggling in a society lacking in female family support due to geography and modern lifestyle to question their instincts, themselves and their mothering abilities. I've written about this and the "Science of Childcare"before. The vulnerable are being exploited, cynically fed the message that there is a "right" way to do things, that we are a homogenous bunch for whom there is a recognised process. If only!

But what if you have "nothing to hide"? Why then is an intrusive, "Big Brother" type public sector a problem?

Because so much depends on WHO is observing and judging. Like writing history, any perspective is subjective, viewed through  spectacles all too often coloured with prejudice.

And that is precisely my point. There is an alarming trend towards prejudice and suspicion of those with knowledge and understanding. A judgemental public body does not expect a reaction, and certainly not an educated response. In the medical world this has been explored in a study reported here which clearly illustrated the difficulties those with knowledge and understanding of their condition face.

There is no such things as pure truth and honesty and a government - ANY government - only tells you what it is in your interest to hear, or their understanding of it. This is why the NHS continues to propagate the "EatWell Plate" despite the overwhelming evidence that our obesity epidemic is due to a diet which is carbohydrate heavy and demonises animal fats. There is a stream of educated and informed opinion on the NHS website which someone is tasked with deleting regularly, because they cannot answer it and lack the supporting evidence for their claims. The simple fact is, it might be the 21st Century but there is very little we are actually certain of - we are still learning and life is a "best fit" experiment by and large. So it is highly inappropriate for any centralised control of something which should be as individually focussed as education.

What is worse is the dissemination of these centralised "truths" via local teams of poorly informed individuals with little respect for anything - or anyone - beyond their next performance audit. 

"Safeguarding" is rammed home at every opportunity and prioritised with suspicion being paramount. Parents are encouraged to access support, revealing details of family life for public scrutiny and assessment (the comments in the copious notes made after every interaction with a health visitor, nurse etc about your child and parenting would often shock you - they can be extremely judgemental, based on little more than a passing interaction.) If you fit their preconceptions you might get lucky, otherwise YOU are the problem. The square peg in the round hole again. For example the whole CAF system is based on inputs and outputs through a flow chart. Certainly in Suffolk in the past you could only have three meetings, and if there was no resolution at the end of this process you proceeded to Child in Need. Another flow chart System and so it goes on. And if there is no convenient route to a satisfactory conclusion the finger is turned and pointed at YOU, the parents. Because unless you can proceed to the "situation improved, no further action" box the only one left is to address parenting issues..... CYPS do not even need to consult, let alone defer to any experts actually involved with your child!

There are far too many stories just from Suffolk to list but the system fails far too many. The process however is destructive, intrusive, yet ignorance is never an excuse for suspicion, yet it is legitimised in the current system.

A parent has FEWER RIGHTS in the family court than someone on trial for murder in a criminal court. Yet the way we view parents in this country is the real crime.

But I digress, this post is supposed to be about my experience over the past week.

My children have gastrointestinal problems, it's a family issue and some of us are more severely affected than others. The younger two have diagnoses of Eosinophilic Disease and there is a high probability there is an element of this in the issues the rest of us have. (See "What is EGID? in my Recipe Blog.) I've been dealing with these problems since becoming a mother 15 and a half years ago, I know a fair bit about it - I do have a brain (although much of it is still mothballed after three pregnancies and years of disturbed nights!) and also a photographic memory. I won't apologise for either and like many other mothers I seek to do the best for my children - which includes researching and attempting to make sense of their difficulties. And it's just as well I and so many others I know do this, because too many times poor communication between health professionals, mistyped clinic letters (dictated and typed in INDIA in the case of GOS) causes potentially serious errors which informed mothers are the first to pick up on. After all, we are "in the firing line" in several respects if things go wrong...

So when H ends up severely constipated and impacted and sent to hospital as an emergency by our GP I like to think the GOS plan, our experience and my knowledge of my own child might count for something.
How wrong can you be?
The suspicion of a mother who knows her child, who is willing to work with them but wants to discuss options and possibilities and actually personalise a treatment plan is so shocking they might as well have sent me home and treated him without me. Ineptitude and appalling lack of professionalism on so many levels aside (they "forgot" to order his X Ray to see if his bowel was obstructed, a life threatening scenario) I am so angry at the patronising attitude from doctors who think they are God but have never met my child before. My son was subjected to six days of seriously sub-optimal  care because they couldn't bring themselves to 1) ask me about him 2) listen when I realised they weren't asking and c) admit they were running into problems. Their refusal to deviate in ANY way from the guidelines the chose to stick to (don't get me started on those they chose to ignore) meant my non-routine child was given the wrong care and ended up in A and E two days after discharge. It takes a very strong person to stand up and say no, to question and challenge. But I did - and we made more progress in 6 hours than they did in 6 days. (The document I intend to write on Movicol will be coming in the future, for now I have written about it here.)

This trend towards a quasi Victorian social arrogance - but with the educated and informed the new victims of our perpetual dumbing down and simplification of life is as alarming as the novel "Brave New World". The powers that be feel they need to save us from ourselves and administer the new logic, whilst "safeguarding" those who are not up the mark.
Sounds like something out of the old USSR doesn't it?

Knowledge is something to be proud of, to be valued, not to be arrogant over and always to be viewed as partial - a "work in progress" to be complimented, added too, edited. Never should it be something to be ashamed of - nor lack of knowledge an excuse for poor professional judgement. A parent's knowledge of their child is invaluable, not inconsequential, and it is an arrogant and strait jacketed professional who forgets that - and who forgets that they, like anyone else, are always learning. That ignorance is expected amongst parents is a pretty cynical type of prejudice, any parent has something useful to offer in terms of information and understanding of their child.

Prejudice is endemic in society - it always has been. But the current prejudice against those who exercise their individual rights, who make choices, who inform themselves and want to work WITH the system or alongside it but who do not want or seek State control of the minutiae of their lives or engage in an endless battle against the powers that be is a prejudice we are allowing to seep unchecked into our society. It both horrifies and alarms me. It can't end well.

Feeding Tube Awareness Week

Today marks the start of Feeding Tube Awareness Week.

There are many different reasons why children and adults need feeding tubes, not always the ones you might imagine either. There are those who can't eat, and those who can't absorb enough nutrition even though they appear to eat well. Those who won't eat, because you cannot imagine the fear involved in eating if you know swallowing could cause you pain, stop you breathing, stop bowel function - association is very powerful. There are also those who can eat and must not, for whom the switch can be painful emotional, psychologically.

If you haven't been there you shouldn't judge, shouldn't assume, but neither should you feel sorry for the person with that tube. Because feeding tubes save lives, give parents back their children, give back life to adults to spend more time with loved ones, facilitate living when barely existing is the alternative. They can restore normality and health - albeit a slightly altered version.

I was so grateful for my son's tube, it gave us our bouncy, cheeky, intelligent little boy who began to enjoy life once he was feeling better. It gave us HIM as a focus instead of how much he ate and drank. Things are still a little wobbly but for us his tube has done its job, and we are hoping 2013 is the year we bid it farewell.







Feeding tube awareness is so vital for the minority of us who have to live with them. We've had many comments over the years "Give him to me...I'll get him to eat more." "But he looks all right, my kids don't eat either." and more recently "But he eats really well, why on earth would he need a tube?"





Just like any other disability, awareness is key, because with awareness comes understanding, and with understanding comes support. Because many mothers with a tube fed child feel a sense of failure - nourishing our children is our most fundamental role. It's like a "badge" of failure at times, when in fact taking that difficult step agreeing to tube feeding can be one of the best things you do for your child.

And here he is. My Superstar :)

Happy Birthday Harry.

After a particularly traumatic time with my eldest son four years earlier I was extremely apprehensive at the thought of going through a similar thirty+ hour labour. Given the inescapable fact that I was hurtling past full term carrying what the scans testified was a baby with a large bowling ball for a head I wasn’t desperately encouraged that the obstetrician's view that “second time was usually easier” could possibly be true. 

The irony was that as a mum with a virtually inactive thyroid I was required to have frequent "growth scans" to check my new addition was growing appropriately. What the scans highlighted, but no one seemed interested in, was that my baby was growing exponentially... Forget centiles, this boy had a whole graph of his own when it came to head size and his femur wasn't so small either! Natural Labour wasn't on the cards either as allegedly thyroid disease usually puts paid to this, and certainly after 42 weeks my sense of humour was suffering a severe and potentially terminal failure. We had sold our house and finally found another (on my due date) and had approximately six weeks before relocation. Having a little time to settle in with my new son was definitely the preferred option, before packing and putting everything into storage and moving in with my parents. (Yes, we really have done that twice.)

In a last twist of fate the hospital couldn't locate my delivery notes from my first child as I had since married and changed name, and of course there was no such thing as a NoSQL database at that point to associate the data which DID match. (Clearly my husband should have got this IT project out a few years earlier...) So, the jovial Obstetric Registrar assured me a bed would "come up soon" and there was nothing to worry about and he was certain as it was a second baby all would be fine.
Someone once said to me that "God never gives you more than you can cope with". I think I laughed at that point.....

It wasn’t. Nearly three weeks overdue I was induced and my baby became very, very stuck. Like so many mothers of children with disabilities I frequently find myself wondering what, if anything might have “caused” his difficulties? What could I, should I have done differently? Because nearly losing your baby before he even makes it into the world is not a good start. Not emotionally, not physically...... For either of you. We came closer than I usually choose to remember to losing our little boy, who then valiantly recovered leaving me going through an extremely unpleasant post-heamhorragic episode. Nothing about Harry's birth was easy, or straightforward, but then I often ponder on the appropriateness of this arrival since he's not one for making a quiet entrance even now!

Despite such a dramatic entry into the world, Harry was by no means a sickly child. Note the “l” in that word. Very important that.... Because just like his siblings before and after he was a very *sicky* child. (No “l”). All my children have reflux, mine were the babies everyone admired from a distance, those babies that other people declined to cuddle or hold close “just in case”. Fair enough really, an effortless deluge of second hand milk is not a good look - I’ve worn it many a time and I assure you the reaction from others isn’t a good one. Sympathy, surprise, even horror sometimes because we really are not talking about possetting here. Not small amounts of baby spit, but most of the feed from a good hour before. Nonetheless I felt fairly unperturbed dealing with this, after all I had gained the proverbial T shirt over the past four years, I was an expert with experience and knowledge to boot. If only that were the only challenge my new addition was going to throw at me!

Many years on, with a collection of "diagnoses" to confound any medical student my wonderful, unique, gifted, outrageous, witty, impossible, intuitive son turns eleven tomorrow. Such an incredible journey I feel privileged to have shared. It's been a journey of such highs and lows a Hollywood blockbuster could not emulate, a journey of true discovery and education. 

Today however I know what she meant. But what she should have said is - "God never gives you more than you are capable of learning". After eleven years I am still travelling, still learning. And what an amazing journey it is.
Happy 11th Birthday Harry. xx

Christmas Thoughts!

Twas the day before Christmas, when all through the house

The children were squealing, “The cat’s caught a mouse!”...

A present for Harry, her favourite friend

She brought him the one thing a small cat would send.

The Free From mince pies were safe in the tin,

No dairy, or soy, wheat or gluten was in

Mummy had not had to bake much this year

‘cos Genius sent a large box of good cheer!

The Mulled Wine was flowing, Norad was on

The stockings were found and the chocs were all gone

Presents were wrapped, a last minute panic-

Have I remembered them all, the town must be manic!

Daddy had gone to pick up the meds

Last delivery this year, Mummy had said

The regular trips to the pharmacy gate

Collection of crate after crate after crate.......

We keep them in business, or so it must seem

To keep our kids well, it is always our dream

It seems never ending, a burden at times

Whilst onlookers claim “they always look fine”

How little they know, the long sleepless nights

Tummy aches, traumas, it’s not fair and not right

As we all keep going with loud cheery voice

It’s the right thing to do - and we don’t have much choice

There are always so many worse off than you

With loved ones in hospital, so sad but so true

People with no home on this Christmas night

We just can’t ignore them - that would not be right

So please all this Christmas with all the good cheer

Spare a thought for all those not so lucky this year

We all live in such an affluent place

Yet neglect the most needy - it’s such a disgrace

Spare a thought for the homeless, the mentally ill

The sick and the frightened - they need your Goodwill

Support those who help, who give of their time

And make a donation as you sup your mulled wine

Crisis and Shelter, Macmillan and Mind, 

So many to choose from I’m certain you’ll find

A cause with some meaning that speaks out to you

Christmas means sharing and giving it’s true.

So we wait for the man in the jolly red suit

With “Norad Tracks Santa” hot in pursuit

I’m thinking of friends, near, far and here

And sending out wishes of good Christmas Cheer

It’s been a good year with much to remember

As we come to the end of another December

We hope that the next one will turn out all right

Merry Christmas to all and to all a good night!

Seriously - VOTING for the local police commissioner?

How has it come to this?

On Thursday last week a Poll Card dropped through the letterbox. I didn't think much about it until on closer inspection I noted it was for the local Police Commissioner. Since when did the public choose such a vital local professional? We might as well shut our eyes and pin the tail on the proverbial donkey  - we would have as much chance blindfolded of picking a suitable candidate.

And what does "suitable" mean? Something different for each locality maybe, but that's something I would prefer those who know the candidates to decide. A commissioner needs gravitas, respect, authority, experience and other such attributes I could not possibly assess. Considering there has been absolutely no publicity whatsoever for this election I certainly don't feel qualified to vote - and disagree with the underlying premise that this should be an elected role.

Can you imagine the scenario - someone with some campaign experience and political knowse but little on the job training gets elected and needs to command the respect and obedience of a force responsible for enforcing local law and order. Someone the rank and file might not have picked, or someone with sufficient private resources to to further their external campaign when they would have had little success winning internal votes within the region's force. Chaos. Or at subdued rebellion ... at the very least resentment. How does that work when a united front is needed to fight crime?

Hang on. That all sounds a little familiar? There is a certain theme here both in Education and Health is there not?

It's hard enough at any time, but giving those so ill informed a greater say in issues like this is the same as central government interference in local issues in my book. Two extremes which are equally inappropriate. I'm all for increased openness and accountability but by those qualified to do so. It's not "Big Society", it's passing the buck - or more precisely, passing the target. I sincerely hope these new commissioners are as good as their manifestos and that their qualifications do indeed exceed dog walking and golf.... because when things go wrong they are going to need the powers of a politician to deflect the criticism which will stream from both local and national sources. And surely, that is NOT in the job description of local Police Commissioner?

It is over-politicisation (if that is even a word) and under valuation in the extreme. But it is more than that - it is a basic avoidance by Central Government to tackle a thorny problem and avoid shouldering the criticism weighing them down since the 2011 riots. Which in my opinion is not "Big" on anything except responsibility avoidance. Using decentralisation in this way wraps everything in a political fog and undermines core values we rely on to make society work.

All about Allergies, immunity and Autoimmune Conditions

When most of us think of the word "allergy" we are thinking of a systemic immune response, or at least an immediate and visible reaction. For myself as a child, allergies meant allergic rhinitis - streaming eyes, runny nose, and atopic reactions (rashes, usually itchy) to almost everything it seemed. My bedroom floor was regularly hoovered, as were the curtains and the bedding was washed every few days. My teddy lived in the freezer during the day for some time too to help eradicate the house dust mites I was so allergic to. I was on Beconase inhalers for years and we probably should have taken out shares in Piriton... However there are different kinds of allergic responses.

IgE MEDIATED RESPONSES
The above are all IgE mediated responses. True allergies, and allergies you can test for. IgE is an immunoglobulin. An immunoglobulin is "any of a class of proteins present in the serum and cells of the immune system, that function as antibodies".  There are five subclasses of immunoglobulins, explained here far better than I could. DO read that link, it's the single best source I have found for non medics to explain your immune system and how it is classified.

IgE responses can be tested for - in Skin Prick Tests, and in RAST blood tests. The former have to be properly done to be accurate and reliable - we spent two years carting around an epipen for our second son who was allegedly allergic to peanuts - only to be retested a couple of years later (properly) and be told this was in fact rubbish. (Whilst some allergies can be outgrown, this is almost never the case with an IgE reaction to peanuts.) RAST blood tests are interesting, because they cannot in fact measure the severity of the reaction, the higher the number the higher the exposure rather than severity of response, so an older person would be expected to have a higher count.

NON IgE MEDIATED RESPONSES
You may think that a non IgE response would have to be what is termed an intolerance, but you would be wrong- along with an alarming number of health professionals I have encountered! An intolerance does not involve the immune system at all. A non IgE allergy is also known as a Type IV sensitivity, or cell mediated response. It is a local reaction and is rarely possible to test for. Gut allergies are delayed hypersensitivities, which is why food allergies are so traumatic and difficult to manage, requiring strict exclusion diets to determine responses to possible triggers. Imagine an eczema reaction in the gut - it's a localised response to an allergen (or a false allergen which the body responds inappropriately to) and causes a localised problem - no anaphylaxis, no outside response (although IgE responses are often present in addition in those with gut allergies) and is very difficult to diagnose.
Gut allergies are always responses to proteins, protein molecules are those the immune system responds to. Problems with carbohydrates/sugars such as lactose intolerance are not (as far as I know!) allergies.

GUT INFLAMMATION
Now imagine that patch of inflamed, irritated gastrointestinal tract - if your skin has a patch of eczema it is less supple, less flexible, cannot function at its best. Gut tissue is the same - it cannot function as well as it becomes inflamed. Inflammation ANYWHERE in the GI tract can cause symptoms anywhere else along its length. So, you can have reflux (which is only ever a symptom, be it from food allergy, obesity, muscle disease, ligament laxity, developmental delay etc) constipation, vomiting, diarrhoea, trapped wind, acute pain, chronic pain, bloating, wind - all from gut inflammation due to a localised allergic response. All too often I hear of children and adults with reflux symptoms, who have an upper endoscopy ("scope" where a camera is used to look down your throat as far as your stomach, and sometimes down to the small intestine below but only a small way down.) and a ph study which is negative and they are told there is no inflammation, no problem. It's happened to us too, my daughter was fobbed off for years until someone bothered to look lower and found inflammation and ulceration, causing the reflux further up. Bowel inflammation can, and does cause reflux. There are often other clues but sometimes it is that simple.

APPROPRIATE CARE
What is so concerning is the difficulty so many parents are having in getting appropriate care for children with clear reactions to food. Any parent with a child suffering from food allergies will tell you how their child reacts - yet if skin prick tests and RAST tests are negative many doctors come to the conclusion there cannot possibly be an immune response. Some doctors prescribe patch testing, which does indeed show delayed responses, but only on the skin. If it is only your gut tissues which is reacting, they are not going to be particularly helpful.

Another useful test is an serum IgA blood test. Immunoglobulin A is the major antibody found in the membranes of the respiratory and gastrointestinal tract. The second most common immunoglobulin in the human body, IgA can also be found in tears, saliva, mucus, and colostrums. IgA is one of the most important immonoglobulins in local immunity. Interestingly those with gut allergies often have low IgA levels, and in those who outgrow their gut allergies their IgA levels often rise approximately 6 months before such improvement become obvious when closely monitored. This is another reason why the antibiotic Azithromycin is so successful as an anti inflammatory agent in the gut, because of its role in the absence of IgA.

REFLUX and GUT INFLAMMATION
There is a huge surge in babies with reflux in the West, which is often due to gut allergies such as Cows Milk Protein allergy or reactions to other food proteins. It is often outgrown by the age of one but in those whom it persists into childhood underlying causes need to be investigated - any paediatrician should tell you that. The gold standard test for reflux used to be a ph study, measuring the ph at the top of the stomach. However, reflux caused by bowel inflammation is unlikely to be acidic unless the stomach contents at that time are acidic! Reflux caused by bowel inflammation is more likely to be alkaline, and shows up best using an impedance study or pressure test, used in conjunction with a ph probe. Gut inflammation will reduce gut functionality and therefore cause pressure changes along the GI tract.

No one is exactly sure why there is almost an epidemic of gut inflammation in the West. Many will tell you it is the overuse of antibiotics, the increasing prevalence of GM foods, over production , pesticides, chemicals etc but the truth is we just don't know. One thing is certain though that gut allergies are on the rise. In America there has been a surge in the number of diagnosed Coeliac Disease cases - interestingly Coeliac is another delayed hypersensitivity, as is Chrohn's Disease. Eosinophilic Disease is also thought to fit into this category which makes it so very difficult to treat and manage.

FOOD ALLERGIES AND BEHAVIOUR
Until quite recently there was little understanding of the way gut allergies worked. Recent research at Great Ormond Street has shown how neurotransmitters in the gut sit next to mast cells which are responsible for these local gut reactions. As these mast cells degranulate they release huge quantities of toxins which cause a local pain feedback cycle. They are also soaked up by the neurotransmitters and enter the central nervous system. This is thought to be how food allergic reactions cause the behavioural issues we often see in children with food allergies and could also explain why the casein and gluten free diet for Autism might just work for some children, who in fact display ASD type behaviours due to delayed gut hypersensitivities.

VACCINATIONS
Local gut reactions also cause an increase in histamine levels which make the gut wall more permeable. Anyone heard of Leaky Gut Syndrome? Something I thought highly "alternative" and improbable until I was immersed unwillingly into the world of gut allergies. What is more concerning is recent GOS research which is supporting the theory that the blood brain barrier is permeable (as is the gut) when local immune activity is present. Teething can also precipitate this permeability by raising histamine levels. There is in fact current speculation as to whether a highly allergic child - whether IgE or non IgE  - and/or one who is actively teething should have their vaccines postponed/delayed. This is similar to the theory postulated by Andrew Wakefield, whose totally flawed study left him hung out to dry but which buried the real message that timing is actually important with vaccination and that the links between the gut, Autism and vaccination might well have more to do with histamine and gut permeability than multiple vaccination programmes.

AUTOIMMUNE DISEASES
Lastly what i find particularly interesting coming from an EGID perspective is that several Autoimmune diseases are also Type IV hypersensitivites. Hashimoto's Thyroid Disease (which I suffer from) Diabetes Type 1, Arthritis... all the same type of reaction by the body. There are extremely strong links between gut allergies, immune profiles and autoimmune diseases. My children also have low IgM and IgG levels - again, common in those with autoimmune disease, but also caused by gut inflammatory conditions!

So despite being non-IgE, impossible to test for allergies, the immune profile of these localised, delayed hypersensitivities is perhaps more profound than the more obvious, recognisable IgE responses we are all more familiar with. I think it's about time the medical profession sat up and took notice of the autoimmune time bomb in the West and the surge in gut allergies - REAL food allergies so many people (and particularly so many children) suffer from ARE relevant, and health professionals in the twenty first century have a responsibility to take them very seriously indeed.


DISCLAIMER - I am not a doctor, the information above I have ben told, read and learned over the years. The opinions are not only my own, but it must be stressed that this is a Blog not a medical document and whilst knowledge and opinion is useful you must follow the advice of your/your child's doctor. By all means discuss the above, I have carefully referenced the information but I am not medically trained. I support and endorse vaccination programmes - having children with reduced immunity I know the importance of herd immunity and prevention of disease. I always endeavour to research issues affecting our family however and take each intervention as an individual case.