continued Further complicating the allergy picture are the different kinds of antibodies. "The IGE is the one that gets the most publicity, because it is involved in true, immediate allergic reactions like your immediate reactions to peanuts, shellfish, and so forth. Reactions that occur within 15 minutes after exposure are related primarily to IGE. They are what are called cytotoxic antibodies. Hemolitic anemia, for instance, is one of them, where certain substances will cause that anemia. It's called cytotoxic because it attacks the red blood cells and makes them burst. Then there's the Type III antibodies, which have to do with the immune-complex disorders, like serum sickness. For instance, if you take penicillin today, and you don't get a reaction in 15 or 20 minutes, that means you don't have the IGE antibodies, but, if in a week, you start breaking out in hives and getting aches and pains and joint swelling, that's an immune-complex reaction. That's a very complicated reaction, and it's one of those self-perpetuating actions that can go on for weeks or months and be very prolonged. Then there's the Type IV reaction, which is a delayed reaction in which the lymphocytes [cells in lymphatic tissue] and cytokines [extracellular factors that alter and affect other cells] are involved. It's also called a tuberculine reaction. For instance, if a person was exposed to tuberculosis, and you test him with the skin-test, you don't see a reaction in 15 minutes. You'll see it in 24 to 72 hours. Those are the different types of reactions."
Some people suffer from allergies in reverse. "That's called 'anergy.' That's where you don't react. Let's say you had tuberculosis years ago, and I skin-tested you, and you don't react. That means you have anergy. Very commonly AIDS patients will have that. They have such severe immune deficiency that when you skin-test them for TB, not only is the skin-test negative, but their delayed reactivity to a lot of other things is also negative. That person may have tuberculosis throughout his lungs and his brain and still have a negative skin test because he has anergy. Of course, that's why he dies, because he has no immune system to fight back. That's one of the problems we have with transplant patients. We interfere with normal immune mechanisms so much in trying to help the patient tolerate the organ, and that's one of the risks. This applies to treating several forms of cancer and how far we can go with chemotherapy too."
During the 1960s the majority of Brandon's patients were children, but with the growth of pediatrics, almost none of his patients are children anymore. Treating kids forced him to change his methods of testing -- a precursor to the more advanced methods now available. "When it comes to small children, you have to be very careful about skin-testing them. When I did skin-test little children -- like one-year-olds -- I had enough trouble with severe allergic reactions that I immediately abandoned it. I skin-tested a baby about a year old and got an anaphylactic [extreme shock] reaction to milk. We treated it and everything went fine. I still take care of people in that family, so I know they don't hold it against me, but I learned that wasn't the right thing to do. I decided it would be better to work with elimination measures and diet. In those days, we did tests by way of 'passive transfer.' That's where you take blood from the allergic individual, separate the serum, and inject it under the skin to a nonallergic patient and mark the spots where you injected the person. Then you skin-test into the spots with dog hairs, dust, feathers, and so forth. The reason we abandoned the passive-transfer test was the worry about transferring diseases like hepatitis or, nowadays, HIV and so forth. We always tried to find a family member to be the nonallergic individual. Nobody does that today except in research at universities. Nowadays we have the RAST test, in which we measure the allergy antibodies through the blood. Now we measure the antibodies directly in the serum of the blood. This is very, very good and very safe. The disadvantage is that you get more 'false negatives' with it. A person may be allergic to something, but the RAST test may come out negative. On the other hand, the disadvantage of the skin test is that you have more 'false positives.' I personally think the RAST test is a great thing. It's finally coming to the fore, even though it's been out for 30 years now!
"What's bothering me now is that there is a new treatment coming out called 'anti-IGE.' It's a shot you would take every two to four weeks that blocks the allergic antibodies, which sounds fantastic. So no matter what you're allergic to, it's blocking the allergic reaction. But what I think is going to happen is that doctors will draw blood on their patients, RAST test it, find out what the patient is allergic to, tell them to avoid this, that, and the other thing. But instead of giving them allergy shots to build up their immunity to what they're allergic to, it'll be 'Oh, I'll just give you anti-IGE shots, because that'll cover the waterfront.' So you won't have to have allergy shots. The public needs to know that anti-IGE does not stimulate immunity against the things to which you're allergic. It's simply keeping your IGE antibodies from reacting. I don't think we have any evidence to show that the risk of allergic reaction to it is any smaller than the risk of taking allergy shots. In other words, you can get anaphylactic reactions to anti-IGE as well as allergy shots. You're not doing anything to stimulate the normal immune system to stimulate what we call 'blocking antibodies,' which block the allergy. That's where the allergist comes into the picture, because he can prescribe the appropriate solutions so the patient can build up his immunities to whatever he's allergic to. I can just visualize the drug salesmen telling doctors, 'You don't have to send patients to an allergist anymore, just give them anti-IGE shots.' Then I can see doctors saying, 'Gee, if it's that good, I don't have to do any allergy tests! I'll just give them anti-IGE shots!' We've got to work on things that stimulate the immune system and stimulate anti-allergy antibodies. The antihistamines and all the other medications we take, the anti-IGE are all what I call 'symptomatic treatment' or 'passive treatment.' God has a reason for each of the immune processes in our body, so that when we suppress IGE, we're allowing something else to flare up."