Part 4: The following section is a posited belief about the mechanism of allergy/autoimmune development and is still in debate.

Let us say that the child was born via C-section, bottle fed with cow’s milk formula and had limited exposure to good bacteria. Uh-oh.

Now we have a problem where the bacteria in the intestine are neither friendly nor beneficial. It is well known now that these abnormal bacteria are causing negative alterations in the immune system, and thus the gut lining is poorly maintained. If this poorly maintained gut lining starts to allow large food proteins and other pathogens to leak into the immune sub-layer, the risk for disease rises and we believe that we have a failure of tolerance.

Hypothetically in the case of allergy, if a child eats a peanut and that protein fragment happens to fall through the gut lining to the immune layer, or is abnormally recognized by a hyper-alert poorly tolerant immune system as foreign, we now have a tolerance break point. The child’s immune system may abnormally recognize this peanut protein fragment as a foreign invader and develop an immune response that we see as an IGE antibody mediated food allergy.

From then on, every time the child consumes a peanut, the immune system thinks that he or she is being attacked by a pathogen and destroys it, and unfortunately the host as well (hypothesis again).

This pattern of immune and gut lining dysfunction is believed to be the route to many diseases— and it all starts at birth and progresses afterward based on our environmental experiences. Thought leaders like Drs. Alessio Fasano, Gerry Mullin and Jeffrey Bland are chasing this hypothesis mechanistically to its origin.
From the available evidence we now know that improper microbial exposure and a poorly developed microbiome in the early years of life is a major risk factor for the development of autoimmunity and allergic disease.

We have significantly oversimplified this process, knowing that it is incomplete, with the goal of making it understandable as we see it today. This hypothesis will evolve over time and become clearer. The main thrust of these hypothetical discussions is to give actionable advice in 2018 terms to mitigate disease risk.

So, stay tuned for emerging data that adds more pieces to the puzzle of allergic and autoimmune disease and proves the pathway of disease.

Here is an excellent quote by Dr. William Parker, “A synthesis of evolutionary biology, epidemiology, modern medicine, and immunology strongly suggests that biome reconstitution and maintenance should be a major thrust of the medicine of the future. Old paradigms of pharmaceuticals as a cure for immune-associated disorders are potentially as inferior to biome reconstitution as anti-cholesterol drugs are inferior to a healthy diet and adequate exercise. We cannot escape the biology imposed by our evolution, and the medical science of the future will take that fact fully into account. At present, we need to direct intensive research toward biome reconstitution.”

In the meantime, we will focus on repairing the microbiome. Next week we will give you some ideas about what to do to reduce your risk of developing allergic or autoimmune disease.

End of Part 4

Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Contact him at newsletter@salisburypediatrics.com