1. Talk with your doctor as a couple, not individually. Your healing takes place within a system, a relationship, so give your doctor the opportunity to talk to both of you. Talking together prevents some of the problems of “interpretation” from spouse to spouse.

2. Talk as a couple and with your doctor about sex and about concerns about the heart disease. There are many types of heart disease and very little research on sex and heart disease, so communication and mutual openness is important. Everybody who has ever had heart disease wonders about sexual issues. You are not alone in your concerns. Anxiety is worse for the heart than embarrassment, so take the risk and share your concerns.

3. Don’t try to prove you are “all better” by trying a sexual marathon. Return gradually to the sexuality the marriage desires. Sexual tests always flunk anyone who tries them.

4. With or without heart disease, it is better to be sexually active when you are in good general health. Look at this issue as a general issue, not just one related to the heart muscle. Sexual health is a cornerstone of general health.

.5. Avoid alcohol and heavy, rich meals. We all should do this anyway, and the risk factor for stroke or heart attack is increased for anyone when he or she drinks, eats a lot, and has sex.

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A craving for sugar is undoubtedly more common, so we will deal with this first. Since eating sugar will give the yeast a burst of growth and therefore precipitate symptoms such as bloatfng within a few hours, one would expect sufferers from candidiasis to be averse to sugar. Presumably there is some positive response to sugar before the bloating sets in, but what might this be? The most likely answer is that the Candida lowers the blood sugar, by constantly using up the sugar supplied in food, producing a type of hypoglycaemia. Eating a lot of sugary food would relieve this, if only temporarily.

The reported craving for yeasty foods is far more difficult to understand, since Candida does not feed on other yeasts as it does on sugar.

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There’s scarcely an asthma or hay fever sufferer alive who hasn’t been pinched, punctured and impaled by skin tests or allergy injections – or both. Most traditional allergists use skin tests to identify the responsible allergens. Minute quantities of purified extracts of suspected allergens – dust, pollens, moulds and so on – are applied to or injected into the skin on the lower arm (or, less frequently, the back). If a red welt or bump (what doctors call a ‘weal’) flares up at the site of the test, it’s assumed that the person is allergic to the extract. No welt, no allergy.

And so it goes for twenty or thirty items. Traditional allergists usually concentrate on inhalants – particles of dust, pollen, mould and animal dander (fur or feather residue) – all items that provoke an IgE response. Many allergists say they cannot use conventional skin tests alone for food allergies; they just aren’t reliable enough. Instead, many prefer to use skin tests along with elimination diets. Foods are avoided and then reintroduced one by one to determine which ones can be tolerated and which cannot. Or elimination diets alone may be used. Either way, the most common food allergens – milk, wheat, corn, eggs and a few others – are the key suspects.

Avoiding what bothers you has always been the stock advice for people with allergies. That makes sense. If you start to sneeze and itch when a dog or cat enters the room, you don’t take in stray animals. If you go through truckloads of tissues when the pollen season gets underway, you don’t take long drives in the country. If strawberries make you break out in hives, you eat raspberries instead.

Many times, though, people become so sensitive that the smallest amounts of pollen, dust or whatever make them ill. Or they’re allergic to things that are impossible to avoid. Traditionally, allergists have attempted to build up an allergic person’s tolerance of such items with standard doses of the allergen. The idea is to stimulate immunity without causing an out-and-out reaction. Basically, immunotherapy (sometimes called hyposensitization or desensitization) seems to work on the same principle as vaccination against smallpox, cholera, diphtheria, tetanus and so on.

Standard immunotherapy against allergy takes about six months to build up to a protective dose, beginning with a very weak, standard dose that is gradually increased every week until protection is achieved. Injections are then given either on a regular basis or whenever a reaction is anticipated, such as at the start of the pollen season.

Yet many people go through standard allergy diagnosis and immunotherapy and still suffer. Why?

Traditional allergists are often the first to admit that skin tests aren’t always what they’re cracked up to be.

‘Some authorities claim that a good history and careful skin testing are reliable 95 per cent of the time in allergy diagnosis,’ write Dr William T. Kniker and colleagues from the Division of Immunology-Allergy, Department of Pediatrics, University of Texas Health Science Center in San Antonio. ‘In many instances it is clear that results are not that good because too many patients are incorrectly diagnosed as sensitized to various allergens and inappropriately given immunotherapy. . . . Because skin testing . . . uses unstandardized antigens, testing techniques and scoring systems, it is to be expected that misinformation commonly is obtained.’ (Italics ours.) The doctors add, ‘Skin testing in the diagnosis of allergic disease is, in reality, not a uniform technique comparably practiced by all.’ (Bulletin of the New York Academy of Medicine, September 1981.)

Obviously, any treatment based on a shaky diagnosis will be doomed from the start.

‘Undoubtedly, thousands of persons are receiving “allergy shots” on the basis of skin tests that were incorrectly performed or erroneously interpreted, or both,’ stated Postgraduate Medicine.

Incidentally, immunotherapy is only available for a few select allergies and doesn’t always bestow complete protection. So, many allergy patients are routinely prescribed drugs like antihistamines and steroids to relieve their symptoms. However, drugs do not cure allergy either and they all have unpleasant side effects.

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You can start out with an allergy to, say, wheat and eventually develop allergies to other, related foods like barley, rye or rice, all members of the cereal family. Apparently, antibodies become less choosy and may begin to react with related allergens once the allergic response is established. Some immunologists believe that cross-reactions that were too weak to be noticed at first later surface as antibodies develop greater and greater affinity for that particular kind of antigen.

Furthermore, one allergy may exacerbate another, even if they’re not necessarily related. A person with both milk and pollen allergies, for example, may react to milk only during the pollen season, when his or her system is overloaded. Interrelated allergies (co-allergies) underlie the importance of considering all possible allergens.

Controversy in allergy

Not all unpleasant reactions to everyday substances are accompanied by a jump in IgE or other antibodies in the blood. You can develop a stomach upset, a headache, heart palpitations or anxiety from drinking coffee, yet your antibodies don’t budge an inch. Tartrazine (E102), a widely used food colouring, produces hives or asthmatic attacks in sensitive people – with no apparent rise in antibodies.

The fact that some reactions are not accompanied by measurable levels of antibodies doesn’t prevent them from being called allergies by some doctors. There are, after all, other mechanisms in the immune response besides the antigen-antibody reaction – some only recently discovered, some no doubt awaiting discovery. Some doctors believe, for instance, that chemicals and drugs that cause allergic-like reactions work directly on the basophils and mast cells with no antibody intervention whatsoever.

Out of that school of thought has evolved the concept that anything in our environment – including the food we eat, the air we breathe, the water we drink and the places where we work and play – can trigger unpleasant reactions in certain people. That concept harks back to the original definition of allergy; any unusual adverse reaction. So this view, while revolutionary when compared to the modern understanding of allergy, at the same time makes simple, old-fashioned common sense.

Many doctors who espouse the new approach call themselves clinical ecologists. Some are allergists; others are ear, nose and throat specialists, doctors of internal medicine, psychiatrists or primary care physicians. These doctors take up where traditional allergists leave off. Environmental factors have more of an impact on health and well-being than has been previously acknowledged, they say. So in addition to considering well-known allergies to dust, mould, pollens, fur and a handful of foods, doctors taking this tack give special attention to individual susceptibility to factors usually overlooked by traditional allergists – pesticides, herbicides, food additives and other chemicals infused into the food, water, air and homes of the twentieth century.

That in itself is the subject of considerable debate. Because reactions to environmental additives don’t always trigger a rise in immune complexes like IgE, they are not always regarded as a bona fide allergy by doctors in the mainstream of medical practice. Sensitivity, yes, agree traditional allergists. But allergy? No. And that difference of opinion as to what is and isn’t allergy has also led to differences in the methods of treatment.

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The explanation seems to lie in the intricate workings of the immune system, our bodies’ defence against outside invaders. Although not yet fully understood, immunity is basically our cells’ ability to recognize and destroy anything perceived to be foreign and harmful: bacteria, viruses, fungi and poisons (collectively called antigens). Understanding immunity helps you to understand both the causes and the treatment of allergy.

Think of immunity as a series of defensive actions by your body. ‘Search and destroy’ missions are controlled by two special kinds of white blood cells called B-lymphocytes (or B-cells) and T-lymphocytes (or T-cells, which hail from the thymus gland). Together, B-cells and T-cells wage war against all invading antigens.

B-cells set up camp in the lymph nodes and bone marrow, launching large numbers of special antigen-fighting proteins called antibodies into circulation at the first sign of an invasion. T-cells, meanwhile, pitch in by ‘pre-treating’ the invading antigens, changing them into a form easily neutralized or destroyed by antibodies.

It’s a remarkably sophisticated battle plan. The antibodies (called immune bodies or immunoglobulins by scientists) are of five general types: IgA (shorthand for Immunoglobulin A) and, similarly, IgD, IgE, IgG and IgM. Within each group, molecules link up in such an infinite variety of patterns that a specific antibody is produced for just about every possible antigen in the world. Luckily for us, that ability to produce an unlimited variety of customized antibodies develops without prior exposure to the antigen, be it a virus, bacteria or something else. In other words, antibodies are able to recognize the enemy, sight unseen.

The immune response rolls into action as soon as any substance perceived as foreign enters the body, whether it’s inhaled, swallowed, touched or injected. As a system for fighting off infections and disease, the antigen-antibody reaction works quite well. And like any good military system, it has a reserve plan. Once the activated B-cells have done their initial duty, some continue to reside as ‘memory’ cells in the body’s lymph glands. There they stand ready for future encounters should the antigens they fought once again trespass into body territory. Those very same memory cells, in fact, provide continued immunity after our first exposure to certain diseases, such as a childhood bout with the mumps or this season’s strain of the flu.

However, a popular saying states that if anything can go wrong, it will – and the immune system provides no exception. In many allergic people, lymphocytes mistake a perfectly normal and harmless substance like wheat or dust or pollen for an enemy antigen. Inappropriately, the lymphocytes jump into action to initiate plasma production of antibodies – usually the IgE type – against what they seem to regard as the enemy. Antibodies, in turn, latch on to either of two types of cells within the body; basophils, a type of white blood cell; or mast cells, found in the respiratory tract (nose, throat and lungs), gastrointestinal tract (stomach and intestines) and skin. The IgE-loaded cells grow sensitive to that allergen, as the mistaken antigen (be it wheat, dust or whatever) is known.

Whenever the allergen is encountered, sensitized cells release a flood of natural body substances – mainly histamine, plus other histamine like substances called allergy-mediators. Normal amounts of those substances do us no harm, but too much tends to expand blood vessels, causing inflammation and discomfort. If the cells in the nose, eyes and sinuses are affected by histamine or other allergy-mediators, the allergic person sneezes, has a runny nose and itchy eyes – the symptoms known as hay fever to you and allergic rhinitis to your doctor. If the skin is affected, hives (or urticaria) appear. If the digestive tract is affected, you suffer with nausea, vomiting or diarrhoea. In the lungs, an allergic response can lead to tightened and clogged airways – the hallmarks of asthma.

An allergic reaction can begin immediately – within seconds or minutes – or be delayed for a day or two. If severe enough, any allergic reaction can land you in hospital for medical help. The worst reaction by far is what’s called anaphylactic shock: the throat swells shut and the lungs fill with fluid. It’s like trying to breathe with a plastic bag pulled over your head. Fortunately, anaphylactic shock is relatively rare, especially with good allergy management.

In some people, an allergy may not become obvious until late in life when, after repeated contact with the allergen, a person suddenly develops a sensitivity. What happens is that after the first few uneventful encounters, a certain threshold of resistance is surpassed. You might unexpectedly break out one day after eating tomatoes – having eaten them freely all your life.

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Life with an allergy becomes an obstacle course of triggers to avoid. Pollen counts are followed like the FT Share Index. The cat is farmed out. The house is purged of all dust, with the bedroom stripped of curtains and carpets. Favourite foods are shunned. Arms are turned into pin-cushions by dozens of skin tests. ‘Injections’ are wincingly endured.

And yet for many, the misery remains.

But now there’s hope, thanks to the pioneering work of a small but growing number of doctors who treat allergy in a new and different way. Their approach – sometimes known as clinical ecology – is an offshoot of traditional allergy treatment, yet at the same time challenges some widely accepted concepts about allergy. They’ve even questioned the definition of what an allergy is.

In plain English, an allergy is an out-of-the-ordinary sensitivity to substances that don’t bother most people. Most people, for instance, can tolerate normal amounts of dust around the house. For others, however, a day’s accumulation guarantees a stuffy nose and a tough time breathing. Likewise, most people can eat tomatoes with no problem. A small number, however, immediately break out in a rash. Yet the allergy stereotype of the wheezy kid who can’t have a dog or the young woman whose skin breaks out whenever she goes near a tomato is only part of the story. Dust, pollen, moulds, fur and foods such as tomatoes, strawberries or seafood are only a few of the everyday items to which people can be allergic. Dyes, soaps, detergents, cleaning supplies, pesticides, cosmetics, plastics, drugs and pollutants are also potential troublemakers. (Many substances that are toxic in moderate or large doses, such as pesticides or food additives, tend to cause allergy in much smaller, so-called safe doses.) In short, anyone can be allergic to anything under the sun. (And sometimes even sunlight itself!) So even if fur, dust, tomatoes or some other common allergy trigger is identified as the major cause of your troubles, you and your doctor may be overlooking other, less common but important contributing causes. And unless all potential allergy triggers are considered, your symptoms may stubbornly persist.

Moreover, there’s much more to allergic reactions than wheezing, sneezing and itching. Unsuspected allergies can masquerade as any one of dozens of problems – anxiety, headaches, fatigue, depression, backaches, arthritis, colitis, gallbladder problems, hyperactivity, ulcers, even high blood pressure and compulsive eating or drinking. (And that list is far from complete.) In other words, while the skin, nose and lungs are the most common targets for allergy, any part of the body – muscles, brain, joints and so on – can and does react.

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