CARDIAC ARRYTHMIAS DUE TO FOOD AND OTHER ALLERGIES
By Robert W. Boxer, MD
I first became interested in the relationship between cardiac arrhymias and foods after hearing and reading papers by Dr. Solomon Klotz of Orlando, Florida. Dr. Klotz originally wrote on the connection between allergy and heart disease over 30 years ago, and about 14 years ago he updated his writings. Approximately 12 years ago, at the Illinois State Medical Society meeting, I presented a paper on cardiac arrhythmias due to foods and wrote a small chapter on the same subject for the textbook Clinical Ecology. In preparing these preparations, besides studying several patients intensively, I reviewed the literature on this topic, which turned out to be much more extensive and to go back farther than I had expected – back to the early 1900s, when clinicians first began to realize that there was a relationship.
In recent years there has been renewed interest in the role of allergy in heart disease. Several articles regarding the heart and its role in anaphylaxis have appeared in major journals; one study showed that patients in anaphylactic shock were often having allergic involvement of the heart muscle. Demonstration of the presence of mast cells (cells that contain the allergic mediators) tends to confirm the suspicion that the heart itself can be an allergic shock organ. It is now thought by some observers that the sustained hypotension or low blood pressure that may persist after anaphylaxis in some patients is actually due to allergic involvement of the heart and that this perhaps explains the rapid resolution brought about in some patients by anti-allergic measures. Of current interest is the possibility that allergy can induce spasms of coronary blood vessels and perhaps precipitate or contribute to the development of angina, or even mycardial infarction. At the very least, this association of allergy with heart disease explains or helps clarify some of the clinical observations that many physicians have made over the years.
For example, it has often been observed that food allergies can induce cardiac arrhythmias. (It is also thought that chemical and inhalant sensitivity can do the same. Freon propellants have long been suspected of inducing cardio toxicity and arrhythmias either in toxic doses or in regular doses in extremely sensitive persons, though this subject remains somewhat controversial.) Besides foods themselves, food additives, food preservatives, and other ingested chemicals can cause immunologic or non-immunologic responses. Among non-immunologic cardiac responses is food-aggravated gallbladder or esophageal disease, particularly hiatus hernia, which can induce vagovagal reflexes that occasionally cause arrhythmias.
Suspect foods may cause symptoms or potential cardiac symptoms within minutes of their ingestion or, and this is the cause for confusion, the symptoms can be delayed for hours. Perhaps for this reason, the Holter Monitor, a portable device used to continuously monitor cardiac rate and rhythm, is rarely used to detect cardiac arrhythmias due to foods. Nevertheless, this diagnosis is suggested in any patient who is having and cardiac manifestation and who can be demonstrated to be allergic (though non-immunologic mechanisms may also contribute). Sometimes confirmation can be made by challenge feeding and testing or by provocative testing, but most often it is done by suspicion, perhaps on the basis of testing (blood tests), leading to elimination diets with either improvement or lack of improvement.
In other words, if a patient shows strongly allergic to wheat and milk on blood or skin provocative tests and then eliminates these foods from his or her diet for a period of weeks or months with an improvement of cardiac status, the diagnosis is suggested, but it is of course still presumptive. To be really scientific, one would have to double blind the study by adding the food back without the patient or the investigator knowing, to see whether symptoms would eventually recur, obviously a difficult, if not impossible, procedure. Also, such double-blind, crossover studies are difficult in food allergy because avoidance for a period of time leads to a loss of intolerance, and therefore rechallenge takes a while before sensitivity again develops.
For me, the exciting part of this saga is the growing awareness in the rest of the field of allergy, and perhaps internal medicine and cardiology as well, that allergic factors may be significant in some cardiac patients, that the heart itself is a shock organ, and that coronary artery spasm, long suspected of contributing to angina or even myocardial infarction, may be triggered by allergy.
Article from NOHA NEWS, Vol. XIII, No. 3, Summer 1987, pages 2-3.