Food Allergy, Asthma, Anaphylaxis, and Autonomic Dysfunction

Written with Charles Cho

Food allergies are a rapidly growing medical and public health problem. Recent studies estimate an incidence of 5% in children younger than 5 years old and 4% in adults. In severe cases, subjects can experience anaphylaxis and even death if exposed to a food to which they are sensitive. There is no known cure. Rather, doctors recommend that the sufferer avoid exposure to the allergen. The mechanism of disease is thought to be immunologic.

A number of drugs can be used during an acute food allergy attack, but only one — intramuscular injection of epinephrine — immediately resolves all of the symptoms associated with the episode. Tellingly, epinephrine is a neurotransmitter/hormone of the autonomic nervous system (ANS) that augments sympathetic function. Emerging data in the literature supports a neuro-immune connection, particularly in light of how the ANS innervates and regulates lymphoid tissues and other constituents of the immune system. It is possible that food allergy syndrome (and perhaps all cases of anaphylaxis) may require both an allergic sensitivity and an underlying inability to generate an adequate sympathetic response (or an underlying parasympathetic/ vagal dominance).1
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Therapeutics as the Next Frontier in the Evolution of Darwinian Medicine

Evolutionary medicine (also referred to as Darwinian medicine) is the application of evolutionary theory to the understanding of human ailments.1 2 3 It explores evolutionary mechanisms of disease, offering a complementary framework to the proximate mechanistic explanations that prevail in medicine today. In this paper, we consider the application of evolutionary theory to the treatment of ailments.

A major contribution of evolutionary medicine is the framing of human diseases as maladaptations of our prehistoric factory settings. Our physiologic processes were shaped during prehistoric evolution to meet the needs of the era, but those same processes may behave maladaptively in the modern environment and produce disease. We take that notion one step further and propose an overarching therapeutic paradigm for human ailments based on evolutionary theory—the induction of adaptations in the body as a way to treat disease. It is the idea of creating somatic traits in the body that evolution might otherwise need to create over many generations through the sheer force of variation and natural selection. In the same way, that evolution has endowed us with traits that shield against biotic and abiotic stress to maintain homeostasis, we propose treating patients by endowing the body with buffers against ailments.
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