By Paul G. Donohue, M.D. November 20, 2011 12:00 AM

DEAR DR. DONOHUE: In January of 2007, I was a passenger in a friend’s car when it was involved in an accident. I received two fractured vertebrae and severe bruising across my stomach. In June of 2007, I was diagnosed with Guillain-Barre syndrome. I was paralyzed from my feet to my neck, and stayed in the hospital for 63 days. Could the onset of GBS have been triggered by the stress and trauma of the auto accident? I did have a sore throat right after the accident. can GBS start in the throat? You have stated that GBS occurs one to two months after a respiratory or digestive-tract infection. is the incubation period set in stone?

Guillain (gee-YAWN)-Barre (buh-RAY) syndrome first begins as funny sensations in the feet. A paralysis then sets in, starting in the legs and moving upward in the body. the paralysis results from an antibody attack on nerves by the immune system. Antibodies are proteins that serve as ammunition for the immune attack. In 70 percent of GB patients, the ascending paralysis is preceded by a respiratory or digestive-tract infection by one to three weeks. I’m sure there are different time intervals for this; nothing in medicine is set in stone. the germ causing the digestive-tract illness is most often the bacterium Campylobacter (KAM-puh-low-BACK-tur). one of the viruses causing a preceding respiratory illness is the Epstein-Barr virus — the virus of mononucleosis, which features a sore throat as part of its symptoms. the bacteria and viruses don’t actually cause GB. They cause the immune system to produce antibodies against these germs. Those antibodies also are directed against nerves. It’s the antibodies that are responsible for GB. I cannot find information supporting stress or trauma as causing this illness.

DEAR DR. DONOHUE: my doctor refuses to prescribe prednisone for my problem. my feet, hands and knees are stiff. She says my problem isn’t bad enough. I am in pain. how should I get help?

Joint stiffness is a sign of many illnesses. Osteoarthritis is the leading cause in older people. Rheumatoid arthritis is another illness featuring stiff joints. Shortly after the discovery of cortisone (prednisone is a cortisone drug), it was used for the treatment of rheumatoid arthritis with great success. However, side effects from giving the drug in high doses for prolonged periods of time created more problems than the illness itself. Prednisone isn’t used for the more common osteoarthritis. Tylenol, Advil, Aleve and many other similar drugs are. Hot packs are another useful treatment. If you give me the diagnosis your doctor has made for your stiffness, I can expand on it for you.

DEAR DR. DONOHUE: each year, my cholesterol stays around 205. it might be 215 or 195, but mostly it hovers around 205. my HDL is 95 (2.4 mmol/L), and my LDL is 91 (2.35). do I need to be concerned about a cholesterol of 205?

You don’t need to be concerned about a cholesterol of even 215 mg/dL (5.3 mmol/L). There’s leeway in cholesterol measurement. It’s not exactly the most precise science. Rejoice at your readings, and rejoice even more at your HDL and LDL readings. both are terrific. an HDL (good cholesterol) of greater than 40 (1.04) is good and one greater than 60 (1.5) is excellent. an LDL (bad cholesterol) of 91 is very good. A value less than 100 is optimal. stop obsessing about cholesterol.

Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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Allergy is the body’s acknowledgment to the attendance of some aggravating abettor alleged an allergen. Individuals act abnormally in their responses to allergens; accordingly some humans are added allergic than others.

It acclimated to be afflicted that all allergens were protein substances, and it was accepted to allege of “protein sensitivity.” It is accepted that some allergens are carbohydrates, and at atomic a few are chemically accompanying to the fats. All allergens accept one affair in accepted – they activate a acute getting to acknowledge by bearing antibodies.

The allergic acknowledgment after-effects from intricate actinic processes, such as agitator reactions, and is accompanying to the processes by which amnesty is developed. becoming allowed to a assertive antibody whose articles accept served as an allergen is one anatomy of allergic response. If the antibodies which a assertive allergen produces are anchored aural a accumulation of the body’s beef rather than getting chargeless in the bloodstream, again these beef in which the antibodies are amid may be afield afflicted if apparent to this specific allergen.

Kinds of Allergen

1. Some allergens access the physique by getting inhaled. These cover pollens; dusts; vapors, such as tobacco smoke; emanations such as dandruff; and able odors such as perfumes .

2. Assertive foods abet as allergic acknowledgment in acute persons. These cover wheat, milk, chocolate, eggs, strawberries, nuts, pork, and angle .

3. Some bodies become acute to drugs or biological agents. These, then, can serve as allergens .

4. Assertive bacilli may action as allergens. The affection produced if these bacilli access a person’s tissues are the aftereffect of the allergic response.

5. they are allergens which could could cause the allergic acknowledgment through a simple acquaintance with the dermal or close membranes of a acute person. These cover articles from plants such as adulteration oak and adulteration ivy, and assertive dyes, metals, plastics, furs, leathers, elastic products, cosmetics, and chemicals such as insecticides .

6. Even concrete agents such as heat, cold, light, and burden may could could cause an allergic response. many a hay-fever dead begins to apprehend if he accomplish into ablaze sunlight.

LOS ANGELES — People with suspected food allergies may need to submit to an oral food challenge — ingesting the food in a doctor’s office while symptoms are assessed — in order to receive an accurate diagnosis, according to new guidelines issued Monday by a consortium of food allergy experts led by the National Institute of Allergy and Infectious Diseases.

The guidelines specifically rule out attempting to diagnose a food allergy solely by skin-prick or blood tests that merely suggest an individual is “sensitized” to a particular food. those tests, however, may be combined with a medical history and physical exam and, if needed, an oral food challenge, to arrive at a diagnosis.

Adherence to the recommendations should help people discover whether they are truly allergic to certain foods, said Dr. Hugh Sampson, a professor of pediatrics at Mount Sinai School of Medicine in New York and past-president of the American Academy of Allergy, Asthma & Immunology.

“A lot of physicians order large numbers of blood tests of various foods and when they find small amounts of antibody present, they indicate to the patient that they are allergic to this food and shouldn’t ingest it,” he said. many patients, especially children, are placed on “highly restricted diets” that are probably not necessary.

Doctors use a broad range of criteria to diagnose and define food allergies. The variation has led to wildly divergent estimates of food allergies that range from 1 percent to 10 percent of the U.S. population. Most likely, about 3 percent to 4 percent of Americans have some type of food allergy, Sampson said, although the prevalence appears to be increasing. The guidelines should help identify those people and free others to expand their food choices.

The guidelines also stress that some food allergies will disappear. for example, 80 percent of children with allergies to eggs or milk will outgrow the problem.

“Each food is different, and each allergy is different,” said Dr. Amal Assa’ad, a professor of pediatrics, allergy and immunology at Cincinnati Children’s Hospital Medical Center. “Some food allergies resolve with time. We want to get the message across that food allergy needs consistent follow-up. It’s not a lifetime verdict.”

More than 30 professional groups, along with federal and lay organizations, participated in drafting the guidelines, which were published Monday in the Journal of Allergy and Clinical Immunology. The document is intended for doctors. however, the National Institute of Allergy and Infectious Diseases will release materials to help patients understand the guidelines.

The document lists tests that can be used in making a diagnosis and those that are not recommended. for example, an IgG test, which is a common test for a type of antibody, is not recommended for helping to diagnose food allergy, said Matthew Fenton, chief of the Asthma, Allergy and Inflammation Branch of the Division of Allergy, Immunology and Transplantation at the National Institute of Allergy and Infectious Diseases.

“One of the other things we’ve seen is there are a number of different diagnostic tests that are marketed,” he said. “It’s difficult to know which tests are scientifically validated. We looked deeply at which tests were most helpful.”

Other diagnostic methods are underused, Sampson said. While tests such as skin-prick tests and blood tests to detect IgE — a natural substance that increases when someone is exposed to allergens — are frequently used to indicate a food allergy, far fewer patients undergo an oral, food-challenge test.

“If you are still left in a situation where the diagnosis isn’t clear, (the guidelines) stress that the oral, food test is the only way to get at that answer,” Sampson said.

The guidelines also specify that immunotherapy treatments are not ready for prime time. Immunotherapy treatments expose a patient to the particular allergic food, such as peanuts, in small amounts in order to build tolerance for the food. While studies show immunotherapy is promising, too little is known about its safety and effectiveness at this point in time, Fenton said.

Likewise, no changes were made in existing guidelines concerning the need for people with egg allergies to avoid egg-based vaccines. however, the panel indicated that newer vaccines containing much smaller amounts of egg protein may make it feasible in the future for egg-allergic people to tolerate vaccines.

The panel also said not enough evidence exists to show that avoiding or consuming certain foods during pregnancy or while breast-feeding influences a child’s risk of developing particular food allergies.