Allergies, Autoimmunity & ASD

Presented by Claudia Miller, MD, PhD, at the Fall 2012 Autism Research Institute Conference.

Please Note: This presentation is over a decade old. Some data and theories may be outdated. We keep this and other older presentations available to demonstrate the evolution of autism understanding and care, and to ensure that autistic voices from the past continue to be heard.

One hundred fifty years ago, with no germ theory of disease, and no immune theory of disease to guide them, doctors had no way of answering such questions, let alone saving the lives of hundreds of thousands of soldiers dying from infections during the Civil War.

Today’s doctors face the same dilemma, as another new theory of disease emerges from the post-World War II petrochemical revolution. This time it’s an exposure-driven dynamic—TILT, or Toxicant-induced Loss of Tolerance—with evidence from dozens of industrialized nations linking chemicals in our diets and environments to a wide range of unexplained chronic illnesses, from asthma and allergies to chronic fatigue, depression and autoimmune disorders, to attention-deficit hyperactivity disorder and, yes, autism. In a recent study of 400 consecutive chronically ill patients who visited a primary care clinic, 20% met stringent criteria for chemical intolerance. Recent evidence also suggests that mothers of children with ADHD and autism, and their children, share a common bond: chemical intolerance.

Environmentally controlled medical facilities could help doctors determine whether today’s chronic illnesses are environmentally mediated and whether the symptoms are reversible. As a first step, doctors can take an exposure history and use the validated Quick Environmental Exposure and Sensitivity Inventory (QEESI) to diagnose chemical and food intolerances. (www.drclaudiamiller.org)

Brief Overview:

• Parallel Symptoms and Initial Trigger: Dr. Miller’s interest in autism grew from noticing that the symptoms of chemically intolerant adults (initiated by exposures to pesticides, remodeling materials, or the Gulf War) were exactly parallel to symptoms reported by parents of children with autism, including food and common chemical intolerances.

• The TILT Mechanism: The core concept is Toxicant-Induced Loss of Tolerance (TILT), a two-step process: an initial major exposure event initiates the loss of tolerance, and subsequent low-level, everyday exposures (like foods, fragrances, or cleaning agents) trigger symptoms in the newly sensitive individual.

• The Role of Masking: In sensitive individuals, symptoms from a variety of low-level exposures can overlap in time and recur—a phenomenon known as masking. This makes it difficult for both the patient and the physician to identify the specific cause of ongoing issues like headaches or depression.

• High Prevalence of Chemical Intolerance: This problem is not rare; studies show that approximately 20% of chronically ill patients seen in a routine family medicine clinic meet criteria for high chemical intolerance. However, this issue often goes overlooked as practitioners aren’t trained to ask the right questions.

• Environmental and Genetic Factors: The dramatic increase in autism prevalence over recent decades parallels the exponential rise in synthetic organic chemical production and pesticide use since World War II. Furthermore, having multiple genetic polymorphisms (e.g., those involved in detoxification) can significantly increase the risk of chemical intolerance.

• Need for Environmental Medical Units (EMUs): To properly diagnose and treat complex conditions, such as autism, Dr. Miller advocates for Environmentally Controlled Hospital Units (EMUs). These units would eliminate background exposures to see if a patient improves, and then systematically reintroduce common foods and exposures one at a time to identify their specific triggers.

• Case Study Evidence: A case from the 1950s describes a 10-year-old with extreme autistic-like behaviors who showed dramatic improvement after five days in an environmental unit. Reintroducing foods (like corn) or conventional foods (which contained pesticides or food coloring) triggered a regression, demonstrating that truly organic food was essential for his well-being.

Published: 12/05/2012

Claudia Miller, M.D., M.S. is Assistant Dean and Professor of Environmental and Occupational Medicine at the University of Texas School of Medicine in San Antonio. She co-authored the professionally acclaimed Chemical Exposures: Low Levels and High Stakes (Wiley), and currently is working on two new books, including one on autism and ADHD. The website drclaudiamiller.org provides a downloadable, validated questionnaire for assessing chemical and food intolerances.