Following uncomplicated gestation and birth, L. H., a boy, was first seen for diaper rash at about 4 weeks of age. His father suffers from a severe neurodermatitis that required a number of periods in hospital and special climates. His mother suffers from acne and a mild degree of renal failure. Two younger siblings have less severe neurodermatitis and asthma.

The newbom infant had had a sensitive skin, with "acne of the newborn” Dermatomycosis of gluteal folds and marked candidiasis diaper rash. Severe seborrheic dermatitis also developed. At age of about 8 weeks this had become a typical generalized neurodermatitis. The child was breastfed and initially developed well, weighing 8 kg at about 3 months.

When he was about 5 months, a period of serious inflammatory and purulent processes began, with superinfection of the skin, taking among other things the form of herpetic eczema, otitis and conjunctivitis. Numerous attempts at treatment based on the anthroposophical approach or using the homeopathic armamentarium proved unsuccessful at this time. He was given zinc, for instance, potentized sulfur, Bryophyllum, treatment for shock with Argentum, oral quartz, Conchae, Causticum, Tuberculinum, Medorrhinum in various potencies and combinations. None of these brought a change, nor did other attempts at treatment (Schuessler's biochemic salts, classical homeopathy). They did not put an end to the serious reduction in quality of life due to constant, tormenting pruritus. Treatment consisted in a permanent strict diet, eliminating all foods that were not tolerated, with detailed records kept, intestinal flora substitution and numerous medical treatments, including constitutional medication. Protein-loss enteropathy continued in spite of all treatment. Long-term nutrition using hydrolysates also had relatively little effect initially.

The boy was finally admitted to the Filder Clinic. His weight, a good 8 kg at 3 months, had now gone down to about 7 kg. Notable laboratory findings were extreme hypoproteinemia and extreme protein shift, with immunoglobin E levels elevated to 10,000 IU. Hydrolysate nutrition did result in weight gain, but there was no change in the pruritus and generally reduced condition. A first major improvement came with a visit to Portugal.

The boy had also developed asthma at 15 months. This had resulted in additional treatment, also on an inpatient basis, and injections of an unidentified preparation by a non-medically qualified practitioner which had resulted in fatty tissue necrosis. The boy's general condition had gradually improved with the hydrolysate diet, though his skin was still bad, with the pruritus markedly affecting his quality of life. Long-term gastrointestinal treatments with symbiotic cultures and lactobacilli had contributed to this. Recurrent inflammatory episodes had again and again caused the skin condition to worsen, followed by improvement, and much the same applies to the recurrent otitis and other febrile illnesses.

Marked stabilization followed a central pneumonia when the boy was a good three years old. His mental state improved greatly, for he had been extremely shy, anxious and depressive before. However, asthmatic conditions, inflammatory conditions and depressive episodes followed one another again and again during preschool age. Constitutional treatment with measures to support the liver and promote digestion continued.

When he started school, there was a definite change to a healthy, competent schoolboy. Asthmatic episodes were merely seasonal, during the flowering period, and occasionally if he had an infection or got excited. The skin condition was not brilliant, but the pruritus tolerable. A markedly depressive mood was evident, especially around his 9th birthday.

The boy had practically no treatment between his 10th and 12th birthdays. He could now take care himself to eat only things he was able to tolerate. Self-medication during this period included Tabacum, Cuprum compounds, Tartarus stibiatus and intermittent doses of DNCG. Measles at about age 11 resulted in further stabilization. The boy was able to cope with more stress without developing asthma at this time.

At age 12, after a 2-year interval, a new approach was taken to treatment, testing for food intolerances. Basal allergies to milk, feathers, nuts, cocoa and egg were most marked. The boy also showed distinct sensitivity to certain varieties of fish, molds, paprica, apple varieties. These triggered episodes of urticarial eruptions and occasionally asthmatic conditions, probably due to amines such as histamme or to salicylic acid compounds. Pulmonary function was excellent, however, with vital capacity and forced vital capacity well above normal. The need to eliminate all food allergen, especially milk.

This case record serves to illustrate that even an extremely hysterical constitution with broad-spectrum food sensitivities can be controlled, giving life a positive quality, if the situation is suitably monitored and treated for many years. From today's point of view it might have been helpful to use more organ preparations (Amnion, Puimo, Renes, Plexus pulmonalis). My own, more recent experience has shown that these give very good results, especially with early treatment.

Karl-Reinhard Kummer, MD

Posseltstr. 7, D-76227 Karlsruhe, Germany