Testing For Allergies 225Miller’s Method (provocation-neutralization)
Also known as serial end-point skin titration, this is the method
that enabled me to find some remarkable and obscure allergies, which
would otherwise probably have remained hidden.
It was first developed by Carleton Lee of Missouri in the late
1950s. Lee began a series of investigations by injecting his allergy patients
with antigens at different concentrations. He noticed something interesting:
sometimes he provoked a symptom, which wasn’t surprising, but sometimes
a patient’s symptoms would disappear over the space of just a few minutes,
which was very surprising indeed. It was one of those lucky situations
where the right person is in place, at the right time, to draw useful scientific
conclusions. Lee realized immediately that diluting an antigen could make it
effective at neutralizing the symptom associated with the allergy.
In fact it emerged that only one specific dilution had this
serendipitous effect, which Lee christened the “neutralizing dose”;
unfortunately, it is different for each patient (and each allergen) and has
to be tested individually. But it is a major advance and offered much
symptomatic relief for suffering patients. Herbert Rinkel and others went
on to improve Lee’s method and promote its more widespread use, and the
first definitive book explaining the technique in detail was written by Joseph
B. Miller (Food Allergy: Provocative Testing and Injection Therapy, Charles
C. Thomas, Springfield, Illinois, 1972); hence known as Miller’s method.
Lee’s widow has (quite rightly) campaigned to have it recognized as
the Lee-Miller method.
The Method
After testing the control and being assured of the zero baseline
reaction, a food test reagent (or dust or chemical) is injected superficially
into the skin, making a deliberate wheal. If this grows compared to the
control over, say, 10 minutes, this suggests an allergy. The bigger the wheal,
the more probable the culprit up to a point. Thus far it looks like scratch
or prick testing; but because of the safety factor implicit in the explanation
below, we use quite concentrated reagents, which cause foods to show up
often, unlike with the scratch or prick method.
Sometimes a symptom is produced (provocation) and this is much
more conclusive. Remember these substances are tested one at a time, so
there is usually no doubt which food caused the symptom.