“In Lyme disease and other VBDs, the immune system becomes impaired by the pathogens themselves. Borrelia bacteria, for example, can evade the immune system through biofilm formation and immune suppression, allowing the infection to persist in the body. This chronic infection leads to a prolonged inflammatory response, with cytokines promoting systemic inflammation and immune dysfunction.”
—Dr. Myriah Hinchey, ND
Lyme disease is one of the most common vector-borne diseases (VBDs) in the United States, with over 476,000 new cases diagnosed annually. However, recent data suggest that the true number of annual Lyme cases may exceed three million when accounting for underreporting in surveillance data. It’s caused by the bacteria Borrelia burgdorferi, which is primarily transmitted by the bite of black-legged ticks. Lyme disease is notorious for its ability to mimic many other illnesses, leading it to be called “the great imitator.” However, Lyme disease does not act alone. It is often accompanied by other infections commonly referred to as co-infections because they are contracted at the same time from the same bite. These infections, along with Lyme, can trigger or exacerbate conditions like pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorder (PANDAS), both of which cause severe neuropsychiatric symptoms. Understanding the link between these diseases, the role of the immune system, and the impact of gut health is key to diagnosing and treating these complex conditions.
Lyme Disease and Vector-Borne Diseases (VBDs)
Lyme disease, caused by multiple species of the Borrelia bacteria, not just B. burgdorferi, is transmitted primarily through the bite of an infected Ixodes scapularis and Ixodes pacificus (the black-legged tick). There are several sources suggesting other possible routes of transmission, including vertical transmission from mother to fetus in utero. However, Borrelia spp are not the only microorganism that may be transmitted. Other vector-borne diseases, including those caused by Bartonella, Babesia, Ehrlichia, Anaplasma, Rickettsia, Mycoplasma, and the Powassan virus, frequently occur alongside Lyme disease. These co-infections have detrimental synergistic effects on the body and complicate both the diagnosis and the treatment of Lyme disease. The presence of these additional VBDs often causes more severe symptoms and often overlaps with Lyme’s own wide range of signs, including fatigue, pain syndromes, weakness, cognitive dysfunction, and neurological issues. Vector-borne diseases can affect almost every organ system in the body, with symptoms ranging from fever, chills, malaise, night sweats, headaches, stiff neck, muscle weakness, post-exertional malaise, muscle aches, joint pain, cardiac symptoms, shortness of breath, GI symptoms, anxiety, depression, brain fog, and fatigue to more severe neurological manifestations, such as encephalitis and Lyme neuroborreliosis. The key challenge in treating Lyme disease and other VBDs is that the immune system’s ability to fight these infections can become impaired, leading to chronic illness that persists even after antibiotic treatment. Chronic Lyme disease, sometimes referred to as post-treatment Lyme disease syndrome (PTLDS) by the CDC, does not fully recognize the ongoing nature of Lyme, as symptoms can continue despite treatment. These lingering symptoms can wreak havoc on the body, especially when co-infections are also present.
PANS/PANDAS: Autoimmune Response to Infection
PANS and PANDAS are autoimmune disorders where the body’s immune system mistakenly attacks its own brain tissue, leading to abrupt changes in behavior, personality, and movement. Both conditions are triggered by infections, with Group A Streptococcus (GAS) bacteria being a well-known trigger for PANDAS. However, Lyme disease and other VBDs like Bartonella and Mycoplasma are increasingly recognized as significant contributors to PANS/PANDAS.
PANS refers to a broad spectrum of infections or factors that can trigger neuropsychiatric symptoms, including an abrupt onset of OCD, anxiety, panic, separation anxiety, extreme fear, restricted eating, deterioration of handwriting, regression in school performance, motor tics, and bedwetting. PANDAS specifically refers to neuropsychiatric symptoms triggered by Streptococcus infections, although there is typically additional underlying immune dysfunction. When an infection like Borrelia or Bartonella enters the body, it can initiate a dysregulated immune response that not only targets the pathogen but also the brain, leading to neuroinflammation. This inflammation is believed to affect areas of the brain involved in behavior and movement, including the basal ganglia, which plays a significant role in motor control and emotional regulation.
The Connection Between VBDs and PANS/PANDAS
The link between Lyme disease, other vector-borne diseases (VBDs), and PANS/PANDAS lies in immune system dysfunction. Infections like Borrelia (Lyme), Bartonella, Babesia, and Mycoplasma can cause an overactive immune response, leading to chronic inflammation and neuropsychiatric symptoms. The immune system becomes dysregulated, and the body’s normal response to infections is altered, causing an ongoing cycle of inflammation that can affect both the body and the brain.
In Lyme disease, the Borrelia bacteria can evade the immune system through various mechanisms, such as by forming biofilms and releasing proteins that suppress immune activity. This immune evasion results in persistent infections that continue to trigger inflammation throughout the body. Similarly, in PANS and PANDAS, the immune system produces autoantibodies that target the brain, particularly the basal ganglia, leading to the neuropsychiatric symptoms observed in these conditions. Both Lyme and PANS/PANDAS share the feature of immune system dysregulation, where the immune system’s response to infection causes more harm than good, affecting both the body and the brain.
Immune System Basics: The Body’s Defense Mechanism
The immune system is the body’s defense against harmful invaders like bacteria, viruses, and other pathogens. It is made up of two main branches: the innate immune system and the adaptive immune system. The innate immune system provides the body’s first line of defense, recognizing general patterns of pathogens and responding quickly. It includes physical barriers like the skin and mucous membranes, as well as immune cells like macrophages and neutrophils that engulf and destroy pathogens.
The adaptive immune system is slower to respond but provides a more targeted defense. It involves lymphocytes, including T cells and B cells, which recognize specific pathogens and remember them, providing stronger and faster responses upon re-exposure. Cytokines, small signaling proteins, play a crucial role in coordinating the immune response by promoting inflammation and immune cell activation.
However, when the immune system becomes dysregulated, it can lead to chronic inflammation. This is seen in both Lyme disease and PANS/PANDAS, where the immune system becomes overactive, causing harm to the body and brain.
The Complex Interplay of Gut Health and Immune Function
The gut plays a critical role in regulating immune function. The gut-associated lymphoid tissue (GALT) is an important part of the immune system, acting as an interface between the external environment (such as food, toxins, and microbes) and the immune system. The gut microbiota—trillions of microorganisms living in the gut—help modulate immune responses and maintain a balance between proinflammatory and anti-inflammatory cytokines.
Dysbiosis, an imbalance in the gut microbiota, is linked to immune system dysfunction. When the gut microbiome is disrupted, it can lead to increased intestinal permeability, commonly referred to as “leaky gut.” This allows harmful substances, such as undigested food particles and toxins, to leak into the bloodstream, triggering inflammation and further disrupting the immune system. In individuals with Lyme disease and PANS/PANDAS, this dysregulation can exacerbate symptoms, as the gut and immune system are intricately connected. Supporting gut health through proper diet, probiotics, and reducing environmental stressors can help restore balance to the immune system.
Immune System Dysregulation in PANS/PANDAS
In PANS and PANDAS, immune system dysfunction is central to the pathogenesis of the disease. Both conditions are characterized by an abrupt onset of neuropsychiatric symptoms, including OCD, anxiety, mood swings, and cognitive impairment. The immune system produces autoantibodies in response to infections, and these antibodies mistakenly target the brain, leading to neuroinflammation.
This autoimmune response leads to the activation of proinflammatory cytokines, which further exacerbate neuroinflammation and neuropsychiatric symptoms. The underlying cause of immune dysregulation in PANS/PANDAS can be triggered by infections like Streptococcus, Borrelia, and other VBDs. By understanding the immune system’s role in these conditions, it becomes clear that treating the infection while restoring immune balance is key to recovery.
Immune System Dysregulation in Lyme and VBDs
In Lyme disease and other VBDs, the immune system becomes impaired by the pathogens themselves. Borrelia bacteria, for example, can evade the immune system through biofilm formation and immune suppression, allowing the infection to persist in the body. This chronic infection leads to a prolonged inflammatory response, with cytokines promoting systemic inflammation and immune dysfunction.
This dysregulation is not limited to Lyme disease but extends to other VBDs like Bartonella and Mycoplasma. These infections can disrupt the immune system’s ability to mount an effective defense, leading to persistent symptoms that affect both the body and the brain. Chronic VBDs like Lyme disease share the common thread of immune dysregulation, which leads to ongoing inflammation and a cycle of persistent illness.
Chronic VBDs and PANS/PANDAS: Immune Dysregulation Driven by Proinflammatory Cytokines
Chronic Lyme disease, VBDs, and PANS/PANDAS all share a common feature—immune dysregulation driven by proinflammatory cytokines. Cytokines are key signaling molecules that regulate the immune response. While they are essential for fighting infections, an overproduction of proinflammatory cytokines can lead to chronic inflammation, which contributes to the symptoms of both Lyme disease and PANS/PANDAS. In these conditions, the immune system becomes overactive, leading to prolonged symptoms and ongoing damage to the body and brain.
The challenge in treating these diseases lies in managing the infection while restoring immune competence. Conventional treatments often focus on antibiotics and anti-inflammatory drugs, but these may not be enough to fully address the underlying immune dysfunction. A holistic approach that includes herbal treatments and lifestyle modifications can help support the immune system and restore balance.
The Problem: Killing the Infection While Restoring Immunocompetence
The key challenge in treating Lyme disease, VBDs, and PANS/PANDAS is not just eradicating the infection but also restoring immune competence. Traditional antibiotic treatments can help kill the pathogens but may not fully address the underlying immune dysregulation. Additionally, long-term use of antibiotics can contribute to dysbiosis, further disrupting the immune system.
Restoring immune competence requires a multifaceted approach that includes herbal treatments to modulate immune responses, reduce inflammation, and support gut health. Herbal remedies such as Japanese knotweed, Cat’s Claw, and Astragalus have shown promise in supporting the immune system and promoting healing in individuals with Lyme disease and PANS/PANDAS. These herbs help regulate cytokine production, reduce inflammation, and support overall immune function.
Resolving Multiple Infections with Herbals
Herbal medicine plays a crucial role in resolving multiple infections simultaneously. Plants like Cryptolepis, Houttuynia cordata, and Sida acuta are known for their antimicrobial properties and can help target pathogens like Borrelia, Babesia, and Bartonella. These herbs also support immune modulation, helping to restore balance to the immune system while addressing chronic infections.
By combining herbal treatments with dietary and lifestyle changes, individuals with Lyme disease, VBDs, and PANS/PANDAS can support their body’s natural healing process, reduce inflammation, and restore immune function.
Lyme disease and other vector-borne diseases, when left untreated or inadequately treated, can lead to chronic illness and immune system dysfunction. PANS and PANDAS, autoimmune disorders that trigger severe neuropsychiatric symptoms, are often triggered by infections like Lyme. Both conditions are driven by immune dysregulation, where the immune system becomes overactive, leading to chronic inflammation and persistent symptoms.
Understanding the role of the immune system, the gut, and herbal medicine is crucial for successfully treating Lyme disease, VBDs, and PANS/PANDAS. By addressing infections, reducing inflammation, and restoring immune competence, individuals can regain their health and alleviate the long-term effects of these complex diseases.
In addition to naturally treating patients with complex medical conditions at TAO in Connecticut, Dr. Myriah Hinchey created LymeCore Botanicals™ to provide quality, clean, and effective herbal formulas for Lyme disease and other tick-borne infections and is highly active in sourcing, testing, and making the herbal formulas she uses to treat her patients. Dr. Hinchey also founded LymeBytes™, a multimedia company dedicated to educating patients and other practitioners on the truth about Lyme disease and tick-borne disease and focuses on bringing patients, practitioners, and resources together for healing Lyme disease.
Healthy cells are the foundation of a healthy body. Every organ, tissue, and system relies on well-functioning cells to produce energy, support immunity, eliminate waste, and carry out repair. When cells are nourished and protected, the body is better equipped to maintain balance, recover from stress, and resist disease, including complex conditions like neurodegenerative disorders.
Lipid Replacement Therapy (LRT) is a natural, science-based approach to restoring cellular health by repairing the structural fats (lipids) that make up cell membranes. These membranes are essential for regulating what enters and exits the cell and play a critical role in energy production, detoxification, and communication. Damage from chronic inflammation, environmental toxins, infections, or aging can compromise these membranes, leading to cellular dysfunction, fatigue, and increased vulnerability to disease.
LRT addresses this by supplying high-quality phospholipids and supportive nutrients that integrate directly into damaged membranes, helping to restore function and resilience. One of the key benefits is improved mitochondrial performance; when membranes are intact, cells can produce energy more efficiently, which is vital in conditions associated with fatigue or neurological decline.
In neurodegenerative diseases such as Autism, Alzheimer’s, Parkinson’s, ALS, and vaccine injury, restoring membrane integrity and reducing oxidative stress may support brain health by protecting neurons and promoting more effective cellular communication. While LRT is not a cure, it complements other therapeutic strategies and may slow neurodegenerative progression by improving the health of the cells that form the brain and nervous system.
LRT is safe, non-invasive, and can be integrated into daily life through oral supplements or clinical infusions. For those living with chronic illness or neurodegeneration or seeking to preserve long-term vitality, LRT offers a powerful, foundational approach to healing the body from the inside out.
Practitioner LRT training is available through DNA — our next Workshop is April 24-25th.
http://dnadr.org/coursedescriptions
I have been a practicing pediatrician since 1979. After graduating from medical school and swearing the Hippocratic Oath to ‘do no harm’ I have always aspired to being the best diagnostician, the best physician, the best clinician for any parent and child who would engage me to care for them. For over 25 years I though I was doing exactly that. About 22 years ago I started to notice that the kids in my practice were changing. The best part of being a pediatrician was to become part of a ‘family’ from the moment the child was born through elementary, middle and high school, often through college to possible marriage or child bearing themselves. I felt like the grandpa to so many as I was privileged to be part of the growth and development of the children.
Practicing pediatric medicine involved listening to the parent, teaching them about normal childhood development, , giving guidance about growth and nutrition and treating their relatively infrequent illnesses. Once in a while a serious medical issue would present and I was pleased to be able to make the proper diagnosis, recommend the best treatment and continue to follow up to see the child bounce back to where they were prior to the onset of the illness. In all the years in practice I could count on one hand the number of true medical disasters I had to face often leading the demise of the child. I will never forget those kids or their parents. Guiding them through a serious or terminal illness brought me closer to the family, learning how to be sympathetic and empathetic and holding their hands tightly
The past 20 years have been entirely different. My move from general pediatrics became necessary as I began to encounter chronically ill children who had many associated problems. Many of them presented with bizarre behaviors that had acute onsets. The numbers of kids who were having learning disabilities and attention difficulties were increasing. They were having strange obsessive behaviors, seizures, motor tics, rashes, all varieties of stomach and digestive issues including constipation and/or diarrhea, feeding and food compulsions and avoidance. In my mind I started to question not only what was happening but why was this seemed to be on a dramatic rise. I did not merely shrug my shoulders like so many of my colleagues at the time, but started to question these ‘co-morbid’ medical symptoms and how they might be related
I went to my first ‘autism’ conference in Philadelphia in 2003. I sat up front listening to other MD’s and PhD’s talk about how they were personally affected with a chlld or grandchild diagnosed with autism. My experience with any autistic child dated back to my college days as a psychology major. I remember a boy named David who was autistic. It was a good day if he rolled a ball back and forth while he sat on the floor in the corner of the room. I learned at the conference that there were underlying biomedical reasons for ‘autism’ and autistic -like behaviors and found it most interesting that I did not recall learning about any of these issues. I started to apply what I had learned to patients in my practice, ordering stool analyses, organic acid tests and more complete blood testing only to face ridicule from my colleagues and friends. “We don’t do these things in this practice” I was told. I was given an ultimatum to do what the partners wanted to do or move on. I chose the latter.
I worked with a brilliant doctor who served as my preceptor and mentor during my pediatric residency. After being asked to leave my practice and join him 3 times over a ten year period, I knew it was time for me to move on to another level of pediatric practice. I continued working with my new colleague until his retirement at age 80. Since then I have been in a solo practice now entering its 13th year. Funny thing is that the only disadvantage to being a solo practitioner after all the years with partners is that there is no one else to blame for any errors in judgement but me! That put the pressure on for sure!
Now I am faced with a continually growing practice, parents of younger and younger children calling daily hoping I can help them where their pediatricians, neurologists and developmentalists have failed them. I explain that what we call ‘autism’ is merely a word that describes 3 behaviors regarding eye contact, social skills and the ability to communicate properly. The new explanation of ‘neurodiversity’ or ‘Gods work’ is an excuse for not taking the time to investigate many other medical problems associated with the ‘spectrum’ diagnosis. I explain how genetic ‘mistakes’ may be the’ smoking gun’ but the epigenetic triggers, environmental, infection, contaminated food, toxin exposures ‘pull thel trigger’ and start the ball rolling toward negative physical, mental and emotional outcomes.
Using all the tools I learned in my early medical training would serve to help me understand the individual issues befalling these kids. Being a good listener when a parent tells me that they often felt something was ‘off’ or wrong with their child sometimes from early infancy would help guide me. Ignoring their observations by chalking them up to their inexperience as a first time parent, the child was a boy, the household was multilingual was not the proper way to receive this information. Performing a complete physical examination checking the child out from head to toe, looking at the way they behave and seeing how they respond to my directions, how they process spoken instructions, if they can actually sit still and focus are extremely important when I try to draw conclusions and connect the dots to successfully treat them. I did not want to look at their headaches, their flushed faces, their dilated pupils, their coated tongues and pharyngeal redness, their rashes, their itching, their abdominal pain, the discoloration of their skin, the integrity of their hair and nails, their toe walking, the inability to walk without holding onto the walls and their general inability to stop moving as separate unrelated symptoms or just ‘behaviors.’ I learned more about the function of their nervous system by observation not by using a reflex hammer.
I have explained to parents that their child’s brain is like a big house with many rooms and that they have been smelling smoke coming from some of those rooms. Yet the fire department wont come to put out the fires! They see that the game plan they have been following as handed down by their developmental pediatrician or neurologist isn’t working. That the same recommendations for breast feeding over formula were not working for all kinds of reasons many which only serve to make the mom feel inadequate because their infant wont latch on. That infant formulas are primarily made of high fructose corn syrup which will make their baby look big and fat. The observation that ‘big and fat’ doesn’t equal ‘good and healthy.’ When I have my first consult with them I recognize that they are giving me pieces of a 1000 piece jigsaw puzzle yet I only see how 50 of those pieces fit together. It’s the other 950 pieces that need to fit together properly, not forced to fit together to make the picture whole.
Speaking metaphorically to parents helps them understand what I am trying to do. If they don’t get the metaphors I will tell them I am the new detective on the case of ‘what happened to their child’ which no one else seems to have the time nor inclination to solve.
Yes I order a significant number of tests. Yes I have been accused of practicing ‘shotgun medicine’ by immunologists. Honestly I didn’t even know what shotgun medicine was only to find out they were referring to ‘ordering every test in the world’ and hoping to find something abnormal. I have been told by gastroenterologists that the comprehensive stool analyses I wanted to order were ‘junk tests’ and should never be done regardless of their CLIA approval and recognition as legitimate tools for purpose of diagnoses. I have been reminded that autistic kids are all constipated because they are withholders and that Miralax was the only way to correct this problem. I have been told that the genetic testing to rule out Fragile X syndrome is the only test worth doing. Now I am aware of the study of genomics and exome sequencing is the way to go. I have been accused of taking advantage of families who are so desperate that they will spend any amount of money getting ‘ripped off’ by docs like me who only take cash and not managed care insurance reimbursement. It seems that any of us who are trying to do the right thing, to understand and treat the underlying comorbidities that are found in so many of the spectrum kids, are being labeled as quacks, antivaxxers, conspiracy theorists, essentially violating all the rules of good medical practice and that we must stop what we are doing!
Yet here we are, the incidence of autism has increased from 1 in 10,000 over 20 years ago to as high as 1 in 32 to 1 in 10 with no end in sight. Projections put the incidence as high as 1 in 2 kids in the next 10 years. With the imminent changes in our government, the possibility of having RFK Jr organizing the necessary changes in our food supply, the vaccine schedule and the recognition that we are essentially poisoning our children, many folks seem hopeful for a better future. I think the jury is still out on that one. The industry lobbying in our government to do things with callous disregard for the effects of their products, their contaminated foods and medications is reported daily. We understand that ‘forever chemicals’ and ultraprocessed foods can be responsible for neurological disorders and cancer, yet autism is never mentioned among them. The talking heads on the news and social media that bombard us with what is ‘real science” and that any connection between vaccines and autism has been debunked, the lack of attention to randomized double blind controlled studies have been done over the past 30 plus years is never open for debate is part of the problem. Reports in the news about forever chemicals, lead poisoning, arsenic in baby foods and apple juice, contaminated food packaging all have been proven to cause neurological damage and intellectual disability. These reports come and go with the turn of the page in the very newspaper in which they are published. They are instantly forgotten sound bites on network news or mocked by ‘TV doctors’ who are paid to promote inaccuracies and basic untruths so we can all feel better about ourselves and go back to making the same mistakes over and over again
What I can do is continue to treat each patient as an individual, never assuming what is wrong with them without proof, never denying parental observations about who their child was before they saw regression or failure to progress in their development. I know that the increasing incidence of autism spectrum diagnoses cannot be accounted for by better diagnosis and recognition by my fellow pediatricians. Seriously have any of these people been to the pediatricians office lately? The visit may last 5-6 minutes, The practitioner is almost never the same as the last one who saw the child preventing any continuity of care. There is no time for any guidance or counseling about child development, proper feeding and nutrition. There is only time to administer the vaccines, refuse to discuss or grant the parent the right to make and consent to an informed decision. There is only time to threaten the questioning parent with expulsion from the S leaving them without any medical professional to rely upon.
So here I am, working along side of many other medical professionals from all over the world who refuse to accept the status quo. We continue to question what happened. We continue to do legitimate testing to establish diagnoses based on our conclusions about the underlying ‘ root’ causes of autism spectrum disorders. I suppose I could retire and hang around, maybe take up golf or do whatever my retired friends are doing. I don’t think that would make me happy. I always keep the Hippocratic Oath in mind and remind myself every day that I must do NO harm. I think that ship has sailed for many medical professionals which makes me sad and angry. But its not about me after all. Rather it is about the folks that want me to try to help them out of the mess they find themselves and their children in every day. I think I understand that this is my purpose and the reason I chose to be a pediatrician in the first place.
What is Bartonella?
Bartonella is a genus of gram-negative bacteria that can infect humans and other animals. It typically appears in the shape of short rods. Upon entering its human or animal host, it begins to rapidly divide, with a division time ranging from 24 to 48 hours. This rapid division allows Bartonella to efficiently infect various cells within the body, including endothelial cells, microglial cells, macrophages, red blood cells, and immune cells.
There has been a rapid expansion of Bartonella species in the last 30 years. In 1990, only three species of Bartonella were identified. By 2020, over thirty-seven species had been identified. The most common species that infect and cause disease in humans include Bartonella henselae, Bartonella quintana, Bartonella bacilliformis, Bartonella koehlerae, Bartonella elizabethae, and Bartonella vinsonii berkhoffii. To completely rule out Bartonella, testing for all species should be conducted. In my option, one of the largest mistakes in healthcare is the failure to test for Bartonella, and when testing is conducted, it often involves insensitive methods and fails to test for all species
How do you contract Bartonella?
Bartonella can be contracted from eight known vectors. The most commonly known vector is cats, as Bartonella is often referred to as ‘Cat Scratch Fever.’ The next most common vector is ticks. Many parents are in disbelief that their child could have Bartonella since they never found a tick on them. However, Bartonella can be transmitted gestationally from the mother. There is also evidence that it can be contracted from mosquitoes, sand flies, lice, fleas, and spiders.
Prevalence of Bartonella in Children:
Approximately 13,000 cases of Bartonella are diagnosed in the US annually. Children under the age of 14 years old account for 32.5% of all cases, with the highest incidence observed among children aged 5-9 years.
This is likely a gross underestimation since Bartonella is not commonly tested for, leading to misdiagnoses and underreporting of cases in both children and adults. Evidence supporting this includes a research article that investigated the prevalence of antibodies to Bartonella henselae among symptom-free children living in central Italy. The results revealed that over 60% of children had antibodies to Bartonella, suggestive of exposure (Massei et al., 2004).
A retrospective study published in the Journal of Pediatrics examined known infectious etiologies in 231 children with encephalitis in Houston. The results indicated that the most common bacteria associated with encephalitis in children was Bartonella (Erickson et al., 2020). However, Bartonella is still not commonly tested for by medical providers.
Symptoms of Bartonella:
Additional symptoms of acute Bartonellosis:
These are the symptoms most commonly identified with Bartonella. However, many symptoms associated with Bartonella are often overlooked or misdiagnosed as other disorders.
Other symptoms of Bartonella include the following:
In children, Bartonella symptoms often present as neuropsychiatric issues. This makes it difficult to identify as they are often categorized as mental disorders or behavioral issues, rather than being recognized as an underlying infection contributing to neuroinflammation resulting in neurobehavioral symptoms.
Bartonella Symptoms in Children:
Treatment for Bartonella:
To effectively eliminate Bartonella, treatment must be implemented for a prolonged period of time, which can last for years. Although this may be discouraging, symptoms should improve during treatment. The reason for continuing treatment for extended periods is to fully eradicate the infection from the body. While there is no guarantee that one will never become exposed again, it is possible to eliminate current infections as long as treatment continues for a sufficient duration.
My preference is to use antimicrobial herbals to treat Bartonella. In my clinical experience, I do not see a difference in the length or success of treatment between those who use antibiotics and those who use antimicrobial herbals. Due to concerns about the prolonged use of antibiotics and the length of treatment needed, antimicrobial herbals are sufficient and effective at achieving desired results and are often better tolerated.
The top three antimicrobial herbals for Bartonella are the following:
Japanese Knotweed: It is the number one herbal against Bartonella, effective against all phases of the infection. It also inhibits the cytokine cascade initiated during infection.
Cryptolepis: This is a necessity for Bartonella treatment, containing diverse bioactive compounds, including alkaloids such as cryptolepine and quindoline, which provide antimicrobial properties. It is active against all phases of Bartonella, including the stationary non-growing phase and the growing log phase.
Houttuynia: This herb has antimicrobial benefits against Bartonella. Bartonella is responsive to immune cells called CD4+ cells. Lower numbers of these cells allow Bartonella to invade the body more easily and produce stronger symptoms. Houttuynia helps increase CD4+ immune cells, aiding in the fight against Bartonella.
It is important to work with your child’s healthcare provider when implementing antimicrobial treatment.
REFERENCES:
Erickson, T. A., Muscal, E., Munoz, F. M., Lotze, T., Hasbun, R., Brown, E., & Murray, K. O. (2020). Infectious and Autoimmune Causes of Encephalitis in Children. Pediatrics, 145(6), e20192543. https://doi.org/10.1542/peds.2019-2543
Laldinsangi C. (2022). The therapeutic potential of Houttuynia cordata: A current review. Heliyon, 8(8), e10386. https://doi.org/10.1016/j.heliyon.2022.e10386
Massei, F., Messina, F., Gori, L., Macchia, P., & Maggiore, G. (2004). High prevalence of antibodies to Bartonella henselae among Italian children without evidence of cat scratch disease. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 38(1), 145–148. https://doi.org/10.1086/379824
Mills-Robertson, F. C., Aboagye, F. A., Duker-Eshun, G., Kaminta, S., & Agbeve, S. (2009). In vitro antimicrobial activity of Cryptolepis sanguinolenta (Periplocaceae). African Journal of Pharmacy and Pharmacology, 3(9), 476-480.
Zhang, Y., Alvarez-Manzo, H., Leone, J., Schweig, S., & Zhang, Y. (2021). Botanical Medicines Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Polygonum cuspidatum, and Alchornea cordifolia Demonstrate Inhibitory Activity Against Babesia duncani. Frontiers in cellular and infection microbiology, 11, 624745.
Informed consent is defined as “permission granted in full knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with knowledge of the possible risks and benefits.”
BMC Public Health, “Research and Publication Ethics to Consider,” BMC Public Health
Most people think of informed consent in the context of surgery, when medical personnel go over a document stating the expected benefits of the surgery and risks (including death). It is important for parents to consider the value of informed consent in less dramatic situations, such as when a doctor recommends antibiotics for an ear infection, medications for obesity, or vaccines to prevent infectious diseases. Barbara Loe Fisher, a tireless advocate for vaccine safety since her son had a severe adverse reaction to a DPT vaccine decades ago, states
“The right to informed consent is an overarching ethical principle in the practice of medicine, for which vaccination should be no exception. We maintain this is a responsible and ethically justifiable position to take in light of the fact that vaccination is a medical intervention performed on a healthy person that has the inherent ability to result in the injury or death of that healthy person.
During COVID, recipients of the ‘vaccine’ (really categorized as gene therapy products) were denied informed consent because the boxes containing vials of COVID ‘vaccines’ initially included a piece of paper designed to mimic the usual package inserts marked “this page intentionally left blank.” There was no information about the vial’s contents, mechanism of action, or expected side effects. Renata Moon, MD, a pediatrician from Washington state, testified she could not possibly give parents information to make informed consent decisions when the package inserts for COVID products were “intentionally blank.” She also testified she had seen a dramatic rise in pediatric myocarditis since COVID shots were introduced. See her dramatic Senate committee testimony here.
Baruch Green, “WATCH: Pediatrician Says ‘Massive Increase’ in Myocarditis, Asks What We Are Injecting in Children,” December 9, 2022, https://vinnews.com/2022/12/09/watch-pediatrician-says-massive-increase-in-myocarditis-asks-what-we-are-injecting-in-children/.
People who were mandated to get COVID injections to keep their livelihoods were not being offered true informed consent. There should not be coercion to get an experimental medical product or lose a job.
In pediatrics, immunizations are the most common intervention for which patients or their parents need to learn about the risks and benefits. There may be an assumption in some practices that parents consent, verbally or in writing, after a statement that “your baby is due for these four shots today.” A full discussion of each vaccine’s purpose, the benefits and potential risks, and the synergistic risks of getting multiple vaccines on the same day is difficult to fit into the seven-to-fifteen-minute office visits typical scheduled in insurance based pediatric practices today.
Kendra Liljenquist, Rachel Hurst, Laura Sotelo Guerra, et al., “Time Spent at Well-Child Care Visits for English- and Spanish-Speaking Parents,” Academic Pediatrics, 23 no. 2 (2023): p. 359-362, doi: https://doi.org/10.1016/j.acap.2022.06.009.
Clinicians administering vaccines to children are required by law to show patients or guardians Vaccine Information Statements edited and updated by the Centers for Disease Control (CDC). Each VIS form has information about how to report adverse events following vaccination to the Vaccine Adverse Events Reporting System but there are no penalties for failure to report.
Ideally, consenting to a medical intervention should be in a time period that allows you to consider your options and decide. Consent for elective surgery should be obtained when surgery is scheduled, not when staff are ready to wheel you into the operating room. Consent for immunizations for your child should be considered before the vaccine is in the syringe.
No type of coercion or bullying or bribing should be a part of the informed consent process, according to the principles of the Nuremburg code.
E. Shuster, “Fifty years later: the significance of the Nuremberg Code,” N Engl J Med, 337 no. 20 (1997): p. 1436-40, doi: 10.1056/nejm199711133372006.
During COVID, peer pressure was used to manipulate children into getting COVID injections. It was unethical to promise pizza parties or field trips in exchange for everyone in the class getting an injection, especially since the shots were only approved for emergency use. The pediatric trials involved small numbers of pediatric patients and were underpowered to detect side effects. There was no convincing data about benefits for pediatric patients nor any long-term data about side effects. Officials driving the bribing strategies exploited the developmental stages of children when peer pressure was a major driving force.
A Washington DC mayor declared that students as young as eleven years old could consent to a COVID injection without the consent of the parent and without the primary care physician knowing. Fortunately, that ill-conceived strategy was overturned in court after lots of work by parents and professionals who pointed out that tweens do not have the cognitive maturity to make abstract decisions about medical interventions.
“Children’s Health Defense Wins Federal District Court Injunction On District of Columbia’s Minor Consent for Vaccinations Act,” press release, March 21, 2022 https://childrenshealthdefense.org/press-release/childrens-health-defense-wins-federal-district-court-injunction-on-district-of-columbias-minor-consent-for-vaccinations-act/.
One pragmatic flaw in the plan to immunize children at school without parental knowledge is this: if the child develops a side effect or a new medical problem, neither the parent nor the doctor will know to consider the immunization as a possible trigger.
Once a vaccine is put on the US National Childhood Immunization Schedule, the pharmaceutical industry is protected from liability if adverse effects occur.
House – Energy and Commerce; Ways and Means | Senate – Labor and Human Resources, H.R.5546 – National Childhood Vaccine Injury Act of 1986, by Rep. Henry A. Waxman. 1986. https://www.congress.gov/bill/99th-congress/house-bill/5546
Parents cannot sue the manufacturers or medical providers even if a child has a severe reaction or dies. Death immediately after vaccines is extremely rare but can happen.
Pharmaceutical industry protection from lawsuits contrasts with product liability rules for other companies. For example, Monsanto was held legally liable for lymphomas caused by Round-up, Ford paid for Pintos that exploded, and the tobacco industry was fined when it was shown that cigarettes cause lung cancer. Too little, too late – but accountability, nonetheless.
In the United States, if your child has a bad reaction to a vaccine, you must go through the National Childhood Vaccine Injury Act of 1986, which leads you to “vaccine court.” I have been there as an expert witness for injured children, and the bar is extremely high to get justice and compensation. Every medical product we prescribe has both known, reported and unknown side effects. Medical professionals must make treatment decisions based on imperfect and incomplete information. Patients and parents must decide whom to trust for medical advice.
Here are five crucial vaccine questions to consider:
You can download and print them to see lots of information about their mechanisms of action, potential serious side effects, the frequency of common side effects and ingredients.
In my pediatric office, we did not follow a “one size fits all” schedule for vaccines. I did not offer vaccines while the child was acutely ill. I considered the family history and the child’s developmental status before making vaccine recommendations. Even then, the family was always free to disagree with me. My staff did not shame or blame parents for their sincerely made decisions.
The other side of the informed consent coin is informed dissent. You may have concerns about heavy metals or ingredients in vaccines. Even doctors like me who try to order the “cleanest” vaccines have limited choices in the marketplace. You may look at the data that unvaccinated children have fewer chronic illnesses and decide to take the risk that your child might get a vaccine preventable disease. For those of you who believe declining or delaying vaccines is irresponsible, remember that people with free will make decisions all the time that are not in their own best interests. People eat poor quality food and don’t exercise enough. Doctors still take care of those people who develop diabetes, heart disease or obesity related to lifestyle choices.
Most parents sincerely try to make good health decisions for their children. I recommend you find a doctor who respects your right to ask questions about your children. For most people, love for their children is such a powerful force that they make huge sacrifices to nurture and raise them. Making medical decisions on a child’s behalf is an important parental responsibility.
Author: Richard E Frye, MD, PhD, FMAPS, Autism Discovery and Treatment Foundation, Phoenix AZ
Many physicians are becoming more aware of the problems with abnormally low levels of folate in the central nervous system (CNS), which, when severe, is known cerebral folate deficiency (CFD), in children with neurodevelopmental disabilities such as autism spectrum disorder (ASD). Normally folate is transported into the CNS using a special mechanism known as the folate receptor alpha (FRα). One of the main causes of problems transporting folate into the CNS are two antibodies known as the blocking and blinding FRα antibodies. Over the last decade we have luckily been able to order a test for these antibodies known as the Folate Receptor Antibody Test (FRAT). The wonderful thing about diagnosing an individual with FRα antibodies is that the standard treatment, leucovorin, is safe and well tolerated.
Over the last few years, we have learned more about the biomarkers for diagnosing central folate abnormalities. This blog will provide an update on some of the new findings.
About two years ago, we published a paper demonstrating a third biomarker of folate abnormalities in children with ASD known as soluble folate binding proteins (sFBPs). sFBPs have been described in cancer research but they have not been discussed in neurologic or developmental disorders. Essentially sFBPs are proteins in the blood which bind to folate, making it less available. For the FRAT test, these proteins were primarily thought of as an annoyance because they interfere with the assay that measures blocking FRα antibodies. This results in an inability to measure blocking FRα antibodies on the FRAT. What we found is that the patients with sFBPs are some of the most severely affected individuals and they require higher than usual doses of leucovorin to respond. We found patients who had not responded to any treatment improving on high doses of leucovorin and finally showing show improvement. We do not know what exactly what the sFBPs are, but some have suggested that they might be FRα proteins that have dislodged from the cell surface. Over the next year or so, we aim to investigate what exactly these proteins are in our new lab at the Autism Discovery and Treatment Foundation. We are excited because we believe this is yet a third biomarker of central folate abnormalities in ASD.
At the beginning of this year, we published a study demonstrating that the blocking FRα antibody could be used to predict the amount of improvements in ASD symptoms with leucovorin treatment. In general, we found that scores on the Social Responsiveness Scale (SRS), a scale that measures ASD symptoms, were higher (worse) as the blocking FRα antibody titer increased and that treatment with leucovorin resulted in a greater decrease (improvement) in the SRS for individuals with higher the blocking FRα antibody titers. We also found that concurrent treatment with subcutaneous injected methylcobalamin and fatty acids further improved scores on the SRS. This now provides a guide to predict how much improvement will occur with leucovorin treatment. However, the dosing of leucovorin is still understudied, so further research is needed to better understand the response to the optimal dose of leucovorin.
Earlier this year, along with Drs Lindsey Wells and Nancy O’Hara, we published our results on the investigation into the prevalence of the FRα antibodies in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). Surprisingly, we found that about 64% of children with PANS and/or PANDAS from the clinics of Drs O’Hara and Wells were positive for one of the two FRα antibodies, with the majority positive for the binding FRα antibody. Interestingly, PANS/PANDAS patients with ASD had lower binding FRα antibody titers than the PANS/PANDAS patients without ASD. In addition, severe tics were a predictor of higher binding FRα antibody titers. This now opens other biomarkers for individuals with PANS/PANDAS as well as puts a new treatment in the armamentarium for PANS/PANDAS patients.
We have known that some children with ASD do not react well to the commercial brands of leucovorin, requiring a compounded form of the medication but we have started to become aware that specific commercial brands of leucovorin, not only are less effective, but may resulted in worsening behavior and regression in some patients. This is very important as I have found that many children who do not respond to leucovorin are simply using one of the brands that is suboptimal. This provides support for developing a safer brand of leucovorin that we know is well tolerated and effective. Over the last several years we have been researching a special form of leucovorin called levoleucovorin. Levoleucovorin is the L isomer of leucovorin. Most drugs contain two mirror images of themselves. This is called the racemic mixture of the drug. In racemic mixtures, one of the forms is the active form while the other form is inactive and only can result in adverse effects. Thus, a Swiss company called Aprolol has developed a liquid form of the L isomer of leucovorin which only has the active form of leucovorin. We have several clinical trials ongoing to learn more about this formulation as a potential standard treatment for ASD.
Central folate abnormalities and their treatment is an exciting and emerging area of treatments for children with neurodevelopmental disorders. Hopefully further research will continue to improve our ability to diagnose these disorders and apply the optimal treatment.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting 1 in 36 children and is associated with physiological abnormalities, most notably mitochondrial dysfunction, at least in a subset of individuals. This systematic review and meta-analysis discovered 204 relevant articles which evaluated biomarkers of mitochondrial dysfunction in ASD individuals. Significant elevations (all p < 0.01) in the prevalence of lactate (17%), pyruvate (41%), alanine (15%) and creatine kinase (9%) were found in ASD. Individuals with ASD had significant differences (all p < 0.01) with moderate to large effect sizes (Cohen's d' ≥ 0.6) compared to controls in mean pyruvate, lactate-to-pyruvate ratio, ATP, and creatine kinase. Some studies found abnormal TCA cycle metabolites associated with ASD. Thirteen controlled studies reported mitochondrial DNA (mtDNA) deletions or variations in the ASD group in blood, peripheral blood mononuclear cells, lymphocytes, leucocytes, granulocytes, and brain. Meta-analyses discovered significant differences (p < 0.01) in copy number of mtDNA overall and in ND1, ND4 and CytB genes. Four studies linked specific mtDNA haplogroups to ASD. A series of studies found a subgroup of ASD with elevated mitochondrial respiration which was associated with increased sensitivity of the mitochondria to physiological stressors and neurodevelopmental regression. Lactate, pyruvate, lactate-to-pyruvate ratio, carnitine, and acyl-carnitines were associated with clinical features such as delays in language, social interaction, cognition, motor skills, and with repetitive behaviors and gastrointestinal symptoms, although not all studies found an association. Lactate, carnitine, acyl-carnitines, ATP, CoQ10, as well as mtDNA variants, heteroplasmy, haplogroups and copy number were associated with ASD severity. Variability was found across biomarker studies primarily due to differences in collection and processing techniques as well as the intrinsic heterogeneity of the ASD population. Several studies reported alterations in mitochondrial metabolism in mothers of children with ASD and in neonates who develop ASD. Treatments targeting mitochondria, particularly carnitine and ubiquinol, appear beneficial in ASD. The link between mitochondrial dysfunction in ASD and common physiological abnormalities in individuals with ASD including gastrointestinal disorders, oxidative stress, and immune dysfunction is outlined. Several subtypes of mitochondrial dysfunction in ASD are discussed, including one related to neurodevelopmental regression, another related to alterations in microbiome metabolites, and another related to elevations in acyl-carnitines. Mechanisms linking abnormal mitochondrial function with alterations in prenatal brain development and postnatal brain function are outlined. Given the multisystem complexity of some individuals with ASD, this review presents evidence for the mitochondria being central to ASD by contributing to abnormalities in brain development, cognition, and comorbidities such as immune and gastrointestinal dysfunction as well as neurodevelopmental regression. A diagnostic approach to identify mitochondrial dysfunction in ASD is outlined. From this evidence, it is clear that many individuals with ASD have alterations in mitochondrial function which may need to be addressed in order to achieve optimal clinical outcomes. The fact that alterations in mitochondrial metabolism may be found during pregnancy and early in the life of individuals who eventually develop ASD provides promise for early life predictive biomarkers of ASD. Further studies may improve the understanding of the role of the mitochondria in ASD by better defining subgroups and understanding the molecular mechanisms driving some of the unique changes found in mitochondrial function in those with ASD.
Greetings, MAPS Community,
During the recent Medical Academy of Pediatric Special Needs (MAPS) conference in the
Spring of 2024, I had the privilege of presenting on Screen Addiction and
Neurodevelopmental Disorders, which has been the focus of my research and clinical
practice. Specifically, I discussed how excessive screen use can exacerbate symptoms
across various neuropsychiatric disorders and even mimic diagnoses.
Drawing from my experience in treating patients with gaming addiction and
neurodevelopmental disorders, one question has persistently been on my mind: Could
individuals diagnosed with Autism Spectrum Disorder (ASD) who also meet the criteria
for gaming addiction inadvertently influence the outcomes of ASD treatment studies?
My hypothesis posits that some cases of gaming addiction might present symptoms
that closely mimic those of ASD, leading to the term “Virtual ASD.” In these cases,
individuals may receive an ASD diagnosis despite having fewer physiological
abnormalities typically associated with the condition. This overlap between gaming
addiction and ASD has the potential to impact the effectiveness of ASD treatments in
research settings significantly.
Simply stated, patients with gaming addiction (mimicking ASD) respond better to
addiction treatment. It doesn’t respond well to the biomedical treatments for ASD, such
as Folate, B12, Sulforaphane, Detox, etc., that we have learned from MAPS and other
brilliant providers. Yet, they were included in Autism research for those biomedical
treatments, potentially reducing the effectiveness of those treatments in research.
Gaming Addiction not Autism? Is this misdiagnosis.
This is not a misdiagnosis. ASD is diagnosed clinically, meaning diagnoses are based on
clinical observation. Whoever presents with the signs and symptoms of Autism and
meets the criteria will be diagnosed as Autism, including those with “Virtual Autism.”
However, the prognosis can be different among those with “Virtual Autism.” Successfully
treating the dependency on screens can drastically improve their Autism symptoms to
the point where some individuals no longer meet the criteria for diagnosis. A lack of
awareness of Gaming disorder also contributes to this, which is newly added to
diagnosable conditions in ICD-11. Autism individuals who have diagnosable conditions
as the underlying cause are not new to this field; approximately 20% of children with
ASD have a diagnosable genetic syndrome. These syndromes can be due to missing or
extra stretches of DNA, misspellings in genes, or biochemical abnormalities. (ASD and
Associated Genetic Conditions | CHOP Research Institute)
My child has a Gaming addiction. Does that mean my child has “Virtual Autism” and not
Autism?
Some people have “Virtual Autism,” and we don’t know the accurate prevalence, which
I’m planning to conduct research. Some are Classical Autism individuals who are also
addicted to Gaming. Nonetheless, both populations benefit from the treatment of
Gaming Addiction. “Virtual Autism” patients will likely improve more than classical
Autism individuals with gaming disorder, but treating gaming addiction improves
Autism symptoms for classical autism cases, too.
Step back, please; what is gaming disorder?
Gaming disorder is defined in the 11th Revision of the International Classification of
Diseases (ICD-11) as a pattern of gaming behavior (“digital-gaming” or “video-gaming”)
characterized by impaired control over gaming, increasing priority given to gaming over
other activities to the extent that gaming takes precedence over other interests and
daily activities, and continuation or escalation of gaming despite the occurrence of
negative consequences.
How is gaming disorder identified?
For gaming disorder to be diagnosed, the behavior pattern must be severe enough that
it results in significant impairment to a person’s functioning in personal, family, social,
educational, occupational, or other important areas and would normally have been
evident for at least 12 months.
What is “Virtual Autism”?
For those unfamiliar with the concept, “Virtual Autism” refers to a scenario where
individuals exhibit symptoms or behaviors resembling those of ASD, such as social
difficulties, repetitive behaviors, and communication challenges, without the typical
underlying physiological abnormalities observed in individuals with ASD. Interestingly,
treating screen dependency in these cases can drastically improve ASD-like symptoms.
The term “virtual” implies that the presentation of autism-like symptoms is not primarily
due to inherent neurological differences associated with ASD but may be influenced by
excessive screen use. It’s crucial to note that virtual autism is not recognized and
diagnosed as ASD. My concern lies in the potential misattribution of gaming addiction
symptoms to ASD, which could inadvertently include individuals in studies whose
physiological conditions differ significantly from traditional ASD cases. This could lead to
misleading conclusions in research findings or diminish the significance of biomedical
research outcomes.
To address this gap in understanding, I proposed three key research topics and am in
the process of conducting studies.
Our hypothesis suggests that the recent surge in ASD diagnoses may, in part, be
attributed to the inclusion of individuals with gaming disorders. We believe that these
researches have the potential to inform diagnostic practices, treatment approaches, and
future research directions in the field of neurodevelopmental disorders. I’m excited
about the potential implications of this work and look forward to updating you on our
progress at the next MAPS conference.
If you may also wonder,
I will be presenting again about Screen Addiction at the Fall 2024 MAPS Conference. If
you want to learn more about it, please join us in the Fall!
Citations:
– World Health Organization (WHO)
– Kushima M, Kojima R, Shinohara R, et al. Association Between Screen Time
Exposure in Children at 1 Year of Age and Autism Spectrum Disorder at 3 Years of
Age: The Japan Environment and Children’s Study. JAMA Pediatr. 2022;176(4):384-
391. doi:10.1001/jamapediatrics.2021.5778
– Harlé B. Intensive early screen exposure as a causal factor for symptoms of
autistic spectrum disorder: The case for «Virtual autism». Trends Neurosci Educ.
2019;17:100119. doi:10.1016/j.tine.2019.100119
– Christakis DA. Early Media Exposure and Autism Spectrum Disorder: Heat and
Light. JAMA Pediatr. 2020;174(7):640-641. doi:10.1001/jamapediatrics.2020.0659
Seasonal allergies and mast cell activation represent significant challenges for pediatric patients, impacting their daily lives and necessitating effective management strategies. Patients with Asthma, Autism, PANS/PANDAS, and other autoimmune conditions are especially vulnerable to having “flares” this time of year. Incorporating a holistic approach that encompasses environmental controls, targeted supplements, and appropriate medications is imperative for optimizing therapeutic outcomes and improving the quality of life for affected children.
Understanding Seasonal Allergies and Mast Cell Activation
Seasonal allergies, clinically referred to as allergic rhinitis, arise from hypersensitivity reactions to environmental allergens such as pollen, mold spores, and animal dander. Mast cell activation syndrome (MCAS) is characterized by dysregulated mast cell activity, leading to the release of excessive inflammatory mediators and subsequent allergic symptoms.
Distinguishing between mast cell activation and IgE-mediated allergies is crucial in the management of allergic conditions in pediatric patients. IgE-mediated allergies involve the immune system’s production of immunoglobulin E (IgE) antibodies in response to specific allergens, leading to the activation of mast cells and basophils upon subsequent exposure. This cascade triggers the release of histamine and other inflammatory mediators, precipitating allergic symptoms. In contrast, mast cell activation syndrome (MCAS) encompasses a broader spectrum of symptoms arising from dysregulated mast cell activity, independent of IgE-mediated mechanisms. While both conditions can manifest with allergic symptoms, MCAS may involve a wider array of triggers and can present with more variable and systemic manifestations beyond typical allergic reactions like gastrointestinal, behavioral, and neurologic symptoms. Consequently, the distinction between these entities informs diagnostic and therapeutic approaches, guiding clinicians in tailoring interventions to address the underlying pathophysiology and optimize outcomes for pediatric patients.
Testing
Accurate diagnosis of allergic conditions, including IgE-mediated allergies and mast cell activation syndrome (MCAS), is pivotal for effective management in pediatric patients. Testing for IgE-mediated allergies often involves skin prick tests or blood tests to detect allergen-specific IgE antibodies. These tests help identify specific allergens triggering allergic responses, guiding allergen avoidance strategies and treatment decisions. In contrast, diagnosing MCAS can be more challenging due to its heterogeneous presentation and lack of standardized diagnostic criteria. Laboratory assessments, including serum tryptase levels, chromogranin A and urinary histamine, leukotriene, and prostaglandin metabolites, may aid in corroborating the diagnosis, although results may vary. Clinical evaluation, including a thorough history and physical examination, remains paramount in identifying potential triggers and distinguishing MCAS from other allergic conditions. Integration of laboratory findings with clinical assessment enables clinicians to formulate tailored management plans, incorporating environmental controls, targeted therapies, and pharmacological interventions to alleviate symptoms and improve the quality of life for pediatric patients affected by allergic conditions.
Allergies and the Gut Microbiome
The gut microbiome also plays a crucial role in shaping immune development and regulation, with alterations in its composition implicated in the pathogenesis of allergic diseases in children. Research suggests that a diverse and balanced gut microbiota promotes immune tolerance and helps mitigate allergic sensitization. Therefore, interventions aimed at modulating the gut microbiome hold promise as holistic approaches to managing allergic diseases in pediatric patients. Probiotic supplementation, prebiotic fibers, and a diet rich in fruits, vegetables, and fiber can foster a favorable gut microbiota profile, enhancing immune homeostasis and reducing the risk of allergic conditions. Additionally, promoting breastfeeding in infancy, minimizing antibiotic use when possible, and encouraging outdoor play and exposure to diverse environmental microbes may further support healthy immune development and reduce the incidence of allergic diseases in children. By addressing the gut microbiome as part of a holistic treatment approach, healthcare providers can optimize therapeutic outcomes and improve the overall well-being of pediatric patients with allergic diseases.
Environmental Controls
Supplemental Support
Pharmacological Interventions
Conclusion
Incorporating a comprehensive approach to managing seasonal allergies and mast cell activation in pediatric patients is essential for achieving optimal therapeutic outcomes and enhancing their quality of life. By combining environmental controls, dietary choices, targeted supplements, and judicious employment of pharmacological agents, healthcare practitioners can effectively mitigate allergic symptoms and minimize disease burden in this vulnerable population.
Citations:
What if your child or patient suddenly developed strange symptoms of OCD (Obsessive-compulsive disorder), severe anxiety, tics, or hyperactivity out of the blue? These symptoms can be associated with an autoimmune disorder called PANDAS.
These symptoms can appear seemingly overnight with a dramatic onset. Symptoms may include anxiety, motor and vocal tics, obsessions, compulsions, and a variety of other issues including somatic symptoms like abrupt onset of bedwetting or severe and disruptive restless sleep.
When something like this happens to a child, it’s frightening. It’s normal to have many questions as a concerned parent or practitioner, which is why I wrote my book to help guide you through everything you need to know, and why I also mentor Physicians about PANDAS syndrome.
What Causes PANDAS?
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection or PANDAS is an abnormal immune response associated with strep infections. A child with a strep infection in their throat, sinuses, or elsewhere produces antibodies that should fight the invading bacteria.
In children who develop PANDAS, the immune system goes awry, and the antibodies instead attack and inflame an area of the brain called the Basal Ganglia. This attack on a different area of the body, here a part of the brain responsible for mood, movement, and behavior, is called molecular mimicry. This immune system attack is also facilitated by the breakdown of the blood-brain barrier (BBB) by toxic mediators, immune cells, and more.
When this autoimmune attack on the brain occurs in susceptible children, the result is an abrupt onset of neuropsychiatric symptoms like anxiety, OCD, tics, and more.
How Do I Know If My Child/Patient Has PANDAS?
Some diagnostic criteria include:
Other PANDAS symptoms may include:
How Is PANDAS Treated?
PANDAS can be a devastating diagnosis for both the parents and the child. Parents need guidance and support to manage their child’s symptoms and find the proper treatment.
Treatment of PANDAS should be individualized to the child’s behavioral and medical needs. Medications should include antibiotics and/or antimicrobials for an underlying strep infection, anti-inflammatories to calm the inflamed nervous system and nutraceuticals, botanicals, cognitive behavioral therapy and perhaps low doses of psychoactive medications for OCD and other symptoms.
Behavioral therapy is helpful in managing anxiety, depression, OCD fears, and other behavioral issues. Therapy for parents and the entire family can be beneficial for dealing with the stress of the diagnosis and managing disturbing symptoms.
Though some children may need more invasive interventions such as IVIG or plasmapheresis, the majority of children can recover with an appropriate 3-pronged approach of antimicrobials, anti-inflammatories and therapeutic and nutraceutical approaches to their care.
Find a Doctor Who Specializes in PANDAS Syndrome
It’s important for parents to know where to turn to make sure your child receives the proper diagnosis and treatment for this autoimmune disorder.
I have devoted my career to focusing on treating PANDAS and other neuropsychiatric disorders. I train and mentor clinicians in the U.S. and abroad on how to recognize, diagnose, and treat PANDAS.
If you think your child or patient is showing symptoms of PANDAS, prompt diagnosis and treatment is critical.
We have a health crisis of pandemic proportions in the United States, and it has nothing to do with a virus. The crisis I am referring to is the catastrophic decline in pediatric health that we have witnessed in the last fifty years. In the 1960’s the rate of pediatric chronic disease in the U.S. was a bit over 10%. By 2007 (the last time these numbers were published), the rate was over 50%.[1, 2] The most serious illness rate in pediatrics (that which interferes with daily living) went from a rate of less than 2% in 1960 to over 8% in 2010.[3] According to the National Institute for Health Care Management (NIHCM), our current numbers include a 20% rate of obesity, 10% rate of asthma (16.8% for black children), over 20% of high school children with suicidal ideation, 9.2% rate of anxiety, and a 8.1% rate of depression.[4] If you compare pediatric health in the United States to the rest of world, you will find our outcomes behind Canada, all of western Europe, Japan, Australia, South Korea, and even countries like Croatia, Estonia, and Belarus. When you look at our place in international rankings, we typically are in the mid-30’s (there are 29 industrialized, rich nations).
We have made huge gains in the treatment of acute medical issues—particularly with infections and acute leukemias. The rise in chronic pediatric illness has been in four fundamental areas: asthma, neurodevelopmental issues (including autism, learning disabilities, and ADHD), mental health issues, autoimmune disorders, and obesity. What ties all these conditions together? The concepts of immune dysfunction and environmental toxicity. The immune dysfunction connection is obvious with conditions like autoimmunity and asthma. We now know that chronic (neuro) inflammation is involved with many mental health and neurodevelopmental issues including autism, ADHD, major depressive disorders, bipolar disorder, and schizophrenia. Environmental toxicity has also been linked with these disorders (including obesity) by directly impacting immune function, altering the endocrine response, and disrupting the gut microbiome.
What do we do about this problem? Based on the infographics from the NIHCM, our situation is not for the lack of doctor visits or vaccines: about 90% of children had seen their doctor in the past year and over 93% were up to date on all required vaccines. Clearly the answers to these problems lie outside of the traditional medical system that we currently have. I have always said that you don’t find health at the bottom of pill bottle or at the end of a needle—these are crisis interventions. Health is found through the basics of good nutrition, exercise, engagement with peers, and maintaining a clean environment for the child. All these things need to start with mom before she ever gets pregnant and continue through the process of breast feeding. Food should be organic, when possible, with minimal processing. Any animals or animal products should be from free range, organically raised animals. For children that have already developed conditions, I would recommend seeking out a MAPS trained practitioner. At MAPS, we delve into the true causes of illness and treat our patients at that level. By understanding the biochemistry and physiology of health, our practitioners can choose the best path forward for the patient in front of them and use all the tools that are available.
We do have a crisis of pediatric health here in the United States. Fortunately, we also have a solution called MAPS.
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