Why Treatment Sometimes Fails

When I was a young houseman working in Johor Bahru, I would always remember what my boss Datuk Lim Kee Jin often said: 

"When medical treatment fails, remember the dictum that either the diagnosis was wrong, or the drug used was wrong, or the dosage was wrong, or the time for treatment was wrong, or some other complications or other medical conditions have been missed out."  

Applying this principle to why allergy treatment sometimes 'fails' in my practice, the diagnosis may not be allergy but a fungal or parasitic infection or the wrong dose was prescribed, meaning that the neutralising dose of the treatment may be wrong. 

It is often the expectation of patients to get well quickly but most of the time in treating the cause of allergies, it takes considerable time and effort. 

Here's an example: let's say we have diagnosed the offending allergen to be yeast. Now, the cornerstone of treatment would be total avoidance of the foods with yeast. It's not as easy as it sounds, as avoiding yeast means avoiding bread, most biscuits, 'pau' (Chinese pastry), certain roti canai (Indian breads), alcohol and most vitamins (many of them are manufactured from yeast) can be a daunting task for a lot of patients. 

The period of abstinence can be very long i.e. I prescribe a period of one year after the condition completely heals. It may seem a long and daunting task but there are many, many out there who have done that. And achieving a cure is worth the effort.       

In some cases there may be more than one substance that is causing the allergy. I have always advocated that a food log be kept and if there is a breakout, one can then suspect the allergen and then discuss with me. I often learn from my patients as to what to avoid and this helps me to pass the information to newer patients.

Failure of allergy treatment needs further investigaion by Doctor and Patient

And my learning continues.