California Considering Ban on
Allergy Treatment By Chiropractors

Stephen Barrett, M.D.

The California Senate has approved a bill that would prohibit chiropractors from treating allergies. The bill—SB 352—would (a) specify that the practice of chiropractic does not include the treatment of hypersensitivity to foods, medications, environmental allergens, or venoms, (b) prohibit a chiropractor from advertising the ability to treat these conditions, and (c) specify that violating these provisions constitutes a cause for discipline by the State Board of Chiropractic Examiners [1].

The bill's author, Senate Minority Leader Bob Huff, became concerned about chiropractors who claimed that they could cure allergies with a laser device. Although the state Board of Chiropractic Examiners promised to address the problem, Senator Huff concluded that they were not moving quickly enough and introduced a bill to ban the diagnosis and treatment of allergies by chiropractors.

The Senate Hearing

On January 9, 2012, the California Senate Business, Professions and Economic Development Committee held a hearing on S.B. 352 [2]. During the proceeding:

• An allergy specialist noted that allergies can be life-threatening.
• Dena Robertson illustrated the problem by describing how a chiropractor had claimed that he could cure her daughters' allergies with laser treatments. Her older daughter, who was allergic to dog and cat hair, was treated for about eight sessions, after which she petted a cat and other severe symptoms that were manageable with medication at home. The younger daughter was severely allergic to nuts. Following laser treatments, the chiropractor said she should be able to eat nuts. However, after eating a candy that contained almond oil, she had an anaphylactic reaction (a sudden, life-threatening allergic reaction characterized by a sharp drop in blood pressure, difficulty breathing, and hives) that required emergency room treatment.
• A California Medical Association representative expressed support for SB 352.
• Fred Lerner, D.C., chairman of the California Board of Chiropractic Examiners agreed that chiropractors should not be treating food allergies with anaphylactic reactions. But he said that the bill was not necessary because his board had been working on a regulation to stop that. He also indicated that several chiropractors who had advertised the use of lasers to treat allergies had been disciplined.
• Cathy Donahue, D.C., president of the California Chiropractic Association, expressed opposition to the bill, saying that "that we differentially diagnose every condition [so] that we can appropriately refer for those patients that should be referred, co-manage those who should be co-managed, and treat the ones that we can treat individually in our
• Based on the objections, Senator Huff agreed to remove the prohibition against diagnosis, and this was removed by unanimous vote of the committee.

The bill was subsequently approved by the California Senate by a 34-1 vote and referred to Assembly for further consideration.

Can Chiropractors Treat Allergies?

The 2005 Job Analysis of Chiropractic, a periodic report based on a major national survey, stated that "chiropractic management of allergies primarily consisted of adjusting subluxations and providing specific nutritional advice." The book also reported that among responders to the survey who encountered allergy patients, 15.5% said they didn't treat them, 21.1% said they treated them solely, and 63.5% said they co-managed the patient's care with another health professional. The survey is interesting, but doesn't indicate whether the chiropractors did anything useful [3].

Should chiropractors be allowed to treat allergy? It seems to me that to answer this question, it is necessary to explore two things. One is whether chiropractors can do anything to help people with allergies. The other is whether they have any relevant training.

Neither of the two leading chiropractic textbooks provide any information about allergy treatment. Principles and Practice of Chiropractic states that when taking a history, patients should be asked whether they have any allergies [4]. However, I could find nothing in the book abut how to manage them. Chiropractic Technique: Principles and Procedures does not list "allergies" in its index [5].

Inquiries to online discussion lists drew a few replies from chiropractors who reported that they were taught that they were made aware of the use of history-taking and elimination diets in managing food allergies but had little or no practical experience in applying that knowledge.

Although many chiropractors suggest that spinal manipulation can benefit people with allergies, there is no logical reason to belief that. The most definitive survey of chiropractic studies related to allergy was published in 2004. After searching for clinical trials related to asthma and allergy, its authors concluded:

Many of the claims of chiropractic success in asthma have been primarily based on anecdotal evidence or uncontrolled case studies. Three recently reported randomized controlled studies showed benefit in subjective measures, such as quality of life, symptoms, and bronchodilator use; however, the differences were not statistically significant between controls and treated groups. There were no significant changes in any objective lung function measures. . . . There is currently no evidence to support the use of chiropractic spinal manipulative therapy as a primary treatment for asthma or allergy [6].

A review published in 2010 concluded that "No statistical significances were obtained with chiropractic care during the treatment of children with asthma." [7]

From what I have seen, chiropractic students have very little training or practical management experience in the treatment of allergies. Even if they become knowledgeable, chiropractors are unable to prescribe drugs when needed. even worse, however, many chiropractors are using quacky methods to diagnose and treat allergies:

• Applied kinesiology (AK) is the term most commonly used to identify a pseudoscientific system of muscle-testing and therapy. Its basic notion is that every organ dysfunction is accompanied by a specific muscle weakness, which enables diseases to be diagnosed through muscle-testing procedures.
• Nambudripad's Allergy Elimination Technique (NAET), based on the notion that allergies are caused by "energy blockage" that can be diagnosed with muscle-testing and permanently cured with acupressure and/or acupuncture treatments.
• Electrodermal skin testing, in which a computerized galvanometer is used to detect supposed "energy imbalances." Some of these devices are falsely claimed to detect when people are allergic to substances
• Various types of blood tests can assess the levels of certain immune responses to certain substances, but the responses are not necessarily related to allergy. Chiropractors who uses these tests tend to give inappropriate dietary advice and to prescribe unnecessary dietary supplements.
• Low-level lasers have been claimed to detect and correct allergies through the use of light. One, for example, is claimed to "calculate negative body responses for thousands of allergens through safely exposing the body to the harmonic frequency of each allergen. Once the list of negative body responses (allergies) is detected, your nervous system is retrained through immune conditioning to not have these negative responses."

The Proposed Regulation

A few days after the hearing January 9th, the California Board of Chiropractic Examiners released its "Proposed Regulatory Language for the Use of Lasers," which said: "Nothing in this section shall be construed to authorize the use of a laser by a chiropractor outside the chiropractic scope of practice. This includes, but is not limited to, laser ablation or surgical procedures and the laser treatment of allergies in cases where there is a known risk anaphylactic reaction to the individual being treated." [8] In other words, it would be illegal to use a laser device to treat someone who is known to have a life-threatening allergy. But it would still be legal to use lasers to treat allergies that are not known to be life-threatening. And it would still be legal for chiropractors to use the wide variety of quacky treatments identified above. I believe the proposed regulation would be nearly the same as doing nothing. The proposed regulation is open for comment until March 13th [9].

The Bottom Line

There is certainly no reason to believe that chiropractors can offer anything special to allergy patients. Although SB 352 was drafted in order to save lives, the current version would also protect pocketbooks from a wide variety of practices that waste their time and money. Legislative efforts to reduce the scope of chiropractic are very rare and are likely to meet with great resistance from the chiropractic community. If you agree that S.B. 352 is a good idea, please send an e-mail to Senator Huff's staff.

Referencesº

1. California S.B. 352, as amended.
2. Robertson D. Testimony before the California Senate Business, Professions and Economic Development Committee, January 9, 2012.
3. Christiansen MG and others. Job Analysis of Chiropractic - 2005. Greeley CO: National Board of Chiropractic Examiners, 2005.
4. Haldeman S and others, editors. Principles and Practice of Chiropractic, Third Edition. New York: McGraw-Hill, 2005
5. Bergmann TR, Peterson DH. Chiropractic Technique: Principles and Procedures, Third Edition. St. Louis: Mosby/Elsevier, 2011.
6. Balon JW, Mior SA. Chiropractic care in asthma and allergy. Annals of Allergy, Asthma, and Immunology 93(2 Suppl 1):S55-60, 2004.
7. Kaminsky A and others. Chiropractic care for patients with asthma: A systematic review of the literature. Journal of the Canadian Chiropractic Association 54:24-32, 2010.
8. Proposed regulatory language for the use of lasers. California Board of Chiropractic Examiners, released January 18, 2012.
9. How to comment on proposed laser allergy regulation.

This article was revised on March 10, 2012.

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