A HISTORY OF ELECTRODERMAL TESTING

Presented by Dennis W. Remington, M.D. to the Utah State Medical Association Joint Committee Meeting: Unproven Health Practices Committee and Ethics and Judicial Committee, July, 1990 (Abridged; reprinted with permission)

Sublingual provocative-neutralization techniques for treating patients with adverse reactions to inhalants, foods and chemicals has been "proven" beyond any reasonable doubt by numerous double-blind studies executed by various investigators in multiple centers and reported in a number of peer-reviewed medical journals.   For the purposes of this paper, the original Webster's dictionary definition of "allergy" will be used, which is "a condition of unusual sensitivity to a substance or substances which, in like amounts, do not affect others."   These adverse reactions include the IgE-mediated responses typically described by traditional allergists, but also encompasses other adverse reactions, regardless of the causative mechanism.

The sublingual testing and treatment techniques offer tremendous benefits and safety to sensitive people compared to treatment by traditional desensitization injections.   Effective results often occur within minutes from the time therapy is started instead of taking many months or even years as did traditional desensitization therapy.   A much more extensive range of reactions to allergenic substances could be controlled, including reactions to various foods and chemicals.

The testing by providing symptoms, and then by trial and error finding an optimal treatment dose (neutralization dilution) which eliminated those symptoms, was a long, laborious procedure.   The provided symptoms were often very unpleasant for the patient.

[Electrodermal testing utilizes] electromagnetic energy in various ways to give information regarding bodily function.

Instruments which measure passive electrical energy:

Electrocardiograph - The electrocardiograph was first developed in 1887 and records in a graph form the electrical activity emanating from different areas of the heart.

Electroencephalograph - The EEG was developed in 1875 and simply records the electrical activity emanating from various areas of the brain.

Chinese electric pulse testing - For years, Chinese physicians have used various characteristics of the pulse as diagnostic indicators of disease.   In recent years they have devised a diagnostic instrument which correlates electrical activity at the radial pulse with the specific pulse characteristic.   Pulse diagnosis can now be done electrically.

Chinese gastrointestinal analysis - This instrument recently developed in China measures electrical activity of various areas of the gastrointestinal tract in a way similar to electrocardiography.   Various patterns of activity have been correlated with various disease states.   Developers believe that this is a very safe, non-invasive, accurate alternative to traditional western medical examinations such as endoscopies and barium contrast study X-rays to identify such conditions as peptic ulcers, stomach cancers, achlorhydria, spastic colon, pancreatitis, etc.

Instruments which measure response to stimuli:

•  Non-electromagnetic stimuli

Stress electrocardiogram - An electrocardiographic tracing is taken while the patient exercises vigorously.   Subtle changes in cardiac function in response to exercise can be identified and early heart disease can be identified.

Sleeping or sleep deprivation electroencephalogram - Some abnormalities can presumably be identified on an EEG tracing if the patient is either asleep or sleep deprived, which might otherwise be missed if taken under normal wakeful circumstances.

Nystagmometry - Eye movement, in response to stimulation of the ear with either cold or hot water, is recorded electrically to identify inner ear problems.

Galvanic skin response - The electrical conductance between two electrodes placed on the skin is measured.   The patient is then subjected to various stimuli and any change in skin conductance is recorded.   Any stimuli causing increased sweat production will very quickly increase the conductance and give a change in the readings, which are usually recorded on a graph.   This technology is a major constituent of lie detector testing.   It is also used in biofeedback technology.   In a strict sense, this instrument measures the response of the person under exposure to electric energy frequencies in the audible range.   In this case it is not as much the frequency or intensity of the energy that influences the changes, but rather the meaning that the words convey to the subject.

•  Electromagnetic stimuli:

Electromyography - A nerve is stimulated electrically, and the response of the muscle to the stimulation provides useful information about the functional status of that muscle or the integrity of its associated neurons.

Brain Stem Audiometry - This test involves subjecting a person to sounds at various frequencies and intensities and then measuring the resultant brain wave activity in response to that sound.

Cochlear Michrophonics - A sensitive electric sensing devise is placed on the cochlea of the inner ear, and the electrical response to challenge, with various sound waves, gives valuable information about cochlear function.

X-Ray - Electromagnetic energy in the X-ray frequency is projected through a body part to be analyzed and the rays are collected on a photographic plate.   Various body tissues absorb the radiation at different rates causing various shadows to appear on the plate.

Magnetic Resonance Imaging - The tissues to be tested are placed in a strong magnetic field.   Five different tissue variables are utilized to construct images of various structures.

Binocular Iriscorder - Pupillary light reflex can be evaluated by stimulating the eye with electromagnetic energy in the visible light frequency and then measuring the response of the iris.   A great deal of information can be determined about the optic nerve function and the autonomic nervous system by the characteristics of the response.   Very subtle diseases, such as pesticide toxicity, neurological damage and autonomic nervous system defects can be detected with this technology.

History of "Electomedicine" and Electrodermal Testing 1

The first reported use of electricity in medicine was in 2750 BC, described in Egyptian tombs, using the fish species Malopteurus electricus .   Several descriptions of therapeutic benefits, including pain control from exposure to the electric eel, were described by the Greeks in the first century.

Around 1600, William Gilbert, an English physician, coined the word "electric" and established the difference between electricity and magnetism.   In 1752, Johann Schaeffer published the book "Electrical Medicine."   By that time, many physicians were reportedly using electricity in their practices.   In 1830, Carlo Matteucci, a professor of physics at Pisa showed that electrical current was generated by injured tissues.   In 1858, Dr. Francis, a Philadelphia physician, was first to describe the relief of dental pain by electricity.   After 164 successful tooth extractions using "galvanism", he received a patent on May 25, 1858.   Although his device was denounced by the Pennsylvania Association of Dental Surgeons, the methods used by Francis spread throughout America and Europe.   In that same year, W.G. Oliver of Buffalo claimed the discovery of "electrical anesthesia", reporting a 98 percent success rate using a vibrating generator for dental pain.    Again in that same year, Harding, At the University College Hospital, London, Confirmed Oliver's results with studies of 40 tooth extractions.   He also set up a control subject who had results when the current was applied but did not experience any change under the same conditions without current.   By the late 1800's, the use of electricity in medicine was wide spread and described in such medical texts as Osler's "Practice of Medicine."

At the turn of the century, the business atmosphere in the United states ". reflected laissez-faire policy at its extreme.   High government officials were corrupted by the railroads, the public was swindled by flagrant stock-market manipulations, embalmed beef was shipped to soldiers in the Spanish-American War.   Advertising contributed to the immorality of business with its patent-medicine ads offering to cure all the real and imagined ailment of man.   There was a ‘pleasing Medicine to cure cancer', another to cure cholera.   No promise of a quick cure was too wild, no falsehood to monstrous. 2 "   A variety of electric gadgets emerged and were marketed in a similar manner to snake oils and other patent medicines by various charlatans.   This problem, together with the "almost total lack of standards in medical education and practice at that time, produced a deplorable situation. 3 "   To investigate this situation, the Carnegie Foundation established a commission headed by Abraham Flexner.   The commission'' final report was published in 1910 and it produced an almost instantaneous revision of medical education.

Electrotherapy became a scientifically unsupportable technique and it disappeared from medical practice.   Doctors using electric instruments of any sort were branded as quacks and charlatans.   In the backlash of this mindset, electronic devices of diagnostic or therapeutic value have been slow to be accepted.   Even now, a great deal of suspicion surrounds the use of electrodiagnosis and electrotherapy. In spite of the virtual disappearance of all electrical therapy, investigation has continued into the electric nature of biological systems in health and disease states.   A great deal has been discovered and legitimate diagnostic and therapeutic devices based on these sound discoveries have emerged.

In the early 1950's, Reinhold Voll, a German medical doctor, developed an electronic testing device for finding acupuncture points electrically.   He was successful in finding acupuncture points and demonstrating that these points, known to Chinese acupuncturists for millennia, had a different resistance to a tiny electrical current passed through the body, than did the adjacent tissues.   Many other researchers have also verified that electrical conductance at the acupuncture points is significantly greater that surrounding tissue.   Voll then began a lifelong search to identify correlation's between disease states and changes in the electrical resistance of the various acupuncture points.   He thought that if he could identify electrical changes in certain acupuncture points associated with certain diseases, then he might be able to identify those diseases more easily or earlier when treatment intervention was likely to be more effective.   Voll was successful in identifying many acupuncture points related to specific conditions and published a great deal of information about using acupuncture points diagnostically 4 .   (Until Voll, these points had been used mainly for treatment).   He found, for example, that patients with lung cancer had abnormal readings on the acupuncture points referred to as lung points.

Changes also occurred in the electrical conductance of the acupuncture points supplying musculosketetal structures that are inflamed.   These changes in acupuncture point resistance relating to lung cancer have been verified more recently by researchers from UCLA and USC.   In a double-blind study, 3 patients with lung cancer and 20 controls (who had negative chest x-rays) had the electrical resistance of several acupuncture lung points and several small intestine points measured.   There was an 87 percent correlation between the testing results and the results of the x-ray diagnosis for the lung points and no correlation with the small intestine points.   Of interest, there were no false negative and 4 "false" positives.   Two of these false positive readings were from the same patient who had an "inconsistent shadow" on his lung X-ray, but had shown no evidence of disease with tomograms and a CT scan. 5   These "false positive" readings could have been from lung cancer not yet diagnosed or some other degenerative disease process or could have been merely incorrect readings.

Another study from the Pain Management Clinic, Department of Anesthesiology, UCLA School of Medicine, evaluated the ability of electrodermal testing to identify, in a blinded fashion, areas of pain.   Forty patients were determined by medical examination to have musculoskeletal pain.   Each patient was draped to hide any physical evidence to suggest where the pain might be.   The physician conducting the electrodermal testing had no prior knowledge of the patient's history and was not allowed to talk to the patient.   Based on increased skin conductance at specific acupuncture points of the ears, the physician determined, with greater than 75 percent accuracy, the location of the pain, a highly significant result.   This study also pointed out that electrodermal testing technique "is often sensitive to pathological problems of which the patient is only minimally aware.   When some patients were told of their auricular diagnosis results, they suddenly remembered having a minor of old pain problem in that body area, a problem which they had neglected to mention during the medical evaluation," and thus were considered to be "misses" in the statistical analysis. 6   The results of this test were therefore more impressive than the statistical analysis would indicate.

A great deal has been done throughout the world correlating changes in electrical conductance at acupuncture points with various disease entities.   Much of the German, French, Japanese and Chinese literature has not been translated.   Only a few examples of the many articles related to finding and measuring acupuncture points electrically are referenced in this paper. 7-21 Voll discovered that certain acupuncture points showed abnormal readings when subjects were reacting allergenically.   He made several serendipitous discoveries related to "allergy" testing.   He noted some unusual readings on certain acupuncture points when a patient had a bottle of medicine in his pocket.   He could remove the bottle and consistently get different readings when the bottle was in his pocket compared to when it was not.   At first he was baffled as to how a closed bottle of medicine outside the body could affect the acupuncture readings.   It was even more baffling when he discovered that the glass bottle of medicine could change the readings when it was in contact anywhere along the closed electric circuit involved with the testing procedure.   Voll and his colleagues then began work to identify the nature of this strange phenomena.   They inserted a metal plate into the circuit and demonstrated that many substances that precluded changes in acupuncture point readings when ingested could produce the same changes when placed on the plate (even in closed glass bottles).   They assumed that there must be some kind of electromagnetic energy being emitted from the substances and that these energy fields somehow traveled along the electric circuit to the body (perhaps like the energy waves representing a person's voice travels along the electric circuitry of a telephone line). Voll and other scientists have conducted various experiments in an attempt to characterize the energy form that is being measured.   As yet, no clear consensus of opinion exists as to exactly how this phenomenon functions.   For that matter, no clear consensus exists how any electric phenomena function.   Although it used to be thought that electricity was fairly straightforward and well understood, many discoveries in the last few years have made many scientists question older theories.   Robert Beck, a physicist well known for his pioneering work in various areas of electromagnetism, said the following, "Man is an extremely complex biocosmic resonator. People ask me occasionally why this or that works and I tell them the truth, that although I'm a physicist, I don't know what electricity is.   Neither does anybody else.   But we can certainly build a lot of marvelous things with it, from toasters to television sets to computers.   And it will be quite a few years before even the effect of some of these simple stimulation type devices are well understood, much less fully understood." 22 Electrodermal testing devices have been extensively studies by Dr. William Tiller from Stanford, who is a professor in the Department of Materials Science and Engineering.   He has written extensively in an attempt to explain the electric behavior of the skin and how electrodermal diagnostic and treatment instruments function. 23,24   Dr. Cyril Smith, Ph.D. physicist in the Electrical Engineering Department at the University of Salford, England, has also written extensively in an attempt to explain various electromagnetic phenomena, including electrodermal testing on acupuncture points. 25   Other world leaders in bioelectric medicine include Robert O. Becker, M.D. and his landmark book entitled, The Body Electric: Electromagnetism and the Foundation of Life , 26 and Bjorn Nordenstrom, M.D. and his books The Electric Man 27 and Biologically Closed Electric Circuits . 28 Whether or not a diagnostic or therapeutic modality is fully understood has absolutely no bearing on its effectiveness or usefulness. It is beyond the scope of this paper (and of this writer) to attempt to explain the phenomena involved in electrodiagnostic testing.   In fact, it would seem better to have no explanation at all than have an incorrect theory.   For example, the drug Hydergine has been shown to be effective for improving cerebral function in older people in a number of double-blind controlled studies.   The mechanism was thought to be through increasing cerebral blood flow.   When further studies failed to show increased blood flow, the drug was thought by many to be ineffective and fell into disfavor.   More recent studies have shown a variety of actions that could explain the results of therapy and once again has become widely used. 29

Evidence for Reliability of Electrodermal Testing

Food Allergy Characteristics

1.  Food allergy is a complex issue.   It is not just a yes or no situation.   Various types of food reaction have been described including the following:

• Fixed allergy - A person with a fixed food allergy will react to that substance each time they come into contact with it, often even with a very tiny exposure.   It doesn't matter how long it has been since the last exposure, re-exposure will still produce a reaction.
• Cumulative allergy - A person with a cumulative allergy to foods will only react to a specific food when they ingest enough of it to exceed their allergy threshold for that food.   It may take a substantial amount of that food to evoke a reaction.   A specific food may be tolerated just fine one day, but if ingested the next day will likely produce a significant reaction.
• Variable allergy - A person with variable allergies may react at certain times when eating a food, but tolerate it well on other occasions.   Some people react to specific foods when certain pollens are in the air, but not at other times.   This may represent a complex commutative response in common antigenic material in several foods or a reaction to a combination of a food and a pollen.   Some women react adversely to certain foods during a particular phase of the menstrual cycle or during pregnancy.   In most cases, the reason for the variability is not clear.
  

2. The mechanism or mechanisms causing adverse reactions to foods are not clear.   Although much early attention was focused on the role of IgE antibodies, it is clear that many reactions are mediated through other mechanisms.   Much recent attention has focused on the role of IgG antibodies and some workers believe that IgG antibodies correlate more closely with the clinical picture of food allergy than do IgE antibodies.   Prostaglandins and related hormones have been shown to play a role in some cases.   In other cases, adverse reactions may be non-immunologic responses.

3. There is no 100 percent reliable test for food allergy to which other tests can be compared.   With no reliable standard of comparison, there is no way that any new test can be reliably judged.   Almost daily we see patients in the office who have been tested with skin or RAST tests who are puzzled by the results.   They usually describe negative testing for foods to which they clearly and predictably react and positive tests for foods which they have repeatedly eliminated and reintroduced with no observable clinical response.   Each test has its limitations and shortcomings, including the following:  

• History - Many patients have a history of reacting after ingesting a meal but do not have a clear understanding of what specific food caused the reaction.   Many patients ingest specific foods like dairy products or wheat several times daily and have never deliberately avoided those and other foods long enough to see if symptoms clear.   Many are puzzled by the observation that they seem to react to a specific food sometimes but not at other times.   Most patients do not have enough understanding of the nature of food reactions to have intelligently evaluated individual foods.
• Food re-challenge - After a food is avoided for a time and then reintroduced, there may be no initial response if the reaction happens to be cumulative or variable.   The best that can be determined by a one-time challenge is that the person must not have an immediate, fixed reaction to that food.   A food challenge must be repeated several times over two days or so to rule out these other forms of food reaction.
• Double-blind food capsule test - Although this test may work reasonably well for a fixed reaction on someone with a low threshold for that food, it is in general a very unreliable test for food reactivity.   One study showed that this technique correlated in only 30 percent of cases with skin testing and in less than 8 percent of cases with RAST testing. 35
• RAST and related tests - RAST test for IgE have shown a reasonable correlation to food reactions but it is clear that many non-IgE responses occur in response to food ingestion.   IgG testing is becoming popular and some advocates believe in correlates better with clinical responses to food challenge.   Obviously, IgG antibodies also do not explain the whole realm of food reactivity.
• Skin testing - Various types of skin responses have been investigated and are reasonable correlated with clinical food response in some tests but not in others.   It was long thought that the skin response was mediated exclusively through IgE antibodies.   If this were the case, a better correlation between IgE antibodies and skin responses should be shown (unless both tests simply have a high level of error).

Disadvantages and Advantages of Electrodermal Testing

One of the biggest advantages of using electrodermal testing is in detecting sensitivities and identifying optimal treatment dosages instead of relying on trial and error, as used in intracutaneous serial dilution titration techniques, or with sublingual provocative-neutralization techniques. Another useful application of electrodermal testing is in testing medications.   Every doctor in primary care is faced with patients who seem to react to a lot of different medications and who need to be given something to control blood pressure, or who need surgery, or who are on a lot of medications and there is strong evidence that they are reacting to one or more of their drugs.

There is a great deal of concern about iatrogenic disease these days, in fact believed to be responsible for about 36 percent of hospital admissions.36   An estimated 2 percent of hospital patients even die from iatrogenic causes.37   A great number of these unfortunate problems are cause by adverse reactions to drugs.   Skin testing for identifying such problems is rather inadequate, since many of the drugs are not available in an injectable form for testing purposes.   Even if an injectable form is available, the patient still might react to the dyes, fillers or excipients in the oral form.   Many of the reactions from drugs are non IgE, and may not even show up on skin testing.   In the past, the only option was trial and error and it was often only after several unpleasant reactions that a tolerable, effective choice was found.   With trying to sort out a patient's problems on a lot of drugs it is even more complex.   One has the dilemma of trying to decide whether to stop everything and then reintroduce medications one at a time, whether to stop only one drug at a time or whether to try switching some of their drugs to other types.   Going off of certain medications can be potentially dangerous to the patient.   The electrodermal testing will usually indicate within a few minutes which medications are likely to be a problem.   This testing can also indicate which medications are likely to be well tolerated.   Based on that information, it is generally a simple matter to avoid the problem drug and introduce medications likely to be well tolerated.   Although this technique is not foolproof and may not pick up every type of adverse reaction, it is certainly a lot better than a shop in the dark as with an entirely trial and error approach.

Conclusion

Acupuncture points have been known for thousands of years and the principles of electricity have been understood (at least somewhat) since before the 1600's.   It has been known for many years that acupuncture points have different electrical conduction than the surrounding tissues.   Changes in these electrical readings in conjunction with disease states have been investigated extensively.   Using electrodiagnostic instruments for measuring allergy responses has been around for over 35 years.   This technology has been studied and utilized around the world by thousands of doctors.   Many studies including a number of double-blind studies have been done validating this procedure.   The chances of these reporting results occurring by chance alone are one in many millions.   Electrodiagnostic testing has many advantages and would certainly be useful in every hospital and in the office of every doctor who prescribes medications. It is the belief of this writer that the use of electrodiagnostic testing fulfills all the requirements to be considered adequately proven including:   •  A number of double-blind studies from various centers validating its efficacy.   •  Experts in the field who deal with this technology acknowledging its usefulness and accuracy.   •  Electrodiagnostic testing having been in use around the world for many years by thousands of medical doctors.  

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