Introduction to Allergy

What Your Doctor May Not tell You About Children's Allergies and Asthma: Simple Steps to Help Stop Attacks and Improve Your Child's Health
by Paul Ehrlich, M.D., Larry Chiaramonte, M.D.

Allergies and asthma among children are epidemic!
What you don't know could be a matter of life and death.

Allergic reaction and asthma attacks among children have increased 95 percent since 1980! One in thirteen school-age children has asthma, and the greatest rise in the incidence of allergies and/or asthma is occurring among preschool-age children. Now two renowned physicians on the front lines of pediatric allergy and immunology explain why these chronic diseases have become so prevalent and offer sound strategies to help children (and their worried parents!) breathe easier.

• Learn why children with allergies are often misdiagnosed.

• Understand the difference between the major drug groups-both prescription and over-the-counter-their advantages, disadvantages, and effectiveness.

• Discover alternative and holistic remedies that can help your child.

• Recognize symptoms of allergies at all stages of childhood-from newborns to teens.

• Allergy-proof your home, your pets, and your car.

• Learn the myths and realities of steroids.

• Decode food labels and learn what "secret" ingredients can be deadly for children with food allergies.

If you are the parent of an allergic child, it is very likely that you are an allergy sufferer yourself. You know the misery that allergies can bring, on a scale from annoying itching of skin and eyes at one end, to debilitating sneezing fits, to life-threatening asthma attacks or anaphylactic shock at the other. You know how allergies can be misdiagnosed. You know about the drowsiness induced by some antihistamines, the inconvenience of carrying nebulizers and inhalers. You know how the joy of childhood can be diminished by eternal vigilance about foods, activities, and environments.

We know about them, too. We are both board-certified allergists. For some sixty years between the two of us, we have been treating children like yours, and from what we have seen, the prognosis for allergy treatment is troubling.

For one thing, allergies seem to be becoming more frequent.

Part of this is due to changes in the way we live. We live in homes that are sealed to trap heat in the winter and cool conditioned air in the summer. We have wall-to-wall carpeting and throw rugs on our floors. But this comfortable and energy-conscious approach creates an environment in which dust mites thrive. Energy efficiency means that there is less fresh air from outside being exchanged with stale air indoors, which means that dust builds up inside. Carpeting may be comfortable to walk on, insulating, and attractive, but dust that settles on it doesn't come out.

In a sense, allergy is a price we have paid for progress. The body's defenses-the immune system-evolved to help us fight off parasites that afflicted our ancestors when mankind had very little ability to influence either their environment or their diet. The first great impetus for the development of allergies may have been the invention of shoes, which kept worms or other parasites from entering our feet and thereby put parts of the immune system out of work.

Frank T. Vertosick, Jr., author of a recent book called The Genius Within: Discovering the Intelligence of Every Living Thing, advances the theory that the brain is not the only part of the body that can learn from experience. He writes, "The immune system must learn and recall billions, perhaps trillions, of different molecular patterns. Our lives depend on its ability to make instant discriminations between friend and foe, not an easy task." While our specialty is Allergy and Immunology, we will reserve judgment on whether this constitutes "intelligence" or not. However, we never cease to wonder at the resourcefulness of the immune system, not only its resiliency in combating disease, but also its potential for mischief when it goes awry.

Because of modern sanitation, climate control, and immunization, many of the original problems the immune system evolved to combat no longer exist routinely in advanced industrial countries like ours. However, the defenses are still within us. Like soldiers demobilized at the end of a war, they need time to adjust after the fighting stops, but in the case of immunity that has evolved over aeons, the adjustment hasn't begun. Idle hands make the devil's work. These are defenses in search of an enemy, and they spend their time attacking all kinds of things-molds, pollens, chemicals used in the construction of our homes-and in the process of attacking those irritants, they throw off toxins that make us sick.

There's a saying that what children need in their homes to keep allergies from developing is a pound of dirt, as would be the case on a farm. That theory recently gained support in a study published in the summer of 2002 saying that infants raised in homes with two or more cats and dogs developed allergies at roughly half the rate as children in pet-free homes. Moreover, they were less allergic not just to dogs and cats but to pollens and other common allergens as well.

If progress is causing all that trouble, is it worth it? Or should we all move into mud huts?

We'll leave that to philosophers. In the meantime, we have the obligation to try to keep ahead of our bodies' own defenses. The science allows us to give it a try. And what the science says is that the jury is still out on exposing children to cats and dogs to try to protect them against allergies, as the author of the study was among the first to point out. After all, the data cited in the above-mentioned study were contrary to long-established wisdom and practice on the subject. It may well be a statistical anomaly. The results must be repeatable. So, much to the consternation of animal-loving new parents in families with a history of allergy, we must advise that they not run out to the animal shelter and stock up on new pets.

Why Treatment May be Getting worse

The science is good, and it's getting better. As the understanding of allergy grows, so does the effectiveness of drugs to tread various conditions, as well as environmental adjustments to minimize attacks.

And it's not for want of treatment. Many general practitioners and family practitioners are doing more to treat allergy than their counterparts did when we began practice decades ago. Indeed, a generation ago, most GPs (general practitioners) didn't even acknowledge allergy as something to be taken very seriously. One of your authors-Dr. Ehrlich- is the son of a late and much respected pediatrician who rarely referred any of his patients to allergists, even when his won son became one. Instead, children and their parents were given antihistamines and counseled to put up with sneezing. Skin conditions were treated with all-purpose ointments and creams. Bad asthma attacks were controlled with systemic cortisone, which would affect the whole body, not just the lungs. Prolonged cortisone use had substantial long-term side effects.

Today, we know what works to keep asthma under control, but doctors don't always do it. In 1990 and 1991 the National Institutes of Health convened experts under the leadership of Albert Sheffer, MD, from Harvard Medical School to produce guidelines for the treatment of this growing threat to public health. However, as the Journal of Asthma has pointed out, these treatment guidelines are not followed in 50 percent of cases, although as the most recent NIH data show treatment has never been safer or more effective. (The American Academy of Allergy, Asthma and Immunology, www.aaaai.org, has position statements on treatments currently deemed effective.)

Copyright © 2003 by Paul Ehrlich, M.D. and Larry Chiaramonte, M.D.

About the Author

Paul Ehrlich, M.D. is a graduate of the Columbia University and New York University School of Medicine where he earned his B.A. and M.D. respectively. Dr. Ehrlich trained at Bellevue Hospital in Pediatrics and Walter Reed Army Medical Center in Allergy and Immunology.

Dr. Chiaramonte received his B.S and M.D. degrees fro Yale University. At Bay View Medical Center in Baltimore he became the first family practice resident in the country. He was trained in pediatrics at Albert Einstein Medical School in New York City an din allergy and immunology at John Hopkins University. He is a board certified in both fields.