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Allergic Asthma

The acute attack of allergic (or extrinsic) asthma is an episodic shortness of breath which lasts hours or days and varies from a tightness in the chest to a severe difficulty in breathing, accompanied by wheezing sounds in the lungs. It may develop suddenly; it may be accompanied by a cough which produces thick mucus; and it may cause breathing which is easy in inspiration but difficult in expiration. Prolonged coughing spells may cause vomiting of food and mucus. Between attacks, the child may be free of symptoms, or he may suffer from spells of coughing and difficulty in breathing.

The attack becomes chronic if the above symptoms continue for a few days in which mild activity and minor events (such as laughing) may be enough to start a new strong attack.

The acute attack becomes statics asthmaticus if it is not relieved by the conventional asthma drugs. The child becomes apprehensive and agitated; he leans forward in his bed, sweats, and strains to expand his chest; he has a quick heartbeat and a wheezing sound in the lungs that one can hear at a distance; his chest becomes inflated; and his breath sounds are diminished.

Allergic asthma may be caused by foods such as nuts, shellfish, eggs, chocolate, fresh fruit, and mustard; by inhalants such as pollen, house dust, epidermoids, and molds; by drugs; and by bacteria and viruses.

A special kind of asthma caused by molds has certain characteristics which distinguish it from other types of asthma. It has a dramatic onset at night. The child wakes up short of breath, livid, and panicky, but with very little wheezing in his chest. Or it may happen during any day of the year, provided that day has been sunny and warm. The child is free of symptoms when snow is on the ground because snow covers the soil and prevents the mold spores from rising into the air. It is also connected to the eating of mold-containing foods such as Chinese sauces or blue, Roquefort, or Camembert cheeses or to the drinking of any kind of beer fermented with yeast. It is frequent among children of farmers because manure, compost, dead leaves, and musty hay harbor molds.

The advent of air travel (causing extreme changes in the climatic environment), the increase of intermarriage, the use of molds as drugs (penicillin), and the frenzied pace of modern life all contribute to an increase in this kind of asthma.

Non-allergic Asthma

Non-allergic (intrinsic) asthma comes about when a spasm in the muscles of the bronchi occurs after irritants such as cold, damp air, or air containing fumes, tobacco smoke, insecticides, perfumes, and sprays succeed in breaking a child’s asthma threshold. An asthma threshold is a theoretical line of defense against spasm situated in the sensory nerve endings lying under the mucosa of the lungs.

Mixed asthma is both allergic and non-allergic at the same time; aspirin asthma is neither allergic nor non-allergic.

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This assumes that the affected person makes IgE antibodies to the synthetic chemical concerned (see p25), or responds with some other inappropriate and damaging immune reaction. Since the chemicals concerned are too small to act as antigens in their own right, they would have to combine with body proteins and act as haptens.

It has been suggested that this can happen with some food additives, particularly preservatives and synthetic colours. These cause chronic urticaria (nettle-rash) in some people, and urticaria is sometimes due to an allergic reaction. There are also isolated cases of tartrazine (a synthetic colouring) causing acute asthma attacks, or a severe reaction that resembles anaphylactic shock in some very susceptible people. Other food colourings, particularly the synthetic ones, have been known to cause allergic dermatitis, mainly in food workers exposed to large amounts. The preservative, sorbic acid, has occasionally caused allergic dermatitis when used in medicinal creams.

In most of these cases, the tests to show that the reaction really is an allergic one have not been carried out. And when a group of patients who were apparently allergic to tartrazine were tested for IgE antibodies, none were found. So it looks as if these are not allergic reactions at all, even though they produce allergy-like symptoms. Doctors suspect that tartrazine produces symptoms in these people by directly affecting the immune response in some way – perhaps by stopping the synthesis of immune regulators called prostaglandins, or by triggering mast cells directly. In the case of synthetic chemicals apparently causing asthma, the effect may be due to irritation rather than an allergic reaction. This is well known for metabisulphites and sulphur dioxide.

These are cases where the symptoms provoked by chemicals at least looked like allergic symptoms. In the majority of chemical-sensitive people, the symptoms are not those commonly associated with allergy. So it seems unlikely that chemical sensitivity is allergic in origin. It is possible, however, that synthetic chemicals might affect the immune response in some way. This has indeed been shown for some chemicals, but the usual effect is to lower resistance to disease, rather than to make allergies more likely.

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Inhalation challenge (nasal and bronchial provocation)

Because skin tests sometimes miss the mark entirely, some doctors use an inhalation challenge for allergy to inhalants. To test for mould allergy, for instance, a small amount of dried, powdered, sterilized mould is placed on the end of a toothpick and sniffed. Symptoms are expected to appear within five minutes if the individual is allergic to mould.

So far, these tests all carry an element of anxiety – the fear that you will react. No wonder – that’s the whole idea. The ideal allergy test, from the patient’s point of view, is one that’s accurate, yet doesn’t risk a reaction. Enter the RAST test.

RAST (radioallergosorbent test)

The RAST test measures the amount of IgE in your blood. It’s certainly safe, since the test is conducted on a blood sample in the laboratory. Anaphylactic shock, which occasionally occurs with skin testing, is impossible with a RAST test (although you still have to endure the discomfort of a needle). RAST is more sensitive than a puncture or scratch test.

‘One of the criticisms of the RAST test is that it’s expensive,’ comments Dr Jonathan V. Wright, from Kent, Washington, who uses the RAST test a great deal. ‘Unfortunately, no other test comes as close to it in accuracy.’

A RAST test measures the amount of IgE (allergy-provoking antibody) in the blood. In contrast, skin tests merely measure the weal-and-flare – indirect evidence of IgE activity. More precise measurement of IgE activity by RAST means that, if needed, allergy injections can be started at a customized dose, and relief can be expected in three or four months. In contrast, allergy injections based on skin tests are begun at a lower estimated dose and gradually increased until the optimal dose is reached, which sometimes takes six months to a year. (Incidentally, IgE levels run higher in smokers than non-smokers, for some unknown reason. Be sure to let your doctor know if you smoke so that factor can be taken into consideration when interpreting your RAST test.)

For all its advantages, the RAST test is somewhat controversial. Aside from increased cost, doctors must resist the temptation to rely on it too heavily for diagnosis. For instance, many people react positively to both skin and RAST tests for cereal grains, but eat them routinely with no ill effects. Like any allergy test, the RAST is meant to supplement, not replace, a good, thorough medical history. Consequently, many doctors feel that the most accurate way of testing for food allergy is still elimination and re-challenge.

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Nausea nearly always suggests food allergy. You may not vomit every time you feel nauseated – but you may feel like you’re going to. And that can certainly make you less sociable and productive.

Consider the case of a thirty-two-year-old woman who had felt nauseated nearly every day of her life since childhood. The only way she could keep from vomiting in public was by taking large doses of antihistamines. Car travel was an ordeal – a two-hour trip required several pit stops.

‘She became depressed, lethargic and lost her zest for life,’ say the doctors who treated her. ‘And her relationship with her fianc? was strained because she was becoming short-tempered and losing her sex drive because of her constant nausea.’

When the woman fainted after drinking a cup of tea, she was sent to a hospital for neurological tests. The doctors also decided to investigate the possibility of food allergies.

‘On the basis of her dietary history, tea was excluded from her diet, and the vomiting and nausea ceased,’ say Drs Ronald Finn and H. Newman Cohen. ‘By avoiding tea she has been symptomless for five months, and is able to travel long distances by car without feeling sick’. (Lancet.) And oh, yes – she got married.

Most people have far less trouble than this woman did in figuring out that a particular food is making them sick. Nausea usually occurs shortly after you’ve eaten something that disagrees with you rather than hours later. So it’s easy to notice a pattern. But if you occasionally feel nauseated for no apparent reason, you may need to keep a diet diary to trace your nausea to the offending food.

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Blood pressure is affected by seventeen known variables. Smoking, over-weight, salt consumption, stress, use of oral contraceptives, exposure to lead and cadmium – these, among other factors, are all possible causes of hypertension. To that list we may eventually add allergy.

A few years ago, Dr Lloyd Rosenvold, of Hope, Idaho, noticed that some of his patients developed high blood pressure from allergy to certain foods. Another doctor, George Fricke, of Sacramento, California, studied a group of twelve hypertensive people – some with blood pressure as high as 210/140 – in whom elimination of allergic foods brought blood pressure down to normal. And in a study of food allergies and migraine, Dr Ellen Grant, a neurologist in London, discovered that when a group of fifteen hypertensive people avoided migraine-producing foods, their blood pressure also returned to normal (Lancer).

Surprising findings? Not really. High blood pressure is more than a simple matter of getting too much salt in the diet. After all, we all know someone who salts his or her food heavily and has normal blood pressure. Whether blood pressure rises or not seems to be a matter of individual sensitivity to many factors, some of which doctors haven’t yet identified clearly. Allergy, it seems, is one of those factors, and its presence could help to explain why certain foods or habits raise blood pressure in some people but not others.

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Most people think car sickness is just one variety of motion sickness – the nausea and dizziness that attack some travellers on aeroplanes, buses and cars. A few people with car sickness, however, may be reacting to car exhaust fumes, moulds and dust in the car air conditioner or the odour of new vinyl upholstery. All those triggers can make an allergic traveller feel nauseated and sometimes dizzy or headachy.

But even if they don’t feel outright nausea, people with allergy induced car sickness can become irritable and easily annoyed by delays or other drivers’ mistakes. And there are a host of other possible symptoms. They may feel dopey and under-react to traffic situations. Perceptions may dull and reflexes slow down. Vision may blur. The driver may underestimate the time and distance needed to stop, or even fall asleep at the wheel.

If you get sick, tired or irritable on car trips, take less heavily traveled routes to avoid breathing heavily polluted air. Above all, don’t drive in the wake of a bus or diesel truck if you can possibly avoid it.

When you stop to fill up, close the window while the service station attendant fills the tank. At self-service stations, wear a handkerchief over your nose and mouth to block out fumes while you fill your tank. (Be sure to remove the handkerchief when you approach the cashier, so he won’t mistake you for a robber!)

Allergic people should have their car air conditioners cleaned regularly before and during the hot weather season to eliminate mould and dust. As for sensitivity to vinyl car interiors and upholstery, you’ll be less likely to get sick if you buy a car that’s at least two years old. As vinyl ages, it gives off less odour.

Much of the fatigue that’s blamed on ‘highway hypnosis’ may actually be due to car-related allergies. Following these precautions will not only help you arrive at your destination feeling well, but will also cut down your chances of a traffic accident along the way.

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The pain suffered in a personal tug-of-war with allergy is like the pain of any struggle – partly physical and partly psychological. Anxiety, depression and fatigue may be direct results of an allergic reaction somewhere in the body. Or they may result from the many aggravations of dealing with a chronic allergy: sticking to a restricted diet. Vigilance against airborne allergy triggers. The fear that no matter how careful you are, you’ll get zapped anyway. The sense of alienation from your non-allergic spouse, family or co-workers. Resentment over your bad luck. And above all, the desire to lead a normal life again.

Those are the ‘effects of the effect’, as one highly allergic person put it. And easing the psychological and emotional effects of being allergic goes a long way towards successful, drug-free relief from the allergies themselves. In the case of asthma, for instance, one doctor observed that people who have uncontrolled apprehension – panic over breathing problems, fear of recurring symptoms and so on – tend to over-use steroids and other asthma medication. And they’re more likely to be frequently hospitalized for their condition, adds Jerald F. Dirks, Psy. D, former chief of clinical psychology at the National Jewish Hospital and Research Centre and the National Asthma Centre in Denver.

Actually, a little anxiety over allergy is useful – it motivates an individual to do something about the problem, rather than just roll up his or her sleeve for an injection or swallow a pill. Too much anxiety, on the other hand, can lead to an unhealthy with the illness, to the point where you begin to neglect the other important aspects of life – family and friends, career goals, travel plans, hobbies. In the case of food allergies in particular, over-anxiety can lead to what one doctor calls ‘food neurosis’ – an all-consuming obsession with what you can and cannot eat, and paranoia about eating away from home.

‘Allergic people can easily slip into the me versus them attitude if they’re not careful,’ says Iris R. Bell, a psychiatrist in San Francisco. ‘Many people begin to look at their environment as their enemy. Soon, they feel that everything they eat or breathe might make them sick. And it’s a very difficult position not to get yourself into, because it’s true that certain things can make you sick,’ she acknowledges.

‘But too much worry over allergies can make allergies worse,’ Dr Bell continued. ‘That may explain why some people feel worse when they first begin to pay attention to their diet or environment. One theory is that they develop what psychologists call a “conditioned response”. After one or more symptom-causing encounters with an identified allergen, they may break out from simply looking at chocolate, or start to feel sick when someone nearby reaches for a cigarette.’

The secret to avoid ‘worrying yourself sick’ is to learn to cope with allergies realistically, rather than to let yourself slip into the role of a lonely exile. And coping is easier if you avoid focusing on being a ‘patient’. Granted, you may feel like a patient if you have to record every mouthful of food you eat or if you’re following a Rotary Diet. Nonetheless, says Dr Bell, you should try your best to shift away from the mindset of ‘I’m sick’ -towards ‘I’m getting well’.

‘Some people say, “I’m sick today, and until I’m well I can’t do this or that,” ‘ continued Dr Bell. ‘That attitude can lead to a terrible cycle in which you never do anything, and then you feel worse about yourself because you aren’t doing anything you enjoy.’

In other words, allergies can exact quite a toll in terms of damage to self-image – but only if you let them.

‘I don’t expect people to deny that they’re sick,’ says Dr Bell. ‘But on the other hand, I’ve seen people who focused so much on being allergic that it became their whole identity – and a way to avoid life’s stresses.’

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