Posts Tagged ‘childhood asthma’

The days when doctors wanted their patients to obey orders and ask no questions are largely gone. Patients with allergies and other forms of sensitivity - or their parents -

have to play a key role in managing the disease. Most doctors now recognise this, and encourage their patients to learn about their illness, its diagnosis and treatment, and to

be partners in their own medical care.
Quite apart from this, there are aspects of allergy management where few doctors can afford the time to become experts. The nitty-gritty details of dust-mite avoidance or food

labelling practices are good examples. You can usefully supplement your doctor’s treatment here, by informing yourself.
But where should this process stop? That is a difficult question which doctors are increasingly forced to consider. One modern phenomenon, being discussed in many medical

journals at present, is the abundance of medical information on the Internet. Some doctors dread the arrival of patients who have logged on the night before their appointment

and are armed with a huge number of facts about their illness -some accurate, some utterly wrong and some highly debatable. But other doctors welcome the fact that patients are

actively interested in their health problems.
The reactions of doctors to ‘Internet patients’ highlight an issue that also runs right through this
book - that of medical orthodoxy. Who decides what is true and what is false in medicine, and how do they do it? Make no mistake - this is a deep and abiding problem which

afflicts not just scientific medicine, but science in general.
If a doctor, confronted with a web-page claiming that allergies are caused by space aliens intent on
destroying Western civilisation, snorts ‘Rubbish!’, he or she is not, strictly speaking, taking a scientific approach. In science, you should consider all the different

hypotheses.
In theory, science works by questioning everything and taking nothing on trust - but you can’t make much practical progress if you stick rigorously to that approach. Neither

scientists nor doctors start their careers by running experiments to establish the truth of everything they were ever taught. At some point in science, and in scientific

medicine, you have to assume that certain things are probably true, and proceed accordingly. If you make significant progress working on those assumptions, then the chances are

they were correct. But a good scientist always remembers that they are only assumptions.
Scientific medicine rests on a huge number of assumptions. Some of these are clearly accurate - for example, that eating wheat triggers coeliac disease -and it would be

time-wasting to argue about them. But this ‘fact’ about coeliac disease began as just a theory (see p. 70), and a highly debatable one. It has taken time for it to become

substantiated by more and more evidence.
Some medical assumptions become enshrined as facts rather too quickly. Fifty years ago, orthodox medicine accepted as a ‘fact’ that many asthmatic children had ‘intrinsic

asthma’, which was psychological in origin. Research since then has shown that there is almost always an allergy underlying childhood asthma. Many other examples could be given

of medical ‘facts’ that are overturned by subsequent research.
Doctors thirst for certainty, something that is quite understandable when they are faced with so much human need. A significant part of the healing power of medicine comes from

placebo effect (see p. 233), and that relies on patients having faith in the doctor. The traditional way for doctors to cultivate that faith was by assuming an air of absolute

certainty - about their diagnosis of the patient’s illness, about the treatment, and about medicine in general. This need for certainty has always hastened the transformation of

assumptions into facts.
The fatherly authoritarian attitude of old-fashioned doctors was, in large part, a reflection of how little they had in the way of useful treatments, and how much they relied on

placebo effect. Modern doctors have far more genuinely effective remedies to offer and can afford to take a different approach. Many now rely on a different kind of authority,

one based on intelligence, good information, flexibility, curiosity and openness. It’s a form of authority that allows a doctor to say ‘I could be wrong…’ or, ‘Let’s try this

and see what happens…’ without losing face.
Unfortunately, there is another powerful force at work in this complex situation, and that is quackery -the age-old business of selling phoney cures (see p. 209). Official

bodies within the medical community try to curb quackery by weighing the evidence about novel treatments and coming to decisions on their validity. This can be very useful. But

in deciding what is, and what is not, good scientific medicine, medical organizations always run the risk of mistaking their own unverified assumptions for facts.
Establishing criteria for good treatment is essential in medicine, but when this develops into dogmatism, that is decidedly unhealthy. Among the treatments that are being

dismissed as valueless today, there are
several that deserve a fairer hearing.
Some of these treatments have been shown to work by the most excellent of scientific methods. The use of elimination diets in Crohn’s disease is a good example - for some

patients, there is a huge and sustained improvement, suggesting that their disease was caused, at least in part, by food sensitivity. The tactic used by those who want to reject

this evidence is simply to ignore it. When scientific review papers (summaries of all the current knowledge and latest research) are written about Crohn’s disease, the research

on diet is usually not mentioned. Evidence that is routinely ignored in this way slips into oblivion because most doctors only have time to read the review papers, not the

original research reports.
Occasionally - and this is even more shameful -good scientific evidence that goes against the grain of current orthodoxy is actually misreported in review papers. This happened

with an impeccable scientific study showing the benefits of an elimination diet for some patients with rheumatoid arthritis. By missing out certain key facts, a review author

managed to give the impression that the results of this study supported the conventional view on the subject (that diet makes no difference to rheumatoid arthritis), whereas

they actually disputed the conventional view.
Unthinking rejection of new treatments often occurs with currently untreatable diseases such as autism and Chronic Fatigue Syndrome (CFS). Such medical problems always attract

experimental treatments, just as they always attract sheer quackery, and sorting out one from the other is not easy - it takes time, and a clear-headed approach, not knee-jerk

dismissal.

If you have a child with allergies, sooner or later some friend or relative will tell you not to worry

because your child ‘will probably grow out of it’. Your doctor may well say the same thing. But what

does this mean? Do all children shake off their allergic symptoms as they get older? If the symptoms

go, is the underlying disease completely cured? And why treat allergies if they disappear of their own

accord? The truth is that the relationship between allergy and age is incredibly complex, and doctors

only understand a tiny part of it. The best anyone can offer is a broad overview of how allergies

change with age, with few explanations of the underlying mechanisms, and absolutely no predictions of

what the future holds for any particular allergy sufferer.
It is certainly true that the classical allergic diseases, such as atopic eczema, hayfever and

childhood asthma (see box on p. 11), frequently disappear as children grow up. Babies tend to shrug off

food allergy and eczema by the time they are toddling, and a fair number of asthmatic children lose

their symptoms before they are ten years old, while others do so in their teens or early twenties.
Unfortunately, the disappearance of symptoms does not mean that the underlying disease has necessarily

disappeared, particularly in the case of asthma. Quite a few young adults find themselves wheezy and

breathless again in their late twenties or thirties, especially if they take up smoking. One study of

children who wheezed before the age of seven found that:
• 25% lost their asthma for a time – anything between two years and 25 years – only to get it

back again by their early thirties. Some recovered and relapsed more than once.
• Over 70% shook off asthma and were still symptom-free by their early thirties when the study

ended.
• Only 2% remained asthmatic throughout. Realistically, anyone who has ever been asthmatic should

regard themselves as ‘at risk’ indefinitely and never be careless with their health – don’t smoke, keep

away from smoky bars and clubs, eat a good diet with plenty of fruit and vegetables (206) and avoid

activities that involve an asthma risk, such as strenuous exercise in cold air.
Workplaces with high exposure to allergens, such as saw mills, bakeries or laboratories using animals

(see pp. 133-4) are not recommended for those with a history of allergy. Anyone who has ever had eczema

should also take care with cosmetics and soaps, choosing the gentlest brands. They should also protect

their hands (57) and avoid hairdressing or bricklaying as an occupation, or anything else where skin

irritation is likely.
Moving on
Growing out of classical allergies seems to be a consequence of the child’s immune system changing and

maturing as it grows. This same process, unfortunately, can also substitute one allergic disease for

another.
`When Alex developed eczema as a baby I hoped that she’d grow out of it in time. Well she did,

gradually, and by the time she was five it seemed to have cleared up, but then she started having a

snuffly nose that never really went away. A year or so later, she began wheezing whenever she got a

cold, and this has now developed into asthma.’ The pattern described by Alex’s mother Jenny will be

familiar to many parents, who watch their children slowly work their way through all the allergies in

the medical textbooks. Doctors call it the atopic march or allergic march.
Fortunately, even this type of allergic pattern can have a positive outcome eventually. Many such

children become allergy-free in time, and develop into healthy adults.
In the meantime, there are several itchy, wheezy or sneezy years to get through, and since childhood is

a time to be enjoyed, not endured, treatments that alleviate the symptoms of allergies are generally

welcomed. Being energetic, healthy, ‘normal’ and able to join in with sports and other activities is

particularly important for a child’s social development and self-confidence.
Treating the symptoms also prevents any long-term and irreversible damage, such as the thickening and

loss of elasticity that occurs in the airways of children with untreated asthma.
At the same time as treating the symptoms, it makes sense to maximise the chance of the child growing

out of the allergy. Parents can tip the odds in the right direction by providing an environment that

reduces the chance of new allergies developing. A detailed action programme is described on pp. 248-9.
Allergies that begin in adult life
What about those people who develop classical allergic diseases for the first time as adults - or even

in old age? Will they too ‘grow out of it’ with the passing years?
Only a minority of people develop such allergies for the first time as adults, although the numbers

seem to be increasing. The older you are when your allergies begin, the less likely you are ever to

throw them off. On the positive side, they are unlikely to get a great deal worse than they are at the

outset, especially if you take care of yourself and keep the air at home as unpolluted and

allergen-free as possible (see pp. 114-31).
In the case of asthma that develops in adulthood, there may not be an allergic reaction involved.

Whereas allergies play a part in asthma for 80-90% of children, the figure is thought to be lower for

adults. Nevertheless, it is well worth investigating the possible role of allergens, because avoiding

them is one of the most effective treatments.
The outlook for food intolerance
Food intolerance causes a wide variety of symptoms, from baby colic to migraine. A full list is given

on p. 76. Although far less is understood about food intolerance than about true allergies, there is

much more certainty about the future for affected individuals. With rare exceptions, people find that

the problem clears up as long as they totally avoid their problem food for a year or two. After this

period of strict avoidance, they can eat the food again in moderation but should never forget that the

problem can return. Eating the culprit food very regularly will turn the clock back and all the

original symptoms will return. This change for the worse may be irreversible for people with severe

reactions such as rheumatoid arthritis.
Safety first
Anyone who suffers the life-threatening allergic reaction known as anaphylactic shock (58) is probably

going
to have this for the rest of their days. Some children do become tolerant of food allergens in time

(allergies to milk, eggs or soya may well disappear, whereas fish or peanut allergy is probably going

to be permanent) but before concluding that there is no longer any risk, some extremely careful and

cautious testing should take place. Talk to your doctor about how to proceed. Skin-prick tests may be

helpful, but there must be resuscitation equipment close to hand as anaphylaxis can occur. Never give

the child any of the food to eat, until you (or, preferably, the doctor) have first tested it in other,

less risky, ways. For example, you can smear a little on the face to see if there is any reaction. If

there is none within 24 hours, put a tiny amount on the outer lip and watch again.
If both these tests produce absolutely no reaction then a very small amount of the food can be eaten as

a test: this should be done under medical supervision. The amount can be slowly increased with

successive tests, until it seems certain that no reaction will occur even with a normal portion.