Granted, you can't asthma-proof the great outdoors. However, you can limit your exposure to outdoor pollens and mold spores to reduce your asthma symptoms. If you have experienced asthma symptoms in early spring, tree pollens maybe one of your asthma triggers; late spring, grasses; late summer to autumn, weeds; summer and fall, alternaria and cladosporium, both of which are molds.
- Stay inside in the middle of the day and afternoon, when the pollen and spore counts are highest.
- Exercise and do other outdoor activities just after sunrise, when pollen and spore counts are lowest.
- Use air conditioning, if possible.
- Close windows during seasons when pollen and mold are highest. Your health care provider can tell you when these seasons are in your area.
- Avoid wet leaves, yard debris, and other outdoor sources of mold.
- Avoid pillows, bedding, and furniture stuffed with kapok, a silky, fibrous material made from the seed pods of the silk-cotton tree. The fibers could contain pollen and spores.
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Thursday
Saturday
Case history of hyperactivity
John was brought to the Allergy Clinic because of concerns about his progress at school. He was seven years old at the time. His teacher had complained that his concentration was poor and that he was giddy during class. His mother added that he sometimes 'goes wild, absolutely wild’ and that he is likely to thrash out at anyone within striking distance when he gets into one of these moods. John, for his part, was more concerned about the fact that he had frequent headache, and that he was always running to the loo with diarrhoea. He also complained of feeling tired all the time — a paradoxical symptom, given that he was always on the go and never paused for a moment's rest. During his visit, he stuck his nose into every nook and cranny of the office, mauled every valuable item on the desk, spent less than 5 per cent of the time in his chair, and was pulled back several times from expensive medical equipment. Throughout this time, he shouted several unrepeatable sentences at his mother, and interrupted our conversation frequently. John, by any reasonable standards, was suffering from hyperactivity.
Hyperactive children have long tested the patience of their parents, siblings and teachers. They have also eluded the best medical attempts to categorise and tame them! Over the years, doctors have espoused, and then rejected, countless descriptive terms for the condition. This may be because the condition is in fact a conglomeration of several different conditions with overlapping features. Thus, it is important that we agree somewhat more precisely on what it is we mean by ‘hyperactivity'.
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Hyperactive children have long tested the patience of their parents, siblings and teachers. They have also eluded the best medical attempts to categorise and tame them! Over the years, doctors have espoused, and then rejected, countless descriptive terms for the condition. This may be because the condition is in fact a conglomeration of several different conditions with overlapping features. Thus, it is important that we agree somewhat more precisely on what it is we mean by ‘hyperactivity'.
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Sunday
Depression: moody tiredness
Four years ago Paddy came down with the flu. He described himself as 'unwell ever since'. He complained of fatigue, sore muscles and bones, and a disturbed sleep pattern. So far, his symptoms could have been considered 'a possible case of CFS1 and this was the reason for his referral. However, as we delved a little further into his symptoms, Paddy gave a very clear picture of depression, and it became obvious that he was not suffering from a Postviral Fatigue Syndrome. His tiredness was described as 'a moody tiredness, a weariness — like a heavy weight holding me down'. He had lost interest in his job, he didn't feel like socialising, and he avoided situations that he had relished heretofore. He was socially withdrawn, and he had lost all sense of pleasure in life. Finally, his sleep disruption was classical of depression: he woke every morning at 4 a.m., and try as he might, he could not get back to sleep again.
We spoke at length about his depression, but we could not find an obvious cause for it. He was happily married with a few healthy kids, his business ventures were going well, he had no financial difficulties and there were no recent stresses. In spite of all that, Paddy was depressed, and quite considerably so. His fatigue was simply part and parcel of that. We should now look again at Paddy's original flu. He clearly thought it was responsible for his plight. However, we have just said that he was not suffering from a Postviral Fatigue Syndrome. What role, then, did the virus play in all of this? The answer is quite simple: viral infections not only induce fatigue states, they can give rise to depression.
Anxiety: restless tiredness
Jenny was convinced that she had multiple food allergies. She was sure that these were the cause of her chronic fatigue. She thought, for example, that onions gave her a bloated tummy, that yeast and bread gave her a rapid heartbeat, and that beef gave her diarrhoea and a jittery feeling in the pit of her stomach. However, she would still experience these symptoms when she avoided (what she thought were) her troublesome foods. That's why she thought that she had other food allergies not yet discovered.
But her symptoms were of interest in their own right. Look at them for a moment apart from the foods which were said to cause them. She was tired all the time, she had bouts of diarrhoea and a bloated abdomen, her heart was beating too fast, and she felt jittery in the pit of her stomach. These are physical symptoms of anxiety, and they call for further exploration. 'Well, yes,’ she confessed, 'I am a bit of a worrier.' Jenny frequently stayed awake for hours at night thinking about the events of the day, worrying about her children, and planning her chores for the morning. She also described having to live through many days with 'a strange feeling of something bad about to happen'. Nothing particularly bad ever did happen, but Jenny was unable to calm her mind with such reassuring thoughts. She had an anxiety disorder, and her fatigue was just a manifestation of that.
Jenny was encouraged to eat all foods, even those she thought were making her ill. Meanwhile she was given some medical treatment for her anxiety. She improved greatly over the following few months.
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We spoke at length about his depression, but we could not find an obvious cause for it. He was happily married with a few healthy kids, his business ventures were going well, he had no financial difficulties and there were no recent stresses. In spite of all that, Paddy was depressed, and quite considerably so. His fatigue was simply part and parcel of that. We should now look again at Paddy's original flu. He clearly thought it was responsible for his plight. However, we have just said that he was not suffering from a Postviral Fatigue Syndrome. What role, then, did the virus play in all of this? The answer is quite simple: viral infections not only induce fatigue states, they can give rise to depression.
Anxiety: restless tiredness
Jenny was convinced that she had multiple food allergies. She was sure that these were the cause of her chronic fatigue. She thought, for example, that onions gave her a bloated tummy, that yeast and bread gave her a rapid heartbeat, and that beef gave her diarrhoea and a jittery feeling in the pit of her stomach. However, she would still experience these symptoms when she avoided (what she thought were) her troublesome foods. That's why she thought that she had other food allergies not yet discovered.
But her symptoms were of interest in their own right. Look at them for a moment apart from the foods which were said to cause them. She was tired all the time, she had bouts of diarrhoea and a bloated abdomen, her heart was beating too fast, and she felt jittery in the pit of her stomach. These are physical symptoms of anxiety, and they call for further exploration. 'Well, yes,’ she confessed, 'I am a bit of a worrier.' Jenny frequently stayed awake for hours at night thinking about the events of the day, worrying about her children, and planning her chores for the morning. She also described having to live through many days with 'a strange feeling of something bad about to happen'. Nothing particularly bad ever did happen, but Jenny was unable to calm her mind with such reassuring thoughts. She had an anxiety disorder, and her fatigue was just a manifestation of that.
Jenny was encouraged to eat all foods, even those she thought were making her ill. Meanwhile she was given some medical treatment for her anxiety. She improved greatly over the following few months.
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Thursday
Irritable Bowel Syndrome
Mavis was referred to the allergy centre presented to him with a host of symptoms, including abdominal pain, bloating of the abdomen, nausea, loss of appetite, heart-bum and constipation. The surgeon had taken a look inside her bowel and found it to be normal in appearance. Mavis was neither amused nor consoled! 'What's causing all my trouble, then?' she enquired defiantly. The surgeon, to his great regret, gave her the usual dietary advice for patients with constipation: it made her worse! It also made her desperate, and she was willing to try the Low Allergy Diet. Within seven days all of her symptoms faded into obscurity. 'Mind you,' she explained, I nearly gave up in the first few days because I got this dreadful headache, and my muscles and bones were terribly sore.' She was describing the classical withdrawal symptoms that some patients suffer when they stop eating the very thing that is making them so ill. Mavis had an Irritable Bowel Syndrome. In her case it was driven largely by food intolerance.
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Wednesday
Case history
Consider Abigail, for instance, a 32-year-old scientist. She was working in the research and development department of a multinational firm. One day there was a chemical spillage in her laboratory and she became violently ill. She was admitted to hospital with headache, nausea and muscle pains. That was a year ago, and she has suffered ever since. In particular, she complained of fatigue, depression, anxiety, headaches and muscle spasms. She also developed asthma and rhinitis. Some of her symptoms got worse when she was exposed to chemical smells — even smells we take for granted, such as pot-pourri and perfumed soap.
By the time she presented to the Allergy Clinic, several hospital specialists had reassured her that nothing 'physical' was wrong. By this they meant that they could find no physical explanation for her symptoms. She did not have a brain tumour, her blood was healthy, and she had no obvious signs of disease. She was told that her symptoms were 'functional'. In other words, everything looked okay, it just didn't function properly.
Antidepressant medication improved her mental state considerably, but she was left with her most troublesome symptoms. Having thus excluded any other explanation for her symptoms, and in some desperation, Abigail went on a ten-day Low Allergy Diet. To her great relief, all of her symptoms improved. She identified the problem foods one by one, and remains well as long as she avoids these. She is also careful to avoid chemical smells, but even these are more easily dealt with now that she is eating the 'right' diet. Abigail had Multiple Chemical Sensitivity, but most of her symptoms were due to the associated food intolerance.
This case introduces us to another important issue, namely the concept of 'total load'. Let me explain. Abigail had a poisonous event from which she developed chemical sensitivity. This in turn led to food intolerance. Thus, she was reacting adversely to many chemicals and — although she didn't know it at the time — several foods. The total load on her system was considerable. When she reduced the load (by avoiding intolerant foods and chemical smells) she was much better able to cope with transient chemical exposures.
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By the time she presented to the Allergy Clinic, several hospital specialists had reassured her that nothing 'physical' was wrong. By this they meant that they could find no physical explanation for her symptoms. She did not have a brain tumour, her blood was healthy, and she had no obvious signs of disease. She was told that her symptoms were 'functional'. In other words, everything looked okay, it just didn't function properly.
Antidepressant medication improved her mental state considerably, but she was left with her most troublesome symptoms. Having thus excluded any other explanation for her symptoms, and in some desperation, Abigail went on a ten-day Low Allergy Diet. To her great relief, all of her symptoms improved. She identified the problem foods one by one, and remains well as long as she avoids these. She is also careful to avoid chemical smells, but even these are more easily dealt with now that she is eating the 'right' diet. Abigail had Multiple Chemical Sensitivity, but most of her symptoms were due to the associated food intolerance.
This case introduces us to another important issue, namely the concept of 'total load'. Let me explain. Abigail had a poisonous event from which she developed chemical sensitivity. This in turn led to food intolerance. Thus, she was reacting adversely to many chemicals and — although she didn't know it at the time — several foods. The total load on her system was considerable. When she reduced the load (by avoiding intolerant foods and chemical smells) she was much better able to cope with transient chemical exposures.
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Tuesday
Food intolerance: an unrecognised cause of chronic fatigue
Brenda was a forty-year-old housewife with all the symptoms of a Chronic Fatigue Syndrome. Her trouble started, two years ago, with a viral infection of the thyroid gland. She was perfectly well before this, but never right since. In particular, she complained of bouts of extreme fatigue, recurrent sore throats, pains in the arms and legs, stiffness across the shoulders, swollen glands in her neck, headaches and unrefreshing sleep. She had not been symptom-free for a single day in the past two years. She consulted her doctor frequently, first with one thing and then with another. She found this hard to cope with for, as she said of herself, she took pride in the fact that she hardly ever 'bothered the doctor'.
Everything was normal on physical examination. The blood tests were also normal; and so, in view of the ongoing symptoms, her doctor referred her to the Allergy Clinic. Brenda went on the Low Allergy Diet and within ten days all of her symptoms abated. Two years of abject misery came to an end simply by changing her diet! Subsequent food challenges revealed that she had multiple food intolerance. She reacted very badly to wheat, especially, but also to a host of 'otherwise harmless' foods, including bananas, onion, yeast, mushrooms, rice and oats. Because it would have been very difficult to avoid all of these foods, and to prevent the development of other food intolerance, she was offered a course of desensitisation. She has never looked back.
I would also like to introduce you to Gerry. He was a young lad in his early teens who complained of constant fatigue. His mother told me that he had never really recovered from a glandular fever three years previously. She described him as lethargic, always sitting down, with no real energy or interest in anything. For his part, Gerry also complained of frequent bellyaches, recurrent sore throats, and dizzy spells. He too was placed on the Low Allergy Diet, and he too lost all of his symptoms. He reacted badly to wheat, rye and oats — all gluten-containing foods. He had a biopsy test to exclude coeliac disease, and this was negative. We can safely say, therefore, that Gerry had a post-glandular fever fatigue prolonged by food intolerance — in his case, non-coeliac gluten intolerance.
In both of these cases there is a clear history of viral onset. One had a thyroid infection; the other a glandular fever. In each case, the patient slid imperceptibly from a state of viral infection into one of food intolerance. Patients have been known to develop IgE allergies, such as hay fever and asthma, in the wake of viral infection; but the development of food intolerance under similar circumstances has received less attention. This is a pity because, as these cases so clearly demonstrate, postviral food intolerance can cause years of suffering.
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Everything was normal on physical examination. The blood tests were also normal; and so, in view of the ongoing symptoms, her doctor referred her to the Allergy Clinic. Brenda went on the Low Allergy Diet and within ten days all of her symptoms abated. Two years of abject misery came to an end simply by changing her diet! Subsequent food challenges revealed that she had multiple food intolerance. She reacted very badly to wheat, especially, but also to a host of 'otherwise harmless' foods, including bananas, onion, yeast, mushrooms, rice and oats. Because it would have been very difficult to avoid all of these foods, and to prevent the development of other food intolerance, she was offered a course of desensitisation. She has never looked back.
I would also like to introduce you to Gerry. He was a young lad in his early teens who complained of constant fatigue. His mother told me that he had never really recovered from a glandular fever three years previously. She described him as lethargic, always sitting down, with no real energy or interest in anything. For his part, Gerry also complained of frequent bellyaches, recurrent sore throats, and dizzy spells. He too was placed on the Low Allergy Diet, and he too lost all of his symptoms. He reacted badly to wheat, rye and oats — all gluten-containing foods. He had a biopsy test to exclude coeliac disease, and this was negative. We can safely say, therefore, that Gerry had a post-glandular fever fatigue prolonged by food intolerance — in his case, non-coeliac gluten intolerance.
In both of these cases there is a clear history of viral onset. One had a thyroid infection; the other a glandular fever. In each case, the patient slid imperceptibly from a state of viral infection into one of food intolerance. Patients have been known to develop IgE allergies, such as hay fever and asthma, in the wake of viral infection; but the development of food intolerance under similar circumstances has received less attention. This is a pity because, as these cases so clearly demonstrate, postviral food intolerance can cause years of suffering.
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Friday
Crohn's disease
Aideen was a 33-year-old business executive. She had always enjoyed the best of health, but then her bowels started 'acting up'. She first noticed that she was passing slimy stuff, like raw egg white, from the back passage. This could happen on its own or with the stool. She then developed abdominal cramps, and the stools became looser. Within weeks she was feeling quite unwell with loss of appetite, fatigue and joint pains. Finally, blood started to appear with every bowel motion. She was admitted to hospital and a biopsy of the intestine confirmed that she had Crohn's disease. She was treated in hospital with medication, and given instruction on how to administer the medication to herself at home on an ongoing basis. That worked well but Aideen still had symptoms, and besides, she wasn't happy with the notion of taking medication for any length of time. In fact, when I saw her she had stopped her medication entirely and her symptoms were beginning to flare up again. She started the Low Allergy Diet and came back for review ten days later. She was able to report a reduction in all symptoms, although they hadn't cleared completely as yet. In view of her improvement, she was willing to stay on the diet for another few days, and this time her symptoms were virtually gone. Subsequently, we challenged her intestine with various foods and, in so doing, identified which foods were safe for her, and which ones were not. It was clear that Aideen had food intolerance and that this was playing a significant part in her Crohn's disease.
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Tuesday
A word about chemically induced food intolerance
Nancy worked as a technical assistant in a chemical plant. One day, she smelt something funny corning from one of the vents. She didn't recognise the smell, no one else seemed bothered by it and no alarm sounded. She continued working. One by one the laboratory personnel became ill. They started to cough, one of them vomited, and several developed headaches. Meanwhile the smell was getting stronger. They put two and two together, realised that they were dealing with a chemical accident and left the premises smartly. Nancy was admitted to hospital, and discharged a few days later without treatment. That was last year, and Nancy has never been right since. In particular, she still had headaches, muscle pains and dizziness. She was also tired, and could not manage much outside of her routine work. On closer questioning, Nancy admitted to other symptoms, including bloating of the abdomen, bouts of diarrhoea and the occasional tummy cramp. She also complained of an increased sensitivity to chemical smells, such as bleach, polish, perfume, and the like. We put her on the Low Allergy Diet and all of her symptoms disappeared within twelve days. She was pain-free for the first time since the accident. One by one we reintroduced foods and identified which ones were causing her trouble and which were safe. She is now well into a course of desensitisation to allow her to eat a wide and nutritious diet without suffering the ill effects of food intolerance. Nancy had developed multiple food intolerance as a complication of chemical toxicity at work.
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Monday
Contact Allergic Stomatitis Case history
Anne Marie had her first set of dentures fitted by the dentist some eight months ago. Everything was going well until she developed a stinging sensation on her tongue. She also complained that her sense of taste was altered, and that her mouth was 'generally sore'. She removed her plate for a few days and her symptoms gradually settled. She then returned to the dentist, and was given a new plate in the hope that this would solve her problem. It didn't. All of her symptoms returned within a week. Inside her mouth, one could see only a mild redness together with a few blisters on her palate — where she had most contact with the dental plate. In spite of the paucity of visible disease, Anne Marie had a contact allergic stomatitis.
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Friday
A word about oral infection
Patricia also thought that she was allergic to 'something used by the dentist'. The day after her last visit she developed a crop of mouth ulcers. Her mouth was also generally sore and a bit swollen. The ulcers healed spontaneously within nine days, and she had completely recovered by the time I saw her. Her clinical history was fully consistent with a diagnosis of herpes (viral) infection in the oral mucosa and gums. We call this acute gingivostomatitis. Nevertheless, she was nervous about future dental treatment, so we patch-tested her anyway. The results were negative, suggesting once again that she had experienced a non-allergic event.
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Monday
Anaphylaxis Case history
The 8th of November 1994 is for ever etched in our minds. It was the end of another busy day as we sat around with our three children, eating what was left of the Halloween nuts, and catching up with each other's news. Our eldest daughter, Aisling, was then aged five. She started to cough, and complained of a sore throat whilst eating. I looked in her mouth and, finding nothing amiss, clapped her reassuringly on the back as doctors sometimes do. She then went upstairs to brush her teeth in preparation for bed, still complaining of pain. Her protests on the stairs were put down to another attack of the 'Shirley Temples'! By the time she reached the bathroom, her face was peppered with enormous hives, and her tongue was swollen with angry lumps. I threw a blanket around her, lifted her into my arms and rushed downstairs to the car. I was headed for hospital. On the way, she started to wheeze, and then slumped to one side in the back seat. I shouted at her: 'Aisling! Stay with me now, baby, stay with me!' But she could hardly speak. She was weak, very weak. I drove like a lunatic, one eye on Aisling, the other on the road; hazard lights, headlights and horn flashing and sounding as I weaved my way dangerously in and out of traffic. I thought I would lose her. But I knew that if I could just get her there alive she would have a chance. Adrenaline, that's what she needed now, and nothing else would do. I ran into the emergency department, trembling; by now her eyes were swollen like balloons, her breathing was noisy and distressed, and hives were spreading to the rest of her body. I handed her over to the medical staff and prayed. Aisling was in the throes of anaphylaxis.
I would estimate that her symptoms began within three or four minutes of eating nuts, and that another five minutes had: elapsed before we reached hospital. Her symptoms were dramatic, and they developed at a terrifying pace. This was, without doubt, a potentially life-threatening situation. To our great joy, Aisling pulled through. But, sadly, others like her have been less fortunate. Each year, some six to eight people die from this sort of allergy in the British Isles.
The blood tests came back a few weeks later. They confirmed a definite allergy to Brazil nut. The other nuts, including peanut, did not show up in the blood. However, the skin test to peanut was most certainly positive. Aisling, for her part, was unable to sleep for about a month. She had got an awful fright. There is no doubt, however, that she now fully understands her situation. Thank you, Lord Jesus, that I didn't die when I ate the nuts,' she prays. Brian was just a babe in arms at the time, and remained oblivious throughout; but Fiona, who was only three years old, became wonderfully protective of her older sibling. She wouldn't let her eat anything — and I mean anything — before I asking us if there were nuts in it! Thankfully, Aisling is a very I sensible young lady, and never eats a new food without first asking us whether it is safe to do so. She also carries an adrenaline syringe at all times: in her schoolbag, in the car and in the home. She is brought to friends' parties with a present in one hand and a syringe in the other. The hosts at each and every event are discreetly taken to one side for a brief but very clear instruction: no nuts! And if a 'hidden' nut is eaten accidentally: use the adrenaline!
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I would estimate that her symptoms began within three or four minutes of eating nuts, and that another five minutes had: elapsed before we reached hospital. Her symptoms were dramatic, and they developed at a terrifying pace. This was, without doubt, a potentially life-threatening situation. To our great joy, Aisling pulled through. But, sadly, others like her have been less fortunate. Each year, some six to eight people die from this sort of allergy in the British Isles.
The blood tests came back a few weeks later. They confirmed a definite allergy to Brazil nut. The other nuts, including peanut, did not show up in the blood. However, the skin test to peanut was most certainly positive. Aisling, for her part, was unable to sleep for about a month. She had got an awful fright. There is no doubt, however, that she now fully understands her situation. Thank you, Lord Jesus, that I didn't die when I ate the nuts,' she prays. Brian was just a babe in arms at the time, and remained oblivious throughout; but Fiona, who was only three years old, became wonderfully protective of her older sibling. She wouldn't let her eat anything — and I mean anything — before I asking us if there were nuts in it! Thankfully, Aisling is a very I sensible young lady, and never eats a new food without first asking us whether it is safe to do so. She also carries an adrenaline syringe at all times: in her schoolbag, in the car and in the home. She is brought to friends' parties with a present in one hand and a syringe in the other. The hosts at each and every event are discreetly taken to one side for a brief but very clear instruction: no nuts! And if a 'hidden' nut is eaten accidentally: use the adrenaline!
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Friday
A word about dental allergy
Susan is an eighteen-year-old student nurse. She was referred to the Allergy Clinic by her dentist because of a rather frightening reaction she had in the dental chair. She told me that one of her cheeks started to swell just as the dentist completed a filling. Her tongue was also swollen, so much so that her speech was slurred. The dentist packed her off to the hospital, where she was admitted for observation. Her blood pressure was low, her heart was racing and she felt a bit faint. She was put on a drip to support her blood pressure, and she was given an antihistamine injection to reduce the swelling. This treatment was quite successful, and she was discharged the following day with no ill effects. Susan had a reaction to dental material(s). We now had to find out what it was that caused her such grief, lest she suffer it again. There were several possibilities. She could have been allergic to the dentist's latex gloves, the local anaesthetic, the mouthwash, or indeed any other material used during her treatment. It was also possible that she had a non-allergic reaction to the local anaesthetic. Such reactions can cause swelling, low blood pressure, fast heartbeat and even fainting.
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Tuesday
Atopic keratoconjunctivitis
Dermot was a fifteen-year-old schoolboy with several years of itchy, watering eyes. He also had a history of rhinitis and asthma. His eyes remained itchy in spite of anti-allergy eye drops and antihistamine tablets. His only relief came about by vigorously rubbing the eyes. His action was quite classical: he would press his curled index finger over his closed eye, and rub in a circular motion. And I mean rub! The eye surgeon diagnosed atopic keratoconjunctivitis with corneal deformity. His cornea had lost its nice smooth dome-shaped appearance, and looked more like the oval end of a rugby ball! We call this conical deformity 'keratoconus'. Dermot now needed a corneal graft (and here's one more good reason to sign your donor card!); without a healthy cornea from a donor eye, he would go blind. But how would a graft survive all this rubbing? The eye surgeon referred him to the Allergy Clinic for help with the allergic aspects of his disease. From the history, we suspected that certain airborne allergens were making him worse: house dust, animal danders, feathers and grass pollen all made his eye intensely itchy. He also noticed that perfumes, and the like, could aggravate his symptoms. Having confirmed his allergies by skin tests, we started him on a course of desensitisation. He has had four injections over the past eight months and his symptom are much better controlled. Specifically, the itch and the rubbing have ceased, and the surgeon is now ready to proceed with the graft.
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Friday
Non-allergic triggers of conjunctivitis
In common with other allergic diseases (such as eczema, rhinitis and asthma), allergic conjunctivitis may be aggravated by non-allergic triggers. Failure to understand this could lead to many a wild-goose chase. Maureen was one such patient. She had moved into the area some three years earlier, and since doing so developed 'hay fever' symptoms. Her most troublesome symptom was watering of the eyes, but she also had rhinitis. Her symptoms were particularly bad whenever she went outdoors during the summer months. She was convinced that something in the air was affecting her. However, the skin tests failed to show a relevant summer allergy. She was not allergic to any of the pollens. Nor was she allergic to mould. Her only positive reaction was to our old friend, the house dust mite. This didn't fit with her expectations, and she remained convinced that 'we were missing something'. Going back into her history, she told me that her eyes were especially bad on bright, windy days. 'Maybe it's the silage, or the fertiliser being spread by neighbouring farmers,' she thought out loud, 'They never did that near my last house, you know.' Maureen had an allergic conjunctivitis and rhinitis related to the house dust mite. Her 'seasonal exacerbations' were in fact the result of non-allergic triggers: the combination of wind and sunlight. Other non-allergic triggers include inert dusts, such as chalkdust and the chemical vapours commonly found in household products.
Are there any complications?
Allergic conjunctivitis is a miserable condition. It can disrupt academic performance and summer holidays, and impair the overall quality of life. It can be particularly nasty when associated with eczema, because it may affect the cornea, the transparent part of the eye through which we see the outside world. Allergic inflammation of the cornea can result in scarring, ulceration, cataract formation and corneal deformity. We call this 'atopic keratoconjunctivitis': atopic referring to the allergic disposition, and kerato- referring to the corneal involvement.
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Are there any complications?
Allergic conjunctivitis is a miserable condition. It can disrupt academic performance and summer holidays, and impair the overall quality of life. It can be particularly nasty when associated with eczema, because it may affect the cornea, the transparent part of the eye through which we see the outside world. Allergic inflammation of the cornea can result in scarring, ulceration, cataract formation and corneal deformity. We call this 'atopic keratoconjunctivitis': atopic referring to the allergic disposition, and kerato- referring to the corneal involvement.
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Tuesday
Oral Allergy Syndrome Case History
It all started two years ago for Caroline. She was eleven years old when she first noticed that something was amiss. Her mouth went numb and her upper lip swelled after eating melon. It passed of its own accord, she shrugged her shoulders and forgot about it. Two months later she had a similar experience, this time with an apple. Her lips and tongue felt ‘funny’, a bit numb, or maybe there was a slight tingle (she found it hard to describe). Within weeks, she was reacting in this way to carrots, peppers, lettuce, kiwi and cherries. By the time I saw her, she had stopped eating all fruit and vegetables. However, she discovered that if these foods were cooked first they caused her no trouble — except, perhaps, for carrot. Of some concern was the fact that she was now likely to get chest pain and shortness of breath if she inadvertently ate a forbidden food, such as when she visited a friend and the vegetables were cooked al dente (slightly raw, the way they should be). She denied any other allergic history, and this is the only unusual aspect of her case. On skin-testing she reacted as expected to silver birch pollen (see below). She also had positive skin tests to egg, potato, peanut, soy bean, orange, strawberry, pear, banana, lemon, coconut, grape, peas, tomato and onion! I gave up testing her at that stage, and I did a blood test to confirm that the skin tests were truly positive, and not just a quirk of her funny skin, or my imagination! Every single blood test came back positive. On blood test, she was allergic to all of the foods mentioned above, but she was also positive to grass pollen and mould! Caroline had a classical case of Oral Allergy Syndrome.
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Monday
An example of contact allergic conjunctivitis
Mrs. Neary was a middle-aged woman used to a good social life. As such, she had frequent cause to 'make herself up', and very glamorous she was too! She knew that cheap jewellery gave her a rash, but that didn't bother her because she didn't like cheap jewellery anyway. She was bothered by a recurrent rash on her eyelids, though. She couldn't understand it, having never suffered from the like before. Patch tests confirmed her sensitivity to nickel, but they also revealed a problem with one of her favourite moisturisers. It contained avocado, and she had become allergic to it. 'But I've used it for years!' she protested. (You've heard it all before, right?) She had sensitised herself to it over time. 'But why are my hands not affected then?' she persisted. 'Because the skin over your eyes is only 0.55 mm thick, and it's very delicate, that's why!' All she had to do now was avoid the offending allergen. She should also be careful not to handle nickel (coins, keys, cutlery, etc.) as this could contribute to periorbital dermatitis as well.
The outcome is not always so clear for patients with suspected cosmetic allergy. Some unfortunates have 'status cosmeticus' — a non-specific irritation to virtually all cosmetics. To confound matters, they may have no outward sign of irritation or allergy, but they complain of burning or stinging whenever they wear cosmetics. Some of them will have slight redness over the cheeks, with or without slight swelling of the eyelids, but nothing more substantial than this. Treatment? Avoid all cosmetics!
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The outcome is not always so clear for patients with suspected cosmetic allergy. Some unfortunates have 'status cosmeticus' — a non-specific irritation to virtually all cosmetics. To confound matters, they may have no outward sign of irritation or allergy, but they complain of burning or stinging whenever they wear cosmetics. Some of them will have slight redness over the cheeks, with or without slight swelling of the eyelids, but nothing more substantial than this. Treatment? Avoid all cosmetics!
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Saturday
A few examples of asthma triggered by foods
Kevin was a four-year-old boy plagued with allergies. Mum and Dad knew that he was allergic to eggs. They made him extremely ill. Within ten minutes of eating them he would break out in a rash of hives and vomit violently. He also had eczema, asthma and rhinitis. Finally, and this is the reason his parents brought him to the Allergy Clinic, he had become hyperactive in recent months. 'He was always an active child,' they said. 'But this is ridiculous! He gets mood swings, loses his temper, and disrupts his Montessori class.' We put him on the Low Allergy Diet in the hope of improving his mood and behaviour. He enjoyed great relief from all his symptoms within ten days of his diet. 'His mood is much lighter, and he is now so pleasant,' his parents told me. 'Not only that, but his asthma, eczema and rhinitis are better than they have been for years.' Asthma can be triggered by allergy to food — particularly when other symptoms of food allergy are present!
Bernard was a little older than Kevin when I first met him. He also had a long history of asthma, and he too had other symptoms of food allergy. In particular, he frequently complained of bellyache and headache. Every day, he took two inhalers and one tablet to control his asthma. Notwithstanding his medication, he had a constant cough. In addition, he had several bad attacks each year requiring treatment with steroids. We put him on a ten-day Low Allergy Diet. By day seven, his lung function had improved quite dramatically. We then set about expanding his diet again, and managed to reintroduce all major food items without incident — until we came to soft drinks. Within thirty minutes of drinking a well-known branded lemon drink he developed an acute asthmatic attack. The drink was laden with metabisulphite — a preservative, and a recognised problem for some asthmatics. Asthma can be triggered by an allergy to food additives!
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Bernard was a little older than Kevin when I first met him. He also had a long history of asthma, and he too had other symptoms of food allergy. In particular, he frequently complained of bellyache and headache. Every day, he took two inhalers and one tablet to control his asthma. Notwithstanding his medication, he had a constant cough. In addition, he had several bad attacks each year requiring treatment with steroids. We put him on a ten-day Low Allergy Diet. By day seven, his lung function had improved quite dramatically. We then set about expanding his diet again, and managed to reintroduce all major food items without incident — until we came to soft drinks. Within thirty minutes of drinking a well-known branded lemon drink he developed an acute asthmatic attack. The drink was laden with metabisulphite — a preservative, and a recognised problem for some asthmatics. Asthma can be triggered by an allergy to food additives!
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Thursday
A few examples of asthma triggered by inhalant allergy
Nuala is a housewife and mother of two. She has been very unwell in recent years with asthma. She also had repeated sinus and chest infections. Furthermore, she was admitted to hospital on two occasions with pneumonia, and once to have her nasal polyps removed. Not surprisingly, some concern was expressed about the state of her immune system. Skin tests were interesting, to say the least. She was highly sensitive to house dust mites and grass pollen, moderately sensitive to several mould species (Aspergillus, Alternaria, Candida, etc.), and mildly reactive to dog. She then told me that her home was an environmental disaster area! They had problems with rising damp, and the wine cellar (they had a wine cellar!) was very damp and musty. As it happens, they were about to move house anyway, so they paid particular attention when looking at new property to avoid mouldy conditions. She improved dramatically within weeks of the move, and remains well at the time of writing (three years later). Asthma can be triggered by mould allergy!
Bartley is an accountant who loves to forget about it all on horseback in an open field. So he was particularly upset to realise that he was starting to wheeze every time he went near his horse. He was perfectly well at other times. Skin tests confirmed his allergy: within ten minutes of scratching his arm with horse allergen he produced an enormous response. He was not allergic to anything else. Horse allergen is a potent one, and it is capable of triggering a severe and rapidly progressive asthmatic attack. Asthma can be triggered by animals!
John Hamilton was Archbishop of St Andrews in the sixteenth century. He had asthma. He also had a lot of money. Displeased with local treatment, he called for a renowned physician, Jerome Cardan of Pavia. Jerome travelled from Italy to Scotland with nothing much more than his bag. He took one look at the sorry priest puffing and wheezing in his bed. 'Get rid of that feather quilt!' he exclaimed, turned on his heel and returned to his lodgings. This may have been the shortest consultation in history, but the cleric's recovery was so complete that he rewarded the good doctor with 1,400 pieces of gold, and a gold chain for his neck. Asthma can be triggered by an allergy to feathers!
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Bartley is an accountant who loves to forget about it all on horseback in an open field. So he was particularly upset to realise that he was starting to wheeze every time he went near his horse. He was perfectly well at other times. Skin tests confirmed his allergy: within ten minutes of scratching his arm with horse allergen he produced an enormous response. He was not allergic to anything else. Horse allergen is a potent one, and it is capable of triggering a severe and rapidly progressive asthmatic attack. Asthma can be triggered by animals!
John Hamilton was Archbishop of St Andrews in the sixteenth century. He had asthma. He also had a lot of money. Displeased with local treatment, he called for a renowned physician, Jerome Cardan of Pavia. Jerome travelled from Italy to Scotland with nothing much more than his bag. He took one look at the sorry priest puffing and wheezing in his bed. 'Get rid of that feather quilt!' he exclaimed, turned on his heel and returned to his lodgings. This may have been the shortest consultation in history, but the cleric's recovery was so complete that he rewarded the good doctor with 1,400 pieces of gold, and a gold chain for his neck. Asthma can be triggered by an allergy to feathers!
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Tuesday
Case history for airborne allergies
Adrian is a thirteen-year-old boy who loves sport. He has suffered from asthma since early childhood. He was taking three different inhalers every day, and was still getting symptoms. Moreover, he was waking up in the early hours of the morning for 'a few more puffs' of his inhaler. When things got out of hand, and they did several times a year, he needed oral steroid tablets. In addition, he occasionally had really bad attacks requiring admission to hospital. These were mostly associated with infection. His family doctor wondered whether there was an allergic aspect to his asthma and referred him to the Allergy Clinic. Adrian said that he manages to get by if he 'takes things easy'. But he was a sportsman, and did not want a sedentary lifestyle. He was very frustrated by his inability to ran without coughing and wheezing. Taking his inhaler before a football match did not help. He also had hay fever — and a cat!
Skin tests revealed that he was highly allergic to many airborne allergens, including pollens, dust mites and moulds. He was also allergic to the cat. The first job was to clean up his home environment. He went to town on this, and adopted comprehensive allergen avoidance measures. He asked someone else to adopt the cat. His asthma improved within weeks, but he still had some way to go. We then started a course of desensitisation. By the time of his fourth dose, his lung function had improved considerably, he was sleeping through the night, he played football for the school team, and he had enjoyed a summer without hay fever. We are now weaning him off his inhalers.
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Skin tests revealed that he was highly allergic to many airborne allergens, including pollens, dust mites and moulds. He was also allergic to the cat. The first job was to clean up his home environment. He went to town on this, and adopted comprehensive allergen avoidance measures. He asked someone else to adopt the cat. His asthma improved within weeks, but he still had some way to go. We then started a course of desensitisation. By the time of his fourth dose, his lung function had improved considerably, he was sleeping through the night, he played football for the school team, and he had enjoyed a summer without hay fever. We are now weaning him off his inhalers.
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Sunday
A few examples of asthma triggered by inhalant allergy
James was eight years old when he first came to the Allergy Clinic. His history is quite classical and demonstrates much of what you have just read. In the first place, he came from an allergic family. His mother and several cousins had a history of hay fever. He himself had a history of eczema as a baby, but this had cleared up long ago. 'He's sneezing and wheezing!' his father said. 'And he coughs. Boy, does he cough, especially at night when we're all trying to sleep! He was taking the usual inhalers but still getting into trouble. Like most asthmatic children, he got a bit of a wheeze when he ran about. His father, unfortunately, was a chain-smoker, and this was sure to make things worse. Skin-prick tests showed that James was allergic to the ubiquitous house dust mite, and had a lesser sensitivity to silver birch pollen. His father promised to smoke only in the back garden, and he took careful note of the measures required to reduce the dust mite allergen in James's bedroom. The boy then had one dose of desensitisation and improved so dramatically that his mother thought he was 'cured'! However, it wore off after a few months (as expected) and he is now well into his course of jabs and on the road to more permanent relief. Asthma is often triggered by the house dust mite!
Declan was a businessman in his late thirties. He had asthma as a young lad for a few years and then grew out of it. However, it came back to him last autumn, together with the symptoms of rhinitis. It wasn't particularly bad, he said, more of a nuisance than anything else. Again, skin tests confirmed his allergy to dust mites. He had no other allergy. Desensitisation brought about a great improvement. The last time I saw him for a booster dose he told me that he had stopped his inhalers altogether. Asthma in adults can also be triggered by house dust mites!
Helen is a university student coming up to her summer exams. She is 'really fed up today' because she has asthma. In fact, she tells me that she gets asthma at this time every year, and it interferes with her study. She also gets the other symptoms of hay fever. Once the summer holidays are over, she has no asthma. Skin tests confirm her allergy to grass pollen, and the fact that she is not allergic to other allergens. She has 'hay asthma1. Asthma is sometimes triggered by seasonal allergens!
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Declan was a businessman in his late thirties. He had asthma as a young lad for a few years and then grew out of it. However, it came back to him last autumn, together with the symptoms of rhinitis. It wasn't particularly bad, he said, more of a nuisance than anything else. Again, skin tests confirmed his allergy to dust mites. He had no other allergy. Desensitisation brought about a great improvement. The last time I saw him for a booster dose he told me that he had stopped his inhalers altogether. Asthma in adults can also be triggered by house dust mites!
Helen is a university student coming up to her summer exams. She is 'really fed up today' because she has asthma. In fact, she tells me that she gets asthma at this time every year, and it interferes with her study. She also gets the other symptoms of hay fever. Once the summer holidays are over, she has no asthma. Skin tests confirm her allergy to grass pollen, and the fact that she is not allergic to other allergens. She has 'hay asthma1. Asthma is sometimes triggered by seasonal allergens!
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