Achooooooo! That Sneeze Could Really Be an Overlooked Allergy : Health: Allergies often are overlooked in youngsters and may remain undiagnosed for years, ushering in suffering that can extend into adulthood.
Although an estimated 6 million youngsters get hay fever each year--and one of every five visits to the pediatrician is for an allergy-related disorder--allergies are often overlooked in American children and adolescents.
The problem is that allergy symptoms in children can be “much more subtle than they are in adults,” said allergist Stanley Wolf, a clinical professor of child health at George Washington University, and youngsters may be misdiagnosed as suffering from chronic colds or other illnesses.
Yet so-called “hidden” allergies are “extraordinarily frequent in children,” said Michael Kaliner, chief of the Allergic Diseases Section at the National Institute of Allergy and Infectious Diseases. About 70% of allergy sufferers experience their first symptoms before age 30, Kaliner said. Half develop allergies before puberty.
Some common symptoms of “hidden” allergies in children are the skin rash known as eczema, chronic coughs and bronchitis, diarrhea, migraine headaches and colitis.
Even otitis media--middle-ear infections--may be due to allergies in a small proportion of children, allergist Robert Wood said at a recent meeting on pediatric trends, sponsored by the Johns Hopkins Medical Institutions in Baltimore. The most likely candidates for allergy-related inner-ear infections, he said, are youngsters 5 to 7 years old, who either have frequent ear infections or persistent fluid in their ears.
“Any child with recurring colds, nasal stuffiness, ear problems, food sensitivities, hives, rashes or diarrhea, needs to be evaluated for allergies,” Kaliner said.
Left untreated, allergies can make life miserable. Misdiagnosis often leads to unneeded medication. But most often, allergies simply mean lost days from school. “Among all the chronic disease afflicting children, allergies are the No. 1 cause of school absenteeism,” Kaliner said.
This time of year, children with allergies are likely to suffer from the classic symptoms--sneezes, watery eyes, stuffy noses. But other symptoms are malaise, being out of breath after running and just an overall feeling of being sick. “If children seem wiped out, think allergies,” Wolf said.
Kids are not alone in their allergy misery. One in five Americans suffers from allergies, according to government estimates. An estimated 35 million Americans sniffle, hack and sneeze through springtime each year. Most blame their watery eyes, blocked nasal passages and drippy noses on so-called “hay fever”--a misnomer that describes neither their condition (which is feverless) nor the cause (definitely not an allergy to hay).
“Hay fever” is a catch-all term for what doctors call allergic rhinitis, or inflammation of the nasal passages produced by exposure to an irritant.
The most common irritants are the pollens discharged in the spring by blossoming trees, grasses and weeds.
Winter isn’t much better. The more humid climate provides the perfect environment for dust mites--microscopic bugs that thrive in the dirt and dust rampant in even the most meticulous households. The dust mites themselves don’t cause an allergic reaction, but their droppings do. These microscopic fecal balls contain an intestinal enzyme that can be particularly irritating to humans.
Genetics also plays a role. If one parent has allergies, a child has a 33% chance of being allergic, health officials say. When both parents are afflicted, there is an 80% to 100% chance that a child also will suffer from allergies.
Yet few people need to suffer from allergies today. “Most people--more than 80% of those with allergies--can be helped,” Kaliner said.
The first step is simply removing the culprit allergen. Allergist Wolf recalled one child who tested positive for allergies to molds. The child’s home had a basement that flooded each time it rained, producing the perfect medium for molds to grow. “I told his parents that they didn’t need an allergist, they needed a contractor to put in a sump pump,” Wolf said.
But if removing the mold, the family cat or other irritant does not work, allergists can turn to a new generation of antihistamine drugs that block the allergic response. Unlike older antihistamine agents, the new drugs don’t cause drowsiness. One called terfenadine can be used in children as young as 6, said Kenneth Schuberth, an allergist in private practice in Maryland. Marketed under the trade name Seldane, the drug has been available for about three years. Another drug, astemizole (brand name Hismanal), was introduced within the past six months and is approved for use in children as young as 12.
Both drugs work by blocking the release of histamine, a potent chemical released from certain white blood cells that causes the body to overreact against allergens. Histamine and the other chemical compounds start a cascade of events that begins with the loosening of cells lining the mucous membrane of the nose and ends with clogged nasal passages. Along the way, sneezes are triggered and mucous production is increased. Both are the body’s way of ridding allergens from the nose.
Antihistamines--drugs that counteract the effects of histamine--have been around since the 1940s. The most well-known is Chlor-Trimeton, a drug now available over-the-counter. The older antihistamines are about a tenth the cost of the newest generation, but their main disadvantage is that they cross into the brain and produce drowsiness.
The next line of defense against allergies involves nasal steroid sprays. The oldest, called Nasalide, can produce a stinging sensation because it is mixed with propylene glycol. The two newcomers--Becanase and Vacenase--are in a watery fluid that doesn’t sting. The benefit of using them in children is that the steroids only work in the nose and don’t get into the circulation of the body.
Another type of drug actually prevents allergies before they start. Called Nasalcrom--for cromolyn sodium--the drug acts by preventing white blood cells from releasing chemicals such as histamine. Its drawback: the need to spray it in the nose four to six times a day.
For some children who aren’t helped by medications, the answer may be allergy shots that alter the body’s immune response to certain allergens. Weekly injections for about two years help about 75% of allergy sufferers who take this treatment. The cost: $500 to $1,000 a year.
As researchers look for more effective treatments, the challenge for physicians is to develop better methods of identifying allergy sufferers and pinpointing the cause of their type of allergy.
One way to test children for allergies is to have them blow their noses into a square of plastic wrap. The nasal secretions are placed on a slide, stained to make the cells more visible and then viewed under the microscope. If more than a quarter of the cells are a type known as eosinophils, “there’s a pretty good chance that you’re dealing with an allergy,” Schuberth said. The test is so simple, he said, that “every pediatrician should be able to do this today in the office.”
To determine what causes the allergy, patients must undergo skin sensitivity tests. New techniques now rely on a dull needle that doesn’t prick the skin and involve a minute amount of allergen. Today, “it takes less than 30 tests to determine what someone is allergic to,” Kaliner said. The price tag: about $150 to $300.
The allergy test of the future is likely to involve more sampling of nose secretions. Researchers at Johns Hopkins and at the National Institute of Allergy and Infectious Diseases are experimenting with a new generation of tests that involve placing potential allergens in the nose and monitoring the reaction with a tiny nasal catheter.
“It’s possible that someday you can do a relatively simple nose test instead of a blood test and it will pop out an answer,” said Gordon Raphael, an allergist at the allergy institute. “But it’s still a ways down the road.”
WHY ALLERIGIES MAKE US SNEEZE Sneezing is a reflex. When we inhale an irritant such as pollen, the brain signals the uvula to depress, allowing a great amount of air to pass rapidly through the nose and mouth, clearing the nasal passages. If we are allergic to pollen, the body produces histamines, which in turn, cause more mucuous secretion--hence, a runny, sneezy nose.
