One Child in Twelve: Asthma and Allergies

I'm scheduled to do an interview with Newsday this week.  The question we will discuss is this: "will the warm winter cause an unusually severe allergy season?" The problem with print media is that the readers can't see you shrugging your shoulders.

There are few scientific studies to inform the answer, but lots of educated guesses.  We are already seeing and hearing signs of Spring.  There was a blazing cardinal on my front lawn this morning and yesterday a visit to Planting Fields Arboretum rewarded us with a feast of colors not at all typical for March.  As a result, there should be an early rise in the levels of pollen - the stuff that trees and grasses produce to reproduce.  And so, those individuals whose immune systems mistake this material for an invading organism will mount a vigorous counter attack that works, biologically speaking, like a circular firing squad.  We call such individuals "allergic" and their dysfunctional responses, "hay fever" and "asthma."

Hay fever is the quintessential misnomer, having little to do with hay and nothing to do with fever. Those of us who get it (around 10 - 30% of the population) experience itchy eyes and noses, congestion and discharge.  The allergic swelling of our nasal passages also blocks up the outlets of our sinuses, predisposing us to sinus infections, also called "sinusitis."  Many experience lack of sleep and the symptoms are both uncomfortable and distracting.  Nonetheless, hay fever is a minor affair when compared with what happens when the same kind of irritation and inflammation take place in the bronchi (the branching network of conduits that transport gases to an from the lungs.)  And this more serious condition, of course, we call "asthma".

Asthma has been understood and misunderstood for centuries.  We currently know that asthma is a genetic disorder, usually appearing in childhood, often coexisting with infant eczema and nasal allergy, and involving constriction of muscles in the bronchial wall AND inflammation of the bronchial lining.  Although wheezing is a classic sign, not all wheezing is due to asthma, not all individuals with asthma wheeze, and most important, not all wheezing is detectable without a stethoscope.  As a matter of fact, most wheezing in children is not.  Consequently, this most common chronic disease of childhood remains under diagnosed and, when diagnosed, often under treated.  

What will this allergy season be like?  As Yogi Berra famously said, "it's hard to make predictions, especially about the future."  What I WILL predict is that we have much more work to do to effectively apply what we already know and what there is yet to learn to help individuals - and children in particular - to thrive in every way, even if they have asthma.