ASTHMA IN CHILDREN: THE INHALED ALLERGENS – OUTDOOR ALLERGENS – POLLEN ALLERGYPollen is a powder-like substance seen in some flowers. The grains are very small in size and in majority of the cases, yellow in colour.Pollens are released from the flowers early in the morning, often before sunrise. Hence patients who are allergic to pollens are more likely to get an attack at that time. Different asthma patients are allergic to different pollens; some only to one, but most to more than one.Only some of the pollens cause asthma. Around a hundred of them are known to cause this disease. The pollens suspected of triggering allergic reaction are extremely light and float in the air and are carried over long distances by the wind.Wind pollinated plants, as distinct from insect, water or self pollinated plants, have flowers which are usually unattractive in appearance, comparatively small in size, rarely have any smell, and contain no nectar. Their pollens are light, dry and abundant in quantity. They are carried over long distances, sometimes for hundreds of kilometres.Pollens of common garden flowers such as of rose, marigold, phlox, do not cause asthma; their pollens are heavy, large and sticky, and therefore do not float in the air.*25\260\8*

CAUSES OF PERENNIAL ALLERGIC RHINITIS: MOLDSA mold is a tiny member of the group of plants we call fungi. These are plants that lack a definite root and stem and have no leafy structures. Molds contain no chlorophyll and are composed of multiple, microscopic branching threads. Because they lack chlorophyll molds depend upon other plants and animal materials for nourishment.Allergy-causing molds reproduce by forming microscopic spores that are then widely distributed by currents of air. It is to these airborne mold spores that we become allergic. In the air, the behavior of mold spores is very similar to that of pollens. Molds are common additions to outdoor and indoor air, and mold counts, like pollen counts, are commonly performed on outdoor air using special gathering devices.Molds’ ability to disperse on air currents depends upon a range of temperature, humidity, and wind conditions somewhat similar to that of the pollens. For example, certain mold spores settle with rain and increased humidity, only to rise again into the air with drying and increased wind. Others depend upon a rising humidity and rain droplets to release them into the air.Molds differ from pollens in that, in general, they do not enter and exit the air with seasonal regularity. In other words, with a few very specific and localized exceptions, there isn’t any “mold season” as there is a ragweed season. Molds tend to be in the outdoor air most of the year – from early spring until (and even after) the first frost. In general, however, mold counts are the highest in the warmer summer months.Like trees, grasses, and weeds, only a few of the many types of molds have been shown to cause allergic rhinitis. In fact, just four molds – Alternaria, Aspergillus, Hormodendrum, and PeniciIlium – account for most mold-induced allergic rhinitis. Alternaria and Hormodendrum are prominent outdoor molds. Aspergillus and Penici Ilium are common indoor molds. Penicillium is that green fuzzy stuff sometimes seen in homes. That dark, fuzzy stuff that may grow on the refrigerator walls or on foods such as bread or onions is another allergy-causing mold known as Rhizopus.
Where Do These Molds Tend To Grow?Molds can grow and reproduce almost anywhere. It is not difficult for them to find suitable conditions of light, temperature, and humidity. Indoors, they may grow on floors, carpets, bedding, mattresses, and pillows (especially foam rubber), basements, food products, garbage pails, refrigerator drip-pans, humidifiers and air conditioning systems, wall paper, paints, plastics, flowers, soiled upholstery, wool clothing, old books and magazines, fruits, berries, and bathroom tile. Outdoors, molds commonly grow on garage dust, rotting or decaying vegetation, fresh cut grass, piles of leaves, rotting wood, compost piles, pasture grass, melons, peas, bananas, cotton, tomatoes, corn, sweet potatoes, mushrooms, hay bales, and areas of deep shade. The cutting of grass, raking of leaves, and thrashing and baling of hay can launch millions of mold particles into the air. These settle on your clothing and are carried into your home.
How To Tell If You Are Allergic To MoldsThere are several clues. First, molds are a common cause of year-around allergic nasal symptoms. Another clue would be a flare-up of symptoms during the summer months when there is relatively little pollen but much mold in the air. Also suggestive are symptoms that worsen in the late fall after the ragweed has cleared from the air. In addition, symptoms that worsen during activities in areas where molds tend to grow and reproduce suggest molds as a possible allergen.
Food Cautions For Mold Sensitive PeopleSome people who are sensitive to airborne molds may react if those same molds are ingested. Foods developed by fermentation, meats, aged cheeses, and foods whose shelf lives are relatively long are the most likely to be mold contaminated. If you suspect that the ingestion of these or any other foods causes any type of symptom, nasal or other, you should avoid them and discuss your suspicion with your physician or allergist.*18/322/5*

The Allergic History

An allergic history should be taken by the child’s doctor and should include:

Name

Address

Chief complaint

Family history of allergies

Infectious and contagious diseases

Immunizing procedures and reactions

Pets in the house

Bedding (covers, blankets, mattresses, sheets, etc.)

Nose and throat infections (colds, tonsillitis)

Food idiosyncrasies

Present illness:

Initial attack

Subsequent attacks

Last attack

Tentative diagnosis

http://drugswatcher.com/product_info.php?cPath=50&products_id=2290Skin testing

Once the allergic history and other standard workup procedures are completed, skin testing is begun. This involves the provocation of an allergic reaction in the skin through exposure to a minute amount of an allergen. It is the easiest and simplest method of detecting sensitivity to an inhalant allergen, but it has little value unless the above-mentioned studies point to it.

One method of skin testing is to first prick or scratch the surface of the skin and then put an allergenic extract on the abraded area. Another method (intradermal) is to introduce, with a needle, a small quantity of an allergenic extract between the layers of the skin. A third method (used to detect the cause of contact eczema) is the patch test, which places a piece of gauze soaked in the suspected allergen on the skin for a prolonged period of time. A fourth method, rarely used now, is the conjunctival test, performed by putting a drop of an allergenic extract in the eye.

All these tests may be performed before, while, or after allergy symptoms are present. However, some drugs used to control allergies, such as antihistamines, adrenalin, aminophylline, atropine, and ephedrine, may reduce the intensity of the skin’s reaction to the test. These drugs should be discontinued forty-eight hours before any skin test is performed. (Cortisone, on the other hand, even though very effective for allergies, has no effect on a skin test.)

The skin of the inside of the arm is used for scratch or intradermal tests because the arm allows the use of a tourniquet in case of a severe reaction to testing. To perform scratch tests, a small scalpel which can make an incision in the skin (without drawing blood from it) is used. The skin site is cleaned with alcohol, ten scarifications are made, and a small amount of an allergen extract is placed over each scarification. To perform intradermal tests, the skin site is cleaned with alcohol, a different allergenic extract is put into each one of ten disposable allergy syringes, and an injection of 0.02 cc. of each extract is made between the layers of the skin.

After performing skin tests, an “immediate” reaction may appear after fifteen minutes, or a “delayed” reaction may appear ten to fifteen hours later. (Delayed reactions are known to occur when testing for molds.) These tests are read differently by different allergists. Some doctors consider that:

a.     A slight skin reaction is a one-plus reaction.

b.     A moderate reaction is a two-plus reaction. ñ A marked reaction in a three-plus reaction.

d.     A marked active reaction (or one with “branching” feet) is a four-plus reaction.

Others use a mathematical way of reading the tests, depending on the size of the wheal:

a.     1/2 cm. is considered a one-plus reaction.

b.     1 cm. is considered a two-plus reaction.

ñ     1 1/2 cm. is considered a three-plus reaction, d. 2 cm. is considered a four-plus reaction.

Still others prefer to measure the intensity of a reaction according to the size of a standard circle:

a.     A wheal as large as the head of a pin is a one-plus reaction.

b.     A wheal as large as a dime is a two-plus reaction.

ñ     A wheal as large as a nickel is a three-plus reaction.

d.     A wheal as large as a quarter is a four-plus reaction.

*29/99/5*

Doctors who are aware of food intolerance and experienced in diagnosing it have a different statistical outlook. They vary in their estimates of how many patients might trace some or all of their symptoms to food, but most come up with a figure of 20-30 per cent. The surveys described above, that showed large numbers of patients suffering from psychosomatic symptoms, took little account of the possibility of food intolerance. Many of those classified as ‘psychosomatic’ may in fact have been sensitive to food.

On the other hand, more objective methods of assessing psychological disorders have also pinned the ‘psychosomatic’ label on problems such as irritable bowel syndrome and migraine – diseases that are claimed as prime indicators of food intolerance. And forms of treatment that address the mind rather than the body – including psychotherapy and hypnotherapy – have been successfully used to treat them. In the next section we will look more closely at these apparently conflicting claims in relation to one particular disorder, irritable bowel syndrome or IBS.

*202\180\8*