ALLERGIES: THE FAST-GROWING THREAT TO PUBLIC HEALTH

SIDNEY KATZ October 21 1961

ALLERGIES: THE FAST-GROWING THREAT TO PUBLIC HEALTH

SIDNEY KATZ October 21 1961

ALLERGIES: THE FAST-GROWING THREAT TO PUBLIC HEALTH

SIDNEY KATZ

Soon, nearly all of us may have allergies

WHEN A MEDICAL STUDENT recently asked an experienced physician what branch of the profession he should specialize in, he was told, “Become an allergist. The way things arc going, everyone, eventually, will become allergic to something.”

From studies which have been made, we have evidently almost reached that stage now. According to the best estimates, ten percent of the population suffers from major allergic illnesses; another fifty percent from minor allergies. The number of working days lost in Canada per year because of allergic diseases is now placed at three million.

The total number of allergy cases will increase in the future. Allergy is largely an inherited disease. In Canada, “the allergic belt” — the Great Lakes and St. Lawrence River regions — also happens to be the most thickly populated part of the country. Dr. Harry L. Bacal, director of the allergy department, Montreal Children's Hospital, advises his students. “If you're allergic and intend to fall in love, direct your endeavours to a nonallergic girl.” A New York allergist. Dr. Harry Swartz, is more outspoken. “Allergic couples in love should promptly fall out of love,” he says. “They should be discouraged from afflicting society with allergic children.”

Ironically, the introduction of thousands of new foods, drugs, synthetic materials and consumer goods — all designed to make our lives healthier and more comfortable — has multiplied the number of allergic victims. A person is capable of becoming hypersensitive to anything he can touch, inhale or swallow'.

Many people have already developed allergies to such modern products as soapless detergents and plastic goods. Doctors have found patients suffering from hives, asthma and headaches after eating peaches allergic not to the fruit itself but to the residue of insecticide which clings to it. Some people are now reacting to restaurant french fried potatoes, because the peeled and sliced potatoes have been treated w ith a bleaching agent to prevent browning. The wax used to preserve parsnips and rutabagas has also been identified as an allergycausing substance. People who enjoy fresh fish sometimes can’t tolerate it frozen, because of certain antibiotic solutions used in the freezing process.

More people can now afford pets than could a few years ago. Pets are a major source of allergens. Thick-coated dogs fill the air with potential irritants. People now spend more time vacationing in the country and this has resulted in a spate of shock reactions to insect bites. In Guelph, a University of Toronto allergist has already collected twenty such cases. C. D. F. Miller, an entomologist with the Department of Agriculture in Ottawa, speculates, “It may be due to an evolutionary development in man or to the growing use of drugs which might be upsetting man’s natural immunity to bites. No one can say.”

Of the newest allergy-causing substances, the so-called "wonder drugs” are among the most serious. With scores of antimicrobial, antimalarial, anticonvulsive, antiarthritic, antihistaminic and tranquilizing drugs on the market, the drug allergy situation has become both be-

wildering and frightening. Speaking to a Toronto audience, Dr. Arnold R. Rich, emeritus professor of pathology at Johns Hopkins University, warned that “the harmful and even fatal results (of these drugs) are more common than is ordinarily appreciated.” One out of every ten persons suffers an allergic reaction to one of the most commonly used antibiotics, penicillin. In the United States alone, more than 1,000 deaths have been traced to penicillin allergies. 1 recently examined the files of Medic-Alert — an organization which supplies warning silver bracelets to people who suffer shock reactions to various drugs. MedicAlert already has 2,000 letters on file. They come from people in every part of the country, from Victoria to St. John’s, Newfoundland, describing their severe reactions to a variety of drugs, including antitetanus serum, penicillin, sulfa drugs, cortisone, Chloromycetin and aspirin.

In the w'akc of this mass hypersensitivity an entire new “allergy industry” has arisen. The study and treatment of allergy is now a welldefined medical specialty such as ophthalmology or surgery. The Canadian Academy of Allergy, nonexistent seventeen years ago, now has more than a hundred doctor members. Thirteen allergy clinics are in operation across Canada. Millions of dollars are now spent annually on drugs and devices to reduce the symptoms of allergy. Chemical companies have produced dust control sprays. Air-conditioning firms offer for sale antiallergy devices. Their air filter units range from simple activated charcoal units which suck air across charcoal to expensive electronic conditioners which trap dust by causing it to adhere to electrically charged metal plates. You can now buy “no-fuzz” blankets, latex foam mattresses, “hypo-allergenic” insecticides and deodorants, and toys made of plastic for children allergic to stuffed toys. There’s no guarantee, of course, that the child won't become allergic to plastic.

Unfortunately — among children particularly — a high proportion of allergy sufferers do not receive medical treatment. Many parents ignore their children's allergies with the comment, “They'll grow out of it.” This cavalier attitude causes much unnecessary discomfort. One followup study at the Montreal Children’s Hospital revealed that fifty-two percent of children given preseason hay fever treatment went through the season with little discomfort while among those who received no treatment, the nonsufferers amounted to only thirteen percent. “Many parents don’t take their allergic children to a doctor for years.” says Dr. C. Collins-Williams, director of the allergy clinic at the Toronto Hospital for Sick Children.

In a study of 5,152 children in Connecticut, New York and Montreal. the American College of Allergists found recently that 1,031 suffered major allergies and that two thirds of these had gone untreated. Other research has demonstrated that the sooner a child starts getting allergy “shots” the sooner he'll outgrow' allergies. Further study of untreated allergic children may help explain hitherto baffling cases of impaired learning at school, poor work habits and poor classroom behavior. CONTINUED ON PAGE 50

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Pregnant women should avoid highly antigenic foods: eggs, nuts, seeds, fish, chocolate, spices

What, precisely, is an allergy — the baffling, capricious disease which has assumed the status of a major public health problem?

Simply stated, it is an abnormal reaction to some ordinary and usually harmless substance. We all breathe grass and tree pollens but only some of us get hay fever. Milk is supposed to be an ideal food for

children, yet it can make some children deathly ill. An allergic reaction is actually a normal, defensive reaction of the body gone wrong. The body has a built-in defense mechanism which immediately springs into action when a foreign substance invades it — be the invader a bacteria, a virus, or an allergic substance like ragweed pollen. Millions of antibodies

(proteins produced by the plasma cells in the body) pour into the blood stream to grapple with the invader, or antigen as scientists call it. For each type of invader, a specific kind of antibody is produced. Once summoned to duty, the antibodies remain in the body to do battle against the same invader again, if necessary.

Dr. Béla Schick, a pioneer allergist in

the U. S., once observed that “without allergy, the human race could not long survive." Indeed, doctors have long been making use of the antigen-antibody reaction to protect us against such diseases as polio, diphtheria, smallpox and whooping cough. They inject us with weak doses of the germs which cause these diseases, thus activating the production of antibodies. When the germ strikes again, we are immune. In the body of the allergic person, however, things have gone awry. He reacts to a harmless substance. And he reacts in such a way that the antigenantibody reaction produces severe damage to the body instead of protecting it. The list of allergic symptoms is endless: hives, eczema, swellings, stomach pains, recurring headaches, running nose, watery eyes and asthma. Some of the reactions are serious. Dr. Arnold R. Rich listed twenty conditions of “lesions and disturbances of function” which included arthritis, myocarditis (inflamed heart muscle tissue), and three forms of nephritis — inflammation of the kidney.

To head off or minimize such distressing symptoms, allergists have recently been giving particular attention to preventive work with children. They have identified what they term an “atopic allergic person” — one who inherits the tendency to be allergic. “The medical history of the atopic person, if he’s not treated, follows a familiar course,” says Dr. J. D. L. Fitzgerald, chief allergist of the Toronto Western Hospital. “In turn, he’ll react to allergens with his skin, stomach and respiratory system.” As an infant, he’ll suffer skin rashes; at two years of age, if not earlier, he's developing food intolerances: still

later, he gets hay fever and asthma.

Out of his wide experience at the Montreal Children’s Hospital, Dr. Harry L. Bacal has recently outlined a preventive program for the potentially allergic child. During pregnancy, he says, the mother should avoid highly antigenic foods — which include eggs, nuts, seeds, fish, chocolate and spices. Cow’s milk should be limited to one pint a day, and even then it should be boiled for ten minutes. Once the baby is born. Dr. Bacal strongly recommends breast feeding. His studies show that the child fed cow's milk from birth is seven times more likely to develop eczema. Furthermore, fifty to sixty percent of the children who have eczema, later develop bronchial asthma.

Dr. Bacal strongly condemns the current fad of introducing infants to solid food at an early age. He feels that prematurely adding a solid food to an infant’s diet results in future sensitization to that food. Unfortunately, he says, mothers compete with their friends and neighbors in adding to the number of items in their youngsters’ diets as quickly as possible. Doctors, acting under pressure, have wrongly gone along with the trend. Dr. Bacal once asked a leading pediatrician when he recommended introduction of a certain solid food into the diet of an infant. “One month before the other pediatricians,” was the reply.

What is the role of the emotions as a cause of allergy and in determining the frequency and severity of the symptoms? Allergists, psychiatrists and other medical scientists are by no means agreed on the

answer.

At one extreme, there are authorities like Dr. John H. Mitchell of Ohio State University, who claim that chronic hives and dermatitis can’t be understood as a manifestation of the antigen-antibody reaction. They are really psychological disorders or “pseudo-allergies.” To Drs. Wil-

liam B. Guy and Roberî J. Shoemaker, of the University of Pittsburgh, eczema is not an allergy at all: it is a condition suffered by people with a certain kind of skin chemistry reacting to emotional frustration. “Patients improve.'’ they say, “when they begin to use aggressive techniques to solve their problems. They dare to express rebellion . . . they sever old dependency ties . . . they move to positions of increased personal freedom.”

Some allergists think the most effective treatment for juvenile asthma is what they lightly call a “parentectomy”—a separation of the child from its mother. Dr. Murray

Peshkin, former president of the American College of Allergists, states flatly that “incurable asthmatic children are cured when taken away from their mothers for a few years." As proof, he points to the high proportion of cures at two large residential treatment centres for asthmatic children in Colorado. “The change of climate has nothing to do with the cure," he says; the children are the victims of overprotective mothers. "The illness begins in infancy as a genuine allergic asthma to some food, dust or pollen. In time, the sensitivity burns itself out and in ninety

percent of the cases they develop an immunity.”

Other authorities, like Dr. J. D. L. Fitzgerald of Toronto, deplore the present tendency to attribute allergic symptoms to the emotions. They believe emotional disturbance is the result, not the cause, of the allergic symptom. The chronic asthmatic, for example, is under a mental and physical strain, and as a consequence, is anxious, easily depressed or aggravated. When his symptoms appear, he becomes upset. The more upset he becomes, the worse become his symptoms and so on.

“Controlling the emotional upset may reduce the frequency and severity of the asthma, but it will do nothing to alter the basic trouble,” says Dr. Fitzgerald.

There appears to be little doubt, however, that the emotions are often deeply involved in cases of food allergy. This is one of the major findings in a recent study of 600 food-sensitive patients by Dr. William Kaufman, an internist at Bridgeport. Connecticut. A person can eat an allergenic food and suffer no ill effects if he is emotionally serene, says Dr. Kaufman. But if he is upset within four meals after eat-

ing it, he might experience a severe reaction. Some patients suffered food sensitivities throughout their entire lives because they attached symbolic meanings to different items of fare. One man became deathly ill when he ate oysters because he associated them with a thick chunk of mucus he had coughed up during a bout with pneumonia. Another man enjoyed rabbit pie when he thought it was chicken but had to be rushed to a hospital when told he had eaten rabbit. He went into a shock-like state. As a child, he had kept rabbits as pets and, for him, eating them was tantamount to cannibalism. Another of Dr. Kaufman’s patients was a graduate student who always drank martinis before making love to his fiancée on Saturday nights. On Sunday mornings he would break out in a severe rash. Tests revealed that he did have a slight sensitivity to vermouth but not enough to account for the severity of his reaction. Later, Dr. Kaufman learned that the student had been raised in a strictly religious home where his parents had taken a dim view of extramarital relations. “The rash,” concluded Dr. Kaufman, “was induced more by the emotional stress about his behavior, than by the vermouth.”

Reactions are worse in winter

In some subtle way, food reactions are also influenced by climate and season. Dr. Albert H. Rowe of East Bay Hospital. Oakland, California, recently found that food allergy symptoms tend to be more severe when the patient lives on an ocean coast or beside a large lake or river: become less severe if he moves as little as five or ten miles inland. “Some chemical or ionizing characteristics of the marine air may be the factor,” Dr. Rowe speculates. Cold weather also encourages symptoms. Many patients have told Dr. Rowe: “I can eat foods in summer that I can't touch in winter.”

Some researchers are also becoming convinced that there is an intimate link between alcoholism and food allergy. They feel the compulsive drinking of an alcoholic after he takes his first drink of the day is comparable to the uncontrollable sneezing of a hay fever victim after contact with a pollen. A few months ago, Dr. Herbert E. Karolus published his findings after studying the food sensitivities of 422 al.oholics at the Keelcy Institute, Dwight, Illinois.

In introducing his study. Dr. Karolus writes, "An almost universal action of the alcoholic is to attempt to solve his problem by changing his beverage, say, from gin to whisky or from whisky to vodka. Surprisingly enough, this seems to work briefly sometimes.” Dr. Karolus put his subjects on a fasting diet for a few days, then gave them meals made of foodstuffs used in the manufacture of alcoholic beverages. They showed a sharp reaction. “Some patients.” he said, “showed increasing flushing, excitement. unsteadiness of gait. In some, a complete change of personality took place. Serenity was replaced by belligerency; a drink was first requested, then demanded. It was reasonable to suppose that had alcohol been accessible to the patient, he would have begun a drinking cycle.”

Skin tests were made with grape, rice, apple, barley, corn, hops, juniper, rye and other substances. Dr. Karolus noted that the average patient reacted to seven of them; some to as many as thirteen. His conclusion: “Examination of 422 alcoholics has led to support of the belief that there is a demonstrable relationship between alcoholism and food allergies. While it is too early to draw any definite conclusions, the findings are interesting enough to encourage further studies.” Ten years ago, at a meeting of the Society for Clini-

cal Research, a distinguished American allergist, Dr. T. G. Randolph, was far less cautious. He described how a group of his patients, all ex-alcoholics, exhibited a high degree of sensitivity to food used in the manufacture of their preferred drinks— foodstuffs such as barley, wheat, rye and sugar cane. Tested w'ith these foods, they responded with headaches, fatigue, weakness and nervousness —in other words, with a group of symptoms remarkably similar to their former hangovers.

At present, there is no simple cure for allergy: no single treatment for all cases. In dealing with a patient, the doctor first attempts to identify the offending agent or agents by taking a careful history of the patient’s living habits, diet, occupation and so on. He is likely to perform skin tests which, while helpful, are not infallible. Once the cause of the allergy has been identified, the patient is advised to avoid contact with it. If he can't—-as in the case of pollens from grasses and trees — the doctor may “desensitize” him with injections of small amounts of pollen over a period of several months. Recently, allergists have begun to use a single "one-shot" injection, which grants protection for several months. To reduce the unpleasant symptoms of allergy, a variety of drugs are now in use. the best known being the antihistamines. There are many antihistaminic drugs; one may succeed where another fails. For severe allergies, more potent drugs — like adrenalin and the corticosteroid hormones—are used.

Some people accentuate their allergy problems by self-medication. For example, the use of local remedies—applying drops and sprays to the nose—is not advised. They frequently make the condition w'orse because the tissues swell more as the shrinking effect of the drug wears off. "The patient u'ho doctors himself with whatever is fashionable at the drugstore at the time is not doing himself a favor,” says Dr. John H. Toogood, an allergist in 1 ondon, Ontario.

But doctors can make mistakes, too. Dr. I. S. Kahn of San Antonio. Texas, tells of a woman who w'as advised to have a brain tumor operation to rid herself of recurring dizziness and headaches. Before the surgery took place, it was discovered that her symptoms w'ere entirely due to a wheat allergy. “Often food allergies are confused with appendicitis,” says Dr. Kahn. One man who was opened up for an appendectomy, was later discovered only to be hypersensitive to fish. Another patient—a woman who was told she had arthritis— was merely allergic to cocoa.

Many of the severe allergic shocks or anaphylactic shock reactions could be avoided. “The patient has usually had a warning which he didn't heed,” says Dr. J. D. L. Fitzgerald of Toronto. Anybody who finds that a dose of aspirin or peni-

cillin is the cause of extreme discomfort should be wary of these substances in the future, and be prepared for an emergency. Dr. Fitzgerald urges anyone who has had an excessive reaction to a bee or hornet sting, to carry with him an emergency kit consisting of a hypodermic needle and doses of adrenalin and cortisone. He should then prepare himself for the following summer by a series of anti-insect sting shots, a cocktail usually made of wasp, bee, hornet and yellow jacket extracts.

Such precautions won't be necessary, of course, if medical researchers can discover

how to prevent and cure allergies. At present, scientists are speculating about the possibility of immunizing children to a wide variety of allergens from the time of birth. They have already done this, up to a point, in the laboratory, by giving infant animals an “acquired tolerance.” The most recent issue of the Journal of the American Medical Association announces a giant stride forward in the diagnosis of allergic conditions. It is now' possible to identify a person who is hypersensitive to bee stings, penicillin and other agents before symptoms appear. The new tech-

nique involves study of the basophil, a rare and fragile blood cell.

Dr. Howard G. Rapaport, chief of the Children's Allergy Clinic. Mount Sinai Hospital. New York, suggests still other directions from which hope may come in helping the allergic. “Perhaps the future lies." he says, “in the discovery of the role of enzymatic mechanisms and the use of synthetic substances capable of searching out and destroying the allergy-causing factors. Or perhaps we shall discover some other means of protection. Only tomorrow can tell.” ★