The Allergic March

The Allergic March

More kids are suffering from allergies and asthma, complicating day-to-day living for them and their parents.

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The retriever had been around only a month when Aidan Pimentel, then 5 years old, broke out in welts. That development led his parents to asthma and allergy specialist Dr. Jerry M. Shier, who confirmed that Aidan had dog and other allergies and warned them about the chance of asthma. “Because he had a high risk of getting asthma, it really became a non-question,” says Bethany Mancilla, Aidan’s mother. “The dog was just a puppy, and it was hard and sad for us to do that, but I really didn’t want Aidan to be struggling.”

Shier told the Greenwich Forest neighborhood family that Aidan would suffer if they kept the dog. “So, after we plunked down the cost of getting the dog, we found a new home for the dog,” says Mancilla, vice president of business development and licensing for a biotech company in Annapolis.

Stories of similar trigger events are common among Bethesda-area parents who have children with allergies or asthma. What follows for many of these families is a new way of life, in which awareness, avoidance and compliance rule, and missteps can lead to daunting and even life-threatening situations. “It’s life altering when you’re told that you have to read every label of every food that your kid eats,” says Dr. Heidi Isenberg-Feig, founder of Potomac Family Allergy and Asthma in Rockville and Ijamsville.

Melissa Witten, a Bethesda mother of two boys with allergies to peanuts, tree nuts and sesame, knows the drill well. “You have to be very, very careful. We check the ingredients of everything they eat.”

As her sons Andrew, 10, and Paul, 12, Become more independent, the situation grows even more challenging. They go to restaurants with friends and their parents, and always have to ask questions about what’s in the food. “It can be hard for children to fend for themselves, and other parents sometimes find them overly cautious,” Witten says.

Witten carries an EpiPen everywhere she goes, but some parents are simply not comfortable with the notion of carrying and using an unfamiliar drug delivery system. An EpiPen is used to treat severe allergic reactions such as difficulty breathing, tightness of the chest or swelling of the mouth, lips or tongue from insect stings or bites, foods, drugs or other causes. Some parents worry about the burden of having the EpiPen “and not knowing what to do with it,” Witten says. Steps for using a disposable EpiPen include removing the safety cap, holding the device firmly against the thigh, applying pressure and counting to 10.

Witten’s sons attend numerous sporting events and participate in many other activities, all as the parental worry meter ticks away. “We always feel like we’re taking a bit of a chance, but they have to do stuff. So, it’s just difficult,” she says. Witten says her boys complain now and then that they can’t experience things the way other people can. “But you know everyone has their issues, everyone has their medical conditions, and this one happens to be theirs,” she says.

“There is significant statistical evidence that allergies have been on the rise over the past 20 years,” says Shier, who practices at the Asthma and Allergy Center, which has offices in Rockville and Silver Spring. In fact, the number of people under 18 in the U.S. with a food or digestive allergy increased 18 percent from 1997 to 2007, according to a study released in October by the Centers for Disease Control and Prevention. About 3 million kids under 18—nearly 4 percent of the age group—had a food or digestive allergy in 2007. That’s up from 3.3 percent in 1997. In addition, children with food allergies are two to four times more likely to have conditions such as asthma, eczema or respiratory allergies when compared with kids who don’t have food allergies, according to the CDC study.

From 2004 to 2006, there were approximately 9,500 hospital discharges per year with a diagnosis related to food allergies among children under age 18, according to the CDC study. There were approximately 2,615 reported hospitalizations per year for food allergies from 1998 to 2000. (The report says the findings could be related to increased awareness, reporting and use of specific diagnostic codes for food allergies or could represent a real increase in children who are experiencing food-allergic reactions.)

Dr. Vincent Vaghi, an allergy and asthma specialist with offices in Rockville and Germantown, says he is “amazed” at the number of food-allergic children he has seen in the past two to three years. “Clearly, we’re seeing more patients, percentage- wise, than I saw back in the ’70s and ’80s,” he says.

There is no simple answer to explain why, Vaghi says. “I’ve talked to experts who are far smarter than I in this field, including one who runs a clinic at [Johns] Hopkins [University],” he says. “I don’t know whether it’s more refined food that we’re seeing now, whether the kids aren’t exposed to other allergens early on, [whether] they’re being breastfed longer; I don’t know the answer to those questions.”

Asthma statistics are also jarring. According to the American Academy of Allergy, Asthma & Immunology, asthma rates in children under the age of 5 increased more than 160 percent from 1980-1994. In 2002, 9 million children under age 18 were diagnosed with asthma in the United States. During the same year, school-age children missed more than 14 million school days due to asthma, according to the AAAAI.

“The term everyone is using these days is ‘the allergic march,’” says Shier, an assistant clinical professor at George Washington University School of Medicine.

“Infants typically will start with eczema within their first three months to one year, and then move on to having [a] food allergy, then to having asthma, and then nasal allergies. So, the frequency has increased.”

Medical experts don’t know exactly why allergies and asthma are on the rise, but some believe that increased parental awareness has led to earlier diagnoses. “The most important environmental risk factors for asthma are exposure to indoor allergens (domestic mites, cat and dog dander, cockroach allergen and fungi), outdoor allergens (pollen), tobacco smoke and occupational sensitizers,” according to an article by Dr. Bradley E. Chipps on asthma in infants and children.

The so-called “hygiene hypothesis” is also gaining momentum. Some researchers believe the “Western lifestyle—with its emphasis on hygiene and sanitation—has resulted in changes in our living conditions and an overall decline in infections in early childhood,” according to the National Heart, Lung and Blood Institute Web site. “Many young children no longer experience the same types of environmental exposures and infections as children did in the past. This affects the way that the immune systems in today’s young children develop during very early childhood, and it may increase their risk for atopy and asthma. This is especially true for children who have close family members with one or both of these conditions,” the NHLBI Web site says.

Treatment helps

Aidan Pimentel, who was allergic to the family puppy and later developed asthma, has received allergy injections for the past five years. The vaccines have helped the Bethesda Elementary School student, now age 10,manage his allergies and, fortunately, his asthma is mild, says Aidan’s mother, Bethany Mancilla.

Aidan showed a marked improvement in symptoms after getting weekly shots at the doctor’s office, so much so that he now gets the shots every three weeks. As a result, the Pimentel family decided to try its luck again last February. “We knew that Aidan was in pretty good shape, and based on the research we did, we knew certain dogs were likely to be OK,” Mancilla says. So far, the Yorkshire terrier has worked out.

Mancilla says only one of her other three children is showing signs of allergy issues. Her youngest son James, 4,may soon visit the allergist. He is exhibiting some of the same symptoms Aidan does when his seasonal allergies flare up, including a runny nose and puffy eyes, she says. Most patients see a significant improvement after the first year of allergy injections or immunotherapy, medical experts say. Allergy injections contain small amounts of allergens.

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