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Astelin (Azelastine)

During her infancy Julie had suffered quite badly with cracked dry skin, a condition called atopic eczema, and her mother had read that this can be caused by an allergy to milk. Does this then play any part in her asthma? There is no doubt that for a proportion of children with asthma, allergic reactions to foodstuffs are important as a cause of their condition. The foods most commonly incriminated are cow’s milk, eggs, wheat, cheese, yeast, fish, pork and peanuts. Some children are sensitive to the preservatives or colouring agents used by food manufacturers and in particular tartrazine and quinoline in squashes and cola. While it is often difficult to identify the aggravating foodstuffs it is worth eliminating each one in turn from the child’s diet to see if there is improvement.
Atopic or allergic eczema as in Julie’s case is indeed associated with a milk allergy. This could be strongly suspected by a careful history of her progress through infancy and by seeing if she had suffered any of the following symptoms:
• Colic
• Irritability
• Repeated vomiting
• Diarrhea
• Snuffled nose
• Poor sleep pattern
• Persistent nappy rash
Taken in isolation many babies have one of these symptoms, but if your child has at least three of these then a milk allergy is a strong possibility. Julie, in fact had suffered from all of them at different times and her mother kept her off milk for six weeks. During this time Julie seemed much happier and livelier without any sign of wheezing. It was reasonable to assume therefore that milk allergy was certainly playing a part in her asthma.
Both Simon’s and Julie’s parents asked about desensitizing injections. This arose with particular reference to the house-dust mite, as although it is possible to keep the bedrooms clear of dust in their own houses what would happen when they went to stay with friends and relatives or were away on holiday? In these circumstances the rooms would not be free of the dreaded mite and consequently breakthrough asthma could well occur. In an attempt to overcome these sorts of problems researchers developed a method of stimulating the body’s defense system to produce more of the cells which cope with individual allergens. Unfortunately, this method, although having the potential for curing asthma, has two major drawbacks.
First, the stimulating solution has to be given by a series of injections which are administered once a week for eighteen weeks and repeated each year for three years. Secondly, it is unusual in asthma for there only to be one allergic cause. We have already seen that Julie is allergic to both house dust and milk and no doubt there are others, so there seems little point in desensitizing her to only one of these. Mixing two or more allergens in the one treatment always brings disappointing results as it seems the immune system can only deal with one allergy at a time.
Consequently I never now recommend desensitization as it is cruel, if not barbaric, to subject a child to weekly injections. If there was a guarantee they would work then a case could perhaps be made, but not otherwise. Both Julie’s and Simon’s families seemed relieved when I rejected the desensitization approach.

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