Allergies and Asthma

    The first person with allergies to use this spray was another relative—extended families help when you are trying something new. Joe, a grandson, was allergic to grandmother’s cat and they were planning a visit. My daughter called and asked what to do. I gave her all of the normal things to do to try to avoid exposure: shampoo the carpets, keep the cat outside, reserve a close motel room in case, and stock up on antihistamines. And I sent her a bottle of the spray. She used it about every four hours and Joe had no problems except when he first woke up after a night’s rest and mom noticed some swelling around the eyes. This was gone about 30 minutes after the first spray. Dad took the kids back for another visit several months later and was there for about four hours when Joe's face started swelling. He called my daughter and asked her to send the spray by overnight mail. After a night elsewhere they were able to resume the visit with regular use of the spray.  This is a picture of Joe. 

Rethinking allergies 

    Allergens, the irritants that trigger allergies, and our response to them are most of the time considered a bother and not important. We seldom think twice about taking an antihistamine or using a nasal steroid. Margie Profet is a biologist who thinks differently. She asks the evolutionary question, Why did this symptom complex develop in the first place? She points out that many allergens are structurally similar to toxins and that, as we repeatedly point out in this site, the runny nose is a defense. More about defenses is on the pages dealing with increases and helping, or on our other page dealing with Common Sense Medicine, but basically they are symptoms, like diarrhea, fever, and a runny nose, that help our bodies deal with environmental problems. A runny nose is our immune system trying to wash out the toxin/allergen. While our food supply and environment is likely safer and freer from toxins than it was for our ancestors we still feel that honoring our body's defenses is the best policy.  

    Allergens also come in different sizes and shapes; some of them are smaller and more soluble and are able to get into our system faster. Others, like the cat dander that gave Joe his problem, are less soluble. Joe was able to control his allergies by washing his nose every four hours. My son, who is allergic to some grasses needs to carry his bottle with him when he is outside in the fields and spray his nose every hour. For people like him who can't otherwise avoid their allergen, desensitization is probably the best option. For parents with infants who are interested in preventing problems, early exposure to a farm environment is significantly associated with less allergy and asthma. This idea is called the hygiene hypothesis and is based on the consistent finding that people who have been exposed to significant toxins in their childhood have fewer problems with allergies as adults. In the future we may possibly have easy and safe ways to expose our children to these toxins that will avoid the allergy problems. When these toxins are exposed to infants and children their immune system has little trouble in focusing on the bad guy and realizing that the ragweed or cedar are not really as bad as the other toxins. In the meantime we need to honor what our immune system is trying to do.

Asthma

    Asthma is closely related to allergy since most people with asthma have some allergy. Becka was the first person with asthma to clean her nose with this spray. She is Jerry’s cousin’s daughter. Becka’s mother heard about Heather and wanted some of the spray for her son who had lots of ear problems. When I described what it does she asked if it would help Becka too. Becka didn't have allergies as much as she had chronic sinus problems, which may have been allergy related.  I knew it wouldn’t hurt. Becka was on five different medications for her asthma, she was getting a shot from her doctor weekly, and she was in the ER about every 6 weeks. Mom sprayed her nose regularly three times a day. About a week later Becka had an episode of cleansing, like John Michael, where she got rid of all the mucus in her nose. The next week she did not have any trouble with her asthma and a week later mom took her off all of her asthma medication. Six months later she was active playing basketball and doing gymnastics without any trace of her asthma. A year and a half later Becka had another asthma attack while she was visiting family in Phoenix. She had stopped cleaning her nose regularly some time before. I suspect that Becka will have to repeat her earlier experience again and use it  more regularly if she wants her nose to stay clean and not trigger her asthma.

    After my experience with Becka I used it on other asthmatic patients. One of the first was an 11-year old boy, with no prior history of asthma, who came to my office wheezing with a peak flow of 150. Peak flow measures how much air a person can force out and gives a rough idea of the openness of the airway. 150 isn't very good, but it improved with a breathing treatment with albuterol, so I gave him a prescription for an inhaler and a bottle of the spray and told him to clean his nose regularly for a few days. He took the bottle to the school nurse and every class break he would spray his nose. He did not get the albuterol inhaler. His peak flow on the next three days went from the 150 to 250, to 350, and to 450, which was normal for his size.

    Cora is my last example. Cora has had diabetes and asthma for about twenty years, long enough for her airway to get remodeled so that it is always narrower than normal. Currently there is no way to treat this problem; we just try to keep it from getting worse. She has been on multiple medications for her asthma, including steroids that makes her diabetes harder to manage.  She began using the spray regularly about two years ago. The only problem she has had with asthma since is when she goes to the hospital and leaves her spray at home. She is not taking any of her previous asthma medications. Her peak flow remained at 150 to 200 for about 6 months, but was 350 after a year of regular use of the spray. This is Cora.

What is asthma?  

    After I saw what happened to these people I had to figure out why. What I saw didn't fit into the models we have of asthma. Asthma is defined as reversible bronchoconstriction and chronic airway inflammation and our questions and treatment are focused almost entirely on what we can do to reverse the bronchoconstriction or block the inflammatory response that triggers the constriction. I was faced with evidence that cleaning the nose eliminated asthma. What's the connection?

    Researchers are getting around to answering this question, but it is slow going. The "one airway hypothesis" is based on the well demonstrated fact that nasal irritants trigger a neurological response, termed by some the nasal-bronchial reflex, that results in bronchospasm. People studying asthma have some difficulty with the concept that the major triggers for asthma are in the nose. We don't often ask our asthmatic patients what it is that triggers their asthma attacks, but if we did the answers would cluster around sinus conditions, allergies, and viral upper respiratory infections. These problems all begin in the nose.

    When the nasal immune system identifies one of these irritants that it cannot wash out, even though it tries (as any person with allergic rhinitis can readily attest), it must focus on limiting the damage. If it cannot wash it out at least it can prevent it from getting into the deeper parts of the body where it may cause more serious problems. It does this by using the nasal-bronchial reflex to close down the airway — by damming up what it considers a polluted stream. Reflexes are always defenses that protect us. The gag reflex prevents us from aspirating food or drink, the light reflex protects our eyes from bright light, and the nasal-bronchial reflex protects our lungs from perceived pollutants in the upper airway—asthma is a defense.  We have been looking at the wrong aspects of asthma for the last 50 years. That's not very flattering to all of our researchers who are not attracted to this idea. But I can't explain the benefits I see any other way. 

          Just the other day I got some more confirmation for this idea. One of those letters came that Doctors get from the drug companies telling of another warning about their drug. This time the drug was salmeterol or Serevent and Advair. This drug is used as a long acting bronchodilator. It is not for use in acute episodes because it doesn't work fast enough. A study the drug company had done showed that over 28 weeks asthmatics who received salmeterol in addition to their other asthma medications died more frequently than if they received a placebo. The number was not great, 13 out of 13,174 versus 4 out of 13,179, but that is the kind of problems we see when we block a defense. The trend was even greater for African-American patients.

Wendell Berry is a contemporary American poet who is interested in the benefits of a more simple life. One of the things he said was that if we are looking for answers don't go to the temples. It's the desert or the wilderness that gives us the prophets, not the temples. By the time temples are built the builders are more interested in maintaining the status quo than in finding answers. While I don't claim prophetic insight the point here is that Hale Center is far from any kind of major center of higher learning or medical research.

    A thought provoking example of this concept is the results of studies done on observed drowning victims by the Dade County Coroners office in Miami. I emphasis observed because the most common explanation of this anomaly is that the person was killed somewhere else then dumped in the water. About 20% of these people had dry lungs. That is, they had such a profound response to water in their nose and throat that their airway shut down—just like people with asthma. There was no water in their lungs.  These people did not drown in the traditional sense of water in the lungs—they suffocated, just like people with asthma.

Return to home

Am J Forensic Med Pathol 1985 Dec;6(4):301-4

An assessment of lung weights in drowning cases. The Metro Dade County experience from 1978 to 1982.

Copeland AR.

The lung weights in known cases of drownings, both fresh and salt water, were studied in 220 cases over the past 5 years. Statistical comparison was performed with both a natural disease and a "normal" population. The frequency of "dry lungs" in drowning was also noted.

 

Am J Public Health. 2003 Nov;93(11):1858-64.

Do risk factors for childhood infections and malnutrition protect against asthma? A study of Brazilian male adolescents.

da Costa Lima R, Victora CG, Menezes AM, Barros FC.

Post-Graduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil. roclima@terra.com.br

OBJECTIVES: We studied the association between early life conditions and asthma in adolescence. METHODS: We conducted a population-based birth cohort study involving 2250 male 18-year-olds residing in Brazil. RESULTS: Approximately 18% of the adolescents reported having asthma. Several childhood factors were found to be significantly associated with increased asthma risk: being of high socioeconomic status, living in an uncrowded household, and children being breastfed for 9 months or longer. CONCLUSIONS: The present results are consistent with the "hygiene hypothesis," according to which early exposure to infections provides protection against asthma. The policy implications of our findings are unclear given that risk factors for asthma protect against serious childhood diseases in developing countries.

 

Curr Opin Allergy Clin Immunol. 2003 Oct;3(5):325-9.

Environmental exposure to endotoxin and other microbial products and the decreased risk of childhood atopy: evaluating developments since April 2002.

Braun-Fahrlander C.

Institute of Social and Preventive Medicine, University of Basel, Switzerland. c.braun@unibas.ch

PURPOSE OF REVIEW: The hygiene hypothesis proposes an association between the change in exposure to microbes and the increased incidence of atopic diseases in recent decades. Exposure to microbes and childhood infections and their association with atopy has thus attracted much scientific interest. This review focuses on new developments in the field of epidemiology. RECENT FINDINGS: Studies in adults confirm that exposure to orofaecal pathogens are associated with less asthma and allergies. In seropositive individuals, no increase in allergy prevalence over time was noted. Similarly, the generational increase in atopy and allergic rhinitis was not observed in individuals who were exposed to a farming environment in childhood. More than 20 studies have been published examining the effect of exposure to a farm environment in children and adults. Most consistently, the 'protective' farm effect was related to livestock farming and thus to microbial exposure. A dose-dependent inverse relationship between exposure to endotoxin in the mattress dust of children and the occurrence of atopic diseases was shown in rural environments in Europe. In addition, the blood cells of farmers' children were shown to express higher amounts of innate immunity receptors. Only a few farm studies have so far included an objective measure of the microbial environment. The examined exposure to endotoxin might partly be a surrogate measure of a much broader spectrum of immunomodulatory microbial compounds present in a rural environment. SUMMARY: The 'hygiene hypothesis' has gained much credibility, but the results should be balanced against the benefits of established hygiene standards.

 

Prog Cell Cycle Res. 2003;5:49-57.

Airway smooth muscle cell hyperplasia: a therapeutic target in airway remodeling in asthma?

Ammit AJ, Panettieri RA Jr.

Respiratory Research Group, Faculty of Pharmacy, University of Sydney, NSW 2006, Australia.

Severe asthma is characterized by airway remodeling due, in part, to increases in airway smooth muscle (ASM) mass. Regulation of ASM hyperplasia is considered an attractive therapeutic target for the potential treatment of airway remodeling in asthma. In order to develop anti-remodeling drugs, researchers have utilized cell culture techniques to elucidate the cellular and molecular mechanisms underlying ASM cell proliferation and to identify the critical cell cycle events that regulate ASM cell growth. Attractive lead compounds that have emerged from in vitro studies can now be examined in new animal models of airway remodeling, thus providing tools to design novel therapies to prevent or abrogate airway remodeling.