PEDIATRICS Vol. 48 No. 6 December 1971, pp. 930-938
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PEDIATRIC ALLERGY: SOME IMPRESSIONS GAINED OVER A 37-YEAR PERIOD

William C. Deamer M.D.1

1 Department of Pediatrics, University of California School of Medicine, San Francisco, California

The most effective treatment of allergy is discovery and removal of the allergen. Injection therapy, while useful in some forms of inhalant allergy such as hay fever, is a less effective measure.

Respiratory tract allergy is frequently mistaken for respiratory tract infection. A history of repeated episodes of bronchitis or pneumonia should suggest the possibility of asthma. Similarly, a history of repeated "colds" should suggest allergic rhinitis.

Increased sneezing and itching and rubbing of the nose are frequent minor symptoms of allergic rhinitis. Coughing at night and coughing on exertion are common minor symptoms of asthma. Since allergic rhinitis and asthma often occur together and share the same etiology, all four of these minor symptoms may serve as a guide in identifying and treating asthma.

Positive skin tests for allergy may be found in as much as 50% of "normal" individuals, many of whom may have no recognized clinical allergy. Positive skin tests therefore do not constitute evidence of clinical symptoms.

Nonspecific trigger factors such as nervous tension, respiratory tract infections, fatigue, climate, exercise, and smoke or strong odors may precipitate an attack of asthma. Frequently overlooked are the more important specific factors such as pollens, house dust, animal danders, and foods.

An important variable factor in asthma is the state of the patient's sympathetic-parasympathetic nervous system balance. At times this may act to augment synergistically the action of the chemical mediators of the allergic reaction, thus involving non-immunological as well as immunological factors.

Food allergy or intolerance is a frequently unrecognized cause of asthma and allergic rhinitis. It is also a frequent cause of the tension-fatigue syndrome–a common but little known entity.