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The Allergy Prison (continued...) By SUSAN DOMINUS
To many parents of nonallergic children, such precautions can seem like ludicrous concessions to a few overprotective, overindulged neurotics. Even sympathetic people might reasonably get fed up when, say, they can't serve their daughter's birthday cake until three different people pore through the ingredients list and debate whether it poses a mortal threat. The incredulity ofthose frustrated parents is not surprising: there is something almost supernatural about the extremity of the phenomenon. "After my son was rushed to the doctor because he touched an egg noodle -- just touched it -- my friends finally apologized to me for what they'd been saying about me behind my back," says Kathy Franklin, a mother in New York City. Parents of highly allergic children tend to know how annoying they can be and that they can come across as the most overly anxious people ever to hector a school nurse. For the most part, they don't much care. To them, their obsessive precautions are the least they can do. When Amy Nathan goes grocery shopping, she checks every product's lists of ingredients, reading every one of the millimeter-high words no matter how many times she has bought it before. The recipe could change, if only slightly. Then she double-checks that list as she unpacks the groceries, then triple-checks it once again before actually serving the item. She frequently follows up with manufacturers to grill them about their production procedures. (The F.D.A. recently examined 85 independent cookie and ice-cream manufacturers and found nearly one-quarter of their products contained ingredients not listed.) Her routines are part talismanic ritual, part doctor's orders. "I tell my patients, if people point at you when you walk down the street and say, 'Look at that neurotic parent,"' says Paul Ehrlich, a pediatric immunologist in New York City, "then and only then are you being careful enough."
But even accounting for food neurotics, Sampson, widely considered the country's foremost expert on pediatric allergies, is convinced that food allergies -- medically proven ones -- are increasingly prevalent. Sampson tested comparable groups of children in the 1980's and in the 1990's and found that the presence of antibodies to peanuts had increased by 55 percent. Actual allergic reactions had increased by 95 percent. "The study is certainly not conclusive," Sampson says, "but it does suggest that something has changed." For all Sampson knows, it's the nut itself; it could also be that children are now introduced to some of these foods at earlier ages, before their immune systems are fully developed. (If a child who is breast-feeding has the right genetic predisposition, he might react to the nuts in his mother's diet, thereby triggering an allergy that could otherwise have remained latent.) Another theory, however, that is gaining currency among immunologists is that some change in the environment, something added or missing, has disrupted the workings of the immune system. Among the white blood cells that protect the body, there are two kinds of lymphocytes that interact in a kind of subtle feedback mechanism -- the kind that fights intracellular infections (like viruses) and the kind that fights extracellular infections (like parasitic worms) and, erroneously, allergens. In a healthy body, as the production of one kind of cell is triggered, a protein is released that suppresses the production of the other kind. And vice versa -- it is an efficient way of making sure that the body's resources are allocated to the most urgent task. As allergies of every kind have risen in developed nations, immunologists have started to question whether a third kind of lymphocyte, which controls the activities of the other two, has lost its capacity to keep both arms of the defense system in check. This regulatory failure would account for the recent rise in autoimmune diseases like multiple sclerosis, in which the infection-fighting system becomes so overactive that it turns against the body's own cells. When the allergen-fighting system speeds out of control, the result is hay fever / or children who develop life-threatening reactions to peanuts. Just what environmental change might have tweaked this immunological balance is a subject of heated debate in research journals and at global medical conferences. It could be that children today are exposed to too few of the previously commonplace infections -- like malaria or tuberculosis -- around which our immune systems evolved. "If some element has always been present in our environment, it must continue to be there if our systems are to be set up properly," explains Graham Rook, professor of medical microbiology at the Royal Free and University College Medical School in London. He paraphrases the Nobel Prize-winning biologist Jacob Monod: "Evolution turns the inevitable into the essential." That essential factor missing from our lives could also be something as mundane as dirt. A proponent of the so-called hygiene theory, Rook believes that at an earlier, less sanitary period of human evolution, our immune systems developed in relationship with the microbes in dirt. Rook points to a study conducted in Bristol, England, that surveyed 14,000 children born in 1992. It found that children who washed their hands frequently had a much greater likelihood of developing asthma, a kind of allergic response, than those who washed less frequently. Studies in Germany show that children brought up on farms are less likely to develop allergies, as are those who have dogs. Of course, farm children are also less likely to be exposed to scourges like cockroaches, mold and diesel-heavy pollution, all of which are associated with high asthma rates. But researchers believe those factors trigger the symptoms of asthma rather than cause a predisposition to it. Page |
o doubt, some of the rise in allergies can be attributed to greater awareness and the culture's diminishing tolerance for illness in any form. And as with most diseases, with increased awareness comes a degree of hypochondria. These kinds of allergies play upon two of our most persistent preoccupations -- health and food. "It's always tempting to relate some physical event or symptom back to what you've put in your mouth," says Dr. Hugh Sampson, chief of the division of pediatric allergy and immunology at Mount Sinai Medical Center. "Hypochondria is a big problem in this area." He doesn't sound so much frustrated as accepting of the fact that some of the parents or patients who come to see him will want to discuss allergies that do not exist. "There's definitely a certain personality type," he says. "It's usually the person who comes in and says they're allergic to 30 different things, as opposed to the person who comes in and says she thinks she has an allergy to Brazil nuts." Relatively simple blood tests can reveal whether the allergen-specific antibody known as IgE is produced in response to a given food. Nonetheless, Sampson occasionally hears reports of parents who seem so invested in their child's unproven food allergies that the child ends up dangerously malnourished. 
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