Some practical aspects of allergy

Abstract

T HE practical aspects of allergy are quite different for physician, parent, and patient. The physician is primarily interested in diagnosis and treatment. The parent and patient are concerned with immediate results of treatment, its execution, cost, and inconvenience, as well as the prognosis and possible complications of the disease. The emphasis in this presentation will be on respiratory allergy, and some aspects of eczema and urticaria, since our experience with nearly three thousand allergic children seen in the Duke Hospital Pediatric Allergy Clinic in the past ten years shows these to b.e the most common problems. M. ajor allergy is present in at ,least 10 per cent of the general population, and an additional estimated 50 per cent may have minor allergy. 1 Asthma began before 10 years of age in at least one-third of adult asthmatics reported by Derbes and Engelhardt. 2 A tabulation of some of our personal experience with allergic children stresses even more the early age of onset (Table I). These observations emphasize the importance of major allergy as a pediatric problem. If time permitted a discussion of minor allergic symptoms in children we would find that allergy often accounts for much other illness as well. The pediatrician has a unique advantage over a consulting allergist, in that he already knows the family history, the details of environment, the emotional factors, activities, infection, diet, and medication which the child has had since birth. He knows which children are unsupervised or overprotected, which households are chaotic and which ones run smoothly (Table II) . This knowledge of nonspeeific and possible allergic factors is considered vital information by the allergist, who acquires it only by laborious cross examination. The only thing the pediatrician lacks to become a good practical allergist is a little more information about the common allergens, and a reminder that allergic diseases vary greatly in severity. In mild allergy the onset of symptoms following exposure to an allergen is more delayed than in marked sensitivity and may require reinforcement by nonspecific factors.