I definitely wish that the docs had been on the ball with the asthma thing with me, because maybe things would have been different.  My asthma is scary unpredictable.  But I wasn't diagnosed until I was eight or nine, and I didn't start getting any real preventative treatment until high school.  Until then, I just had albuterol, a neb, and the ER.  Looking back, my mom says it was clear that I was asthmatic very early - but no one really knew all that much about it then.

My brother's asthma is very different - he only needs to carry a puffer now, and was able to cut out inhaled steroids entirely a few years ago.

We have been beyond fortunate to have had not one, but TWO sh*t-hot allergists who were cutting edge and SUPER-smart in terms of dealing with the allergic march in a holistic (not "palliative" or ISOLATED as "allergy") manner-- and aggressively intervening in any way that seemed beneficial and with better benefits than risks.  We're partners in an evolving treatment plan.  ANYTHING that we can do that has a reasonably defined long-term safety profile, we're going to do.

Heck YEAH we've been all over damping or slowing the allergic march.  Genetically, DD drew aces.   

By all indicators at 2yo, my 14yo DD should have severe asthma and be scarred from eczema.  That's the trajectory that she was on-- it was VERY clear, even by 17-20 mo.  Multiple anaphylaxis events, increasingly severe and sensitive, etc. etc.

  Neither of those things is true, and I readily attribute that 'steering' of the process to the advice that we got from those two physicians.   That and a lot of nerve on our part-- doing it is less easy to do as a parent than as a physician who isn't related to said child, I suspect.  Still; while she may have to live with anaphylaxis risk, she does NOT have to live with limited activity as a result of remodeled airways, and her skin is more or less intact.   Her asthma is reasonably predictable-- we don't fear it, and some people very definitely DO live with that reality.  At 18mo, she was shaping up to be one of them. 

Mechanism-mechanism-mechanism.  That's the name of the game.  Once we understand TH1/TH2 switching from a causative standpoint, we have a handle on sensitization. That's where the $$ and focus must go.  MUST.

Thanks for explaining TT ... sometimes I have a hard time keeping up with you  .

That is the radical portion. Identifying biomarkers for allergy to start vaccinations in infancy. It won't help our kids or probably this generation, or at least not all of them in the same way, but depending on where you are in the allergic march some intervention may subtly alter it by degrees and to consider the march itself by degrees.

Catching the "march" early would be really challenging in many cases.  By age 1, dd already had asthma & FA.  At that time, I had no real clue about any of this stuff.  With what I know now, I suspect a lot of the early warning signs were missed by both myself & the ped.


I'm off to db's house for TG  ... I've "tasted" a bit too much from the sides I'm bringing.
Have a good one!

That's great Janelle.

In the past, we tried having less docs, but sometimes the advice I would get about issues outside of their immediate area of expertise was not really that great.

I guess there are pros & cons to each approach.

I think I'm happy with the mix of docs we have now.  We travel quite a distance for our allergist now, but as far as I'm concerned, it's totally worth it.  We need somebody more local for the asthma and they handle that really good, but I would prefer that they don't handle the FA. 

Quote from: LinksEtc on November 28, 2013, 10:19:00 AM
Let me count the specialists we've seen for the atopic related stuff:  allergist, pulmo, derm, GI, ENT, & ped.  These docs often see things from their own corner of the atopic room & sometimes they fight, ok - let's say disagree, with each other.  When that happens, guess who gets to decide - yep, that would be me.  It's much nicer when they complement one another & communicate as a team.

I got super lucky when I found a doctor in the area that specializes in my 3 main problems - Allergy, Pulmo, and Sleep.  He even has a research center attached to his office and does research for all three of them, which is awesome.  I haven't been able to qualify for any of his studies (most of them disqualify based on daily pred use), but there are numerous times that we have tweaked my meds because of the results of a study, and it has made a difference.

If the talk sponsored by ACAAI about the 'future' continues as was presented we're probably making a turn in medicine for the allergic individual for precision in testing, precision in individual presentation, with more attention to the allergic march and the patient's individual circumstances. Previously my stance was staunchly for a food anaphylaxis expert. That's changing. My ground-up build model for the ideal doctor is one with advanced protocols on SLIT with the target for early intervention of sensitization, emphasis on environmentals including best formulations on dust mite which is bodies and feces from multiple species. Just as you're doing I look at asthma and ENT on the same page as the whole disease however, and whenever, it presents. I've stopped looking at as food allergies.

For Links: I'm following up on Hugo Van Bever since his presentation on allergic march. He is a little radical in a sense but he is a stern advocate of treating the disease earlier in the chain from all approaches than dissecting the symptoms to divvy up to assorted, uncoordinated branches of medicine. http://www.nuh.com.sg/scripts/WebFormShowProfile.aspx?id=13383

Can I get on that soapbox for just a moment?

Yes, yes, yes to what this doc said about needing a holistic approach for treating atopic kids.

Let me count the specialists we've seen for the atopic related stuff:  allergist, pulmo, derm, GI, ENT, & ped.  These docs often see things from their own corner of the atopic room & sometimes they fight, ok - let's say disagree, with each other.  When that happens, guess who gets to decide - yep, that would be me.  It's much nicer when they complement one another & communicate as a team.

My FAS passion these days - having special versions of asthma plans for those having both FA & asthma - in my non-medical opinion -  this is the type of specialty crossover that's needed.

<off soapbox>

QuoteAnd he showed a chart showing the countries with the most allergies. We win that competition. The UK is right at the top followed by New Zealand, Australia, Ireland, Peru, Cost Rica, Brazil and the USA. The list continues but us Brits are far more likely to have allergies than any other nation.

This is true if one purposefully measures out allergy epidemic in terms of how the population in these nations present its allergic disease as
food anaphylaxis. I would disagree based on the research results and growing concern of a rising epidemic of allergic disease amongst the Asia Pacific region and its population. The early part of the allergic march, the sensitization is something all allergic disease shares. This will become important when we pool our research resources globally if we want to find a cure not just further symptom controls for latter presentation of anaphylaxis. The more we look at this as a food problem and not food anaphylaxis as how defined populations present in the global epidemic of rising allergic disease we're going to always lag in a cure. OIT, and even FAHF-2 hammer at tolerance well after the allergic march is in full stride.

Even at an AP congress, research on herbal remedies for symptom control were not the focus or looked upon as a cure. The theme was early mechanism, root-level mechanism, the point at which the allergic march begins sensitization. Even if FAHF-2 can be proven to temporarily control anaphylaxis symptoms it most like likely does nothing to alter or stem the allergic march, not unlike OIT does not provide any prophylactic effect against future sensitization at all.

That's why Xolair has remained the last man standing thus far: it does a lot of stuff at the root level which is why it is effective against asthma as well as anaphylaxis. It tinkers at that root level with the IgE receptors by not allowing that bond to begin with. The IgE builds up with itself forming triangular lattices and somehow gets swept away. I used to think the incidence of anaphylaxis from Xolair was high until I realized that in theory anti-IgE itself is supposed to induce anaphylaxis... which is why the Changs had such a hard time getting funding when they formed Tanox. They were told it could not be done.

Other regions and populations may not be experiencing food anaphylaxis at the same levels to the same foods as the above regions quoted but that doesn't mean it isn't happening and as recent data (November 2013) was presented the two top causes of anaphylaxis in China are not fish or shellfish but wheat and milk. It is also suspected to be widely underreported, undertreated and underdiagnosed. The gateway to that and to the epidemic instances (and growing) of asthma in children is related to dust mite sensitization, which drives a lot of their research. They are looking hard at the allergic march and root level mechanisms in the current belief that by the time we get to food sensitization we're too late because it's nearly a third tier portion of the allergic march. Symptoms are already well understood and can be controlled, if we want a cure we need to spend less dollars on further late symptom controllers (OIT) and look much further up the chain of the allergic march in childhood to provide some prophylactic measures against sensitization.

*off soapbox*

http://www.parliament.uk/documents/post/Adam%20Fox.mp3