Spring is a wonderful time of year. It brings a variety of unique organisms that remind us of the cycle of life. One amazing example is the microscopic egg that develops into a larvae (caterpillar), and eventually a pupa (or chrysalis) that continues to mature until finally a beautiful butterfly emerges.My journey with allergies and asthma began at a young age. As a toddler, I was diagnosed with eczema and by the age of six I had already developed a serious allergic rhinitis and wheeze. After researching my family history, it was no surprise that I had a genetic predisposition to allergic disease. Fortunately, my mother was a nurse and recognized early on that I had developed inhalant allergies.
“June 16, 1959 – Postcard from a family member to my great-grandmother informing her that her grandson had had a difficult time with hay fever while vacationing in Paris”
The day I was skin tested as a youngster remains a vivid memory. I can recall lying on the table as the allergy nurse placed drops from 40 inhalant allergens on my back and scratched my skin with a bifurcated lancet. The procedure itself was not as uncomfortable as the flare up of itching from almost all of the test allergens. I remember that everyone there noted how “brave” I was for laying still throughout the entire procedure.
“1981 – receiving a skin test at Scott & White Hospital’s allergy clinic in Temple, TX”
I also recall my Allergist consulting with my mother about all the allergens that could trigger my allergic symptoms. Looking back, I find it amusing how I was told to avoid things like “grass clippings” and “dust.” Neither of these are specific allergens, but perhaps my physician’s intent was to relate to me the possible sources of allergen exposure, especially around where I lived in Central Texas.
“1981 – discussing treatment options with my Allergist, Dr. George Brashear”
One of the only treatments available to allergic asthmatics like me was a drug called Theophylline, which dates all the way back to the 19th Century when it was extracted from tea leaves. The primary chemical action creates a potent, biological response by relaxing smooth muscle tissue in the lungs. For allergic asthmatics like me, it was likely a life saver.
In the early 80’s, Theophylline was only available in capsule form (which I couldn’t swallow), so my parents broke open the capsules and sprinkled them onto vanilla ice cream or applesauce. Neither of these were particularly effective in masking the extremely bitter taste, and I often gagged when taking the medication. To this day, I cannot eat vanilla ice cream or applesauce (or sprinkles for that matter) without triggering a gag reflex.
During grade school, immunotherapy was recommended to help build a tolerance to the inhalant allergens that triggered my rhinitis and asthma. My mother was vigilant about bringing me to the allergy clinic for my weekly appointments. I actually didn’t mind so much because it also meant I could be excused from school to drive the 30 minutes to the regional hospital to receive my allergy injections. Allergy shots never bothered me. I recall that the nurses lovingly referred to me as, “the human pin cushion” because I never winced or complained after an injection.
Despite several years on allergy immunotherapy, I don’t believe that my allergy symptoms greatly improved. Perhaps some benefit was achieved, but it is safe to say that the original course of immunotherapy in the mid 1980’s did not “cure” my disease. Nevertheless, there have been tremendous advancements in our knowledge of the immune system and how to properly select allergens and formulate treatment. I imagine my allergy immunotherapy mixes today would look quite different.
“2016 Clinical Training – positive skin test reactions to multiple inhalant allergens”
Throughout my grade school years, treatment options for allergy and asthma improved and I learned to manage my disease reasonably well. However, I struggled to keep up with other kids in sports. Soccer was my favorite outdoor activity, but I often had to leave the field to use a rescue inhaler. Swimming in pools was also a challenge because the chlorine triggered bronchial tightening, which made holding my breath difficult, if not impossible.
My middle school years were particularly frustrating. I was bullied because I couldn’t perform at a high level in sports like other boys my age. When I was given special treatment in gym class to avoid asthma attacks, I was often ridiculed. High school and college involved much of the same, but I became adept at keeping my allergies and asthma under control, and out of sight of others. Managing my disease became a daily effort that left an impact on my overall self-confidence. Even now in my 40’s, I notice that I still make an effort to conceal the use of my rescue inhaler in public.
Despite some challenges, my journey with allergies has helped shape my interest in the disease. For a 7th grade Life Sciences assignment I instructed my entire class to act out parts of the immune system (the teacher was a viral pathogen, of course). I modeled the project based on an article in National Geographic that year that described the mechanisms of the immune response. My teacher awarded me the highest marks in the class for that project… a sign of things to come.
“National Geographic – June 1986: Our Immune System, The Wars Within, pg 711”
One of my most frightening experiences with asthma occurred during a July 4th celebration when I was only 10 years old. I joined other kids on a hayride at a local park. It was a very hot, dry and dusty day. Within minutes of taking a seat on the stacks of hay, I began to wheeze. At the end of the ride, my mother recognized that I was in serious trouble and she rushed me to the regional hospital… again, a full 30 minutes away.
In those days, we did not have access to rescue inhalers, so the only available treatment for such an aggressive asthma attack was epinephrine, a drug unavailable in personal dose packs like it is today. I recall being very panicked and scared, straining to draw in even a small amount of air. A few minutes in the car felt like hours. Fortunately, we arrived in time to receive immediate treatment in the emergency room. I recovered quickly, but my experience that day produced a genuine fear that would stick with me for a life time.
A Life’s Work
Thinking back on my life, I am amazed at how very few days passed without me thinking about my disease: Did I take my medication? How will my allergies be affected in this environment? Where is my inhaler? Did I pack my inhaler? What do I do if my allergies or asthma flare up? My “normal” became very different from others who did not have to worry about allergies or asthma.
Now that I am a father of 2 beautiful, young children, I am hyper aware of the earliest possible signs of allergies in my kids (sometimes to the frustration of my wife). My 5-year old daughter developed eczema at a young age and already has exercise-induced asthma. It is likely that her disease progression will mirror my own. My only hope is that I can help her find a way to overcome this disease so it does not consume her daily life like it did for me.
It is easy to see how my childhood difficulties with allergies and asthma drove me to learn as much as possible about the disease. I went on to study Immunology at Texas A&M, and again in graduate school at Harvard. In a wonderful twist of fate, my career has now placed me in a position to have a significant impact on the lives of others with allergies and asthma. I take great honor in knowing that my healthcare contributions could help others conquer this disease.
Bob Erskine is Director of Allergy at Innovation Compounding. He is the architect and clinical liaison for the AllerScripts clinical program, offering allergy skin testing and immunotherapy to medical practices.