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Asthma
Adapted from Pure Facts, July/Aug. 1993, Vol.17, No.6


Dear Doctor:

The Feingold Association Program does not cure asthma, of course, but we can help your patients remove certain irritants from their environments; by using our food lists and program information, they will learn how to eliminate the food additives, salicylates, sulfites, and many of the environmental chemicals likely to cause them problems. Our Product Information Center and 20 years of experience will make it much easier for them. If you are a health care provider, we hope you will let us be a resource and support group for your asthmatic patients; if you are asthmatic, we hope you will let us do our best to help you.

If you have questions, call 631-369-9340 or send e-mail to: help@feingold.org



A past president of the College of Allergists was actually quoted in the early 60's as saying "One of the commonest types of juvenile asthma is caused by an overprotective, domineering mother ... the best treatment is a 'parentectomy' -- separating the child from his mother." - Allergy Quarterly, Vol. 25
then ... In the beginning, as in so many other afflictions where the cause is not understood, parents seeking help for their children's asthma problems found themselves blamed for it.

and now ... Among the potential triggers for asthmatic attacks, the American Lung Association lists: food additives, azo dyes, and benzoate preservatives (i.e., sodium benzoate).

The Food and Drug Administration requires that Yellow No. 5 be listed by name on ingredient labels. This is due, in part, to their recognition of the danger the dye can pose for asthmatics.

More children affected

The incidence of asthma has risen drastically in recent years, particularly in children. Approximately ten million Americans suffer from asthma, and of that number, more than three million are children under the age of 18.  In just four years between 1982 and 1986, the number of affected children grew by 25%. Not only has the disorder become more common among children but it has increased in severity, particularly among black children living in inner cities.  In 1987 the asthma death rate in East Harlem was almost ten times the national average. (Reported in the New York Times Magazine).
Deaths from asthma have doubled in the past decade.
Since 1989 is the last year for which figures have been compiled, this toll could be far higher today.

Asthma disables children more frequently than any other condition, according to Miles Weinberger, professor of pediatrics at the University of Iowa College of Medicine.  He notes that more than ten percent (10%) of all children now have, or have had, asthma and the greatest increase in hospital admissions for asthma is among 1 to 5 year olds.

The rate of children being hospitalized doubled between 1970 and 1978, but innovations in medical treatment do not appear to have kept pace with the growing problem.

In 1979 death from asthma for each 100,000 children ages 5-14 was placed at 0.1, but by 1985 that number tripled to 0.3 deaths.

In people ages 15-24 the increase doubled from 0.2 to 0.4 deaths per 100,000.

A child who is exposed to second hand cigarette smoke is at greater risk for developing asthma, and this is a particular problem if the mother or primary caregiver is the smoker.

According to the Allergy Information Association of Canada, even the unborn child of a smoker may be harmed because a reduction of oxygen available to the mother can affect the oxygen supply of the fetus.

Asthma and allergy
Dr. Benjamin Burrows, a researcher at the University of Arizona College of Medicine, conducted a study of 2657 people and concluded that all types of asthma are allergy-related.  His findings challenged the long-held belief that there were allergic and non-allergic types of asthma.  It was reported in the New England Journal of Medicine, March 1,  1989.

Although statistics lend themselves to various interpretations, professionals who work in this field are clearly alarmed, and the problem is being reported by other countries as well.

Canada's Centre for Disease Control reports similar troubling statistics. Among people between ages 15 and 34, there has been a 163% increase in asthma-related deaths.  (They also note the greatest increase has been in deaths among asthmatic women. Canadian epidemiologist, Dr. Donald Wigle, suggested that "environmental factors such as food additives or air-tight office buildings containing irritation pollutants may be increasing the rate of fatal asthma attacks. [note: an epidemiologist is a scientist who uses statistics to identify potential causes for health problems]

The British medical journal, Lancet, noted a startling increase in asthma among that country's school children. Between the 1940's and 1980's the number of asthmatic children tripled. The Lancet reported: environmental agents -- including traffic jams, industrial and domestic pollutants, ventilation plants, tobacco smoke, natural allergens and food additives -- can help to provoke bronchial hyper-reactivity and so provide the background conditions for the development of asthma.

Other suggested triggers
An often mentioned trigger for asthmatic attacks is sulfur dioxide (Journal of Allergy & Clinical Immunology 1985; 76; 40-45) and the various sulfur based preservatives. Sulfites have been used not only in salad bars, wines, and some convenience foods, but have been added to medicine for asthmatics.

Research at the Royal North Shore Hospital in Sydney, Australia points to MSG (monosodium glutamate) as a potential trigger.

Dust mites, animal dander and cigarette smoke can be potent irritants in air tight homes, schools or offices.

A surprising finding on asthma was reported in the British Medical Journal.  Researchers found that in the majority of asthmatics, an increase in salt consumption led to more severe attacks. (1)

About 1991, the New England Journal of Medicine described artificial flavoring (2) in toothpaste as a potential cause of brochospasms in some asthmatics. (In addition to artificial flavoring, toothpaste typically contains dye and saccharine, both petroleum derivatives which Feingold members report as triggers for asthmatic attacks.)

FDA cautions asthmatics
The Food and Drug Administration lists a wide range of potential triggers for asthmatic attacks. These include exercise, respiratory tract infections, a wide range of environmental irritants, both at home and in the workplace, as well as certain drugs and food additives.

The list of intrinsic asthma "triggers" goes on and on, including aspirin and other anti-inflammatory drugs such as ibuprofin (Motrin, Advil, Nuprin) and indomethacin (Indocin), and the food and drug coloring tartrazine yellow (FD&C Yellow No. 5).  FDA requires that this dye be listed on the ingredient labeling of all foods and those drugs taken internally in which it is used, to alert the 47,000 to 94,000 asthmatics the agency estimates may be sensitive to it.

FDA is also concerned about the group of chemicals known as sulfiting agents that can cause serious problems for an estimated 5 percent of all asthma sufferers (as many as 2/3 of asthmatic children, according to the Harvard Medical School Health Letter). FDA Consumer: 1/95

American Academy of Pediatrics
The following dyes used in medicines were noted by the American Academy of Pediatrics Committee on Drugs as being broncho-constrictors:

 Red No. 2
 Red No. 3
 Red No. 4
 Yellow No. 6
 Blue No. 1
 Blue No. 2
Sources: Editor's note:
When a dye, such as Red No. 2 or Red No. 4, is banned from use in foods, that does not necessarily restrict its use in medicines or cosmetics.
Asthma medication can backfire
There appears to be a growing concern that the use of bronchodilators actually poses a serious threat for asthmatics. When the medicine is inhaled, relief can be fast, giving the impression that the crisis is past and lulling the asthmatic into the belief that he can remain where he is. The medicine opens the airways, exposing the already sensitive lungs to even more of the irritant.
Women at high risk
A study presented at the 1990 World Conference on Lung Health questioned the connection between the practice of prescribing sedatives and tranquilizers, sometimes in combination with antihistamines, and the increase in deaths from asthma.  The Public Citizen Health Research Group reported that women are twice as likely to be given prescriptions for these additional drugs than men, and their death from asthma has increased twice as fast.
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Notes:

  1. Are asthmatics salt-sensitive? A preliminary controlled study. Medici, TC. Et al. Chest. 1993 Oct; 104(4): 1138-43. MedLine

    Epidemiologic evidence suggests that high levels of salt consumption are associated with "spastic" disorders of smooth muscles, ie, essential hypertension and bronchial asthma. Experimentally, it has been shown that high intake of salt leads to increased bronchial hyperreactivity in asthmatics, ie, enhanced contractility of bronchial muscle to spasmogenic stimuli.

    (1) Does salt loading worsen the clinical and functional findings in asthmatics?
    (2) Is it the sodium or the chloride in salt that is important?

    Patients with bronchial asthma seems to be salt-sensitive, the responsible ion being presumably sodium. A low-salt diet appears to have a favorable effect in patients with asthma and to reduce the need for anti-asthma drugs.
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  2. "Shortness of (Fresh) Breath - Toothpaste-Induced Bronchospasm", Spurlock, BW & Dailey, TM. New England Journal of Medicine, December 27, 1990;323(26):1845-1846.   MedLine

    This was a case study of a 21-year-old nonsmoking female. She switched toothpaste and had dramatic resolution of symptoms but with rechallenge had wheezing within 10 minutes. The only difference that could be determined between the two toothpastes was the type of artificial flavor. This patient also had wheezing when she chewed wintergreen and peppermint gum. Toothpaste may be a potential aggravant of asthma.

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Updated 2/1/08