Asthma ... 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.

A past president of the College of Allergists was actually quoted in the early 1960s 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

We have come a long way since the 1960s

… in understanding asthma, and we have developed new treatments to control it, but we still don’t know why this disease is continuing to increase in numbers and severity, or how to stop it. There are many things that can bring on an asthma attack in a sensitive individual. Cigarette smoke, pet dander, mold, mildew, pollen, perfumes, and other air-borne irritants can be to blame. So can milk or other foods, and even exercise and cold air. Some studies have even shown that excessive salt can cause a “spastic” condition in the smooth muscles resulting in asthma (as well as high blood pressure).

But there is a significant problem with the studies that seek out causes for asthma. They don’t address the important fact that while many of the asthma triggers are ancient – after all, pets, mildew, and pollen have been around for a while – asthma has only increased dramatically over the past few decades. So, while there is no doubt that any or all of the above can bring about an attack in a sensitive person, they could not account for the sudden rise in occurrence and severity of asthma – especially when so many medical advances have been made in its treatment.

That leaves us to examine those triggers that are relatively new – factors that are found primarily in industrialized countries like the United States (where asthma is rampant) and things that were not in our lives until fairly recently, or that were not used in large quantity until recent years. This includes food additives, increased environmental use of fragrances, and increased exposure to synthetic chemicals of all types.

 

Author Index
  1. Andrews 2004
  2. Asmus 2001
  3. Dodson 2012
  4. Fasmer 2010
  5. Healy 2008
  6. Nagakura 2000
  7. Niles 2000
  8. Vally 2000
  9. Vally 2002
  10. Vally 2009
  11. Yoneyama 2000
  12. Yusoff 2004
Andrews 2004 Kind of albuterol & hyperactivity

Impact of racemic albuterol compared to levalbuterol on objective measures of hyperactivity and inattentiveness in children with asthma. W. Andrews, M.H. Teicher, A. Polcari, M. Pankratrz The Journal of Allergy & Clinical Immunology, 113(2), Suppl, S32 (Feb 2004)

“Levalbuterol (LEV) 0.63 mg produces clinically comparable bronchodilation compared with racemic albuterol (RAC) 2.5 mg, but with fewer beta-mediated side effects. Parents complain of increases in hyperactivity and restlessness following treatment with racemic albuterol … Attention and activity were measured using an FDA-approved test (McLean Motion and Attention Test) focused on two of the primary symptoms of ADHD, namely hyperactivity … RAC, but not LEV, resulted in a significant increase in heart rate … In this study, treatment with RAC 2.5 mg significantly increased objective measures of hyperactivity and inattentiveness in asthmatic children compared with LEV 0.63 mg.”

Asmus 2001 Double-blind study on additives in asthma treatment

Pulmonary function response to EDTA, an additive in nebulized bronchodilators. Asmus MJ, Barros MD, Liang J, Chesrown SE, Hendeles L.   The Journal of Clinical Allergy and Clinical Immunology. 2001 Jan;107(1):68-72.

” Some nebulized bronchodilator solutions contain additives, such as EDTA, benzalkonium chloride (BAC), or both. OBJECTIVE: Although BAC-induced bronchoconstriction has been well documented in patients with asthma, there is no information on the effects of EDTA on FEV(1) when inhaled in the amounts that would be administered during emergency department treatment of asthma. … CONCLUSION: The amount of EDTA contained in maximum recommended doses of nebulized bronchodilators does not induce bronchospasm. In contrast, BAC induces clinically important bronchospasm, which could decrease the efficacy of a bronchodilator during an emergency.”

Dodson 2012 Chemicals in consumer products

Endocrine disruptors and asthma-associated chemicals in consumer products, Dodson RE1, Nishioka M, Standley LJ, Perovich LJ, Brody JG, Rudel RA., Environmental Health Perspectives, 2012 Jul;120(7):935-43.

BACKGROUND:  Laboratory and human studies raise concerns about endocrine disruption and asthma resulting from exposure to chemicals in consumer products. Limited labeling or testing information is available to evaluate products as exposure sources.

OBJECTIVES:  We analytically quantified endocrine disruptors and asthma-related chemicals in a range of cosmetics, personal care products, cleaners, sunscreens, and vinyl products. We also evaluated whether product labels provide information that can be used to select products without these chemicals. …

CONCLUSIONS:  Common products contain complex mixtures of EDCs and asthma-related compounds. Toxicological studies of these mixtures are needed to understand their biological activity. Regarding epidemiology, our findings raise concern about potential confounding from co-occurring chemicals and misclassification due to variability in product composition. Consumers should be able to avoid some target chemicals-synthetic fragrances, BPA, and regulated active ingredients-using purchasing criteria. More complete product labeling would enable consumers to avoid the rest of the target chemicals.

Fasmer 2010 Asthma & ADHD together

Comorbidity of Asthma With ADHD. Fasmer OB, Riise T, Eagan TM, Lund A, Dilsaver SC, Hundal O, Oedegaard KJ,  Journal of Attention Disorders. 2010 Jun 23.

“Objective: To assess how frequently drugs used to treat asthma and ADHD are prescribed to the same patients. … There was a 65% increased overall risk (OR = 1.65) of being prescribed one of the drugs given a prescription of the other. Women had a markedly higher risk than men. When data for each age group (10 years interval) and each gender were analyzed separately, the strongest associations were found for women between 20 and 49 years of age and men between 30 and 49 years of age. Conclusion: These prescription patterns suggested a marked comorbidity between asthma and ADHD.”

Healy 2008 Case control study on salicylate-sensitive asthma & fish oil

Control of salicylate intolerance with fish oils. Healy E, Newell L, Howarth P, Friedmann PS., British Journal of Dermatology 2008 Dec;159(6):1368-9. Epub 2008 Sep 15.

“We report three patients with disabling salicylate-induced intolerance who experienced abrogation of symptoms following dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs). All three patients experienced severe urticaria, asthma requiring systemic steroid therapy and anaphylactic reactions. After dietary supplementation with 10 g daily of fish oils rich in omega-3 PUFAs for 6-8 weeks all three experienced complete or virtually complete resolution of symptoms allowing discontinuation of systemic corticosteroid therapy. Symptoms relapsed after dose reduction. Fish oil appears a safe and effective treatment for this difficult and often serious condition.”

Nagakura 2000 Double-blind study on fish oil, omega-3 for bronchial asthma

Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma. Nagakura T et al., Eur Respir J 2000 Nov;16(5):861-5

” … The effects of dietary supplementation with fish oil for 10 months in 29 children with bronchial asthma was investigated in a randomized controlled fashion. … Subjects received fish oil capsules containing 84 mg eicosapentaenoic acid (EPA) and 36 mg docosahexaenoic acid (DHA) or control capsules containing 300 mg olive oil. . . Asthma symptom scores decreased and responsiveness to acetylcholine decreased in the fish oil group but not in the control group. In addition, plasma EPA levels increased significantly only in the fish oil group . . .The present results suggest that dietary supplementation with fish oil rich in the omega-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid is beneficial for children with bronchial asthma . . .”

Niles 2000 Sulfites in cows ... what about in meat?

Sulfur-induced polioencephalomalacia in stocker calves. Niles GA, Morgan SE, Edwards WC, Vet Hum Toxicol 2000 Oct;42(5):290-1

“Calves from 3 farms exhibited blindness, head pressing, and circling before death. Brain lesions confirmed polioencephalomalacia. Excess sulfur was found in the diets on all 3 farms . . . Corn gluten feed and corn steep liquor, . . . corn syrup, corn gluten, corn oil, and corn starch have gained popularity as livestock feeds due to their low prices. With this increased usage as livestock feed, increasing number of cases of polioencephalomalacia have been seen. ”

NOTE: What about the meat of those cows who don’t die? What about people with sulfite sensitivity
(especially asthma) who eat it?

Vally 2000 Diet helps sulfite sensitivity; doctors should be aware of sources.

Clinical effects of sulphite additives. Vally H, Misso NL, Madan V., Clinical and Experimental Allergy. 2009 Nov;39(11):1643-51. Epub 2009 Sep 22.

” Sulphites are widely used as preservative and antioxidant additives in the food and pharmaceutical industries. Topical, oral or parenteral exposure to sulphites has been reported to induce a range of adverse clinical effects in sensitive individuals, ranging from dermatitis, urticaria, flushing, hypotension, abdominal pain and diarrhoea to life-threatening anaphylactic and asthmatic reactions. Exposure to the sulphites arises mainly from the consumption of foods and drinks that contain these additives; however, exposure may also occur through the use of pharmaceutical products, as well as in occupational settings. . . To date, the mechanisms underlying sulphite sensitivity remain unclear, although a number of potential mechanisms have been proposed. Physicians should be aware of the range of clinical manifestations of sulphite sensitivity, as well as the potential sources of exposure. Minor modifications to diet or behaviour lead to excellent clinical outcomes for sulphite-sensitive individuals.

Vally 2002 Aspirin-sensitivity & asthma

The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Vally H, Taylor ML, Thompson PJ. Thorax, 2002 Jul;57(7):569-74.

” Aspirin intolerant asthma (AIA) is a clinically distinct syndrome characterised by the precipitation of asthma attacks following the ingestion of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). The prevalence of AIA among Australian asthmatic patients has not previously been reported. … CONCLUSION: The prevalence of respiratory symptoms triggered by aspirin/NSAID use was found to be 10-11% in patients with asthma and 2.5% in non-asthmatics. Aspirin sensitivity appears to be a significant problem in the community and further investigations of the mechanisms of these responses and the possible link between this syndrome and other food and chemical sensitivities are required.”

Yoneyama 2000 Effect of DPT & BCG vaccines on asthma & atopy

The effect of DPT and BCG vaccinations on atopic disorders. Yoneyama H, Suzuki M, Fujii K, Odajima Y,  Arerugi, 2000 Jul;49(7):585-92

” …Among the 82 children aged 0-3, out of the 39 who received DPT vaccination, 10 (25.6%) suffered from bronchial asthma and this ratio was significantly higher than among the children who have not received DPT vaccination (1 in 43, 2.3%), … This was also the case concerning atopic dermatitis (… 18.0% vs … 2.3%) . … if … (bronchial asthma, allergic rhinitis and atopic dermatitis) were combined (… 56.4% vs … 9.3%) … From these results, we conclude that DPT vaccination has some effect in the promotion of atopic disorders, …”

Yusoff 2004 Study on egg-free milk-free diet for asthma

The effects of exclusion of dietary egg and milk in the management of asthmatic children: a pilot study. Yusoff NA, Hampton SM, Dickerson JW, Morgan JB., Journal of the Royal Society of Health 2004 Mar;124(2):74-80

” … The aim of this study was to examine the effects of excluding eggs and milk on the occurrence of symptoms in children with asthma and involved 22 children aged between three and 14 years clinically diagnosed as having mild to moderate disease. The investigation was single blind and prospective, and parents were given the option of volunteering to join the ‘experiment’ group, avoiding eggs, milk and their products for eight weeks, or the ‘control’ group, who consumed their customary food. … results suggest that even over the short time period of eight weeks, an egg- and milk-free diet can reduce atopic symptoms and improve lung function in asthmatic children. ”

Note: Removing eggs and milk also removes most processed foods, commercially baked goods, etc. Is it the avoidance of eggs and milk or the reduction in additives that caused the improvement?

The Diet Connection

The following dyes used in medicines, foods and cosmetics were recognized by the American Academy of Pediatrics Committee on Drugs as being bronchoconstrictors as long ago as 1985:

 

 Red 2
 Red 3
 Red 4
 Yellow 5
 Yellow 6
 Blue 1
 Blue 2

What is not often recognized is that a bronchoconstrictor does not have to trigger an asthma attack itself; it can sensitize the airway, preparing it to over-react to the next allergen that comes along. What is bizarre is that even today some medications for asthma actually contain these colorings and other chemicals known to cause broncoconstriction.

Asthma can also be triggered by sulfiting agents used in foods as a preservative. MSG (monosodium glutamate) has also been implicated as a potential asthma trigger for some people. These additives are not eliminated on the Feingold Program, but they are noted on our Foodlists next to products that contain them.

It has long been recognized that aspirin can trigger an attack in some people; what is less well recognized is that those same people may also be sensitive to the aspirin-like salicylate chemicals present in many otherwise-healthy foods such as apples.

What eventually became the Feingold Diet was originally used for asthma and allergies by allergists at the Mayo Clinic and Kaiser Permanente. The Feingold Diet is an excellent way to help identify triggers involved in asthma attacks.