We've conquered[1] most childhood infections, but extreme reactions to[2] everyday substances[3] pose a new threat[4]

BY JERRY ADLER (with Barbie Nadeau, Anne Underwood and Karen Springen)

The first indication[5] that something was not quite right with Matteo Petracchi came when he was l month old: an oozing skin rash[6] on his face. Over the next few months it got so bad that[7] his skin lesions weren't healing properly[8]. "Instead of[9] oohing and aahing over my baby[10], people were disgusted[11]," says his mom, Cristina Petracchi. At 5 months, doctors ran some tests[12] and found that Matteo was among the 6 to 8 percent of children under the age of 3 with an allergy to food[13]—in this case, breast milk[14]. His mother put him on soy milk[15], but after a few months the skin rashes returned, and Matteo began vomiting[16]. His doctors put him on a predigested chemical milk made from amino acids[17]. Now 2,5, Matteo is allergic to tomatoes, many vegetables and can't even touch milk. Doctors haven't made any promises[18], but when Matteo turns 5 they plan to administer a controlled test of his allergic response to[19] milk and other substances. They're hoping he simply outgrows his allergies[20].

Implausible as it seems, Matteo's condition is at the cutting edge of modern pediatrie medicine, right up there with hay fever[21]. If a popular magazine had run a children's health issue[22] a hundred years ago, the first article might have been about diphtheria[23] or cholera—external threats[24] that the West has largely conquered by antibiotics and sanitation[25]. Instead we are examining allergies, a self-generated danger, the result of an immune system out of sync with its surroundings[26]. It's a threat that may in part[27] be an unintended[28] consequence of our triumph over the infectious scourges of the past[29]. And the urgency is growing[30]. All allergies seem to be on the rise[31], in fact, but "it's not just that more kids have allergies," says Dr. Marc Rothenberg, director of allergy and immunology at Cincinnati Children's Hospital. "The severity of those allergies has also increased[32]." An allergy is an overreaction by the immune system to a foreign substance[33]. According to the Food Allergy & Anaphylaxis[34] Network, almost any food can trigger[35] an allergy, although eight categories account for 90 percent of all reactions[36]: milk, eggs, peanuts (technically, a legume[37]), tree nuts, fish, shellfish[38], soy and wheat[39]. For reasons not fully understood[40], in some people these otherwise harmless substances[41] provoke the same reactions by which the body attempts to rid itself of dangerous pathogens[42]. These may include sneezing[43], vomiting and the all purpose localized immune-system arousal known as inflammation[44]. The lungs may be affected; allergies are a leading trigger for asthma attacks[45]. In extreme cases[46], the reaction involves virtually all organ systems and proceeds to anaphylaxis, a dramatic drop in blood pressure[47] accompanied by extreme respiratory distress[48] that may be fatal without prompt treatment[49].

What can underlie[50] such a self-destructive reaction? An infant[51] who grows violently ill in the presence of as little as one hundredth[52] of a peanut almost surely has some sort of genetic predisposition[53]. Indeed, if one parent has an allergy, chances are one in three[54] that the child will be allergic, according to the Asthma and Allergy Foundation of America. If both parents have allergies, the odds rise to 70 percent[55]. But the children aren't necessarily allergic to the same things as the parents—strongly suggesting that some other factor must be at work as well[56]. And genetics cannot explain the rapid rise[57] in allergies over the past few years[58] or, for that matter, centuries.

So something must have changed in the environment. One obvious place to look is air pollution. Studies by Dr. Andrew Saxon, chief of clinical immunology at UCLA, and his colleague David Diaz-Sanchez, have found a strong correlation between[59] pollutants—diesel exhaust and cigarette smoke—and the development of allergies. Researchers don't believe pollution is the whole story, though[60]; allergies have continued to climb even as smoking and air-pollution rates have fallen[61]. But industrialization has also brought about declines in infectious diseases and close exposure to farm animals[62]. The "hygiene hypothesis" holds[63] that these (mostly desirable[64]) trends have contributed to[65] the rise in allergies. The human immune system, which evolved in a natural environment teeming with hostile bacteria and parasites[66], finds itself uncomfortably idle in the antiseptic confines of the modem suburb[67], and, failing to mature properly[68], takes out its frustration on[69] harmless peanuts and shrimp[70]. Numerous studies have lent support to this general notion[71]. But although many researchers accept the hygiene hypothesis in outline, the emerging picture is of "a complicated relationship, where dose and timing of exposure[72]" play important but still uncertain roles, says Dr. Scott Weiss of Harvard.

So the hygiene hypothesis has yet to generate any concrete prescriptions[73]. The eventual hope, says Dr. Dennis Ownby of the Medical College of Georgia, is for a way to "artificially[74] stimulate the immune system to reduce [allergy] risk without having all these diseases." Meanwhile, though, researchers are developing new drug therapies that go beyond epinephrine[75] (for emergency treatment of anaphylaxis) and the growing array of[76] over-the-counter antihistamines[77]. (Histamine is a key substance in the cascade of biochemical events that constitute an allergic reaction[78].) Newer drugs, like Singulair and Xolair block other chemicals in the chain.

Pediatricians have also begun taking allergies more seriously. One key bit of advice to mothers is to breast-feed infants exclusively for six months[79]. Delaying children's exposure to novel foods in this way[80] is the "hallmark for food-allergy prevention," says the American Academv of Pediatrics. Once an allergy has been diagnosed, the only thing to do is draw a cordon sanitaire around the child[81]. Susan Leavitt of New York, whose 13-year-old son, David Parkinson, is allergic to milk products, eggs, fish, nuts and mustard[82], goes so far as to check out[83] school art supplies[84]; a fourth-grade teacher once mentioned adding eggs to paint for a better texture. Thanks to her vigilance[85], her home-cooked and prefrozen meals and New York's ubiquitous[86] fruit and vegetable markets, David is a healthy, normal boy, an avid skier[87]—and alive.

Opracowanie: Agata Papiorek

Źródło: Newsweek, September 22, 2003.

[1] we've conquered – pokonaliśmy.

[2] extreme reactions to - skrajne reakcje na

[3] everyday substances - na zwykłe, popularne substancje

[4] pose a new threat - stwarzają nowe zagrożenie

[5] the first indication - pierwsza oznaka

[6] an oozing skin rash - sączący się rumień

[7] it got so bad that - pogorszyło się do tego stopnia, że

[8] skin lesions weren't healing properly - uszkodzenia skóry nie goiły się właściwie

[9] instead of - zamiast

[10] oohing and aahing over my baby - zachwyty nad moim dzieckiem

[11] people were disgusted - ludzie czuli odrazę

[12] doctors ran some tests - ludzie czuli odrazę

[13] an allergy to food - alergia pokarmowa

[14] breast milk - mleko matki

[15] his mother put him on soy milk - mama zaczęła podawać mu mleko sojowe

[16] began vomiting - zaczął wymiotować

[17] a predigested chemical milk made from amino acids - poddane trawieniu przedwsępnemu mleko złożone z aminokwasów

[18] doctors haven't made any promises - lekarze nic nie obiecują

[19] plan to administer a controlled test of his allergic response to - zamierząją przeprowadzić pod kontrolą test na reakcję alergiczną na

[20] simply outgrows his allergies - po prostu wyrośnie z alergii

[21] hay fever - katar sienny

[22] if a popular magazine had run a children's health issue - gdyby popularny magazyn wydał numer poświęcony zdrowiu dzieci

[23] diphtheria - dyfteryt

[24] external theats - zagrożenia zewnętrzne

[25] the West has largely conquered by antibiotics and sanitation - Zachód pokonał w dużym stopniu dzięki antybiotykom i higienie

[26] the result of an immune system out of sync with its surroungings - wynik niezgrania systemu immunologicznego z otoczeniem

[27] in part - częściowo

[28] unintended - niezamierzony

[29] our triumph over the infectious scourges of the past - nasze zwycięstwo nad plagami infekcji z przeszłości

[30] and the ugency is growing - sprawa staje się coraz bardziej pilna

[31] all allergies seem to be on the rise - liczba wszystkich alergii rośnie

[32] the severity of those allergies has also increased - alergie te są też coraz poważniejsze

[33] is an overreaction by the immune system to a foreign substance - nadmierna reakcja systemu immunolocznego na obcą substancję

[34] anaphylaxis - reakcja anafilaktyczna

[35] can trigger - może wywołać

[36] eight categories account for 90 percent of all reactions - chociaż zaledwie osiem kategorii produktów odpowiedzialnych jest za dziewięćdziesiąt procent wszystkich reakcji alergicznych

[37] a legume - strączkowe

[38] shellfish - skorupiaki

[39] wheat - pszenica

[40] for reasons not fully understood - z nie do końca wyjaśnionych powodów

[41] in some people these otherwise harmless substances - u niektórych osób te nieszkodliwe substancje

[42] provoke the same reactions by which the body attempts to rid itself of dangerous pathogens - wywołują reakcje, za pomocą których organizm próbuje pozbyć się niebezpiecznych patogenów

[43] sneezing - kichanie

[44] the all purpose localized immune-system arousal known as inflammation - uniwersalny stan gotowości układu immunologicznego, czyli stan zapalny

[45] allergies are a leading trigger for asthma attacks - alergie są głównym powodem ataków astmy

[46] in extreme cases - w skrajnych przypadkach

[47] a dramatic drop in blood pressure - gwałtowny spadek ciśnienia krwi

[48] accompanied by extreme respiratory distress - w połączniu z poważnymi trudnościami w oddychaniu

[49] that may be fatal without prompt treatment - które mogą doprowadzić do śmierci w przypadku braku odpowiedniej pomocy

[50] underlie - tkwić u podstaw

[51] an infant - niemowlę

[52] one hundredth - jedna setna

[53] genetic predisposition - skłonności genetyczne

[54] chances are one in three - szanse wynoszą jeden do trzech

[55] the odds rise to 70 percent - szanse rosną do siedemdziesięciu procent

[56] some other factor must be at work as well - w grę musi wchodzić jeszcze jakiś inny czynnik

[57] the rapid rise - gwałtowny wzrost

[58] the past few days - w ciągu ostatnich paru lat

[59] a strong correlation between - ścisły związek między

[60] researchers don't believe pollution is the whole story, though - badacze nie wierzą jednak, że wszystkiemu winne jest zanieczyszczenie

[61] allergies have continued to climb even as smoking and air-pollutnion rates have fallen - liczba alergii rosła nawet kiedy zmniejszyło się zanieczyszczenie i ilosć osób palących

[62] close exposure to farm animals - bliski kontakt ze zwierzętami hodowlanymi

[63] the "hybiene hypothesis" holds - według hipotezy higieny

[64] mostly desirable - w większości porządane

[65] have contributed to - przyczyniły się do

[66] a natural environment teeming with hostile bacteria and parasites - środowisko naturalne, w którym roiło się od wrogich bakterii i pasożytów

[67] finds itself uncomfortably idle in the antiseptic confines of the modern suburb - czuje się nieprzyjemnie bezużyteczny w odkażonych granicach współczesnych przedmieść

[68] failing to mature properly - nie mogąc prawidłowo dojrzeć

[69] takes out its frustration on - odgrywa się na

[70] shrimp - krewetki

[71] numerous studies have lent support to his general notion - wiele badań potwierdzało tę teorię

[72] dose and timing of exposure - natężenie i czas ekspozycji

[73] yet to generate any concrete prescriptions - musi jeszcze wyłonić konkretne zalecenia

[74] artificially - sztucznie

[75] epinephrine - epinefryna (adrenalina)

[76] the growing array of - rosnąca liczba

[77] over-the-counter antihistamines - sprzedawane bez recepty środki anyhistaminowe

[78] in the cascade of biochemical events that consitute an allergic reaction - w lawinie biochemicznych reakcji, które składają się na reakckę alergiczną

[79] to breast-feed infants exclusively for six months -przez sześć miesięcy karmić niemowlę wyłącznie piersią

[80] delaying children's exposure to novel foods in this way - opóźnianie w ten sposóv kontaktu z nowymi pokarmami

[81] draw a cordon sanitaire around the child - odizolować dziecko

[82] mustard - musztarda

[83] goes so far as to check out - posuwa się nawet do sprawdzenia

[84] school art supplies - szkolne przybory do malowania

[85] vigilance - czujność

[86] ubiquitous - wszechobecne

[87] an avid skier - zapalony narciarz