Two posts in one week? Must be winter break.
Working through the lung unit is the perfect time to get a lecture in about hypersensitivity reactions. “Hypersensitivity” is medicine’s fancy word for “my head takes on the size and consistency of a watermelon when the weather changes” or “my body thinks a cashew is smallpox.”
So last Wednesday, we learned about allergies to nuts and bees and egg and soy and dust and a zillion other things that put people flat on their back for no reason whatsoever. And it sucks. It sucks to have allergies; I have a mild pollen allergy that annoys me for a couple of weeks in the spring. I can’t imagine how much it would suck to have your body reject chocolate or egg products. No Maggie Moos chocolate fudge ice cream. No cake.
Three things about the medicine of allergies:
1) We don’t actually know why people get allergies;
2) We don’t know why some people get allergies and some don’t;
3) We don’t really have cures for allergies. Epipen doesn’t count.
You can see how this would be a frustrating lecture.
I did learn a few things, though. The best idea we’ve got for why we develop allergies is called the Hygiene Hypothesis. You’ve probably heard of it somewhere. The main idea is that exposure to bad stuff in childhood, when your immune system is learning and thus the most flexible, gives you tolerance to allergens. If you get sick a bunch of times in preschool, your body supposedly learns what’s actually bad for you and what’s just masquerading as bad for you. So, parents, if you keep your kid in an antiseptic bubble until they graduate from 4th grade, you’re probably doing them a disservice.
This makes some sense, I guess. It probably explains why allergies are much less common in the (presumably dirtier) developing world, although that might be offset by more kids dying young from actual disease. But it leaves some big questions seriously unanswered. It doesn’t explain why some infants develop allergies, or why some kids grow out of their asthma while others don’t. It doesn’t explain the weirdest of them all, gluten intolerance (how can you develop an allergy to a protein in staple foods? It makes no sense).
Nor does it explain the time course of allergies. We learned that peanut and tree nut allergies have two peaks for when they come on – one in childhood and one in your thirties.
What?! In your thirties!? I thought I was out of the woods! This makes no hygiene hypothesis sense. We don’t know anything.
If I develop a peanut allergy in my thirties, I’m cashing out. I’m going to drink a big glass of muscle relaxants mashed up in a vintage bourbon (presumably I will have doctor friends who can help me get this), make the World’s Biggest Triple-Decker Peanut Butter and Jelly Sandwich, and go down swinging. I’d even toast it, just to show off. Screw you, immune system. Life without Reese’s peanut butter cups can go right to hell.
The other irritating (ha!) thing about allergies is that our treatment for it sucks. Yeah, I know, real Sudafed sort of worked, but have you tried Sudafed since the FDA got all freaked out about meth? The new active ingredient, phenylephrine, does pretty much nothing. I say this as someone who suffers for a few weeks every year in May, so I’m not even close to the worst off.
I’m convinced Claritin is a sugar pill. Taking Zyrtec is like lighting a $20 bill on fire, with similar therapeutic results. Allegra definitely has the best commercials, but that’s about it. The only thing that works for a congested allergy head is Afrin, and you can somehow get addicted to that so when you stop taking it you end up with the World’s Most Clogged Nose.
So let’s say you have an allergy to something, and you want to know what it is so you can get shots to wean yourself off. Leaving aside the fact that shots only kinda-sorta work, you go to your allergist.
When you’re sick and go to the doctor, maybe they draw some blood. Or collect pee. Or just write you a prescription for an antibiotic and send you home (NO REALLY DON’T DO THAT). Not so at the allergist. When you go in for allergy testing, the allergist turns your back and arms into a human Battleship grid. In each square, they inject a small amount of allergen under your skin.
Yes, you read that right. In your quest to determine if you’re allergic to grass or trees, you willingly agree to be stabbed with sharp needles like a hundred times. This is my nightmare. If you get itchy and turn red, congratulations! You have an allergy. Here, have some weekly shots for the rest of your life.
Also, here’s some Sudafed. It won’t do sh*t.