By Dr. Paul Ehrlich
Mixed families—that is families where some members are allergic and some are not—must confront daily tensions that go beyond the normal strains of modern life. When one child is severely asthmatic, for example, Mom’s attention seems to focus on that child, upsetting the balance with other siblings and husband. This was the basis for the discipline of family therapy, which was developed at National Jewish Hospital in Denver. Likewise, food allergy families confront the three-dimensional chess game of managing diets, housekeeping, and behavior both at home and school, which affects one and all.
However, environmental allergens also create fault lines. It almost embarrasses me to say it, but I remember a time many years ago when the TV personality Mr. T raised the ire of his upscale neighbors in Chicago by chopping down some stately trees that adorned his property because of his allergies, dubbed “The Lake Forest Chain Saw Massacre.”
The most common source of DEFCON 4 environmental allergen conflict, however, is the family pet. In fact, I just answered a series of questions on this topic from NY Parenting Magazine. How touchy is this subject? When my sons were little, one of them had severe allergies to our cat, Sammy, now, sadly, departed. We held a dinner-table vote, and the result was three to one to get rid of the allergist.
The advice columnist Dear Prudence just had a new variation on this old theme:
Q. Bad Mother, Bad Mother-in-Law?: Ever since my daughter got married our relationship has deteriorated substantially. She and her husband are animal lovers—four to six cats and a dog in the house all day and night. They brought the dog to my 86-year-old dad’s house and he made them keep it in the garage because we are all allergic. My son-in-law “will never cross their doorstep again”—it has been downhill ever since. He spends all the holidays at his mother’s and wants us to come there instead of spending it with my folks. Now my daughter is pregnant and I can’t even spend time in their home without choking up and getting itchy. What is the best way to approach this and keep the peace?
I won’t pass judgment on the family dynamics—that’s Prudence’s job and you can read what she had to say by following the link above. But I’m an allergist.
What can this woman do if she bites the Kleenex and visits her daughter? She can start taking cetirizine a couple of days ahead of time. She can get something called NasalCrom, a form of cromolyn sodium, one of the oldest and safest drugs we have, which helps prevent degranulation of the mast cells in the sinuses, and use that in advance, too. She can have on hand nasal steroids, topical steroids for the itching, eye drops, and if it is really bad, she should be prepared to use oral steroids, although they don’t work instantaneously.
If she has asthma, treatment options have actually regressed. There used to be an inhalable form of cromolyn sodium, which could be puffed ahead of time. Now, sadly, it is no longer on the market. There is an oral formulation called GastroCrom, but I have never used it for prophylaxis. She should be religious about using her inhaled corticosteroids or combination ICS-bronchodilator, and have her albuterol on her at all times.
I don’t know what to do about the 86-year-old father. My own father didn’t live that long.
Photograph: a-house-full-of-cats.com