By Dr. Paul Ehrlich
Over nearly 40 years in practice, I have seen many patients whom I treated in infancy and toddlerhood return to my office as parents and even grandparents of allergic children themselves, with the next generation worse off than the one before. Children who sneeze often have children who wheeze, itch, and react to foods. The challenges of managing these escalating disease burdens multiply with complexity.
As more and more of my patients reach high school their parents begin to agonize over how to protect them when they go away to college. There’s no easy answer to this for food allergies since there is no approved treatment. Research into various forms of immunotherapy, and private practice oral immunotherapy hasn’t produced much data.
Decades of administering allergy shots and prescribing asthma control medication,
however, have taught me a few things about compliance that should be considered in the countdown to college. As we have written on this website before, no medicine can help you if you don’t take it. Easier said than done. In my experience, the biggest barrier to compliance is not logic but behavior. The admonition “act your age” is a double-edged sword. Teenagers take risks and the chances of accidental exposures rises commensurately, as recently published research from Australia reiterated recently. Carrying inhalers and auto-injectors is a drag. The more pills you have to take at each meal, the more likely you are to forget, or just get plain tired of keeping up.
One thing I tell families where the teenager will be continuing a course of allergy shots is to consider the size of the campus when applying. My patients who go to a compact school like Columbia tend to be more compliant than those who go to a sprawling one like Wisconsin or Michigan, where the infirmary may be half an hour away on foot from dormitories and classrooms. Likewise, the farther away you are from your lifesaving paraphernalia like albuterol inhalers and auto-injectors, the less likely you are to go back for it. As we move towards an era of oral immunotherapy and other demanding treatments, these challenges will present themselves again.
So plan ahead. Try to anticipate the behavioral barriers to compliance, and if your kid’s heart is set on a Big Ten school, one answer is both practical and healthy: ride a bicycle.