Enhancing our ability to treat various conditions

As we continually enhance our ability to prevent and treat a wide variety of conditions that threaten the health and lives of children, our tolerance diminishes for ailments that seemed trivial when infection shortened too many lives.

For a minority, however, atopic disease results in a continuous battle with runny, itchy eyes and noses; itchy, irritated, and abraded skin; and breathing that is compromised by tight, inflamed lungs.

In recent decades, temporizing, symptomatic therapy for the manifestations of atopic disease has improved. Our antihistamines are less sedating, and our options for treating reactive airway disease have increased.

As described in the article in this issue by Scott H. Sicherer, MD, and Lawrence D. Sher, MD, identification of offending allergens through serum testing answers many questions, but it raises even more.

Despite careful clinical studies by dedicated investigators, there still are no effective means of reliably identifying the specific food or environmental provocateur of the itching that interrupts sleep and compromises childhood activities. And there is no drug or vaccine that reverses the specific immunologic reactions that provoke allergic symptoms.

Risks from treatment with corticosteroids (topical, inhaled, and systemic) and inhaled bronchodilators are accepted because they reduce symptoms and complications, and those risks generally can be managed and minimized with judicious use. The magic bullet, the medication that targets the specific immunologic mechanism leading to an atopic manifestation in susceptible children without causing a general reduction in immunity, remains elusive.

If one is challenged to list the 10 diseases or conditions that warrant the greatest commitment in energy, time, and money from scientists and government, atopic diseases might not be on that list. For children who suffer daily, and nightly, with coughing, itching, and limitation of activity, this misdirection of immune energy is at the top of that list-and their parents probably would agree.

Research intended to unmask the details of the misdirected immune activity that results in eczema, asthma, and allergic rhinitis and to interrupt that activity is badly needed. If successful, it would increase school attendance, reduce hospital days, enhance daily activities, and normalize childhood for millions.