Simple medical problems can surface in strange ways.
In the USA police confronted the parents of a seven-year-old boy and questioned them about physical abuse. The next-door neighbour reported that the child was regularly awake during the night, screaming in a state of terror. The parents admitted this but couldn’t explain the situation. They denied abuse, physical or otherwise. A local doctor checked the boy and found no sign of abuse but significant breathing problems. He couldn’t breathe through his nose and his chin was dropped in a reflexive, self-protective manner. The parents claimed he had been like that since infancy but didn’t think it unusual.
The boy was admitted to hospital and discovered to have severe sleep apnoea – intermittent and recurring episodes where he stopped breathing. Examined under anaesthetic he had adenoid swelling so large it obstructed his nose completely (the adenoid is spongy tissue located at the back of the throat that can block nose breathing). Surgical removal produced a dramatic and instant cure. The seven-year-old started to sleep normally and there were no more night terrors. The neighbour was thanked. The police backed off. Order was restored.
Sleep apnoea
The case described above shows how a blocked or obstructed nose, whether due to hay fever or not, can cause a multitude of medical problems, some simple and others more problematic. In adults and children the usual cause is an allergic swelling of the nasal lining, often due to a grass pollen allergy – in other words, hay fever. Children can also get a blockage at the back of the throat due to enlarged adenoids. Interference with sleep can become a major issue here. The term sleep apnoea has been coined to identify this collection of symptoms.
In plain English this means the nose is so obstructed that the adult or child cannot breathe through it properly at night. The person snores heavily and the pattern of snoring is something like this: snore, snore, snore, snore, snore, snore, snooooorrrreeee, snoooooorrrrrreeeeee, snooooooorrrrreeeeee . . . no breathing at all . . . for quite some time . . . SNORRRRRRRRTTTTTTT, yawn, more normal breathing and then back to snore, snore, snore, etc. The no-breathing episodes can last for 20, 30 or even 40 seconds at a time and this pattern continues through the night. The end result is recurring spells without oxygen that deprive the snorer (and anyone unfortunate enough to be in the same room) of restful, restorative sleep.
While this might read as amusing, in reality it’s a serious health concern. For adults, persisting sleep apnoea can put pressure on the cardiovascular system. More common effects include:
In children it leads to daytime drowsiness, grumpy mood and poor school performance. In severe cases it may cause or at least contribute to ADHD.
It is estimated that the proportion of children with blocked noses, be it due to allergy or swollen adenoids or tonsils, could be as high as 25 per cent. That’s a lot of kids with disturbed sleep (among other symptoms). And it means there are a lot of parents out there wondering just what is wrong with their child.
Persisting hay fever, or all-year-round hay fever (as described in Chapter 2), can leave the person concerned with a seriously blocked nose. When the obstruction reaches a critical point, usually when as little as 60 per cent of the nasal airway is obstructed, sleep apnoea becomes a problem. For children as well as adults. Don’t ignore it. Sleep apnoea is a major quality of life issue and can be dangerous if not addressed.
Hives
If this section seems repetitive then I apologize. However there’s no other way to explain the link between hay fever and hives, or urticaria, than by going back over some of the material I dealt with in Chapters 2 and 4 – and have another look at Figure 4.1, on page 30, showing the nose, throat and sinuses.
The lining of the nose is delicate and easily damaged. Running along the inside are three shelf-like structures called turbinates, which clean, filter, warm and moisten the air we breathe before it enters the lungs. But the turbinates are easily injured. Ignoring physical trauma, any challenge that aggressively irritates the nasal lining may cause the turbinates to swell. The challenge can range from infection to allergy, from cigarette smoking to inhaling chemical vapours, etc. When the turbinates swell they block the little tubes that drain the sinuses into the nose. Now we not only have a nose problem but the beginning of sinusitis. If the swelling within the nose persists the sinuses cannot breathe, their air pockets stagnate and become a rich feeding ground for infection. Running along the ceiling of the nose is an exquisitely delicate nerve ending that transmits the sensations of taste and smell to the brain. With prolonged pressure on this nerve from turbinate swelling these sensations fade.
The first to go is the sense of smell, usually a subtle and gradual loss over some months. Once the sense of smell has almost totally disappeared, the sense of taste becomes impaired. And it is the sense of taste for spice that wilts at the beginning. Now the person with hay fever finds most foods taste bland and goes for spicier products. Unwittingly, he or she consumes higher amounts of the additives used by the food industry to spice up its products. Chief culprit in this group is monosodium glutamate (MSG for short), also known as E621, a widely used flavouring agent in pre-packed, prepared and takeaway foods, especially Chinese, Indian, Thai and similar Oriental cuisine.
Jo
Jo is a 19-year-old student. She did exceptionally well in her final state examinations and now studies law in Dublin. Jo also has recurring hay fever with impaired senses of smell and taste. Jo grew up in a small county on the south coast of Ireland. Before moving to university she lived at home with her parents and had a healthy diet with mainly home-cooked food. But everything home-cooked tasted rather bland and Jo kept asking for something with a bit of spice in it. Mother refused. She preferred good, wholesome produce. She rarely used tins, packets, bottles or artificial stock cubes when preparing dinner. So Jo’s wish for spice went unsatisfied.
Once Jo left to continue her studies she started to lead her own life, away from the constraints of her parents. She preferred the city night lights to the college library. She wanted experiences far removed from small-town Ireland. And she didn’t want to waste time cooking. So she ate out a lot, or bought in, or grabbed fast and easy foods such as cup-a-soups, instant rice dishes, instant curries and pre-cooked spicy chicken wings. The easier the food was to prepare, the more attractive it was to Jo. And she enjoyed this produce better; she could actually taste something for a change. It at least had a tang to revitalize her jaded palate.
Unwittingly, Jo was swallowing a significant number of food additives. The tang in her diet was created by chemicals, mainly monosodium glutamate.
One evening she came out in a very itchy rash, which she recognized as hives. The rash subsided with an antihistamine. Then another time her upper lips swelled. The hives returned with a vengeance and it took days and a lot of antihistamines to calm her skin. Finally, one evening after a Chinese meal, Jo’s lips, face and tongue swelled. Her sinuses became inflamed, painful and congested. The hives returned and this time didn’t go away, despite double the usual dosage of antihistamines.
An ingredient in the Chinese meal was peanuts, and Jo concluded she had become allergic to peanuts. This frightened her because she knew that some people can get life-threatening reactions if they have a strong allergy to peanuts. So she went to an allergy centre to find out what was happening.
Allergy testing showed Jo had a strong grass pollen allergy. This was causing her nasal obstruction but certainly not her hives and facial swellings. None of the foods tested provoked a positive response. Conclusion: Jo’s allergic reactions were not due to a food allergy. ‘So what then,’ asked Jo, ‘could be causing this?’ Fibre-optic inspection of her nasal cavity showed a grossly swollen nasal lining with fluid ‘blistering’ along the upper turbinates. More importantly, the swelling was interfering with the delicate nerve ending carrying the sensations of taste and smell to Jo’s brain.
It was explained that to get better she had to avoid specific E numbers (the chemical additives put in certain food products to colour, flavour and preserve). She would also start a treatment plan to restore her nasal lining to normal and recover her lost senses of taste and smell. With full recovery she would enjoy good, wholesome food and not be so inclined to go for spice in her diet. Jo was also informed that if she followed this plan she would improve very quickly.
So what should people with hay fever eat?
Adults and children with hay fever (especially those in the ‘all-year-round’ category described in Chapter 2) look for tangier, spicier foods and flavourings. Unfortunately almost all tang and spice is artificially created using chemicals. People with hay fever can unwittingly make their condition worse (and add in an extra problem) by using artificially flavoured ingredients, especially in Indian and Chinese dishes.
The food and drink industry uses many chemical additives and by law the manufacturer must inform the consumer what compounds are in the can or tin or packet. Nowadays each additive is labelled by number and with the letter E attached (known as ‘E numbers’). As part of Jo’s overall management she had to avoid the following food additives (E number and original chemical name included):
E122 (tartrazine)
E104 (quinoline yellow)
E107 (yellow 2g)
E110 (sunset yellow)
E122 (azorubine)
E123 (amaranth)
E124 (ponceau 4R)
E127 (erythrosine)
E128 (red 2g)
E131 (patent blue)
E132 (indigo carmine)
E120–E219 inclusive (the benzoates)
E621, E622 and E623 (the glutamates)
Especially she had to look out for E621, monosodium glutamate, a widely used flavouring in snack foods, savouries, gravy mixes, stock cubes, and packet and tinned soups, as well as in Indian, Chinese and other Oriental foods.
Jo was told to avoid any product where there was poor labelling or where the label said ‘contains permitted additives’, ‘contains permitted colourings and flavourings’ or ‘colourings and flavourings’. Products coloured red, orange, yellow, blue, lemon or green were banned as they might contain one of the listed agents. If she was unsure about the safety of any product, she was told not to buy it.
Jo was also warned that – for reasons not fully understood – once withdrawn, the casual reintroduction of the banned additives could trigger very aggressive reactions. Dubbed ‘heightened hypersensitivity’, it’s as if the body is taking a breather from all the junk thrown at it. The next time one of the banned chemicals enters the system it will explode with allergic activity, producing hives, facial swelling, tongue swelling and even narrowing of the throat.
Jo managed to stick to her new regime. With her nasal allergy successfully treated Jo improved dramatically. She’s still sticking to the additive-free diet and remains well to this day. She still longs for the occasional Chinese takeaway.
There’s no pleasing some people.