Over the course of 30 years we have detected allergy in countless cases of Allergic Rhinitis and Bronchial Asthma. Same can be said about dermal allergies some extent. Here are some landmark cases those taught me various intricacies of allergy.
First case is that of my teacher Mr. Raverkar who was principal of Science College, Karad. Though a very good person by heart, his personality was marred by some unknown skin disease. He described in details about his problem after my admission to the medical course. After a long description of his endeavor for cure which ranged from local doctors, quacks, indigenous medicines to the top allergy specialist in the country, he disclosed the diagnosis. He had Parthenium allergy. Off course, I could not help him at that time; but I realized that this wretched allergy is an incurable malady.At last he told me that ‘You see young doctor, I do not expect any miracle now, but in due course of time you do a thorough research in this health problem and alleviate the agonies of countless unfortunate patients of allergy.’It is because of him I decided to concentrate on this problem of allergy.It is because of him I accept any allergic disease as a personal challenge
When I started my private practice of allergy, for a long time I had no patient for allergy testing. At last the Ganesh festival opened an opportunity for me. An executive from Mumbai had come to see the festival of Pune; and he developed a severe attack of Bronchial Asthma. I managed him there with a piece of sincere advice to undergo allergy testing. He was a very egoist person who surprisingly permitted to do this test only on Saturday night.
I said ‘yes’!
It was a very cold night. When we finished the testing it was midnight; and both of us were shivering. The report was almost disappointing. Only two allergens had shown weak reactions. First was Parthenium grass. He said ‘Useless! There is no such grass in Mumbai.’ I had to keep mum. Second was wool. “Again useless! ‘We don’t use wool in Mumbai.’ I was almost fighting with my back to wall. I had one ray of hope “You see Sir, you are now wearing woolen sweater, woolen muffler, woolen shawl. Therefore we must confirm right now. We will see the effects of removing these clothes from your room this very night.” Thought of removing all woolen clothes was frightening for him because that was his protective covering for many years. Now it was my time to be adamant. “This is only right time to confirm my contention. Now or never!”
I had on residential phone then. What, in case he gets a severe attack? Somehow, we made some provision of managing the unexpected attack of Asthma.
I was late to get up in the next morning. As soon I realized the gravity of situation I ran to the hospital.The scene was unexpected. That arrogant man was having a cup of coffee quietly; and his wife was relieved. No sooner he saw me than he jumped to his feet. “Yes! Doctor, I am convinced. My asthma disappeared within ten minutes after I removed the woolen clothing.”He used to protect himself from Asthma with woolen clothing all the time.
Moral of the story is that the precautions themselves might produce asthma if the allergy is not properly evaluated.
I cannot forget Mr. Phadake(Name changed) even after twenty five years. He was then an old man of 70 years. His story was peculiar. Every rainy season heralded a terrible period of asthma. He developed so severe attacks that hospitalization was mandatory for him throughout rainy season. He required IV injections of Aminophylline and Hydrocortisones daily. Being a rich man he could afford hospitalization for about four months.
This man appeared on 5the June and asked me if I could salvage him. The weapon of allergy test was ineffective for him as per the text book guidelines. However, I decided to try it with due consent. He too underwent it helplessly. Unfortunately this man showed dermal sensitivity to house-dust-mites. I was rather disappointed; because the results of prevention of house-dust-mites were reported to be poor. However I had to explain them at least as part of formality. He listened them attentively and left with a prescription.
Mr. Phadake appeared after a week with a happy air. He had a surprise in store. Not a single wheeze in whole week was big surprise for him. Asthma attacks were miles away.That rainy season was bad for his doctor. He missed a regular occupant of hospital bed for complete rainy season. The story repeated for many years.
Moral-Even House- dust-mites are preventable in our country and that can give wonderful results.
If I ask you how I might have used allergy as a weapon to change the administration’s attitude towards a health problem; you will, I am pure, not figure out a bit. Here is an interesting story.Kothrud, suburb of Pune was famous for its ‘Kachara Depot’ i.e. garbage dumping ground. If sheltered all the garbage of Pune city. Naturally the residents had to suffer various health and aesthetic hazards. Nobody was prepared to salvage the lamentations of us in spite of vigorous demands.
We can along with the college of Medical Social Workers conducted a survey of Nasobronchial Allergy in the residents around garbage dumping ground. With proper analysis we presented a paper in National Conference of Preventive and Social Medicine, Pune. Usually the purpose of such an endeavor is over at this stage; however we decided to go ahead differently. An abstract was circulated to the lay press which caught up like fire. All the people of the city were shaken. Then M.L.A Mr. Anna Joshi invited me to discuss this problem. He asked legislative Assemble Question (LAQ) based on our studies.
The municipal authorities received a shock. Some how they answered the LAQ. But commendable fact is that Medical Officer of Health changed waste management drastically. The methods of transports, timing and many other things changed.Now Kothrud become lass smelly and less dirty place. People thanked us greatly.I do not say that we had really solid scientific basis for my contention. But I used the twisted facts for betterment of society.A medical practitioner can change the society if proper principle is put in proper way even single handedly.
is another interesting story of an unfortunate child from Satara, a district place in Maharashtra. I used to visit this place as an allergy and chest specialist.
A 13 year boy was brought to me with the history of intractable Bronchial asthma and Allergic Rhinitis for 12 and half years. With usual method of allergy tests I found that this boy has shown weak reactivity to many allergens. However there were two reactions little larger. One was, to my disappointment, parthenium grass. This is very unlikely allergen to incite any disease at the age of half year. Another was equally surprising. – Milk! We don’t expect to produce allergy at that age.With an air of disappointment I decided to follow my usual protocol. I said ‘as per our procedure we have to see the effect of Milk avoidance the only we can proceed further.’ The father was reluctant to do so. Since I was more assertive he had to yield to my suggestions.
I was not very happy with what I got out of that procedure; but we forget in due course of time. A month lapsed; and that boy, father and many others appeared with very happy air.‘Yes doctor, we are convinced of his allergy to milk. We found difficult to digest your contention; but since we are trying any damn thing on the earth for our son why not this? We discontinued milk and to our surprise he has not even sneezed once; leave Asthma.’I passed some relevant remarks and closed the topic. But the other person pursued the subject.
‘Doctor we must confess something here. We were thinking milk is wholesome for health. Therefore to boost his energy we forced him tom drink one liter thrice a day. No matter what happened, he cried, he vomited, milk spilled, we forced the daily quota down his throat daily without fail.’I do not know what remarks are to be passed in a situation like this; but the take home massage was clear.
All that wholesome for all may not be so for an allergic patient.
Here one more interesting story of a child. A ten year old boy from Solapur was brought to me for recent onset Asthma. Mother was a very meticulous follower. She learned about the allergy tests and cooperated very well. Usually allergy testing in a child poses very sad scene. Children are frightened, non cooperative and parents, sensitive. Though we allergy test with only relevant minimum allergens children will not understand.
Over all allergy testing and its follow up was not different from many other patients. They reported regularly for four months. They were following the preventions perfectly but there was no response.At last I said, ‘let us revise everything. We did with all meticulous care, but no dent could be made. We had to sit for awhile watching each other’s face. Father said, ‘One point may need some clarification. We are giving XXXX protein powder to boost his energy. Is that OK?’‘There lies the culprit!’ I exclaimed.
This powder contains soyabean which has shown stronger sensitivity in your child; but when we discussed about it they denied about its inclusion in his diet.Thus an allergen was finding entry in patient’s body under a disguise right under the vigilant mother’s nose.Be aware Allergens can enter your body in any of the standard disguises like tonics, healthy foods.
Indian mother-in laws are not as dominating over their son-in- laws as western counterpart. Here is a story of mother-in–law of an Ayurvedic practitioner. This lady was decent middle class abiding by all the restrictions possible in her socio-economic-health conditions. Still she developed Asthma. The son-in law referred to me for allergic evaluations.
Allergy tests showed she had large number of positive allergens but avoiding all of them could not produce any beneficial results. Again we review of the case showed that we had not covered ginger even though it was positive.
‘Ginger is an Ayurvedic medicine which have no adverse reactions.’ Patient justified son-in- law’s therapy. ‘But let us prevent it for one month and see the results. OK?’I do not know what she thought; but on next follow up she had a very important finding to tell me.‘Doctor, my asthmatic attacks are drastically less after I discontinued the ginger.’She had another surprise in store. She used to take one cupful of ginger juice three times a day!
Morale is universal-Anything under the sun including sun may produce allergy.
Rheumatoid Arthritis was a remote disease for me ; mainly because I am a Pulmonologist and allergy specialist. Rheumatoid Arthritis is a disease of joints. My interest in this malady suddenly awakened when my aunty came with her swollen joints. As a standard specialist I tossed her to my orthopedic friends. They investigated and put her on steroids. When she showed all the reports to me I noted some interesting observations. Her clinical presentations were like Bronchial Asthma, and more important she had raised Eosinophil count.
This E –cell often attracts my attention since long time. As I am working on it I am getting convinced more and more about its utility. As a special case, or maybe out of curiosity, I decided to try my simple methods of allergy testing on her. She too was frustrated with her illness and consented to undergo the ritual.Allergy testing was eventless. As per usual protocol I told her prevention of some allergens. She departed with assurance of follow up reporting.After one month she appeared with drastic changes. Her pallor disappeared, pink shade appeared, joint swellings reduced; apatite improved. Frankly I never expected any thing like this. Over and above she required no medicines.
As a speculative physician I thought of some coincidence. But patient was happy and I hade to continue the prevention trial for some more time. We observed for one year completely.I personally was convinced of the success obtained in this case ; but I had difficulties in convincing our colleagues.With lot deliberations and persuasions I could register this subject for the Ph D of University of Pune.
Sometimes people’s faiths can compel to think in different fashion. Something like this happened with the villagers from Jalgaon, a small place in Satara District. There are people with an implicit faith in me due to which they bring all varieties of complicated cases to me irrespective of the system affected. Once Vishnu, my school pal, brought his relative with loose motions to me. A quick look into the records revealed that it was a case of Ulcerative Colitis. After explaining the situation I expressed my helplessness. He said, why not? you can try something different than others. I said that this disease supposed to be originating from unknown substances there fore allergy test can be tried as an experiment. The patient consented and we did allergy tests. There were foods like milk wheat etc. We decided to prevent milk first. To my surprise patient’ loose motions stopped almost without any medication.
She has reported frequently in last four years. Recently she complained aggravations of her symptoms We did her allergy tests again and found similar allergens positive. Naturally we advised to continue the same preventive measures. Six months have elapsed after this procedure and we are yet to hear anything from her.
I know that this is going to raise frowns of our colleagues for many reasons. First is the offense of crossing my limits. Primarily trained as chest physician I should touch upon the diseases beyond my scope. Many of them get offended because of hurt egos. They feel that nobody other than themselves knows the subject better; therefore it is their right to discover something new.
In the era of evidence based medicine such work is going to more difficult. Our consumer courts do not show sympathies to people like me. Therefore I urge patients like you to consider some exceptional circumstances like this to submit for a new experiment especially if no strange external substance is introduced in your body
The Eosinophil cells are very interesting cells which usually indicate worm infestation or presence of foreign allergens. It is often overlooked in clinical practice; as the significance can not be stretched more than this. It has been found to be present in large number of diseases in varying proportions; therefore a clinician ususaly does not spend more time with this cell.
We had an interesting case of Eosinophilia.Mr .Deshpande(name changed) was our milkman with multiple activities. He was always on his bicycle but hr developed intractable lower limb pain. As usual he underwent ascending grades of medical services to land ultimately in a high tech hospital. Naturally he was fully investigated and was advised to undergo to spinal surgery. We had really confusing set of investigations. On the radiology side he had doubtful spinal nerve compression for which many would not like to pun him in the dangers of a major surgery. However they had advised him to undergo one.
We do not know why he reported to us with all his reports . More surprising was that he was willing to undergo any investigation we suggested. Due his unusual cooperative we investigated further to add more confusion. We did lumber puncture and found that his CSF showed albumino-cytological disproportion. It means that proteins of CSF were more than normal; but the cellular element was less. This again becomes a matter of curiosity. His serum proteins were not having normal pattern.
We were trying desperately to look for cause of his limb pain. On one fine morning I found that he has one tender spot on thigh, I took the x-ray thigh and found that there was an osteolytic shadow. Our orthopedic surgeon suggested open biopsy. It costs fair amount; but he didn’t refuse. Only he requested for more time so that he can raise money.
When I was reviewing all his reports I found that only investigation which was repeated frequently was Haemogram. So we did it which had another surprise in store. It showed 26% Eosinophlila . This was a matter of curiosity needing another set of investigations. He requested to start some medicines for this.Though I was reluctant, I decided to start a course of diethycarbazine. He went with some doubts but with no alternative. He returned after a week to give us surprise. His pain was remarkably less and he was able to walk easily. Repeat Haemogram showed drop in E-count to 15%. We continued the same regimen for 6 weeks after which his all symptoms had disappeared and E –count was normal.
Naturally all the indications of further interventions became null and void.He has reported frequently – almost daily! He had no pains of lower limbs in spite of his full rigorous activities.He is now an old man. Though he discontinued our milk supply I meet him occasionally on the roads.
This is the beauty of E- Cells. People have labeled them as evil cells or enigmatous cells or something like that; but I call them Expressive cells. They trying to attract the attention of physicians by their presence; expressing themselves but we fail to appreciate what they are saying!
I distinctly remember John who came first time with his parents. Poor chap had severe allergic rhinitis and off course asthma! As usual we decided to go for allergy tests. The tests were not unusual. Eliminating possible allergens by history and prevention trial, we had done with almost all positive allergens. All were in vein! This was rather surprising. John was honest. He was preventing as per instructions; but the causative allergen remained an illusion. We went for serological tests. Here too, john was tenacious. He never defaulted in anyway.
Almost two years passed in various trials. As a last resort we started immunotherapy empirically. This was never done in past. We had opted for immunotherapy as a last resort with unavoidable allergens.John took this tedious therapy for long time with no avail.At last we decided to repeat skin tests. And still no breakthrough could be achieved.
It was last summary meeting.John had brought all the reports with him.We categorically discussed all the allergens one by one with reference to clinical relevance, and result of prevention. We have not omitted any allergen in our endeavor.There was a reaction positive but John had already declared that there was no pet in his house. Thus its significance was repeatedly undervalued; because there were no cats.
At last I accepted my defeat. Here is a case in which I failed to clinch the allergen in spite of excellent cooperation of patient. “John, I am sorry we really failed in your case. Please continue the standard medical therapy”Both of us were in rather gloomy mood. John packed all the reports and almost walked out of the consulting room.“Just a minute, John. Please come back.”John returned.
“One last question. Really, how many cats you have in your home?” Said I.“ About 35 to 40 ” This time John did not falter.“Oh My god!”There was silent pause. I declared“John, if you have so many cats in house you must have such a severe asthma and rhinitis as bonus. If you do not want these diseases you must curtail love of cats” “Yes Sir” John walked out of room.It was after couple of years that I heard his clear voice phone. John had no allergic rhinitis and no asthma.