Asthma UK community forum
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Debating Chamber No. 1

The debating chamber is for anyone wishing to discuss/debate anything to do with asthma or allergy. It’s a place where serious/medical issues can be raised, discussed, debated and challenged without fear of upsetting anyone.

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What can be discussed in the debating chamber? Well anything really, it’s an area where very straight forward issues can be raised or for that matter very complex subjects like immunology or epigenetics.

It’s an area where previous, current or future asthma/allergy research projects can be discussed. Perhaps an article published in one of the medical journals has caught your attention and you think the article to be interesting, helpful or informative. Why not share your ideas and thoughts with others.

Can we have more than one Debating Chamber? Yes of course we can. Some discussions may only last a few days, whilst others may evolve and go on for many months. If you want to discuss a new subject, just create a new Debating Chamber.

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The chicken and egg conundrum…

What came first asthma or allergy? Any thoughts?

Derek

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For me, definitely allergy. i had my first allergic reaction when I was 6 (I think) and my first asthma attack when I was a teenager.

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I supose it would have to be the allergy but for me I got asthma. But can you have asthma without an allergy to something????

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Hmm, I'm not sure. I had my first asthma attack at age 3 months where as I didn't have any major allergies then, so I guess my asthma came first. However, I've always had allergies of some kind to one degree or another so who's to say that at 3 months old I wasn't have an asthma attack in response to an unidentified allergen. It would have been the height of summer so the asthma may have been triggered by a pollen I guess. The more severe allergies I have didn't really kick in to the extent they are now until about 2 years ago even though, as I say, I've always had some allergies to a lesser extent - i.e. not anaphylactic til a few years ago.

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But cant allergy be an aspect of asthma meaning they come together>?

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I have 2 boys with asthma. 1 seemed to have asthma right off the bat. He was sensitive to almost everything, eg. formula, different foods, laundry detergents, perfumes, new clothes. And my other boy was very tolerant to those things for about 6 months, then he got the virus RSV and everything went downhill from there. He doesn't have too many allergies (other than smoke and grain dust) but the doctor said that many young kids who get RSV later develop asthma. His asthma is mostly from excessive exercise or when he has a virus or is really run down. So I am not really sure which comes first in most cases, but I would have to think that allergies probably come first in some way.

Stevie

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mayb it might seem sometimes that asthma comes first because it is easier 2 diagnose (not sure?) because there are more things ppl could be allergic 2

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definately a thought provoking question deek!

ICorrect me if I'm wrong all you medics out there, but I think you can have asthma without allergies, especially if you have adult onset asthma, so I would say if this is true, that sometimes it's the allergies that spark asthma, and sometimes it asthma and no allergies, so depends on who you are! That might be absolute rubbish as I'm not a doc but that's my input anyway!

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I have adult-onset asthma and no allergies. Still react to all the normal boring irritants though - smoke, perfume, cold air, ozone etc etc. At least I don't have to worry about dust mites, mould and peanuts !

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This is an interesting discussion/debate. Thanks for starting this thread Derek.

I believe that asthma symptoms can be triggered by an allergic reaction to one of the usual suspects, e.g. house dust mites, pet hair, pollens, mould spores et al.

However asthma and allergy are not the same. If you have an allergy it means you are sensitive to ordinary everyday substances to which most people do not react. The allergic reaction may take the form of a runny nose, a skin rash, swelling eyelids or an attack of uncontrolled asthma. Allergy is one of the triggers of asthma symptoms and might occur at the same time as other, none asthmatic symptoms.

An allergy takes time to develop, and an allergic reaction doesn’t happen the first time you come into contact with an offending substance. The immune system needs some time to decide that the ‘innocent visitor’ isn’t welcome.

So yes if your asthma symptoms are allergic in origin your immune system will have already been primed to repel the innocent visitor, by, on the inside, the inflammatory process resulting in those familiar symptoms.

Cal I believe the key word to describe all forms of asthma is 'trigger' whether your asthma is triggered by an allergic response, other reasons, or - as is often the case -a combination of all!

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Ok, but why do triggers, trigger if you are not in some way shape or form allergic to them???

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You don't have to be allergic to something for it to be a trigger, rather it can be an irritant. Things like smoke tend to be irritants in that they 'rub you up the wrong way' (for want of a better phrase) but they don't make your body produce the chemicals etc that are made in an allergic reaction. Does that make any sense?

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Yes, I agree with you. Smoke can be a bad irritant even if it doesn't cause the same type of allergic reaction, rash, stuffiness, etc. When my son had his near-fatal attack, smoke was the major cause of it.

Stevie

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can kids be classed as an irritant????

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Triggers don’t cause asthma, but they are factors which might bring on symptoms or attacks of asthma.

Some common triggers include exercise. I suffer from EIA – exercise induced asthma – which is not allergic in origin. (Although I’ve got a list of allergic triggers as long as your arm! LOL) Other common none allergic triggers include virus infections, - especially colds or flu. I think most folks are familiar with the cold that goes to the chest and worsens asthma symptoms. Hence the importance of flu jabs. Other none allergenic triggers include cigarette smoke. That is a real problem for people with ‘twitchy’ lungs or bronchial hyperresponsiveness. Again a real none allergenic trigger for me and lots of other folks on this forum! Emotional factors and stress can also make existing asthmatic symptoms worse.

Mel, - Must be able to put kids, - either little, or six foot three – into none allergenic triggers!

Mia

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i thought so!!!

mine always set me off anyway!!

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Maybe that's why my lungs have been so grumpy this week - big kids!

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Ange,

Big kids are worse than little kids. Their problems are so much bigger to deal with.

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i wish people would stop saying they get worse as they get older,

there bad enough now and im trying to imagine it being a bit better in a few years time not worse, :-(

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As Mia said, maybe its just little kids tend to have little problems. As the kids get bigger, problems become increasingly more complex with boundaries frequently being challenged. Apart from that, its child’s play.

You will never hear of me losing the wig (rag), …well not on here anyway – LOL.

Take hair,

Derek

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My 9 year old can sometimes have an attack after laughing too hard.

Stevie

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Me too Stevie, i have been ventilated following and attack of the giggles!!

Andrea xx

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Right guys, …I think we have identified some of the many triggers that cause asthma exacerbations, but what are the actual causal factors of asthma?

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I get it now, I am also set off by laughing! Its one of my most comon triggers. (which I obviosly am not allergic to).

Blame my non thinking on my low pf!

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Im a firm believer that we are too clean now adays which is why asthma is on the increase , i certainly cant remeber my mum having a chemical cleaner for this and another one for that! Plus because cleaning is alot easier due to gadgets and gizmos (fancy hoovers etc) its done more often. Also kids arent playing outside as much so not coming in contact with lurgies so have a poorer immune system. I have noe qualms about letting my kids play in the mud and make mud pies!!

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saying that though hops, apparantly my health visitor once found me sitting in the rubbish bin so it can't be said that I was kept away from all the lurgies, yet my asthma is really bad.

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What fascinates me more is the genetic element and the way that in our family males get allergies and the like while the females get asthma. But also very curiously my older brother is absolutely fine and so are his family but between him and me my dad had mumps very badly and he suddenly got major allergies and eczema and I was born about a year later both me and my younger sister have problems. So do her kids and mine interesting eh! Also my great grandmother died of asthma so guess there must be a genetic bit to all this what do you think Deek - get that investiwig on for me.

Den

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Just been reading Red Dens post, there seems to be a similar female theme in our family.

Asthma is only on my mums side however, it seems to affect only females and its the oldest female that gets it worst. My nana was the oldest and she is a fairly severe asthmatic as far as I am aware her brother didn't have asthma. My mum is the oldest of three she is a severe asthmatic her brother is unaffected but yet her much younger sister is an asthmatic but fairly mild in comparision (upto now though neither of her two children have developed it).

I am the oldest of three my sisters developed asthma when they were around 8/9 years old my middle sister has now grown out of hers while my youngest sister still has probs from time to time. I was diagnosed at 17 and while at first it appeared mild it quickly became apperent that my asthma is severe.

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There's definitely a genetic element to asthma and allergies in my opinion (humble as that opinion may be). Whilst I'm the only person in the family to have asthma, one of my brothers has some allergies, as does my mum and apparantly her dad had got very bad hayfever (none have allergies to the extent that I do though). Also one of my cousins on my mum's side had terrible eczema as a child, requiring admission to costa at times, and my youngest brother (who was my cousin when he was born and we adopted him when he was 2) also used to get eczema, though doesn't now.

Re my allergies: I noticed they got a lot worse after I'd had Lyme Disease ... and actually my asthma did too, but that worsening wasn't immediate. However, I've read that Lyme Disease can cause many problems even years after the infection.

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I agree that genetics definately do play a part too. but im my family the links isnt as clear as some other posters. My mum is a very mild asthmatic as was my sister, my older is brother is moderate but can react severly with his asthma to a few allergens, and then there is me who has multiple allergies and severe asthma, before my mum thereis no history of allergies etc, but both my brother sister and myself have all had excema severly as kids as have all 3 of my kids but only my middle one has asthma and hayfever so im interested as to how things willl pan out over the next few generations!!

As for the cleanliness hypothesis i mentioned, i was always messy as a kid but i think its generally thought to be more the sleaners used in the home over the last 15+yrs that are having the impact.

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the people that have asthma in my family are 2 of my nieces and 1 of my nephews and my son,my mum does have severe allergy's to some purfumes and other strong smelling things like certain soap powders and air fresheners.

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I think in my family it must skip a generation my great great granma had it (and died of it) my grandma has it and i have it and no1 has it inbetween

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There is definitely a genetic link. In fact there are lots of scientists out there trying to find the Asthma gene. In my family my great great grandmother had it, my grandmother had it, and my mum had very bad hayfever. I have asthma, and One of my sisters has it, but is in denial. My daughter has it. I know that the consultants always note the familial link.

cheers

ri

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If asthma was solely a genetic condition, identical twins (who have the same genes) would have the same chances of developing asthma. But studies have shown that in 41% of cases only one identical twin will develop the condition.

Similarly, if asthma was solely governed by environmental factors, identical twins would have the same chances of developing asthma as non-identical twins – but the same studies have shown that the chances of developing asthma are more than twice as high if twins are identical.

These research findings imply that rather than inheriting asthma itself, we inherit a tendency or susceptibility to develop asthma. And this inherited tendency will only come to fruition if we are also exposed to the environmental stimuli that can trigger asthma.

Many people have an inherited tendency to develop asthma, especially if other close relatives already have asthma. It’s even more likely if you or your partner is atopic. Being atopic in itself does not automatically cause asthma, but it does make you or your children more susceptible to developing conditions such as asthma, eczema and hay fever.

In my family my paternal grandmother suffered from asthma, (sadly died from as well) which I seem to have inherited plus eczema. One out of my three sons suffers from asthma. My brother has never wheezed or suffered from any sort of atopic symptom in his life ( despite being a heavy smoker) but his daughter, - my niece - suffers from both eczema and asthma, whilst his son – my nephew suffers from hayfever only. So some people – like my brother –might have an inherited tendency to develop asthma, but may never get asthma.

Individual genes have been identified, but equally research is going on looking at the combination of a number of different genes that determines the asthma tendency.

But, like many other medical conditions it’s a combination of genetic and environmental stimuli that leads to actual symptoms. You might have inherited a genetic susceptibility to get asthma but something else is needed to ‘switch’ the switch within the environment we have all experienced, starting ‘in utero’ to early childhood, adulthood and old age. ( Asthma can start at any age.)

There must be two Nobel prizes waiting out there. One for the person who discovers the exact cause of asthma and on for the person who discovers a cure!

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asthma seems to run down my dads side in my family. My grandmother had sever asthma (and saldy died form it when I was v young), and a few of my cousins on that side have asthma and allergies. Neither my my mum or dad do. I am the oldest and have asthma and hayfever etc, but my younger brother and sisters only have hayfever. It is strange to see how the conditions develop and who they develop in family wise. No next generation yet though my sister is due to pop next month so we shall ahve to wait and see.

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Mia agree totally like most things need to meet the right or wrong conditions to trigger the problem. Think thats what they think about cancer and lots of other diseases. I think I am so much worse than rest of family cause my dad had just met his trigger in the year before I was born. However reading all this from other people it seems most have a female linked problem now that is interesting why more than males? Look at board is that cause we females like more support or are we representing the asthma population as a whole in our numbers versus the males?

Den

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On my side of the family asthma is equally spread through male and females but I think my aunt and myself are the worst on my husband's (Andrew) side his dad, one brother have asthma but andrew and my son both have hayfever. Andrew's sister has bad allergies but I don't think she has asthma, more hayfever and sinusitis.

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Sorry guys, haven't been able to contribute to the discussions recently, been a bit too busy (although I have been reading).

I thought I would paste in the following information that I posted on the old AUK boards back in December as I believe this to be very relevant to the discussions (to those who have been around since the olden days - sorry for repeating myself).

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I have put together some useful extracts from an excellent (US) reference book titled Indoor Allergens which I am sure will be of interest: -

Common Diseases Clearly Related to Allergy and IgE Antibody

Three common diseases are clearly related to exposure to indoor allergens: asthma, rhinitis (hay fever), and allergic skin conditions (i.e., eczema and urticaria). Although specific causal genes have not been identified, the genetic predisposition for these diseases is well established. If neither parent has a history of allergy or atopy, a child has only a 0-19% chance of having a childhood allergic disease. If one parent has atopy, the risk rises to 31-58%; if both parents have atopy, the risk rises still further to 60-100% (Zeiger, 1988). In addition, an earlier age of onset of allergic disease is related to a family history of atopy (Smith, 1988).

Socioeconomic Status

Socioeconomic status seems to contribute significantly to asthma prevalence rates and to indices of disease severity. Studies have shown that asthma prevalence rates among children are inversely related to socioeconomic status and residential mobility and are directly related to crowding (Lebowitz, 1977, 1989). Schwartz and colleagues (1990) found that both residence in central cities and low income significantly contributed to asthma prevalence rates. Poverty has also been associated with increased hospitalizations for asthma (NHLBJ, 1991). A study of inner-city children in the United States demonstrated a cumulative prevalence rate of asthma of 10.6% (Mak et al., 1982). (Inner-city asthma death rates in Chicago were two times greater than those for the United States; in New York City they were three times greater than those for the United States [Evans, 1992; K. B. Weiss et al., 1992a].)

Demographics - Age

Asthma prevalence rates are highest in earliest childhood, declining to a low at around age 20 and then slowly increasing with age (Barbee et al., 1985; Mak et al., 1982). Between 5 and 14% of children will have a respiratory illness with wheezing at some time (Barbee et al., 1985). All wheezing in children is not asthma, however; an infectious disease, bronchiolitis, is also associated with wheezing.

Hospitalization rates for asthma vary with age. NCHS data (1992) indicate that from birth to age 14, 169,000 hospitalizations occurred due to asthma (30.8 hospitalizations per 10,000 population); from age 15 to 44, 86,000 hospitalizations occurred (19.1 per 10,000 population); from age 45 to 64, 86,000 occurred (18.2 per 10,000); and for age 65 and older, 102,000 occurred (32.4 per 10,000 population).

Source of extracts

Pages 56, 70 & 69 of Indoor Allergens – Assessing & Controlling Adverse Health Effects., published 1993., Author – Committee on the Health Effects of Indoor Allergens, Institute of Medicine.

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Sex Imbalance in Allergy

Far more woman than men become allergic. This gives a crucial link in the immunosuppression chain of evidence, because this frequency is so frequently seen in illnesses involving the immune system such as autoimmune conditions. The female preponderance in SLE is striking, and this is an illness in which psychological factors are not an issue. It is also highly significant that the sex ratio in allergy is 50:50 till puberty. Only hormonal factors can account for the changed ratio thereafter. Several clinical studies have shown that male hormones can improve immunity and female hormones can harm it.

(extract from allergy paper/critique presented by Fabienne Smith, allergist)

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There are quite a few males in my family with asthma, it comes from my mum's side mostly. My uncle has severe asthma and so does my cousin, she's in hospital at the moment. My mum has asthma and so do both my brothers, my brothers are mild and my mum's is a little bit worse. One of my brothers and me also had eczema as children and teenagers. My mum gets hayfever, and my brother who has eczema and asthma also has allergies including hayfever (he's allergic to my Sandie). My Aunty on my dad's side also has asthma which is mild. We don't know about anyone before that though. Then there's me, I'm guessing my asthma is moderate and I have allergies, hayfever and I used to have eczema.

Beth

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Inherited / Acquired

With reference to my recent post re - extracts from ‘Indoor Allergens’.

“If neither parent has a history of allergy or atopy, a child has a 0-19% chance of having a childhood allergic disease”.

This is very interesting and supports the view that allergy can be acquired rather than inherited, albeit that in most cases allergy is indeed an inherited/genetic characteristic. Late onset asthma could well be further evidence of this ‘window of vulnerability’.

Because allergy/asthma can be acquired, then this will undoubtedly result in an increase in the prevalence of asthma over time as the acquired condition becomes an inherited characteristic that can be passed onto siblings.

Derek

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my son has had asthma since he was a baby,

i only found out i had asthma in june of this year.

does that mean he's got it because of me???

i thought there was asthma on his dads side,but have found out there isnt.

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Hi d58 I think you have to avoid thinking you 'gave it to him' as such its hard but yes it is familial and both my kids have mild asthma. They have seen how sick I have been but the chances of really major breakthroughs for them is very high thats if they ever become unwell with it. Ask yourself if you would rather be alive and manage with asthma or not have been born know what i would choose.

Hope you can get your head round it all I did know right from pregnancy that there was a high chance they would get it as well.

Den

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I had bad excema as a child, diagnosed asthmatic in teens but seemed to 'grow' out of it and now i think its just that i get a bt chesty sometimes. I also had cat allergy as child but much improved now. My husband has never had anything like this. My daughter has never had problems but my son has battled with severe breathing probs from min he was born. He has severe asthma, developed hayfever, has allergies and dabbles now and then in excema.

Its very clear to me that my son has unfortunatly taken after me with the whole package and yes i do wish he hadnt but I cant beat myself up over it as I cant change it. He has fought a real battle for 11 years but I know he would have rather do that than never been born if that makes sense. Please try not to send yourselve on guilt trip d58, being a parent is a one long guilt trip without adding to it ;-)

julie

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thanx red den and julie

the thought it could of come from me never even entered my head till the other day because ive been trying to track my family roots and his dad side as well,there wasnt 1 person on his dads side with asthma,i never thought it could of come from me,as i have only just found out i have asthma myself.

love

mel xxxxx

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