HOW TO ASCERTAIN ASTHMA: THE DIAGNOSTIC TESTS – BREATH TESTS OR LUNG FUNCTION TESTS – PEAK-FLOW MONITORING – INTERPRETING PEFR READINGKnowledge to read PEFR accurately can help predict the condition and provide valuable time and opportunity to take necessary steps to prevent an attack. More specifically, knowing PEFR helps in the following ways:A drop in PEFR indicates that there are allergenic substances in the environment. An effort should be made to localise the cause and prevent its recurrence.How to Ascertain Asthma  65In some cases, it also helps in the diagnosis of the disease. It has been seen that if within a day, there is variability of PEFR of up to 20 per cent, or an improvement of up to 20 per cent after giving a bronchodilator, it is quite likely that the condition is asthma.PEFR reading also helps in monitoring the progress of a particular mode of treatment.There are two very important reasons for taking peak flow reading at home. First, asthma does not behave the same way 24 hours a day. It tends to get worse at night and get better during the day. Taking a peak flow meter reading at home helps the physician to know the change in the condition. Second, having a peak flow meter at home gives sufficient time to consult the doctor and get proper instruction for its management. Nine out of ten times, a physician experienced with home Peak Flow Meter can help neutralize an attack quickly, and avoid the emergency room of a hospital.Who Should Use a Peak Flow Meter?• Children who experience severe attacks with little warning.• Children who need to travel long distance to receive medical attention.• Children who require high-dose inhaled corticosteroids or daily oral corticosteroids.• Children with wild variations in peak flow, i.e., greater than 20 per cent of their best peak flow.• Children whose medical history appears to provide an unsatisfactory guide to treatment.*56\260\8*

It is possible to confuse allergy to milk with an allergy to the penicillin contained in the milk of cows treated with penicillin; with an allergy to the fish used to feed the cows; with a lactase enzyme deficiency (a baby’s intestines may lack the enzyme that digests the sugar of milk); or with a celiac disease (an intestinal malabsorption of milk).

The incidence of allergy to cow’s milk is increasing daily because breast feeding has diminished greatly in this country. Babies are now fed formulas based on evaporated cow’s milk, which is inexpensive, easy to procure, and nourishing. It is an ideal food for calves; but it frequently causes allergies in atopic babies.

Cow’s milk is composed of fats, sugars, and many kinds of proteins. Among the proteins, only lactalbumin is allergenic. However, because lactalbumin is different in each kind of animal species, changing cow’s milk to goat’s milk may ease the allergy. If this change proves unsatisfactory, then powdered cow’s milk (which has been boiled and refrigerated) should be tried.

If this altered kind of milk does not provide relief, then a substitute must be found to feed the baby. This is a very important decision whose consequences must be weighed carefully; at times it might be preferable for a child to have a mild case of eczema or some nose stuffiness instead of depriving him of a nourishing food. However, if it is imperative to eliminate cow’s milk from the diet of a baby, then all the food items which may contain milk must also be eliminated. Such foods include cheese, cream, and butter; custard, Junket, ice cream, milk pudding; batters, waffles, pancakes, cakes, cookies, and prepared flours (such as Bisquick); ordinary bread; malted milk, Ovaltine, Cocomalt, drinking chocolate, buttermilk, canned or dried milk; milk chocolate candy, chocolate creams, filled candy bars, nougat; cottage cheese and other cheeses; Cream of Rice and macaroni; foods prepared with milk, cheese, and cream, such as gravies, cream sauces, fritters, rarebits, timbales, souffles, au gratin dishes, and omelets; Weiner schnitzel, frankfurters, and other sausages (because dried skimmed milk may be used in them as a binder) ; powdered milk.

The elimination of cow’s milk from the diet of a baby must be made complete by feeding him with plates and spoons of a disposable nature. Minerals, iron, and vitamins have to be added to the diet, and substitution should be made wherever possible.

Butter substitutes: Marparv, Willow Run oleomargarine, Mother’s Nuspread.

Whipped cream substitute: Rich’s Whipped Topping.

Cow’s milk substitutes: Isomil, Mull Soy, Neo-Mull Soy, Pro-Sobee, Soyalac, etc. This kind of milk is prepared from the soya bean plant which is of vegetable origin and is usually well tolerated; however, it may sometimes cause large and frequent bowel movements, and its taste may have to be improved upon with a few drops of vanilla extract, molasses, or honey. If it is not well tolerated, feeding has to be achieved with strained lamb meat instead. The following is Row’s strained lamb formula which is a complete and healthful food:

8 oz. strained lamb or 6 oz. strained beef

3 1/2 tbsp. sesame oil or soy oil

2 tbsp. sugar

1 tsp. calcium carbonate

1/2 tsp. salt

1000 cc. or 41/2 cups water

2 tbsp. potato flour or 2 1/2 tbsp. tapioca flour

Combine the flour, salt, and sugar in one cup of water. Cook over low heat for ten minutes; then add the lamb (or beef), the oil, and enough water to make a volume of 41/2 cups. Cook over low heat for ten to fifteen minutes. Reduce the amount of flour if you wish a thinner product.

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One study showed that some children had high IgE levels for foods that caused behavioural problems, so it seems that this could sometimes be a true allergic symptom. However this is a controversial area, and conventional allergists do not seem eager to welcome behavioural disorders such as hyperactivity into their domain.However, there are innumerable reports of children with allergic disorders such as asthma or perennial rhinitis (runny or congested nose) who also show a cluster of symptoms that includes an inability to keep still, excitability, clumsiness, poor memory and short attention span. These symptoms, often known collectively as hyperactivity or the hyperkinetic syndrome are dealt with more fully in Chapter Eleven. Some of these children show an interesting reaction when the allergenic foods are removed from the diet and other allergens avoided: their mental and behavioural symptoms clear up at the same time as their physical ones. Reintroducing those foods brings the bad behaviour back along with the wheezing or runny nose. Although the mental symptoms could be a result of the physical ones, this seems unlikely.

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