When Fan Yu-chung entered elementary school this year, he was asked if he had gone to kindergarten. He thought for a long time, and it seemed as if he had and it seemed as if he hadn't. It turned out that he had gone to kindergarten but that the days he had attended were pitifully few. "We usually just gave away our tuition money for nothing, because he was so often ill that he rarely could go," the boy's mother says. All of seven, he has already checked into the hospital for overnight stays 17 times since he got bronchitis at four months.

What's behind his poor health is an allergy common among today's children: asthma.

Allergies are now the most common chronic ailments suffered by children. They include asthma, rhinitis (nasal allergies), allergies to food, atopic dermatitis (skin allergies), and allergies to medicines. Among these, asthma has the biggest impact on children's lives, keeping more children under the age of 11 from pursuing normal activities than any other medical problem.

According to an epidemiological survey of Taipei children carried out by Hsieh Kuei-hsiung, the head of Chang Gung Children's Hospital, the percentage of children suffering from asthma rose from 1.3% in 1974 to 10.79% in 1994-an eight fold increase in 20 years. Those suffering from allergic rhinitis (whose seasonal variety is commonly known as "hay fever") rose to 33.53%, or one out of three children.

Why are they gasping?

How does an allergic reaction take place? Simply put, after a person with an allergy comes into contact with an allergen (allergic stimulant) in the environment, the body displays a sensitivity to it. If this sensitivity is on the skin, it is called "atopic dermatitis;" if it is in the nose, it is called rhinitis; and if it is in the trachea it is called "asthma."

The symptoms of rhinitis are sneezing and a runny nose, and they usually start right after rising from bed. But because the symptoms aren't severe and don't present major obstacles to going about life, most parents aren't very concerned about rhinitis. Still, J. L. Huang of the pediatrics department of Chang Gung Memorial Hospital points out that rhinitis shouldn't be ignored, because if children suffer from it for a long time, their noses will be uncomfortable, and they will lose their concentration, not perform as well as they should academically, and more likely suffer from otitis and nasosinusitis.

Parents, however, get quite nervous about asthma. Most assume that it always causes its victims to wheeze and gasp for air, but J. L. Huang points out that one can have asthma without such breathlessness. Constant coughing, particularly dry coughing, coughing in the middle of the night, or coughing after exercise, is potentially a sign of asthma in its early stages.

Atopic dermatitis tends to be concentrated in certain areas. New-borns get it on the head-on the cheeks and behind the ears. Later it goes to their backs and the skin on the outside of joints. When they are old enough to go to nursery school, it tends to spread to the skin on the inside of joints and may even cover the whole body with its itchy rashes.

Many people suffer from several allergies, and in Taiwan today more than one-third of the population suffers from at least one.

Allergies are hereditary. Studies show that if one parent has an allergy, there is a one-in-three chance a child will have one; if both parents have one, the chances rise to two in three. A study of school-age children in Taipei shows that 30% of children with asthma have a parent or grandparent who suffers from it too, and as many as half of children with rhinitis have a parent who also has it.

But those with allergies do not necessarily have to endure allergic reactions. Chou Cheng-cheng, a specialist in allergies and rheumatism in the pediatrics department at NTU Hospital, says that if you limit exposure to allergens in the environment, you can prevent allergic reactions.

Good mothers

The question is, how do children living in modern "civilized" environments avoid being harmed by them?

In order to minimize allergens in the home, families with asthmatics aim for cleanliness and simplicity in decoration. Outside, children with allergies can protect themsleves with surgical masks, hats and long-sleeved shirts.

But too much about the environment is beyond one's control. One mother of an allergic child says that for the sake of safety, she only dares to take her child outside on "good days." By good days, she doesn't mean those regarded as auspicious in the traditional farmer's almanac, but rather days without rain or strong winds-sunny days when the air quality is good. Another mother says that ever since her child began suffering from asthma, she hasn't dared to bring the child to the homes of good friends or neighbors, because she has no control over the environment there.

And many asthmatic children face numerous prohibitions on what they can eat: overly spicey food is off limits, as are raw and cold foods. One Mama Chao says that when her six-year-old asthmatic son sees other children or family members eating ice cream, she automatically says, "Chiang Chiang can't eat that." His expression of longing combined with his self-restraint is truly heart-breaking-it's just that the torturous, anxiety-ridden scenes of bringing him to the emergency room in the middle of the night are more so. Eventually his mother decided to emigrate to America. Although she and her husband struggled there, starting from scratch, their son no longer suffers from asthma, and so she thinks the move was worth the trouble.

But some people move abroad, and have a honeymoon first year, only to find that their child starts showing symptoms of hay fever-sneezing and irritated eyes-in the second year.

Changing the body

When the outside environment is too hard to change, then the only choice is to change one's own body. Immunotherapy is designed to change a body's ability to adapt to an environment.

Immunotherapy treatment is very long, and it usually takes two or three years before there are results. First it is necessary to find the source of a patient's allergy, and then these allergens are put into the body in tiny quantities and concentrations. These desensitize the body, until an environment with such allergens won't trigger an allergic reaction, or at least the symptoms will be greatly lessened. Immunotherapy starts with injections once a week, after which they are given once every two weeks and then finally once every four weeks.

More than 80 percent of allergy sufferers will find that their symptoms improve after such treatment, but there is a degree of risk. Not everyone is suited to such treatment. Chou Cheng-cheng points out that patients must be absolutely certain that a given allergen is the one and only source of their allergy, and doctors will only consider immunotherapy if this allergen is hard to escape in the environment, the patient has at least a fairly heavy allergic reaction to it, and there are no drugs that can control it.

Civilized treatments

Standard drugs used against allergies can also bring good results. Inhaled steroids are currently the main drug used to treat asthma, but most parents believe that once their children start taking steroids, they'll never be able to shake the habit. Other parents worry that the child will immediately suffer from serious side effects. Chou Cheng-cheng explains that by inhaling steroids, they can use smaller amounts than they would taking them orally and still get better results, because when steroid pills are swallowed, they must get digested and be circulated through the whole body to get to the lungs, whereas inhaling steroids brings them right to where they are needed.

In the past, the parents of asthmatic children used to ask doctors to write notes excusing their children from gym class, outdoor assembly, and clean-up-or even to allow them to take a leave from school. Now, with proper treatment, asthmatics almost never need to stay away from school or abstain from enjoyable exercise. Chou points out that several swimmers who won gold medals at this summer's Olympics were asthmatics.

As for the "allergy vaccinations" that allergy sufferers dream about, could they become reality? Chou points out that basic research has already been done on vaccines, but it hasn't gotten to the stage of animal testing.

It seems that for civilization's diseases, hope of effective treatment is closely tied to progress in science and technology. But might not those advances in turn lead people to even greater suffering from new diseases? That is beyond our ability to predict.

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During a summer camp for asthmatics, one camper has had an attack. Other campers, "who have gained a doctor's knowledge through being ill," are no strangers to this condition, and are busy "directing" the procedure. (photo by Hsueh Chi-kuang)

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Rising rates of allergies among school-age Taipei children

Allergic rhinitis

Asthma

Nettle rash

Atopic dermatitis

Source: NTU Hospital pediatric department

Graph by Lee Su-ling