BOX 2-1 Impact of Allergic Disease on Quality of Life

Allergic diseases can disrupt childhood education and family life and have a negative effect on quality of life.

  • Unpredictable absences from work may affect employability.

  • Over-the-counter medications commonly purchased to reduce symptoms of allergic rhinitis may make people sleepy; performance impairment has been shown.

  • Children with asthma are absent from school far more often than nonasthmatic children.

  • Children with asthma may become ill because of school activities that most people accept as routine, such as keeping a hamster in class or workers painting a hallway.

  • Allergic dermatitis is characterized by severe paroxysmal itching, which can disrupt work or school activities.

  • People with asthma often pay much higher health insurance premium rates (and may be denied insurance).

  • People with asthma may be unable to work at jobs that expose them to allergens or irritants.

  • The accepted treatment for occupational asthma is removal from exposure. This often requires a job change and may cause job loss.

  • Treatment for contact dermatitis is to prevent the exposure. This may require a job change and may cause job loss.

Once a diagnosis of asthma is made, the contribution of allergy to asthma is of great interest. Allergy may be confirmed through either skin testing or measurement of specific IgE antibodies in blood samples, or both. The causal relationship between allergy and asthma is established by the individual's history (see Chapter 5). For example, asthma that occurs in the spring may be due to allergens from tree pollen. People with perennial asthma are often unaware of the allergens that trigger their disease. Current recommendations include environmental modification as an early step in asthma management (NHLBI, 1991).

The diagnosis of asthma in population-based studies has been made in a variety of ways. Diagnostic criteria may be influenced by the local language, customs, and definitions and by physician habits, questionnaires, and study objectives (Kryzanowski et al., 1990). Examples of the epidemiologic definition of asthma include a history of episodic or persistent wheezing, a physician diagnosis of asthma, evidence of reversible airflow obstruction on pulmonary function tests, evidence of bronchial hyperreactivity, or a combination

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