THIS CONDITION (Allergic Bronchitis) cannot be diagnosed without giving very careful consideration to the conditions of the nose, throat, bronchial tubes, lungs and heart and aorta that can produce coughing in an individual. Such conditions may be eliminated by a careful history, physical examination and X rays of the chest.
Allergic bronchitis usually starts early in infancy or childhood as a cough which is persistent, without evidence of serious changes in the heart and lungs from infection or foreign bodies. The patient usually has an associated perennial allergic rhinitis, hay fever or bronchial asthmatic attacks. There may be wheezing with this cough. Bronchial asthma, emphysema or bronchiectasis frequently follow untreated allergic bronchitis.
It is a condition which, like the other respiratory allergies, may be perennial year-around or seasonal. If it is associated with infection, the condition is often called asthmatic bronchitis. Some consider this a bacterial form of allergy, whereas others consider it strictly an infectious bronchitis. If there is an associated allergy, together with a history of good general health, absence of fever, a nonproductive cough, a negative tuberculin test and essentially negative X rays, there is not much doubt of allergic bronchitis. A careful study of all other possible conditions should be made before a final diagnosis is made. The following interesting case illustrates the need for minute attention to detail.
Allergic Bronchitis Case
This is the story of 10-year-old Joan M., an only child. Joan’s parents were not wealthy, but Mr. M. had a supervisory job which paid him adequately. Since Joan was the only child they could have, the parents showered her with attention. They gave her everything and guarded her health constantly.
It was with consternation and bewilderment that they suddenly found their daughter losing weight and acting generally sluggish. Joan was hurried to the family physician, who examined her thoroughly but could find no immediate cause for the sudden alteration of the child’s health.
“Have you been feeding her well-regulated meals?” the doctor asked Mrs. M.
“The same as always, doctor,” she replied. “You know that I have taken the best care of Joan.”
The physician agreed. “Yes, but sometimes we can kill a person with kindness,” he reminded her.
“Joan isn’t spoiled,” said Mrs. M. “We’ve just tried to do our best for her.”
The doctor prescribed vitamin concentrates and kept the girl under constant observation for several months, but her weight continued to drop and the child developed a dry cough.
Her lungs were X-rayed, but the pictures were clear. Another thorough examination failed to indicate the source of the trouble, so the doctor began to think about a consultation with a specialist.
During the next few weeks, Joan submitted to all the standard food tests, the pollen and dust tests and the bacterial tests, but all gave negative reactions.
The physician leaned back in his chair and looked at the worried faces of Mr. and Mrs. M.
“We’ve done just about everything to help Joan, but we haven’t hit upon the right thing,” the doctor told them. “We’ll have to check on her environment.”
The parents couldn’t quite understand what could possibly be wrong with the child’s environment, but they were agreeable to anything that might help.
“All right, then,” said the doctor, “let’s begin with you, Mr. M. Exactly what kind of work do you do?”
“I’m plant superintendent at the B}Packing Company,”
he replied. “We manufacture food extracts.”
“What particular extracts do you handle yourself?”
“Well, none in particular. I only get around to see that things are running right,” Mr. M. answered. “Sometimes the machines break down, and I have to get them back into operation as quickly as possible.
“What kinds of machines do you have?” the doctor asked.
“Several,” said Mr. M., enumerating. “There is the grinder, the pulverizer and the extractor.”
The doctor interrupted. “Would you say that the pulverizer turns the food into a dust?”
“Well, yes,” replied Mr. M. “It practically has to be a dust before it goes into the extractor. That is where other ingredients are added and the extract produced.”
“Are the grinding and pulverizing machines covered in any way?”
“They can’t be. The men are constantly adding raw materials to them.”
“Does the plant have some sort of exhaust system to keep the air clean?” asked the doctor.
“Plant’s too old for that,” answered the man. “They have talked about an air-conditioning system, but they keep putting it off.”
“What kinds of extracts do you make at the plant?”
“Oh, all kinds. You see, there are several divisions. Until eight months ago, I worked at the fruit flavor division. Then I was transferred to the vanilla extract division. That’s where I am now.”
“You say vanilla extract?”
“That’s right.”
“That’s made from the vanilla bean, isn’t it?”
“Yes, and it’s an interesting process. You ought to come out to the plant sometime and let me show you through,” suggested Mr. M.
“That’s exactly what I was thinking, and the time is right now,” replied the doctor.
At the plant, the doctor exposed several culture media to the air around the grinding and pulverizing machines. Back in his office an hour later, he examined the cultures under the microscope and found them to be thick with microscopic vanilla bean dust.
At Mr. M.’s home that evening, the doctor asked: “Do you change clothes before you come home from the plant every day?”
“No. My job isn’t a dirty one. I always wear the same suit to work.”
“I have reason to believe that Joan’s trouble is being caused by the vanilla bean dust you carry home on your clothes, and there are only two ways to prove it. First we’ll try a skin test, using the vanilla concentrate, and, if there is a reaction, you will have to help me prove that vanilla is Joan’s persona] poison.”
The doctor made the test and found, as he had suspected, that Joan showed a marked reaction toward the extract. The father verified this finding by wearing a different suit for work than he did in going to and from the plant. The idea was to eliminate all traces of vanilla bean dust in the home.
Within the two months following, Joan began to pick up weight. She lost the dry cough, and gradually returned to the normal, healthy state she had enjoyed before her father was transferred to his new job. Written By: Jack A. Rudolph, M.D. & Burton M. Rudolph. M.D., Continue Reading, Bronchiedasis
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