The Boy Who Cried "Achoo!" Living with Severe Allergies
The Waiting Game
The doctor will be with you in just a second.”
Elbert Liang nodded politely at the nurse as she closed the door, then shifted his weight on the thin blue mattress, careful not to rip the transparent plastic sheet. His mother sat beside him in a chair by the blood pressure machine, flipping through the pages of a tabloid magazine too quickly to actually be reading them. They waited in light silence, punctured occasionally by a child’s cry in the waiting room or a flushing toilet, knowing full well it would be quite a bit longer than a second.
Both were all too familiar with the inside of a doctor’s office. Ever since he could remember, Elbert had spent quite a bit of time in them, lying on the same blue mattresses under the fluorescent lights as the doctors drew blood and performed tests and made him do quite a bit of waiting. Sometimes it was for his sleep apnea. Sometimes it was for cold-induced asthma. Sometimes it was for a sinus infection. This time, it was for his allergies. He’d had a particularly bad allergic reaction several weeks ago and nearly lost consciousness. Now, he and his mother were waiting for the results of a blood test that measured the amount of antibodies his body overproduced in response to more than a dozen allergens, from dust mites, to pet dander, to tree pollen and fungi. The test would give him a better idea of what exactly he was allergic to.
Elbert already had a feeling that the results would be pretty bad. He just didn’t realize how bad until the doctor came back in, grey eyebrows raised at the clipboard holding Elbert’s charted results.
“This is one of the worst allergy test results I’ve ever seen,” he finally declared. “You reacted to almost every single thing that we tested for. Normally, if there were just one or two things, you could potentially take a shot monthly to slowly gain immunity, or avoid the triggers entirely.” He paused. “But this—there’s no avoiding this.”
Looking back, it’s kind of tragically ironic that now Emory University senior Elbert didn’t realize he had allergies as a child. He’d always suffered from itchy skin and a stuffy nose, but it was also the only state of health he’d ever experienced growing up. He didn’t have anything else to compare the symptoms to, so he didn’t know any better.
“I remember one time when I was a kid, I went to the doctor, and I remember thinking that my nose was actually particularly un-stuffy that day. When I got there, he told me that I was severely congested,” Liang laughed. “That was confusing to me, because it was one of my better days.”
That appointment would become the first in a long queue of medical consultations about not only his congestion, but an equally exhausting list of allergy symptoms: itchy and irritated skin, rashes and hives, watery eyes, drowsiness, difficulty sleeping, difficulty breathing, facial swelling, and fatigue. As a child, he’d already been on the receiving end of a skin prick test, which checked for immediate allergic reactions to as many as 40 different substances at once by penetrating the skin’s surface with a series of allergen-coated lancets. About 10-15 minutes after the skin pricks, the nurse observed his skin for signs of allergic reactions.
Normally, if the skin reacted to an allergen or two, it would develop a small red, itchy bump that may look like a mosquito bite. But in Elbert’s case, his reactions to all the allergens were so severe that it was impossible to tell what he was or wasn’t allergic to. His entire back, instead of presenting a neat biological chart of allergy indicators, became a swollen mountain range of red wheals. It was impossible to tell where one swelling stopped and another began, and the nurses had to apply antihistamines to control the inflammation. He and his mother left the appointment that day not knowing much more than Elbert was really allergic to a lot of things, which they couldn’t help but feel they had already figured out for themselves.
I Can Live With That
So the results of the blood test he finally got done his first year in high school were helpful, if a bit of a downer. Elbert simply says that he’s “allergic to everything” for the sake of simplicity, and while the real list of allergens isn’t quite that extensive, there’s no denying it’s long. In varying degrees of symptom and severity, he’ll react to corn, wheat, soy, peanuts, dust mites, shellfish, pollen, animal dander, and almost every single plant and weed. To some, he’ll react with some minor drowsiness or skin irritation. For others, exposure can be more dangerous. For example, the blood test informed him that he is deathly allergic to a specific species of tree, which interestingly to this day he is unable to name or identify.
Just because Elbert takes some risks, though, doesn’t mean he’s completely defenseless against his body’s overprotective and backfiring immune system. On a daily basis, he arms himself with an arsenal of medications. Singullair, which is normally used to treat asthma attacks, helps to reduce chronic swelling in the airways. Zyrtec, an antihistamine, reduces the effects of natural chemical histamine in the body, which is responsible for a range of allergy symptoms: sneezing, itching, watery eyes, runny nose. Zyrtec D is the leveled-up version of Zyrtec. In addition to antihistamines, it also includes a decongestant that helps keep sinuses clear. And last but not least, Elbert tops off his daily allergy medication sundae with Flonase—a steroid hormone nasal spray that reduces swelling and mucus in the nasal passageway.
Even though they don’t have any physical side effects to the best of Elbert’s knowledge, they certainly have a side effect on his wallet. Flonase is $22.99 for one-month supply, while Zyrtec is $18.99. Zyrtec D is $24.99 for 24 pills of 12-hour relief, and Singullair is $9.99 a month. Altogether, he spends approximately $80 per month or $960 every year for access to a the daily cocktail of chemicals he depends on. And because Elbert has been relying on allergy medication since he was about eight, that’s over $13,000 spent total. Not to mention, these price tags on living with allergies don’t include the lifestyle measures his parents implemented growing up to help minimize his exposure to environmental allergens, like switching out carpets for hardwood floors or hiring services to clean out the house’s air vents. Nor do they factor in the health costs just to conduct allergy testing in the first place. A skin allergy test can cost $60 to $300, and a blood test can cost $200 to $1,000. The rising costs of just living with allergies are a question that many families are forced to grapple with as the price of EpiPens skyrockets. Elbert was lucky that his family had the resources to afford to make drastic changes in order to keep him healthy.
But even protected by these preventative measures while growing up and defended by a shield of multiple medications, having severe allergies still prevents Elbert today from engaging in certain activities that others might take for granted as a part of living life. To him, taking a walk barefoot in the grass would be an invitation for his skin to flare up in immediate protest. He has to take a shower every time he vacuums around his apartment, simply because of the brief exposure to dust mites. He pays for petting a cat with skin irritation and itchiness. The long list of prohibited foods like peanuts, breakfast cereal, and tamales that might trigger an allergic reaction have to stay off his menu. He can’t just opt to pass out on a friend’s carpet for a night, unless he wants his alarm clock in the morning to be rapid facial swelling. And don’t even get him started on pollen.
“Pollen is the worst,” he said seriously. “It’s worse than dust. Pollen makes me really drowsy.”
It’s hard to enjoy a nice spring day when you have to take a nap afterwards just for breathing the air.
But it’s not just minor, day-to-day choices Elbert has to think about as a result of his medical conditions. Having severe allergies also affects many of his larger life decisions. For example, before going to college, the average prospective undergraduate might look at a number of factors, including national rankings, campus culture, department offerings and extracurricular opportunities. Elbert had to look into another potential deal breaker: potential allergen exposures. According to him, his allergies were a big consideration for where he was going to college.
“I did a lot of research on the pollen count in Atlanta, and the present trees and weeds,” said Elbert. “It wasn’t the deciding factor, but I did look into it.”
Sick of Allergies
These sacrifices in lifestyle aren’t just in the name of day-to-day comfort and quality of life, important as those elements are: they’re also integral to Elbert’s overall health. He figured this out the hard way, and in some ways, a bit too late. For instance, just like with his allergies, Elbert’s sleep apnea, a serious sleep disorder that occurs when a person’s breathing regularly interrupted during sleep, didn’t get officially diagnosed until he was in eighth grade. Because he was waking up hundreds of times a night, but falling back asleep too quickly to realize, the condition when undetected for most of his childhood, which he mostly remembers as being “extremely tiring.”
There’s two types of sleep apnea, and Elbert was unlucky enough to suffer from both. In those with central sleep apnea, the brain fails to signal the muscles to breathe, due to instability in the respiratory control center. Obstructive sleep apnea (OSA), on the other hand, is caused by some kind of blockage of the airway. For some, the main cause of OSA is excess weight and obesity. During sleep, the soft tissue of the mouth and throat blocks the airway when tongue and throat muscles relax. This same mechanism can happen in the elderly, as these muscles begin to weaken with age. For Elbert, it was due to a combination of enlarged tonsils and inflammation from allergies. Once the condition was diagnosed, the tonsils removed, the medication started and radiation therapy added to reduce inflammation for good measure, his sleep started to improve drastically. But some damage had already been done. To this day, Elbert blames allergy-induced sleep apnea, and lack of oxygen associated with it, for the fact that his little brother is taller than he is.
And the sleeping problems didn’t end there. Part of it is because Elbert still struggles with central sleep apnea, since there’s no real cure for the neurological disorder. The other half of it is because allergies and sleep apnea continue to go hand in hand. Despite adhering to his strict regimen of daily allergy medications, he notices how the occasional blip can lead to a cascading, self-destructive spiral. For example, an illuminating pattern has emerged from his use of nasal spray: towards the ends of the month, when the bottle is less full, sometimes the spray doesn’t come out with the full dose. Coincidentally, this is usually around the same time of month that Elbert starts to get sick.
“I think maybe that’s because I’m not able to breathe as well because I’m not getting the full dose,” he said. “Then my sleep isn’t as good, my energy levels are lower, my immune system is decreased and my body is weaker.”
This ripple effect across his physical state, which affects an even wider circle of social, emotional, and mental health, is one of the reasons that Elbert thinks people should take allergies more seriously.
“One thing that a lot of people don’t realize is that when allergies get super bad, it’s not just like—’oh, my eyes are watering,’ or ‘I have a stuffy nose’—when it’s really bad, it feels like you’re sick. You don’t have any energy and you can’t get up, all you want to do is sleep all day,” Elbert explained. “It’s not as superficial as it might seem.”
Regardless of how inconsequential allergies might seem to an outsider with a less oversensitive immune system, to those who suffer from them, having allergies is more than having to buy a pack of tissues during pollen season. This condition has serious, and sometimes life-altering, economic and medical effects. For the 30 percent of adults and 40 percent of children in the U.S. who have them, allergies aren’t just inconvenient—they’re a way of life.