Next to “How did I get my hay fever?” the question most often presented is, “Why didn’t my hay fever start until I was twenty years old while the 10 year old kid next door has had hay fever for five years?” It is not an uncommon sight to see an eight year old and a forty year old with equally severe symptoms during the hay fever season. Frequently like brothers in arms they may be seen marching into the doctor’s office to take the same shots.
This variable age factor at which hay fever commences has been shown to have a hereditary basis. Observations reveal that when both your parents are allergic the chances are greater than fiftyfifty that if you are going to develop hay fever it will appear before the age of ten and it is al-most certain to appear before the age of forty. When only one parent is allergic the chances are one out of three that if hay fever develops it will be evident before age ten; and about four out of five that it will emerge before the age of forty.
There seems to be no limit to the age at which hay fever and the other allergies may crop out for the first time. Cases have been reported at both extremes of the age scale. Dr. Vaughan mentions that he saw a case of asthma in a baby less than three hours old. Dr. Balyeat speaks of patients who did not develop hay fever until they were seventy-five years of age.
Oddly enough the greatest number of persons develop their hay fever in the period considered to be the prime of life, ages twenty to thirty. The average age seems to be about twenty-seven. This happens to be the exact age at which yours truly acquired more than an academic interest in hay fever.
In general, it may be said, that the greater the family tendency toward being allergic, the earlier you can expect your hay fever to appear. This is equal to saying, that you are destined by heredity to develop your hay fever or other allergic symptoms at a certain time in your life. You may fool mother destiny by never coming in contact with the substance to which you are potentially allergic. Or you may flirt with her for a long time and then some day sail right into her arms. Voyaging foreigners have done just this. Some never had symptoms of hay fever in their native country and have become afflicted with it only since coming to this country. And so we find many foreigners with ragweed hay fevercompliments of North America. Welcome to the fold.
BOYS AND GIRLS TOGETHER
Hay fever may be a summer affair but it shows no partiality in the matter of sex. In general, it seems that sex plays a minor part in the incidence of hay fever. Some investigators report a greater number of cases among males. Others show higher percentages among females.
When the female percentage of hay fever cases is higher it is explained that they have more time and thus appear in clinics more often. When the male percentage is higher, it is said that they spend more time in the outdoors and therefore are more apt to come in contact with allergic substances. The differences are rarely more than five to ten per cent. In general, hay fever may be considered to occur in both sexes with equal frequency.
There does seem to be a sex difference in the rate of hay fever and asthma which is related to age, before and after puberty. For instance, from birth to about the beginning of puberty there are two males to every female allergic person. After the age of 15 to about the age of 45, there are about five females to every three male persons who are allergic. Past age 45 the incidence seems to be about the same.
These proportions show that you can expect many young boys to outgrow their asthma and some other allergies by the time they graduate from elementary school. The percentages are also indicative of the fact that many girls first develop their asthma or hay fever shortly after the beginning of menstruation or just after marriage. Where the allergic condition is known to be related to menstruation, relief from symptoms often occurs after the menopause period, popularly known as change of life.
Some writers have intimated that hay fever is hereditarily transmitted on a sex linked basis. Or in other words that it is inherited more often from the mother’s side than from the father’s side. The first report from Doctors Cooke and Vander Veer indicated little difference in the frequency with which the allergic condition was transmitted by either parent. But later Drs. Bray and Rowe reported a greater tendency for allergies to be transmitted through the female side of the family.
The data on this subject resulting from the survey con-ducted by the writer are interesting. In the allergic group of 231 students there was shown to be 32 allergic fathers, 30 allergic mothers and 4 cases in which both parents were allergic. Thus it may be said that these results tend to confirm the view that there is no difference between mothers and fathers in the tendency to transfer allergies to their offspring.
APPLYING OUR KNOWLEDGE OF HEREDITY
A large part of all of the foregoing information on the role of heredity in hay fever and other allergies is undoubtedly of interest to anyone with hay fever. But what is its purpose? Is it intended to warn you against having children lest they all turn out to be little allergics? Is it meant to give you false hopes that your six year old child will outgrow his asthma? Emphatically, no. We know that the choice of a mate will not be affected by our diagram of the transmission of hereditary traits. Nor will the size of any family be influenced by this chapter. We do not aspire to the role of prophet or family counselor. The latter function should rest with your private physician. Our purpose is to inform you of the cold facts in a warm manner, and after that you are on your own.
HAY FEVER IN OTHER RACES
Negroes and Hay Fever. In 1872 one of the first Americans to study the hay fever problem wrote that in all his experience he knew of only one negro person with hay fever. Twelve years later a London doctor told of a case of hay fever in a negro which he called a rarity. And so the erroneous belief came to be spread that hay fever among negroes was an oddity.
As late as 1928 a southern doctor wrote, “It (allergy) seems to be a disease of civilization, hay fever among negroes is rare.” Statements of this kind provided little comfort or solace to the unfortunate thousands of negroes in the United States who were suffering from hay fever at the very moment the assertions were being recorded for posterity. Each negro sufferer in his own mind must have bemoaned the fact that he was God’s chosen rarity. Some learned soon enough that they were not really a curiosity.
Allergists, serving in hospital clinics, readily learn that hay fever occurs frequently among negroes living in areas where hay fever is prevalent.
Contrast the 1928 statement with the fact that in 1916 a survey in Louisiana showed that there were thousands of negroes with hay fever in that State. The results of this study indicated that hay fever appears one third as often among negroes as among whites. But that survey was made in 1916 for only one State, and since that time no additional examinations have been made. It is our opinion that a wider and more intensive survey is needed before we can generalize about how often hay fever develops in negroes as against whites. Nevertheless we can be quite certain that hay fever is not a rarity or curiosity among negroes. In my own students I have encountered it very often.
HAY FEVER AMONG THE INDIANS
Did you ever see an Indian with hay fever? That is, a full blooded Indian? If you did, you have observed a rarity.
In seeking for knowledge on the presence of hay fever among races other than the white race, Dr. Thomen uncovered some rather interesting information. He received reports from seven doctors and four superintendents of Indian Agencies and Schools in the United States. The doctors and superintendents were in all cases in close association with the Indians for periods ranging from five years to thirty years. The reports showed that there were only six cases of hay fever ever noted among that entire population of Indians which may be conservatively estimated as numbering 75,000. And in three out of the six cases the Indians were of mixed blood. Furthermore, in these very same schools and reservations the white persons employed there frequently suffered from hay fever. Thus, if we can judge by this evidence, it would seem that-hay fever is really rare among full blooded American Indians.
Hay Fever Among the Chinese. A sneezing Chinese is perhaps an odd sight to some. But the oddity may be due to the fact that we see relatively few Chinese in the United States.
As for hay fever in the Chinese we have been unable to locate any surveys. A canvas of twelve allergists in New York has disclosed to us a total of forty Chinese patients treated for hay fever. This of course tells us little about the racial nature of hay fever in the Chinese. But it does in-form us that a number of persons of Chinese blood are definitely not immune to the effects of plant pollens in the production of hay fever in the United States.
Dr. Thomen cites a report that 15,000 Javanese East Indians and a group that he calls Chinese Malays in Sumatra, Dutch East Indies, are free of hay fever. But other Europeans and Americans who frequently visit these regions suffer from symptoms of hay fever.
If you are mathematically minded a bit of arithmatic may be of interest. There are about 10,000 Chinese in New York among a total population of 7,000,000. Judging the rate of hay fever to be about 5 percent, there should be a total of 350,000 persons in New York with hay fever. Of this number the Chinese need contribute only 500 to equal their total quota. Considering that we located 40 Chinese with hay fever by canvassing only 12 allergists in New York City (excluding any doctors practicing in the Chinatown district of New York) it seems that hay fever occurs among the Chinese in New York City as often as it does in the white race.
Hay Fever Among the South Americans. The “South American Way” includes hay fever. Although they do not always call it by the same name as we do, the South American people are affected in the same manner. In Uruguay for instance they have what they call “spasmodic sneeze” and “spasmodic coryza.” The term “coryza” means a cold in the nose in the medical language of any country. This “spasmodic cold” is probably their misnomer for hay fever just as we often misname early summer hay fever by calling it “rose-cold.” Recent investigations have shown the presence of familiar hay fever plants such as the ragweed, English Plantain, and Russian thistle all located down “Argentine Way.” As might be expected from the presence of these villainous plants, the Argentinians suffer from hay fever to the tune of about 200,000 people.
There are many areas in South America that report no incidence of hay fever among their inhabitants. In most instances, we may interpret this to mean that it is not the people who are immune but rather that the localities are free of irritating pollens. But before you decide to escape from your hay fever by traveling to South America you will do well to thoroughly investigate the conditions. And a letter from a friend is not sufficient. In 1928 a doctor re-ports the following reply from the Argentinian Minister of Agriculture, “Hay fever may be considered as being practically unknown in Argentina.” Now contrast this with Dr. Vaughan’s statement in 1939 that 2 percent of the population of Argentina suffers from hay fever.
Why We Study Racial Differences. From our review of the incidence of hay fever among the Negroes, Indians, Chinese and South Americans it would seem that racial differences in susceptibility to hay fever do exist. But be-fore we may speak with authority on hay fever conditions among strong peoples, carefully planned research is absolutely necessary. It is very apparent that our present knowledge of the occurrence of hay fever in other races is meager and flimsy to say the least. Nevertheless, we must continue to seek for it as an aid in understanding the entire hay fever problem.
Inquiry into the occurrence of hay fever in other racial groups is prompted by more than idle curiosity. The main purpose of such research is to aid in the discovery of the mechanism that leads to a person’s becoming allergic. You are probably thinking that we have already done this by learning that the ailment is transmitted through heredity. But nothing could be further from the truth. The knowledge that hay fever is hereditary merely represents one step in the solution to the problem. Investigation of conditions in other races is employed in the hope that it will shed some light on the nature of the blood chemistry which enables you to have hay fever while full blooded American Indians are relatively immune.
Any such knowledge could conceivably be used as a stepping-stone in learning the whys and wherefores of the very symptoms suffered by the hay fever victim. It is a strange paradox that we should know quite a bit about “what” is happening in your body cells and tissues during your hay fever spells, yet from a chemical or physiological standpoint we know very little about “why” it is happening.