Asthma can be tricky for a doctor to diagnose, especially in young kids. Symptoms can mimic other diseases and spirometry, the breathing test to diagnose asthma, requires the patient be able to breathe into a tube, which isn’t possible for most small children.

“The hypothesis has been that people with airway disease will have different metabolism compared to those without disease,” says Dr. Darryl Adamko, head of pediatric pulmonary medicine for the Saskatoon Health Region.

That is, the chemicals in their urine will have a unique compound that could be tested for. His team, based at the University of Alberta where he used to work, is using a technology called nuclear magnetic resonance (NMR) and they believe they have pinpointed what the metabolism of an asthmatic looks like in urine.

They are now working with groups in the United Kingdom and Canada to see how well testing urine for this compound predicts asthma. (Adamko is also testing the theory with COPD, bronchiolitis and allergic rhinitis.)

The researchers are still trying to recruit groups large enough for a robust study, but based on the early results, “it does look like it can differentiate asthma versus COPD or asthma versus no asthma,” says Adamko.

The pediatric respirologist hopes this test will do more than just diagnose. “As you get sicker, your metabolism changes,” he says. That means if someone comes into a clinic or hospital with asthma symptoms, a urine test could tell doctors whether the symptoms will get worse. While Adamko is optimistic his team will be successful, he says it’s at least five years before such a test is used in common practice.

First published in Allergic Living magazine.
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I’ve been going back and forth on the subject since the day he was born. It might have even started before. But the question of when, if ever, to test Judah for nuts continues to plague me.

As a bottle-fed baby (forgive my surgically reduced boobs), my second born showed obvious signs of a milk allergy almost immediately. His vomiting, coiling, tensing up and inconsolable crying during and after every feeding, accompanied by major bouts of diarrhea, caused me to switch him to a soy-based formula before he was three weeks old.

When I saw a slight but noticeable change in his reaction, I stuck with it, 87 per cent convinced that it was a milk allergy. My pediatrician was right behind me.

He did, however, point out that Judah, who was by now a year old, could be facing any number of other issues. This was hopeful, if not convincing. I finally set up an appointment to take the little stinker to our allergist to be tested for cow’s milk allergy. This was almost eight months ago, and the week leading up to the appointment remains vivid in my memory. I struggled hard with that irreconcilable question over whether or not to test for nuts at the same time.

I wanted to know so badly that he that he wasn’t allergic to peanuts and tree nuts like his big brother Lucas, but I didn’t have – and don’t yet have – the emotional wherewithal to deal with the bad news. I’m just not ready. There’s also something blissful about keeping the possibility open to him being free of any nut allergies.

And what if I sensitize him? No allergist will deny that testing could do that. Granted some don’t subscribe to the theory, and current research suggests early exposure may in fact reduce the likelihood of sensitivity to key allergens. But that pendulum continues to swing. When Lucas was first diagnosed almost 3 1/2 years ago, our allergist preferred to wait out exposure for as long as possible, especially for someone who could be genetically predisposed.

So other than the prospect of discovering that little Judah is not allergic to the usual suspects, which would make me the happiest mother in Canada, why risk it?

This is a kid who lives in a nut-sterile world, who has more EpiPens and antihistamines at his disposal than you can possibly imagine (OK, if you’re reading this you can imagine). He’s not in daycare or school, and everyone around him is thoroughly trained to deal with an anaphylactic emergency.

I explained all this to our dear allergist, who looked at me quizzically as if he’d never heard this perspective before. The pomp in his voice was also starting to make me feel idiotic. So I gave him the old journalistic silent treatment, the one that gets people to talk more than they intend. Sure enough, all of a sudden he started to tell me that there is evidence to suggest early testing can cause sensitization, and that I have to do what makes me most comfortable.

He brought himself to agree that Judah lives a low-risk lifestyle, even though he’s considered high risk for anaphylaxis given Lucas’s group of life-threatening allergies. It seems that, with an allergic sibling, his chances of having a serious food allergy was greatly increased. And so I agreed to test him for milk and to decide after that how I felt about further testing. Honey was on side to do whatever I wanted for our little son, of course.

Prick, scratch, prick …. Within 30 seconds I saw the welts forming. Honey was holding Judah with his bare back toward me, and the doctor was by now out of the room. My eyes began to well up as the spots grew. That little shadow of hope that was keeping me afloat for so long was all of sudden replaced with this glaring, unequivocal reality. Right there in the centre of those blossoming blemishes, my presumptions had turned to scientific fact. No matter what I thought or felt before, it hurt like a stake in the heart.

Honey, was unfazed. “You knew it. You’ve known it all along,” he kept saying, which was cold comfort (and made me want to stick a stake in his mouth just to end the added torture he was inflicting on me).

The doctor returned with a sympathetic look on his face. Words weren’t necessary. He knew I knew. As a courtesy he asked if I had any further thoughts about testing for the nuts, to which I quickly responded, “absolutely not!” I didn’t have to confer with Honey nor would he dare contradict my position on our kids’ allergies, as it goes in our life. And that was the end of that.

We were booked for a follow up eight months later – at which time we could revisit the big question. That was last week’s appointment. We conveniently cancelled.

Still, there isn’t a week that goes by I don’t wonder, contemplate and even fantasize about getting the verdict on Judah. And just when I forget about it for a day, someone will ask, “is he allergic to nuts too?”

My answer? “We treat him like he is.”