Allergies

What is an allergy?


An allergy is an abnormal sensitivity or exaggerated reaction of the immune system to a substance, which, in the majority of people causes no symptoms at all. The substance that triggers the allergy is known as an allergen. Examples of allergens include tree, weed, grass, pollen, pet dander, insect venom, dust mites, mold, foods, latex, and drugs. The body’s immune system makes an antibody called IgE, in response to being exposed to an allergen. People with allergies, make IgE antibody that is specific for the allergen that they are allergic to, which then in turn can cause allergy symptoms. Symptoms associated with allergies are sneezing, itching, nasal congestion and drainage and are referred to as allergic rhinitis, or more commonly, hay fever. Eye itching and swelling are referred to as allergic conjunctivitis. Asthma, eczema, and hives can also be conditions associated with allergies.

How do allergies develop?


Genetics play a major role in the development of allergies. If one parent has allergies, a child has a 40% chance of having allergies. If both parents have allergies, the risk is even greater. Even though children may be born with a predisposition to develop allergies, they do not always develop the same allergies as their parents.

Allergies can develop at any age with symptoms occurring later in life.

Children with allergies are also more likely to develop asthma. It is estimated that 80% of children with asthma have evidence of allergies. Therefore, recognizing and treating allergies can have a significant impact on reducing asthma symptoms.

What should I expect when I see an allergist?


The allergist will conduct a patient history including an assessment of your symptoms, a relevant physical exam, and a thorough environmental evaluation. If the doctor feels it is important for your treatment plan, a skin test/allergy test may be done. You may be tested for a variety of allergens based on your evaluation. Common test include trees, grass, weeds, dust mites, animal dander, and foods.

What are the symptoms of allergies?


Allergy symptoms include:

  • Runny nose
  • Post nasal drip
  • Sneezing
  • Congestion
  • Coughing
  • Itchy / Watery eyes

Less common allergy symptoms include:

  • Headaches
  • Loss of taste and smell
  • Low productivity/Poor concentration
  • Fatigue
  • Sleep disturbances
  • Snoring

Allergies can interfere with your day-to-day activities and sleep. Allergies can result in loss of productivity, missed work or school, and an overall poor quality of life. Seeking the help of a board certified allergist is the key to treating your allergies effectively.

What is allergy testing?


Allergy tests, combined with the knowledge of your allergy specialist to interpret them, can give precise information as to what you are or are not allergic to. Testing done by an allergist is safe and effective for adults and children of all ages.

1. Skin prick test

A skin prick test, also called a puncture or scratch test, checks for immediate allergic reactions to as many different substances at once. This test is usually done to identify allergies to pollen, mold, pet dander, dust mites, and foods.

Allergy skin tests are not painful and you will not bleed from testing. Most patients experience nothing more than a mild to momentary discomfort.

The nurse draws small marks on your skin. He or she will then lightly scratch the skin on the back with a small plastic device. After 15 minutes the sites are examined to determine if you are allergic to the substance. Positive reactions will resemble a mosquito bite in size. The reaction may itch, but will subside quickly.

2. Intradermal Skin test

You may need a test that uses a needle to inject a small amount of allergen extract just under the skin on your arm. The injection site is examined after about 15 minutes for signs of an allergic reaction.

Blood tests called RAST may be performed when skin testing cannot be done due to medications or skin conditions. Results are not available immediately as it generally takes a week or more to obtain results of RAST testing. Which tests are better, skin or blood?

Allergy skin testing is the most accurate and preferred method of evaluating allergies. These tests are safe, minimally invasive, and easily interpreted. Blood assays or RAST may present the clinician with diagnostic challenges. Studies have shown variability between different labs so that results can be difficult to interpret. Blood tests also may have decreased sensitivity compared to skin testing. Depending on the individual patient, more than one type of test may be utilized for an accurate diagnosis.

Treatment


When it is found that an individual is allergic, therapy is began with the purpose of making symptoms less severe and occurring less frequently. Generally three modes of therapy are utilized:

ENVIRONMENTAL CONTROL
Avoidance and elimination of the offending allergens are the ideal solutions in helping the allergic person prevent the occurrence of symptoms. Unfortunately, many allergens, such as pollens, house dust, and molds cannot be completely avoided. However, when specific allergens in the environment produce symptoms, these allergens should be eliminated. Specific methods of environmental control are described on separate forms.

MEDICATION THERAPY
Antihistamines, decongestants, bronchodilators, etc., are useful in the treatment of allergy, asthma, and other allergic disorders. It is best to start medication at the first sign of your symptoms, rather than waiting until the symptoms are severe and more difficult to control. Thereafter, medications should be taken regularly, as prescribed, as long as your symptoms persist. If new or unusual symptoms occur, consult your physician.

IMMUNOTHERAPY
The purpose of immunizing injections is to make one less sensitive to unavoidable inhaled substances such as pollens, dust, and/or mold spores. These injections offer the only means by which the degree of sensitivity can be, in time, diminished. This therapy consists of injections. In most cases, the treated patient gains a resistance to the allergens, so that allergic symptoms are decreased or eliminated. The duration of extract injections depends largely on your progress. Generally, it is advisable to continue the injections for a minimum of three to five years, and go through six to twelve months essentially free of symptoms before stopping injections. Initially, allergy injections should be given twice weekly (unless otherwise indicated) for approximately three and one half (3 1/2) months. After this, they may be given every one to four weeks as determined by the benefit you receive from the injections.

TIPS FOR ALLERGEN AVOIDANCE:


DUST AND DUST MITE AVOIDANCE

  • Wash all bed linen (sheets, pillowcases, blankets, mattress pads, bedspreads, and comforters) in hot water (130 degrees) at least once weekly. Warm and cold water do not kill dust mite allergens.
  • Select blankets and comforters that withstand the rigors of hot water washing. (Down comforters should be avoided, especially if allergic to feathers). There are products available that may be added to your wash that will allow you to remove dust mite allergens in all water temperatures. These products may be purchased from companies in our information packet.
  • Encase pillows and mattresses in zippered allergen-impermeable encasings. This prevents the allergens from escaping, decreasing the amount of inhaled allergen exposure while sleeping. If covers are not purchased, you may wash pillows in hot water at least every two weeks. Note: When a product is labeled “hypoallergenic” or “non-allergic”, it means that the materials used to make the product have been shown not to cause allergic symptoms. However, these products will support dust mite growth and are not dust mite barriers.
  • When possible, you should replace upholstered furniture with leather, wood, plastic or vinyl. Any items in your home made of fabric are a reservoir for dust and dust mite allergens.
  • If possible, carpet should be removed from your home. Wood, tile, and linoleum are easier to keep free of dust. This is not always possible because of the expense. In this case, you should vacuum carpet at least twice a week. Use a vacuum cleaner with a HEPA filter. You may also need to wear a mask while vacuuming. Leave a room that has been vacuumed or dusted for at least 20 minutes to allow airborne dust to resettle. It will help to dust and dust mop using a damp mop or cloth to keep airborne dust to a minimum.
  • Products may be purchased that can be sprayed or dusted onto the carpet, upholstered furniture, blanket, comforters, and draperies that will neutralize allergens rendering them non-allergic and harmless. These treatments last about two to four months.
  • Heavy curtains are other good sources of dust collection and should be avoided. Shades or washable curtains are recommended.
  • The humidity level should be kept below 50% because dust mites thrive at high humidity levels.
  • Furnace filters should be checked and cleaned or replaced as needed. You may purchase special vent filters to cover your vents to clean the air before it enters your room. HEPA air cleaners may be used to remove dust allergens from the air.
  • Keep rooms, especially your bedroom as clutter free as possible. No stuffed animals (except those that can be washed in hot water) and wall hangings such as pennants or posters that tend to collect dust.
  • For stuffed animals or pillows that cannot be washed in the washing machine, you can place these items in a zipped-lock bag and place the bag in the freezer for 24 hours to kill the dust mites that may be present in the items.
  • Keep clothes and books in drawers or in the closet.

MOLD AVOIDANCE

  • Molds are found outside in the air, in fallen leaves, cut grass, compost piles, rotting wood, barns, mulch, and in most areas that do not see much sun. Indoor molds can be found thriving in dark, warm, humid areas, including bathroom walls, shower stalls, tile grout, pillows, mattresses, under carpeting, unwashed clothes, refrigerators, air conditioners, humidifiers, plant soil, concrete, garbage cans, and damp basements.
  • Reduce the humidity level in your home to below 50% by using your air conditioner or a
    dehumidifier. Humidity gauges may be purchased at home improvement stores.
  • Most surfaces can be cleaned using a 10% bleach solution that will kill mold and inhibit growth temporarily. There are some non-bleached formulas that may be purchased. There are also mold inhibitor products that may be purchased from companies in our allergy information packet that we provide.
  • Steam cleaning carpet is not recommended. Moisture may be trapped in the carpet padding and will create a haven for mold growth.
  • Wear a mask when mowing the lawn, raking leaves, gardening, or working in damp basements.
  • Do not hang clothes outdoors, as this will attract airborne mold spores.
  • Moist soil in houseplants can grow mold. You can prevent the mold spores from becoming airborne by placing a 2-inch layer of pebbles or small stones over the top of the soil.
  • Do not use a humidifier unless your humidity is below 25%.
  • It is recommended that you change your pillow once a year. Buy pillows that resist mold growth such as polyester filled pillows. Foam rubber pillows are not recommended.
  • There are some foods that may cause increased symptoms in mold sensitive persons. These are listed in information packets that are given to patients after the skin tests are completed. Patients do not have to avoid these foods entirely. They just need to be familiar with these foods and avoid them when they are having increased allergy symptoms. They may be able to tolerate these foods in moderation.

PET AVOIDANCE

  • The most effective treatment for alleviating pet allergies is, of course, finding another home for the pet. Some people are not willing to part with their pets even if they are allergic. We therefore provide information to help decrease allergen exposure as follows.
  • Keep your pet out of your bedroom and off of the furniture.
  • Remove carpeting or spray with a denaturing solution to deactivate pet allergies.
  • Use a vacuum cleaner with a HEPA filter. Pet allergens can pass through standard vacuum cleaner bags.
  • Use efficient vent and furnace filters to prevent allergens from being circulated through the duct system.
  • Use of air cleaners can help filter some of the pet allergens from the air.
  • “Swiffer” brooms are good for cleaning up pet allergens from floors, and the cloths can be used for dusting furniture.

Allergies can be the underlying cause of frequent sinus, ear, and upper and lower respiratory tract infections. Untreated allergies can even exacerbate or cause asthma; The Academy of Allergy, Asthma and Immunology states “approximately 80 percent of all asthma in children and half of all asthma in adults are caused by allergies.”

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