A Guide to allergies and Asthma
by Joel Laury, MD - Board Certified Allergist and Immunologist
Section 1
Introduction
First of all, I am not giving out medical advice. Trust me, every single person is very different, and I would never suggest that ‘one size fits all.’ This blog is a collection of my thoughts on allergies, after over 25 years in practice. I hope this may help you in some way, but this can never replace a well trained physician looking at you individually.
Warning – the reason that specialist physicians exist is that many diseases are too complicated for a general doctor to know everything about everything. So don’t assume, just because you read this, that you can treat yourself without expert input.
Second of all, the general approach to any medical problem is first to get a good history. Listen well, and do not bend to the facts to suit your preconceived notions. Keep your mind open to all possibilities. The next step may often be a physical examination. Is there a rash? What does it look like, where is it? Are there abnormal heart or lung sounds? Finally, testing might be done. If you suspect allergies, then allergy testing may be needed. Worried about pneumonia? You may need an X-ray. History, physical exam, then testing if needed. Once you have an idea what the problem is, then you can decide on treatment. You can’t skip any steps.
Section 2
Allergies - Who is Getting Them?
Allergies: It used to be a punch line in jokes - oh, I am allergic to homework, or to Sally, or to whatever. Allergic diseases used to be unusual. Not any more. The number of people with allergies has increased tremendously over the past century or so. Asthma has literally become an epidemic. Food allergies are so common now that airlines and schools have written policies about how to deal with these issues.
Up to one quarter of the US population may have had some kind of allergic disease at some point in their life. I feel that those people who don’t take allergies seriously are those who don’t have allergies. Allergies can be a big deal, and some can even be life threatening. Treating allergies can ‘add years to life and life to years.’
We all know of someone with allergies. It could be the kid at school, who may use up an entire box of tissues every day. Maybe this is your best friend, who can’t come over to your house for a meal, afraid that he could end up in the emergency room if he eats peanuts. This could be your co-worker , who scratches her arms and legs all day long. You may not realize that the person in front of you is allergic to penicillin. Your new neighbor may be severely allergic to bee stings.
Recent data suggests that at maybe 50 million Americans have some kind of allergy. And the numbers have been increasing steadily for over a century, with no clear end in sight. Why? And what is an allergy?
Section 3
What Are Allergies?
Let us start at the beginning. The general idea of allergy is that your body is reacting against something it should not. You are set up to fight against germs, parasites and other invaders to prevent them from harming your body. So it makes sense that if you breathe in something bad for you, you sneeze, to get rid of it. Your nose gets stuffy, so that you don’t breathe any more in. Your nose runs, to wash everything out. An itch tells you that you are exposed to something bad. These are normal reactions, and important for your body.
An allergy happens when your body reacts to an allergen. (An allergen is anything that causes your body to react with an allergy.) This is anything that you normally should not fight off, as it is not a germ or parasite or virus. Common allergens include medicines, pollens, foods, pets, dust mites and molds. The point is that your body reacts to the allergens as if it were a foreign invader. When the body fights this off, you suffer ‘friendly fire.’
Section 4
The Scientific Explanation to - What is an Allergy? - Scene I
If you don’t like long scientific explanations and big words, you may want to skip the following part. But I think it is important to explain.
The first step in an allergic reaction is recognition. Your body’s immune system sees something and declares ‘this is foreign; this is not good.’ (Kind of like a fighter jet has “IFF” – identify friend or foe.) This does not happen the first time you are exposed. That is why I always hear ‘How can I be allergic to penicillin? I have taken it twenty times before, with no problem.” The answer is that this is the only way you can become allergic. If you have never seen it before, you don’t make an allergic response. If that is that way your body’s immune system is, and you are exposed in the right way, your body now recognizes this allergen as ‘foreign,’ and prepares to fight it off.
This may take as little as one week to recognize an allergen, or can take years. Certain allergens are more likely to trigger an immune response than others. Among foods, peanuts, tree nuts, eggs, milk, fish and shellfish commonly cause allergies. Rice and lamb, on the other hand, are less common allergy triggers. People are often allergic to cats and dogs, but usually not to reptiles or amphibian pets.
Once your immune system decides that an allergen is a problem, it sends a message through chemicals (charmingly called IL-4, IL-5, IL-13 and others) to do something about this. One of the first things that these chemicals do is to make an antibody called immunoglobulin E, or IgE. IgE is one of 5 types of antibodies your body makes. More about that later. IgE does nothing, floating around the body. IgE attaches to cells called mast cells. They act a little like floating mines. As long as no one touches them, they are fine. But, if an allergens meets up with an IgE attached to the mast cell (actually two, but it doesn’t matter), watch out!
Section 5
The Scientific Explanation to What is an Allergy - Scene II
The mast cell explodes! The fancy word is degranulate. A lot of chemicals, already stored in the mast cell, come out. These chemicals include histamine, and tryptase, and the list goes on. It seems that every year, scientists find new ‘preformed mediators’ (chemicals stored in the mast cells). These chemicals lead to an ‘immediate reaction.’ In the skin, they cause redness, swelling and itching. This is called urticaria (hives) and angioedema (swelling). They can make the eyes itchy, red and burn. They lead to a stuffy, runny, itchy nose, and you may sneeze. In the lungs, the muscles tighten up (‘bronchospasm’), and produce mucus and fluid, leading to difficulty breathing. In the gut (GI tract), nausea, vomiting, diarrhea or stomach cramping may occur. If enough histamine is released in the blood stream, it can lead to heart attacks, from the blood vessels in the heart tightening up; the blood pressure may drop to dangerous levels, from the blood vessels in the rest of the body opening up. The same chemicals can cause different reactions, depending on where and how much is released.
But wait, there’s more! As if that wasn’t enough! The mast cell then starts making ‘newly formed mediators,’ making matters worse. They produce prostaglandins, interleukins and other chemicals. These may cause the body to have the same reactions as preformed mediators; in addition, they cause the body to produce more IgE, mast cells, and other cells involved in allergy, such as eosinophils or basophils. The point is, this makes sense. The IgE on mast cells act as a sentry. When an invader is noticed, first there is a counterattack (histamine and company). Afterwards, longer lasting, stronger reinforcements are brought in (eosinophils, basophils).
Believe it or not, that is just the bare basics. What I find with immunology is that whatever I understand, there are another ten layers underneath of even more complicated stuff going on. And then, the next year, even more stuff is discovered. And the funny thing is, nowadays, all of this incredibly complicated stuff is becoming important!
Section 6
Why Are Allergies Increasing So Much?
Obviously, it is not genetic. Our gene pool has not changed in the past century, but the number of people with allergic diseases have significantly increased. When one or both parents have allergies, the risk is much higher in the children. Still, many children have allergic diseases, yet neither of their parents do. So why the increase in allergic diseases?
Short answer, we are not sure. There are a lot of good theories out there, and some may be partially true. One of my favorite theories (I did not come up with this) is called the hygiene hypothesis. Children growing up in ‘third world countries’ have very few allergic diseases. When East and West Germany were reunited, the people living in the ‘clean sanitary modern’ West Germany had significantly more allergies than those growing up in East Germany. Children who grow up on farms, or have older siblings, are less likely to have allergies. Children born through C-section have a higher risk of developing allergic diseases.
The theory that puts this all together, is that we need to be exposed to dirt and germs for our immune system to develop normally. If we are not exposed to the right amount (and type) of germs early on, then the immune system stays in the ‘immature’ stage, and does not mature enough to ignore allergens and to treat them as innocent bystanders. Since we have become so much more germ free over the past century, that may be why more people have allergies. There is a fascinating idea out there (not ready for prime time, in my book) that one can give people with allergies, or certain other diseases, parasitic infections. The suggestion is that this decreases allergic or autoimmune diseases by resetting the immune system.
Of course, a century ago, we did not have wall to wall carpeting (which increases dust mite exposure). We had fewer indoor pets (increasing pet dander exposure). We did not sit down and watch TV or computers all day long (which stops us from taking as many deep breaths as we should, maybe increasing the risk for asthma). In addition, there really was no replacement for breast milk for nursing infants (as breast milk may decrease the risk of many diseases, including allergic ones).
Section 7
When Can I Get Allergies? The Allergy March ?
Allergies can affect anyone, at any time of their life. Yet, certain kinds of allergies are more likely at certain times. Very young children are more likely to have atopic dermatitis (more about this later) and food allergies. Many may outgrow these problems, eventually. Others, as they get older, may get allergic rhinitis and conjunctivitis (don’t worry, I’ll explain the big words soon). They may later develop asthma. Medication allergies, on the other hand, are more likely as we get older. Have I seen 70 year olds with rhinitis for the first time? Have I seen a 6 year old with penicillin allergy? Of course I have. Sure, any allergy can happen at any age, but this is the usual way things happen.
This is called the ‘allergy march.’ Young children may get atopic eczema. Fascinating studies suggest that the skin barrier is the problem. When food gets onto that damaged skin, your body is more likely to develop an allergy to that food. If newborn skin is very carefully kept moisturized, the rate of atopic dermatitis is lower. Not only that, but food allergies are much less likely to occur, according to many studies. In one study, not one child getting moisturizer developed an allergy to any food! The idea is that food is supposed to be eaten. When you eat food, your body says ‘Okay, this substance is a food, I won’t react to that.” That is called oral tolerance. If the food is first seen through broken skin, the immune system is more likely to think of that food as ‘foreign,’ and fight against it.
Recent studies show that eating peanuts early, at four to six months of age, protects against peanut allergy. If your child waits until he/she is two or three years old before eating peanuts, the risk of peanut allergy may be ten times higher! This may also relate to having the body exposed to peanuts first as food, rather than getting peanut butter on the skin.
Section 8
How can you tell if someone has allergies?
The medical term for allergy is atopic disease. This includes allergic rhinitis and conjunctivitis (hay fever and rose fever), asthma, atopic dermatitis, medicine allergy, insect sting allergies, and similar problems.
Let’s start off with allergic rhinitis, ‘hay fever’ or ‘rose fever.’ Generally, you don’t have a fever, but you can feel lousy. Sometimes you can see that someone has allergies by the way she looks. He may sneeze or have a clear runny nose. She might have circles under her eyes, called allergic shiners. (I remember that I had to write a note to school about one young girl, explaining that she had enough sleep, her mother was taking good care of her, and the circles under her eyes were from allergic rhinitis.) Sometimes, he may have extra folds under their eyes (called Deny-Morgan folds). She may breathe through their mouth.
With atopic dermatitis, you may see patches of eczema (scaly red rash), especially in the folds of the elbows and knees and dry skin. You may notice bumps on their skin, which look like goose bumps or chicken skin. These are usually found on the outer arms, legs, cheeks or backside. Called keratosis pilaris, they occur because when the skin is so dry and thick, that the hair follicles under the skin are unable to come out.
With asthma, you may notice that these people have a hard time breathing out, and you might hear wheezing or coughing.
A common question is how you can tell if you suffer from a cold, or allergic rhinitis. This is not easy, and people get the two confused. If you note a ‘cold’ every pollen season, maybe that is not an infection, but allergies. If you feel terrible every time you cut the grass, or rake leaves, blame that on allergies. If everyone in your household is sick, and you get a runny nose and sneeze, that sounds more like a cold (virus).
Section 9
Allergens
Okay, enough with the heavy lifting for now. What can you be allergic to?
In short, just about anything. However, some are allergens are more common than others. Grass pollen is most common cause of allergic rhinitis. Allergens which cause rhinitis (stuffy, runny, itchy nose and sneezing) are usually pollens, animals dust mites, cockroaches, and molds.
People can get a rash, since they are allergic to their own sweat! Different types of allergies include people allergic to sunlight; some are allergic to Benadryl, or to steroids and other medicines used to treat allergies. One common allergic condition is urticaria (hives). (More about this later.)
Sometimes this may continue for months or years, and no trigger can be found.
Years ago, in England, researchers drew blood from people with hives, and then skin tested them with their own serum (part of the blood). Many people had developed hives where they were tested, showing that they were allergic to themselves!
Section 10
Difference between allergies and irritants. Problems that appear to be allergies but are not.
Think about if you burnt your arm. The next day, a little warm water will hurt. You are not allergic to the water, but because of the damage to your skin, you are more sensitive to something that normally would not bother you. So too, having allergies will make you more sensitive to irritants which may not bother others as much.
In the same way, perfumes may cause sneezing, headaches, or even severe asthma. You may not be allergic, but the irritant may be enough to cause a bad reaction. So first of all, allergens are really out there. If you have allergies, you may be even more sensitive to irritants. However, these can also bother you, even if you don’t have any allergies.
When your body notices an allergen, it quickly reacts. That is why most allergies are called ‘immediate type hypersensitivity.’ Within 15 minutes, more or less, you notice symptoms.
Let me tell you one of my favorite stories. In the 1990s, an article was published about en epidemic of asthma in Barcelona, a port city in Spain. On many occasions, the ERs would be full with people with severe asthma. No matter how hard they looked, the doctors and scientists could not figure out why. It wasn’t any particular time of year. Neither weather patterns nor pollution levels were causing this. Testing did not show that these people were allergic to the same allergens, and many were not allergic to anything tested.
Finally, after a lengthy investigation, the culprit was found. On certain days, soybeans were being unloaded from the docks into silos. One of the silos had a crack, and the soybean dust ended up in the air, throughout the entire city. When the epidemic asthma patients were tested, most of them were allergic to soybean.
What is my point? There are at least three possible reasons why someone may appear to have allergies, but testing does not show anything. First of all, we could be stupid. That is the point of the Barcelona study – if we are not looking for the right allergen, we will, mistakenly, say that you are not allergic.
Another possibility is that many allergens can trigger the immune system to react, even without using the classic allergy pathway. For example, there is a disease called vernal conjunctivitis. It usually involves boys age 5 to 15. During the spring pollen season, their eyes get very itchy, red and watery. Allergy testing is negative. If you were to challenge these people exposing them to pollen, their eyes react. The cells involved are eosinophils, not mast cells. Similarly, some bacteria produce a chemical called endotoxin. People who breathe this in may develop significant immune responses, including asthma, but this bypasses the whole allergy pathway, yet still leads to major problems. The thinking is that another pathway, called toll like receptors (TLRs), is involved.
There is a third reason that some folks get a runny nose, asthma, or other ‘allergic-type’ reactions, without being allergic. They still feel the same, whether exposed to allergens or not,. These people have ‘non allergic’ rhinitis. We don’t completely understand why, but we do know that allergies have nothing to do with their symptoms. With them, I still recommend avoiding exposure to allergens, as this may prevent them from developing allergies. In addition, their partners or children or others who share their environment may benefit significantly. And of course, avoiding common allergens may prevent the immune system from being directly activated.
Section 11
Allergic rhinitis and the ‘Cat Paradox’
Many types of non allergic rhinitis exist. The most common cause is infectious rhinitis, also called the common cold. Vasomotor rhinitis is another frequent type of non allergic rhinitis. Here, when you feel cold, or go from a hot to a cold environment, you sneeze and your nose runs. Large meals may trigger a similar reaction (gustatory rhinitis). Hypothyroidism (a low thyroid condition) or certain medicines, including beta blockers (used to treat high blood pressure), may lead to stuffy nose. . Many people sneeze when they go into the bright sunlight (photic reflex).
Cat paradox – I don’t think any one understands this yet. I see this all the time. A child is living happily in a home with cats. The child then leaves for college. When she comes back to visit, she feels awful! She may notice rhinitis, and/or asthma symptoms, which disappear when she leaves home again. What happened? Studies show that cat owners with more exposure to cats become desensitized to these animals, almost like receiving allergy shots/drops. (The more cats, the better off the owners are.) This protection is only temporary. When they leave this environment (for example, they go off to college), their allergic sensitization soon come back. When they come home, they are exposed again to cat allergen, and they may suffer a bad reaction. No one understands why this happens, and only with cats, no other pets or allergens. (Fun fact – people who are allergic to cats are also allergic to lions and tigers.)
Section 12
Allergens – pollen, dust, pets, molds, dust mites, vermin
Okay now that we know you can be allergic to anything, what are common allergens? Let’s start with pollens. Pollen is microscopic. Plants can pollinate to create seeds in two ways. One way is using insects, like bees and butterflies. These plants tend to produce beautiful flowers, to attract insects. They only need to produce a little pollen, since the insects will carry the pollen to other plants for them. In general, these do not cause many allergies, since there is so little pollen around. (I have seen a lot of patients complain that they feel worse near lilacs, lilies, or other strongly scented flowers. I wonder if this may be from the perfume irritating their nose, more than the pollen.)
Other flowers are not insect pollinated. (Get ready for it – anentimophilous – an meaning not, entimo meaning insect, and philous meaning loving). These have small flowers that we may not even notice. They include many trees, grasses and weeds. To ensure the next generation, these plants produce large amounts of pollen. When we go outside, we have significant exposure to these pollens, which can trigger allergic reactions.
Different plants live in different parts of the world, and the same plants may pollinate in different times of the year, depending on the local climate. In the northeast US, trees may start producing pollen from late February until the end of May. In Florida, they start to produce pollen in the middle of the winter. My poor snowbird patients suffer in Florida in the winter with the pollen there, and then come back north just in time for the pollen season here.
The grass pollen season may be in May and June in the northeast; the summer and fall sees more weed and ragweed pollen. There are all kinds of interesting names for the weeds, including pigweed, ragweed, English plantain, mugwort, chenopod and dock. Across the US there are many types of ragweed, including giant ragweed, short ragweed, and false ragweed. The point is that pollen can be found all over, except for certain deserts. Ragweed pollen has been found one hundred miles away from the shore, at the ocean. So even if your yard is perfectly weed and grass free, you still suffer allergies from the plants one block away, or a few miles away. Patients have told me that when they move to a new environment, they do well for a few years, before developing allergies to the pollens found in their new home.
Section 13
Dust - Pet Dander
Of course you can be allergic to your house dust. But we don’t test for dust (anymore). Why? Because dust varies so much from one house to another, so testing may miss important allergies if you are testing for the wrong dust. House dust contains human skin, dust mites, cat and dog dander, and Alternaria mold, as well as other ingredients. I test for these, individually. This means that if someone is allergic to any of these allergens, they should improve by decreasing their exposure to dust at home. Even if there has never been a cat or dog in the house, there is cat and dog dander in the house dust, according to many studies.
I hear a lot of people complain about road dust, when they live near highways, or when road work is being done nearby. This is different than house dust, but can still cause problems. Car exhaust fumes, diesel exhaust fumes and other pollutants can make asthma and rhinitis worse. People who live close to major highways have high rates of asthma (and heart disease, too).
Forced air ventilation can stir up a lot of dust. Even when the ducts are cleaned, the dust comes back quickly. I remember one schoolteacher whose desk was right by the air ducts. Every day at school, she had a stuffy and runny nose, due to this. She finally slipped a janitor twenty dollars to place a filter on the outflow, and she felt almost completely better. Putting a filter in the basement, where the air goes in, is a good idea, but a lot of dust can collect in the rest of the system, so we usually recommend using a filter (or cheesecloth) right where the ducts vent out into the room.
Vacuuming can stir up more dust. We recommend special vacuum cleaner bags with filters, to stop the fine dust from going through the bag back into the room, causing allergy symptoms. You can use the special HEPA vacuums as well, but they are expensive. When dusting, you should use a wet rag, or a spray that won’t let the dust go into the air, since that can cause allergy problems as well.
Animal dander is another common allergen. A couple of interesting facts about this. Around 99% of American homes have cat and dog dander in their dust. This is true even if no cat or dog has ever lived in the house. And these levels of pet allergen are high enough to cause allergies in people living there. Why? People with pets have a lot of dander on their clothing. When they go outside, that dander goes into the air, into the dirt and mud. The people without pets then bring that dander back into their own homes.
A study a few years ago looked at schoolchildren without pets, and the amount of cat and dog dander in their home. When they had many classmates who owned pets, they had much higher levels of animal dander in the home, as compared to children who had fewer classmates with pets.
Section 14
Molds & Dust Mites
Molds get a lot of publicity. The whole ‘toxic black mold’ (stachyhbotris) controversy may be less clear cut than reported. However, there is no question that there are thousands of types of molds, indoors and outdoors, that we are all commonly exposed to.
The common ones that can cause allergies include those with names like Aspergillus, Alternaria, Penicillium and Cladosporium. Penicillium is that common blue/green mold you may find if you leave bread or fruit around too long. (Although it is related to the antibiotic penicillin, I have seen people allergic to one and not the other.) Alternaria is found indoors in house dust, and also outdoors, especially in the fall, when the leaves fall off the tree and start rotting. Aspergillus niger is the black mold you may see around the shower. Aspergillus, although found indoors and out, is used commercially as well. Aspergillus oryzae is used to ferment soy beans, to make soy sauce.
When patients are concerned about mold exposure at home, there are two important things I let them know. If you are doing a mold count, the most important part is to measure indoor and outdoor levels at the same time. If the outdoor count is the same or higher than the indoor count, then you can not blame the building that you are in for you symptoms. In my experience, over 90% of people who complain of allergies near visible mold are not allergic to molds. However, then are usually allergic to dust mites, which thrive in damp conditions where mold grows.
Dust mites are microscopic creatures that can cause a lot of allergy problems. They eat dead human and animal skin. (Their Latin name is dermatophagoides; derma means skin, and phagoides means eating). They eat the dead skin that we all produce, and then excrete it with enzymes. So really, then digestion takes place outside of their bodies. They then eat that digested skin (called coprophagia – don’t ask) and are able to survive on this. You actually are not allergic to the dust mites, but to their feces. These particles are relatively large. This is important since this means that dust mite allergens tend to be on soft objects, such as pillows, blankets, clothing, carpets, upholstery and stuffed animals. They are not in the air for long. Covering pillows and mattresses is more effective than air purifiers for dust mite allergies. Even brand new clothing may be full of dust mites. I have seen people get hives from a new sweater, and the only allergy he had was to dust mites. Many of my patients who worked in retail clothing sales also note significant allergy symptoms from new clothes. Even if you buy a new mattress, within several months it is full of dust mites.
Dust mites need water to live. The only place that they can get water is from the environment, usually the air. So, the more humid a place is, the more dust mites you may have. That explains why avoiding humidifiers helps, because dust mites die off if the humidity is less than 40%. (Of course, if the air is too dry, you may be miserable from this too. Therefore, humidity should be below 40%, but above 20%). Humidifiers may have molds growing inside them, which they put in the air with the moisture, and may cause problems as well. We usually recommend keeping the bedroom somewhat cool, around 60 to 65 degrees. In winter, the relative humidity will not be so low, and so while the absolute amount of water in the air may be low enough to kill off dust mites, people won’t feel uncomfortably dry. Keeping the windows open a crack in the winter may feel better, for this reason.
Basements are generally damp, and so are usually full of dust mites. I recommend against living in the basement. Carpets in the basement are even worse, since the dust mites live in carpeting.
Different areas of the world have different mites. There are tropical dust mites (Blomia tropicalis), storage mites, mites found on plants, and the list goes on. Here, I am focusing on the usual dust mites that live where I practice, in the northeast US.
Section 15
Feathers and Dust Mites Continued
Several years ago, a noted allergist and researcher sat next to me at a conference. I had a great time, since he spent so much time disagreeing with every word the lecturer said. After the lecture, I asked him a question. I told him that we all knew the story of a king of Scotland who suffered from severe asthma, which improved when his physician got rid of his feather pillows and comforters. So we know that feather or down has a lot of dust mites living in it. However, he had just published a study showing that feather pillows had fewer dust mites than standard pillows.
He first told me that he had known for years that everything that he had learned in medical school was a lie. Only recently did he realize that everything he taught in medical school was also a lie. He explained that modern feather and down pillows have thick ticking (covering the stuffing). Since dust mites can’t go into or out of the stuffing, so they are less of a problem. The old time feather pillows, however, are still full of dust mites, and should be avoided.
Many years ago, I was presenting at a hospital grand rounds. One of the doctors there asked if you can be allergic to a beard. He mentioned a patient. She started complaining about allergies when her husband grew a beard. When he shaved it off, she improved. I had no brilliant answer for him at that time. A few years later, I read in the New York Times that dust mites do live in beards. (I mailed him that article.)
More recently, I was seeing a man for terrible dust mite allergies. He was in his twenties, with long hair and a beard. He was about to start on allergy shots (immunotherapy), and then he stopped coming to see me. He came back a year later, and I asked him what had happened. He told me that when he got a haircut, and shaved off his beard, he felt so much better that he no longer needed allergy shots.
One of my patients wanted to do a science project about dust mites. He collected dust from his vacuum cleaner, and looked under the microscope for dust mites. He did not see any! I was embarrassed. At the next allergy meeting, I asked a representative of an allergy extract company to explain this. He explained that dust mites hold onto surfaces, like carpets. The best way to see them is to heat up a part of the carpet, so they will let go and you can see them.
A few of my patients were concerned about dust mites biting them. The truth is that they don’t bite us. They are so small that we can’t see them without a microscope, so we would never feel them even if they did bite us. In a condition called parasitosis, people are convinced that parasites are eating their skin. They may bring me in pieces of their skin in a plastic bag, to show me the ‘parasites.’ This is a psychiatric condition, not an allergic or parasitic one.
Other common allergens include cockroaches and mice, especially in the inner cities. Laboratory rats and mice can cause a lot of significant allergies for lab workers. Veterinarians and some farmers have a lot of exposure to animals. Some farmers are around a lot of hay (grass) exposure, some are exposed to toxic gases from silo gas, and molds and bacteria from rotting produce. I often hear about strong allergic reactions to horses, and hunters may have allergic reactions to the deer. Warehouses have a lot of dust exposure. Stored clothing, at home or in warehouses, are full of dust mites. Latex exposure just from walking into a hospital used to be very common, but that is improving now.
Section 16
Allergic Rhinitis
Let's start with allergic rhinitis - What is it?
I try to explain this to parents. Imagine that you have a bad cold. Your nose is stuffy, itchy and runny, you are sneezing, and you have itchy eyes and a drip in your throat. You can’t sleep well, and you’re embarrassed to go out in public because of your sneezing and runny nose; you keep a whole bunch of tissues nearby. But a cold goes away in a few days – this problem does not. You may have allergic rhinitis. Allergic rhinitis is among the most common problems in America. Some people may outgrow this, but around three quarters of those with allergic rhinitis will still have it ten years later. In addition, allergic rhinitis increases the risk of developing asthma, sinus or ear infections (otitis media).
Some people suffer this way all year around (perennial allergic rhinitis), while others only have to endure symptoms during their pollen season (called seasonal allergic rhinitis). They may feel fine until they cut the grass or only when they go to work, or when visiting grandma who has cats. A friend was playing catch in the spring with his son. He picked up the baseball from the grass, then rubbed his eye. It swelled shut for three days!
It can be hard to tell whether someone is suffering from allergic rhinitis, a cold, a sinus infection, or other causes of nasal misery. With irritant or non allergic rhinitis, individuals feel worse near perfumes, cleaning fluids, wood or cigarette smoke. Pollen, pets, mold and dust do not bother them. Generally, a cold goes away in about a week. If not, this might mean that you have a sinus infection. If you develop a “cold” every year at the same time, you might suffer from allergic rhinitis.
Okay, now you are an expert on allergy symptoms, and common causes of allergies. What can we do about treating allergies?
Treatment of allergic rhinitis
There are three steps to treating allergic rhinitis. First and most important is avoidance. If you are not breathing the allergen in, you will have no problems. The second step involves taking medicines. If this does not work well enough, then allergen immunotherapy (“allergy shots” and “allergy drops”), the third step, may be needed.
To be explained further..........