Section 17

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Many allergy sufferers give up at this step – you can’t get rid of all of your exposure, they feel, so why bother? 

Many people say that they do not want to see an allergist, because he or she would tell me to get rid of my pet, which I will not do. I tell them that environmental control is the only recommendation that I have, where I can look them in the eye and say that there are no side effects from doing this. You can really lower your exposure to allergens, and it makes a huge difference.

Will avoidance (I call this an environmental control program) help? Yes, most people, most of the time. I see patients years after their first visit, who come in for an unrelated problem. They tell me that since they reduced their allergen exposure, their allergies disappeared, or were so slight that they did not notice them any longer.

Of course, it is best to know what you are allergic to, so that you don’t spend time and money avoiding cat dander, for example, when your are allergic to grass pollen. It may not hurt to decrease other exposures, but it may not help, either.

I usually focus mostly on the bedroom, because that is where people spend the most time at home. 

It is much easier to follow one or two simple instructions, and not a larger number. That is why I start with recommending covering the pillows and mattresses, and lowering humidity. The most effective step to treat dust mite allergies is to stop breathing in dust mite feces. These particles are microscopic (10 to 40 microns) but large enough that they settle out of the air quickly. That is why an air purifier does not help, since the particles are not in the air. Most of your mite exposure comes from your pillow. While you lying are in bed, the dust mites are right by your nose, and you breathe them in all night long. Encasing (covering) your pillows and mattresses with a cover that does not let the dust mite particles through is the most effective way to stop this. Some people wrongly fear that this is sleeping on vinyl or plastic. Good quality covers are available which do not make you sweat, don’t make noise, and are hardly noticeable. You put your sheets and pillowcases over the encasings, and forget about them. 

Dust mites need moisture from the air to live. That is why I recommend keeping the room humidity below 40%.  Using a clean humidifier in the winter, where the indoor humidity is kept at less than 40%, may be okay. (A hygrometer is used to measure humidity.)  

There are more ways to avoid dust mites. Hardwood floors or tiles offer no hiding places for the dust mites to live in, so the bedroom rug should be removed. Pet dander is great food for dust mites, so keeping pets out of the bedroom (because almost no one keeps them out of the house) helps. Removing stuffed animals is straightforward, and most parents understand that. A favorite stuffed animal should be washed in hot water regularly. (My daughter never forgot that I told her keeping a stuffed animal in the freezer kills dust mites by decreasing the humidity.) Hot water, above 130 degrees F, kills dust mites. So wash sheets and blankets regularly in hot water. Sure, hard blinds are better than soft curtains. Cleaning up the room helps. (Parents occasionally ask me to tell their child to clean the bedroom! If the parent’s word is not good enough, why should they listen to me?) Using special vacuum cleaner bags, which stop the dust from coming through, helps. 

I am always afraid of offering too many suggestions, as people may then give up and do nothing at all. And realistically, what are the chances that your child will actually clean up her room, and keep it clean?

I usually do not recommend the commercial powders to put on carpets and soft toys to decrease dust mite exposure. Studies show that these don’t help much. One type of powder kills the dust mites (acaracide), but leaves behind the protein that you are allergic to. A month or so later, the dust mites come back. The other kind of powder dissolves the protein, but leaves dust mites around. 

When people ask me what kind of dog they can get I answer: “An outdoor dog.” I understand that almost no one gets rid of the family pets, since they are part of the family. I often hear people state “I would get rid of my child, my wife, my husband, before I get rid of the dog or cat.” I get it. I am convinced that one of the main reasons people don’t visit an allergist is that they fear that they are allergic to their pet.  One a hot summer day, a woman stopped by my office waiting room, to enjoy the air conditioning. However, since she had brought along her dog, we could not allow them to stay in the waiting room of an allergy office. We try to schedule patients with service dogs for the end of the day, and not keep them waiting at all.

So, ideally, no pet, at least in the bedroom. If possible, wash it weekly. Cats do not like water on their fur, unless they have been bathed since they were kittens. I usually suggest washing dogs with baby shampoo, so that the fur does not dry out. A HEPA (high efficiency particle accumulator) filter in the bedroom is a good idea. It should be powerful enough to do six air exchanges per hour – these HEPA filters are often labeled as to what size room they can clean. They suck in air and run it through small filters to trap all particles in the air above a certain size. HEPA filters do a good job removing animal dander, pollens and molds from the air. They don’t help for dust mite particles, since these are usually not in the air.  

I do not recommend the less expensive electrostatic filters. They put an electrical charge on particles in the air, so they get stuck and are no longer airborne. Not as effective as HEPA filters in cleaning the air, they also produce ozone which can make asthma worse.

Okay, this is part you know, but don’t want to hear. There is no such thing as a non allergenic breed of cat or dog. Certain people may notice more allergies to one breed than to another. It is just that no breed is guaranteed to be safe for everyone. I have seen severe reactions from Bichon Frisés, poodles and other ‘non allergenic’ dogs. Studies show no difference in the amount of allergen produced by different breeds of dog, whether or not they are considered ‘hypo-’ or ‘non allergenic. So too, one can be allergic only to male dogs, and be fine near female ones. 

Some people swear by their long hair versus short hair cats, or find that an exotic breed is better for them. I was taught that white cats are less allergenic than black cats, kittens are more allergenic than older cats, and that male cats are more allergenic than female cats. 

You are more likely to be allergic to furry or feathered animals like cats, dogs, mice, rats, rabbits, horses, birds, guinea pigs, hamsters… You get the picture.  Lizards and snakes and turtles are less likely to cause problem.

The word sounds scary, doesn’t it? Attack of the killer mold! Actually, we are surrounded, indoors and out, with them. Tens of thousands of types of molds have been identified. Without molds/fungi, (including yeasts), we would not have bread, wine, soy sauce, and several antibiotics. 

Molds can cause life threatening infections in people with a weak immune system. Some fungi infect healthy people, but may not be life threatening.  

A fungus can grow inside a person. This could be a fungus ball in the lungs, caused by Aspergillus mold, called an aspergilloma. This may grow in the lungs and people can be allergic to it (ABPA allergic bronchopulmonary aspergillosis) and can be severe. Similarly, fungi can grow in the sinuses, leading to allergic fungal sinusitis. 

Here I am only going to discuss molds triggering allergic reactions when breathed in.

The first step in decreasing mold exposure at home is to decrease humidity. If there is a water leak, remove the water source. Fix the leak in the ceiling. Keep the basement dry with a dehumidifier.  

Unfortunately, even after removing the moisture, it may take up to a year for the mold count to come back to baseline. Dilute bleach is the best way to directly kill molds. 

A HEPA air purifier may help remove it from the air. Some mold will still be around, since there are so many of them outdoors.

Pollen are the most common allergen in the Northeast US. 

In the spring, cars may turn green from pollen in the air. The large white floating particles seen outside are not allergenic, since they are too large to be inhaled. The pollens we react to are microscopic; they go deep into our eyes, nose and lungs and make us miserable.

Avoiding this is difficult! 

Even if no weeds or grass grow in your yard, pollen travels far. Ragweed pollen can be found 100 miles off shore. So the pollen from down the street, or even miles away, may cause problems as you breathe it in. 

If you know which pollens you are allergic to, you may want to stay indoors during that time. Following the pollen counts on television and internet may help you. Realistically, you want to go outside and enjoy life, so you will be exposed. If allergic to grass, do not venture outside when someone is mowing the lawn. 

The pollen count is highest between 6 and 10 a.m., so stay indoors around that time. The pollen count may be one thousand times lower inside than outside so keep windows and doors closed! 

A HEPA filter may also help as well as air conditioners, set to recirculate inside air.

There are different types of allergies, so there are different types of testing. For allergic contact

dermatitis, the reaction may take several days to happen. Think about poison ivy (which we don’t

test for, since 95% of the population is allergic to this). You don’t break out with a rash while

you are in the woods, but you may break out two or three days later, and the itchy rash may last

for weeks. When testing for this delayed type reaction, we put a patch (feels like a very large

bandaid) on the back. We take if off after 48 hours, and check for delayed reactions at 48 and 72

hours, and at one week. This looks for reactions to allergens such as nickel or other metals,

preservatives and cosmetics.

Hay fever and food allergies are caused by immediate type reactions. Most people react within

20-30 minutes after exposure. This kind of reaction is due to your body releasing histamine from

allergy cells (mast cells). Histamine can cause itching and swelling and irritation. 

The reaction you have depends upon where the histamine is released and how much is released.

If the pollen (for example) touches your eye, causing histamine release in the eyes, you may have itchy and

watery eyes.

 If you breathe the allergen into your nose, you may have sneezing, itchy nose,

stuffy or runny nose. 

If it goes into the lungs, you might have difficulty breathing, wheezing or

chest tightness.

 If you eat the allergen, you might have stomach pain, nausea, vomiting or

diarrhea.

 If there is a lot of histamine released, you might feel faint, or have hives or swelling as

well.

A blood test (called a RAST) is available to look for these immediate type allergies. It is less

sensitive than skin testing (meaning that it may miss some real allergies), but can be done even if

you are taking antihistamines.

Allergists usually perform scratch testing. A small plastic device is used, on which suspected

allergens (dust, pollen, foods, for example) are placed. This is placed on the arm or back, and

then pressed lightly onto the skin. This barely scratches the skin, and does not hurt. Within 15-

20 minutes, someone with allergies should react. Usually, the area may get red and swollen, and

you may notice itching. This usually goes away within minutes to hours. 

The scratch test cannot be done if you are taking antihistamines. This test can be done at any age. 

If this is negative, and allergy is still suspected, intradermal testing can be done. This involves injecting a very small amount of allergen under the skin. This is not done for food allergies.

Nickel is a common cause of allergic contact dermatitis (which may look like poison ivy). You may get a rash from costume jewelry, snaps on jeans and even from handling coins! One trick that works well is to coat the snaps or watch band with clear nail polish, so they do not touch your skin. Even nickel in certain foods can cause a rash. A chemical, called dimethylglyoxime, turns bright red if it touches nickel. This can be easily bought, and allows you to test for the presence of nickel. 

Food allergies vary tremendously. Some people may get short of breath if they smell seafood cooking,. Others may be able to eat one peanut, but not more. 

I recommend that the foods you are allergic to should not be kept in the home, to avoid any possible accidents. An allergic reaction may arise when you eat out. Your friend’s Aunt Sally’s secret recipe may contain marzipan, made from almonds, and cause a bad reaction. In a restaurant, the waiters may ‘cross contaminate,’ serving you your chicken with the same utensils used for the shrimp you are allergic to. The wait staff may not understand how severe your allergies are, and just take the walnuts off the salad before serving it. 

You may tell them that you are allergic to milk, but they see nothing wrong in putting cheese on your sandwich. They think they are doing you a favor by slipping this food allergen into your food, to prove to you that allergies really don’t exist. 

So, when it comes to food allergies, don’t trust anyone. Also be aware that companies may change the ingredients in the foods that you have previously eaten safely. This means that you have to check the labels every time that you buy that product.