Allergies

It’s hard to believe that things as unrelated as pollen, animal dander, bee venom, foods and mold can all potentially lead to the same type of problem. What these substances have in common is that they are proteins and are among the most common allergens. They can cause severe allergic reactions in some people.

With so many potentially allergenic substances, it’s no wonder allergic diseases are among the major causes of illness and disability in the United States. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), the prevalence of allergies has continued to rise in industrialized countries for more than 50 years. Worldwide, up to 30 percent of people suffer from seasonal and year-round allergic rhinitis, and 20 percent suffer from skin allergies.

An allergy is a response of a person’s immune system to a normally harmless substance, one that doesn’t usually cause problems for most people. In the allergic woman, an offending substance can trigger an immune system response, which functions as the body’s defense against invading agents such as bacteria and viruses, to respond to a “false alarm.” Her immune system treats the allergen as an invader by generating large amounts of a certain type of antibody—a disease-fighting protein known as IgE—that attaches to specific body tissue and blood cells. The cells are then triggered to release powerful inflammatory chemicals such as histamine, cytokines and leukotrienes. These chemicals act on tissues in various parts of the body, such as the respiratory system, and cause the symptoms of the allergic response.

Allergies can be more than just bothersome. Some allergens cause symptoms of asthma and rhinitis like sneezing, runny nose, stuffiness and watery eyes; skin irritations like itching and hives or eczema; or gastrointestinal distress. In some people, the allergic response can lead to anaphylaxis or anaphylactic shock—a sudden and sometimes deadly drop in blood pressure. Anaphylactic shock can also potentially stop the heart or lead to complete closure of air passages, causing death by suffocation.

Pollens, molds and fungi, dust or dust mites, animals, medications, foods, latex and other substances can trigger acute or chronic symptoms. Food allergies which are the most likely to cause anaphylaxis, are most commonly caused by ingestion of peanuts, tree nuts, shellfish, fish, milk, eggs, wheat and soy.

Contact allergies are allergic reactions caused by a person’s skin touching a substance. They are most often caused by nickel, rugs, fabric softeners, deodorants, cosmetics, perfumes, preservatives, dyes and foam insulation. Plants such as poison ivy, poison oak and sumac are also leading causes of contact dermatitis. There is a compound in these plants that can cause severe skin reactions in people who are sensitive to it—up to 85 percent of Americans. Such reactions usually occur two days after exposure and can persist for weeks unless proper treatment is obtained.

Allergies can have a genetic component. If one parent has allergies, each child has about a 30 percent chance of having an allergy. If both parents have allergies, it is much more likely (about 70 percent chance) that their children will have allergies. Adults usually do not lose their allergies, but children may outgrow them. In addition, while people are born with a genetic predisposition to allergies, sometimes they don’t develop them until well into adulthood. Exactly why this occurs is unknown. Some researchers speculate that the more you are exposed to a potential allergen, the moreantibodies to that allergen you can build up, until finally one day, they are released in an allergic reaction. Once “sensitized,” you will likely experience the symptoms again on subsequent exposures to the allergen.

Diagnosis

The most common allergic responses are upper and lower airway problems such as nasal congestion (stuffiness, sneezing, runny nose) and wheezing, along with itchy eyes. If you suffer from allergies, you may have experienced one or many of these symptoms:

sneezing
congestion or stuffiness
runny nose or postnasal drip
itching of nose and throat, including the palate
dark circles under the eyes caused by decreased venous blood flow due to poor drainage from persistent nasal congestion
a crease mark on the nose from rubbing it upward
watery eyes
itching of the eyes
dry eyes
conjunctivitis, or an inflammation of the membrane that lines the eyelids, causing red-rimmed, swollen eyes and sometimes crusting of the eyelids
wheezing, coughing, chest tightness from allergic asthma or shortness of breath from exertion
In addition to these symptoms, some food allergies may cause the following symptoms:

itching in the mouth (lips, throat, tongue or palate)
difficulty breathing or swallowing
a drop in blood pressure leading to feeling faint and weak
abdominal pain
diarrhea or vomiting
hives or skin itching
eczema (more common in children)
The main symptom of a contact allergy is an itchy, persistent rash.

Some women develop reactions in response to environmental agents, such as cigarette smoke, paint fumes, plastics and perfumes; temperature and humidity changes; and strong smells. These are not true allergic reactions involving antibodies and the release of histamine or other chemicals. Similarly, food intolerances, such as an inability to digest milk products or gluten or sensitivity to monosodium glutamate (MSG), are not true food allergies.

It’s not uncommon for women with allergies to develop asthma. The symptoms of asthma include coughing, wheezing and shortness of breath due to a narrowing of the bronchial passages or airways and to excess mucus production and inflammation. Similarly, extended bouts of rhinitis can lead to chronic sinusitis.

If you suspect you have an allergy and it bothers you to the point you need to seek treatment, you can see a general health care provider or an allergy specialist. If you have cold-like symptoms that last for more than two weeks, you should seek proper diagnosis and treatment. These symptoms can lead to sinusitis, which may require more aggressive treatment. Your health care professional will discuss with you your medical history, your symptoms and when they occur.

Helpful questions to sort out your symptoms include:

Do allergies run in your family? If so, which relatives have them, and what are they allergic to?
Do you develop recurring symptoms at certain times of the year or are symptoms present year-round?
Does being around pets trigger symptoms in your eyes, nose or chest?
Do eating certain foods cause symptoms to flare?
How long do your symptoms last?
What seems to make symptoms worse? What makes them better?
Have you tried any medications to alleviate your symptoms? Were they successful or not?
Are you taking any over-the-counter or prescription medications? If so, which ones? (It’s often helpful to take your medications with you to the appointment.)
Do you use the medications as prescribed by your health care professional?
Are you allergic to any medications?
Your health care professional should examine your nasal mucous membranes, as well as your eyes, ears, mouth and throat. Nasal membranes may appear swollen and pale or bluish. If you have a suspected food allergy, you may be asked to undergo prick testing and keep a food and symptom diary.

Allergy specialists use skin tests to determine the specific allergens that may be responsible for your allergies. He or she will inject diluted extracts from allergens—particular foods, pollens, dust mites, etc.—under your skin or to a tiny scratch or puncture on your arm or back. With a positive reaction, a raised, reddened area with a surrounding flush will appear at the test site, indicating antibodies to that specific allergen are present in the skin. Prick tests are done first; an intradermal test may also be required.
Your health care professional might also do a blood test, which is not as sensitive as a skin test. Using a sample of your blood, the test looks for levels of antibodies to particular allergens.

If your health care professional suspects a food allergy, he or she may try an elimination diet, but only if your reactions are not severe. This technique involves not eating any of the suspected trigger foods for a week or two to see if your symptoms go away. Then, you return the food to your diet over several days to see if the symptoms appear.
Another procedure used to objectively diagnose food allergy is the double-blind food challenge. You ingest a dried (or otherwise modified) form of suspect food—usually in a capsule form––under clinical supervision to see if a reaction occurs. Neither you nor the health care professional knows which capsule contains the allergen. This test should not be used if your reactions are severe. It’s rarely performed because of its high cost and is used more often to rule out a food allergy in cases in which your health care professional suspects the reactions are due to something else. These oral food challenges may be done if blood tests or skin tests were negative or not definitive.

Treatment

It’s important to remember that if you suffer from any severe allergic reaction—such as anaphylactic shock or asthma that causes shortness of breath or difficulty breathing, or any other extreme discomfort—you should seek medical attention immediately.

In fact, if you’ve ever had a previous severe allergic reaction, you should ask your health care professional about carrying an epinephrine injector with you to treat anaphylaxis. And be sure you know how to inject yourself with epinephrine quickly and correctly. If you have to use it, be sure to call 911 and seek medical help immediately. Until help arrives, lie down and raise your legs above the level of your chest to increase the blood flow to your heart and brain.

The first course of treatment is avoiding the allergen. (For more details, see the section on Prevention.) Your health care professional may also prescribe medications, recommend over-the-counter remedies or suggest allergy shots or injections available for inhaled allergens and venom. Although there is no cure for allergies, one of these strategies or a combination of them may provide significant relief from allergy symptoms.

Your health care professional may prescribe some medications that can be used alone or in combination. These include:

Antihistamines counter the effects of histamine that is released in response to the allergen. Antihistamines relieve sneezing and itching in the nose, throat and eyes; may reduce nasal swelling and drainage; and are used to treat hives. The older drugs (called first-generation antihistamines), which include chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl) and hydroxyzine (Hydroxyzine HCL), cause drowsiness and increase the risk of vehicle and occupational injuries.Some of the newer (second-generation) antihistamines, such as fexofenadine (Allegra), loratadine (Claritin), desloratadine (Clarinex) and cetirizine (Zyrtec), have fewer side effects. Loratadine, cetirizine and fexofenadine are available over the counter and in generic forms. It is important to take these medicines daily for optimal effect. Some people, however, do experience mild side effects including drowsiness, dizziness, headache, nervousness, nausea, diarrhea, abdominal discomfort, dry mouth or dry or itchy skin with some of these medications. You should always let your health care provider know what other medications you are taking.
Other second-generation antihistamines are azelastine (Astepro) and ketotifen (Zaditor). Azelastine is approved for use in the nose and eyes, and ketotifen in only the eyes. A new combination of a nasal steroid (fluticasone) and a nasal antihistamine (azelastine) recently became available by prescription (Dymista).

To treat eye symptoms of allergic conditions, such as inflammation, itching, watering and burning, your health care professional may prescribe antihistamine eyedrops that block histamine release. Don’t use any other eyedrops while using these, and be sure to remove contact lenses to apply the drops to your eyes. If you wear contacts, you’re probably safer switching to glasses during your treatment.

If you are pregnant, keep in mind that some of these antihistamines’ effects on an unborn baby are untested; similarly, their effects on breast milk or nursing infants are in some cases not known. Always tell your health care professional if you are, could be or could become pregnant, and discuss your situation with him or her before taking any medications. Both cetirizine and loratadine are category B for pregnancy, meaning they appear to be safe, although they have not been tested specifically in pregnant women. Only loratadine should be used when breast-feeding because cetirizine can enter breast milk.

Topical nasal steroids are anti-inflammatory drugs that reduce allergic inflammation. They decrease the number of the histamine-releasing cells in the nose and reduce mucus secretion and nasal swelling. These wet corticosteroid nasal sprays include mometasone (Nasonex), triamcinolone (Nasacort AQ), fluticasone (Flonase), budesonide (Rhinocort) and ciclesonide (Omnaris). There are also newer dry nasal sprays, including beclomethasone (QNASL) and ciclesonide (Zetonna). And there is the combination nasal steroid and antihistamine spray that recently became available by prescription (Dymista). Although they are generally safe when used at recommended doses, side effects of these medications may include:
stinging or burning of the nose
sneezing after application
bleeding of nasal membrane
scabbing or crusting of nasal membrane
perforated septum (rare)
headache or lightheadedness
unpleasant (or loss of) taste or smell
soreness in the nose
Cromolyn sodium (Nasalcrom) is an over-the-counter nasal spray that may help to prevent allergic reactions from starting. When used as directed, it may provide relief from allergies and has few side effects—which may include stinging or burning of the nose, headache, bad taste, runny nose or postnasal drip. Its main disadvantage is that it must be used three to four times a day. While tests have shown it is unlikely to harm an unborn baby, don’t use cromolyn sodium without first talking to your health care professional if you are pregnant. It’s not known if this medication passes into breast milk; talk to your health care professional if you are nursing.
Decongestants, such as pseudoephedrine, help reestablish drainage of the nasal passages and relieve symptoms such as congestion, swelling, excess secretions and discomfort in the sinus areas. These over-the-counter (OTC), behind-the-counter and prescription drugs can be taken by mouth. To get the more effective decongestants, you have to ask at the pharmacy counter because they are kept behind the counter. You can also get OTC nasal decongestant sprays. Be careful not to use nasal sprays and drops for more than three or four days, or you might end up even more congested because of a rebound effect. Your health care professional may advise you to take an antihistamine in combination with a decongestant to relieve other allergic symptoms. Decongestants may produce side effects such as nervousness, insomnia, rapid heartbeat and elevated blood pressure. If you are pregnant, talk to your doctor before taking pseudoephedrine (or any other OTC medication for congestion).Some over-the-counter products should not be used by people with high blood pressure, diabetes or other medical conditions, or if they’ve taken an MAO inhibitor in the last 14 days. If you have any medical conditions, be sure to consult your health care professional before self-treating.

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