A Checklist Of Allergens

An estimated 75 to 85 percent of all people who have asthma test positive to some type of inhaled allergen. An allergic reaction in the airways can result inimmediate blockage, the aftereffects of which may last weeks or longer.

Physicians often ask the following questions to help determine the role, if any, allergies play in your asthma:

• Is asthma worse in certain months? If so, are there symptoms at the same time of allergic rhinitis--sneezing, itching, andnose runny and obstructed at the same time? (pollens, outdoor molds, and dust mites)
• Do symptoms appear when visiting a house where there are indoor pets? (animal dander)
• If there are pets in the patient's home, do symptoms improve when the patient is away from home for a week or longer? Do nasal, eye, and chest symptoms improve? Do the symptoms become worse during the first 24 hours after returning home? (animal dander)
• Do eyes itch and become red after handling the pet? If the pet licks the patient, does a red, itchy welt develop? (animal dander)
• Do symptoms appear in a room where carpets are being vacuumed? (animal dander or mites)
• Do symptoms develop when the patient goes into a damp basement or a vacation cottage that has been closed up for a period of time? (molds)
• Do symptoms develop related to certain job activities, either at work or after leaving work?
• If symptoms develop at work, do they improve when away from work for a few days?

Once specific allergens have been identified, your physician can recommend a plan to significantly reduce exposure to the offending allergens and irritants.

Asthma & Allergies In Children

Heredity plays an important part in the development of allergic diseases and asthma in children. Children who have one parent with asthma have about a 25 percent chance of developing asthma. If both parents have asthma, the likelihood jumps to 50 percent.

Atopy is another risk factor for asthma. Atopy is an inherited tendency to develop allergy but not a specific form. In other words, both you and your child might be allergic to something but not necessarily to the same thing.

An atopic person's body responds to allergens in the environment by producing immunoglobulin E (IgE) antibodies. These are proteins that develop in response to foreign substances in the body. Your physician may measure your child's IgE antibodies to test for allergies. Children with asthma are more likely to have specific IgE antibodies than children without asthma.

Does this mean that asthma is an allergy? No, but allergies can cause asthma flares. In babies and some adults, food allergies may bring on asthma flares. In the United States, foods that children are most likely to be allergic to include milk, eggs, wheat, fish, soy, and peanuts. Babies with food allergies may also have frequent runny noses, wet coughs, and eczema.

Not surprisingly, toddlers have more exposure to molds, house dust, and animal dander, which are also triggers for asthma.

Older children may have asthma episodes when exposed to pollens. Additionally, young children who have had viral, lower, respiratory-tract infections are more likely to develop asthma later in life than are children who have not had these infections. Bronchiolitis, bronchitis, croup, pneumonia, and allergic rhinitis (hay fever) can all make a child more susceptible to asthma.

As you can see, hereditary factors make it more likely that some children will get allergies and/or asthma than others, but environmental triggers bring on the episodes. Besides allergens, other asthma triggers include air pollutants, particularly tobacco smoke. In fact, children who are likely to develop asthma will develop it earlier if they live with smokers.

In some children, perfume can bring on an asthma flare. Exercise is another common asthma trigger, especially if the air is cold. Wind, rain, and dramatic weather changes sometimes provoke episodes, too, as do activities like laughing, crying, or hyperventilating.

Most children who develop asthma will have their first episode before their third birthday. Nearly 25 percent of children with asthma have more than one allergic symptom. Children who develop asthma when they're older generally have more allergic symptoms, and more boys than girls have associated allergic symptoms. If you and/or your spouse have asthma, your asthmatic child is more likely to have multiple allergic symptoms. There is nothing you can do about a family history of asthma and allergies, but, fortunately you can control exposure to many of the environmental factors. Whenever possible, keep your child away from triggers that may cause an episode.

About Allergies & Antihistamines

Stop Chasing Your Runny Nose

Do you find that you sneeze when you go outside on a spring day, your nose runs when you are near animals, and your eyes water when you are around a dusty house? Antihistamines may be the answer to help your allergic symptoms.

Antihistamines combat our body's reaction to "allergens." An allergen is an ordinarily harmless substance which we breathe or eat and which the body recognizes as "foreign." The immune system responds to the allergen by producing antibodies to destroy it. If you are prone to allergies, a special type of antibody is produced called IgE which makes you sensitive to the allergen. Once formed, the IgE antibodies attach themselves to the surface of special cells called "mast cells." These cells line the nose and throat and the tissues surrounding the eyes. Each time you are exposed to an offending allergen, it may cause more IgE antibodies to be manufactured, increasing your likelihood of an allergic reaction.

Now about your runny nose: after the allergen combines with the IgE antibodies on the mast cells the cells become activated and release histamine. This chemical attaches to receptors for histamine on the surface of cells in your nose causing you to sneeze, develop a runny or itchy nose and eyes, and get congested.

Antihistamines have been developed by pharmaceutical companies to attach to the same receptors as histamine does. Thus, histamine can be released from the mast cell but fails to cause any allergy symptoms because its receptors are already occupied by the antihistamines.

The discovery of antihistamines about 50 years ago brought welcome relief to individuals suffering from allergies. These early antihistamines effectively blocked histamine but had unwanted side effects like drowsiness or feeling "out of it." In recent years, the pharmaceutical industry has created antihistamines which do not cause drowsiness. The so-called nonsedating prescription antihistamines have safely helped many millions of individuals relieve their allergy-related misery while remaining alert for activities such as driving a car, operating a machine or even studying for an exam.

Taking Nonsedating Antihistamines Safely

Since nonsedating antihistamines have been introduced to the market, rare heart complications and deaths have been seen in patients taking either terfenadine (Seldane^®) or astemizole (Hismanal^®) especially when used in conjunction with other medications. The side effects, irregular heart beats, are very rare. However, to be on the safe side, here are some suggestions to help reduce the likelihood of adverse reactions from occurring when taking these medications.

• Always tell your physician and pharmacist about any medications that you are currently taking. Erythromycin, ketoconazole (Nizoral^®) and itraconazole (Sporanox^®) can interact with nonsedating antihistamines and increase their risk of causing cardiac side effects.
• Ask your physician and pharmacist for the medication package inserts for you to read.

Allergies & Aspirin Sensitivity

How many times have you heard the saying, "Take two aspirins and call me in the morning."? But wait, aspirin is not for everyone. Some individuals with asthma may be sensitive to aspirin. In fact 10 percent of children and adults with asthma have an allergy to aspirin and other anti-inflammatories such as ibuprofen. In these patients, ingestion of aspirin can cause severe asthma attacks that are difficult to control. Therefore most asthma specialists recommend that people with asthma avoid aspirin and medications containing aspirin. Acetaminophen (Tylenol^®, Datril^®, etc.) should be substituted instead.

If you are aspirin intolerant:

• Avoid aspirin-containing medications.
• If you have accidently taken aspirin and develop symptoms, seek medical attention immediately.
• Wear a Medic-Alert bracelet marked "aspirin intolerance."

Allergy Treatment: Immunotherapy (Allergy Shots)

Immunotherapy, also known as hyposensitization shots or allergy shots, has been part of medical practice since 1911. Immunotherapy is one of the tools allergists use to treat allergies. Small amounts of allergens (allergy producing substances) are introduced to the body through injections over a period of time. You cannot be vaccinated all at once like you can for tetanus. Instead, you will require increasing doses of the allergen to teach your body's immune system a protective response versus an allergic response. If you were to receive the top immunizing dose, you would be at risk of having a severe allergic reaction.

How Does Immunotherapy Work?

Immunotherapy works by changing the way your immune system recognizes an allergen. At the onset of your injections, your body sees the allergen as harmful; after you have been hyposensitized your body should not respond in this way. Allergy injections build your resistance to things that cause allergic symptoms, so the next time you are exposed they will give you less trouble. Immunotherapy is not a "quick fix." Injections need to be given on a regular schedule. The change in your immune system is not from injection to injection, but, a gradual change that can only be recognized after continued, long-term treatment.

Who Is Immunotherapy Indicated For?

Allergy injections are used in people who have severe symptoms which cannot be relieved by taking medication or avoiding allergens. These include severe life-threatening reactions to stinging insects (bees, wasps, yellow jackets, hornets, fire ants). The most common reason for immunotherapy is to reduce symptoms from inhaled allergens causing allergic rhinoconjunctivitis (allergy symptoms of the eye and nose) and allergic asthma (coughing, wheezing, shortness of breath) after exposure to an airborne allergen. Allergy hyposensitization has not been established to be effective for atopic dermatitis (eczema), food allergies, or hives.

Allergies & Too Much Medicine

Why do I need to take so much medicine? What about side effects, both long and short-term? Why does taking medicine have to be so confusing? Why are my medications so expensive? These are just a few of the medication-related questions we receive in our mail, over the phone, and at patient-education conferences around the country. It is apparent that people are concerned about medicines.

The first step to understanding your medications is to realize that the little pill or puff you take is not a quick-fix cure but a "tool in the tool box for fixing asthma and allergies." Medicines are part of a plan.

It would be silly to try to build a house without a set of blueprints. Will the doors be placed in appropriate locations; will the pluming and electricity work properly? Many people try to manage their asthma and allergies without a blueprint; they have a few tools but they don't know exactly how to use them.

Before you can understand your medicines you must have an asthma/allergy management plan. A management plan defines the goal for getting asthma and allergies under control. Your goals should include normal function of your airways and the ability to participate in physical and social activities without breathing being compromised. They should include sleeping through the night without symptoms of asthma or allergy, no hospitalizations, emergency room visits, or unscheduled visits to your physician, and no fear about what to do when breathing problems are approaching.

An asthma/allergy management plan gives specific direction for reaching these goals. It will explain the physiology of the disease, the anatomy of breathing, and explore environmental changes that can be made to improve your breathing. It will provide instruction for using various tools properly and in a timely fashion. During the period between diagnosis and control of asthma/allergy symptoms, this may include the use of a peak flow meter and/or daily symptoms diary in addition to medications.

Finally, an asthma/allergy management plan should always be written down and saved in a place were can be referred to often. Management plans may change as you or your child age, if changes are made in your day-to-day environment, or as you get better at controlling symptoms. Review your notes with your physician and nurse before you leave your appointment. Your health is precious and may be compromised if you don't!

If you can't answer the following questions with extreme confidence, you don't have an asthma/allergy management plan. Call your physician and make an appointment.

• Do you have an asthma/allergy management plan?
• Is it written down and do you understand it?
• Do you know what to do when recovering from an asthma/allergy episode, when you are all better, and if you should continue taking medications?
• Do you know how to keep an asthma/allergy episode from returning? (prevention plan)
• Do you know how to recognize and respond to an asthma/allergy episode that is approaching? (early intervention)
• Do you know how to recognize and respond to an asthma/allergy emergency?

Asthma is a breathing condition that is always present but not always noticed. Asthma can be divided into two parts: "noisy" and "quiet." The noisy part of asthma is the part most people recognize easily. It is the part where you may experience one or more of the following: wheezing, shortness of breath, chest tightness, and coughing. The quiet part of asthma is not so familiar. In fact, researchers only recently discovered the component of asthma called inflammation. You don't feel inflammation until it has become so severe that you feel as if someone is sitting on your chest.

The noisy and quiet parts of asthma are much like a day at the beach. It's a beautiful, sunny day, so you pack a picnic, sodas, and sunscreen and stake out a place in the sun. Carefully, you slather the sunscreen over every inch of your body to avoid sun damage to your skin. You then build sand castles with the kids, read a book, and take a little snooze. That evening, while slipping into a pair of jeans, you discover that you failed to put sunscreen on the back of your thighs. You have a lobster-red sunburn! All day long that sunburn was quietly sneaking up on you. You didn't notice it until long after the sun had gone down and you were changing clothes. The quiet part of the sunburn progressed enough to become (ouch) noisy!

The same thing happens in the airways. We only notice asthma once it has become noisy. Until then, we compensate for compromised levels of breathing so well that we think we are breathing just fine. The medicines we take for asthma treat the noisy and quiet parts of asthma if used properly. Most of us are willing to use our noisy medicines (bronchodilators) because we know they help us breathe easier and turn off the noisy coughing and wheezing.

Sometimes we wait to see if the noisy part of asthma will go away on its own before we use the medicine. But that's like waiting to see if a cloud will come along to shield you from the sun. Sometimes we use noisy medicines more often than we should because we don't know any better. For example ,if your physician says, " Just use the inhaler when you feel you need it," you may feel you need it every hour and think that is normal. When your physician prescribes a medicine ask for specific instructions on how to use it, how to know it is working, and how many times a day it can be used before seeking more help.

Some people put off using their quiet medicines (such as inhaled anti-inflammatories) because they can't feel them working. However, if you use a peak flow meter and keep a daily symptom diary you should be able to see objective evidence that your lung function improves steadily and your symptoms disappear when quiet medicine is taken. You are able to perform daily life activities with renewed enthusiasm because you feel a burden has been lifted from your chest. Fresh air, deep breathing, ah--it feels so good!

There are many things to learn about asthma and allergy medicines:

• The different types of medicines such as bronchodilators, corticosteroids, sedating and nonsedating antihistamines, decongestants, and generic medications.
• The various delivery methods; oral, inhaled, sprinkled on food, topical (spread on the skin), and injected.
• The time they take to work and dosages needed; fast-acting, long-acting, once-a-day, twice-a-day, and so on.
• The delivery devices you use with your medicines; spacers, holding chambers, nebulizers, and metered-dose inhalers.

One sure way of knowing if you are using too much medicine is to look around your environment. Have you taken steps to remove the allergens and irritants responsible for your symptoms in the first place; or are your suffering from "Leaky Sink Syndrome?" The Leaky Sink Syndrome occurs when people expect their medicine to fix something they could fix at the source.

To get an idea of how the Leaky Sink Syndrome works, let us say, for example, a water pipe under your kitchen sink is spraying water everywhere. You call the plumber. The plumber arrives and starts bailing water off the floor while you look on with disbelief and your furniture and carpets are getting ruined. You say to the plumber, "Don't you think you should turn the water off so you can fix the leak?" That would make sense, but the plumber keeps bailing. Finally, you insist, "Hey, my things are getting ruined!" And he replies, "That's what you have insurance for."

Do you suffer from the Leaky Sink Syndrome? Leaks can include (but are not limited to) furry or feathered pets, tobacco smoke, mold and mildew, cockroaches, rodent droppings, hobby and craft fumes, dust mites, and certain foods. Allergy-proofing your home and work environment turns leaks off at their source.

In most cases, allergy-proofing removes or reduces the need for medications all together. Sometimes, your efforts are not immediately rewarded because a person's airways need time to heal. Using a daily symptoms diary will help you identify improvements made by changes in the environment. Some people need medication despite their best allergy-proofing efforts and may also be candidates for immunotherapy, or allergy shots.

Don't expect medications to compensate for a leaky environment! The more leaks, the more medicine will be needed, and the more likely a person will experience unwanted side effects. Turn off asthma and allergy leaks at their source!

Food Allergies

A true food allergy involves the body's immune system which overreacts to harmless things. The body has made specific antibodies against that food; when the food is ingested, it reacts with the antibodies and triggers the release of histamine. Allergic reactions can include asthma, hives, stomach cramps, diarrhea, vomiting, and other symptoms. Food allergens, the parts of food that cause allergic reactions, are usually proteins. Most of these allergens can still cause reactions even after they are cooked or have undergone digestion in the intestines. The most common food allergens include cow's milk, eggs, peanuts, soybean products, finfish, shellfish, corn, wheat and gluten.

What Is A Food Intolerance?

Food intolerance is different than a food allergy. A food intolerance is an abnormal physical response to a food or food additive that is not due to allergy. Whether a food intolerant person reacts to the food in question can depend upon "the amount of food that is eaten, or the way the food is processed" says Dr. Raymond Brady of Allergy Associates, Portland, Oregon. For example, people that lack the enzyme to break down the lactose in milk might be able to drink lactose-free milk. A person with a food intolerance might also be able to eat that particular food in very small amounts if it is not eaten very often. The symptoms are very similar to food allergies--stomach cramping and diarrhea. Lactose and gluten are two substances that many individuals do not tolerate well.

Lactose intolerance is caused by a lack of lactase, an intestinal enzyme that digests milk sugar. Discuss with your doctor the purchase of milk to which lactase has been added, or you can add the commercial lactase enzyme to your milk to break down the lactose.

Gluten intolerance occurs when gluten, a combination of proteins found in wheat, rye, oats, barley and buckwheat, irritates the lining of the small intestine. As a result, food nutrients are inadequately absorbed from the intestine.

How Is A Food Allergy Determined?

Accurate diagnosis of a food allergy depends on evidence from more than just a single test. A doctor will take a detailed medical history, a physical examination and a skin test and may ask you to keep a food diary. Once the food is suspected, the doctor may suggest an elimination diet. The suspected food is eliminated from the diet for a period of time. If the symptoms are relieved, the food might be added back under the doctor's care to confirm that the food can indeed cause symptoms.

How To Treat A Food Allergy

The best treatment is to avoid eating the offending food and learn to read food labels. Ingredients are listed on food labels in order by weight. The first ingredient is present in the greatest amount and the last in the least amount. Some labels on foods are not required to show a complete listing of all ingredients, so beware! Be a label reader. Ingredients for a product may change, so make it a practice of reading labels on all products.

Pet Allergy Facts

How can such sweet, cuddly animals make people so miserable? It's easy! Approximately 10 percent of the population in the U.S. is allergic to animals. For those with asthma the percentage increases to 20 to 30 percent.

It is not the animal hair or fur that is of concern. Dander, outdoor allergens that cling to fur, and the proteins in animal saliva and urine are the problems. All animals produce dander. There is no relationship between the length of a pet's hair and its tendency to cause an allergic reaction. A short-haired animal is just as likely to produce an allergic reaction as is a long-haired variety.

While many animals including dogs, birds and rabbits are a primary cause of allergic reactions, it is the cat that is the most allergenic pet. It is estimated that 28 percent of the homes in the U.S. have at least one cat. This totals to 50 million cats in households throughout the country! Approximately six million Americans are allergic to cats. Exposure to cat allergens in early childhood may lead to the development of asthma in those children who are predisposed to this illness.

It is the small size of the cat dander that allows the allergen to remain airborne for a long period of time. The heating and cooling system within a house helps to circulate the cat allergen throughout the house. Dander is breathed in through the nose and lungs and can produce allergic symptoms. Many people are allergic to the animal's saliva. Salivary secretions are deposited throughout the house and when dry become airborne. Keeping an animal outdoors is preferable, but also presents problems. Outdoor allergens, pollen and mold cling to fur. Any contact between the allergic person and the animal may cause a reaction.

There is no such thing as a nonallergic cat or dog. Frequent bathing of the pet, appropriate indoor-outdoor ventilation, frequent vacuuming with a HEPA filter vacuum cleaner and removing carpets and upholstered furniture can reduce the amount of cat allergens in a home. However, removal of the pet is often necessary. Environmental controls must still be instituted in this circumstance. Cat allergen can linger in carpets and mattresses for months, even years after the animal is removed from the home. Environmental controls to speed up the removal of cat dander include cleaning heating and air conditioning ducts, thoroughly cleaning walls, professionally cleaning all upholstery and carpets and using HEPA air cleaners throughout the house.

Many people that test negative to animals may still have a tendency to develop allergies after exposure to a pet for a period of time. If you feel your family must have a pet in the home consider turtles, fish, hermit crabs or reptiles for the allergic patient.

Source: Allergy and Asthma Network/Mothers of Asthmatics, Inc.