Patient Education

 UNDERSTANDING YOUR ALLERGIES

Copyright 2002, Regional Allergy & Asthma Consultants, PA

WHAT IS AN ALLERGY?

An allergy is an abnormal reaction to something that ordinarily causes no harm to someone who is not allergic.  It may be caused by inhalation (pollens, dust, mold, and animal danders), ingestion (foods, medications), injection (medication, insect sting), or skin contact (poison ivy, jewelry, latex).  Here we will focus on inhalant allergies, since this is the most common and bothersome type of allergy. 

 

When a person comes in contact with something to which they are allergic, a complicated reaction occurs.  First, histamine and several other substances are immediately released at the site of the reaction, causing itching, redness, swelling, congestion, and mucus production or tearing.  Later, over hours or days, smoldering inflammation may develop, causing more severe and ongoing symptoms. 

 

Respiratory allergies most commonly affect the nose, causing sinus problems, stuffiness, excessive runny nose, postnasal drainage, sneezing, or itching.  The itching may extend to the back of the throat and deep inside the ears.  The eyes are also frequently involved with redness, tearing, itching, and puffiness.  Asthma, which is a reaction of swelling and inflammation inside the lungs, is commonly caused or aggravated by respiratory allergies as well. 

 

WHO GETS ALLERGIES?

Allergies are common, affecting one in every four to five people.  A tendency to allergies is inherited.  If one parent has allergies, each child runs a 30-50% chance of developing allergies.  If both parents have allergies, the likelihood rises to 60% or more.  Allergies may develop at any time in life, but commonly do so in childhood and early- to mid-adulthood.  Sometimes an environmental change, such as a move to a new climate, will trigger allergies. 

 

HOW ARE ALLERGIES DIAGNOSED?

Allergies are sometimes diagnosed based on the patient's family history, symptoms, exam, and response to a trial of allergy medicines.  In cases where symptoms are interfering with school, work, exercise, or sleep, or when medicines do not work or cause side effects, then allergy testing is recommended.  This testing determines with certainty whether a patient is allergic, what he or she is allergic to, and how severe the sensitivity is.  This information can then be used to develop a customized treatment plan with avoidance measures, medications, immunotherapy injections, or any combination of these to achieve the best long-term results.  

 

In most cases we perform skin testing, since it is the most accurate, rapid, and cost-effective approach to diagnosing allergy problems.  A light application of each suspected allergen is made to the patient's skin.  Those to which the patient is sensitive will cause an itchy but temporary red bump on the skin.  This mild form of an allergic reaction is caused by the release of histamine at the test site, and is what happens to a larger extent in the nose and eyes of people with "hay fever," and the lungs of people with asthma. 

 

For the majority of our allergy tests, we use a small disposable plastic device with prongs that gently pricks the skin surface with virtually no pain.  Even young children will usually tolerate the testing without difficulty. 

HOW ARE ALLERGIES TREATED?

There are three basic approaches to treating allergies: 1) avoidance of the offending allergens; 2) medications to suppress symptoms; and 3) allergy injections to reduce the level of allergic sensitivity.  We often recommend a combination of these approaches to achieve the best long-term results, depending on the nature and severity of the allergy. 

AVOIDANCE:

This is the ideal preventive strategy, but often difficult or impossible to achieve.  Microscopic outdoor pollens and mold spores, for instance, travel in the air for many
miles, so are not avoidable except by staying indoors in an air-conditioned and filtered environment.  Animal allergies may be treated by moving a pet permanently outdoors, but this may be difficult when the pet is a trusted member of the family.  House dust mite and mold levels may be partially reduced in the home with aggressive measures, but are more difficult to control at work and school.  We will advise you on what strategies will be most effective for your particular situation. 

 

All of our patients, regardless of what allergies they may have, will have significantly more trouble with respiratory symptoms if exposed to cigarette smoke.  Therefore, cigarette smoking must be moved completely outdoors and out of the car.  It is not adequate for other family members to smoke only in a designated room, or to smoke only when the patient is away from home.  The fine cigarette particles harmful to our respiratory tracts stay airborne for up to 24 hours, and rapidly spread throughout the home.  Even the most sophisticated and powerful air cleaning devices are quickly outpaced by smoke, and are not a substitute for always keeping smoking outdoors.

MEDICATIONS:

Medications to treat allergies may be effective in reducing symptoms temporarily, but provide no permanent or lasting benefit once they are stopped.  Most are safe for long-term use, but some patients tire of taking medications long-term, or find they lose their effectiveness over time, particularly in cases of severe allergies.  We may use a number of different types of medications to treat an allergy problem, including:

 

1.         Antihistamines - These help to relieve itching, sneezing, and runny nose due to allergies and may be taken regularly, or only when needed.  They are less effective against nasal congestion, unless combined with a decongestant.  The over-the-counter antihistamines usually cause drowsiness and may be overly drying or cause urinary retention.  In addition, some people perform poorly in skills requiring good hand-eye coordination (like driving), even if they donít necessarily complain of being sleepy.  For these reasons, we tend to use the newer prescription antihistamines, which donít have these side effects.  Many can be taken only once daily.  Examples include Claritin, Allegra, Zyrtec, and Clarinex.

 

2.         Decongestants - These may be taken by themselves or in combination with an antihistamine.  They reduce nasal congestion, sinus pressure and ear popping, and have some drying effect as well.  They are usually taken only when needed.  Some people find they cause too much stimulation or insomnia, and in these cases are best avoided at nighttime or altogether.  They may raise blood pressure slightly, so must be used with caution in patients with hypertension.  Examples include Sudafed, Duratuss, Entex, and Defen LA.

 

3.         Nasal sprays - The most effective nasal sprays for allergies are those that contain cortisone or steroids.  Examples include Flonase, Nasonex, Nasacort, Rhinocort, Nasarel, Tri-Nasal, Beconase, and Vancenase.  These are not the type of steroids some athletes abuse, but are rather related to steroids produced by your body every day.  They act solely on the lining of the nose to reduce the swelling, inflammation, and itch of allergies, much like cortisone cream relieves a skin rash.  Although some people notice benefit within a day or two, peak benefits are usually seen after a few weeks of regular use.  For maximum benefit, nasal steroids should therefore be used regularly during your allergy season.  They may be used along with antihistamines and decongestants if needed.  They should be stopped if causing pain or bleeding.  There are several other types of nasal sprays (both over-the-counter and prescription) that may be beneficial for you, and we will recommend these when appropriate.  Examples include Nasalcrom, Astelin, and Atrovent.  Do not use an over-the-counter nasal decongestant spray (such as Afrin) for more than 3-4 days since severe "rebound" nasal congestion will develop with prolonged use. 

 

4.         Eye drops - Over-the-counter allergy eye drops are appropriate for occasional use, but should be avoided for long-term or frequent use, or if you have glaucoma.  For better results and safer use, there are several excellent prescription allergy eye drops available.

ALLERGY INJECTIONS:

Allergy injections are the most effective long-term preventive strategy for allergy treatment.  They build up your internal immunity to the exact items to which you are allergic to block your sensitivities to pollens, dust mite, molds, or dander.  Patients on allergy injections generally have far fewer and less severe symptoms, and therefore need less medication to control their allergies. 

 

The length of treatment depends on the nature and severity of the allergy.  Patients should especially consider immunotherapy if their allergies interfere with work, school, recreation, or sleep.

WHY IS IT IMPORTANT TO TREAT ALLERGIES

The day-to-day misery of allergies--sneezing, itch, congestion, cough, and difficulty breathing--are enough to warrant treatment.  However, the potential long-term complications of allergies make treatment even more important.  Inflammation and congestion from allergies block the normal "plumbing" of the ears, sinuses, and lungs.  This blockage causes problems, including ear and sinus infections, which are 3-4 times more common in allergic individuals. 

 

Nasal congestion from allergies can lead to a number of other problems, as well.  Chronic mouth-breathing in the allergic child predisposes to orthodontic problems, including overbite.  Asthma can be worsened for two reasons: first, nasal congestion interferes with the normal filtering, warming, and humidification of inspired air; and second, the postnasal drainage from allergies can aggravate the cough and wheeze associated with asthma. 

 

Allergic individuals are also more likely to develop asthma.  Some studies have suggested that treating allergies preventively, at a young age, reduces the chances of developing asthma. 

 

We are here to maximize your long-term health and well‑being.  We look forward to working with you in a number of ways to most effectively meet that goal. 

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Last updated 4/23/2002

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