An allergy is an unusual response of the body to an environmental agent. While most individuals may not be allergic to a particular item, some individuals are genetically predisposed to allergies to certain agents or become allergic as time goes by. The development of allergies depends on genetics, environmental interactions, degree of exposure to the particular allergen and duration of exposure and yet unknown factors. The specifics of allergies are far from clear at this time although much research is currently ongoing in this very dynamic field.
Allergic rhinitis is a condition in which an individual manifests nasal or sinus symptoms of being allergic to any agent to which they are exposed to. These foreign agents could be inhalants or aerosolized particles such as pollens, dust mites, animal or pet dander, foods, certain chemicals, aspirin or non-steroidal medicines such as ibuprofen, or certain medicines. Typically a type I hypersensitivity reaction results in early reaction to these allergens and a type III reaction to a delayed response that may take hours to develop.
Symptoms of Allergic Rhinitis
Typically sneezing, clear nasal discharge, postnasal drip, itchy eyes, itchy nose, nasal congestion, headaches, eye tearing, itchy palate and even itchy ears may manifest with allergic rhinitis. Allergic eye symptoms may coexist with allergic rhintis. Allergic rhinitis may also predispose to persistent or chronic sinusitis and asthma. Symptoms may be seasonal or all year round.
Common Airborne Allergens
Our data has shown that dust mite, pollens, molds and cockroaches are the most common allergens. Pollens may be weeds such as ragweed, trees such as mesquite, oak, pine, cedar or grasses such as Johnson, Bahia or Bermuda grass. Animal dander especially to cats and dog dander are less common but not infrequent. Most individuals are allergic to more than one antigen.
Common Food Allergies
Milk, wheat, corn, egg, tree nuts, soy are amongst the most common food allergies. Of course there are individuals who are allergic to peanuts, shellfish, onions, lettuce, berries, fruits, bananas, etc. Food allergies can be identified by a process of elimination. Creating a food diary and correlating the symptoms with the type of food consumed is the best technique in identifying the culprit food allergen.
Testing for Allergies
Generally speaking there are two types of tests. However, the personal history of an individual is important in guiding allergy testing. Skin testing either as prick test and percutaneous or intradermal testing is performed more commonly and is more sensitive than blood or RAST testing.
Purpose of Allergy Testing
Allergy test identifies airborne and some food agents you might be allergic to. It also guides us in further treatment of allergies. Skin testing is generally less positive with food allergies than with inhalant allergies. Typically prick testing is performed on the back only after it is clear that the individual did not take antihistamines, nasal steroids, oral steroids, singular or beta-blockers for one week prior to the skin testing.
Skin Testing in Children
Generally we have been successful in skin test especially prick testing in children above the age of 3. If your child is very queasy or squeamish, then a RAST test may be offered.
Downside of Blood RAST Testing
While the RAST test is quite reliable, it tends to underestimate the incidence of milder allergies.
Immunotherapy (Allergy Shots)
Immunotherapy is designed to increase your resistance to the allergens that cause your symptoms. Unlike in Europe where monovalent or single antigen immunotherapy is practiced, in the US generally we generally practice polyvalent immunotherapy or shots that contain multiple allergens. Allergy shots are also called subcutaneous immunotherapy or SCIT. They are injected just under the skin in the forearm and you are monitored for about 20 minutes thereafter for a reaction. That means we give shots containing multiple allergens under the skin to increase your immunity to allergens you are allergic to. In general, injection with one or two shots once or twice a week is initiated and over months it is decreased to one a week to once every other week and then monthly when maintenance dosing is achieved. The duration of therapy is about 2-3 years.
Risks of Immunotherapy
Either during allergy testing or during shots, an anaphylaxis reaction can occur. Tongue or voice box swelling may occur during this resulting in breathing difficulty. Typically an Epipen shot and steroids with benadryl may be given right away. If you are on immunotherapy, always carry an epipen shot with you for use in an emergency.
Allergy drops or sublingual immunotherapy, also called SLIT, is a relatively new form of immunotherapy in the US. While it has been practiced in Europe and South America for over 30 years, it is more widely adopted in the US now. Drops containing allergens that you are allergic too are mixed in a bottle and placed under the tongue. This is a daily treatment and the duration is 2-3 years as well. There are minimal side effects to date with the most common one being a bad taste.
Advantages of Allergy Drops
There are minimal side effects. You do not have to come to the office weekly. Travel is possible while on drops and missing a few days of treatment does not require going back to the original dose of treatment. It is very convenient form of therapy.
Are Allergy Drops Paid for by Insurance Carriers?
No. Because they are not FDA approved yet, they are not approved by insurance
carriers. However, we believe that it is a matter of time before that happens.
Managing & Treating Your Allergies
- Wash all bedding, including mattress pads, in hot water or bleach every 10 days.
- Clean your home. Dust mites are the by most studies the most common allergen to cause allergic reactions. Regular use of a vacuum cleaner with a HEPA filter, washing items in hot water, and mite proof casings will reduce these allergens.
- Use of HEPA filters in the bedroom, study or the TV room will help reduce the pollen and particle count.
- Dust mite matter and pet dander hide in fabric, such as curtains, furniture upholstery, carpets and bedding. Keeping these clean is important.
- Remove carpeting in your home if possible
- Avoid smoking
- Basements, bathrooms, kitchens and rooms with reduced ventilation must be well ventilated to prevent or reduce mold growth.
- Bathe pets once a week to reduce pet dander, and, if possible, keep your pet out of the bedroom. Wash your hands after petting animals.
- Because chalk can irritate children with allergies advise the children not to sit too close to the chalkboard
- Limit the number of indoor plants; mold thrives in potting soil.
- For individuals with food allergies, always read the ingredients before ingesting a new or packaged food. When dining out, ask restaurants for a list of ingredients or to prepare a meal without the offending food or additive.
- Nasal steroids are very effective in improving nasal symptoms of allergic rhinits. Non-sedating antihistamines (such as claritin, allegra, zyrtec) are also effective but less so. Antihistamine nasal sprays may also reduce symptoms.
- Immunotherapy such as subcutaneous immunotherapy , also called shots, is very effective in reducing an individuals allergic reaction over the long term.
- Alternatively, consider drops or sublingual immunotherapy. Because allergy drops are not FDA approved, they are not paid for by insurance carriers. However, drops are very safe and increasingly research on them shows them to be very effective.
Contact our office to learn more about Allergy Services or to schedule an appointment.