Why is my nose still congested and why am I still sneezing in the winter when all the pollen is gone? If you have allergies, the answer is often an allergy to dust mites.
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 parasites, to respond to a “false alarm.” The 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 can 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, itchy or red 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, animal proteins, medications, foods, latex and other substances can trigger acute or chronic symptoms. Food allergies, which are 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. Testing for these substances is readily available.
Allergies can have a genetic component. If only one parent has allergies, a child has about a 30 percent to 40 percent chance of developing allergies. If both parents have allergies, the odds are closer to 70 percent.
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.
The most common allergic responses are upper and lower airway problems such as nasal congestion (stuffiness, sneezing, runny nose) and wheezing, along with itchy, watery eyes. If you suffer from allergies, you may have experienced one or many of these symptoms:
In addition to these symptoms, some food allergies may cause the following symptoms:
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 but are intolerances
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 and respiratory muscle contractions. Similarly, extended periods 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 possible triggers.
Helpful questions to sort out your symptoms include:
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 skin testing. A food and symptom diary is another useful tool to determine less obvious food allergies.
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 for definitive diagnosis as a skin test. Using a sample of your blood, the test looks for levels of antibodies to particular allergens. This type of testing can be helpful for people who have skin conditions such as rashes, hives or dermatographia that make it difficult to do skin testing or who have an unusual history of reacting to allergens not available for testing.
If your health care professional suspects a food allergy, he or she may suggest an elimination diet, but only if your reactions are not severe. This technique involves not eating any of the suspected 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 reappear. A procedure used to objectively diagnose food or medication allergy is the challenge test. During a challenge test, you take a very small amount of an allergen by inhaling it or taking it by mouth. It’s very important that challenge tests be supervised by an allergist or other physician with specialized training in allergies.
Another kind of challenge test 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 in pinpointing a specific food reaction.
Reviewed by Dr. Bruce Prenner
Allergy Partners of San Diego
Allergy Partners releases smartphone app for patient use
Asheville, North Carolina, July 5, 2016- There is now a mobile app for patients, integrated within Allergy Partners’ Patient Portal and EMR, which provides customized, interactive coaching for the patient’s specific condition and helps track medications, allergy injections, triggers, and symptoms.
APpal, developed by URXmobile System (www.urxmobile.com) with input from Allergy Partners physicians, boasts new technology that will ideally improve the health of patients. Through the interactivity of alerts, educational information and videos, as well as proactive modules on topics covering allergies and asthma, patients quickly realize the full potential of the app. Essentially, as the patient utilizes and interacts with the app, the better it gets to know the patient and can assist with ongoing support for treatment plans. Alerts and content are personalized and take into account a variety of factors specific to the individual user that occurs over time. “We’re not just telling a user to ‘use your inhaler properly’, rather, we’re explaining it in a very human way that is much more appealing to people.” said David Thompson, CEO URXmobile.
In a recent article published in The Journal of Allergy and Clinical Immunology: In Practice, researchers from the Scripps Clinic evaluated the usefulness of a mobile app in the management of asthma. Working with URXmobile, the researchers developed a minimally intrusive smartphone app designed to provide individualized and timely educational support to patients with asthma. The education was based on the National Asthma Education and Prevention Program (NAEPP) guidelines. Sixty adult patients with poorly controlled asthma were provided the app for a 4 month period. The Asthma Control Test (ACT), a standardized and validated measure of asthma control, was performed before, during, and after app use. Additionally, changes in lung function and use of systemic steroids (for example, prednisone) were assessed before and during use of the app. Finally, a patient satisfaction survey asked patients about their experience with the app.
The study found that use of the app led to the following:
1. Improved asthma control as ACT scores improved from 16.6 (inadequate to poor control) to 20.5 (controlled)
2. Improved lung function with a 7.9% increase in FEV1 (measure of lung function)
3. Fewer asthma flares with a reduction in steroid use from 0.5 to 0.3 courses per 6 month period
4. Patient surveys showed that patients found the app to be very easy to use, personalized, and helped them manage their asthma better.
Available on iOS and Android, APpal is free to Allergy Partners’ patients and its use is highly encouraged. App technology provides an extension of care beyond the office visit that encourages adherence to treatment plans discussed between the patient and their physician. Being able to document symptoms and triggers as they occur, having a personalized coach to assist with using an inhaler, as an example, taking self-assessments between visits and having the option to message the office directly from the app, is an irreplaceable value to being a patient of Allergy Partners. As one patient stated, “When I moved to a new city, my asthma was out of control and I tried various medicines but many times forgot to take those meds consistently. So when I would have a flare-up, I would blame it on the fact I wasn’t consistent with my meds. But me and my doctor realized that something else was going on that was causing these flare-ups. We did an allergy test and found out that I was allergic to many external factors and that allergy shots were the best method for me. Without monitoring my asthma routinely using the app, I don’t know how long it would have taken me to say enough was enough. The app was the driving factor that helped me progress in finding a solution for my asthma problems.” Always striving to provide the latest advancements in diagnosis and treatments, the new APpal app is no exception for the leaders in allergy and asthma care.
A soft launch among 700 Allergy Partners’ patients has yielded glowing reviews and allowed even more enhancements to be completed before making it available to all. “I really liked how it became more customized the more I used it,” said one patient. Another testimonial from a current user states, “My asthma is better controlled now than it’s been for 20 years. I had no idea that I was overusing my rescue inhaler and I’m an RN with 32 years of experience. I just figured that I had the worst asthma and would never obtain the results I have now.”
Allergy Partners, P.A. is the nation’s largest allergy, asthma and immunology practice. Their network of 56 primary practice locations spans 23 states and encompasses over 133 total locations of care. Allergy Partners currently employs approximately 134 full- and part-time allergists and immunologists, 27 mid-level providers and over 900 practice employees. As Allergy Partners’ reputation continues to grow, the group remains committed to their vision and to bringing only the best physicians and practices into their care network.
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