We are dedicated to providing state-of-the-art treatment for patients with allergies, asthma and other allergic conditions.
Information about a newly diagnosed medical condition can be overwhelming. We want to ensure that our patients have a resource that they can easily access in order to have all of the information necessary to take control of their medical condition and improve their quality of life. Our physicians have written these condition profiles as a resource to help you learn more about your diagnosis and treatment options.
Allergic rhinitis, commonly referred to as hay fever, is a very common condition affecting more than 20% of people living in the United States. Allergic rhinitis is caused by exposure to substances in the air called allergens. Allergens are usually harmless substances, such as pollen, dust mites, pet dander or mold that the immune system typically ignores. However, in people with allergic rhinitis, the immune system mistakenly identifies these allergens as ‘intruders’ and generates a reaction against them.
In allergic individuals, the immune system produces a specific type of antibody called IgE (the ‘allergy antibody’) against the allergen (e.g. cat dander). The IgE antibody coats immune cells called mast cells. Mast cells exist everywhere the body comes in contact with the outside environment (the skin, respiratory tract, gastrointestinal tract) and contain a number of chemicals, such as histamine, that cause allergic symptoms. On exposure to an allergen, the IgE molecules bind to it and this triggers the mast cell to burst and release its histamine and other chemicals.
The histamine and other chemicals released from Mast cells causes many of the common symptoms of allergic rhinitis such as sneezing, runny nose, and nasal congestion. Eye symptoms include itchy, watery, redness and, at times, swollen eyes. The ears and roof of the mouth may itch as well. In asthmatic patients, allergen exposure can trigger cough, wheeze, and shortness of breath. Importantly, up to 70% of asthmatic patients have underlying allergies. People with allergies are also more prone to ear and sinus infections.
A careful history, physical exam and detailed knowledge of the area’s native plants and pollination patterns are key elements in the proper diagnosis of allergic rhinitis. Identification of allergens is best done with allergen skin testing. In skin testing, a small amount of purified allergen extract is introduced into the skin using various device techniques. If a person is allergic to say cat dander, a skin test to cat dander will cause the mast cells in the skin to release histamine and a small hive will develop within 15 minutes. Blood based allergy tests (commonly called RAST tests) measure IgE antibody in the bloodstream and can also be used to diagnose allergy triggers. Such testing, however, has limitations and skin testing remains the preferred method to identify allergic triggers.
The cornerstone in the treatment of allergic rhinitis is to avoid allergens that trigger symptoms (Click here to see Allergy Partners Environmental Control Handbook). A variety of medications are useful in treating symptoms. Antihistamines are useful for alleviating itching and sneezing, while decongestants alleviate congestion. Nasal sprays (both steroid and antihistamine) effectively treat many nasal symptoms while a variety of antihistamine eye drops are available for eye symptoms. Immunotherapy is a very effective treatment for allergic rhinitis, allergic conjunctivitis, and asthma. Unlike medications that treat symptoms only, immunotherapy truly modifies the immune system and prevents symptoms from developing in the first place. Immunotherapy is effective in approximately 85% of patients and reduces symptoms, need for medications and may prevent asthma in young children.
As the nation’s largest single specialty allergy practice, Allergy Partners boasts its decades of experience in treating a variety of allergic conditions such as allergic rhinitis and asthma. Your Allergy Partners physician will work to develop a comprehensive, personalized and cost effective treatment program designed to alleviate symptoms and improve quality of life.
For more information on this condition, visit: American College of Allergy, Asthma, and Immunology
Anaphylaxis is a rare but severe allergic reaction which can occur suddenly and potentially be fatal.
In most cases, people with allergies develop mild to moderate symptoms, such as watery eyes, a runny nose or a rash. But sometimes, exposure to an allergen can cause a life-threatening allergic reaction known as anaphylaxis. This severe reaction occurs due to an over-release of chemical mediators within the body, leading to symptoms in multiple body systems. Allergies to food, insect stings, medications and latex are most frequently associated with anaphylaxis.
Anaphylaxis symptoms occur suddenly and can progress quickly. The early symptoms may be mild, such as a runny nose, a skin rash or a “strange feeling.” These symptoms can quickly lead to more serious problems, including:
If you have a history of allergies and/or asthma and have previously had a severe reaction, you are at greater risk for anaphylaxis.
Allergists have the training and expertise to review your history of allergic reactions, conduct diagnostic tests (such as skin-prick tests and oral food challenges) to determine your triggers, review treatment options and teach avoidance techniques. Consultation with an allergist is recommended if:
An anaphylactic reaction should be treated immediately with an injection of epinephrine (adrenaline). An auto-injector should be prescribed so that it can be available at all times. Two injections may be necessary to control symptoms, due to persistent or biphasic reactions. Here are some tips for reducing the risk of anaphylaxis:
1. Know your trigger. If you’ve had anaphylaxis, it’s very important to know what triggered the reaction. An allergist can review your medical history and, if necessary, conduct diagnostic tests. Some of the most common triggers include: foods, insect stings, latex or medications.
2. Avoid your trigger. Avoidance is the most effective way to prevent anaphylaxis. An allergist can work with you to develop specific avoidance measures tailored specifically for your age, activities, occupation, hobbies, home environment and access to medical care.
3. Be prepared. Prompt recognition of the signs and symptoms of anaphylaxis is critical. If you unexpectedly come into contact with your trigger, you should immediately follow the emergency plan outlined by your doctor, including the self-administration of epinephrine. Teachers and other caregivers should be informed of children who are at risk for anaphylaxis and know what to do in an allergic emergency.
4. Seek treatment. If a severe reaction does occur and epinephrine is administered, you should be transported to the nearest emergency facility by ambulance for additional monitoring.
5. Tell family and friends. Family and friends should be aware of your condition, your triggers and know how to recognize anaphylactic symptoms. If you carry epinephrine, alert them to where you keep it and how to use it.
6. Wear identification. Wear and/or carry identification or jewelry (bracelet or necklace) noting condition and offending allergens.
7. See a specialist. Allergists have the training and expertise to review your allergy history, conduct diagnostic tests, review treatment options and teach avoidance steps.
Allergy Partners physicians are board certified experts in the diagnosis, treatment, and management of allergic diseases, including anaphylaxis. If you are having symptoms suggestive of anaphylaxis, your Allergy Partners physician will take a detailed history, perform a physical exam, and order appropriate testing to confirm the diagnosis. Working together, you and your Allergy Partners physician will develop a comprehensive and personalized treatment plan.
Angioedema is the term for abnormal swelling of a particular area of the body due to fluid leaking from blood vessels just under the skin. Angioedema is most commonly seen with allergic reactions, but it is also seen with certain infections and illnesses.
Allergic angioedema may happen after bee stings, foods, medications, and “regular” causes of allergies such as pollens or animal dander. Angioedema can also occur repeatedly over a long period of time as part of a condition called “chronic urticaria and angioedema”.
In addition, C-1 esterase inhibitor deficiency is a rare disorder of the clotting system that can lead to recurring swelling of both internal and external body parts. Most cases of C-1 esterase inhibitor deficiency are inherited and termed Hereditary Angioedema (HAE).
Angioedema due to allergic reactions is often seen in combination with hives. The affected area is often more painful or uncomfortable than itchy. Swelling can last hours or even days. The eyes, lips, tongue, hands, and feet are most commonly involved. Patients with C-1 esterase inhibitor deficiency can experience internal swelling and intense pain.
It is important to identify the cause of angioedema if possible, and the first step is a careful interview and physical exam with an experienced medical professional. It is difficult to find a specific reason for chronic episodes of swelling, but episodes of angioedema due to bee stings, foods, medications, or allergens can be investigated with skin testing. Other laboratory tests can help point to any sources of inflammation or infection.
Simple or mild cases of angioedema can be treated with rest, ice, and antihistamines. More severe or persistent cases can be treated with high doses of antihistamines, ranitidine (or similar drugs), and corticosteroids. Patients with C-1 esterase inhibitor deficiency can now be treated with several new medications that either replace the missing enzyme or block the reaction leading to episodes of angioedema.
Allergy Partners caregivers are experts in evaluating the possible causes of angioedema. Our allergists are also trained to provide the latest, state of the art treatment options, and have participated in the original clinical trials for many of these therapies.
For more information on this condition, visit: Hereditary Angioedema Association
Asthma is a common lung disorder characterized by inflammation and muscle spasm within the small airways in the lungs, leading to symptoms of cough, wheezing, chest tightness and/or shortness of breath. Asthma may develop at any age, but most commonly presents in early childhood or mid-adulthood. Most cases that occur in childhood improve greatly over time and with appropriate treatment. Asthma that develops in adulthood typically responds well to treatment but is less likely to be outgrown.
Asthma is the most common chronic disease in children and affects approximately 34 million Americans. Asthma has a strong genetic component and often runs in families. Individuals with allergic conditions such as food allergies, eczema and hay fever are at increased risk for the development of asthma as are individuals who have immediate family members with asthma. For reasons that are not completely clear, the incidence of asthma and other allergic diseases has been steadily rising over the past several decades.
Asthma severity varies greatly from very mild to debilitating. Unfortunately, asthma can be fatal and over 4,000 Americans from asthma every year. For the vast majority of asthmatics, however, asthma can be well controlled with the right strategies and treatment.
Common symptoms of asthma include one or more of the following:
Individuals with asthma may have one or more trigger including:
Asthma is a clinical diagnosis and usually suspected when the characteristic symptoms occur, especially at nighttime, with exercise, with colds or with allergy flare-ups. A favorable response to asthma medicines is suggestive of the diagnosis as well. Definitive diagnosis and optimal treatment of each individual case requires not only periodic exams, but also measurement of lung function, starting by five or six years of age. This is accomplished with spirometry which measures the amount and rate of air flow from the lungs. Often spirometry is performed before and after the use of a bronchodilator medication such as albuterol. This medication will cause a characteristic rise in air flow confirming asthma. Other tests such as a methacholine challenge or measurement of exhaled nitric oxide can also assist in the diagnosis of asthma. Since allergies are a common trigger in up to 85% of individuals with asthma, allergy skin testing is an integral part of the initial evaluation of asthma in order to optimize treatment. Chest x-rays, blood work and other tests are rarely needed for the diagnosis and management of asthma, unless other medical problems are suspected. Some examples of other medical conditions that can mimic or aggravate asthma include chronic sinusitis, acid reflux and vocal cord dysfunction. If these conditions are suspected, further testing and treatment may be needed to optimize treatment and outcomes.
Avoidance of allergens and irritants: Depending on the person’s history and results of allergy testing, specific measures to reduce exposure to the substances to which one is allergic is a vital part of asthma management. This will help reduce the amount of medications needed to control asthma.
Treatment of underlying medical conditions: Chronic sinus problems, acid reflux (heartburn), obesity, and other conditions may aggravate asthma. It is important that these problems be addressed in order to have optimal control of asthma. Since viral infections are common triggers of asthma, yearly flu vaccinations are recommended for patients with asthma.
Medications: Asthma medications can be divided into two broad categories, controller therapy and quick relief/rescue medicine. Controllers treat the underlying inflammation produced by asthma and must be taken adherently on a daily basis for maximal benefit. These usually contain low-dose inhaled corticosteroid medicines, but can also be in tablet form in the case of montelukast. Despite using controller medicines daily, patients can often experience breakthrough symptoms during exercise, with colds or upon exposure with allergens. During these episodes, rescue inhalers help dilate the airways to help relieve symptoms of an asthma attack.
Allergy Immunotherapy Injections: Allergy injections are the most effective long-term preventive strategy for the treatment of allergies. For many individuals, allergies are a significant trigger of asthma and aggressive control of their allergies can decrease the amount of asthma symptoms these individuals experience. Allergy shots can help build up your immunity to the exact items (allergens) to which you are allergic. They can improve asthma directly by reducing the sensitivity of the lungs to inhaled air-borne allergens which can contribute to airway inflammation. And they can indirectly improve asthma by reducing inflammation of the nasal and sinus passageways, thereby re-establishing the normal filtration and humidification of inspired air that is important for lung health. Furthermore, control of environmental allergies can help reduce the number of respiratory infections one experiences which are a major asthma trigger one experiences. The length of treatment depends on the nature and severity of the allergy.
Allergy shots are a great treatment option for patients whose asthma symptoms interfere with work/school/recreation/sleep, or in those individuals who would like to reduce their reliance on medications over the long term.
As the nation’s largest medical practice solely dedicated to the treatment of asthma and allergies, Allergy Partners provides you and your family with expert asthma care. Our physicians will combine an in depth medical history and physical examination with state of the art diagnostic testing to establish if you have asthma. We will then aggressively identify and treat underlying triggers and manage your symptoms so that your asthma can be better controlled with the least amount of medication necessary.
For more information on this condition, please visit: American College of Allergy, Asthma & Immunology
Coughing is considered “chronic” when it’s been present for more than two months. Colds and respiratory infections are responsible for most brief cough illnesses, but longer-lasting cough illnesses often indicate allergies or other conditions, such as:
The type and timing of the cough can help identify the cause, and symptoms such as “allergies”, throat-clearing, wheezing, shortness of breath, and heartburn can help point to one of the common illnesses associated with cough.
A careful medical interview and physical exam is the key to finding the cause of chronic coughing. Allergists are especially well-suited for evaluating and treating chronic cough because of their training and areas of expertise. Postnasal drip (allergies), asthma, and gastric reflux alone or in combination are responsible for most of the cases of chronic cough, and most medical professionals first try a “therapeutic trial” of medications that treat these conditions.
Chronic cough treatment is tailored to the cause:
For patients with allergies, treatment can include avoidance of triggers, prescription nasal steroid sprays, antihistamines, decongestants, and allergen immunotherapy (allergy shots).
Avoiding known triggers can reduce the intensity of atopic dermatitis. Irritants, stress, heat/sweating, infections, and allergens can all cause exacerbations.
Those who have non-allergic nose or sinus problems may respond best to older antihistamines (those that may make you sleepy) by mouth or prescription antihistamine nasal sprays.
Asthma is usually treated with the combination of daily inhaled corticosteroids and as-needed inhaled albuterol. Medications such as Singulair® are sometimes used instead of the steroids. Patients with asthma can also benefit from identifying and avoiding any allergies, as well as allergen immunotherapy if they have significant allergies.
Gastroesophageal reflux (“GERD”) is treated with lifestyle changes (such as weight loss, avoidance of spicy & fatty foods, and not eating right before bed) and use of a moderate dose of a “proton pump inhibitor” such as omeprazole. It may take weeks or sometimes months for cough due to reflux to respond to reflux therapy.
Allergy Partners’ caregivers are well prepared and trained to evaluate and treat the many possible causes of chronic cough. Please consider contacting your local Allergy Partners clinic for an appointment.
For more information on this condition, please visit: American College of Allergy, Asthma & Immunology
Dermatographism is a skin disorder characterized by the skin becoming raised and inflamed (hive-like) when stroked or rubbed with a dull object. The name dermatographism derives from the Greek language and translates literally as “skin writing” (see picture). It is believed to be caused by mast cells, a type of white blood cell often involved in allergic reactions, releasing histamine and other inflammatory substances into the surrounding skin. This causes the skin to become red, raised and itchy.
The underlying cause of dermatographism is not known, but it is not considered to be life threatening or contagious. It is often confused with an allergic reaction to the object causing a scratch, when in fact it is simply the act of being scratched that causes the skin to change appearance.
This condition may last for days, weeks, months or years. Dermatographism often begins in association with some type of infection, such as, an upper respiratory tract infection, and can occur at any age. There appears to be no known racial variance in prevalence. Dermatographism occurs in approximately 5% of the population.
Oftentimes, an individual may present with symptoms of generalized itchiness or the sensation of burning. Irritation at one site of the body can result in mast cells in other parts of the body releasing histamine although they have not been directly stimulated. Dermatographism is a condition limited to the skin. If you experience other symptoms that are concerning, such as, difficulty breathing, seek immediate medical attention. Symptoms can be induced by tight or abrasive clothing, watches, glasses, heat, cold, or anything that causes stress to the skin or the patient. In many cases it is merely a minor annoyance, but in some rare cases symptoms are severe enough to impact a patient’s life.
Dermatographism is often diagnosed after a physician rubs or strokes the skin with a dull object and the characteristic red, raised, itchy rash appears.
Normally, the swelling and irritation reduces itself with no treatment within 20-30 minutes, though in extreme cases, itchy red wheals may last anywhere from a few hours to days. If treatment is necessary, antihistamines are usually effective.
An allergist can help make the diagnosis of dermatographism by taking a careful medical history and performing a physical examination to rule out other disorders that may present similarly.
Any undesirable side effect or reaction to a medication is called an adverse drug reaction. Most people, however, call any adverse drug reaction an allergy. In truth, only about 5-10% of adverse drug reactions are true drug allergies. In a drug allergy, the immune system reacts to a medication or its metabolites and it is this immune response that triggers symptoms.
Other adverse drug reactions do not involve the immune system and are therefore not drug allergies. However, both allergic and non-allergic drug reactions can cause similar symptoms and can be easily confused. Regardless of the cause, all adverse drug events need to be evaluated by a doctor, as some allergic and non-allergic drug reactions can be severe or life-threatening.
Most allergic reactions start immediately after taking the drug. On the other hand, it’s possible to develop an allergic reaction to a medication even after a person has been on it for several weeks. Additionally, an allergic reaction to a drug can occur even if the drug had caused no reaction in the past.
A careful medical history is extremely important in diagnosing drug allergies, including the nature of symptoms, timing of symptoms, specific drugs taken and previous history of allergic reactions. For some drugs, particularly certain antibiotics, an allergy skin test may be done to determine whether a person is allergic. A small amount of the drug is injected in the skin of the arm or back, and if the individual is allergic to the drug being tested, a red raised bump will develop. Tests to identify drug allergies are not available for many drugs. Sometimes a drug provocation test is done. During drug provocation testing, gradually increasing amounts of the drug in question are given until a reaction occurs or the drug is tolerated at a full dose. This is usually only done when there are no acceptable alternative drugs available.
Desensitization: In some cases, sensitivity to a drug can be reduced by starting with a tiny dose and gradually increasing it over time. This can take from 1-10 days and is generally done under medical supervision at a doctor’s office, hospital or allergy clinic. In general, this is only done when a person is allergic to a drug and a satisfactory alternative is not available.
Drug allergies can be very difficult to diagnose. It takes a physician with expertise such as a board-certified allergist/immunologist to know which questions to ask and what tests to perform. Your Allergy Partners physician has the training and experience to know how best to diagnose and manage your drug allergy.
For more information on this condition, please visit: American College of Allergy, Asthma & Immunology
A telltale sign of dust allergy is sneezing but it can also cause other uncomfortably and annoying symptoms. These can include stuffy or runny nose, itchy or red and watery eyes. Dust allergies also make it difficult to breathe and may trigger asthma symptoms, such as wheezing, coughing, tightness in the chest and shortness of breath.
People with dust allergies often suffer the most from being inside their own homes or in other people’s homes. Symptoms often worsen during or immediately after vacuuming, sweeping and dusting since the process of cleaning can stir up dust particles, making them easier to inhale.
If you think you may have an allergy to any of the components of dust mentioned above, it’s best to see an allergist. Your allergist will ask detailed questions about your work and home environments, family medical history, frequency and severity of symptoms and exposure to pets and other possible triggers in order to determine the cause of your symptoms.
Often an allergist will need to conduct a skin test to determine exactly what is triggering an allergic reaction.
Skin tests involve using a small, sterile probe to prick the skin with extracts from common allergens, such as tree pollen and pet dander, and observing the reaction. A positive reaction (a raised welt with redness around it) may indicate that you are allergic to that substance.
After a dust allergy is identified, your allergist will recommend one or more of the following treatments:
Allergy Partners physicians are board certified experts in the diagnosis, treatment, and management of allergic diseases, including dust allergy. If you are having symptoms suggestive of dust allergy, your Allergy Partners physician will take a detailed history, perform a physical exam, and order appropriate testing to confirm the diagnosis. Working together, you and your Allergy Partners physician will develop a comprehensive and personalized treatment plan.
Eczema (Atopic Dermatitis)
Atopic dermatitis, also known as eczema (pronounced “EK-zema”), is a skin condition that causes dry, scaly, red, and itchy skin. It can occur at any age, and is more frequent in some families.
Eczema affects 10-20% of children and 1-3% of adults. The cause of atopic dermatitis is unknown, but genetic factors play a strong role. The symptoms are secondary to a dysfunctional outer layer of the skin known as the epidermis. Normally, an intact epidermis keeps out environmental irritants, allergens, and microbes. Because the skin is not working properly, these substances get into the body which leads to inflammation. In children with moderate to severe atopic dermatitis, up to 2/3 of them may have some underlying food allergy.
Most people with atopic dermatitis have symptoms before the age of five. Intense itching of the skin, patches of redness, small bumps, and skin flaking are common symptoms. Scratching can lead to additional inflammation, which causes a cycle of itching and scratching that worsen the condition and can potentially lead to decreased sleep and quality of life. In severe exacerbations, the skin may actually start oozing which can be a sign of infection.
There is no specific test to diagnose atopic dermatitis. The diagnosis is based on clinical information like the patient history and physical examination. Testing done by a well-qualified allergist can identify potential triggers like environmental or food allergens.
SKIN CARE, SKIN CARE, SKIN CARE! Appropriate skin care is the cornerstone of treatment for atopic dermatitis. Aggressive moisturization with a good quality, hypo-allergenic lotion or cream is the key to preventing skin dryness.
An allergist can help identify environmental or dietary triggers and work with patients and their families in creating an effective and practical treatment plan. Skin testing to identify these potential triggers should be performed by a trained professional.
Eosinophilic esophagitis (EE) is a relatively newly recognized disease that has been increasingly diagnosed in both adults and children since 2000. It is characterized by a large number of white blood cells called eosinophils that cause inflammation in the esophagus (the tube that connects the mouth and stomach).
This inflammation prevents the esophagus from functioning normally and leads to symptoms. EE commonly occurs in people with other allergic diseases such as allergic rhinitis (hay fever), asthma and/or eczema.
Reflux that does not respond to usual therapy:
The only way to definitively diagnose EE is through endoscopy with biopsies, usually done by a gastroenterologist. The endoscopy is often performed when treatment with reflux medications has failed to relieve symptoms. During the endoscopy, the gastroenterologist looks at the esophagus, stomach and duodenum (the first part of the small bowel) through an endoscope (small tube inserted through the mouth) and takes multiple biopsies (small tissue samples) which a pathologist reviews under the microscope. A high number of eosinophils (>15 per high power field under the microscope) suggests a diagnosis of EE.
Once EE is confirmed, allergy testing is recommended as many patients with EE have underlying food and possibly environmental allergies that are contributing to the abnormal inflammation seen in the esophagus. The most common type of allergy testing is skin prick testing, but patch testing to certain foods can be useful as well. In patch testing, a small amount of the foods is placed on the skin (usually the back) and covered with tape for 48-72 hours. At that point, the site is assessed for evidence of redness and inflammation indicating food allergy.
At present the two main treatments recommended are dietary management and topical corticosteroids.
Elimination Diets – All “positive” foods on allergy testing are removed from the diet. Often this is the only treatment needed.
Six-food Elimination Diet – Patients eliminate the top 6 most allergenic foods (dairy, eggs, wheat, soy, peanuts/other nuts, fish/shellfish).
Elemental Diets – All sources of protein are eliminated from the diet except for an amino acid (building blocks of protein) formula. These diets are mostly used in young children with EE.
Food Trials – This involves adding back one ingredient at a time to one’s diet to determine specific foods causing a reaction. They begin after symptoms resolve and eosinophils have cleared.
Medications – Medications most commonly include steroids to control inflammation and suppress eosinophils. They can be taken orally (a form of prednisone) or topically (swallowed asthma inhaled steroid such as fluticasone or budesonide).
The diagnosis and treatment of eosinophilic esophagitis requires a multidisciplinary team approach involving gastroenterologists, allergists, and nutritionists. As part of the nation’s largest allergy practice, Allergy Partners’ physicians provide the expertise needed to accurately diagnose underlying allergic triggers to EE. With this information, a personalized and comprehensive treatment plan aimed at alleviating symptoms of EE can be formulated.
For more information on this condition, please visit: American Partnership for Eosinophilic Disorders
Eye Allergy, also known as Allergic Conjunctivitis, is a very common disorder affecting millions of people every year. The conjunctiva is the mucous membrane covering the whites of the eyes and the inner side of the eyelids. If something irritates this clear membrane, the eyes may water, itch, hurt, or become red and or swollen. There are many causes of conjunctivitis, including viral and bacterial infections. However, 50% of conjunctivitis cases seem by primary care doctors are allergic in nature. Eye allergy can occur alone or along with nasal allergy symptoms such as sneezing and stuffy nose.
In an allergic person, the immune system identifies common airborne materials as invaders, or allergens. On contact with these allergens, the immune system reacts and releases a variety of chemicals, including histamine, that cause the symptoms of allergies. In those with Eye Allergy, allergic triggers can be present indoors and outdoors. The most common outdoor allergens are grass, tree and weed pollens that will cause symptoms during particular times of the year. Indoor allergens are pet hair or dander, dust mites and mold and can cause year round symptoms.
The most common symptoms of Eye Allergy include redness, watery discharge, and itching of both eyes. Other symptoms include burning, sensitivity to light, and swelling of the eyelids. Both eyes are generally affected, although symptoms may be worse in one eye. Rubbing of the eyes can exacerbate symptoms. Many people will also have other allergy symptoms, such as sneezing and a runny nose.
Eye Allergy can be very uncomfortable and may disrupt your day to day activities, but usually does not permanently harm your eyes. However, there are rare conditions associated with atopic dermatitis and other diseases that can cause inflammation that could affect the eyesight.
The first line of treatment to ward against developing Eye Allergy is to identify and then avoid allergy triggers. Allergen skin testing is a quick and accurate test that will identify the particular allergens that trigger eye allergies. Once these triggers are identified, you can take environmental control measures to minimize your exposure. This includes:
In addition, your Allergy Partners physician can prescribe medications that will help soothe and alleviate Eye Allergy symptoms. Allergy injections, or immunotherapy, is a very effective therapy to help protect against the allergens causing your Eye Allergy.
Allergy Partners physicians are board certified experts in the diagnosis, treatment, and management of allergic diseases, including eye allergy. If you are having symptoms suggestive of eye allergy, your Allergy Partners physician will take a detailed history, perform a physical exam, and order appropriate testing to confirm the diagnosis. Working together, you and your Allergy Partners physician will develop a comprehensive and personalized treatment plan.
Reactions to food are common and can be divided into two categories; those caused by food allergy and all other reactions.
Food allergies develop when the body’s immune system has an abnormal reaction to one or more proteins in a food. Food allergies can lead to serious or even life-threatening allergic reactions.
Food allergies can be further divided into “classic” and “non-classic” types. Other food reactions, not caused by the immune system, cause unpleasant symptoms and are far more common than food allergies. Examples include lactose intolerance, heartburn (gastroesophageal reflux), bacterial food poisoning, and sensitivity to caffeine.
Although 20-30% of people report food allergies, only 6-8% of children and 3-4% of adults have “classic” food allergy. The most common foods causing allergy are cow’s milk, egg, peanuts, soy, wheat, tree nuts, fish, and shellfish.
In individual with “classic” food allergies symptoms typically occurs quickly, within minutes to two hours after eating. The most common symptoms of food allergy include:
Food protein-induced enterocolitis and proctitis/proctocolitis are common types of non-classic food allergy that are seen often in infancy.
Some individuals suffer from “non- classic” food allergies. The symptoms of this type of food allergy are usually slower to develop and longer lasting than those of classic food allergies. Symptoms commonly include vomiting, diarrhea, abdominal pain, and/or blood in the stool. Food protein-induced enterocolitis and proctitis/proctocolitis are common types of non-classic food allergy that are seen often in infancy.
A complete and detailed medical history is essential for initiating the proper treatment for food allergy. Specific skin and blood testing provides added information on determining the likelihood of “classic” food allergy. If a person had a reaction after eating peanuts, but has never reacted to wheat or eggs and eats them regularly, it is not necessary to test for allergy to wheat or eggs. The gold standard test for all food allergies is the oral food challenge, where the food is ingested by the patient in a controlled setting (clinic or hospital) to monitor for reaction. It is important to note that neither the size of the skin prick test nor the level on blood tests translate into severity of allergy. These tests only speak to the likelihood of any reaction.
Once a food allergy is certain, the best treatment is to avoid the food. Patients must carefully check ingredient labels for all food products. The most important aspect of the treatment plan is to have emergency medications available at all times in case of an allergic reaction. In the case of a severe allergic reaction, timely administration of self-injectable adrenaline is the cornerstone of treatment.
Your Allergy Partners board-certified provider can assist in determining whether or not a food allergy exists, what type of food allergy it is, and what treatment plan is appropriate.
Check out these links to other resources: National Library of Medicine
Hives are raised, red, and extremely itchy “welts” (called wheals) on the skin surface that can last minutes to hours. In medical writing, hives are often referred to as urticaria.
Hives are a common problem that can disrupt sleep, school, and work. They appear quickly when special skin cells called mast cells are triggered to release chemicals that cause the redness, itching, and swelling. Hives can be part of a severe, whole-body allergic reaction called anaphylaxis.
Most cases of short-lasting hives are triggered by allergic reactions, medications, or viral infections. Allergic responses to foods, bee stings, medications, or airborne substances can all cause hives. Physical factors such as pressure, cold, heat, or vibration can also provoke urticaria in certain people. Dermatographism (Latin for “skin writing”) refers to hives that pop up for only minutes after a scratch or irritation to the skin.
It is possible to have hives lasting for weeks or months. This “chronic urticaria” is usually not due to a particular trigger, but instead it can result from abnormal immune reactions involving the mast cell. The severity of chronic hives can be affected by other factors such as stress, medications, temperature, and illnesses.
Individual hives are itchy, raised, and red. The wheals are often paler in the middle. Severe itching is almost always present. The size of hives can range from small bumps to large wheals that spread over an entire body region. Patients with hives often have areas of deeper skin swelling called angioedema. Hives should not leave behind bruising, blistering, or other skin changes unless there’s been severe scratching.
It is important to identify the cause of hives if possible, and the first step is a careful interview and physical exam with an experienced medical professional. Episodes of hives due to foods, bee stings, medications, or allergens can often be sorted out with allergy testing. A simple cause is not often found for chronic urticaria, but laboratory testing can help sort out any source of inflammation or infection that could lead to these issues.
Severe allergic reactions (anaphylaxis) often include hives in addition to other symptoms. In this event it is important to contact emergency services and use an epinephrine auto-injector if available. For hives alone, it is important to identify and avoid the cause if possible. Hives usually respond to medications that block histamine – the major chemical released by the mast cell. These “antihistamines” include the commonly used diphenhydramine (Benadryl®), but mild or ongoing cases of hives can also respond to longer-lasting and less sedating antihistamines such as loratadine (Claritin®), cetirizine (Zyrtec®), or fexofenadine (Allegra®). Severe or persistent cases of urticaria can be treated with the addition of medications such as high dose antihistamines, ranitidine (or similar drugs), and temporary use of corticosteroids (such as prednisone). In severe cases of chronic urticaria, it is sometimes necessary to use other drugs that act on the immune system.
Allergy Partners caregivers are experts in evaluating the many possible causes of hives and allergic reactions. The allergists with Allergy Partners are also trained to provide treatment options that can include avoidance and medications. The evaluation is centered on a careful interview and physical examination, followed by any necessary tests. The tests may include skin testing, which can be done during the initial visit if the patient is not taking antihistamines.
The body’s first line of defense against infectious diseases (like bacteria, viruses, or fungi) is the immune system. The specialized cells and organs of the immune system help identify and fight off these foreign pathogens. If the immune system is not working properly it can lead to several serious disorders like allergies, asthma, autoimmune diseases, or immune deficiency. Immune deficiency disorders lead to an abnormally low resistance to infection.
The immune system may (most commonly) be suppressed by medications or illness. A primary Immune deficiency (PIDD) is present from birth as a genetic disorder that prevents the immune system from functioning properly. An estimated 500,000 Americans are afflicted with PIDDs; 5,000 to 10,000 are severely affected. There are over 150 different forms of PIDDs; almost all of these diseases are considered rare (affecting fewer than 200,000 people in the United States).
Patients with immune deficiency may have infections in any part of the body – the skin, the sinuses, the throat, the ears, the lungs, the brain or spinal cord, or in the urinary or intestinal tracts. The increased vulnerability to infection may include repeated infections, infections caused by unusual or typically benign pathogens, infections that won’t clear up or unusually severe infections. Fortunately, with proper medical care, many patients with immune deficiencies live full and independent lives.
A thorough personal and family medical history along with physical examination is the first step in evaluating a person with a potential immune deficiency. Specific questions may be asked such as:
Laboratory tests (blood tests) that can measure different parts of the immune system may be necessary depending on the clinical history.
The treatment options are specific for each condition. General measures such as eating a healthy diet, decreasing stress, increasing sleep, and practicing good hand hygiene may be warranted. Specific therapies like rotating antibiotic schedules, intravenous immunoglobulin, or granulocyte-colony stimulating factor may be necessary depending on the specific disease.
Board-certified allergist-immunologists receive two to three years of specialty training in the area of immune dysfunction and immune deficiency and are experts in this field of medicine. All Allergy Partners physicians are board certified and will combine your history with information from the physical exam and laboratory testing to provide an accurate diagnosis and develop a personalized treatment plan to address your symptoms.
During spring and summer bees and other flying insects are busy collecting food. Unfortunately sometimes we humans get in their way. In order to protect themselves, they end up attacking and stinging us. Most insect stings produce only local discomfort. Occasionally it can lead to more severe reactions called anaphylaxis.
Anaphylaxis from insect stings results in a significant number of fatalities each year. It is estimated that potentially life-threatening systemic reactions to insect stings occur in 0.4% to 0.8% of children and 3% of adults. At least 40 deaths occur in the U.S. yearly from reactions to insect stings. It is likely that additional deaths are due to insect sting but not recognized and therefore not reported.
Several insects can sting and, due to the anxiety that takes place when a sting occurs, it is very difficult to identify the one to blame. Other insects that can sting are: Yellow jackets, Hornets, Wasps, Fire Ants, Honeybees. These insects are very different but all make venom that causes inflammation when inserted through the sting.
Yellow Jackets- Ground-dwelling insects, nests are concealed in the ground or behind siding or retaining walls. They have smooth thorax, and abdomen is yellow and black. They may be very aggressive and sting with minimum provocation, especially in the presence of food.
Hornets- They make aerial nests that resemble Japanese lanterns, generally in trees, shrubs, roof overhangs, or under surfaces of wooden decks. Nests may not be easily visualized. They can be very aggressive, particularly close to the nest.
Wasps- Have long, thread-like waists, oval abdomens, and elongated posterior legs. Coloration and size of paper wasps vary from region to region. The nests are honeycombed, open, and cone-shaped, often built in dark areas, such as under eaves or porches of homes, behind shutters, or inside dryer vents.
Honeybees- Hives may be domestic or wild. The wild hives may be found in tree hollows or old logs and may contain hundreds of bees. They are usually not aggressive when away from their hives. Always leave a barbed stinger with attached venom sac when they sting.
Bumblebees- Black and yellow, both the thorax and abdomen are hairy. Rarely cause sting reactions. Easy to avoid because are slow and noisy. Venom is not commercially available for diagnosis or therapy.
Most people experience only local reactions. Localized reactions are of little medical consequence and no specific treatment is required. Reactions consist of redness, swelling, itching and pain at the sting area. Sometimes they can become large with extensive red swelling surrounding the sting site, increase in size for 24 to 48 hours, swelling to more than 10 cm in diameter.
There may be involvement of more than one joint area and may persist for several days, 5 to 10 days to resolve. It may be associated with itching, pain, or both. Treatment is aimed at reducing local pain, itching and swelling and consists of cold compresses, oral antihistamines, and/or oral analgesics.
The risk of a systemic reaction in patients who experience large local reactions is no more than 5% to 10%. Systemic Reactions range from skin responses (like, hives and swelling) to life-threatening reactions manifested by wheezing, difficulty breathing, difficulty swallowing, anxiety and decrease in blood pressure. Treatment of anaphylactic reactions caused by insect stings is the same as for other causes of anaphylaxis. If a stinger is present, it should be removed as quickly as possible.
Seek treatment if you experience any of the following:
Allergy Partners physicians are board certified experts in the diagnosis, treatment, and management of allergic diseases, including reactions to insect stings. If you are having symptoms suggestive of such reactions, your Allergy Partners physician will take a detailed history, perform a physical exam, and order appropriate testing to confirm the diagnosis. Working together, you and your Allergy Partners physician will develop a comprehensive and personalized treatment plan.
Natural rubber latex comes from the milky sap of the rubber tree (Hevea brasiliensis) found in Africa and Southeast Asia. Latex is used in a wide variety of products ranging from tires to balloons to medical gloves. Surprisingly, latex paint contains no natural rubber latex protein. Instead, paint contains synthetic latex which does not cause allergic reactions.
In the 1980’s, latex allergy became a far greater problem as healthcare workers began to wear latex gloves to prevent the spread of blood borne illnesses. In latex allergy, the immune system produces a type of antibody called Immunoglobulin E (IgE) that recognizes the latex protein. These IgE antibodies travel to and coat cells called mast cells. Mast cells reside everywhere the body comes in contact with the environment (skin, nose, lungs, and gut) and contain chemicals such as histamine.
On exposure to latex, the latex protein binds to the IgE and the mast cell releases histamine leading to the symptoms of an allergic reaction. People at increased risk of developing latex allergy include heath care workers and spina bifida patients.
Other chemicals used to make latex containing products, such as gloves, can also trigger a delayed type allergic reaction. In this type of reaction, a blistering rash occurs 12-48 hours after exposure only where the skin came in contact with the latex.
In IgE-mediated allergic reactions to latex, exposure leads to a release of histamine from mast cells. This in turn leads to symptoms of hives (urticaria), swelling (angioedema), itching, and flushing. The latex protein can become airborne, especially when it becomes attached to the cornstarch powder used in powdered gloves. Inhaling this airborne latex can trigger sneezing, itchy watery eyes, cough, wheeze and shortness of breath. In particularly sensitive people or with heavy exposure, allergic reactions to latex can be life threatening. Interestingly, latex allergic patients may also note allergic symptoms on exposure to certain foods such as avocado, banana, kiwi, chestnut, white potato, tomato, bell pepper, and peach. Symptoms are typically mild with itching of the mouth but can be severe at times.
Delayed contact allergic reactions to latex and chemicals used in processing latex, cause an irritated rash similar to a poison ivy rash. Symptoms are aggravating but not life threatening and do not increase a person’s risk of developing an IgE-mediated allergic reaction.
Diagnosing latex allergy relies heavily on a detailed history exploring symptoms and possible exposure to latex. In addition, a history of allergic reactions to cross-reactive foods can be very helpful. Skin prick testing using standardized latex allergens is used in Europe, but is not available in the United States. The allergist may perform skin testing to a latex extract made in the office using latex gloves. In addition, skin testing to cross-reactive foods may be of benefit. Given the lack of standardized latex extract for skin testing, a negative skin test may need to be confirmed by a blood based allergy test (commonly called RAST testing) to latex. Finally, in certain circumstances, a challenge test may be recommended to confirm latex allergy. The diagnosis of delayed contact latex allergy is made utilizing allergen patch testing. In patch testing, a standard panel of chemicals commonly used in cosmetics and everyday products including latex and chemicals used in processing latex, are placed on the patient’s back for 48 hours. A positive test results in a characteristic red, raised and at times blistering rash.
Unfortunately, there is no cure for latex allergy. The mainstay of treatment is avoidance of latex and latex containing products. Identifying hidden sources of latex and latex containing products is the cornerstone in the treatment. For mild allergic symptoms, an antihistamine can be beneficial. For more severe reactions, epinephrine is the treatment of choice. An emergency alert bracelet should be worn by those with more severe symptoms.
For contact sensitivity, avoidance is again the mainstay of treatment. Once the chemical triggers have been identified by patch testing, it is possible to identify what products to avoid and what alternative products are safe to use. If symptoms recur, antihistamines can alleviate itching and steroid creams can speed resolution of the rash.
Allergy Partners physicians are board certified experts in the diagnosis, treatment, and management of allergic diseases, including latex allergy. If you are having symptoms suggestive of latex allergy, your Allergy Partners physician will take a detailed history, perform a physical exam, and order appropriate testing to confirm the diagnosis of latex allergy or contact sensitivity. Working together, you and your Allergy Partners physician will develop a comprehensive and personalized treatment plan.
Metal allergy (or hypersensitivity) is an allergic reaction due to an abnormal immune response to certain metals.
Many of these metals are commonly used in orthopedic, dental, cardiac and other implants as well as jewelry.
Metal allergy testing is performed in our office to the most common metal and cement
compounds used in dental and orthopedic implant surgeries. The test requires three office visits usually accomplished in the same week.
The test involves placing patches across your back. We will review the results with you after your final visit. You and your physician can use the results to make the appropriate decisions for your procedure based on your medical history and test results.
Allergy Partners physicians are board certified experts in the diagnosis, treatment, and management of allergic diseases, including metal allergies. If you are having symptoms suggestive of metal allergies, your Allergy Partners physician will take a detailed history, perform a physical exam, and order appropriate testing to confirm the diagnosis. Working together, you and your Allergy Partners physician will develop a comprehensive and personalized treatment plan.
Do you experience a runny nose, watery eyes or start sneezing and wheezing after petting or playing with a dog or cat? You likely have a pet allergy. A pet allergy can contribute to constant allergy symptoms, as exposure can occur at work, school, day care or in other indoor environments, even if a pet is not present.
Animals produce multiple allergens, or proteins that can cause allergy. These allergens are found in hair, dander, saliva and urine. All dogs produce allergens and the allergen levels increase for you if the dog lives indoors and are highest in the rooms where a dog is allowed.
Dust and pollen in an animal’s coat can also cause allergy symptoms. In those cases, the allergy is to dust or pollen, not to the dog.
If you suspect that you are allergic to a pet, see an allergist for proper diagnosis and treatment.
A skin-prick test is the most common way of diagnosing a pet allergy. For this test, a small amount of an extract of the animal allergen is placed on your skin. Your skin is then pricked with a small, sterile probe, allowing the liquid to seep under the skin’s surface. You’ll then be monitored for swelling and redness or other signs of a reaction, signaling an allergy. Results typically become evident within 15 to 20 minutes.
Even if you’re sure your symptoms are caused by a pet, it’s a good idea to be tested, since the symptoms may actually be caused by other environmental exposures.
Avoidance is the best way to manage a pet allergy but we realize that pets are part of the family. Here are some strategies that may help keep symptoms at bay:
Treatments for pet allergy vary, depending on the symptoms. Your allergist can help determine what treatment would be best to treat your pet allergy. Nasal symptoms are often treated with steroid nasal sprays, oral antihistamines or other oral medications. Eye symptoms are often treated with antihistamine eye drops. Respiratory or asthma symptoms can be treated with inhaled corticosteroids or bronchodilators to either prevent or relieve respiratory symptoms.
Allergy shots (immunotherapy) are an effective treatment of allergies, which works by building up a tolerance over time through gradually injecting increasing doses of the allergen(s) that affect you.
While poodles, Portuguese water dogs and a number of other breeds (including several types of terriers) have a reputation for being hypoallergenic, a truly allergy-free breed does not exist. A 2011 study compared dust samples from homes with dog breeds reported to be hypoallergenic and those of homes with other dogs. The levels of dog allergen in homes with “hypoallergenic” dogs did not differ from the levels in homes with other breeds.
Allergy Partners physicians are board certified experts in the diagnosis, treatment, and management of allergic diseases, including pet allergies. If you are having symptoms suggestive of pet allergies, your Allergy Partners physician will take a detailed history, perform a physical exam, and order appropriate testing to confirm the diagnosis. Working together, you and your Allergy Partners physician will develop a comprehensive and personalized treatment plan.
Recurring infections are a common problem and can greatly affect work, school and quality of life. People frequently experience recurring ear infections, sinus infections, bronchitis and/or pneumonia.
An allergist/immunologist is the most appropriate specialist to evaluate and treat both children and adults with these recurring infections.
Environmental conditions (daycare, school) – An infant or toddler at home may get 5-6 upper respiratory infections a year. The same child in daycare may get 10-12 a year. Over time, the immune system builds up and infections become less frequent.
Allergies (allergic rhinitis) – Allergic inflammation in the nose often blocks the sinuses and Eustachian tubes, resulting in frequent sinus and ear infections.
Immune deficiencies – The body’s immune system may not have all the usual “weapons” to fight off infections, thus making one susceptible to frequent infections. There are a number of deficiencies, some mild and others severe, which can lead to recurring infections.
Structural abnormalities (nasal polyps, enlarged adenoids) – A structural abnormality can lead to recurring infections in one particular area, such as a nasal polyp which blocks the opening to one of the sinuses and leads to frequent infections of that sinus.
Allergy Skin Testing – After an appropriate history, your doctor will determine what allergy tests are appropriate. Blood tests to evaluate the immune system, sometimes before and after an immunization. X-rays or CT scans.
One of the key components of your Allergy Partners’ physician’s specialty training is in the evaluation and treatment of recurring infections. We will not only determine the cause of your recurring infections, but will work with you to determine the most suitable treatment plan that will give you the best outcome for your health.
The sinuses are air-filled cavities (hollow spaces) within the facial bones that are connected to the nose. Sinusitis is characterized by inflammation (swelling and irritation) of the lining of the sinuses. When this happens, the tiny hair-like projections that line the sinus cavities can no longer sweep germs, dust and allergens out to be cleared by the body. Instead, these particles become trapped inside.
This causes many of the symptoms of sinusitis (see below). The inflammation is usually caused by allergies and/or infections (bacterial, viral, and rarely fungal). Anatomic defects and immune system problems may also contribute to sinusitis. Acute or new-onset sinusitis lasts for less than 4 weeks while chronic sinusitis lasts for more than 12 weeks.
Common symptoms of sinusitis include:
Diagnosis depends on history, symptoms, and a thorough physical examination. In some cases a sinus CT scan or nasal rhinoscopy (exam using a long, flexible tube with a camera at the end to thoroughly examine the nasal cavity) may be helpful. Mucous directly obtained from the sinuses can be cultured, as well. For many patients who have a suspected allergic component to their disease, allergy testing would be necessary.
Initial treatment can consist of pain medication, nasal irrigation, and a short course of nasal decongestants. Some patients will benefit from the addition of nasal topical steroids and/or antibiotics. For long term treatment, those patients with allergies may benefit from allergy immunotherapy (allergy shots) and patients with anatomic defects may need surgical correction.
Your Allergy Partners provider will take a detailed history and perform a thorough physical examination to come up with an effective, practical, and personalized treatment plan. Additional information like allergy testing may be pursued depending on the clinical history. In those patients that have a significant allergic component to their disease, allergy immunotherapy (allergy shots) may be very helpful.
For more information on this condition, visit: National Library of Medicine
Vasomotor (non-allergic) Rhinitis
Vasomotor rhinitis (VMR) is a condition in which the blood vessels lining the nose swell leading to nasal congestion, and in which the mucus glands in the nose become overactive leading to excessive drainage. VMR can occur at any age, although it tends to be more common as individuals get older.
Common triggers of vasomotor rhinitis include changes in temperature, barometric pressure, or humidity. Strong odors such as perfumes, colognes, smoke and dust can also be triggers for vasomotor rhinitis. Some patients will find that eating causes significant nasal drainage or congestion. Others will experience more difficulties in breathing during the Spring and Fall due to the changes in temperature and humidity that occur during these times of the year.
It is important to understand that VMR is a nonspecific response to virtually any change or impurity in the air, as opposed to allergic rhinitis (or hay fever), which involves a response to a specific protein in pollen, dust, mold, or animal dander.
Symptoms of VMR are similar to those of allergies, with frequent congestion, runny nose and/or postnasal drip. Patients with VMR, however, often have less sneezing and itching than patients with rhinitis caused by allergies alone. Some patients have both conditions, and when they occur together, the two may aggravate one another.
We usually diagnose VMR by taking a careful history and performing a thorough exam of the nose and throat. In addition, we often perform allergy testing to make sure there is no allergic basis for any of the symptoms, since this would affect our treatment approach.
Unfortunately, there is no cure for VMR, however several medications are available to help alleviate symptoms. Immediate cessation of smoking and avoidance of second hand smoke is imperative as non-specific irritation from smoke will drive nasal drainage. One of the most effective treatments for VMR is the use of over-the-counter nasal saline spray or mist, which can be used as often as needed to soothe the nose and loosen any thick mucus. Nasal steroid sprays (Ex. Flonase, Veramyst, Nasonex), nasal antihistamine sprays (Ex. Astepro, Patanase) and nasal anticholinergic agents (Atrovent) can greatly decrease the amount of drainage produced from mucus glands within the nose. An oral decongestant can also be used to dry up watery drainage or to relieve nasal congestion, but these are generally used sparingly since they may cause insomnia or aggravate hypertension, particularly in elderly patients.
Vasomotor rhinitis often overlaps with environmental allergies so it is important to be tested for environmental allergies as the presence of allergies may influence medical treatment. Through a focused medical history and targeted allergy testing, your Allergy Partners physician will be able to determine whether or not your symptoms of nasal congestion are being caused by allergies, vasomotor rhinitis or other conditions altogether.
The Centers for Disease Control recommends everyday actions to help
prevent the spread of respiratory diseases.
Learn how the COVID-19 vaccine is affecting the allergy suffering population and what you need to know about it.