Do You Know What You’re REALLY Allergic To?

Flowering trees do not usually trigger allergies. If you start sneezing when you encounter one, chances are that other trees — or other allergens altogether — are to blame.

Consider this: you walk down the street and see a beautiful tree with blooming purple flowers. As you get closer, you start to sneeze uncontrollably. It’s obvious you’re allergic to the tree, right? Probably not…

First, trees with flowers are usually insect pollinated, not wind pollinated. Pollen carried by insects rarely ever makes it into your system. So if it is pollen that’s causing your reaction, it’s probably not the flowering tree that’s to blame. Then why does it always seem to work that way — you see the flowers, the tree is clearly in bloom, and you start sneezing — if flowering trees are not allergy-inducing? Because they blossom at the same time as wind-pollinated trees. There may be a grove of Juniper trees two miles away and a gust of wind picked up its pollen and delivered it right into your path. Maybe you didn’t even see the Juniper pollen, which makes it an even more likely culprit; the smaller the pollen size, the farther travels and the more easily it sneaks into your nose and lungs. Then again, your allergy trigger could be pollen from recently mown grass or the patch of weeds growing in a nearby field.

Now imagine stepping into the home of a friend. Within minutes, a sinus headache comes on strong. Although there’s no pet present, cat hair covers the couch and a shaft of sunlight reveals dust wafting through the air. Either of those could be a source of your allergy symptoms. In fact, cat protein lives in a home for many months after its furry owner has vacated the scene. Or, cockroaches — completely hidden from view — could be to blame. The roaches may be long gone too, but it’s what they leave behind that gets your histamine flowing.

Last scenario… You take a bite out of an apple and your mouth tingles and your lips feel slightly swollen. Are you allergic to the apple? Hard to believe, since you just had a slice of apple pie and didn’t have any problems. You might be experiencing Oral Allergy Syndrome (OAS). Simply put, the apple is related to certain kinds of pollen to which you are sensitized and, in its raw form, the apple triggers allergy symptoms.

So, how do you tell what you’re really allergic to? There’s only one reliable way — an allergy test. First, when you visit an AllerVision-affiliated provider, your doctor will ask questions to get clues to what allergens MIGHT be to blame. Then you’ll most likely receive a pain-free skin test that will reveal your allergy sensitivities in just 15 minutes. Combined with the questions you answered, your doctor should be able to identify your allergy triggers on the spot so you can discuss treatments. That, of course, is the bottom line — we want you to enjoy the great outdoors — or whatever’s really causing your allergies.

To find an AllerVision-affiliated doctor — who’s qualified to offer allergy examinations — please click here.

Does Your Child Have Allergies?… Are You Sure?

Allergies can cause a wide variety of symptoms, many of which you might not expect.

Viruses, bacteria, allergens — there’s any number of small organisms that can make children feel bad. Often the hardest part of treatment is determining the true cause of your child’s illness. For instance, is the latest ear infections the result of a “bug” going around day care or is grass pollen triggering an allergy?

Compounding the situation, allergies manifest themselves in many different ways. Of course, everyone knows that allergies can cause sniffles, watery eyes and sneezing. But here’s a list of other common, though often undiagnosed allergy symptoms in kids:

• Asthma
• Frequent ear infections
• Sinus headaches
• Nasal polyps
• Conjunctivitis (eye irritation)
• Skin rashes and eczema
• Mental problems such as confusion, slow thinking, depression and forgetfulness
• Respiratory effects including endless colds, chronic cough, recurrent bronchitis
• ADHD (Attention Deficit / Hyperactive Disorder)

That’s right,  allergies can even trigger ADHD. So, what do you do? The first step is a full allergy evaluation by a qualified medical provider. An allergy test alone — even a skin test, the gold standard — is not enough; it can show that your child is sensitive to an allergen but not determine if that is causing symptoms. Your provider should conduct a full health history. The results, in conjunction with your answers to when and where your child exhibits symptoms, can help determine if his or her maladies are allergies or something else.

One key to remember is that if your child’s ailments come and go regularly, or if they stay around constantly, there’s a good chance allergies are to blame. If they’re “one and done,” it may be just the cold going around. When in doubt, ask your provider for a full allergy evaluation. To find an AllerVision-affiliated doctor who is qualified to do this, click here.

The Allergy Family History: A Key Component to Diagnosing an Allergic Condition

Family history plays a large role in diagnosing allergies.

Many chronic medical conditions may stem from underlying allergic process: rhinitis, asthma, bronchitis, sinusitis, atopic dermatitis, otitis, conjunctivitis, headache, GI problems and, of course, drug allergies and anaphylaxis. Your physical exam— along with allergy testing — can often help make a specific diagnosis. However the diagnosis begins before you get there. The History is always a key element in the diagnostic process. I have found that, in regards to allergy, the Family History may be the most important component of all.

Allergic diseases have a clear genetic link. While the exact transmission of allergies has not been precisely defined, medical research has demonstrated a strong familial relationship. Allergic parents tend to have allergic children. It makes sense that allergic asthma follows the same pattern. In fact the greatest predictor of childhood asthma is not IgE levels or any other specific allergy skin or blood test; it’s maternal asthma.

IgE-mediated allergic disease can manifest with a variety of presentations. I always ask my patients if anyone in their immediate family — parents, sisters, brothers, aunts, uncles, grandparents, and don’t forget the patient’s own children — has allergies. You sometimes have to give them a nudge by specifically mentioning sinus disease, skin rashes, asthma or allergy to Penicillin. Each of these are indicators of IgE-mediated disease in the family.

I have found the link to be so strong, in fact, that when a patient presents to me with asthma and no family history of allergy, I have doubts. If they had no immediate relatives with allergy, I perform an extra careful search for a non-allergic source for their respiratory symptoms. Of course, I still investigate the allergy angle for the sake of completeness and the possibility that their family members have not been properly diagnosed. But if the family history is truly allergy-free, there is generally another source for the patient’s symptoms, such as Alpha 1 antitrypsin deficiency — an enzyme deficiency that can mimic asthma and bronchitis.

Patients often ask, “My mother (or father) has a specific food or drug allergy, do I need to avoid that product?” The patient has no symptoms but the parent has a terrible reaction to a food or medicine. This is tricky. My advice is to be vigilant! We are not identical replicas of either of our parents but it is wise to be on the alert for any symptoms of allergy to parents’ severe triggers and to avoid the offender at the first hint of a symptom. This recommendation is consistent with my frequently-lectured theme to medical students and patients alike: allergic sensitization occurs after repeated exposure. Sometimes it takes several exposures before the body’s IgE response erupts in a clinical reaction.

We can’t escape our genetics, but we can limit or avoid potential allergen exposures. This holiday season of Christmas, Hanukah and Kwanzaa, when surrounded by family, it might be a good idea to ask around and complete your own Allergy Family History!

Dr. Dean Mitchell

Peanut Allergy Treatment: Close to Reality!

Allergy treatment has crossed another major barrier as reported in the January/February edition of The Journal of Allergy and Clinical Immunology: In Practice. The lead authors in this multi-center research led by Drs. Wasserman, Factor and Baker demonstrated that IgE mediated peanut allergy can be effectively treated with oral immunotherapy!

This study was designed to administer small doses of peanut flour to peanut-allergic children and young adults, followed by incrementally increasing the doses up to the equivalent of eating eight peanuts. At conclusion, 91% of the study patients were able to tolerate 800mg of peanut protein daily. This is quite an achievement!

While studies have been published regarding a number of different foods, peanut has been the main target as it’s the most frequent cause of allergy-related fatalities. Until now, most researchers were understandably afraid to conduct trials on peanut-allergic children because of the risk of an anaphylactic reaction or death. It’s important to note that the study was not without risk: many of the participants experienced side-effects related to the peanuts, including skin, respiratory and gastrointestinal symptoms. However, the good news is that 85% of the participants reached the maintenance dose to achieve peanut tolerance. This is a tremendous accomplishment and one that parents of children with peanut allergy will tell you can bring a lot of peace of mind. In response to the study, select private practices around the country have begun to add oral peanut immunotherapy to their list of services. A discussion with Dr. Factor at The New England Food Allergy Center confirmed that his practice has been successful in treating these patients, but he cautioned that it must be undertaken carefully and with a tremendous commitment on the part of the patients.

In the meantime, it’s critical that all of your patients with a history of a systemic reaction to any food be prescribed an epinephrine injector. The established standard on the market has long been Epipen. Today, the new AuviQ injector is a voice activated model that takes the patient or a person assisting who has never used the device through the simple steps of administering it. Until food allergy treatment is more widespread, be ready to lend a helping hand — or shot in this case. At the same time, stay tuned for more exciting developments on the horizon in the realm of food allergy treatment!

– Dr. Dean Mitchell