House CallOct/Nov 2013 Issue

Allergies Q & A- Asthma Every Autumn, Skin Test, & More!

Photo © iStockphoto/Thinkstock

Photo © iStockphoto/Thinkstock

Asthma Every Autumn

Every year between Halloween and Christmas, I develop respiratory problems that often lead to full-blown pneumonia. This keeps getting worse the older I get. Last year, I came down with asthmatic bronchitis and lost over three weeks of work. Could this possibly be an allergy—but to what? What should I do?

It could definitely be an allergy, leading to problems with asthma. Based on the timing of your symptoms, I would guess it’s an allergy to either dust mites or outdoor mold. If you feel your symptoms worsen when you’re inside your home, dust mites are the likely culprit. If you notice problems most when doing yard work, such as raking leaves, mold is the likely cause. Consult an allergist. You should be tested to determine if you’re allergic to dust mites or mold and to see if you have asthma.

If dust mites are the cause of your symptoms, a multi-faceted approach is necessary. These microscopic critters tend to “bloom” in late summer and fall after warm and humid weather. They feed off dead skin particles shed into carpets, upholstered furniture, bedding and mattresses. Avoidance focuses on these areas of your home. I recommend that a dehumidifier be run to keep your home’s relative humidity below 30 percent during warm, humid summer months. If possible, replace your carpets with hard surface flooring or, at the very least, vacuum the carpets frequently. Wash your bed linens in hot water at least weekly and dry them in a hot drier. Purchase high-quality dust mite-proof encasements for your pillows and mattresses.

If mold is the culprit, avoid raking or agitating fallen vegetation, as the airborne dust is laden with mold. In addition, try to stay indoors on windy days.

If these measures aren’t sufficient, your doctor may recommend medication to control the inflammation caused by allergen exposure. You may only need treatment during this time of year. Many doctors now use a test, called exhaled nitric oxide, to measure airway inflammation and guide the amount and duration of treatment.

Reaction from a Skin Test

I just took a skin prick test for allergies and find that I’m allergic to many, many things. During the test, my back (where the doctor placed the allergens) became so inflamed and covered with hives that they stopped the procedure and bathed my back with cortisone. Is this normal?

It is not unusual. Some can be very sensitive to skin prick tests. People can develop hives that last an hour or so but sometimes hives can last a week after the testing is completed. Although this isn’t “normal” per se, it’s not anything to worry about; the bumps and itching will slowly resolve. The fact that you reacted so strongly is a good indicator that you do have allergies, although it doesn’t necessarily mean those allergies are going to be severe. Sometimes there’s a “disconnect” between the size of a skin test reaction and how you will actually react to that allergen when exposed.

Allergy Testing

A skin prick test shows that I’m allergic to wheat, eggs and dairy. I’m not surprised about any of this except the eggs. I have never once reacted to eggs and I eat them all the time. Could the test be wrong?

Yes. One of the problems with both skin and blood (IgE) testing for food allergies is their high “false positive” rates. This means that you can test positive but not really be allergic. If you don’t seem to have any problems when you eat a food for which you have tested positive, it is most likely a false positive and avoidance is probably unnecessary. Be certain to discuss this with your allergist.

Pollen Allergy

Since I have a lot of pollen allergies, I want to keep my new baby inside with all the windows closed. Am I being paranoid?

A recent study suggests that high-risk infants (babies with a family history of pollen allergy) exposed to high levels of pollen very early in life are at significantly greater risk for developing hay fever and asthma later in life. These babies are not prone to develop other allergic conditions, such as food allergies or eczema. Whether risk can be lowered by reducing pollen exposure is a question that remains unanswered.

I generally recommend that my pollen-sensitive patients avoid being outdoors when pollen counts are high. It may be worthwhile to keep your infant (younger than 6 months) indoors on high-pollen days.

Infant with Reflux

My pediatrician diagnosed my newborn son with reflux and prescribed antacid drops, which I’ve been giving him every night. What are the implications of using this type of medicine on babies?

A recent study evaluated the prevalence of food allergies in children treated with antacid medications in infancy. The research revealed that babies who were given acid-reducing medications did, in fact, have a higher rate of food allergies than those who did not take this medicine. Researchers suggested that treatment with antacids may have increased the likelihood of developing food allergies—but an alternative hypothesis exists. The children may have had food allergies already, which prompted treatment with antacid medications. Obviously, more research is needed.

This study is of particular interest to me as my own daughter had problems with spitting up and reflux-type symptoms when she was an infant. Fussy and irritable, she seemed to do somewhat better after she was put on acid reflux medication. At the same time, my wife and I noticed that the baby broke out in hives and vomited whenever my wife ate wheat cereal an hour or two before breastfeeding. I checked the baby for allergy to wheat and other foods and she tested positive for wheat. When my wife eliminated wheat from her diet, the baby stopped having episodes with hives and vomiting, although she continued to have some spitting up and reflux-type symptoms.

My personal feeling is that there may be some link between acid reflux and food allergies but it is too early to know whether treatment with reflux medications is the cause or simply a marker of risk in children who may be having food-related problems early in life.

Seasonal Allergies

How am I supposed to deal with all my seasonal and airborne allergies? Is there any way to get over them? I need to strengthen my immune system.

Allergies aren’t caused by a weakened immune system but rather an overactive, misdirected one. There are generally three approaches that allergists recommend for treating seasonal allergies. These are often employed together for best results.

(1) Avoiding your allergy triggers as much as possible.

(2) Using medications. Some medicines, like antihistamines, can be purchased over-the-counter. Others, like nasal sprays, are available only with a prescription.

(3) Administering immunotherapy. This is a method where we teach the immune system to behave more normally by administering minute doses of allergen over time. Immunotherapy is administered through injections (allergy shots) or sublingually, which involves putting the allergen under the tongue.

A multi-faceted approach usually works best, particularly for those whose symptoms are severe. Speak with your allergy specialist to find the treatment plan that works best for you.

New Flu Shot

Is there any progress on a flu vaccine for people who are allergic to eggs?

A new trivalent flu vaccine (it protects against three strains of the flu) has been approved by the Food and Drug Administration and added to CDC’s Advisory Committee on Immunization Practices recommendations for people with egg allergy. This vaccine, called Flublok (also known as RIV3), provides an alternative approach for egg-allergic individuals because it is not cultured in eggs. Flublok is approved for adults between the ages of 18 and 49. Check with your doctor for details.

Neal Jain, MD, is a practicing board-certified allergist/immunologist in the department of pediatrics at Maricopa Medical Center in Phoenix and at San Tan Allergy & Asthma in Gilbert, Arizona.

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