1. Why do people have allergies?

Allergic illness is due to a combination of genetics and exposure. If one parent has allergies, each of their children will have a 30-35% chance of developing allergies. If both parents have allergies the chance is almost 70%. Each parent gives 6 HLA genes to their children. The combination of the 12 HLA genes determine if the child is predisposed to having any number of immune related conditions including allergies, asthma, arthritis, lupus etc. In addition to the genetic component each individual has to have exposure to allergens to develop allergies. If you’ve never been stung by a bee you cannot be allergic to the venom.

2. Is local honey good for allergies?

No. Bees collect nectar from flowering plants to use to make honey. In the process they get covered in the flowers pollen. The pollen that people react to is in the air from wind pollenated plants. Cross pollination using insect vectors is much more efficient and therefore less pollen needs to be produced. Cross pollination via wind requires an enormous amount of pollen to be produced in order to insure success. It is this large amount of pollen released that makes allergic people miserable. Honey may be a placebo, but a pleasant one none the less.

3. Do I have to go on allergy injections if I go to the allergist?

A lot of people think that if they go to the allergy doctor they will be put on shots. That is an option but not the only option. Allergy testing will allow you to know what is causing the symptoms. Some antigens you can successfully avoid and thereby decrease your symptoms. All allergic diseases have an early and late phase response. The early phase is histamine driven and will respond to anti-histamines. The late phase is not. Late phase reactions are due to inflammatory responses caused by the early phase. Inflammation causes cellular infiltration of the local area which only responds to anti-inflammatory medications. If you have only taken antihistamines to treat your allergies, you have been under treated. A Board Certified Allergist can provide a combination of medications to give you maximal relief.

4. Do I need nasal surgery or allergy treatment?

No one wants to have surgery unless they really need it. Surgery is needed if a person has an anatomical obstruction of their nasal/ sinus passageways that results in persistent congestion and frequent infections. Allergies can cause persistent congestion and frequent infections, but are usually associated with sneezing runny nose, nasal itching and post nasal drip. Allergic symptoms vary in intensity with exposure (good days and bad days). Anatomical obstruction is constant, it does not change sides or have good days. If you are not sure have your primary care physician prescribe a round of steroids. If the congestion dramatically improves see and allergist, if it doesn’t get a Cat scan of your sinuses and see an ENT.

5. How common is allergic disease?

Allergic rhinitis is the most common chronic medical condition. Depending on which study is quoted the prevalence is 20 to 30 % of the population. Allergic rhinitis is the most common chronic medical condition of childhood and is responsible for a large number of missed school days every year. This means a lot of missed work for parents. If your child has missed more than 10 days of school in the last year it is a good idea to have them evaluated for allergies. Proper treatment will result in a happier, healthier child who is able to attend school and have better school performance. If you or your child is sick all the time maybe it is allergies, not viral illnesses.

6. How dangerous is Asthma?

Asthma was responsible for 3400 deaths last year in the United States. This is down from 5000 deaths annually prior to 2001. This decrease is due to better awareness and understanding of the disease process. The symptoms of asthma are shortness of breath, chest tightness, wheezing and coughing. Most of these symptoms are due to late phase inflammation in the airways. Inflammation of the airway causes thickening of the bronchial wall, increased mucous production and bronchial hyper-reactivity (twitchy airways). When the bronchial wall thickens the space inside (lumen) used to transfer air from the alveoli to the outside is smaller. This means the resistance to air flow increases, making it harder to breath. The biggest problem turns out to be getting air out of the alveoli. Once the alveoli are expanded as far as they will go then you can’t get new air in. Rescue inhalers can decrease shortness of breath transiently, but unless the inflammation is turned off in the airway the asthma will not improve.

7. Explain Allergic eczema in children.

Allergic eczema (Atopic dermatitis) is characterized by dry skin with patches of thickened, cracked and flaking skin. The common sites for eczema are the creases of the elbow, back of the knee, shin and the tops of feet. But it can be anywhere. These children are itchy, irritable and miserable. The most common causes are allergy to Dust mite (50%), family pet (25%), a specific food (25%). Avoidance of these antigens is very effective at decreasing the severity of the eczema. Treatment of eczema includes topical steroids, oral antihistamines, topical antibiotic ointment and skin moisturizers. Oral antihistamines help decrease the itching. Topical moisturizers lubricate the dry skin. It is the dryness that starts a lot of the itching. Ointments are better than creams, creams are better than lotions. My favorite is Vaseline petroleum jelly. It is cheap and stays on the skin for hours and does not contain any dye, preservative or fragrance to irritate the skin. Topical steroids treat the inflammation. Topical antibiotic kills staph bacteria that gets into the plague. You will not be able to clear the lesion with steroids until you kill the bacteria. There are newer agents for eczema, including biologic agents, but these are extremely expensive and in most cases not necessary.

8. How do allergy shots work?

Allergy shots, immunotherapy, retrain your immune system to no longer react to the things you are allergic to. After finding out what you are allergic to by testing we make a vaccine that contains the antigens to which you are allergic. We start giving you injections of very small doses that you don’t react to and build to higher doses. During the buildup process shots are given frequently until you reach the maintenance dose. This usually takes 3-4 months. Once on maintenance shots are given weekly, then twice a month, then monthly. Most patients feel benefit from the injections within the first few months after reaching maintenance. After 5 years of immunotherapy we retest you to see if you still need to be on injections.

9. Do oral allergy drops work as well as the shots?

No. Studies done in the United States show a 50% response sometime in the second year of treatment. Allergy injections show a 70-80% response in the first 8 months of treatment. The big drawback of sublingual drops is the cost, usually $3600.00 a year. Which is not covered by insurance. Allergy injections cost usually $1100.00 2000.00 the first year and about $300.00 a year the next 4 years. Estimated total cost for 5 years Shots $3000.00, Oral drops $18,000.00. And the shots are more effective!

10. How painful is the testing?

Allergy testing is more irritating than painful. Testing is done in 2 stages, scratches and intradermal. Scratch testing is done on the surface of the skin with a slight prick/puncture of the skin and introduction of the allergen. Intradermal testing is done with a lateral injection of extract into the skin with a tiny needle. Tests are positive in 15 minutes with positives swelling, turning red and itching. Young children can be a challenge to test due to their fear of shots. We often use an anesthetic cream to test children. It numbs their skin, we distract them with a movie and get it done. Allergy testing by lab work is available, but it is not as accurate and much more expensive.