Archive for the ‘Allergy Information’ Category



Three Ways To Treat Allergic Problems

Friday, July 5th, 2013

There are three ways to treat allergic problems: avoidance, medication and immunotherapy.

Avoidance

Avoidance of the things that cause your allergies is a very effective means of alleviating allergy symptoms. However, this is not always possible.

Implementing environmental control measures can reduce your exposures thereby reducing your symptoms.

Allergic patients who respond well to environmental control are those typically allergic to dust mites, pets and mold.

Medication

There are two general categories of medications; those that relieve symptoms and those that prevent symptoms. Medications are often available in pill form (systemic) or topical (local). Systemic medications (pills, syrups or injections) are delivered by the bloodstream to the entire body.

Local medication (nasal sprays, eye drops, inhalers, lotions and creams) are applied directly to the area involved in the allergic reaction. Generally speaking, local medications have fewer side effects than systemic medication.

Medications that are made to relieve symptoms include antihistamines and decongestants for allergic rhinitis, and bronchodilators (inhalers) for asthmatics. Preventative medications are the anti-inflammatory steroids (topical and systemic).

Immunotherapy

Immunotherapy is a means of retraining your immune system to no longer react to the things you are allergic to.

The response to immunotherapy varies depending on your age, and the allergens to which you react. People under the age of twenty years old respond more favorably (80-90% with remarkable improvement). Individuals over the age of fifty five are less likely to respond (50%).

People who are allergic to dust mite, pet and pollen allergens respond better to immunotherapy than mold allergic individuals. Food allergies do not respond to immunotherapy. The only treatment for food allergy is avoidance.

What Are Allergies?

Friday, July 5th, 2013

Allergic diseases occur in people who are genetically predisposed and have had prior exposure to an environmental antigen. Antigens, or allergens, are usually protein molecules that are produced by plants or animals. Common allergens include pet dander, plant pollens, insect droppings and insect venom. Antigen exposure in genetically predisposed people, results in sensitization and eventually allergic symptoms. Allergic symptoms include nasal congestion, sneezing, runny nose, itchy watery eyes, chest tightness, wheezing and shortness of breath, skin rashes and gastrointestinal complaints. Food allergies are more common in children and can be severe. Symptoms of food allergy can be as mild as nausea, vomiting, diarrhea and skin rashes or as severe as asthma and anaphylactic shock.

Most allergies individuals have family members who also have allergies. If one parent has allergies, each child has a fifty percent chance of having allergies. If both parents have allergies, each child has a seventy five percent chance of having allergies. Children who develop skin problems (Eczema) at an early age are at a higher risk of developing allergic rhinitis and asthma as they grow up. Early diagnosis and treatment can prevent development of asthma in children. Allergy symptoms, and some of the medications used to treat allergies, can impair a child’s performance in school and an adult’s performance at work.

People who have developed sensitivities to environmental antigens (such as weed pollen, cat, dust mite, etc.) will have allergic reactions when they are exposed. Reactions start within minutes of exposure and will continue until you treat the symptoms and avoid the causative antigen. Allergic reactions have two phases, the first starting with the mast cells in your body releasing histamine. Histamine dilates the blood vessels. Dilating the blood vessels allows fluid to leak out of the blood into the tissue. Leakage of fluid into the tissues causes swelling and increased mucous production in mucous membranes.

The second phase is triggered by histamine and other mediators recruiting inflammatory cells (T cells and others) into the local area. Once enough inflammatory cells are present in the local area, these cells begin producing hormone like molecules called cytokines. Cytokines allow the inflammatory cells to communicate with each other and perpetuate the inflammatory response. It is this self-perpetuating inflammatory response which is responsible for the inability of antihistamines and decongestants to maintain long term control of allergic symptoms. Anti-inflammatory medications are necessary to turn off the second phase of the allergic response.

Common allergic diseases are allergic rhinitis, asthma, urticaria, anaphylaxis, allergic eczema, and food allergies.

Allergic Rhinitis

Friday, July 5th, 2013

Allergic rhinitis can either be seasonal or perennial.

Seasonal rhinitis is due to the presence of plant pollens in the outdoor air. The plants in bloom are responsible for the pollen and symptoms it causes. The predominant seasonal antigens are three pollen (February – April), grass pollen (April – August), and wee pollen (September – October). Flowers are usually not the culprits because they are pollinated by insects such as bees.

Perennial rhinitis is caused by allergens that are present in the air year round. Examples of such allergens are dust mites, molds, animal dander and, in the years with no freezing winter temperatures, grass pollens.

Typical symptoms of allergic rhinitis include itchy watery eyes, sneezing, runny nose, nasal itching, congestion, post nasal drip, headaches, dry cough, ear fullness and ringing, decreased sense of smell, taste and fatigue. Many people feel their symptoms are due to “sinus problems” or a “cold”. Sinus infections and colds tend to be associated with fever and yellow to green mucous whereas allergic rhinitis is associated with clear mucous and tends to occur repeatedly throughout the year. Other findings one might see are dark circles under the eyes called allergic shiners, and a crease across the top of the nose due to chronic nasal rubbing. People with allergic rhinitis also tend to have bad breath due to the postnasal drip. Common complications due to untreated allergic rhinitis include sinusitis, nasal polyps, and otitis media.

Allergic rhinitis responds to medical treatment and allergy shots. The medications commonly used include antihistamines, decongestants, and steroid sprays.

Effective means of controlling allergic rhinitis include:

  • Avoidance of allergens
  • Medications
  • Allergy shots

Why I Became An Allergist

Friday, July 5th, 2013

“Dr Schreiber, We have a 25 year old female inbound by EMS with hives, shortness of breath, and hypotension. They will be here in two minutes. Do you have any orders for the paramedic prior to arrival?”
“Start two IV’s and run fluids in wide open. Start supplemental oxygen. We will be waiting in trauma two.”

As the patient was hustled down the corridor to trauma two, I listened to the paramedic tell the ER Nurse the history. “She is 25 years old with a history of being allergic to red dye. She was eating at a restaurant and ordered cheese soup after confirming with the waiter that it did not contain red dye. Within minutes of eating the soup she started feeling funny and asked the waiter to call 911.Currently her vitals are: heart rate 125 beats per minute, blood pressure 70 over palpable, respiration 80 per minute with an oxygen saturation of 90% on room air. She is covered in hives form head to toe, semi alert due to her low blood pressure and in extreme respiratory distress.”

As the paramedics and ER nurses were transferring the patient from the gurney to the emergency room bed, I reached into the crash cart and grabbed a dose of Epinephrine 1:1000, drew up .3 cc and injected the patient with the Epi. I massaged the shot site to increase the speed of uptake while I ordered IV steroids and Benadryl. I also prepared to intubate the patient to safeguard her airway.

In less than one minute I witnessed my first medical miracle. Her hives started to fade, she went from panting at 80 breaths per minute to taking a deep breath, sighing and then she looked up at me and said “Thank you!”

I was told in pharmacology that Epinephrine worked quickly, but this was magic! From dying to thank you in 60 seconds! Wow! She did well and was released from the ER after 23 hours of observation.
These events happened in 1989 at Bexar county hospital in San Antonio, Texas when I was an Internal Medicine Intern. This was my very first exposure to anaphylaxis.

Anaphylaxis is one of the most terrifying experiences a person can have. One can transform from perfectly healthy, to near death, in a matter of moments after exposure to something they have been sensitized to. Common triggers are insect stings, medications and certain foods.

What shocked me most was how little the faculty and staff in the ER knew about anaphylaxis. They knew how to treat anaphylaxis acutely to save the patients life, but not how to prevent the next episode from occurring. This is one of the incidents that piqued my interest in allergy as a career.

After two years of internal medicine residency I knew I did not want to practice internal medicine for the next thirty years. During my third year of residency I took two immunology based electives; Rheumatology and Allergy. My impression of Rheumatology was that it was more about managing chronic pain than it was about immunology. My interest in Rheumatology quickly faded. During the first week of my allergy elective I knew I had found my specialty. Convincing my wife that she and our children would have to endure two more years of my training was not all that easy. She was tired of poverty, but nonetheless supported me like a trooper. After residency I took a two year fellowship in Allergy at UTMB in Galveston. I have never regretted my decision, as I have never found anything more rewarding than improving the quality of life of an allergic or asthmatic patient.

Tell Tale Signs Of Allergies

Friday, July 5th, 2013

Signs Of Allergies In Katy TX

A bit like that famous brand of soup, allergies come in many different varieties, so there is no single set of symptoms that can be isolated as being a clear indicator of an allergy, or a collection of allergies.

Similarly, the severity of allergic reactions varies from case to case too.

For the vast majority who are allergic to a specific trigger or triggers, the reaction is unpleasant but nevertheless mild whereas at the other end of the scale, a severe allergic reaction can lead to anaphylactic shock which can be lethal.

So, there are variables to take into account but having said this, it is true that there are some ‘telltale’ signs that some malady that you appear to be suffering from has an allergy at the root.

To begin with, the most common symptoms of an adverse reaction to a specific allergen are sneezing, vomiting, difficulty breathing, swelling and pains or cramps. On top of this, the severity of symptom could then be classified as mild, moderate or severe.

To give you some idea of where the ‘border’ between these somewhat arbitrary classifications is, mild symptoms of an allergic reaction might include a runny nose and/or congestion, rashes, itches, watery eyes and so on.

All these are unpleasant and uncomfortable but ultimately, there is no long term damage likely.

Next on the roster is a moderate allergic reaction which might be characterized by more severe itching and a distressing shortage of breath, perhaps caused by swelling around the face, eyes, nose or throat. In this case, treatment may be necessary, depending on the severity of the situation.

Finally, you have the – fortunately rare – occurrence of severe allergic shock or Anaphylaxis. This may start with a sudden, unexplained outburst of itching around the eyes or face, swiftly followed by more serious symptoms that can include swelling that makes breathing very difficult, violent pain, cramps, diarrhea, vomiting and perhaps dizziness or confusion.

As I suggested earlier, anaphylaxis can lead to toxic shock, bodily shutdown and ultimately, death. In this case, the patient needs immediate medical attention especially if they are known allergy sufferers.

Another clue as to the presence of an allergy is an element of the same thing happening at the same time or in the same circumstances with a degree of regularity.

For example, I’ve highlighted ragweed as a prime cause of allergies in this part of the world. This tends to mean that the problem is worst in late summer, in August and September.

Thus, if you were to suffer an unknown reaction at this time every year, there’s a decent chance that you’ve just found your culprit!

It’s the same with places. If you start sneezing repeatedly and uncontrollably every time you enter a particular room in the house, then suspect that something in that room may be the root cause of your problem.

As you can see, there are plenty of telltale signs that might indicate that you are allergic to something. Next time you’re feeling a bit under the weather, this might be something to think about.

If you’d like to take the guesswork out of the equation schedule a visit in our Katy or Cy-Fair office for an allergy test. We look forward to taking care of you.

The Benefits Of Immunotherapy

Friday, July 5th, 2013

Katy, TX ImmunotherapyAllergen immunotherapy is the only form of treatment that tackles the underlying cause of an allergy as opposed to offsetting or alleviating the symptoms. It alters the course of the illness rather than masking the symptoms caused by it as does every other form of allergy remedy.

Immunotherapy is a very effective form of treatment for some 95% of allergy sufferers who try it and although it is a ‘slow burn’ remedy that takes effect gradually, the benefits of the treatment are generally long term too.

The way that the treatment works is by slowly desensitizing the allergy sufferer to the allergens that cause them problems.

As they become less sensitive, the degree of reaction that they exhibit to the allergen falls until they – hopefully – reach a stage where their allergy is ‘cured’.

To begin the treatment, the specific allergen that is the cause of the problems is identified with a blood test. After this, a small dose of the allergen is injected every week, with the dose usually increased to build up immunity in the patient as quickly as possible.

In all but 5% of patients that undergo this form of treatment, an effective protective antibody – known as Immunoglobulin G or IgG for short – is gradually built to the point where it provides protection without any further treatment.

As suggested, this does not happen overnight. Nevertheless, many patients notice a significant improvement after six months of treatment, after which, progress in monitored and evaluated every six months.

A period of two years is generally considered to be sufficient to make a final assessment of whether the treatment will be effective or not. If so, it is commonly necessary to continue for 4 to 5 years before the dose may be reduced or stopped.

Once this happens, symptoms may return in 20% of patients in the first year, 30% in the second and 50% after three years or more. The other 50% could therefore be said to be ‘cured’ although there is no guarantee that it is a permanent or complete ‘cure’.

Nevertheless, immunotherapy is the only form of treatment for allergies that actually tackles the root of the condition, and the benefits are obvious.

Whereas symptomatic treatments – those (such as antihistamine drugs) that deal with the symptoms – do not offer any long term cure or relief, immunotherapy can. This is especially true when it used to treat common allergies to dust, pollen and animal dander, while it is often good for treating asthma as well.

Even when immunotherapy is not totally effective, it can offset the severity of your allergy, meaning that you can safely reduce medication levels to a minimum. For anyone with an allergy, immunotherapy is definitely one option that is almost always worth considering.

To determine if you are a prime candidate for immunotherapy treatment, schedule a visit in our Katy or Cy-Fair office today.