Archive for April, 2010

Is It Too Early To Take My Allergy Medication?

April 26, 2010

Last week, a patient who usually does not have spring allergy symptoms until early to mid May called me to ask if it was too early for him to start taking his allergy medications.  He stated that he had started to feel eye and nose symptoms and wondered if it was OK for him to begin taking the medications.  After a short conversation where I was able to ascertain that his symptoms were in fact most likely allergic and not the result of a cold, I quickly answered that he should absolutely start his allergy medication. 

I think there are a few interesting things to learn from this encounter.  First off, it is never too early to start allergy medications.  I think people who know they are allergic to a certain pollen should start medication as soon as the pollen is in the air, even if the pollen is only present at low levels that do not yet cause symptoms.  In fact, it is appropriate to start medications even if a particular pollen is not detectable yet, if it is expected to be present in the air very soon and you know it causes symptoms.   It is always easier to treat mild allergy symptoms than allergy symptoms that are full-blown.  

Within in the context of my patient’s question, it is important to be aware of the fact that you can develop a new allergy at any time.   A pollen that might not have affected you one year could cause bad symptoms the next.  Also, although we like to think that trees pollinate like clockwork in a given geographic region, there are always minor variations in the timing of pollination.  This year, for instance, several trees began pollinating earlier than usual in the New York metropolitan area.  I think this might be because we had a few days of record-breaking heat in early April.  

Another thing to learn from this is that if you are experiencing allergy symptoms at a time of the year when you usually don’t, it is important to make sure you are actually having allergy symptoms and are not dealing with some sort of cold or viral infection.   People with allergies can usually tell the difference.  Some objective differences include the fact that allergies to do not cause fever or colored nasal secretions, and that itching is usually not a huge factor with colds.   Allergy medication is usually not helpful for a cold and could be counterproductive to your natural immune response to the cold. 

As always, I encourage people to listen to their bodies and adjust treatment accordingly.  You are the best judge of what is happening to you.  If you think you are experiencing allergy symptoms, it is probably appropriate to take your medications instead of suffering with symptoms.  You can always figure out later if you have developed a new allergy or if, as was the case with my patient last week, the pollen season just started a little earlier for you this year.

Note: The content of this blog is for informational purposes only and is not meant as specific medical advice for a specific person.   If you have a medical problem, please contact your doctor

Can Food Allergy Be Prevented In Infants?

April 18, 2010

The development of a food allergy in an infant is often a traumatic event for a parent.  It conjures up all sorts of emotions surrounding the fear of life threatening reactions.  It is disturbing as it means their infant will need to avoid certain foods.  But also, it brings up potential feelings of guilt that somehow the parent, often the mother, did something or did not do something that could have prevented the problem.

The reality is there is little that can be done to prevent a specific food allergy in an infant.  In the 1990’s it was felt that avoidance of certain foods during pregnancy, or the delay of introduction of certain foods in infancy, could potentially reduce food allergy in infants.  However, ongoing research does not support this and, in fact, it is possible that delaying the introduction of foods may increase the incidence of food allergy and not decrease it (see related entry from January 12, 2010).

Here is the bottom line on this subject at the present time:

1. There is no good evidence that maternal dietary restrictions during pregnancy is effective in preventing allergy in infants.   We need more data to be able to know whether dietary restriction during breast-feeding has any impact on the development of a food allergy.  It is important to note, that once an allergy is diagnosed in an infant, there very well might be a need for the mother to avoid certain foods, but that is after the fact, not to prevent the allergy to begin with.

2. For infants with one first degree relative (parent or sibling) with allergic disease, there is evidence that exclusive breast-feeding for at least 4 months decreases the incidence of eczema and cow’s milk allergy in the infant in the first two years of life.

3. For infants with one first degree relative with allergies, exclusive breast-feeding for at least 3 months is associated with a lower incidence of wheezing in infants.  This protection does not extend to a lower incidence of asthma at 6 years of age.

4. For infants with one first degree relative with allergies who are not exclusively breast-fed, the use of extensively hydrolyzed formula may have a temporary protective effect on the development of eczema in early childhood.

5. There is no evidence that delaying the introduction of solid food beyond 4-6 months of age has any significant impact on the development of allergic disease.  This extends to delaying the introduction of foods like fish, eggs and those containing peanuts.

6. Infants whose skin is  exposed to foods either through direct skin contact with foods in the home or through contact with moisturizers or skin products that contains various foods, prior to exposure of that food through actual feeding through the gastrointestinal tract, might have an increased risk of developing an allergy to those foods.  This impact might be higher in infants with eczema.

Please remember that the information in this entry pertains to infants without a specific allergy.  Once an infant has a specific food allergy, avoidance and other measures must be taken in order to avoid potentially severe allergic reactions.

Note: The content of this blog is for informational purposes only and is not meant as specific medical advice for a specific person.   If you have a medical problem, please contact your doctor.

Tree Pollen Allergy And The City

April 15, 2010

It is not unusual for me to see a patient in the office who grew up in a rural community but didn’t really start having bad tree pollen allergy symptoms until moving to the city.  In fact, I saw just such a patient yesterday, which prompted me to write this.

There are several potential explanations for this.

First off, people can develop a new allergy at any time or an existing allergy can worsen at any time.  So it is totally possible that a person either was not allergic to trees growing up or had minor allergies to trees growing up, but is very allergic as an adult.

In terms of the city though, most people assume that since there are generally fewer trees in the city that allergy problems should be less.  That is not really the case.  Tree pollen in particular can travel quite far.  Tree pollen has been found by researchers up to 2000 feet in the air and up to 25 miles off shore.  And so, it is not just tree pollen from trees physically in Manhattan that contribute to symptoms there, but also pollen from trees in rural New Jersey blowing in across the Hudson River.

The most important reason for the severity of allergy symptoms in the city however, lies in the fact that studies have shown that pollution can exacerbate allergy symptoms in allergy sufferers.   Therefore, the same level of pollen in the city would likely cause more symptoms in the city than in a rural community.

Note: The content of this blog is for informational purposes only and is not meant as specific medical advice for a specific person.   If you have a medical problem, please contact your doctor

Can’t I Just Get A Shot Before The Season To Prevent These Allergies?

April 13, 2010

Every once in a while I have a patient who has heard of someone who received one shot and was fine the entire allergy season.  Invariably the story involves an older relative who used to get a shot just before the pollen season and swore it helped for the entire season.  The only medication that could possibly work in that way is a long acting injectable steroid.

The problem is, long acting injectable steroids are associated with way too many potential side effects to warrant using them in this way and for this purpose.  First of all it should be pointed out that these medications stay in your system and provide broad-based anti-inflammatory activity for about three weeks.  Do you really want to be injected with a drug with lots of potential side effects that could stay in your system for three weeks?  The more important potential side effects include: 1)increase in blood pressure, 2)suppression of the natural immune response of the body to infection, 3)suppression of the adrenal gland and 4)alteration in mood ranging from irritability to emotional lability to depression.

I never give injections of long acting steroids to patients with seasonal pollen allergy.   There are many good medications available with excellent side effect profiles that control symptoms in most patients.  Those who have particularly bad symptoms or whose symptoms do not respond to a combination of medications usually do benefits from shots, but not the single shot of a long acting steroid, but the series of shots commonly known as allergy shots.

Soy Allergy: Will My Child Outgrow It?

April 10, 2010

About 0.4% of children are allergic to soy, making it a common food allergen, but less common than allergy to peanut, cow’s milk or egg.  Since soy is included in many prepared and processed foods, it is a relatively difficult allergen to avoid.

A very common question from parents is whether their child will outgrow a particular food allergy and if so when.  A recent study has shown that although most children outgrow soy allergy at some point, they don’t outgrow it as quickly as previously thought.  The study included 183 children.  Here are the numbers: 25% outgrew the soy allergy by 4 years of age, 45% by 6 years of age and 69% by 10 years of age.

The most common symptoms seen with soy allergy in this study were those relating to the skin such as eczema or hives, and those  related to the gastrointestinal tract such as vomiting, diarrhea, abdominal pain and bloody stools.  Only 5% of children with soy allergy in this study presented with lower respiratory tract symptoms such as wheezing or difficulty breathing.

Children with very high levels of soy allergy as determined by soy allergy specific IgE blood testing, tended to grow out of their allergy more slowly.   It might be helpful for your allergist to follow levels over time to help predict when your child might outgrow the allergy.

It is important to point out that although most people with soy allergy develop the allergy as a young child, adults can definitely develop soy allergy at any age.  In my experience soy allergy in adults is sometimes dose dependent with symptoms only occurring upon consumption of large amount of soy.

Tree Pollen Allergy And Foods: The Oral Allergy Syndrome

April 9, 2010

Certain fruits, vegetables and nuts contain allergens that cross react with tree pollen, specifically the pollen of birch and alder.  These foods include the following:

Nuts: Almond, Hazelnut

Fruit: Apple, Apricot, Cherry, Kiwi, Nectarine, Peach, Pear, Persimmon, Plum, Orange

Vegetables: Carrot, Celery, Fennel, Potato

Although most people with tree pollen allergy can eat these foods without any problem, up to 1/3 of people who are allergic to tree pollen will develop symptoms of what is called the Oral Allergy Syndrome.  The most common of these symptoms is itchiness of the mouth and throat.  A small minority of people who have symptoms of the Oral Allergy Syndrome will have more widespread symptoms seen in other forms of food allergy and it is sometimes difficult to differentiate those who will have just the oral and perioral symptoms from those who have more general allergy symptoms.   Most people with the Oral Allergy Syndrome are only allergic to a few of the foods listed above and not all of them.  In my experience the most common foods to cause symptoms are apples, carrots, cherries and peaches.   Having said that, I do have patients who react to all of the foods.

It is very important to point out that the tree pollen cross reacting allergens in these fruits and vegetables are generally not the major allergens of the foods, but are minor allergens that tend to be heat labile.  That means that these minor allergens lose their effect as allergens with exposure to heat and usually people with this form of food allergy can eat the food in a cooked form without any problem.  So raw apples are a problem, but apple pie, apple sauce and apple juice are usually OK.  It is not unusual for me to see a patient in my office who thinks they are allergic to the skin of the apple or to a pesticide sprayed on the apple because they know they are fine with cooked apple.   Invariably these are people with tree pollen allergy and they are experiencing the Oral Allergy Syndrome.  Also, these allergens tend to be acid labile which means that they lose their effect as allergens when they are exposed to stomach acid.  That is one reason why the symptoms are usually confined to the mouth.

There is some evidence that the common nasal and eye allergy symptoms that people with tree pollen allergy have, may get worse with exposure to these foods in people with the Oral Allergy Syndrome.  I usually recommend that people who have oral itchiness with exposure to one or more of these foods avoid those foods completely in the raw form, especially during the pollen season as it can make their other pollen allergy symptoms worse.

It is important to speak to your allergist about this form of food allergy in order to determine if you need to avoid the foods completely or only in the raw form.  Remember a small percentage of people with this form of food allergy can have more widespread symptoms of an allergic reaction or anaphylaxis with exposure.

Why Do I Only Seem To Be Bothered By Dust During The Pollen Season?

April 8, 2010

Allergy symptoms develop when the allergic immune response is strong enough to evoke release of enough allergic mediators or chemicals by the body to result in symptoms.   The mediator people are most familiar with is histamine since antihistamines are the most common medications used to treat allergy symptoms.

Think of the histamine and other allergic mediators your body is producing as a liquid that is filling an empty cup.   And, think of the symptoms as only developing when the liquid in the cup runs over.  Many people are only slightly allergic to things like dust or dogs, and exposure may not necessarily result in symptoms, or result in only minor symptoms,  since the histamine released in the allergic response to these things is not fully filling the cup.  During pollen season however, if a person is highly allergic to pollens, that cup is already full and anything, regardless of how small, that is added to the cup will result in the cup running over and significant symptoms developing.   And so, you might find that various allergens that don’t affect you in any signifcant way, or at all, in the winter, result in severe symptoms during the pollen season in the spring.   Make sense?

Tree Pollen Allergy: You Don’t Need To Suffer

April 7, 2010

Despite the fact that there are many good medications to control and treat seasonal pollen allergy, people continue to suffer unnecessarily.  Here are some helpful hints:

1. If non sedating over-the-counter antihistamines are not controlling your symptoms, see your allergist.  There are a variety of prescription medications including oral antihistamines, oral leukotriene antagonists, nasal steroid sprays, nasal antihistamine sprays and an assortment of eye drops that can be used.

2. Use combinations of medications.  If one medication is not working, most people stop that medication and try another one.  Often a combination of medications is what is needed.  Usually this is done by combining together medications that act in different ways or at different sites.  This should be done with the help of your allergist.

3.  Learn exactly which pollens you are allergic to and start your medications before those pollen counts get too high and before you have symptoms.  If you know you are allergic to a specific pollen, you can anticipate when the counts of that pollen will be high.  Trees, grasses and weeds pollinate on a fairly regular schedule each year.  That schedule varies by geographic region.  It is more difficult to reverse symptoms that are already in full force as opposed to preventing severe symptoms in the first place.

Also, check out my March 25 post.

Pollen Counts and Mold Spores

April 6, 2010

From early spring through late fall various pollens and mold spores cause allergic symptoms for people with allergies.  There are two good websites that you can reference to find out what the pollen or mold spore count is in your area on any particular day.   This information is helpful for people with allergies because it can help guide you with regard to medication needs.  I encourage you to check them out. In addition to listing the pollen counts and the specific types of pollens contributing to the count for a particular day, this website also provides a forecast of what you can expect over the next several days. This is the National Allergy Bureau (nab) website hosted by the American Academy of Allergy, Asthma and Immunology (aaaai).

Cow’s Milk Protein Allergy: New Approach

April 5, 2010

There is relatively new information on children with cow’s milk protein allergy that is worth mentioning.  Up to 80% of infants and young children with documented allergy to cow’s milk protein can tolerate cow’s milk when it is fully cooked in baked goods.  It is important to note that those who can not  tolerate cow’s milk in a fully cooked form, can have very severe allergic reactions when consuming baked foods that contain cow’s milk.   Parents of a child with cow’s milk protein allergy can consult their allergist to see if a supervised challenge of a baked good containing cow’s milk protein, such as a muffin or cake, is appropriate for their child.  This is NOT something any parent should try on their own outside of the doctor’s office and even a supervised challenge in the doctor’s office is not appropriate for all children with cow’s milk protein allergy.   Again, DO NOT TRY THIS AT HOME!