Allergen Immunotherapy has been shown to have numerous effects on the immune system that increase your tolerance to allergens. These include the production of antibodies called IgG4 and IgA that block allergens from interacting with the immune system. It also causes the production of a substance called Il-10 on the surface of the nose and elsewhere which has anti-allergy effects. Other effects include the production of cells known as regulatory lymphocytes which redirect the immune systems reaction to a more typical non-allergic response.
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Animal Allergies can occur with almost any furry pet. Most animals responsible for allergies are mammals, and include cats, dogs, mice, horses, hamster, guinea pigs, rabbits and rats. The latter is a problem for many biological laboratory workers. Saliva, skin and urine are the source of animal allergens, which accumulate on the fur because of self-grooming. The easiest solution for control of animal allergies is to remove the animal from the home. Unfortunately, precious few people are willing to part with the family pet. Other alternatives include keeping the pets out of the bedroom. Removing the carpeting in the bedroom is helpful because it is a trap for animal dander and allergens. An air purifier in the bedroom is also recommended because the allergy-causing substances produced by animals remain suspended in the air for long periods of time. Bathing the animal frequently has also proven effective. It is not known precisely how frequently you should do this, but every two weeks is suggested. When these measures do not provide relief, allergen immunotherapy can markedly decrease your sensitivity to your furry friends. There is no specific breed of dog or cat that can be recommended for allergic individuals as there is great individual variation in the amount of allergen each animals produces. A common misconception is that some animals have hair, not fur. They are basically the same thing. Controversy exist as to whether growing up in a home with an animal prevents the development of allergic sensitivity to pets. Until clarified, it is best not to have an animal in the home if you have other environmental allergies or a strong family history of allergies because it has been repeatedly shown that exposure precedes sensitization
Dust Mites are microscopic creatures related to lice, ticks and spiders, and are a major cause of perennial allergies. It is estimated that there are approximately forty mites living in a speck of dust. Most exposure to dust mites occurs in the bedroom. Most mites live in your pillow, mattress and box spring and eat the dead skin that is shed from your body every day. It is not the mite itself that causes allergy symptoms, but the waste product of the mite or feces. Enzymes in the mites digestive tract that break down or digest food are passed into mite feces and are the active substance that causes your allergies. These incredibly small particles easily pass through conventional sheets and bedding because of the large amount of space between the threads. They subsequently become airborne where they can easily be inhaled. To control dust mites, cover the pillow, mattress and box spring with dust proof encasements. Remove the carpeting in your bedroom. Do not use a humidifier; mites thrive in a humid environment. Keep the humidity at about forty per cent, which is the level that will kill mites. Remember to vacuum around the bed frame and slats supporting the mattress. Wash all bedding in hot water once a week and be certain to use blankets and comforters that can be washed in hot water. Remove all visible dust from the surfaces of all furniture, Venetian blinds , window sills and bed frames. Keep shades open to allow direct sunlight into your bedroom, which will also kill mites. Do not store objects under your bed. Buy vinyl or leather furniture to avoid mites from entering the furniture. The less carpeting throughout your home, the better you will feel. Keep bookcases as far away from your bedroom as possible because they are large dust collectors. Run a dehumidifier in your basement to kill mold. Since mites can also eat mold and mold may be required to make skin scales more digestible for the mite, this will also decrease the mite population. Avoid feather bedding because feathers and skin are made from the same protein known as keratin. Consequently, dust mites can also eat feathers in addition to skin. Chemicals to kill mites in your carpet are not effective for more than a couple of days. It is not necessary to have the ducts cleaned if you have forced hot air heating or central air conditioning. Applying a filter strip to the air register will accomplish the same thing at a fraction of the cost.
Computers and workstations can also be a major source of dust mites. Static electricity that builds up on a computer attracts dust, and sitting in the same spot for eight hours leads to an accumulation of skin scales to feed dust mites. Be certain to move your keyboard and monitor for a good cleaning. Wipe down cables to remove adherent dust. Remove your computer frame to vacuum dust that resides inside the computer. (Be certain to unplug the computer before attempting this). Put a vinyl mat under your seat for easy cleaning of your area.
Pollens from various trees, weeds and grasses are responsible for many seasonal allergy symptoms. Pollen is the yellow dust-like substance released by flowering plants to create the next generation of plant. Trees release pollen during the first half of spring, grasses during the second half of spring, and weeds primarily at the end of the summer. In the north eastern United States, pollens from Birch, Maple, Oak, Hickory and Willow are the major trees causing allergy. Most grasses are related, meaning if your are allergic to one, your allergic to all of them. The exception to this is Bermuda grass, which is found mostly in the southern United States and on golf courses. It has a pollen different from northern grasses. The major weeds causing allergic hay fever are Ragweed, English Plantain and Mugwort. To control pollen allergy symptoms, stay indoors when possible, use an air purifier and air conditioning to remove airborne pollen. When these measure are ineffective, medical treatment usually begins with non-sedating antihistamines, anti-inflammatory steroid nasal sprays and antihistamine eye drops. If allergy symptoms persist despite medication, allergen immunotherapy has been proven to be very useful.
Mold or fungi cause various types of disease in humans, including infection and allergy. Some fungi grow well in dry environments, but most require substantial amounts of moisture. They are found wherever there is a source of organic or previously living material, including decaying vegetation, wood or cellulose. Mold spores, which are used for reproduction, are the allergy causing part of the mold. Mold spores are released into the air and begin to rise in the spring, and peak in July through October. The amount of spores in the environment can be estimated by microscopic examination of settled dust samples. High mold counts correlate with musty odors, damp spots, and moisture or water damage in your home. Mold counts are also higher in homes with pets, infrequent vacuuming, carpeting and visible mold. Indoor mold exposure usually occurs to the molds Penicillium, Cladosporium and Aspergillus. Damp basements or bathrooms can generate mold spores that spread throughout the house. Many work-place environments have high mold counts and have been linked to various symptoms, but these do not appear to have an allergic basis. To reduce indoor mold counts, infiltration needs to be controlled by keeping doors and windows closed, and using air conditioning for cooling. Indoor moisture should be kept below forty per cent with a dehumidifier, all water leaks should be sealed and clothes dryers should be vented outside the home. Visible mold contamination can be eliminated by spraying a dilute solution of bleach on the contaminated surface. Mix one cup of bleach with one gallon of water for an inexpensive remedy. Carpeting is an indoor reservoir for mold allergens, and should be removed. An air purifier will also remove mold spores and should be placed in the bedroom. Make sure your cooling and heating vents are clean and have a fresh filter at least once a year. Thoroughly inspect your refrigerator for mold, indoors and out. Mold is likely to grow around water lines, door gaskets and on top of the refrigerator. Some molds produce potent toxins whose link to human disease is still being investigated. Except in a few isolated instances mold toxins probably do no cause a significant amount of human disease.
Sinusitis is an infection of the hollow, bony sinus cavities in the skull that directly connect, and usually affect the nose. Infection can be caused by viruses and bacteria. Fungi can also cause infection, but this tends to occur in people with a weakened immune system or diabetes. The guiding principals of treatment are to open the natural drainage sites of the sinuses into the nose and eradicate infection with antibiotics. Swelling of the lining of the nose (mucosa), from infection or allergy is the most common cause of obstruction. Regardless of whether allergies are present, nasal steroid sprays will shrink the mucosa and aid drainage from the sinuses. A decongestant nasal spray such as oxymetazoline will also shrink the mucosa, but a rebound in swelling occurs if used beyond a maximum of five days. Saline nasal spray can be used frequently, which thins the mucous and washes out the sinuses. Antihistamines should not be given while being treated for a sinus infection because they slow down the natural infection clearing properties of the mucosa lining the sinuses. Antibiotics need to be given at least two weeks beyond clearing of symptoms. Some of the antibiotics approved by the Food and Drug administration for acute sinus infection include Augmentin, Omnicef, Cefzil, Cipro, Biaxin, Tequin, Levaquin, Lorabid and Avelox. None have an indication for chronic sinusitis but are still useful. Therapy usually begins with a narrow spectrum antibiotic for two weeks. Broader spectrum antibiotics are added next and treatment is continued up to eight weeks. The last course of therapy may involve the addition of an antibiotic that kills bacteria that grow without oxygen (anaerobes) as well as an oral steroid such as methylprednisolone. Long term control of allergies with immunotherapy is necessary to prevent recurrence. If symptoms and disease do not respond to medical therapy, then endoscopic sinus surgery to drain the sinuses may be necessary. This type of surgery is minimally invasive, and removes only small amounts of diseased tissue at the points of sinus drainage. Older types of sinus surgery were more destructive of normal sinus tissue and left many people "nasal cripples".
Asthma is a reversible lung disease that presents with coughing, shortness of breath and wheezing. The underlying problem with airways is inflammation. In the majority of patients, the inflammation is a result of allergies, but asthma can occur without allergies. In either case, inflammation leads to excessive mucous production, thickening of the airway wall and enlargement of the muscles surrounding the air passages. The end result of swelling and thickening of airway muscles is obstruction to airflow. Airways also become irritable, and react with obstruction when in contact with minor irritants , cold air or exercise. Fortunately, properly managed asthma is a reversible disease. Medications to treat asthma are classified as controllers and rescuers. Controlling medications target the processes that cause the airways to become inflamed and irritable. These include inhaled and oral corticosteroids, leukotriene antagonists, and monoclonal antibodies to remove allergy causing antibodies from the circulation. Controlling medications should never be used to relieve the symptoms of an acute asthma attack because they are very delayed in onset of action. Rescue medications are bronchodilators that work quickly and target the muscles that surround the airway. They work by relaxing the muscles that surround the airway and subsequently increasing the airway diameter . The most common drug in this class is albuterol. A well-controlled asthmatic should not require albuterol more than twice a week or awaken from sleep more than twice a month with wheezing. Therefore a person with well controlled asthma will need one or less albuterol metered dose inhalers in one year. If symptoms are occurring more frequently, it means that underlying airway inflammation has not been adequately controlled. Of course, allergic triggers should be identified and controlled as much as possible to decrease airway inflammation. If exercise or cold air trigger asthma symptoms, using an inhaled bronchodilator fifteen minutes before the event should allow one to normally complete the activity. A new medication known as Xolair works by a novel mechanism. It's use is reserved for patients with severe asthma , whose symptoms persist despite the use of all available medications. The drug is a monoclonal antibody that removes allergy and asthma causing IgE antibodies from circulation. Prior authorization is needed from your insurance company to administer this drug because it is expensive.
Atopic Dermatitis (AD) is a chronic, itchy skin disorder that affects people who have food or environmental allergies ("atopy") or have a family history of allergy. The rash has a characteristic distribution depending on the persons age. In the first year of life, it usually occurs on the face, knees and elbows. Adults usually have eczema on the inside creases of the elbows, behind the knees and occasionally the eyelids. Atopic dermatitis can also cause nipple eczema and a deformation of the clear part of the eye known as the cornea, that can affect vision. It is not understood why atopic dermatitis has a preference for specific areas of the skin. The first step in diagnosis is demonstrating the presence of "atopy" or that allergic triggers are causing the rash. This involves food and environmental allergy skin testing. Treatment usually begins with anti-inflammatory steroid creams, hydrating the skin and protecting it with a high quality, hypoallergenic moisturizer. A mild soap, for example gylcerin, can be very effective. Staphylococcus bacteria may infect eczematous skin and amplify the inflammatory process. Treatment with an anti-staph antibiotic usually results in significant improvement. Newer drugs for AD include the medications tacrolimus and pimecrolimus. Both drugs are an outgrowth of advances in drugs that prevent the rejection of transplanted organs. Patch testing with foods or dust mite allergens is an advance in the diagnosis of atopic dermatitis and is called the "atopy patch test".
Allergic Rhinitis is caused by the inhalation of airborne environmental substances that activate your immune system when they contact the lining of your nose. This results in the release of histamine and other chemicals that cause sneezing, nasal stuffiness, watery nasal discharge and inability to smell. The first priority of treatment is to accurately determine your allergic triggers with a skin test so that the environment can be controlled. Medical therapy includes the use of histamine blocking drugs such as cetirizine, levocetrizine , fexofenadine and desloratidine. Nasal steroid sprays block other chemicals released during allergic reactions and work best when used consistently. Nasal antihistamine sprays help relieve nasal itching, sneezing and runny nose. A decongestant such as psuedoephedrine can be added when congestion is difficult to control. The best long term strategy is to desensitize with allergen injection therapy and decrease exposure to indoor allergens.