Allergies

Overview

An allergy is a reaction of a person's immune system to a normally harmless substance, one that doesn't cause problems for most people.

It's hard to believe that things as unrelated as pollen, animal dander, bee venom, foods and mold can all potentially lead to the same type of problem. What these substances have in common is that they are proteins and are among the most common allergens. They can cause severe allergic reactions in some people.

With so many potentially allergenic substances, it's no wonder allergic diseases are among the major causes of illness and disability in the United States. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), the prevalence of allergies has continued to rise in industrialized countries for more than 50 years. Worldwide, up to 30 percent of people suffer from seasonal and year-round allergic rhinitis, and 20 percent suffer from skin allergies.

An allergy is a response of a person's immune system to a normally harmless substance, one that doesn't usually cause problems for most people. In the allergic woman, an offending substance can trigger an immune system response, which functions as the body's defense against invading agents such as parasites, to respond to a "false alarm." The immune system treats the allergen as an invader by generating large amounts of a certain type of antibody—a disease-fighting protein known as IgE—that attaches to specific body tissue and blood cells. The cells are then triggered to release powerful inflammatory chemicals such as histamine, cytokines and leukotrienes. These chemicals can act on tissues in various parts of the body, such as the respiratory system, and cause the symptoms of the allergic response.

Allergies can be more than just bothersome. Some allergens cause symptoms of asthma and rhinitis like sneezing, runny nose, stuffiness and watery, itchy or red eyes; skin irritations like itching and hives or eczema; or gastrointestinal distress. In some people, the allergic response can lead to anaphylaxis or anaphylactic shock—a sudden and sometimes deadly drop in blood pressure. Anaphylactic shock can also potentially stop the heart or lead to complete closure of air passages, causing death by suffocation.

Pollens, molds and fungi, dust or dust mites, animal proteins, medications, foods, latex and other substances can trigger acute or chronic symptoms. Food allergies, which are most likely to cause anaphylaxis, are most commonly caused by ingestion of peanuts, tree nuts, shellfish, fish, milk, eggs, wheat and soy.

Contact allergies are allergic reactions caused by a person's skin touching a substance. They are most often caused by nickel, rugs, fabric softeners, deodorants, cosmetics, perfumes, preservatives, dyes and foam insulation. Plants such as poison ivy, poison oak and sumac are also leading causes of contact dermatitis. There is a compound in these plants that can cause severe skin reactions in people who are sensitive to it—up to 85 percent of Americans. Such reactions usually occur two days after exposure and can persist for weeks unless proper treatment is obtained. Testing for these substances is readily available.

Allergies can have a genetic component. If only one parent has allergies, a child has about a 30 percent to 40 percent chance of developing allergies. If both parents have allergies, the odds are closer to 70 percent.
Adults usually do not lose their allergies, but children may outgrow them. In addition, while people are born with a genetic predisposition to allergies, sometimes they don't develop them until well into adulthood. Exactly why this occurs is unknown.

Diagnosis

• sneezing in bursts or single sneezes
• congestion or stuffiness (nasal blockage)
• runny nose or postnasal drip
• itching of nose and throat, including the palate and often the ear canals
• dark circles or "shiners" under the eyes caused by decreased venous blood flow due to poor drainage from persistent nasal congestion
• a crease mark on the nose from rubbing it upward over time (the "bunny crease")
• watery eyes
• itching of the eyes
• dry eyes
• conjunctivitis, or an inflammation of the membrane that lines the eyelids, causing red-rimmed, swollen eyes and sometimes crusting of the eyelids
• wheezing, coughing, chest tightness from allergic asthma or shortness of breath from exertion

In addition to these symptoms, some food allergies may cause the following symptoms:

• itching in the mouth (lips, throat, tongue or palate)
• difficulty breathing or swallowing
• a drop in blood pressure leading to feeling faint and weak
• abdominal pain
• diarrhea or vomiting
• hives or skin itching
• eczema (more common in children)

The main symptom of a contact allergy is an itchy, persistent rash.

Some women develop reactions in response to environmental agents, such as cigarette smoke, paint fumes, plastics and perfumes; temperature and humidity changes; and strong smells. These are not true allergic reactions involving antibodies and the release of histamine or other chemicals. Similarly, food intolerances, such as an inability to digest milk products or gluten or sensitivity to monosodium glutamate (MSG), are not true food allergies but are intolerances

It's not uncommon for women with allergies to develop asthma. The symptoms of asthma include coughing, wheezing and shortness of breath due to a narrowing of the bronchial passages or airways and to excess mucus production and inflammation and respiratory muscle contractions. Similarly, extended periods of rhinitis can lead to chronic sinusitis.

If you suspect you have an allergy and it bothers you to the point you need to seek treatment, you can see a general health care provider or an allergy specialist. If you have cold-like symptoms that last for more than two weeks, you should seek proper diagnosis and treatment. These symptoms can lead to sinusitis, which may require more aggressive treatment. Your health care professional will discuss with you your medical history, your symptoms and possible triggers.

Helpful questions to sort out your symptoms include:

• Do allergies run in your family? If so, which relatives have them, and what are they allergic to?
• Do you develop recurring symptoms at certain times of the year or are symptoms present year-round or both?
• Does being around pets trigger symptoms in your eyes, nose or chest?
• Do eating certain foods cause symptoms to erupt or flare?
• How long do your symptoms last? Days? Weeks? Or longer?
• What seems to make symptoms worse? What makes them better?
• Have you tried any medications to alleviate your symptoms? Were they successful or not?
• Are you taking any over-the-counter or prescription medications? If so, which ones? (It's always helpful to take your medications with you to the appointment.)
• Do you use the medications as prescribed by your health care professional?
• Are you allergic to any medications?

Your health care professional should examine your nasal mucous membranes, as well as your eyes, ears, mouth and throat. Nasal membranes may appear swollen and pale or bluish. If you have a suspected food allergy, you may be asked to undergo skin testing. A food and symptom diary is another useful tool to determine less obvious food allergies.

Allergy specialists use skin tests to determine the specific allergens that may be responsible for your allergies. He or she will inject diluted extracts from allergens—particular foods, pollens, dust mites, etc.—under your skin or to a tiny scratch or puncture on your arm or back. With a positive reaction, a raised, reddened area with a surrounding flush will appear at the test site, indicating antibodies to that specific allergen are present in the skin. Prick tests are done first; an intradermal test may also be required.

Your health care professional might also do a blood test, which is not as sensitive for definitive diagnosis as a skin test. Using a sample of your blood, the test looks for levels of antibodies to particular allergens. This type of testing can be helpful for people who have skin conditions such as rashes, hives or dermatographia that make it difficult to do skin testing or who have an unusual history of reacting to allergens not available for testing.

If your health care professional suspects a food allergy, he or she may suggest an elimination diet, but only if your reactions are not severe. This technique involves not eating any of the suspected foods for a week or two to see if your symptoms go away. Then, you return the food to your diet over several days to see if the symptoms reappear. A procedure used to objectively diagnose food or medication allergy is the challenge test. During a challenge test, you take a very small amount of an allergen by inhaling it or taking it by mouth. It's very important that challenge tests be supervised by an allergist or other physician with specialized training in allergies.

Another kind of challenge test is the double-blind food challenge. You ingest a dried (or otherwise modified) form of suspect food—usually in a capsule form––under clinical supervision to see if a reaction occurs. Neither you nor the health care professional knows which capsule contains the allergen. This test should not be used if your reactions are severe. It's rarely performed because of its high cost and is used more often to rule out a food allergy in cases in which your health care professional suspects the reactions are due to something else. These oral food challenges may be done if blood tests or skin tests were negative or not definitive in pinpointing a specific food reaction.

Treatment

It's important to remember that if you suffer from any severe allergic reaction—such as anaphylactic shock or asthma that causes shortness of breath or difficulty breathing, or any other extreme discomfort—you should seek medical attention immediately.

In fact, if you've ever had a previous severe allergic reaction, you should ask your health care professional about carrying an epinephrine injector device with you to treat anaphylaxis. And be sure you know how to inject yourself with epinephrine quickly and correctly. If you have to use it, be sure to call 911 and seek medical help immediately. Until help arrives, lie down and raise your legs above the level of your chest to increase the blood flow to your heart and brain.

The first course of treatment of allergy is avoiding the allergen. (For more details, see the section on Prevention.) Your health care professional may also prescribe medications, recommend over-the-counter remedies or suggest allergy shots or injections available for inhaled allergens and venom. Although there is no cure for allergies, one of these strategies or a combination of them may provide significant relief from allergy symptoms.

Your health care professional may prescribe some medications that can be used alone or in combination. These include:

• Antihistamines counter the effects of histamine that is released in response to the allergen. Antihistamines relieve sneezing and itching in the nose, throat and eyes; may reduce nasal swelling and drainage; and are used to treat hives. The older drugs (called first-generation antihistamines), which include chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl) and hydroxyzine (Hydroxyzine HCL), cause drowsiness and increase the risk of vehicle and occupational injuries. Some of the (second-generation antihistamines, such as fexofenadine (Allegra), loratadine (Claritin), desloratadine (Clarinex), levocetirizine (Xyzal), and cetirizine (Zyrtec), have fewer side effects. Loratadine, cetirizine, levocetirizine and fexofenadine are available over the counter and in generic forms. It is important to take these medicines daily for optimal effect. Some people, however, do experience mild side effects including drowsiness, dizziness, headache, nervousness, nausea, diarrhea, abdominal discomfort, dry mouth or dry or itchy skin with some of these medications. You should always let your health care provider know what other medications you are taking. Other second-generation antihistamines are azelastine (Astepro) and ketotifen (Zaditor). Azelastine is approved for use in the nose and eyes, and ketotifen in only the eyes. Other prescription antihistamine eye drops include epinastine ophthalmic (Elestat) and olopatadine ophthalmic (Patanol). A combination of a nasal steroid (fluticasone) and a nasal antihistamine (azelastine) is also available by prescription (Dymista). To treat eye symptoms of allergic conditions, such as inflammation, itching, watering and burning, your health care professional may prescribe antihistamine eyedrops that block histamine release. Don't use any other eyedrops while using these, and be sure to remove contact lenses to apply the drops to your eyes. If you wear contacts, you're probably safer switching to glasses during your treatment.
  
  If you are pregnant, keep in mind that some of these antihistamines' effects on an unborn baby are untested; similarly, their effects on breast milk or nursing infants are in some cases not known. Always tell your health care professional if you are, could be or could become pregnant, and discuss your situation with him or her before taking any medications. Both cetirizine and loratadine were category B for pregnancy, meaning they appear to be safe, although they have not been tested specifically in pregnant women. Only loratadine should be used when breast-feeding because cetirizine can enter breast milk. The U.S. Food and Drug Administration recently dropped its letter classifications for over-the-counter and prescription drugs.

• Spray or topical nasal steroids are anti-inflammatory drugs that reduce allergic inflammation. They decrease the number of the histamine-releasing cells in the nose and reduce mucus secretion and nasal swelling. These wet corticosteroid nasal sprays include mometasone (Nasonex), triamcinolone (Nasacort AQ), fluticasone (Flonase), budesonide (Rhinocort) and ciclesonide (Omnaris). There are also newer dry nasal sprays, including beclomethasone (QNASL) and ciclesonide (Zetonna). And there is the combination nasal steroid and antihistamine spray that recently became available by prescription (Dymista).
  
  Although they are generally safe when used at recommended doses, side effects of these medications may include:
  • stinging or burning of the nose
  • sneezing after application
  • bleeding of nasal membrane
  • scabbing or crusting of nasal membrane
  • perforated septum (rare)
  • headache or lightheadedness
  • unpleasant (or loss of) taste or smell
  • soreness in the nose

• Cromolyn sodium (Nasalcrom) is an over-the-counter nasal spray that may help to prevent allergic reactions. When used as directed, it may provide relief from allergies and has few side effects—which may include stinging or burning of the nose, headache, bad taste, runny nose or postnasal drip. Its main disadvantage is that it must be used three to four times a day. While tests have shown it is unlikely to harm an unborn baby, don't use cromolyn sodium without first talking to your health care professional if you are pregnant. It's not known if this medication passes into breast milk; talk to your health care professional if you are nursing.
• Decongestants, such as pseudoephedrine, help reestablish drainage of the nasal passages and relieve symptoms such as congestion, swelling, excess secretions and discomfort in the sinus areas. These over-the-counter (OTC), behind-the-counter and prescription drugs can be taken by mouth. To get the more effective decongestants, you have to ask at the pharmacy counter because they are kept behind the counter. You can also get OTC nasal decongestant sprays. Be careful not to use nasal sprays and drops for more than three or four days, or you might end up even more congested because of a rebound effect. Your health care professional may advise you to take an antihistamine in combination with a decongestant to relieve other allergic symptoms. Decongestants may produce side effects such as nervousness, insomnia, rapid heartbeat and elevated blood pressure. If you are pregnant, talk to your doctor before taking pseudoephedrine (or any other OTC medication for congestion).
  
  Some over-the-counter products should not be used by people with high blood pressure, diabetes or other medical conditions, or if they've taken an MAO inhibitor in the last 14 days. If you have any medical conditions, be sure to consult your health care professional before self-treating.
• Leukotriene inhibitors, medications that block allergy-triggering chemicals, can help ease symptoms in people with asthma and indoor and outdoor allergies. FDA-approved leukotriene inhibitors include montelukast (Singulair and generic), zileuton (Zyflo CR) and zafirlukast (Accolate), all of which are prescription tablets. Montelukast is approved for the treatment of allergic rhinitis and asthma, as well as for the prevention of exercise-induced asthma.

• Immunotherapy, also called allergy vaccine therapy, which consists of a series of injections, reduces allergy symptoms over a longer time. That means it is a true disease-modifying treatment. Patients receive subcutaneous injections of increasing concentrations of the allergen(s) to which they are sensitive. These injections reduce the amount of allergy antibodies in the blood and cause the body to make a different protective antibody. Many patients with seasonal or year-round allergic rhinitis will improve within 12 months of starting immunotherapy, but the most noticeable improvement usually takes place in the second year. In addition to seasonal allergies, immunotherapy is commonly used for patients with indoor allergies to dust mites, pets and mold, and stinging insect (Hymenoptera) hypersensitivity. Patients who benefit from immunotherapy may continue it for three to five years and then consider stopping. Although many patients are able to stop the injections with good long-term results, some may worsen after immunotherapy is stopped. A recently introduced alternative therapy to traditional immunotherapy is sublingual immunotherapy (SLIT) in the form of dissolving tablets. This works similarly to allergy shots in that it slowly desensitizes patients to the substances that cause their allergic reactions. However, instead of being injected, with SLIT, the tablet is placed under the tongue. This appears to be effective and may be more convenient than traditional immunotherapy (plus, it doesn't involve the possible discomfort of an injection). SLIT tablets are available in the U.S. for grass, ragweed and dust mites.

In the cases of food allergies, while antihistamines and decongestants can help alleviate some symptoms, they do not prevent food allergies. The best course of action is to always avoid the trigger food. This, however, is not an easy task, especially when eating prepared or restaurant food. Ask your server about ingredients in menu items, but if he or she doesn't seem certain, ask to speak to the kitchen staff about the presence or absence or specific food allergens in the dishes you want to order.

Currently, there are three treatments being investigated for food allergies. This includes oral immunotherapy, sublingual immunotherapy and epicutaneous immunotherapy. In addition, subcutaneous allergy injections using smaller fragments of allergens are also being investigate.

Treating skin reactions

The cause of eczema or atopic dermatitis is unknown. The primary treatment for skin eczema is aimed at alleviating symptoms. To relieve itchiness and eczema, your health care professional might recommend initially a room-temperature bath to remove crusted skin, followed by immediate application of a moisturizer, which helps conserve the skin's natural moisture.

Topical steroid creams and ointments are effective in decreasing skin inflammation. Two FDA-approved nonsteroidal topical medications, tacrolimus (Protopic) and pimecrolimus (Elidel), also are available for treatment of eczema. These medications, which are in a class of medications called immunomodulators, help maintain normal skin texture, reducing eczema flares. However, due to possible effects on the immune system with prolonged use of these medications—specifically, an increased risk of certain cancers, including skin cancer and non-Hodgkin's lymphoma—the FDA recommends that tacrolimus and pimecrolimus only be used when someone can't tolerate other medications or other treatments have failed. Talk to your health care professional about this risk. Also tell your health care provider if you are pregnant or breastfeeding.

A new treatment approved in 2016 is crisaborole ointment (Eucrisa), which can be used to treat mild to moderate skin inflammation in adults and children aged 2 and older. It is a nonsteroidal, immunomodulated, topical cream that is applied twice daily.

Topical coal-tar preparations also work, but they can be messy and have an unpleasant odor. They should not be used by pregnant women, and there is some evidence that their prolonged use may increase the risk of skin cancer.

If symptoms persist, consult a dermatologist. He or she may recommend application of over-the-counter hydrocortisone cream or, in severe cases, oral corticosteroid medication. Although steroid creams or oral steroids may be appropriate for acute outbreaks or severe episodes of eczema, long-term use is not advisable because of the considerable risk of side effects. Topical steroid creams can cause thinning and spotting of the skin, acne and permanent stretch marks. If used around the eyes, topical steroid medications can, in rare cases, lead to glaucoma. Eczema patients who take oral steroids for long periods may have issues during times stress, plus possible cataracts, glaucoma, weight gain and bone loss. For these reasons, long-term steroid therapy is advised only under a health care professional's supervision.

The newest treatment for adult eczema is a biologic agent called dupilumab (Dupixent). It is approved for moderate to severe atopic dermatitis or eczema that is difficult to control. It is given at home by injection every two weeks and can improve both the rash and itching. Biologic drugs are made from proteins typically derived from human DNA.

There are also alternative remedies that have shown some promise, but results of studies are mixed. Talk with your health care provider before trying alternative remedies. If you are considering taking cod liver oil or fish oil supplements to boost your EPA intake, be sure to inquire about possible adverse interactions with other medications you may be taking.

Alternative remedies that have shown benefit for some people with eczema include: mackerel, herring and salmon, which are high in eicosapentaenoic acid (EPA); probiotics; evening primrose oil and borage oil, both of which contain the essential fatty acid GLA; vitamin C, which can act as an antihistamine; bromelain, which helps reduce inflammation; and flavonoids, which may help reduce allergic reactions. Some herbs may help eczema, including witch hazel, chamomile and St. John's wort creams.

Prevention

Prevention is the best treatment for allergies. By identifying exactly what you're allergic to, you can avoid it if at all possible, sometimes greatly limiting your symptoms without resorting to medical treatments. Visiting an allergist is the most accurate way of determining what exactly you are allergic to.

In cases of airborne allergens, it helps to use an air conditioner inside your home and car. Special air-filtering devices can be added to your home's heating and cooling systems, but cost of the equipment and high utility bills may make this option unaffordable.

Portable HEPA-type air cleaning devices used in individual rooms can be helpful. Ask your health care professional which type would be best. The size of your room is one determining factor; the airflow should be sufficient to exchange the air in the room five or six times per hour.

Vacuuming can worsen your symptoms unless the vacuum is equipped with a special HEPA filter. Following are some helpful tips for avoiding your exposure to various allergens.

Pollens

Unfortunately, short of staying indoors when pollen counts are high—and even that may not help—there's no easy way to evade wind-borne pollen. The pollen granules are so small and light and produced in such huge quantities that they can be carried for long distances. Clearing the offending plants from your own yard does little good. Here are some things you can do:

• Avoid prolonged, close contact with pollens (as well as some molds) by avoiding working outside during allergy season.
• Stay indoors during the time of the highest pollen counts, usually early in the morning on warm, dry, breezy days.
• Keep windows closed at night and don't open until after 10 a.m. Pollen is released between 2 and 10 a.m.
• If you do have to work outside, wear a face mask designed to filter pollen and keep it from reaching your nasal passages.
• If you're planning to travel for vacation, try to go away at the height of your expected local pollinating period, and choose a location where such exposure would be minimal, such as the seashore.
• Vigorously brush or bathe pets coming in from outside.

Relocating is not usually recommended because the person who is sensitive to a particular pollen or mold may subsequently develop allergies to new allergens after repeated exposure at the new location.

Molds

Mold allergens, too, can be difficult to avoid. Here are some tips to reduce your exposure:

• Avoid places where they proliferate such as moist, shady areas outdoors, garden compost piles, greenhouses, mills and grain fields or bins. Indoor hot spots include damp basements and closets, bathrooms, places where fresh food is stored, air conditioners, humidifiers, garbage pails, mattresses, upholstered furniture and old foam rubber pillows.
• Keep the lawn mowed and leaves raked, but have someone else do this for you or wear a tightly fitting dust mask to reduce your exposure.
• Avoid walks through tall vegetation, and avoid travel in the country while crops are being harvested.
• Ensure moldy indoor places, such as summer cabins, are aired out and cleaned before spending time there.
• Use a dehumidifier to dry out the basement, but be sure to frequently remove the water collected in the machine to prevent mold growth there.
• Open a window or use a fan after a warm or steamy shower to allow the humidity to escape.
• Avoid using humidifiers.

Dust mites

Dust mites are most effectively reduced by decreasing the amount of dust in your home. You can:

• Dust-proof your home, especially your bedroom, by removing wall-to-wall carpet, blinds, down-filled blankets and feather pillows. Window shades don't trap dust; curtains can be used if they are washed periodically in hot water. Hardwood floors with washable throw rugs are easier to remove dust from than carpets. Fabric on upholstered furniture traps dust much more so than vinyl- or leather-covered furniture. Washable slipcovers are a good alternative.
• Encase bedding in commercially available allergy-proof covers. Woven microfiber materials are more expensive and more comfortable.
• Wash linens using water hotter than 130 degrees Fahrenheit, which kills dust mite eggs. If you do not want to set your water heater that high, you may dry linens at the hottest dryer setting.
• Frequently dust with a damp cloth or a microfiber-type cloth.

Animals

If you simply can't bear to find another home for your pet, you can try these suggestions:

• Keep the pets out of your bedroom.
• Have someone bathe your cat weekly and brush it outdoors even more frequently.
• Remove carpets and soft furnishings that trap animal dander and dried proteins in dust.
• Use a vacuum with a HEPA filter.
• Use a room air cleaner with a HEPA filter.
• Wear a face mask while housecleaning.

Foods and other ingested substances

• Ask your health care professional for the various names of different forms of the food that you should avoid.
• Read food ingredient labels closely to check for the presence of your trigger food substances. They are often found in places you wouldn't suspect.
• At a restaurant, don't hesitate to ask the cook or chef about ingredients of various dishes and how they are prepared. Be especially aware of cross-contamination.
• If you're allergic to a common medication such as penicillin, wear or carry something with this information, such as a medical alert bracelet or card.
• If you have had anaphylactic reactions, you should wear a medical alert bracelet or necklace identifying this history.
• If you have severe allergies (such as anaphylaxis), be prepared to treat an inadvertent exposure at the first sign of a reaction with a syringe of epinephrine (such as EpiPen, Auvi-Q or generic auto-injectors), obtained by prescription. Be aware that the shelf life for epinephrine is about 12 to 18 months, after which it should be replaced.

Facts to Know

1. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), allergy rates have been rising throughout the industrialized world for more than 50 years. Worldwide, up to 30 percent of people suffer from allergic rhinitis and 20 percent suffer from skin allergies.
2. According to Food Allery Research and Education, up to 15 million Americans have food allergies, including 5.9 million children under age 18.
3. If only one parent has allergies, a child has about a 30 to 40 percent chance of developing allergies. If both parents have allergies, the odds are closer to 70 percent.
4. Adults most often do not lose their allergies, but children can sometimes outgrow them.
5. An allergy is your body's response to what it perceives to be a threat. Your body attacks the allergen in a way similar to how it would attack an invading parasite or tick.
6. The pollens of non-flowering plants, grasses, trees and weeds are so small and light they can travel through the air for miles. Samples of ragweed pollen have been collected 400 miles out at sea and two miles up into the atmosphere. Flowering plants pollinated by insects are not the problem.
7. A pollen count represents the concentration of all the pollen or of one particular type, like ragweed, in a certain area over a certain period of time (usually a day or two).
8. Molds are light and can be easily carried by air currents. The mold season peaks in July in warmer states and October in colder ones, but mold can thrive year-round indoors.
9. It's the waste product (fecal material) of dust mites, not the mites themselves, that cause the allergy. Similarly, the waste products of cockroaches are an important cause of allergy symptoms, particularly in some urban areas of the United States. The best way to get rid of mites in washable items like rugs and curtains is to use water that is hotter than 130 degrees Fahrenheit and a hot dryer setting. Cockroach infestations are best treated by professional exterminators.
10. The major allergen from animals is not their fur, but proteins secreted by skin glands that are found in dander; proteins in the saliva that stick to fur when the animal licks itself; and proteins found in the animal's urine. These are airborne and stick to objects such as walls and furniture. Animal dander remains present for up to six months after an animal is removed from the environment. There is no such thing as a "hypoallergenic" cat or dog. Some people may tolerate short-haired dogs or smaller dogs or certain breeds that don't shed or don't shed much, because they may not release as much dander into the air or onto the floor.

Questions to Ask

Review the following Questions to Ask about allergies so you're prepared to discuss this important health issue with your health care professional.

1. Could the medicine I take for a medical condition—such as blood pressure medicine or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain—cause my allergic symptoms?
2. Do I have any medical reasons for limiting my use of over-the-counter allergy medication?
3. What are the side effects of any medications or treatments you are recommending? Will the medications interact with any other medications I'm taking?
4. How long will it take for my treatment to work? How do you plan to monitor my treatment to see if it's working?
5. What steps can I take to keep my home allergen-free?
6. Is my condition potentially dangerous? Under what circumstances should I seek professional medical care after an allergic reaction?
7. Will my allergies ever change on their own?
8. What are the chances that my children will also have allergies?
9. Do I have a type of allergy that can be helped with allergy shots or sublingual tablets? How can I find out?
10. How do allergy shots and other treatments work?
11. If I take allergy treatments, could I have a bad reaction to them?
12. After I begin allergy treatment, how long before I will feel better?

Key Q&A

Lifestyle Tips

1. Spot hidden food allergens—know their hiding places
   One type of allergic response, anaphylaxis, is a sudden and sometimes severe drop in blood pressure that can potentially stop the heart or close air passages, causing death by suffocation. Avoiding foods that you know you're allergic to is the first step to preventing a serious allergic reaction. The most common food allergens are milk, egg, peanut, wheat, soy, shellfish, fish and tree nuts. But, beware of the hidden sources of your food allergens: unlabeled ingredients in processed food; milk toppings on specialty or bar drinks that can contain eggs; deli slicers used for both meat and cheese products; and ethnic dishes that use peanuts and peanut oil can contaminate dishes prepared without nuts. Nutrition bars often contain nuts or seeds, which can cause acute allergic reactions. Cakes or pies also may have hidden nuts in the crusts, batter or frosting.
2. Mold allergies—some tips for coping
   Damp, shady or dark areas of the home and garden harbor molds, a common allergen for many people. Avoid those damp and musty places if you can. If not, take these steps to "air out" mold: Use a dehumidifier to dry out damp basements. Open a window or use a fan after a steamy bath or shower to allow the humidity to escape. Don't store clothes or other frequently used possessions in damp basements. Avoid moist, shady areas outdoors, garden compost piles and greenhouses.
3. Asthma and allergies can go hand-in-hand
   About 40 percent of individuals with allergies also have asthma, a condition in which the airways of the lungs narrow, resulting in wheezing and problems breathing. Experts say that allergies should not be treated as a trivial problem. Untreated, allergies can lead to the development of chronic sinusitis (inflammation of the sinuses) and asthma. Once diagnosed, a combination of medications may be recommended to relieve seasonal allergies. These medications include antihistamines, topical nasal corticosteroids, cromolyn sodium nasal spray, decongestants and immunotherapy. See your health care professional to assess your symptoms if you think you might suffer from seasonal allergies, or if the steps you take to relieve your symptoms aren't working.
4. Love your pet, but can't stop sneezing?
   All pets can cause allergies—except, perhaps, fish. Pet dander, skin flakes, saliva and urine can cause allergic reactions in people sensitive to these allergens. Another big source of discomfort for pet owners with allergies is the pollen, mold spores and other outdoor allergens brought inside on your animal's fur. If you can't bear to give up your fur-bearing friend, try these strategies to minimize your allergies: Keep your pet out of your bedroom, where you spend the most time. Wash your hands after handling your pet to avoid spreading the dander. Have someone else bathe your pet weekly and brush it outdoors several times a week. Have someone else clean the litter box, and store it away from forced air heating or central air conditioning vents.
5. Asthma and pregnancy—hormonal shifts may improve asthma or make it worse
   It's probably no surprise to women with asthma to hear that hormonal shifts affect their asthma symptoms. Some women with asthma find that their symptoms worsen just before and during menstruation, then improve once their periods end. Asthma may get worse during pregnancy—a time when hormones fluctuate greatly—but asthma symptoms may also improve or stay the same when you're pregnant. About one-third of pregnant women experience improved symptoms, one-third experience a worsening of symptoms, and one-third experience no change. Some asthma medications can be continued during pregnancy, under the supervision of your health care professional. If you breast-feed, it's best to breast-feed your baby before taking your medicine and then avoid feeding again for three to four hours; nearly all asthma and allergy medication enters breast milk, though infants are exposed only to minute amounts.

Organizations and Support

For information and support on coping with Allergies, please see the recommended organizations, books and Spanish-language resources listed below.

Allergy & Asthma Network Mothers of Asthmatics (AANMA)
Website: https://www.aanma.org
Address: 2751 Prosperity Ave., Suite 150
Fairfax, VA 22031
Hotline: 1-800-878-4403

American Academy of Allergy, Asthma & Immunology
Website: https://www.aaaai.org
Address: 555 East Wells Street, Suite 1100
Milwaukee, WI 53202
Phone: 414-272-6071
Email: info@aaaai.org

American College of Allergy, Asthma and Immunology (ACAAI)
Website: https://www.acaai.org/
Address: 85 West Algonquin Road, Suite 550
Arlington Heights, IL 60005
Hotline: 1-800-842-7777
Phone: 847-427-1200
Email: mail@acaai.org

American Lung Association (ALA)
Website: https://www.lungusa.org
Address: 61 Broadway, 6th Floor
New York, NY 10006
Hotline: 1-800-LUNG-USA (1-800-586-4872)
Phone: 212-315-8700

Asthma and Allergy Foundation of America
Website: https://www.aafa.org
Address: 1233 20th Street, NW, Suite 402
Washington, DC 20036
Hotline: 1-800-7-ASTHMA (1-800-727-8462)
Email: info@aafa.org

Food Allergy Initiative
Website: https://www.foodallergyinitiative.org
Address: 1414 Avenue of the Americas, Suite 1804
New York, NY 10019
Phone: 212-207-1974
Email: info@faiusa.org

Food Allergy Network
Website: https://www.foodallergy.org
Address: 11781 Lee Jackson Hwy., Suite 160
Fairfax, VA 22033
Hotline: 1-800-929-4040
Email: faan@foodallergy.org

Books

ABC of Asthma, Allergies and Lupus: Eradicate Asthma - Now!
by Fereydoon Batmanghelidj

Allergies and Asthma For Dummies
by William E. Berger

My House Is Killing Me! The Home Guide for Families With Allergies and Asthma
by Jeffrey C. May, Jonathan M. Samet

Sinus Survival: The Holistic Medical Treatment for Allergies, Asthma, Bronchitis, Colds, and Sinusitis
by Robert S. Ivker

Spanish-language resources

Womens Health
Website: https://espanol.womenshealth.gov/a-z-topics/asthma
Phone: 1-800-994-9662