What is an allergy?
 How is an allergy diagnosed?
 How is an allergy treated?
 How can an allergic reaction be avoided?
         Animal Dander
         Bee Stings
         Drug & Chemical
         Dust Mite
         Food
         Latex
         Mold
         Pollen
 Alternative Medicine

What is an allergy?

Allergy is defined as an abnormal, exaggerated response by the body's immune system against a specific substance that is inhaled, ingested or otherwise contacted. An allergic immune reaction is also known as hypersensitivity. The immune system serves as the body's defense mechanism against countless substances present in the air we breathe, the food we eat and the things we touch. The body's immune system has mechanisms built-in to recognize self from non-self so that we only react to things that pose a danger to our well-being. Sometimes, that recognition system goes haywire and an over-stimulated or hypersensitive allergic reaction can occur.

People who have allergies have an abundance of an antibody called IgE. Following IgE production, these antibodies travel to cells called mast cells, which are particularly plentiful in the nose, eyes, lungs, skin and gastrointestinal tract. The IgE antibodies attach themselves to the surface of the mast cells and wait for their particular allergen. Each type of IgE is specific for one type of allergen only. That's why some people are only allergic to cat dander (they only have the IgE antibodies specific to cat dander) and others seem to be allergic to everything (they have multiple types of IgE antibodies.) The next time an allergic individual comes into contact with the allergens to which he or she is sensitive, the allergens will be captured by the IgE. This initiates the release of chemical mediators such as histamine and other chemicals from the mast cells. These mediators produce the symptoms of an allergic reaction, such as swelling of tissues, sneezing, wheezing, coughing and other reactions.

As the allergic reaction continues, these newly released mediators recruit other cells from the blood to that site, resulting in additional allergic inflammation. Many symptoms of chronic allergic disease, such as swelling, excessive mucous, and sensitivity to irritating airborne pollutants, such as smoke and perfume, are the result of tissue inflammation. Most of this inflammation is due to ongoing exposure to allergens. Some immune systems amplify an allergic response causing it to go on for days from a single exposure. These amplification symptoms are more complex and often take the form of tiredness, aches and pains, headache, congestion, and even flu-like symptoms.

Allergy is one of a group of medical problems that are referred to as the atopic diseases. The following diagram represents the three atopic diseases: allergies, asthma, and eczema, and their strong but not exclusive correlation with one another.


This means that the genes causing each of these medical problems are closely linked and tend to be inherited together. A family history of allergies is the single most important factor that predisposes a person to develop allergic disease. If one parent has allergic disease, the estimated risk of the child to develop allergies is nearly 50%. The child's risk grows to 70% if both parents have allergies. However, the fact that a person has these genes does not indicate that the disease will show itself in the lifetime of an individual. For example, a child who develops eczema early in life is much more likely to have asthma, food allergies and allergic rhinosinusitis. An adult with allergic rhinosinusitis is more likely to eventually develop asthma and various types of eczema. In both cases, while the manifestation of multiple problems is likely, it is not guaranteed. The correlation, however, helps scientists create strategies to prevent the development of these conditions over a lifetime.

How is an allergy diagnosed?

If you are allergic, you are reacting to a particular substance such as a pollen, dust mite, mold, food, chemical, etc. Any substance that can trigger an allergic reaction is called an allergen. To determine which specific substances are triggering your allergies, your allergist/immunologist will safely and effectively test your skin or sometimes your blood, using tiny amounts of commonly troublesome allergens. The allergen extracts or vaccines used in allergy tests are made commercially and are standardized according to U.S. Food and Drug Administration (FDA) requirements. Your allergist/immunologist is able to safely test you for allergies to substances using these allergen extracts.

Allergy tests are designed to gather the most specific information possible so your doctor can determine: (1) if you have an allergy; (2) what you are allergic to; and (3) what will provide the best treatment.

The testing methods approved by the FDA to diagnose allergies are specific skin and blood tests. Both tests measure the same allergy antibody but the skin test is more accurate, cost effective, and sensitive for people over the age of approximately 5 years.

There are several scientifically proven allergy testing techniques that are used by trained allergist/immunologists:

  Prick technique involves introducing a small amount of allergen into the skin by making a small scratch through a drop of the allergen extract. If you have an allergy, the specific allergens that you are allergic to will cause a chain reaction to begin on your skin and you will get a small itchy welt at the site of the scratch. This will develop over about 15 minutes and then slowly resolve over another 30 minutes, so you don't have to wait long to know the results. There is a negligible risk of the reaction affecting other areas of your body. People with allergies have an allergic antibody called IgE (immunoglobulin E) in their body. This chemical, which is only found in people with allergies, activates special cells called mast cells. These mast cells release chemicals called mediators such as histamine, the chemical that causes redness and swelling. With testing, this swelling occurs only in the spots where the tiny amount of allergen to which you are allergic has been introduced. So, if you are allergic to grass pollen but not to cats, the spot where the ragweed allergen touched your skin will swell and itch a bit, forming a small dime-sized hive. The spot where the cat allergen scratched your skin will remain normal. This reaction occurs and tends to resolve within your body quickly.

  Intradermal technique involves injecting a small amount of allergen under the skin with a syringe. This form of testing is more responsive than the prick skin test method. This form of allergy testing may be used if the prick skin tests are negative. Allergist/immunologists generally only use this technique in adults. These tests are read in the first 15 minutes and then over the next 48 hours by the patient, recording results on a Skin Test Reaction Record.

  Blood (RAST) test called a radioallergosorbent (RAST) test are sometimes performed. Since this test involves drawing blood, it costs more, and the results are not available as rapidly as skin tests. RAST tests are generally used only in cases in which skin tests cannot be performed, such as on patients taking certain medications, in children under the age of 5 years, or those with skin conditions that may interfere with skin testing.

  Patch test involves placing a chemical or food on your skin under a small piece of tape and leaving it there for 48 hours before removing it. The tests are read at 48 hours and then checked daily by the patient for about a week.

  Challenge test involves introducing small amounts of the suspected allergen orally, by inhhalation or other route. Challenges are rarely performed, with the exception of medication and food testing. When they are performed, they must be closely supervised by an allergist/immunologist in the office or hospital.

How is an allergy treated?

There are three primary scientific ways to treat allergies: allergen immunotherapy, allergy medications and allergen avoidance.

Allergen Immunotherapy

Allergen immunotherapy is a natural form of treatment using the body's own natural defenses to decrease your sensitivity to substances called allergens. These allergens are identified by allergy testing and corroborated by your medical history as the substances that trigger your allergy symptoms after exposure. Allergy immunotherapy is a proven effective treatment for allergic rhinosinusitis, allergic asthma, and stinging insect allergy. It also may be effective in some individuals with atopic dermatitis (eczema) if they have allergies to airborne allergens. Immunotherapy can potentially modify the allergic disease leading to lasting remission of allergy symptoms. Immunotherapy may play a preventive role in pediatric allergic disease, in terms of development of asthma and new allergies, thus early involvement of the allergy specialist may be important in the child with allergy symptoms.

Not only does immunotherapy naturally resolve most allergy problems, it has been shown to prevent the development of new allergies and, in children and adults, can prevent the progression of the allergic disease from allergic rhinosinusitis to asthma. Allergy is one of a group of medical problems scientists call atopic diseases, that also includes asthma and eczema. The genes that cause each of these medical problems are closely linked and tend to be inherited together. For example, an adult with allergies is more likely to eventually develop asthma and various types of eczema.

Allergen immunotherapy involves injecting increasing amounts of natural allergen mixed in water each week over several months until a certain general level of injection strength is reached. From that point forward, the same injection dose is repeated every two to four weeks for three to eight years. Allergen immunotherapy works like a vaccine. Your body responds to the injected amounts of a particular allergen, given in gradually increasing doses, by developing an immunity or tolerance to the allergen that counters the allergic response. Benefit is achieved rapidly, although several years of regular treatment is necessary to create a memory so that the improvement is lasting. The majority of allergy symptoms are resolved using this method of treatment and its effect is long lasting even after the injections are stopped. Allergen immunotherapy usually leads to the long-lasting relief of allergy symptoms for a lifetime after treatment is stopped provided a full course of treatment has been completed.

There are generally two phases to immunotherapy: a build-up phase and a maintenance phase.

  Build-up phase involves receiving injections with increasing amounts of the allergens. The frequency of injections during this phase generally ranges from one to two times a week, though more rapid build-up schedules are sometimes used. The duration of this phase depends on the frequency of the injections but generally ranges from four to six months. At any time during the build-up phase you can skip up to four to six weeks and pick up where you left off in your schedule. Even if you don't receive an injection for more than six weeks, you can return to a previous dose and continue on from there.

  Maintenance phase begins when the effective therapeutic dose is reached. The effective maintenance dose is different for each person depending on the level of allergen sensitivity (how allergic he or she is to the allergens in the vaccine) and the response to the immunotherapy build-up phase. Once the maintenance dose is reached, there will be longer periods of time between immunotherapy treatments. The interval between maintenance immunotherapy injections generally ranges from two to six weeks. Based on the complexity of your allergy and your response, your allergist/immunologist will decide what range is best for you.

The benefits of immunotherapy, in terms of reduced allergy symptoms, can begin during the build-up phase but may take as long as 12 months to begin. Improvement with immunotherapy is commonly progressive throughout the treatment period but is most dramatic during the first one to three years. Effectiveness of immunotherapy appears to be related to length of treatment and the dose of the allergen. Failure to respond to immunotherapy may be due to several factors including:

  Inadequate dose of allergen in the allergy vaccine

  Missing allergens not identified during the allergy evaluation

  High levels of allergen in environment (i.e. inadequate environmental control)

  Significant exposure to non-allergic triggers (i.e. tobacco smoke)

If there is no improvement after a year of maintenance immunotherapy, possible reasons for failure to respond should be explored. If no apparent reason is found, then discontinuation of immunotherapy should be considered and other treatment options pursued.

Immunotherapy is only recommended for allergic asthma, stinging insect allergy, allergic rhinosinusitis and conjunctivitis. Immunotherapy for food allergies and contact skin allergies is not recommended. The best option for people with food allergies is strict food avoidance. The decision to begin immunotherapy will be based on several factors including:

  Length of allergy season, complications from the allergy, and severity of symptoms

  How well medications and/or environmental controls manage allergy symptoms

  Desire to avoid long-term medication use through a natural drug-free treatment regimen

  Time commitment; immunotherapy will require a commitment of at least three years and optimally, at least five years

  Cost; immunotherapy is a cost effective form of treatment after the first two to three years

The youngest age recommended to start immunotherapy in the United States is five years of age for several reasons; including the difficulty younger children may have in cooperating with the immunotherapy program. Recent studies have suggested immunotherapy may prevent the development of new allergies in children and also may prevent the development of asthma when rhinosinusitis is present. There is no upper age limit for receiving immunotherapy. In considering immunotherapy for older persons, consideration must be given to the other medical conditions (such as cardiac disease) which could potentially make immunotherapy more risky.

Because allergy injections are a natural allergen mixed in water, they are safe for administration to all age groups, including children and pregnant and breast feeding women.

There are two types of adverse reactions that occur with immunotherapy:

  Local reactions are fairly common and present as redness and swelling at the injection site. This can happen immediately, or several hours after the treatment. Usually no treatment is required except cold compresses, antihistamines and ibuprofen.

  Systemic reactions are generalized allergy reactions that are much less common than local reactions. Systemic reactions are usually mild and respond rapidly to medications or just spontaneously resolve. Symptoms can include increased allergy symptoms such as sneezing, nasal congestion or hives. Systemic reactions require immediate treatment and are usually quickly reversible.

Rarely, a serious life-threatening systemic reaction, called anaphylaxis, can develop after an immunotherapy injection. In addition to the symptoms associated with a mild systemic reaction, symptoms of an anaphylactic reaction can include swelling in the throat, wheezing or a sensation of tightness in the chest, nausea, dizziness or other symptoms and even death.

Most serious systemic reactions develop within 30 minutes of the allergy injections and this is why it is recommended you wait in the office for 30 minutes after your allergy injections. Our office staff is trained to monitor for such reactions and to identify and treat systemic reactions.

Immunotherapy should be given under the supervision of a physician in a facility equipped with proper staff and equipment to identify and treat adverse reactions to allergy injections. Ideally, immunotherapy should be given in our office. If this is not possible we can provide comprehensive instructions about your immunotherapy treatment to another supervising physician.

Allergy Medications

  Oral and Nasal Antihistamines block histamine, one of the most important mediators of the allergic response. They can be effective in some forms of non-allergic rhinosinusitis, but not always. They are also more effective for seasonal allergic rhinosinusitis, in contrast to perennial allergic rhinosinusitis. The release of histamine leads to many allergy symptoms, including itching of the eyes and nose, runny nose and sneezing. It is important to understand that antihistamines block the receptor sites in the body for histamine. Therefore, taking the antihistamine after an allergy has started is like closing the barn door after the horse has run out. It may stop the other horses from getting out but the first event has already occurred. Like any allergy medication, these drugs are best taken before, or in anticipation of, an allergic reaction to be most effective.

  Nasal inhaled corticosteroids reduce and control the impact of all or most of the mediators that can cause inflammation in the nose. It improves the nasal symptoms of allergic rhinosinusitis, including itching, runny nose and congestion. These medications take three to five days to become maximally effective.

  Decongestants are important in the care of many forms of rhinitis because congestion is, for the many patients with rhinitis, a troublesome symptom. Antihistamines do not do a very good job with nose stuffiness at all times. Sudafed is the most active medication available currently for the treatment of stuffiness. It should be emphasized that this medication can make sleeping difficult and in some men make urination difficult. Therefore, the use of this medication should be carefully adjusted to your needs and tolerance. If a D is added to your antihistamine name, it is essentially Sudafed.

  Leukotriene modifiers block the action of leukotrienes, a mediator of allergy symptoms and of inflammation. They block both the early response to allergic triggers (itching and sneezing) as well as the delayed response to allergic triggers (congestion). Overall, they are not as effective as antihistamines and nasal steroids in controlling allergy problems as single agents.

How can an allergic reaction be avoided?

Allergen avoidance techniques vary depending on the type of allergen you react to. Many allergens have a seasonal presence, in which case special care must be taken during certain times of the year.

Animal Dander

The most effective method of reducing exposure to household pet allergens is to find your pet a new home or make the pet an exclusive outdoor animal. If a pet must stay in the home at times or continuously:

  Designate a safe room (such as a bedroom) with a closed door where the pet never enters.

  Vacuum thoroughly and often with a HEPA vacuum or a machine equipped with a high-efficiency bag.

  Wash the pet weekly to help reduce allergen shedding.

  Use high-efficiency or electrostatic filters over air vents to reduce airborne pet allergens. A room air cleaner with a high-efficiency filter will reduce airborne pet allergens very little unless other measures have been taken.

Bee Stings

To avoid stinging insects, it is important to learn what they look like and where they live. Most sting reactions are caused by five types of insects: yellow jackets, honeybees, paper wasps, hornets and fire ants.

  Yellow jackets are black with yellow markings, and are found in various climates. Their nests, which are made of a paper-like material, are usually located underground, but can sometimes be found in the walls of frame buildings, cracks in masonry or woodpiles.

  Honeybees have a rounded, fuzzy body with dark brown coloring and yellow markings. Upon stinging, the honeybee usually leaves its barbed stinger in its victim; the bee dies as a result. Honeybees are not aggressive and will only sting when provoked. However, Africanized honeybees, or so-called "killer bees" found in the southwestern United States and South and Central America, are more aggressive and may sting in swarms. Domesticated honeybees live in man-made hives, while wild honeybees live in colonies, referred to as honeycombs, in hollow trees or cavities of buildings. Africanized honeybees may nest in holes in house frames, between fence posts, in old tires or holes in the ground, or other partially protected sites.

  Paper wasps have slender, elongated bodies that are black, brown, or red with yellow markings. Their nests are also made of a paper-like material that forms a circular comb of cells which opens downward. The nests are often located under eaves, behind shutters, in shrubs or woodpiles.

  Hornets are black or brown with white, orange or yellow markings and are usually larger than yellow jackets. Their nests are gray or brown, football-shaped, and made of a paper-like material similar to that of a yellow jackets nest. Hornet nests are usually found high above ground on branches of trees, in shrubbery, on gables or in tree hollows.

  Fire ants are reddish brown to black stinging insects related to bees and wasps. They build nests of dirt in the ground that may be quite tall (18 inches) in the right kinds of soil. Fire ants may attack with little warning: after firmly grasping the victim's skin with its jaws, the fire ant arches its back as it inserts its rear stinger into the skin. It then pivots at the head and may inflict multiple stings in a circular pattern. Fire ant venom often causes an immediate burning sensation.

Stay away from the nests of stinging insects. These insects are most likely to sting if their homes are disturbed, so it is important to have hives and nests around your home destroyed by a professional. Since this activity can be dangerous, a trained exterminator should be hired.

If you encounter any flying stinging insects, remain calm and quiet, and move slowly away from them. Many stinging insects are foraging for food, so don't look or smell like a flower (e.g. avoid brightly colored clothing and perfume when outdoors). Because the smell of food attracts insects, particularly yellow jackets, be careful when cooking, eating, or drinking sweet drinks like soda or juice outdoors. Keep food covered until eaten. Wear closed-toe shoes outdoors and avoid going barefoot. Also, avoid loose-fitting garments that can trap insects between material and skin.

If you are stung by a honeybee that has left its stinger (and attached venom sac) in your skin, remove the stinger within 30 seconds to avoid receiving more venom. A quick scrape of a fingernail removes the stinger and sac. Avoid squeezing the sac because this forces more venom through the stinger and into the skin. Hornets, wasps, and yellow jackets do not usually leave their stingers. Try to remain calm, and brush these insects from the skin promptly with deliberate movements to prevent additional stings. Then, quietly and immediately leave the area.

If you are stung by fire ants, carefully brush them off to prevent repeated stings, and leave the area. Fire ant stings usually result in the development of a blister about 24 hours after the sting. The material in this will become cloudy and appear to be infected, but it is not. Fire ant venom kills bacteria. This is just dead tissue and should be left alone. It will dry and heal within the next seven to 10 days. If the blister is open it must be monitored for secondary bacterial infection. Diabetics and others with circulatory disorders, including varicose veins and phlebitis, can be particularly at risk for complications, and should see a physician to monitor their condition after being stung. Up to 50% of patients develop large local reactions at the site of fire ant stings. Swelling may last for several days and may be accompanied by itching, redness and pain.

Taking the following steps can help in treating local reactions to insect stings:

  Elevate the affected arm or leg and apply ice or a cold compress to reduce swelling and pain.

  Gently clean blisters with soap and water to prevent secondary infections; do not break blisters.

  Use topical steroid ointments or oral antihistamines to relieve itching.

  See your doctor if swelling progresses or if the sting site seems infected.

If you are severely insect-allergic and have had prior reactions, carry one or, preferably, two auto-injectable epinephrine (adrenalin) devices, a short-term treatment for severe allergic reactions. Learn how to self-administer the epinephrine according to your allergist/immunologist's instructions and replace the device before the labeled expiration date.

Remember that injectable epinephrine is rescue medication only. If you are allergic and are stung you must still have someone take you to an emergency room immediately. Additional medical treatment may be necessary. Those with severe allergies should consider wearing a special bracelet or necklace that identifies the allergy and supplies other important medical information in case of an emergency.

People who have systemic allergies to insect venom should always consider receiving insect venom immunotherapy, a highly effective vaccination program that actually prevents future allergic sting reactions in 97% of treated patients. During immunotherapy, our office administers gradually stronger doses of natural venom extract initially every week for about 10 weeks. As maintenance doses are reached the interval between injections is expanded to one month or more. The treatment program generally lasts for five years at which time most people can stop immunizations and still maintain permanent immunity from life-threatening allergic reactions to bee stings. Patients who receive appropriate treatment, such as immunotherapy, and who practice careful avoidance measures can participate in regular outdoor activities and lead a normal life.

Drug & Chemical

Any allergy to a drug or chemical, whether encountered as a food or medication or exposed topically in a cream or ointment, is treated with avoidance. Your allergist/immunologist will help you identify the drug or chemical you are allergic to, understand where that drug or chemical is found and what other drugs or chemicals might be cross-reactive. Identifying a drug or chemical allergy is very difficult because the testing materials available are very limited. An accurate and carefully obtained history is of utmost importance in identifying a drug or chemical allergy. There are no blood tests for drug or chemical allergies. However, there is a skin test available called patch testing that can be used to help identify some chemical or drug allergies. In patch testing, the chemical in question is simply applied to the skin in vaseline with a bandaid-like tape and left for 48 hours before reading.

Dust Mite

House dust allergy is caused by house dust mites and their allergens. Dermatophagoides farinae and dermatophagoides pteronyssinus are the two know species. House dust mites thrive in humidity above 50% and are frequently found in pillows, mattresses, and upholstered furniture. The highest concentration of house dust mite is found in the bedroom. Given that an average person spends a third or more of his life in the bedroom, dust mite avoidance can be difficult.

It is virtually impossible to avoid house dust mites completely. However, there are measures you can take to limit your exposure:

  Encase pillows and mattresses in allergen-impermeable covers. These covers come in four varieties; plastic, polyurethane-coated, tight-woven, and non-woven fabrics. The tight woven type of cover is generally the most effective and comfortable.

  Wash sheets and blankets weekly in hot water (greater than 130 degrees F).

  Remove carpets. If carpets can't be removed, keep them clean by vacuuming weekly with a high-efficiency particulate air (HEPA) vacuum, or use a high-efficiency vacuum bag. Treating them with a powder or spray that helps control dust mites or their allergens is generally not recommended due to poor effectiveness and possible toxicity from the chemicals used.

  Avoid lying or sleeping on upholstered furniture.

  Minimize the number of stuffed toys in the home. If stuffed toys are present in the household, wash them weekly (if machine-washable) at over 130 degrees F, or freeze them in a sealed plastic bag for 24 hours. Both methods will kill dust mites.

  Control humidity levels and dampness by using air conditioners and dehumidifiers. Ideally, keep the humidity level below 50%. You can buy a very inexpensive hygrometer at the hardware store that measures humidity. If your humidity is frequently above 50%, that means you have some water leakage problems or you need to air out your home more regularly. Outdoor humidity is rarely that high unless it is raining or foggy.

  When cleaning and vacuuming, wear a mask so that allergens stirred up do not further aggravate symptoms. If possible, severe allergy sufferers should let others do the vacuuming.

Food

Food allergens, those parts of foods that cause allergic reactions, are usually proteins. Most of these allergens can still cause reactions even after they are cooked or have undergone digestion in the intestines. Numerous food proteins have been studied to establish allergen content.

The most common food allergens, responsible for up to 90% of all allergic reactions, are the proteins in cow's milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts.

All foods come from either a plant or an animal source, and foods are grouped into families according to their origin. For example, peanuts, black-eyed peas, kidney and lima beans, and soybeans are some of the members of the legume family, whereas asparagus, chives, garlic and onion are, surprisingly, members of the lily family.

In some food groups, especially tree nuts and seafood, an allergy to one member of a food family may result in the person being allergic to all members of the same group. This is known as cross-reactivity. However, some people may be allergic to both peanuts and walnuts, which are from different food families; these allergies are called coincidental allergies, because they are not related. Within animal food groups, cross-reactivity is not as common. For example, people allergic to cow's milk can usually eat beef, and patients allergic to eggs can usually eat chicken. With shellfish, crustaceans (shrimp, crab and lobster) are most likely to cause an allergic reaction. Molluscan shellfish (clam, oysters, abalone, etc.) can be allergenic, but reactions to these shellfish are less common.

Sometimes food intolerance is confused with food allergy. Food intolerance reactions are usually caused by factors in the diet other than the proteins that make up food allergens. One of the most common is lactose intolerance. Other food intolerance reactions may be triggered by drug-like chemicals in some foods. Symptoms can include nervousness after consuming caffeine in coffee or soft drinks, headaches triggered by chemicals in cheese and chocolate, or various adverse reactions to chemicals and preservatives added to food, called food additives. These additives may cause adverse reactions in sensitive people. The most common food additives that may cause reactions include benzoates, BHA and BHT, FD&C dyes Yellow No. 5 and Red No. 3, monosodium glutamate (MSG), nitrates/nitrites, parabens and sulfites. However, true allergic reactions to food additives are very rare.

True food allergic reactions can take on several forms. In some cases, the reaction is limited to eczema flares. In others, severe stomach cramps and diarrhea can occur or more generalized reactions, such as hives and even anaphylaxis, are a result. If there is any anaphylaxis risk, injectable epinephrine should be carried with you and you should wear a medical identification bracelet at all times.

Take the following steps to avoid a food allergy reaction:

  Avoid the food. The best way to treat food allergy is to avoid the specific foods that trigger the allergy. Look for recipes that specifically exclude the food you are allergic to.

  Ask about ingredients. To avoid eating a hidden food allergen away from home, food-allergic individuals must always inquire about ingredients when eating at restaurants or outside the home.

  Read food labels. It is important for food-allergic people to read food labels carefully and to become familiar with technical or scientific names for foods. For example, milk may not be listed as an ingredient on a label; rather, the label may list casein (a milk protein), sodium caseinate or milk solids. Not every food that contains wheat identifies it as such; sometimes wheat is listed as gluten. Similarly, egg white is frequently listed as albumin. Government agencies have been working toward improving food ingredient labeling so food-allergic consumers can more easily determine which foods they may need to avoid.

  Be prepared for emergencies. Anaphylactic reactions caused by food allergies can be potentially life-threatening. Those who have experienced an anaphylactic reaction to a food must strictly avoid that food. They may need to carry and know how to use injectable epinephrine and antihistamines to treat reactions due to accidental ingestion. People who are commonly around the patient, such as spouses, co-workers, schoolteachers or daycare workers, should also know to use the injectable epinephrine. Those with food allergies should also wear an identification bracelet that describes the allergy. If you have an anaphylactic reaction after eating a food, it is essential that you have someone take you to the emergency room, even if symptoms subside. For proper diagnosis and treatment, make sure to get follow-up care from an allergist/immunologist.

If you have food allergies, you may also contact the Food Allergy and Anaphylaxis Network (FAAN) for support: (800) 929-4040 or www.foodallergy.org.

Eating Out With A Food Allergy

Food allergy sufferers know more than anyone that one wrong bite can turn a pleasant meal into an emergency room visit or a fatal outcome in some cases. Food allergic reactions vary from unpleasant gastrointestinal distress to life threatening anaphylaxis. Wheat, soy, milk, eggs, and peanuts are the most common food allergens in children. In adults, the list is expanded to include fish, shellfish and tree nuts. Some people have more diverse allergens that can be easily hidden in foods such as different kinds of seeds and spices.

The Food and Drug Administration advises that restaurant operators be aware of the major food allergens. However, there are no Federally mandated allergy safety guidelines for restaurants to follow. Avoiding problem foods and cross-contamination, such as French fries cooked in the same oil as shrimp or meat prepared on a surface where some nuts were recently chopped, requires effective communication between customers, servers and the kitchen staff. Some states such as Massachusetts, Michigan, Montana, New York, and North Caroline are trying to pass legislation related to food allergies and restaurants but, as most of you know, our country is encumbered with threats of lawsuits which can paralyze the legislative process.

There is no guarantee that a meal eaten at a restaurant will be allergen free for any given individual. However, the food allergy sufferer can increase the chances of having a pleasant meal out by following these important steps.

1. Let your server know about your food allergy. If you feel there is a particularly high risk (fish allergy and you are eating in a fish restaurant or a soy allergy in a Chinese restaurant-not exactly a good idea), also let the manager know. Be prepared to be pushy. If your allergy is truly life threatening, as we often see with fish, shellfish, peanut and tree nut allergy, make sure the server knows that your death can be the consequence of their failure. This may sound harsh and, for some, an exaggeration. Nevertheless, it does get their attention.
2. Ask about the kitchen’s procedures for avoiding cross-contamination. This also acts as a reminder to keep your food away from potentially hazardous ingredients. Some restaurants will use other kitchen tools or cook on foil to prevent cross-contamination which we feel is a good idea.
3. Make sure the server checks with the chef and reports back to you that the food you ordered is free of your allergen before they start cooking. Sometimes servers are not as well informed about ingredients as the food allergy sufferer would like. Furthermore, menus change frequently and ingredient lists are often too voluminous for the server to maintain such expertise under all circumstances. The more the people involved in your food chain (server, manager, chef) are informed about your allergy, the safer your meal will be. Some chef’s do not speak english so make sure there is nothing lost in the translation if that is your suspicion.
4. Know the hidden sources of your food allergen! Refer to the Food Allergy Network for details. For example, milk and wheat can be hidden in sauces and marinades and can be missed by the chef. Some restaurants use some processed foods. The labels from these foods must be individually checked by the chef or the manager to ensure your safety. Don’t be afraid to ask to see the label if you are worried.

Latex

Latex is a milky fluid produced by rubber trees (hevea brasiliensis). Using different methods, latex can be processed into a variety of products, such as gloves and balloons. During manufacturing, chemicals are added to increase the speed of curing (vulcanization) and to protect the rubber from oxygen in the air.

Products made from blends of natural rubber latex and other compounds are very common. In those with latex allergy, allergic reactions are most often triggered by dipped latex products. Products that commonly cause reactions can include gloves, balloons and condoms.

In rare instances, people who are allergic to latex may also react to rubber bands, erasers, rubber parts of toys, various rubber components in medical devices, rubber elastic in clothes, or feeding nipples and pacifiers. Products molded from hard, crepe rubber, such as soles of shoes, are unlikely to cause reactions. Nearly all latex paints are problem-free since they do not contain natural rubber latex.

Most people become allergic to latex due to high exposure such as in the work environment (e.g. nurses, doctors, dentists dental hygienists) or from undergoing long or repeated surgeries. The 1990 Americans with Disabilities Act (ADA) covers people with severe allergies to substances such as latex. If you are otherwise qualified but can no longer work with latex in a job setting because of your allergy, work with your employer to determine other options and make reasonable accommodations. If you are allergic and need to wear gloves, or are in contact with persons wearing gloves, there are several options: (1) Try substituting synthetic (vinyl or nitrile) gloves for latex gloves, although they may not work as well in some situations. These work in nearly all situations in which latex gloves are used, including surgery, but in some cases they are more expensive. (2) Try latex gloves made without additional chemicals.

If you have significant latex allergy respiratory symptoms from inhaling latex particles, you need to avoid areas where powdered gloves are used frequently. Ideally, all high glove use areas should use powder-free gloves to avoid allergic reactions. This usually solves the airborne latex allergen problem.

Using latex condoms can be a severe problem for some latex-allergic people. One option is natural skin condoms. These do not contain latex and can prevent pregnancy, but they do not protect against viruses like HIV, which cause AIDS, or some other sexually transmitted diseases (STDs). Synthetic rubber condoms, created to prevent both pregnancy and STDs, are now available.

Manufacturers are currently working to produce latex products that contain less latex allergen. As these products become more available, the risk of reactions in people sensitive to latex, as well as the risk of more people developing latex allergy, should decrease.

Mold

There are many different types of mold that grow almost anywhere. They can be found wherever there is moisture, oxygen, and a source of nutrients suitable to their particular needs. Outside, they grow on rotting logs and fallen leaves, especially in moist, shady areas. In gardens, they can be found in compost piles and on certain grasses and weeds. Often allergy symptoms during lawn mowing are due to mold under the grass rather than the grass itself. The thatch of a lawn is particularly rich in mold. Some molds attack grains such as wheat and rice so that barns, grain bins and silos are likely places to find molds. Hot spots of mold growth in the home include damp basements and closets, bathrooms (especially around showers, windows and the underside of the toilet). Other problem areas are places where food is stored such as refrigerators or a fruit bowl. Refrigerator drip pans, humidifiers, and air conditioners, especially swamp coolers, are notorious sites of mold contamination. Garbage pails, old mattresses and pillows, upholstered furniture and wicker furniture are also favorite mold homes. Avoidance of molds in the Sacramento Valley is virtually impossible, but some measures can be taken to reduce exposure to below an individual's threshold of sensitivity. For some sufferers any mold is too much mold. For these individuals, moving to a low mold climate such as the desert may be the only avoidance alternative.

  The allergy sufferer should avoid the hot spots mentioned earlier where molds tend to concentrate. When avoidance is impossible, a tightly fitted disposable mask or a mask equipped with a HEPA filter should be used. Your allergist/immunologist can provide you with some guidelines for purchasing this equipment. Travel in the country on dry windy days or during harvest should be avoided. A summer cabin closed up all winter is probably full of molds and should be aired out and cleaned before a mold-sensitive person stays there.

  Around the home, a dehumidifier will help dry out damp areas, such as a basement, but water must be removed frequently to avoid mold contamination. Humidity below 60% inhibits mold growth but humidity below 50% can make breathing uncomfortable due to over-drying. A hygrometer can be purchased for under $20 to help you monitor this situation. A HEPA filter can be purchased for small rooms that are difficult to keep dry. Central air conditioning and heating filters should be cleaned regularly and a HEPA filter inserted into the air intake to maximize efficiency. A room HEPA filter may be purchased individually for areas lived in most, such as bedrooms, if desired.

  Mold is often found in homes that have had indoor water leaks or flood problems, such as roof leaks, foundation cracks, water heater and plumbing leaks. To remove mold from walls, use the following common household bleach mixture to scrub away mold:

1. Dilute a non-abrasive household cleaner with bleach and water.

2. Mix in a glass or plastic container, NOT in metal.

3. Using rubber gloves scrub the walls and tiles and remove all visible mold growth. Let dry 1-2 hours, and then scrub again.

4. Rinse with water.

5. Washing the area first with a non-abrasive cleaner such as Bon-Ami is helpful for heavily infested areas in bathrooms and basements.

  Repaint the wall. In bathrooms, use marine paint and avoid wallpaper and carpeting. If mold is found on the concrete slab, scrub as previously instructed before replacing carpeting. Avoid do-it-yourself carpet cleaning using water soaking steam-cleaning processes.

  Healthy, indoor plants may not contribute significantly to the mold problem, but wicker baskets used with the plants can harbor molds. Mold in the plant soil is released only if the soil is disturbed during watering or transplanting. However, terrariums and large planters, especially if used in the bathroom, can be constant mold sources.

  Heat can help rid closets of mold by leaving the light on for a day to a week. Moth preventatives do not inhibit mold growth.

  Use a Dacron-polyester pillow, rather than foam or feather filled. Putting the pillow in the dryer twice a week can control mold that may form in the pillow because of perspiration.

  Do not store firewood inside the house or in the basement or garage.

Mold growing around the house can contribute significantly to the indoor mold levels. Recommendations for reducing outdoor mold sources are:

  Prune and trim large shrubs and trees to allow sunlight into the home and surround areas.

  Maintain your landscaping. Remove dead leaves and other organic debris. Avoid compost, hay, and heavy ground cover such as ivy.

  Avoid using redwood and fir bark chips. Instead use non-organic material such as lava rock or stone.

  Remove standing water and correct areas of poor drainage.

  If your plants appear diseased, consult with a plant expert. Often diseases are caused by molds.

Pollen

For pollen to be allergenic, it must be airborne and enter the respiratory tract. It is important to remember that flowering plants have flowers to attract insects to do the pollination. For this to occur efficiently, pollen from flowering plants must be very sticky and heavy so that it moves with the insect. Rarely does such pollen become airborne. Therefore, contrary to many comments we hear, flowering plants are not very allergenic, if at all. It is the non-flowering aeroallergenic plants such as grass, oak trees, walnut trees, olive trees, etc. that are the most allergenic and create havoc in the Sacramento Valley. Virtually millions of pollen is released annually from these and other non-flowering plants each spring, summer and fall. Even in the winter, some pollen from conifer trees and, in January, from alder trees, can be found. Because the northern Sacramento Valley rarely, if ever, freezes we experience some pollen 12 months of the year although the peak is in the spring from March to early June. These airborne pollens can travel as much as 10 miles on a windy day making avoidance very difficult.

The following general recommendations can be made to try and minimize pollen exposure:

  Stay indoors with your windows closed during the time of year you experience your allergies. If available, keep your air conditioning on, especially during the midday and afternoon when pollen levels are high.

  If you must be outside, do your outdoor activities shortly after sunrise when pollen levels are lower.

  Machine-dry clothes or hand-dry indoors. Hanging clothes outside to dry allows pollen to collect on them.

  Wash and dry your hair to help remove pollen before lying down to sleep to keep pollen out of your bedroom.

  Use a HEPA filter in your bedroom next to the head of the bed. At night, run the HEPA filter on the silent fan so that a gentle breeze of clean air moves over your head throughout the night. If you air out your bedroom in the morning, close it up and run the filter on high for several hours to clear the air before you spend more time in the room.

The northern Sacramento Valley is one of the most allergenic areas in the United States. We can claim this because we are agriculturally based, have an abundance of water, and have a very temperate climate with a long growing season and little to no freezing. In addition, we grow commercially two very allergenic plants, walnuts and olives, which can cause extreme allergic reaction. In addition, our most abundant indigenous tree is the highly allergenic oak. Plush, green, warm areas with lots of lakes, rivers, and streams are great to live in but are also great allergenic plant producers. In reality, it is impossible to avoid pollen exposure without moving to a lower allergenic climate such as the high mountains, desert or ocean. For the majority of pollen allergy sufferers who cannot move, all that is available for relief is medications during the allergy season and immunotherapy, which can generally cure the majority of your allergy symptoms naturally, but requires time.

Alternative Medicine

There are many nontraditional and scientifically unproven allergy tests that claim to diagnose your hidden allergies and relieve your sneezing, congestion, headaches, tiredness and wheezing. Collectively, these practices fall into the category of complementary and alternative medicine (CAM).

On the surface, some CAM approaches for allergies may sound logical, but all are based on unproven theories. To add to the confusion, some of these approaches are promoted by medical professionals. Most of these promoters are not board certified allergist/immunologists and often not even medical physicians. Although CAM therapies may help treat some conditions such as arthritis pain, no such evidence exists for alternative tests and treatments that help allergies. If you're considering a CAM approach for your allergies, you may end up spending your time and money on ineffective and unsafe methods, and delaying conventional treatment that may offer genuine relief. Furthermore, some have been shown to be dangerous.

CAM practitioners base their allergy tests and treatments on controversial theories about what causes allergies without any scientific foundation. They claim that many substances, including those widely accepted as causing allergy, play a role. Examples of such substances include:

  Microorganisms such as yeast (candida albicans)

  Electromagnetic radiation from power lines and electronic devices

  Food additives such as dyes and preservatives

  Chemicals in products such as cleaning solvents, paints and perfumes

  Multiple foods, especially milk, chocolate, corn and wheat

  Molds

  Your hormones, especially progesterone

CAM practitioners typically cite anecdotal case reports and clinical experience as evidence, but they haven't proven that these substances cause an allergic reaction with any scientific information. A person may develop symptoms after exposure to a substance without necessarily being allergic to it. Nevertheless, CAM proponents suggest that "allergies" to many different substances cause a variety of diseases. None of these is a recognized allergic condition:

  Environmental illness (multiple food and chemical sensitivities): Foods, food additives and environmental chemicals, especially chemicals found in cleaning solvents, paints, smoke, gasoline, perfume, and office-machine fumes, are said to cause fatigue, headache, nausea, dizziness and disorientation.

  Candida hypersensitivity syndrome (yeast hypersensitivity): Candida albicans, a fungus that lives inside all humans, usually causes no problems other than yeast infections. But CAM proponents claim that it's responsible for allergies, arthritis, cancer and AIDS.

  Attention-deficit/hyperactivity disorder (ADHD): Although ADHD is a recognized medical condition, CAM practitioners falsely claim that sensitivity to food dyes, preservatives and other additives causes its characteristic erratic behavior and inability to concentrate. Actual causes aren't known, though family history and altered brain function may play a role. Conventional doctors usually treat ADHD as a brain disorder.

  Allergic toxemia (tension fatigue syndrome): A cluster of common symptoms such as fatigue, headache, abdominal pain, paleness and respiratory problems are supposedly caused by allergies to multiple substances, especially foods.

Complementary and alternative practitioners claim their tests reveal allergies that conventional allergy tests miss. These unconventional tests may include:

  Antigen leukocyte cellular antibody test (ALCAT): The practitioner draws samples of your blood and exposes them to 150 to 200 different extracts of foods, drugs, chemicals, pollen, mold and animal dander. A computer analyzes changes in leukocytes, a type of blood cell. If your blood cells flatten, fragment or disintegrate in response to an extract, it's considered evidence of allergy.

  Applied kinesiology testing: In one hand, you hold a vial containing a suspected allergen while the practitioner bends your opposite arm to measure muscle strength. A decrease in strength is considered a sign of allergy.

  Cytotoxic testing: This test is similar to ALCAT. The practitioner draws samples of your blood and exposes them to different extracts. The difference is that a technician looks through a microscope for evidence of cellular changes that indicate allergy.

  Electrodermal testing: In one hand, you hold a negative electrode attached by a wire to an aluminum plate. The practitioner adds vials of food extracts to the plate. He or she then completes the circuit by probing various points on your body with a positive electrode. Fluctuations in the low-voltage electrical current supposedly indicate an allergy to a particular food.

  Skin endpoint titration testing: You receive multiple injections, sometimes up to nine, of increasingly high concentrations of suspected allergens under your skin. If a wheal or welt appears, it's considered evidence of an allergy.

These tests may seem sophisticated, and may superficially resemble the standardized skin and blood tests your allergy specialist uses. However, in truth, there are no controlled clinical trials that show they can convincingly diagnose any allergic conditions. Furthermore, positive tests to many of these approaches can be found in perfectly healthy normal people who do not have any allergies.

No matter how elaborate a CAM theory may be, it likely won't lead to treatments that relieve your allergies. No convincing evidence suggests that CAM treatments are safe and effective for allergic disorders. In fact, some may harm you or make your allergies worse. For example:

  Antifungal treatments: If you're diagnosed with candida hypersensitivity syndrome, the practitioner may suggest you follow a restrictive diet that excludes foods containing yeast, such as bread. You may also be asked to eliminate sugar on the grounds that it encourages the growth of yeast. Some treatments require you to take unnecessary antifungal drugs, a practice that conventional doctors condemn because it can cause such serious side effects as liver damage.

  Elimination diets: If a CAM test indicates that you have multiple food allergies, CAM practitioners may recommend eliminating many types of food. Since this can lead to poor nutrition, they may also recommend a diet that allows a single serving of a suspect food only once every four or five days (a rotary diversified diet).

  Endpoint titration immunotherapy: This treatment is based on skin endpoint titration testing. The CAM practitioner injects extracts of suspected allergens under your skin with the goal of eventually desensitizing you to them. Although this treatment is sometimes called optimal-dose immunotherapy, the treatment dose has been proven to be far too low to be effective.

  Enzyme potentiated desensitization: A very low dose of an allergen such as pollen is mixed with a protein molecule (enzyme) and injected under your skin. The enzyme theoretically prevents your immune system from overreacting to the allergen. A single injection is supposedly effective for an entire allergy season.

  Extreme environmental avoidance: Although avoidance of known allergens, such as cat dander, is an accepted method of conventional allergy control, CAM practitioners take avoidance to extremes. They claim that allergens are numerous and widespread. So, for example, they may advise you to completely remodel your home to make it safe from chemical contaminants, move to an isolated community with low pollution levels or wear a mask in public. Although some environmental restrictions make sense for allergic people, such extreme measures will not be a cost effective approach since true avoidance of many allergens is often impossible.

  Herbs and dietary supplements: CAM practitioners claim that certain herbs and dietary supplements mimic the effect of conventional allergy treatments. Examples include bitter orange, country mallow, echinacea, ephedra, grape seed extract, pycnogenol, quercitin, spirulina, stinging nettle, thymus extract and vitamin C. No evidence shows that these herbs and supplements work as well as prescription drugs or immunotherapy. Some may be dangerous, particularly when consumed in excess. For example, the Food and Drug Administration banned ephedra in 2003 because it increases the risk of heart attack, seizure, stroke and sudden death. And since Echinacea is a member of the ragweed family, it might actually worsen your allergies. Finally, the herbal supplement industry is not monitored closely like the drug industry. Studies have shown, for example, that Echinacea supplements from different companies may contain no Echinacea at all while others are contaminated by a wide range of plants and other substances.

  Homeopathy: Homeopathic remedies are over-the-counter tablets containing extremely diluted plant and animal extracts. The extracts are chosen because they supposedly cause the same symptoms they're meant to relieve. Since onions make eyes water, for example, onion extracts are used in hay fever remedies. These approaches also have no experimental evidence to support their use.

  Neutralization therapy: Based on provocation-neutralization testing, neutralization therapy aims to relieve allergy symptoms with injections or under-the-tongue drops of neutralizing substances. Such substances include extracts of known allergens, chemicals and foods. Again, there is a total lack of data to support this approach and their practitioners rely on testimonials for support.

It's possible that some CAM allergy approaches may someday be proven safe and effective. But until then, the scientific evidence overwhelmingly favors conventional allergy tests and treatments. If a conventional treatment doesn't relieve your symptoms, keep working with your doctor until you find a treatment that does.