Asthma – what you should know!
Powlin Manuel MD, MBA, MS Call Us: (337) 984-0110
Do you feel short of breath with sports, exercise, cough, weather change and even laughter?
You may have asthma. For most of us when we think of asthma, the picture of a person having wheezing and difficulty in breathing comes up. However, all asthmatics do not wheeze; asthma often presents itself with a cough more often than wheezing. Asthma can vary from just exercise-induced spasms to difficult to treat chronic asthma.
For the sake of clarity for treating physicians as well as patients, asthma is classified into:
Mild persistent asthma, and
Severe persistent asthma.
This classification helps the physicians understand the urgency to institute an effective treatment program.
The following pointers will help to decide the severity of asthma:
Intermittent Asthma: In intermittent asthma, the symptoms occur for a duration of fewer than two times per week; patients wake up with symptoms less than two times per month; patients use asthma relief medications less than two times per week If any of these numbers exceeded, then your asthma is not intermittent, and you are suffering from persistent asthma.
Persistent Asthma: Persistent asthma is classified into mild persistent asthma and severe persistent asthma based upon the results from the lung function tests. Pulmonary function test may be normal in intermittent asthma while it decreases in persistent asthma. The nature of severity of asthma can vary depends upon certain factors: allergic asthma versus nonallergic, childhood versus adult-onset, etc. Most children suffer from allergic asthma and are tremendously helped by allergen avoidance. The majority of adult asthmatics do not suffer from demonstrable allergies, rather there are other factors that contribute to inflammation and narrowing of airway tubes.
What you should do to take control of asthma? Taking Control of Asthma
Taking measures to control asthma starts with the understanding of what is different about the airway in patients with asthma. The discomfort experienced by a person with asthma preceding or during an attack of asthma is related to the dynamic changes taking place in the airway. The diameter of the airway tubes is not constant; rather it can change. The airway tube diameter is influenced by the elastic components of the soft tubes, the thickness of the lining of the airway, and the state of tension of the muscles of the airway. Any change in any of these control mechanisms leads to symptoms associated with asthma.
The size (diameter) of airway tubes and symptoms of asthma:
Airway changes in asthma
- Tightness of chest as a symptom of asthma: the tightness of chest occurs when the external environment forces the airway to contract (shrink). This is due to an attempt by nerves of the airway to decrease the number of particles entering the airway. Chemical particles from tobacco smoke, cleansing agents such as ammonia, and allergenic particles such as dusts, molds, and pollen induce such a defense mechanism to act and impart a feeling of tightness of chest.
- Cough and asthma: one of the most common symptoms of asthma is a cough; sometimes cough is a sign of airway irritability – indicating that some potentially harmful particle has entered the airway, and our nervous system is inducing cough to get rid of the particle.
- Wheezing and asthma: while tightness of chest and cough spells indicate an impending asthma attack, wheezing occurs when airway size is reduced, and the air trapping occurs in the lungs. Wheezing indicates that the dynamic forces maintaining the airway diameter have changed in favor of the forces closing the airway, thus less than the necessary quantity of oxygen is reaching the airway.
Tobacco smoke and asthma
Many individuals with asthma feel tight in the chest, start coughing, and start wheezing when they are exposed to an environment with tobacco smoke. The reason is very clear, as tobacco smoke carries many particles that are harmful, the immune system acts by triggering the closing mechanisms of the airway diameter control. While active smoking is detrimental to a healthy airway, passive smoking also contributes the unfavorable environment for anyone with reactive airway disease. Airway goes into spasm leading to the feeling of tightness in the chest; cough becomes a mechanism to get rid of the offending particles, and the state of wheezing suggest a failure of defensive mechanisms, hence distress to patients with asthma.
Dust Allergy and Asthma
Dust mite allergy
If you are allergic to dust the following symptoms are noticed on exposure to dust:
- Blocked nose
- Stuffy nose
- Runny nose
For many individuals, suffering from asthma dust often triggers an attack of asthma. This could be due to dusts acting as a trigger from irritation of the nerve endings lining the airway tubes, as well as nostrils or an allergic reaction to different components of dust. Most of the dust particles are filtered and kept in the nose and sinuses and are thus prevented from entering the lower airway.
Once trapped in the nose, sneezing is triggered resulting in forceful expulsion of dust particles. Sudden production of mucus is one way to wash away the dust particles trapped in the nasal passage. Further entry of dust particles is reduced by blockage of the nose due to swelling of the mucosal lining. Entry of dust particles in the upper airway and sinuses may induce a contraction of the lower airway leading to tightness of chest in those with asthma.
How to control symptoms due to dust allergy?
- Avoid carpet floors if possible.
- Avoid rugs.
- Reduce unnecessary cushions on furniture.
- Reduce the number of stuffed toys in your child’s room.
- Avoid Venetian blinds
- Keep bookshelves clean and free of dust.
There are many measures you need to take in order to achieve a good control of asthma. Remember that asthma symptoms occur when the external environment forces the airway to contract (shrink). This is because the airway diameter can, at any time, based upon the exposure to offending agents, can change – this is in a way eliciting the protective mechanism to reduce the entry of offending agents into the airway.
Based on these facts the following measures will help you to prevent an asthma attack:
1. Avoid exposure to tobacco smoke.
2. Avoid exposure to chemical and perfume sprays.
3. Avoid contact with pets you are allergic to.
4. Do not use humidifiers – as they increase the chance of mold and mite growth.
5. Install ventilators in the kitchen for exhaust.
6. Minimize the use of rugs if you are allergic to dust.
7. Take influenza vaccine every year as any viral infection lead to increased airway sensitivity.
8. Decrease exposure to dust mites using pillow and bed-covers that do not permit mites to cross.
9. Decrease exposure to mites by periodic washing of toys with hot water.
10. Decrease humidity in rooms using a dehumidifier.
11. Wash bed-sheets every week with hot water.
12. Avoid Venetian blinds in rooms
13. Reduce the number of cushions in rooms
14. Avoid lampshades that can collect dust.
15. Reduce the number of bookshelves.
16. Avoid stuffed toys.
Cockroach allergy and asthma
This is the American Cockroach (Periplaneta Americana) on a pink flower.
Cockroach allergy is a very common in the USA. There are two types of cockroaches causing allergic reactions in the airway: American cockroach and German cockroach.
What to do when you have an asthma attack?
Many physicians provide patients with an asthma action plan to properly respond to an asthma attack; follow them carefully. If exercise is known to induce an asthma attack use the inhalers such as albuterol prior to engaging in a strenuous exercise. A rescue inhaler needs to be kept at school. Parental permission and prescription by your physician either to self administer, or to be provided by a school nurse should be made available to the school.
For infants with asthma use your nebulizer with the prescribed dose of medications Watch for the following signs of trouble with asthma attacks and call your physician.
- Blue color
- Struggling to breathe
Go to the emergency room if you notice any sign of trouble
For children over six years the same instructions will apply. You may use an inhaler instead of nebulizers. Nebulizers can be repeated every hour for additional two more times to attain a relief.
Treatment of asthma
Treatment of asthma is generally classified as preventive treatment, maintenance treatment and treatment of acute attacks.
Preventive treatment of asthma
Low dose steroids
Long acting bronchodilators
Treatment of exacerbation
If exacerbation occurs on preventive and maintenance treatment, then we use step up therapy with increasing the dose and adding additional fast acting bronchodilators.
Allergy shots are prescribed for treatment of patients with an allergy to inhalant allergens.
Allergy shots are given to make you tolerate the allergens. Allergens are diagnosed based on the allergy tests done at the office or through a blood test for IgE antibodies in serum. Presence of these antibodies on your lining of the nose, sinuses, airway, and the intestines causes production chemical reactants such as histamine on these areas. Histamine release causes the symptoms of allergy to occur.
These symptoms can interfere with your quality of life in different ways. Allergy shots are administered to make your immune system react less intensely by developing tolerance to the inhalant allergens. The exact mechanism of how allergy shots make you develop tolerance is not clear.
Allergy shots are different individualized to every patient based on the information from the allergy tests. You are given the same allergens that caused the reaction on the tests. Then allergy injections are initiated at a very small dose, enough to stimulate your immune system to develop resistance, but not enough to induce an allergic reaction. For example, if your test showed that you had a significant reaction to Oak Tree pollen at the dose of 100 allergy units, we begin the shots starting at one allergy unit.
Then you are given once a week injections at the doses of 2, 4, 6, 8, and to 10 units. Your exposure is slowly increased to 10, 20, 30, etc. to units to reach higher doses of allergy units to challenge your immune system to develop tolerance to increasing doses to reach the levels of natural exposure in the environment.
Allergy shots are given once per week at our office. It is administered daily between 8 AM and 4.30 PM.
The shots are continued on a weekly basis for about one year, and afterwards the interval is increased to every two weeks, then every four weeks. Every four-week-injection is continued for more than three years, depending on distinctive responses. We ask patients to see the allergist once every six months to make individual variation and adjustment on the doses administered. During these visits, the allergist looks for evidence of decreases in symptoms. The symptom-relief can last at least one year after the discontinuation of allergy shots.
Allergy to Drugs
Many patients develop reactions to medications. It is a very common problem. The reasons for the reactions vary and a proper understanding of these issues will be helpful.
Anaphylaxis is an acute allergic reaction. Reactions due to anaphylaxis could be life threatening. In anaphylaxis your immune system makes an antibody called IgE. On exposure to the mediation you are allergic to, your immune system cells release chemicals such as histamine and leukotrines. These chemicals cause flushing, itching, hives, swelling, wheezing and loss of blood pressure. These types of allergic reactions occur usually within one hour of taking the drug.
The reactions causing hives can be the result of the mechanism explained for anaphylaxis. Hives can appear many days after taking medication. The hives can at times last many days because of the reactions to the drugs which get bound to the body tissue.
Rashes are the most common expressions of allergy to drugs. The rashes typically start on the trunk and spread to the arms and legs, and are associated with itching. Usually the skin rashes start one to two weeks after the exposure. Sometimes there could be associated peeling of skin. At times the drugs such as ampicillin cause such rashes only in the presence of certain virus infections. In these instances, the patient may not be allergic to the drug in future.
Serious Skin Rashes
Skin rashes with bleb formation can be at times serious. These rashes are often associated with a pattern of inner and outer rings. If such a rash is associated with fever and involvement of eyes and mouth, it is called Steven- Johnson syndrome.
Joint Pains, Muscle Pains, Kidney Disorders, Anemia etc
The drug allergies at time can cause joint and muscle pains, nephritis, anemia and other blood disorders. This is due to the fact body produces antibodies of types IgG and IgM. These types of antibodies form complexes with the allergenic drugs and can result in the destruction of blood vessels on skin, causing blood spots (purpura). At times, the reactions are caused by the metabolic products of the drugs rather than the medications themselves. The reactions caused by ceclor, cefzil, epilepsy medications, and sulfa drugs may belong to this group.
Some patients develop fever while on antibiotics and become afebrile when taken off antibiotics. This apparently is due to fever-producing substances generated by the immune cells on exposure to the specific antibiotics.
As allergists, we come across many patients who are considered to be allergic to penicillin because of previous diagnosis established sometime in the past. Most often there is history of developing skin rash associated with use of penicillin in the past. Because of the label, these patients are treated with alternative antibiotics, which are very likely much potent than penicillin exposing to the risk of higher side effects.
The fact is that penicillin allergy is much less common than the reported incidences. We find only a fraction of patients who are labeled as penicillin-allergic, are really allergic. This is based on the negative tests, when we do the test for penicillin allergy. Macy, E. & Nagor, E.W. (2012) found in their research on this subject that only 0.8% of all cases of patients referred with the diagnosis of penicillin allergy had a positive allergy test. Visit www.jaci-inpractice.org/article/S2213-2198(13)00123-2/fulltext for details of this research and their findings.
The over-diagnosis of penicillin allergy and the reason for the patients being told that they are allergic come from the fact that the rash was probably due to the condition for which penicillin was prescribed. The rash was probably caused by a virus, and it had nothing to do with real allergy to penicillin. Allergists can perform an allergy test to rule out allergy to penicillin.
Penicillin allergy is claimed to be common; however only 15% of those with the history shows real sensitivity. Skin tests and blood tests are available for penicillin allergy tests.
Ampicillin and Amoxicillin Allergy
At times patients may develop rash after taking ampicillin or amoxicillin by still may not be allergic to penicillin. This could be due to associated viral infections. Most patients with penicillin allergy can not receive medications containing ampicillin or amoxicillin.
Only two percent of those allergic to penicillin are allergic to cephalosporin and hence should be able to tolerate them.
Sulfa Drug Allergy
There is no specific test for allergy to sulfonamide drugs. Immune reactions to sulfa are common. Because of the special type of structure of the drugs people with reaction to sulfa drugs can also react to medications used to treat arthritis, certain oral ant diabetic agents and diuretics.
Allergy to other Antibiotics
There is no accurate test available to test for allergy to antibiotics like Cipro. Reactions have been reported to these agents and they are thought to be non-immune in nature.
Allergy to Local Anesthetics
Allergy to local anesthetics are rare. Tests are available at the allergist’s office.
Allergy to Aspirin
The symptoms due to allergy to aspirin drugs used to treat arthritis are usually caused by blockage of certain enzymes with over production of chemical known as leukotrines. The symptoms can be as severe as any allergic reaction. Desensitization is possible and drugs may be tolerated in smaller doses.
Allergy to Codeine and Narcotics
These reactions are not due to specific allergy but due to the nature of these drugs. They have the capacity to stimulate the immune cells directly and release chemicals similar to the ones produced during an allergic reaction. The symptoms could be similar to any allergic symptoms. These are rarely dangerous and are often dose related. Patients can still use them in smaller doses.
Reactions to ACE Inhibitors
Reactions to medication of the class of ACE inhibitors used to treat high blood pressure are common. The most common is cough, but more serious reactions can occur. There is no test, available as there is no proof of allergic or immune components.
Allergic Reactions to Radioactive Dyes
These reactions are not rare. There is no evidence of specific allergy: rather they are caused by these agents activating blood cells to produce chemicals causing symptoms of allergy. These patients can be pretreated to prevent allergy reactions and still take the test.
Allergic Reactions to Additives and Preservatives
You can develop allergic reactions to additives and preservatives added to the medications even though you are not allergic to the drug. These include propylene glycol, parabens, thimersol, and gelatin
Atopic Dermatitus (Eczema)
Atopic dermatitis also known as eczema is a very common skin disorder in children. The incidence of atopic dermatitis has increased recently. I have personally experienced the bad impact and stress in the family, as my children and four of my grandchildren suffered from severe eczema.
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Atopic dermatitis is present in 13% of all children in the USA. Of this 50 % will continue to suffer from atopic dermatitis as adults, while 7% all adults suffer from this condition. There are 30 million people at present suffering from atopic dermatitis.
Atopic dermatitis (eczema) shows up differently in depending on the age of onset. In infancy in the first few months of life, dry patches on the cheeks are one common manifestation.
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Atopic eczema is due to many factors, including familial-genetic factors, allergies, deficiency of certain components of skin, and defective mechanisms to protect the skin.
The remedies are based on use of moisturizers, anti-itch lotions, anti-inflammatory lotions, barrier creams, probiotics, body washes, steroid creams, and antibiotic creams. The following is the list of remedies often prescribed to patients with atopic eczema.
The most important measure to keep eczema under control is the use of Moisturizers
A defect in skin-barrier function is the main factor leading to the development of changes in eczema. The key factor to keep in mind is to take all measures to increase the efficiency of skin barrier function; that is achieved by regular use of techniques of hydration of the skin. Keeping the skin hydrated highly essential to reduce flare-ups: the following are some we suggest at Manuel Medical Clinic
- Aquaphor Ointment
- Aveeno Eczema care Moisturizing Cream
- Cera-Ve Moisturizing Cream
- Cetaphil Daily Facial Moisturizer
- Jack Black face moisturizer
- Neosporin eczema essentials daily moisturizing cream
- Olay Quench
- Olay Shea butter Body Wash (liquid wash)
- Sarna anti-itch lotion
- Aveeno Anti-itch
- Biafine cream
- Triamcinolone cream
For bad cases
- Unnas Boot (gauze)
- Balnetar Cream
- Domeboro solution
Culturelle: Patients with eczema use many antibiotics
Taken once daily by mouth, probiotics may be helpful.
Olay Body Wash
Hydrocortisone cream 1%
Acid Mantle Cream
Bleach bath is helpful in those with recurrent skin rashes with infection:
Dilute bleach bath with a 1/8th cup of bleach added to full bathtub once a week helps to keep the bacterial load down and help control a flare-up of eczema.
Poison Ivy Allergy
Poison ivy is one of the most common cause of allergic skin reaction in USA. The skin reaction due to poison ivy allergy is known as poison ivy dermatitis. People with allergic to poison ivy can also experience a reaction also to poison oak, mango, cashew, and Ginko. The plant is identified by leaves being in groups of three or more leaves. It is important to be able to recognize the plant so that you can avoid exposure to them. The plant starts appearing in spring and continue to be there until late fall as wines climbing on trees. Is poison skin rash contagious? This a very common question asked especially from school teachers, to decide if the affected children need to stay home. Poison ivy rashes are not contagious.
The symptoms develop only on those who are allergic to Urushiol present in the plant. The reaction to poison ivy start reaction within 2-4 days of exposure. The dermatitis can vary from a mild rash to a localized area of contact to formation of blisters affecting large areas of the body. Often the exposed areas such as face and arm are affected, and it may show a linear pattern of rash based on the contact. Very sensitive individuals can be affected by even burning of wood with poison ivy on them. People with allergy to poison ivy may also develop allergic reaction other plants that contain Urushiol.
Patients with allergy to poison ivy, poison sumac, and poison oak need to be cautious of the following plants:
Food allergy symptoms are presented by many of our patients, the question is whether it is really due to an allergy to food.
It is estimated that 20 to 25% of people think that they suffer from food allergy according to many estimates. However, if challenge them by food challenge conducted in an allergist’s office 2 to 3 percent confirm an allergy to food. By that standard, only about three percent of the adult population suffers from an allergy to food.
Food allergy is a common problem in children.
Based on food challenges: 6-8% percent of children suffer from food allergy.
Food allergy symptoms develop when an abnormal immune response to food occurs by producing an antibody known as IgE. IgE antibody attaches to a certain cell called Mast cell predominantly present in common areas of exposure, such as gastrointestinal tract, and respiratory linings. The reactions in the intestines result in the production of chemicals such as histamine. Histamine release in the gut causes initial symptoms of vomiting, stomach pain, diarrhea.
If the food allergens enter the blood, such a reaction can occur in the blood causing hives, and an acute reduction in blood pressure and lead to shock and sometimes death. Even swelling of throat, asthma, and difficulty in breathing can occur in some cases. A frequent skin manifestation of food allergy is eczema characterized by the itchy and scaly skin. The common food allergens in children are eggs, milk, and peanuts. Common food allergens in adults are shellfish, peanuts, tree nuts, eggs, and fish.
Many individuals suffer from symptoms such as gaseous distension of abdomen, stomach cramps, nausea, diarrhea, and even vomiting with no evidence of food allergy on allergy testing. This situation is called food intolerance. When physicians test for food allergy, they look for the presence of an antibody named IgE. In a blood test, this is done through RAST test. In this case, IgE antibody against any specific food is measured to decided if they have excess levels of precise antibody in blood. In skin tests, the same antibody is tested by applying specific food items on the scratched skin. If you are allergic to any food, the skin will show redness and swelling if IgE antibody is present in the skin. When your doctor tells you that there is no food allergy it means IgE antibody is not causing your symptoms when you the mentioned food.
Here are other reasons why you may develop discomfort after eating food items when the test shows that you are not allergic to it:
- Lactose intolerance: a deficiency of an enzyme needed to digest milk will result in lactose being digested by normal bacteria present in the gut producing carbon die oxide gas leading to symptoms of bloating, abdominal cramps, and diarrhea.
- Reaction to food additives and preservatives such as MSG and sulfites and food dyes: sulfites releases sulfur die oxide in the intestines which could be irritating to intestines and lungs.
- Contamination of food with bacteria.
- High histamine naturally present in some foods such as cheese and wines.
The diagnosis of food allergy is made from a very detailed history of reactions to specific food items. If food allergy is suspected then tests are done by:
- Skin tests: food tests materials are supplied by various companies. The allergists applies the food items after scratches are made on skin. If you are allergic to a specific food an area of redness and swelling appears within fifteen minutes. The size of the reaction usually indicates the degree of allergy to the specific food.
- Blood tests: serum is sent to the laboratories to look for specific allergy antibodies through tests called RAST. It takes about a week to receive the results.
The most accurate test for food allergy is elimination and challenge test. The reason for this is that there are instances where the patients claim to experience unpleasant symptoms upon eating food, and tests come out negative. In addition to the reasons explained previously such as lactose intolerance of gluten sensitivity, at times the patients experience symptoms without a demonstrable reason based on test results. In such cases, we recommend complete elimination of the offending foods and document the presence of absence of symptoms. If the symptoms disappear after the elimination, the patients should continue to avoid the foods if possible. If you want to confirm the fact, you could start again on the food to see if the symptoms return.
This is termed elimination and challenge. Still this is not a fool-proof test, as the thought of eating a certain food presumed to be allergic in nature may induce the symptoms mostly based on a previous bad experience after eating a specific food. This is in a way similar to post-traumatic stress disorder. The thought of eating a certain food with a negative experience induces the release of particular mediators induces the symptoms. If the allergists suspects strongly this is the case, a blind food challenge test is done at the office to confirm or remove the diagnosis of allergy to the specific food item.
Milk allergy is a common problem we encounter in our Pediatric and Allergy practice. While most children present with a mild degree of problems such as eczema and stomach complaints, rarely the milk allergy can cause serious reactions. During the past forty years in practice we have come across all different types of allergy reactions in children and in adults.
The onset of milk allergy can occur very early as early as the first month of life. The symptoms are caused by immune changes in the gut in response to milk allergy. These immune changes can be due the production of an antibody called IgE antibody or due to changes caused by other antibodies or infiltration of immune cells causing damage to the intestines.
The acute reactions which most parents are worried about are IgE-mediated reactions which can result in life threatening types of events in rare cases. More commonly we see patients with worsening skin rashes (eczema) due to milk allergy.
Recurrent diarrhea is another reason why infants are to the pediatrician which can be associated with allergic reaction. Recurrent diarrhea can lead to malnutrition in some cases. The IgE mediated allergy can be followed by infiltration by an immune cell called eosinophil which can lead to damage to the lining of intestines. These immune cells (eosinophil) accumulating in high concentration in different parts of gut such as esophagus, gastrointestinal tract, and colon. This can result in vomiting, diarrhea, restlessness, failure to gain weight.
Food allergy can also be due to non-IgE mediated processes.
Diarrhea is one of the common presentations in non-IgE mediated reactions, presenting with diarrhea often associated with mucus and blood in stool. This condition improves by making changes in bab-formula in formula-fed infants. The different baby-formula could vary from partially hydrolyzed formula to what is called elemental formula. These are prescribed by your pediatrician or allergist. For more information on different types of baby milk click here:
Anaphylaxis is an acute allergic reaction on exposure to an allergen such as food, medication, or an insect bite, is often a night-mare for any physician to deal with. Anaphylaxis could be of acute onset, severe, and can result in death if not managed properly and on time (Russell, W.S., 2012).
In our experience, the frequent food allergen that can cause an acute allergic reaction (anaphylaxis) include: peanuts, shell-fish, milk, and eggs. The other common foods associated with food allergy include soy, and wheat. Food allergy is more common than most parents and physicians are aware of, especially in younger infants. Drugs commonly involved in acute allergic reactions are: antibiotics, and anti-inflammatory medications such as ibuprofen. Insect allergy induced anaphylaxis could be from flying insects such as wasps, and fire-ants.
Once an acute allergic reaction (anaphylaxis) takes place, immediate treatment is necessary and is best delivered in an emergency-room setting.
The physicians managing such situations will provide the patients with an anaphylaxis-kit which contains adrenalin along with appropriate instructions and training to manage in case of any such future occurrence. Kits need to be made available in school with proper instruction provided to the school personnel. A referral to an allergist to decide the specific allergens is very important.
For more information, visit: http://www.foodallergy.org/anaphylaxis
Air-borne allergens are the most common causes of triggering sinus allergy and asthma attacks. Air-borne allergens change depending on the season and location of your residence. Tree pollen allergy is the most common factor in spring, ragweed in summer, other weeds in fall, and dust mites in winter. Both grass pollen and dust mites are present year-round in most countries, and most of the southern regions of the USA. Upon exposure to an allergen you react if you are genetically programmed to do so. In other words, if you have allergy in the family. In that situation your immune system, on exposure to an allergen interprets the agent to be hostile, and produce an antibody (IgE) to fight the inhalant allergen.
On subsequent exposure, chemical substances such as histamine, interleukin, and tryptase are released leading to common allergy symptoms of sneezing, itching, and watery nose. In those with asthma, cough spells and wheezing could occur. Allergy symptoms can start within minutes of exposure to allergens or within hours after exposure. The products that appear later include leukotrienes etc., which lead to arrival other immune system cells such as eosinophils leading to symptoms of airway swelling and asthma. That is the reason for increased susceptibility to development of asthma after contact with an allergen. The airway becomes primed to react more in the presence of allergens specific to an individual.
Allergic rhinitis and allergic sinusitis are the most common allergy symptoms. This is due to the fact that most of allergens entering the airway are filtered at the nose, thus preventing them from entering the lower airway. Being in contact with allergens in the nose, a set of immune reactions lead to production of histamine and other mediators resulting in nasal congestion, nasal blockage, watery nose, post nasal drip, itching of mouth, throat, and palate, sneezing, sore throat, cough, headache, bad smell in mouth, snoring and other symptoms.
However, there are other factors causing similar symptoms. Nasal congestion and blocked nose are caused by the following: allergic, non-allergic, seasonal, perennial (suffer throughout the year), and episodic (occasional).
Sinus congestion can be due to allergies, in which case you get “sneezing attacks”. Sneezing is a protective reflux, the means by which our local immune system at the nose is trying to get rid of an allergen or an irritant to the nose. Sneezing facilitates the reduction in the number of allergens getting into the airway. If more allergens enter into the lower airway, it can induce a spastic reaction leading to closure of the lower airway and symptoms of asthma.
Many patients when tested for presence of allergies come out negative – which means that the allergy tests did not reveal any positive reaction. They suffer from symptoms similar to those caused by allergens, but the tests are negative. This is considered non-allergic sinus congestion. Lack of sneezing could be an indication that you are not suffering from allergic rhinitis, rather it is non-allergic sinus inflammation. This is often caused by presence of irritants such as dusts, chemicals, and perfumes.
One other common cause of sinus congestion is the lack of mechanism to accommodate changes in the environmental factors such as humidity change and temperature changes. Our nasal passage is normally equipped with nerves that lead to contraction and relaxation of arteries, veins, and the glands that cause secretions. These nerves can compensate for changes in the humidity and temperature and thus we do not suffer. When this mechanism does not work properly due to different reasons, you experience blockage of sinuses. Lack of sneezing could be an indication that you are suffering from non-allergic sinus disease.
Some individuals experience symptoms of allergy only in certain seasons based on their allergy to specific allergens predominant in the air.
Tree pollen is the most common identifiable cause of allergic rhinitis in spring
Grass and tree pollen are the predominant allergens in summer
Weed pollen including ragweed are the main causes for allergic rhinitis in fall
Allergens in winter are mostly dust mites as the exposure is increased because of significantly more time spent indoors.
Tree pollen allergies
Allergy to Oak Tree Pollen
Allergy season is open in Louisiana in March. Based on the patients already presenting with an acute attack of sinus allergy and watching the trees blooming, I can confidentially affirm that allergy season for 2014 has started in Louisiana. Oak tree pollen can be observed plentifully on trees all around us in Louisiana. This is especially applicable to water oak trees, which shed leaves in winter.
Oak tree pollen allergy
Perennial allergic rhinitis with seasonal exacerbation
Oak tree pollen entering the nose, most of them, are held back in the nose by filtering mechanisms of the nasal passage, preventing it from going into the lungs. The antibodies present in the cells of the nose put up a fight, and that results in release of a chemical called histamine in the nose. Histamine increases the blood flow to the area of contact. The glands of the nasal passage release mucus to digest the proteins of the pollen. This results in a watery discharge from the nose (runny nose). Histamine induces sneezing, which helps to expel the allergenic pollen in the sinuses. Now you know how it works.
Recently patients coming to office for sneezing, cough, itchy eyes and misery went up sharply. I find many pine trees starting the bloom.
In places where pine trees are plentiful, pine pollen could be a significant factor causing sinus allergy symptoms. The pine pollen is too large to enter the lower airway. Hence, a symptom of lower airway allergy such as asthma is usually not triggered by pine pollen allergy.
There are two methods used to find out what you are allergic to: skin testing and blood tests.
Skin tests for allergy diagnosis: in the skin tests your allergist applies different environmental and food allergens on the skin using scratch tests.
It is often supplemented by additional tests applied into the skin (intra-dermal tests), if a definite diagnosis is not arrived at by skin scratch tests. In intra-dermal tests suspected allergen is applied into skin and skin reactions are read in ten and twenty minutes.
The blood test for allergy known as RAST on blood samples looks for the same allergens for the presence of antibodies IgE. It is often used in small children with eczema (atopic dermatitis) usually for the suspected food allergens or any other allergen. These tests are too expensive for a complete evaluation.
IgG antibody tests for presence antibodies to food
Tests for the presence of IgG antibodies for food is done by some physicians. Board-certified allergists do not use this test as we believe that the results are not very useful for management of patients with allergies.
Treatment of allergic rhinitis
The mainstay of treatment for allergy involves the following:
- Avoid pets
- Avoid allergenic foods
Reduce exposure to allergens
- If you are allergic to grass pollen, have someone else mow grass
- Implement environmental control measures
Reduce symptoms with medications
- Use antihistamines, preferably non-sedating antihistamines
- Medications such as Singulair may be prescribed
- Nasal inhalations of steroids, antihistamines, and anti-atropine may be prescribed
Immunotherapy (allergy shots)
We recommend immunotherapy for patients who have sufficient degree of symptoms.
Allergenic Plants: Ragweed Allergy
Ragweed pollen entering the nose, most of them, are held back in the nose by filtering mechanisms of the nasal passage, preventing it from going into the lungs. The antibodies present in the cells of the nose put up a fight, and that results in the release of a chemical called histamine in the nose. Histamine increases the blood flow to the area of contact. The glands of the nasal passage release mucus to digest the proteins of the pollen. This results in a watery discharge from the nose (runny nose). Histamine induces sneezing, which helps to expel the allergenic pollen in the sinuses. Now you know how it works.
There are different types of ragweeds: giant ragweed, short ragweed, perennial ragweed, southern ragweed, and canyon ragweed. Ragweeds are mostly distributed on pastures, open fields, and waste places. The pollen gets airborne and can reach areas near the fields in high concentration.
We are in the ragweed season now; ragweed season can start at different times in different regions of the country. The season usually goes from end of July to the end of August. At this time, ragweed pollen is the predominant allergen in the air; it a bad news for people
with ragweed allergy. Ragweeds are very prevalent in USA, but the allergy symptoms occur only in the seasons at which the pollen are distributed in the air.
There are different types of ragweeds: giant ragweed, short ragweed, perennial ragweed, southern ragweed, and canyon ragweed. Ragweeds are mostly distributed on pastures, open fields, and waste places. The pollen gets airborne and reaches areas near the
fields in high concentration.
Ragweed pollen entering the nose, most of them, are held back in the nose by filtering mechanisms of the nasal passage, If you are allergic to ragweed pollen, antibodies present in the cells of the nose put up a fight, resulting in the release of a chemical called histamine in the nose.
Histamine increases the blood flow to the area of contact. The glands of the nasal passage release mucus to digest the proteins of the pollen. This results in a watery discharge from the nose (runny nose). Histamine induces sneezing, which helps to expel the allergenic pollen in the sinuses. Thus, sneezing, runny-nose becomes common problems for those with ragweed allergy.
It is helpful to recognize the weed and try to stay away from them as much as possible. We have posted information about ragweed on our website.