ALLERGIES

CONTROLLING ALLERGIES, FOOD SENSITIVITIES, AND AIRBORNE IRRITANTS

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Allergy symptoms can easily be mistaken for the common cold in much the same way as the other signs and symptoms of chronic airway-digestive inflammatory disease (CAID). In fact, the allergic response is actually one of the main causes leading to CAID: Allergies left untreated will cause inflammation to the sinus membranes, spawning the cascade of swelling and obstruction. Once this occurs,

The Allergic Reaction

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A person becomes allergic when he or she acquires an abnormal immune response to a substance that does not normally cause a reaction. This typically occurs after an initial exposure (sensitization) to the allergen, although multiple exposures to the substance may be necessary.

There is apparently a genetic predisposition to allergies; the incidence

Decoding My Problem

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Review your results from the allergy portion of the CAID Quiz (p. 71). Locate your score so you can define your next course of action. Follow these guidelines:


■ If your score is 0-10 then you can treat yourself with OTC medicines

■ If your score is 11-25 then you need to see your primary-care physician

Choosing an Allergist

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Allergists receive their accreditation in two distinct ways: either by the American Academy of Allergy or by the American Academy of Otolaryngology. Both are equally well trained and proficient in treating allergies.

Your Appointment with an Allergist

Just

ALLERGY TESTING

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The next part of the exam will involve allergy testing to determine what allergies you may have, including ones you may not be aware of. This testing can be performed via various methods. An allergist typically uses the scratch or prick test as a primary tool for allergy testing. The intradermal skin endpoint titration test is believed

ADDITIONAL BLOOD TESTING

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Your allergist may want to see a detailed report of your blood. He or she may send it to the laboratory to see if you have high levels of IgE. Furthermore, he or she may also want to evaluate your immunoglobulin G (IgG) levels if you have bad sinus disease, although these tests are not commonly performed. Your physician will usually do this only if he or she feels that there is an immunologic problem leading to recurrent sinus infections

Primary Allergy Treatment: Avoidance

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Just like there is no cure for CAID, there is no cure for allergies. However, with new techniques and medications, it is possible to live without experiencing the troubling symptoms associated with them.

The most direct way to limit your allergic symptoms is through a few lifestyle changes, most notably by avoiding the known allergen entirely. This is easier

PERENNIAL ALLERGENS

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Because you feel sick all year long, it’s really important to eliminate the particular allergen from your surroundings. The most common perennial allergens are house dust mites, animal dander from your pets, feathers from pillows and comforters, and cockroaches.

Household dust is found all over the world. It is actually a combination of allergens. It is different from road dust in that

HOUSEHOLD PETS

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Allergies to your pets is a heartbreaking problem. I grew up with allergies to animals and I wanted to be a veterinarian. We had a dog, cats, and gerbils, and I loved horses. Allergies to indoor pets may not develop until months or even years after the first exposure. And by then these pets are family members. So if you are wondering if you have to get rid of your pets, my answer is always no. Try modification

COCKROACHES

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Cockroaches are a potent source of allergen. The cockroach allergen comes from the body parts of the cockroach and not the feces, as is the case with dust mites. Cockroach allergen was first found after many patients in the inner city came to public hospital emergency rooms with asthmatic flare-ups. They were found to have positive allergy tests to cockroach. On the other

SEASONAL ALLERGENS

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Avoidance and reducing exposure is the best way to help avoid seasonal allergic reactions, especially when pollen counts are high. These
are the steps that you need to take to minimize contact with these allergens:

1. Stay indoors,

NASAL IRRIGATION

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Irrigation of your nose and sinuses using a neti pot or a nasal irrigator with sterile saline or other solutions will help wash out your nose and
sinuses from the very particles that are causing your allergies. Follow the instructions in category 4 on using a neti pot or nasal irrigator. This practice is especially important if you have seasonal allergies and have spent a large part of your day outdoors.

Medical Treatment for Allergies

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In addition to avoidance, allergies can be successfully treated with medication. This may include a combination of antihistamines, decongestants, antihistamine nasal sprays and eye drops, nasal steroid sprays, anticholinergic sprays, and leukotrienes. I typically start my allergy patients with an inhaled nasal corticosteroid,

ANTIHISTAMINES

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Antihistamines do not destroy released histamine, nor do they interfere with histamine already bound to the receptor site. Instead, they block the receptor site and subsequently block the histamine from binding to the receptor.

Antihistamines

DECONGESTANTS

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Oral decongestants cause the blood vessels in the nose to constrict, and the mucous membranes and the turbinates to shrink. This essentially relieves nasal congestion, improving nasal air flow. The combination of a decongestant and an antihistamine is significantly more effective in reducing total nasal symptoms, including nasal congestion,

MAST CELL STABILIZER SPRAYS

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Mast cell stabilizers have an'anti-inflammatory effect because they inhibit the release of histamine, reducing the amount of histamines and other inflammatory substances released by the mast cells. These sprays must be administered every 4 hours, with the first dose given before the allergic reaction happens.

Side Effects

A bitter taste can occur, although this can be minimized

NASAL STEROID SPRAYS

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Nasal steroids reduce multiple aspects of the inflammatory response and are the preferred treatment for mild allergic rhinitis. They have also been shown to decrease the response to allergens if used before an allergenic exposure. Clinically, it has been shown that nasal corticosteroids are more effective than antihistamines for nasal congestion

TOPICAL AGENTS FOR OCULAR USE

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A mast-cell stabilizer inhibits histamine release, and relieves allergic conjunctivitis (redness and itching). Three types are cromolyn (Crolom), nedocromil (Alocril), and lodoxamide (Alomide).

Antihistamine eye drops block histamine receptors and relieve allergic conjunctivitis. Two agents are ketorolac (Acular) and azelastine (Optivar).

LEUKOTRIENE BLOCKERS

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Leukotriene blockers reduce mucosal inflammation. It is thought to be as effective as a second-generation antihistamine for the treatment of allergic rhinitis. However, the drug is not effective when used on its own. Instead, I use leukotriene blockers as an additional treatment for patients who do not have

ANTICHOLINERGIC AGENTS

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Anticholinergic agents are effective for resolving a runny nose. It is ap - 1 proved, at one strength, for the common cold and is the drug of choice 1 for such conditions as runny nose related to cold weather (skier’s nose) | and/or runny nose related to eating or just excessive postnasal drip. The 1 side effects include headache and nosebleed, but these are very rare. 1 One agent is ipratropium (Atrovent).

SYSTEMIC STEROIDS

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Systemic steroids are usually reserved for severe symptoms that do not | respond to other medications or for patients who cannot tolerate other ' drugs. In these cases, your physician may treat you with either oral or | injected systemic corticosteroids. Treatment regimens include either a preseasonal intramuscular injection or oral corticosteroids, administered j for a week to several weeks. For patients

OTHER THERAPIES ON THE HORIZON

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Researchers are currently developing a new approach to allergies, using medication that is currently used for asthma patients. This is the administration of a humanized monoclonal anti-IgE antibody omalizumab (Xolair). This product seems to give patients with allergic rhinitis relief. However, it is very expensive at this time and is indicated only for severe asthma. Side

Treating Your Allergies for the Long Term: Immunization Therapy

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All of the medications listed earlier are meant to control allergy symptoms. Allergy desensitization (immunotherapy) via allergy shot administration is a safe and highly effective way to relieve and/or eliminate allergic symptoms. In fact, allergen immunotherapy is the only form of therapy that will actually alter your body’s immune response to allergens. In addition, it has been shown that this therapy may prevent the onset of asthma

Food Allergies

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Another category of allergies is allergic reactions to specific foods. Allergies to food can cause skin reactions like hives and eczema. As well, the food allergens can cause swollen lips and upper - and lower - respiratory symptoms like allergic rhinitis and asthma.

Food allergies are more common in people who have other allergies. Food allergies have been witnessed since the beginning of time and can be fatal. At present, the only

Allergies and Gastroesophageal Reflux Disease (GERD)

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Perennial and seasonal allergies can affect not only your sinuses but your digestive system as well. The symptoms of GERD are not truly allergic but they can be related to a direct result of the allergic response. We know that allergies can cause gastroesophageal irritation stemming from the allergies themselves, which can cause GERD. We also know that allergy causes

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