What is an Allergy?
An allergy occurs when a person’s immune system reacts to substances in the environment that are harmless for most people. These substances, known as allergens, can be found in pollen, molds, dust mites, pet dander and hair, foods, stinging insects like bees, and medicines. We see patients at Becker Ear, Nose & Throat Center in New Jersey and Philadelphia with a wide range of allergies and symptoms.
While we do not know the exact reasons some patients develop allergies while others do not, there is a genetic component–allergic tendencies often run in families. About 80% of those with seasonal allergies or “hay fever” develop their symptoms before they are twenty. While most food allergies are developed in childhood, at least 15% are diagnosed in adulthood, most commonly shellfish and nut allergies. There are many different types of allergies that can trigger a wide range of symptoms and conditions.
Nasal, Sinus and Eye Conditions
The term “rhinitis” refers to inflammation of the nasal passages. Symptoms include sneezing, itching, congestion (“stuffiness”), runny nose, and postnasal drip. There are many potential causes for rhinitis including seasonal (also known as “hay fever” or pollen allergy) and indoor allergies, which can usually be attributed to pets, molds, or dust. Some patients have no identifiable allergies on testing and fall into the category of “non-allergic” or vasomotor rhinitis, which usually indicates a hyper-responsiveness of the nose due to a nerve imbalance. Treatment for rhinitis varies based on the diagnosis and cause. Allergic rhinitis (AR) (those due to pollen or indoor allergens) can be treated with avoidance techniques, medications, and immunotherapy (allergy “shots” or “drops”). Non-allergic rhinitis is treated with avoidance (when possible) and medications.
Eye allergies or allergic conjunctivitis often coincide with nasal allergies, but in as many as 30% of patients, these can be the only symptoms. They can include eye itching, wateriness, or redness. Treatments include medications (eye drops and/or oral antihistamines) and immunotherapy.
Skin allergies are very common and come in many different varieties. Atopic dermatitis (AD) or eczema is a lifelong skin disorder that generally starts in childhood. It is closely related to seasonal or indoor allergies and is often the first presentation of the “atopic march,” in which children present initially with eczema followed by allergies and then asthma. Contact dermatitis is another type of skin condition that can be from an irritant (such as excessive exposure to water and soap) or from an allergic substance (such as poison ivy or nickel in costume jewelry). Diagnosis is based on a thorough history and physical as well as skin testing, either with prick testing or patch testing to determine if there is a culprit or inciting allergen. Chronic itching without a rash can also be secondary to allergies, and testing can help identify if there are any environmental factors worsening the symptoms.
Hives or urticaria is an intensely itching and red rash that is characterized by a wheal (raised bump) and flare (redness surrounding). Each lesion should last less than 24 hours although new hives can develop at other sides. Angioedema is self-limited localized swelling which is a deeper form of hives and typically lasts several days to the deeper nature. Sometimes a trigger can be identified such as a food, drug, or insect sting but would be consistent (occurring with every encounter), chronologically concordant (occurring within 30-60 minutes of the presumed trigger), and not occur when the trigger is being avoided. Physical triggers such as pressure or elevated body temperature (as in the case during/after exercise) are also possible. If no identifiable trigger is found, the most common causes in acute hives/angioedema (<6 weeks) is acute illness (usually viral) or stress. In chronic hives/angioedema (≥ 6 weeks), the process is not allergic in nature but more likely secondary to an immune-stimulating process (such as chronic illness/disease, hormonal imbalance, or unidentifiable). Rare causes include urticarial vasculitis, mastocytosis, and hereditary angioedema. Frequently no cause is found and treatment is aimed at minimizing symptoms. A thorough history can determine if testing is warranted and the best treatment options.
Asthma is a reversible airway obstruction with symptoms that can include coughing, wheezing, shortness of breath, and chest tightness which respond to inhalers such as albuterol and to steroids. Diagnosis is based on history, an exam, and lung function tests such as spirometry. Some asthma is intermittent only based on certain exposures (allergens, illnesses) or induced by exercise (ie. exercise induced bronchospasms or EIB). Some is persistent and requires daily medications to prevent or control lung inflammation. A chronic cough can be a sign of asthma, especially in children, and is known as “cough variant” asthma. A cough can also be signs of rhinitis, allergic or nonallergic. Immunotherapy (allergy “shots” or “drops”) can help prevent the progression of allergies to asthma when utilized in children. Reflux is another common cause for a chronic cough. Treatment of a chronic cough is based on a diagnosis, which usually requires evaluation and testing.
Prior to seeing Dr. Becker, I had had 3 sinus surgeries with little to no success. The problem would persist and I would constantly have headaches, congestion, night sweats, etc… I truly feel that Dr. Becker improved my quality of life with the 4th (and hopefully the last!) sinus surgery. In the four years since his surgery, I have had 1 sinus infection, and I am fine taking the occasional allergy pill or nasal steroid spray on a bad day. I will be forever grateful for his expertise.
Anaphylaxis is a severe systemic allergic reaction to a trigger, although rarely can be “idiopathic” or without a cause. Symptoms encompass the respiratory system (throat swelling, asthma-like attack), gastrointestinal system (nausea, vomiting, diarrhea, cramping), or cardiovascular system (low blood pressure, passing out). Skin manifestations often accompany the above symptoms with hives, swelling, and flushing, but when in isolation without respiratory, gastrointestinal, or cardiovascular symptoms, are not considered anaphylaxis. Evaluation is aimed at determining the trigger, so the patient can avoid subsequent exposure. This is done by a thorough history followed by testing to possible culprits.
Food allergies can be divided into immunologic reactions vs. non-immunologic. Non-immunologic reactions include adverse reactions from gastrointestinal disorders, such a lactase deficiency causing lactose intolerance. There is a wide range of food intolerances that cannot be tested for with the typical allergy testing and avoidance is the best treatment.
Oral Allergy Syndrome or Pollen Food Allergy Syndrome
Immunologic reactions include immediate reactions mediated by an allergic antibody (IgE) to a specific food. Symptoms for IgE mediated reactions include hives, swelling, respiratory distress, gastrointestinal manifestations (cramping, nausea, vomiting, diarrhea), or signs of cardiovascular involvement (lightheadedness, dizziness, passing out). The trigger is consistent, with symptoms always occurring with the specific food ingestion regardless of the form it takes (ie. milk allergy symptoms would occur whether the patient ate cheese or yogurt). Symptoms should occur within 30-60 minutes, although rarely up to 2 hours later. There are rare causes such as allergy to alpha galactosidase – found in mammalian meats and associated with prior tick exposure – that can have more delayed reactions many hours later. Oral allergy syndrome or pollen food allergy syndrome is due to cross-reactivity of pollen with certain fruits and vegetables, typically in the raw form. Symptoms are generally limited to the mouth and throat with itching, tingling, swelling sensations. Rarely will symptoms occur beyond the mouth, with systemic or anaphylactic symptoms being even more uncommon. Heating the fruit or vegetable, even for a short period, denatures the cross-reactive protein to allow many patients to eat the food without incident. Immunotherapy (allergy shots or drops) to the culprit pollens have been shown to help improve tolerability to the cross-reactive foods.
Other immunologic reactions that are non-IgE mediated (or mixed reaction) include eosinophilic esophagitis (EoE), food protein-induced enterocolitis (FPIES), and celiac disease (gluten intolerance). EoE and FPIES are evaluated and treated by an allergist, while celiac disease is best evaluated by a gastroenterologist, who can perform a small bowel intestinal biopsy—the gold standard for diagnosis.
Adverse reactions to drugs can be separated into Type A reactions and Type B reactions. Most reactions to medications are from Type A reactions and are predictable based on the known properties of the drug. One example would be stomach upset from long-term ibuprofen use. Type B reactions account for 10-15% of adverse drug reactions and are unpredictable. These reactions can be further divided into drug toxicities/intolerances (at lower than expected doses), idiosyncratic reactions (such as sulfa medications causing anemia in patients with G6PD deficiency), or immunologic drug reactions (drug allergy). Drug allergy can be immediate or delayed. Penicillin is the most highly reported drug allergy, however, 90% of patients with this history are able to tolerate penicillin. This is due to the fact that many patients are probably mislabeled as allergic. Others may outgrow their allergy as their allergic antibodies wane over time. Patients labeled as allergic to penicillin are more likely to be treated with more expensive and broad-spectrum antibiotics (eg. Quinolones and vancomycin) which contribute to the development and spreading of multiple drug-resistant bacteria and higher health care costs. Skin testing can be performed with an FDA-approved product for testing with a high sensitivity and specificity. If testing is negative, an in-office challenge is performed to clear the patient from this diagnosis.
Latex allergy is secondary to hypersensitivity to natural rubber latex from the Hevea brasiliensis tree. Certain populations, such as healthcare workers or those patients using latex-containing medical devices, are at the highest risk. Symptoms can vary from a contact rash to full body systemic reaction or anaphylaxis. Avoidance is the key, even in those with just a rash as progression to anaphylaxis is unpredictable. There are a wide variety of products found in the community and hospital setting and include latex gloves, balloons, condoms, anesthesia face masks, elastic bandages, envelope adhesive, rubber bands etc.
Stinging Insect or Venom Allergies
Venom or stinging insect allergy is a potentially life-threatening condition. The most common culprits are the flying Hymenoptera (honey bee, yellow jacket, yellow hornet, white-faced hornet, and wasp). Symptoms can range from skin or cutaneous only (hives, swelling) to full body systemic reaction (anaphylaxis). Testing is necessary to determine the culprit insect, as even those that study entomology (the study of insects) can have difficulty telling these various flying insects apart. Immunotherapy (allergy shots) can be lifesaving, reducing the patient’s risk of a future systemic reaction from 60-70% to 1-3% after a 3-5 year course.
Recurrent Infections, Immunodeficiency
Recurrent infections can be a sign of an inherited (primary) or developed (secondary) defect of the immune system. Secondary causes of recurrent infections can include immunosuppressant medications, malignancy, structural defects (such as frequent ear infections in young children). Primary immunodeficiencies often present with unusual organisms causing illness, need for intravenous antibiotics for clearance of an infection, or recurrence of infections as soon as antibiotics are completed. Evaluation is based on a thorough history to determine the extent of the illnesses, and if determined necessary, blood testing to evaluate various components of the immune system.
Allergy Testing – Pollen, Pet, Mold, Dust, Food, and Drug
There are several techniques for allergy testing. The most common is known as “prick” testing in which a small drop of the allergen is introduced to the skin using a puncture or scratch device. Trauma to the skin is minimal and “reading” the test occurs 15-20 minutes later. Pollen, pet, mold, dust, and food testing are performed in this manner. Rarely in cases of pollen, pet, mold, and dust testing will intradermal testing be required. Intradermal testing uses a very small needle to place a small amount of the allergen within the layers of the skin. The technique is similar to a PPD or TB (tuberculin) test. Drug testing is also performed in this manner. For both prick testing and intradermal testing, patients must avoid antihistamines for 5-7 days prior to the testing. Antihistamines will block the accuracy of the testing and could result in false negative results. Cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin), diphenhydramine (Benadryl) are all examples of antihistamines. For a more complete list of antihistamines, click here.
Occasionally, blood testing is preferred by the patient or is necessary due to the skin conditions of the patient. Blood testing is also accurate although not as sensitive as skin testing, the preferred method. Blood testing is also preferred in those patients with long history of food allergies, in order to follow a specific level to the allergic antibody to determine when a patient may have outgrown his or her allergy, warranting a food challenge in the clinic.
Contact dermatitis can be secondary to allergic or irritant causes. Patch testing can help determine if an allergy to a substance is the culprit for recurrent rashes. This diagnostic method takes several days as allergic contact dermatitis is a delayed reaction. During the first visit for the test, common potential culprit allergens will be placed on the back and adhered using medical tape. The patient will be instructed to avoid activities that may introduce water to the area (showering, swimming) or cause significant sweating (vigorous exercise). In 48 hours, the patient returns to the clinic for removal of the patches and initial read. Then patients are instructed to return in another 24-48 hours for the final read. Rarely, a third reading is required 7 days after removal. Any positive results can be recorded and instructions on avoidance provided.
Pulmonary Function Testing
Pulmonary function tests help determine how well a person’s lungs are working by measuring the amount of air the lungs hold and how fast the air can enter or exit the system. Spirometry is performed in the allergy clinic and helps to measure the FVC (forced vital capacity) or amount of air the patient can expel from their lungs during forced maneuvers. This is compared to the FEV1 (forced expiratory volume in 1 second) or amount of air they can “blast” out of their lungs in the first second. These measurements can help determine if the patient has a form of lung “obstruction.” Treatment with albuterol can determine if this obstruction if reversible, and would indicate a likely diagnosis of asthma. The test is a simple procedure performed in the clinic and only requires some practice and patient cooperation to blow into a hand-held tube.
Allergy Treatments and Therapies
Allergy Shots or Immunotherapy
Allergen immunotherapy, also known as allergy shots, is a form of long-term treatment that decreases symptoms for many people with allergic rhinitis, allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy. Allergy shots decrease sensitivity to allergens and often leads to lasting relief of allergy symptoms even after treatment is stopped. This makes it a cost-effective, beneficial treatment approach for many people. Both children and adults can receive allergy shots, although it is not typically recommended for children under the age of five, due to difficulty with cooperation and trouble articulating any adverse symptoms they may be experiencing. For older adults, medical conditions such as heart disease should be considered and in those patients who have significant medical issues, the risks of allergy shots may outweigh the benefits. Allergy shots are NOT used to treat food allergies.
The decision to initiate allergy shots is a personal one and will be made in conjunction with your allergist. The choice for shots is based on the severity of symptoms, the number of allergies, effectiveness of medications or avoidance measures to control symptoms, desire to avoid long-term medications, time available to commit to allergy shot treatment, and cost.
Allergy shots work like a vaccine. Your body responds to the injected allergen by developing immunity or tolerance to the allergen. The treatment consists of 2 phases. The build-up phase involves receiving injections with increasing amounts 1-2 times per week. The length of this phase depends on how often injections are received and any delays between injections, but generally ranges from 3-6 months. Once a maintenance dose or “full dose” is reached, the injections are spaced out to 2-4 weeks between injections and this is called the maintenance phase. You may notice improved symptoms during the build-up but it may take as long as 12 months on the maintenance phase to notice improvement. For the best long-term response, this dose is maintained for 3-5 years.
The first allergy shots were given over 100 years ago and there are numerous studies to show they decrease symptoms of allergic rhinitis, allergic conjunctivitis, and allergic asthma. In children, they can prevent the progression of the “atopic march” from allergic rhinitis to asthma. Effectiveness appears to be related to the length of treatment as well as the dose. Many patients experience lasting relief following a standard treatment course, while some may relapse after discontinuation. Treatment doses and lengths are individualized based on the patient’s symptoms and needs.
Allergy shots are not without risk. Injections are given subcutaneously, generally in the back of the upper arm. The typical reaction is local with redness, swelling, and itching at the site of the injection. In some cases, allergy symptoms may increase with sneezing, nasal conjunction, runny nose or eyes. For some patients, hives can occur, and more rarely symptoms of anaphylaxis occur with swelling of the throat, wheezing or shortness of breath, nausea, dizziness, etc. Most serious reactions develop within 30 minutes of the injection, which is why there is a mandatory 30-minute wait following allergy injections. Delay in the treatment of anaphylaxis can worsen the outcome. Although death is extremely uncommon (1 in 2 million injections), it is a potential outcome particularly when life-saving treatment is delayed. All allergy shots are given in the clinic under the direct supervision of properly trained staff, with ready access to life-saving equipment.
Dr. Lupa has been so kind, friendly, helpful, professional and caring. We all love him and all his staff. They have treated my mom’s sinus infection with expertise and kindness. An amazing ability to protect patients from pain, sympathetic and genuinely interested in his patients. I would highly recommend. All get five gold stars!
Sublingual Immunotherapy (SLIT) or “Allergy Drops”
Sublingual immunotherapy (SLIT) or “allergy drops” is an alternative method to treat allergies without injections. Currently, the only FDA-approved forms of SLIT are tablets for ragweed, northern grasses, and dust mites. The safety and efficacy of allergy drops is still being determined and therefore are considered off-label treatment in the United States, with insurance companies not paying for this form of treatment. Regardless, the efficacy of allergy drops has been established in numerous studies both in Europe and the US. Treatment with drops does not seem to be as effective as shots, particularly for long-term sustained improvement. Another limitation is the ability to treat with only a few allergens before efficacy appears to be diminished. However, for many patients who cannot tolerate injections due to needle phobia or time constraints to prevent them from coming to the clinic, allergy drops are a good option particularly when medication improvement is sub-optimal. There are still potential risks for full body systemic reactions or anaphylaxis to allergy tablets or drops, however, the risk is lower than with shots. The first drops from each new vial are administered in the clinic for safety but subsequently, patients take a daily tablet or drop under the tongue at home as prescribed by their allergist.
Oral immunotherapy to foods is being investigated to determine if common food allergies such as peanuts can also be treated in this manner. Studies are promising but safety, efficacy, length of treatment, and doses are still being determined. Therefore, food allergies are best treated with avoidance at this time.
Frequently Asked Questions
How do I know if it’s allergies or cold?
While symptoms can be similar whether it is allergies or an illness, such as a “cold”, the pattern should be more distinct. An illness should be short-lived, lasting days to just 1-2 weeks, and resolve. There is no clear pattern related to exposures or seasons. Allergies tend to start at the beginning of a season and last weeks to months and correlate with the pollinating seasons. They recur every year at approximately the same time, and they may worsen with each subsequent year. For infants and toddlers, it takes several years to develop enough sensitization to allergens (after 2-3 pollinating seasons of exposure) before testing will become positive. Before that time, it is more likely due to viral illnesses that their young bodies have not developed immunity against. Fever is generally NOT associated with allergies.
Can you outgrow an allergy?
Allergies can be outgrown on occasion. Seasonal and indoor allergens tend to get worse until mid-adulthood and then taper off as people age. Some food allergies like milk and eggs are outgrown by school-age in about 90% of children. Other food allergies like peanut, tree nut, and shellfish allergies tend to be lifelong with fewer than 20% of patients outgrowing the allergy. Adults can also acquire food allergies, most commonly tree nut and shellfish allergies.
What are common allergens?
Allergic rhinitis (allergies causing runny or stuffy nose, postnasal drip, sneezing, or eye symptoms like wateriness, redness, or itching) is caused by pollens, molds, dust mites, cockroaches, and pets. Anaphylaxis (or “whole body” allergic reactions) can be caused by foods, drugs, stinging insects (bees, wasps, hornets), and latex.
What allergens are seasonal?
Pollen allergens are seasonal and include tree pollen, grass pollen, and weed pollen. Trees tend to pollinate in the spring months. Grasses tend to pollinate in the summer months. Weeds tend to pollinate in the fall months. In warmer climates, there can be some plants that pollinate over the winter. Perennial or year-round allergens include the molds and dust mites (although these both flourish with humidity). Cockroaches and pet allergens are based on exposures.
What are some common symptoms of allergies?
Allergies can manifest in many ways. Allergies can present with sneezing, stuffy nose or congestion, runny nose, or nose and ear itching. Patients can also have red, itchy, or watery eyes. Migraines can be triggered by allergies. Fatigue is common in allergy sufferers as well.
How are allergies tested?
Typically we perform skin testing as it is the quickest and most sensitive way to evaluate for various allergies. Skin testing usually consists of a prick or scratch test in which we just scratch the surface of the skin with various allergen substances to assess for a reaction. In some cases, this test is negative and we proceed with intradermal testing, which is a tiny needle like a TB test or PPD placement. For either of these type of skin testing, patients must avoid antihistamines such as Benadryl, Zyrtec, Allegra, Claritin for the week prior to the testing or else the test could be falsely negative.
For patients that cannot perform skin testing for various reasons, we can perform a blood test but it takes longer to get the results, often costs more to the patient, and is not as sensitive.
Does allergy testing hurt?
The allergy community has come a long way in testing. For prick testing, the majority of the testing is done like a large “stamper” with multiple pricks in which a group of allergens can be tested at once. Most patients, even children, report that is isn’t uncomfortable or painful. The worst part tends to be the itching afterwards to any substance that the patient is allergic to. Intradermal testing can be uncomfortable since an actual needle is being used, but we reserve that typically for adults and for those we have a high suspicion for an allergy that does not come up on the initial prick testing.
Are allergies and asthma related?
Allergies, asthma, and atopic dermatitis or eczema are related. Many patients have more than one of these. When they start in young children, they tend to develop eczema first, followed by allergies, and lastly asthma. This order of development is called the “atopic march”. Allergies often flare asthma as the upper airways (nose and sinuses) can affect the lower areas (lungs). Part of a successful asthma treatment regimen is to ensure the upper airway symptoms are well controlled.
What is asthma?
Asthma is a lung condition in which the airways become inflamed and swollen resulting in narrowing of the airways. This narrowing combined with an increase in mucus production makes it hard to breathe. About 80-90% of asthmatic patients have allergic rhinitis (allergies affecting their nose).
What causes asthma?
Asthma tends to be genetic and run in families, however, no one completely understands the cause. There are likely also environmental factors that trigger the onset of asthma in a patient. Asthmatic symptoms can be triggered by allergens such as pollen, dust mites, molds, or pets. Many irritants such as smoke or chemical smells can flare symptoms. Exercise and illnesses in some patients can lead to an asthma attack.
Can asthma be cured?
Asthma is a lifelong disease that cannot be cured but can be managed with medications. In young children, often their asthma can improve significantly as they and their lungs grow. Asthma can vary over a patient’s lifetime from intermittent only based on certain exposures to a persistent state that requires some or many medications to control. Allergy shots can help prevent the development of asthma in children who are predisposed to its development, or it can improve asthma symptoms in those patients whose triggers are related to their seasonal or perennial allergen exposures.
How is asthma diagnosed?
History and a physical exam are important to the diagnosis. Symptoms of asthma include cough, wheezing, chest tightness, and shortness of breath. A pulmonary function test can be performed to determine how well you are able to move air in and out of your lungs. It may be necessary to receive a treatment with a medicine that opens the airways (albuterol) and then repeat the breathing test to determine if this improves your ability to move air.
What does an asthma attack feel like and what happens during an attack?
Asthma attacks can present in many different ways. Often, patients report one or more symptoms including persistent coughing that will not stop, rapid breathing, chest tightness or pressure, difficulty talking or completing a sentence without taking additional breaths, and audible wheezing with each breath. In severe cases, patients can feel anxious or begin to panic, can develop blue lips or fingernails, can have tightening of the neck and upper chest muscles (retractions), and can become pale and sweaty. Immediate medical attention is necessary in these cases.
Can you test for food allergies?
We can test for food allergies with prick skin testing or with blood testing. These tests evaluate for the specific IgE or allergic antibody in the patient’s body. This antibody is the one responsible for anaphylaxis or a full-body allergic reaction. This can include symptoms such as hives, swelling, trouble breathing, and vomiting.
There are many types of food intolerances that are not tested for with this type of test, such as constipation or fatigue from certain types of foods. Unfortunately, we do not have good testing available for those types of intolerances.
What are the most common food allergens?
About 90% of all food allergies are due to a few food groups: milk, egg, soy, wheat, peanut, tree nuts, shellfish, and fish. The most common food allergies in children are milk and egg, which are often outgrown. The most common food allergies in adults are peanuts, tree nuts, shellfish, and fish.
What are symptoms of a food allergy reaction?
Allergic reactions can vary from mild to severe and life-threatening.
Symptoms may include:
Cutaneous (skin) signs/symptoms: hives, itching, redness, flares of eczema
Upper airway signs/symptoms: nasal congestion, runny nose, sneezing, or an odd taste in the mouth
Gastrointestinal signs/symptoms: stomach pain, nausea, vomiting, diarrhea
Respiratory signs/symptoms: coughing, trouble swallowing, shortness of breath, wheezing, turning blue
Cardiovascular signs/symptoms: drop in blood pressure (fainting, confusion, weakness, or passing out), loss of consciousness, chest pain, weak or thready pulse
Other signs/symptoms: a sense of “impending doom”, seizures, headaches, sweating
Will antihistamines stop anaphylaxis?
Antihistamines can help treat symptoms of anaphylaxis, particularly itching and hives, however, it does not treat the underlying reaction. Only epinephrine can treat anaphylaxis. Delaying epinephrine (often to see if an antihistamine will work) is a risk factor for fatal anaphylaxis.
How much food allergen does it take to cause a reaction?
Even trace amounts of a food allergen can cause a reaction in very sensitive patients. Although most routes of exposure are ingestions, even touching and breathing the particles can lead to a reaction in some patients.
How long does it take for a reaction to start after eating a food?
Typically symptoms occur within minutes of ingestion and in most cases, within 60 minutes. Rarely will reactions occur up to 2 hours after ingestion.
Who is at most risk for a severe allergic reaction to food?
Having asthma, particularly uncontrolled asthma is a risk factor for having a severe reaction to food. Teenagers and young adults are also at particular risk due to risky eating behaviors and delays in the administration of epinephrine.
Can the severity of allergic reaction be predicted by previous reactions?
No. Someone may have a mild reaction one time and subsequently have a very severe reaction upon another exposure.
Is there a cure for food allergies?
There is no cure for food allergies. Milk and egg food allergies are outgrown by school-age in about 90% of children. This may be due to the maturation of the gastrointestinal system but the exact reason that these foods can be outgrown more often compared to food allergies to peanut and shellfish is unknown. For those with persistent food allergies, there is no current cure, however, there are many research studies investigating ways to desensitize patients to their food allergy.
Can my skin rash be caused by an allergy?
There are many types of rashes that can be caused by allergies. The most common is contact dermatitis, which is a delayed reaction to certain substances. We can perform patch testing to determine if a patient is allergic to common culprits found in lotions, topical medications, and clothing. Some patients, especially chefs, can have contact dermatitis to certain food products.
Atopic dermatitis or eczema is also related to allergies and can be flared by exposures to pollen, pets, and dust mites.
How are allergies treated?
First line treatment for allergies is avoidance. This is really NOT possible for pollen allergies since you can’t stay inside all the time. Sometimes you can avoid pets and animals. Environmental modifications such as keeping the humidity low in the house and vacuuming and dusting weekly can help with some of the dust mite and mold allergies. Usually, avoidance is not enough and patients are often started on allergy medications. Oral antihistamines such as Zyrtec, Allegra, and Claritin are often combined with nasal sprays such as Flonase. For those with allergy eye symptoms, special antihistamine eye drops can help.
Allergy shots are a unique way that allergists can help treat allergy patients. This treatment course involves “desensitizing” the patient to their allergies by giving them small and increasing amounts of the allergen over time. This helps the immune system to alter and slowly start accepting these allergens instead of over-reacting to them in the environment. Allergy shots can decrease or eliminate the need for medications. They can also prevent the progression to asthma in young children who are predisposed to developing the condition.
Are there any downsides to allergy shots?
Allergy shots require a lot of time commitment. Initially, patients come to the clinic at least weekly for several months and then this is spread out to every 2-4 weeks. The typical course of treatment is 3-5 years although some patients may need longer treatment.
Also, they are not without risk as there is the possibility of an allergic reaction to the shot. To provide the safest care possible, all patients receiving an allergy shot are required to stay in the clinic for the 30 minutes after their injection. If an allergic reaction is detected, the patient may need a shot of epinephrine (or adrenaline) to treat and reverse the reaction.
Most patients find these issues minimal once they get used to coming in to the clinic. The allergy staff often becomes like a second family. Most patients also tell me that we “changed their lives” for the better with allergy shots. That is the most satisfying and rewarding part of my job.
Learn More About Allergies
If you suffer from allergies or suspect that you might have developed an allergy, meeting with a specialist at Becker Ear, Nose & Throat Center in New Jersey or Philadelphia can help you get the answers you’re looking for. We offer expert diagnosis and treatment for patients with a range of allergies. To schedule an appointment, contact one of our offices today.