Preparing for Spring Allergies

Coping With Fall Allergies

What are Allergies?

Tree with pollenAllergies are a common chronic disorder that affect about 50 million Americans. They afflict people of all ages, often beginning in childhood or young adult years. They can be seasonal or perennial (year-round), depending on the offending allergens.

How are Allergies Treated?

Many allergy sufferers self-medicate such with over-the-counter medications such as antihistamine pills or decongestants. While these can be helpful for some, they may not adequately treat a patient's specific symptoms. Prescription medications, such as nasal sprays and eye drops, can be useful for many who have persistent symptoms.

Why Allergy Testing?

It can be useful to know what you are allergic to in order to decrease exposure through avoidance and environmental modification. Allergy skin testing is a quick and painless way to determine which allergens you might be sensitive to. These results can also be used to specifically treat those offending allergens with immunotherapy.

What is Immunotherapy?

Immunotherapy, or allergy desensitization, is a treatment in which patients are exposed to their most significant allergens in order to desensitize their immune system to those allergens. Rather than treat the symptoms with medications, immunotherapy actually eliminates the underlying allergy. Increasing doses of the allergen are administered over time to induce tolerance. Typical treatment length is three to five years, and immunity is usually maintained for several more years.

Subcutaneous Immunotherapy

Traditional allergy shots induce the immune system to fight allergies safely, effectively, and naturally. Beginning with small doses and increasing gradually on a weekly basis, the therapy continues until a maintenance level is achieved. The maintenance dose is then injected on a less frequent basis. This therapy is usually covered by insurance.

Sublingual Immunotherapy

Sublingual immunotherapy (SLIT) is a newer method for treating allergies where drops of the allergen solution are placed under the tongue daily. They have been shown to be as effective as shots, but without the needles. They are also safer than shots, allowing the drops to be given at home without having to come to the clinic. While SLIT is not FDA-approved (off-label) and, therefore, not covered by insurance, the cost is reasonable and preferred by many patients.

Allergy Overview

What is allergy?

Allergy is a physiological reaction caused when the immune system mistakenly identifies a normally harmless substance as damaging to the body.

Normally, the human body defends itself against harmful substances, such as viruses or bacteria, but sometimes the defenses aggressively attack usually innocuous substances, such as dust, mold, or pollen.

The immune system generates large amounts of the antibodies called immunoglobin E (IgE), a complex chemical weapon, to attack and destroy the supposed enemy. Each IgE antibody specifically targets a particular allergen—the substance that causes the allergy. In this disease-fighting process, inflammatory chemicals like histamines, cytokines, and leukotrienes are released or produced, and some unpleasant (and, in extreme cases, life-threatening) symptoms may be experienced by an allergy-prone person.

What are allergic reactions?

An allergic reaction may occur anywhere in the body, in the skin, eyes, lining of the stomach, nose, sinuses, throat, and lungs—places where immune system cells are located to fight off invaders that are inhaled, swallowed, or come in contact with the skin. Reactions may result in:

  • Rhinitis (nasal stuffiness, sneezing, nasal itching, nasal discharge, itching in ears or roof of mouth)

  • Allergic conjunctivitis (red, itchy, watery eyes)

  • Atopic dermatitis (red, itchy, dry skin)

  • Urticaria (hives or itchy welts)

  • Contact dermatitis (itchy rash)

  • Asthma (airway problems, such as shortness of breath, coughing, wheezing)

What causes allergic reactions?

Although hundreds of ordinary substances could trigger allergic reactions, the most common triggers—called allergens—include:

  • Pollens

  • Molds

  • Household dust, dust mites and their waste

  • Animal protein (dander, urine, oil from skin)

  • Industrial chemicals

  • Foods

  • Medicines

  • Feathers

  • Insect stings

  • Cockroaches and their waste

  • Latex

Who is affected by allergy?

Allergies can affect anyone, regardless of age, gender, race, or socioeconomic status. Generally, allergies are more common in children. However, a first-time occurrence can happen at any age, or recur after many years of remission.

There's a tendency for allergies to occur in families, although the exact genetic factors that cause it aren't yet understood. In susceptible people, factors, such as hormones, stress, smoke, perfume, or other environmental irritants, may also play a role. Often, the symptoms of allergies develop gradually over a period of time.

Allergy sufferers may become so accustomed to chronic symptoms, such as sneezing, nasal congestion, or wheezing, that they don't consider their symptoms to be unusual. Yet, with the help of an allergist, these symptoms can usually be prevented or controlled and quality of life greatly improved.

How is allergy diagnosed?

In addition to performing a clinical examination and taking a medical history, your health care provider may also use:

  • Skin test. The skin test is a method of measuring the patient's level of IgE antibodies to specific allergens. Using diluted solutions of specific allergens, the health care provider either injects the patient with the solutions, or applies them to a small scratch or puncture. Reaction appears as a small red area on the skin. Reaction to the skin test doesn't always mean that the patient is allergic to the allergen that caused the reaction.

  • Blood test. The blood test is used to measure the patient's level of IgE antibodies to specific allergens. One common blood test is called RAST (radioallergosorbent test).

What is the treatment for allergy?

Specific treatment for allergy will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Allergies and the Immune System

Allergies are disorders of the immune system. Most allergic reactions are a result of an immune system that responds to a "false alarm." When a harmless substance such as dust, mold, or pollen is encountered by a person who is allergic to that substance, the immune system may react dramatically by producing antibodies that "attack" the allergen (a substance that produces allergic reactions). The result of an allergen entering a susceptible person's body may include wheezing, itching, runny nose, watery or itchy eyes, and other symptoms.

What is the immune system?

The purpose of the immune system is to keep infectious microorganisms, such as certain bacteria, viruses, and fungi, out of the body, and to destroy any infectious microorganisms that do invade the body. The immune system is made up of a complex and vital network of cells and organs that protect the body from infection.

The organs involved with the immune system are called the lymphoid organs, which affect growth, development, and the release of lymphocytes (a certain type of white blood cell). The blood vessels and lymphatic vessels are important parts of the lymphoid organs, because they carry the lymphocytes to and from different areas in the body. Each lymphoid organ plays a role in the production and activation of lymphocytes. Lymphoid organs include:

  • Adenoids (two glands located at the back of the nasal passages)

  • Appendix (a small tube that is connected to the large intestine)

  • Blood vessels (the arteries, veins, and capillaries through which blood flows)

  • Bone marrow (the soft, fatty tissue found in bone cavities)

  • Lymph nodes (small organs shaped like beans, which are located throughout the body and connect via the lymphatic vessels)

  • Lymphatic vessels (a network of channels throughout the body that carries lymphocytes to the lymphoid organs and bloodstream)

  • Peyer's patches (lymphoid tissue in the small intestine)

  • Spleen (a fist-sized organ located in the abdominal cavity)

  • Thymus (two lobes that join in front of the trachea behind the breast bone)

  • Tonsils (two oval masses in the back of the throat)

Disorders of the immune system

When the immune system does not function properly, it leaves the body susceptible to an array of diseases. Allergies and hypersensitivity to certain substances are considered immune system disorders. In addition, the immune system plays a role in the rejection process of transplanted organs or tissue. Other examples of immune disorders include:

  • Cancer of the immune system

  • Autoimmune diseases, such as juvenile diabetes, rheumatoid arthritis, and anemia

  • Immune complex diseases, such as viral hepatitis and malaria

  • Immunodeficiency diseases, such as acquired immune deficiency syndrome (AIDS)

How does a person become allergic?

Allergens can be inhaled, ingested, or enter through the skin. Common allergic reactions, such as hay fever, certain types of asthma, and hives are linked to an antibody produced by the body called immunoglobulin E (IgE). Each IgE antibody can be very specific, reacting against certain pollens and other allergens. In other words, a person can be allergic to one type of pollen, but not another. When a susceptible person is exposed to an allergen, the body starts producing a large quantity of corresponding IgE antibodies. Subsequent exposure to the same allergen may result in an allergic reaction. Symptoms of an allergic reaction will vary depending on the type and amount of allergen encountered and the manner in which the body's immune system reacts to that allergen.

Allergies can affect anyone, regardless of age, gender, race, or socioeconomic status. Generally, allergies are more common in children. However, a first-time occurrence can happen at any age, or recur after many years of remission. Allergies tend to run in families. Hormones, stress, smoke, perfume, or environmental irritants may also play a role in the development or severity of allergies.

What is anaphylactic shock?

Anaphylactic shock, also called anaphylaxis, is a severe, life-threatening reaction to certain allergens. Body tissues may swell, including tissues in the throat. Anaphylactic shock is also characterized by a sudden drop in blood pressure. The following are the most common symptoms of anaphylactic shock. However, each individual may experience symptoms differently. Other symptoms may include:

  • Itching and hives over most of the body

  • Swelling of the throat and tongue

  • Difficulty breathing

  • Dizziness

  • Headache

  • Stomach cramps, nausea, or diarrhea

  • Shock

  • Loss of consciousness

Anaphylactic shock can be caused by an allergic reaction to a drug, food, serum, insect venom, allergen extract, or chemical. Some people who are aware of their allergic reactions or allergens carry an emergency anaphylaxis kit that contains epinephrine (a drug that stimulates the adrenal glands and increases the rate and force of the heartbeat).

Treatment for Allergy

How are allergies treated?

Specific treatment for allergies will be determined by your doctor based on:

  • Your overall health and medical history

  • Extent of the allergic disease

  • Your tolerance for specific medications

  • Expectations for the course of the allergic disease

  • Your opinion or preference

The three most effective ways to treat allergies are avoidance, immunotherapy, and medication.

What is avoidance?

Avoidance is staying away from a substance that causes an allergic reaction.

Suggestions for avoiding (some) allergens:

  • Remain indoors:

    • When the pollen count is high

    • On windy days

  • Dust proof the home, particularly the bedroom.

    • Eliminate, when possible: wall-to-wall carpet, Venetian blinds, down-filled blankets or pillows, closets filled with clothes.

    • Wash bedding, curtains, and clothing often and in hot water to eliminate dust mites.

    • Keep bedding in dust covers when possible.

  • Use air conditioning instead of opening the windows.

  • Consider putting a dehumidifier in damp areas of the home, but remember to clean it often.

  • Wear face masks when working in the yard.

  • Go on vacation to the sea shore during the heaviest part of the pollen season.

Your doctor will also have suggestions for avoiding the allergens that cause reactions.

What is immunotherapy (allergy shots)?

Immunotherapy is a type of treatment for allergic patients with rhinitis (hay fever), conjunctivitis, or asthma, or for patients with stinging insect allergy. It is also called desensitization, hyposensitization, and allergy shots. A mixture of the various pollens, mold spores, animal danders, and dust mites to which the patient is allergic is formulated. This mixture is called an allergy extract (vaccine). By administering increasing doses of the allergy extract, the person's natural immune system is enhanced and learns to fight off the allergens. This extract contains no medication such as antihistamines or corticosteroids.

How is immunotherapy administered?

Immunotherapy is given by injection under the skin usually into the fatty tissue in the back of the arm. It is not painful like an injection into the muscle such as a penicillin shot.

How often are immunotherapy injections necessary?

Injections may be given weekly or twice a week until a maximum dose is tolerated. This is called the maintenance dose. It may take about one year to reach the maintenance dose. At this point, the frequency of injections may be decreased to every other week and finally to once a month. Your doctor will establish the appropriate schedule of injections to meet your medical needs.

Symptom improvement and immunotherapy

About 80 to 90 percent of patients improve with immunotherapy. It usually takes from 12 to 18 months before definite reduction in allergy symptoms is noticed. In some patients, a reduction in symptoms is evident in as soon as six to eight months.

Immunotherapy is only part of the treatment plan for allergic patients. Since it takes time for immunotherapy to become effective, you will need to continue the allergy medications, as prescribed by your doctor. It is also important to continue eliminating allergens (such as dust mites) from your environment.

Are there side effects to immunotherapy?

There are two types of reactions to immunotherapy: local and systemic. The local reaction is redness and swelling at the injection site. If this condition occurs repeatedly, then the extract strength or schedule is changed.

A systemic reaction is one that involves a different site, not the injection site. The symptoms may include nasal congestion, sneezing, hives, swelling, wheezing, and low blood pressure. Such reactions can indeed be serious and life threatening. However, deaths related to immunotherapy are rare. If a systemic reaction occurs, the patient may continue taking shots, but of lower dosage.

If you have any questions concerning immunotherapy, always consult your doctor or allergist.

Medication as treatment for allergy

For people who suffer from allergies, there are many effective medications. This is a brief overview of the most commonly used types of medications. The American Academy of Pediatrics recommends against some over-the-counter medicines for infants and young children. Always consult your doctor before taking any over-the-counter medications.

What are antihistamines?

Antihistamines are used to relieve or prevent the symptoms of allergic rhinitis (hay fever) and other allergies. Antihistamines prevent the effects of histamine, a substance produced by the body during an allergic reaction. Antihistamines come in tablet, capsule, liquid, nasal sprays or drops, eye drops, or injection form and are available both over-the-counter and by prescription.

What are decongestants?

Decongestants are used to treat nasal congestion and other symptoms associated with colds and allergies. Decongestants cause the blood vessels to narrow, thus, leading to the clearing of nasal congestion. Decongestants are available both over-the-counter and by prescription. The most commonly used forms are liquid and tablet. However, nose sprays or drops may be prescribed by your doctor. The American Academy of Family Physicians does not recommend decongestants for children ages 4 and younger.

What are types of medications used for asthma and respiratory symptoms resulting from an allergic reaction?

The use of medications for asthma or respiratory symptoms from allergies is highly individualized based on the severity of the symptoms. The following are the most commonly used medications:

  • Bronchodilators. These medications are used to help open the narrowed lungs and may relieve coughing, wheezing, shortness of breath or difficulty in breathing. These are usually considered "rescue medications" for acute attacks of asthma. Types of bronchodilators are beta-agonists, theophylline, and anticholinergics. These medications come inhaled, in pill form, liquid or injectables.

    The short-acting bronchodilators are used as needed as symptoms occur. Longer-acting bronchodilators may be used for maintenance or on a daily basis to help control flare-ups from occurring.

  • Anti-inflammatory medications. These medications help to decrease the inflammation that occurs in the airways with asthma. These include two types of medications:

    • Nonsteroidal anti-inflammatory medications. Cromolyn and nedocromil are two types of nonsteroidal medications that are usually inhaled.

    • Corticosteroids. These medications can be given in a variety of ways. Some of them are inhaled, while others may be taken as a pill or liquid, or even injected. The steroids taken by mouth can have more side effects than those that are inhaled. Talk with your doctor about the best choice.

  • Anti-leukotrienes. These are a relatively new type of medication being used to help control the symptoms of asthma. These medications help to decrease the narrowing of the lung and to decrease the chance of fluids in the lungs. These are usually given by mouth.

  • Anti-IgE antibody. Omalizumab, a monoclonal antibody that attacks an immunoglobulin associated with allergic reactions, can be used for severe asthma attacks in adults and children age 12 and over.

Consult your doctor for more information before taking any allergy medications.

Kelly McGuire, PA-C

Ms. McGuire is originally from a small town in southern Indiana. Her undergraduate training was completed at Purdue University where she received a bachelor’s degree in health science. She then received a master’s in medical science for her physician assistant studies from Midwestern University in Arizona. Pr... Read More

Specialties:

Allergy, General Otolaryngology ENT, Otolaryngology, Head & Neck Surgery, Otology, Physician Assistant

Locations:

South Jordan Health Center (801) 213-4500
University Hospital (801) 587-8368

Christine M. Packard, PA-C

Ms. Packard is originally from Pensacola, Florida. She completed her undergraduate training at the University of Florida and her graduate training as for physician assistant studies was completed at Texas Tech University Health Sciences Center. She stayed at Texas Tech and worked as a physician assistant in the ... Read More

Specialties:

Allergy, General Otolaryngology ENT, Non-Dermatology Allergy, Otolaryngology, Head & Neck Surgery, Physician Assistant, Sinus and Rhinology

Locations:

Redstone Health Center (801) 581-2955
University Hospital (801) 587-8368

Kevin F. Wilson, M.D.

Kevin F. Wilson, M.D., is a board-certified physician specializing in otolaryngology and head and neck surgery. Dr. Wilson received his medical degree from Washington University’s School of Medicine. He is a member of the American Academy of Otolaryngology and a Fellow of the American Academy of Otolaryngic Alle... Read More

Specialties:

Allergy, General Otolaryngology ENT, Hereditary Hemorrhagic Telangiectasia, Otolaryngology, Head & Neck Surgery, Pediatric Allergy, Sinus and Rhinology, Thyroid

Locations:

South Jordan Health Center (801) 213-4500
University Hospital (801) 587-8368
University Hospital
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South Jordan Health Center 5126 W. Daybreak Parkway
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