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 are allergies?

Allergies are problems of the immune system. Most allergic reactions happen when the immune system reacts to a “false alarm.” Normally, the human body defends itself against harmful things, such as viruses or bacteria. But sometimes the defenses violently attack mostly mild things, such as dust, mold, or pollen.

The immune system makes large amounts of the antibodies called immunoglobin E (IgE). This is a complex chemical weapon that attacks and kills the “enemy.” Each IgE antibody exactly targets a certain allergen or thing that causes the allergy. In this way, inflammatory chemicals, such as histamines, cytokines, and leukotrienes, are made and given off. This causes an allergic person to feel some bad or even life-threatening symptoms.

What causes allergies?

Allergens are substances that can be breathed, swallowed, or come in contact with the skin. Common allergic reactions, such as hay fever, certain types of asthma, and hives, are linked to an antibody made by the body. This antibody is called immunoglobulin E or IgE. You can be allergic to one type of pollen, but not another. When you are exposed to an allergen, your body starts making a large amount of matching IgE antibodies. When exposed to the same allergen at a later point, you may have a reaction. Symptoms of an allergic reaction will differ based on the type and amount of allergen you have come in contact with. It also depends on how the body’s immune system reacts to that allergen.

The most common allergens are:

  • Pollen
  • Mold
  • Household dust, dust mites and their waste
  • Animal dander, urine, or oil from skin
  • Chemicals used for manufacturing
  • Food
  • Medicine
  • Feathers
  • Bug stings
  • Cockroaches and their waste
  • Latex

Who is at risk for allergies?

Allergies can affect anyone, no matter what age, gender, race, or socioeconomic status. Often, allergies are more common in children. But a first-time event can happen at any age, or come back after many years of remission.

There’s a tendency for allergies to happen in families. Although the exact family links that cause it aren’t yet understood. In sensitive people, things such as hormones, stress, smoke, perfume, or other environmental irritants, may also play a role. Often, the symptoms of allergies grow slowly over a period of time.

You may become used to constant symptoms, such as sneezing, nasal congestion, or wheezing. You may not think that the symptoms are unusual. But, these symptoms can often be stopped or controlled with the help of a doctor who specializes in treating allergies. And you can have a better quality of life.

What are the symptoms of allergies?

An allergic reaction can happen anywhere in the body. This includes the skin, eyes, lining of the stomach, nose, sinuses, throat, and lungs. These are the places where immune system cells are found to fight off germs that are in breathed in, swallowed, or come in contact with the skin. Allergic reactions can cause:

  • Stuffy nose, sneezing, itching, or runny nose, and itching in ears or roof of mouth
  • Red, itchy, watery eyes
  • Red, itchy, dry skin
  • Hives or itchy welts
  • Itchy rash
  • Asthma symptoms, such as shortness of breath, coughing, wheezing

How are allergies diagnosed?

To diagnose an allergy, your healthcare provider will give you an exam and review your health history. He or she may also do these tests.

  • Skin test. The skin test is a way of measuring the level of IgE antibodies to certain allergens. Using diluted solutions of certain allergens, the healthcare provider either gives you a shot with the solutions or puts them directly on your skin by making a scratch or small puncture. A small red area on the skin means that you have had a reaction.
  • Blood test. The blood test is used to measure the level of IgE antibodies to specific allergens. One common blood test is called radioallergosorbent test or RAST. Newer tests have been developed that may be better than RAST. Ask your doctor about all available allergy blood  tests.

How are allergies treated?

Your healthcare provider will figure out the best treatment for you based on:

  • Your age
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medications, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

The symptoms of allergy sometimes look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

Allergy shots or immunotherapy and medicine are effective ways treat allergies.

Allergy shots. Allergy shots or immunotherapy is treatment for people who have rhinitis (hay fever), conjunctivitis, or asthma. It is also used for people with a stinging bug allergy. A mixture of the many allergens to which you are allergic is made. It is injected into your arm on a weekly basis until a maximum dose is reached.

Most people get better with allergy shots. It often takes from 12 to 18 months before you notice a clear reduction in allergy symptoms. In some people, a reduction in symptoms is evident in as soon as 6 to 8 months.

Allergy shots are only part of the treatment plan for people with allergies. Since it takes time for allergy shots to become effective, you will need to stay on the allergy meds, as prescribed by your heathcare provider. It is also important to keep getting rid of allergens (such as dust mites) from your surroundings.

Medicine. For people who suffer from allergies, there are many medicines that work well. Antihistamines are used to calm or stop the symptoms of allergic rhinitis (hay fever) and other allergies. Decongestants are used to treat stuffiness in the nose and other symptoms linked to colds and allergies. The use of medicines for asthma or breathing symptoms from allergies is tailored for each person based on the severity of the symptoms.

Talk with your healthcare provider for more information about allergy medicines.

What are the complications of allergies?

Anaphylactic shock or anaphylaxis can happen in extreme cases. Anaphylaxis is a serious, life-threatening reaction to certain allergens. Body tissues may swell, including tissues in the throat. It can also cause a sudden drop in blood pressure. These are the most common symptoms of anaphylaxis:

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

Anaphylaxis can be caused by an allergic reaction to a drug, food, serum, bug venom, allergen extract, or chemical. Some people who are aware of their allergic reactions or allergens carry epinephrine. This drug can counteract many of the complications of anaphylaxis, as it can cause the circulation to improve by helping the dilated blood vessels constrict and open up the airways in the lungs. It also increases the rate and force of the heartbeat.

Living with allergies

Avoidance is a very effective way to treat allergies. Ideas for avoiding allergens are:

  • Stay indoors when the pollen count is high and on windy days.
  • Dust-proof your home, particularly the bedroom.
    • When possible, get rid of carpeting, Venetian blinds, down-filled blankets or pillows, closets filled with clothes.
    • Wash bedding, curtains, and clothing often in hot water to get rid of dust mites.
    • Keep bedding in dust covers when possible.
  • Use air conditioning instead of opening the windows.
  • Put a dehumidifier in damp parts of the home, but remember to clean it often.
  • Wear face masks when working in the yard.
  • Go on vacation by the beach during the heaviest part of the pollen season.

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

Key points about allergies

  • Allergy is a reaction caused when the immune system mistakenly thinks a normally harmless substance is damaging to the body.
  • Allergens can be breathed, swallowed, or enter through the skin.
  • Allergies can affect anyone, no matter what age, gender, race, or socioeconomic status.
  • Allergies tend to happen in families. Although the exact family links that cause it aren’t yet understood.
  • Allergic reactions may cause:
    • Stuffy nose, sneezing, itching, or runny nose, and itching in ears or roof of mouth
    • Red, itchy, watery eyes
    • Red, itchy, dry skin
    • Hives or itchy welts
    • Itchy rash
    • Asthma problems, such as shortness of breath, coughing, and wheezing
  • The most effective ways to treat allergies are avoidance, allergy shots, and medicine.
  • Anaphylaxis can happen in extreme cases.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Allergies and the Immune System

Allergic disease is one of the most common chronic health conditions in the world. People with a family  history of allergies have an increase risk of developing allergic disease. Hay fever (allergic rhinitis), eczema, hives, asthma, and food allergy are some types of allergic diseases. Allergy symptoms can range from mild to a serious, life-threatening allergic reaction (anaphylaxis).

Allergic reactions begin in your immune system. 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 over react by producing antibodies that "attack" the allergen. The can cause wheezing, itching, runny nose, watery or itchy eyes, and other symptoms.

What is the immune system?

The purpose of the immune system is to defend itself and keep 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. They affect growth, development, and the release of lymphocytes (a type of white blood cell). The blood vessels and lymphatic vessels are important parts of the lymphoid organs. 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)

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 similar IgE antibodies. The next 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.  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 person may experience symptoms differently. Other symptoms may include:

  • Itching and hives over most of the body

  • Feeling warm

  • Swelling of the throat and tongue or tightness in throat

  • Difficulty breathing or shortness of breath

  • Dizziness

  • Headache

  • Pain or cramps

  • Nausea, vomiting, or diarrhea

  • Shock

  • Loss of consciousness

  • Feeling light-headed

  • Anxiety

  • Abnormal heart rate (too fast or too slow)

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 injectable epinephrine (a drug that stimulates the adrenal glands and increases the rate and force of the heartbeat).

Treatment for Allergy

How are allergies treated?

Your  healthcare provider will figure out the best treatment based on:

  • How old you are

  • Your overall health and medical history

  • How sick you are

  • How well you can handle specific medicines, procedures, or therapies

  • Your opinion or preference

The  most effective ways to treat allergies are avoidance, allergy immunotherapy, and medicine.

What is avoidance?

Avoidance is staying away from a substance (allergens) that causes an allergic reaction. Wash out your nose every day to decrease symptoms of airborne allergens. Ask your healthcare provider on the best device or method to use to wash out your nose.

Suggestions for avoiding (some) allergens

  • Stay indoors when the pollen count is high and on windy days

  • Dust proof your home, particularly the bedroom.

    • Get rid of wall-to-wall carpet, Venetian blinds, down-filled blankets or pillows, and closets filled with clothes when possible.

    • 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.

Your doctor will also have suggestions for other ways to avoid allergens.

What is allergy immunotherapy (allergy shots)?

Allergy immunotherapy is a type of treatment for people with allergic rhinitis (hay fever), conjunctivitis (eye allergy), or allergic asthma, or for people with stinging insect allergy. It is also called desensitization, hyposensitization, and allergy shots. It uses an individualized mixture of the various pollens, mold spores, animal danders, and dust mites that you are allergic to. This mixture is called an allergy extract. It acts similar to a vaccine. Increasing doses of the allergy extract boosts your natural immune system and it learns to fight off the allergens. This extract contains no medicine.

How is allergy immunotherapy administered?

Allergy immunotherapy is given by injection usually into the fatty tissue in the back of your arm.

How often are allergy immunotherapy injections necessary?

You may get Injections 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 go down to every other week and finally to once a month. Allergy immunotherapy injections may be needed up to 5 years or longer. Your doctor will set the schedule and the length of time needed for immunotherapy injections.

Symptom improvement and allergy immunotherapy

About 80% to 90% of people improve with allergy immunotherapy. But, it usually takes from 12 to 18 months before you notice symptom relief.  Some people have symptom relief as soon as 6 to 8 months.

Immunotherapy is only part of the treatment plan for people with allergies. Since it takes time for allergy immunotherapy to become effective, you will need to continue the allergy medicines, as prescribed by your doctor. It is also important to continue keeping allergens (such as dust mites) out of your environment.

Are there side effects to allergy immunotherapy?

There are 2 types of reactions to allergy 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 be serious and life threatening. However, deaths related to allergy immunotherapy are rare. If a systemic reaction occurs, you may keep taking shots, but of lower dosage.

If you have any questions about immunotherapy, always see your healthcare provider or allergist. 

Medicines used to treat allergy

The use of medicines for asthma or respiratory symptoms from allergies are individualized based on your symptoms. These are the most commonly used medicines:

  • Antihistamines. These 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. Contact your healthcare provider for advice before taking this medicine.

  • Decongestants. These help ease swelling and congestion in the nose. They come in pills and nasal sprays or drops. Don't use nasal sprays for more than 3 days or it can worsen your symptoms. The American Academy of Family Physicians does not recommend decongestants for children ages 4 and younger.

  • Corticosteroids

    • Nasal. This type of medicine reduces swelling in the nose. It comes as a spray.

    • Creams or ointments: These help stop itching and rashes from spreading on the body.

    • Oral (by mouth). This type of medicine decrease swelling and helps to stop serious allergic reactions.

  • Mast cell stabilizers. This medicine helps stop the release of  histamines from the body. Histamine causes itching, swelling, and mucus production.

  • Cromolyn. This medicine is used to stop nasal symptoms caused by allergies. It is an anti-inflammatory (decrease swelling).

  • Epinephrine. This self-injectable medicine is given within minutes of a serious allergic reaction. Epinephrine is the most effective treatment to give during an "anaphylaxis" reaction. Call 911 immediately.

 

The American Academy of Pediatrics recommends against some over-the-counter medicines for children. Talk to your child's doctor before giving any over-the counter medicine to your child. Always contact your child's doctor before starting or stopping any allergy or asthma medicines.

  

Jeremiah Alt, M.D., Ph.D.

Patient Rating:

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Dr. Alt’s clinical practice is focused on sinus and nasal diseases including management of acute and chronic sinusitis, polyps, allergy, septal deviation, growths and tumors of the sinuses and skull base, and cerebrospinal fluid (CSF) leaks. Dr. Alt works with a large multi-disciplinary team that consists of neurosurgeons, neuroradiologists, head ... Read More

Aaron K. Kobernick, M.D., M.P.H.

Aaron Kobernick, MD, MPH is an allergist and immunologist with focus on care of allergic disease in patients of all ages.  He is especially interested in care of mild, moderate and severe asthma in adults and children, including population management, air quality, and identifying allergic triggers in the home and in school/work.  He also treats eos... Read More

Kelly McGuire Trythall, PA-C

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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. Prior to moving to Utah, Ms. McGuire li... Read More

Specialties:

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

Locations:

Redstone Health Center (801) 587-8368
University Hospital
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Loida Viera-Hutchins, M.D.

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Dr. Viera-Hutchins received her medical degree from Tulane University School of Medicine, completed her Internal Medicine Residency at Yale New-Haven Hospital, and her fellowship training in Adult and Pediatric Allergy and Immunology at University of California Los Angeles. She worked in private practice in Allergy and Immunology for 3 years follow... Read More

Kevin F. Wilson, M.D.

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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 Allergy, having received advanced trainin... Read More

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