Sep 06, 2019 12:00 AM


It was early winter and Jamie Zussman was struggling with hay fever and asthma. Considering the usual culprits for such ailments were covered by snow or ice, the trigger for her symptoms was a mystery.

“I had no history of allergies or asthma prior to moving to Utah,” explained Dr. Zussman, who works as a dermatologist at University of Utah Health. “My symptoms began shortly after a pregnancy and I was curious as to whether the pregnancy could have triggered the change. However, in the following years, my symptoms returned.”

Each fall she braced for the return of her symptoms and each winter she was left questioning what the root cause could be. After two winters enduring the watery eyes, stuffy nose, and labored breathing, she realized that her pattern of ailments was probably not a coincidence and her allergic flares isolated to the winter season could be indicative of a pattern and specific trigger.

“In the spring months while most people’s asthma and hay fever were in overdrive, mine would disappear and I’d no longer need medication,” Dr. Zussman explained. “When fall and winter returned the severe allergies came along with them.”

There was one idea percolating in Jamie’s mind as to what could be the culprit. Her symptoms always seemed to align with the presence of boxelder bugs appearing in her home. As most Utahns will know, these tiny bugs find their way inside and can quickly overrun a home. Considered harmless, they are often brushed away as a nuisance. Jamie wondered however, if it could mean something more.

Ultimately, she brought this issue to her colleague, allergist Dr. Gerald Gleich.

“Jamie came to me with an idea,” recalled Dr. Gleich, who was not previously aware of sensitivities to box elder bugs.  In order to test her hypothesis, Dr. Gleich suggested that Jamie collect bugs from her home and freeze them.  In clinic, he then proceeded to formulate a solution from their parts to perform a “skin prick” test. This is a test in which a small amount of allergen is scratched on the surface of a patient’s skin to create a controlled reaction to a potential irritant.

Within one minute, Jamie’s skin began to rise and itch in the spot that had been pricked with the boxelder solution. This was considered a positive reaction showing that the bugs could be a potential trigger for her winter allergies. Three additional control subjects received skin prick tests using the same solution. No other participants reacted.

Jamie’s reaction had led to a powerful lead in the search for the cause of her allergies. In the subsequent falls, she had the exterior of her home sprayed to prevent a boxelder bug infestation. Since the initiation of spraying, Jamie has not had any asthma or allergy symptoms and has not required any antihistamines.

While Jamie’s allergy puzzle has come together, the question remains as to whether this is a more widespread issue that could be causing other’s allergies in the fall and winter months. Doctors see several patients during the winter months with unexplainable allergy flares.

There have been two previous studies that linked these bugs to asthma attacks, but they are still considered harmless bugs. The additional information provided by Dr. Zussman’s experience leads us to believe that Boxelder bugs may not be as harmless as was previously believed.

Dr. Zussman and Dr. Gleich’s findings were recently published in the Allergy and Immunology Journal of Clinical Communications. Currently, their method of using a boxelder bug serum via scratch testing is the only confirmatory procedure available for a possibly allergic reaction.

“We’d like to offer some relief to those who suffer from fall and winter asthma and allergy attacks,” said Dr. Gleich. “Luckily Jamie was a physician here at the hospital and allowed us to use her as a test subject. Through her skin reaction and her lack of  flares once she took preventative measures to eliminate box elder bugs from her home we can glean the correlation between boxelder bugs and winter allergies.”

allergies

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