Oral Allergy Syndrome: Why does my mouth itch when I eat certain fruits, nuts and vegetables?

Summer is the season when New Yorkers tend to eat more fruits. Certain fruits, vegetables and nuts can cause oral itching and other symptoms in people with various pollen allergies, particularly tree pollen. The symptoms, which may also include nasal, eye and even gastrointestinal symptoms, usually occur within minutes of eating the food. Rarely, the food exposure can result in anaphylaxis, a more generalized life-threatening reaction marked by low blood pressure, hives and wheezing. Read more

Exercise-Induced Bronchospasm: Cause and Treatment

In the summer, we are outdoors—and hopefully exercising—more often. About 10% of people who exercise will get exercise-induced bronchospasm (EIB). Symptoms may include wheezing, excessive shortness of breath, chest tightness, or just coughing beginning 5 to 10 minutes after exercise. EIB occurs most frequently in persons with asthma, particularly those whose asthma is not well controlled. Various studies show that up to 90% of people with asthma have EIB. But it can also occur in isolation—in a person without asthma. Read more

Tree Pollens: Why May Is Allergy and Asthma Awareness Month

Pollens — the microscopic plant particles that cause seasonal allergies in many people — come from three general types of plants: trees, grasses and weeds. In general, trees pollinate in the late winter/early spring; grasses often overlap the trees at the end of their season and extend late into the summer; and ragweed, the most important of allergenic weeds, starts pollenating in mid-August through September. Read more

Indoor Allergies: Should I Bathe My Cat?

This is the second in a series on indoor allergies—of which cats are common culprits. For people allergic to cats, the major allergen (substance that causes an allergic reaction) is found in the cat’s saliva, urine and dander (dried flakes of skin).

How can I reduce cat allergen in my house?

The most effective way is to rid the house of the cat. This is not acceptable to most people, and after pet removal, the allergen will remain in the house for 6 months or more.  The second choice might be to keep the cat outside, which is not possible in certain climates. And, if the outdoor cat is played with, the sticky allergen makes its way into the house anyway.

What about bathing my cat?

Studies have shown that washing a cat can reduce the amount of allergen on it (the allergen is mostly in cat saliva, and is transferred to the fur by licking). Based on scientific studies, twice weekly washing would be required—and a lot of rinsing, too—so this is not very feasible, nor favored by cats. Perhaps a Cleopatra-style bath (milk bath) would be acceptable to the cat!

What are some other options to reduce cat allergen?

• Removing reservoirs for the allergen, such as carpets, sofas and other upholstered furniture

• Using vacuum cleaners with effective filtration systems

• Installing HEPA-type air filters in rooms, particularly the bedroom

• Increasing ventilation in the house

Is there anything else I can do?

I like to recommend making the bedroom (where we spend most of our indoor time) a “cat-free zone.” After the room is closed off to the cat, it should be cleaned thoroughly, including damp mopping the sticky allergen off the walls, and cleaning window treatments and bedding. After this cleaning, the cat cannot reenter the room (ever), otherwise the allergen level will increase. This means the door to the room needs to remain closed at all times. But, cats are sneaky, so this is not so readily accomplished.

Stay tuned for more information on indoor allergies.

To find an allergist who is right for you, please call the Physician Referral Service at 1 (866) 804-1007 Monday through Friday, 9 am to 5 pm.

‘Tis the Season to Be Sneezin’ and Wheezin’: Dust Mite Allergy

Nasal allergy symptoms (rhinitis) and asthma caused by allergens that are inhaled usually have seasonal patterns. While symptoms from various pollens occur in the spring, summer or late summer/fall, nasal allergy symptoms in fall and winter are due mainly to indoor inhalants and also usually seasonal. But in the case of indoor allergens, this seasonal pattern is the result of spending more time indoors in these months, with the windows closed and heat on, leading to both increased exposure times and increased levels of indoor allergens.

Dust mites—microscopic insect critters that live in our bedding—are the most important culprit among the indoor allergens causing allergic disease. Our pillows and mattresses are loaded with them. When you buy a new mattress that weighs, say, 100 pounds, it will weigh 102 pounds within a couple of years. That extra 2 pounds are from the accumulation of living and dead dust mites and their droppings. Fortunately, dust mites do not bite, though in addition to their role in causing nasal allergy and asthma, they probably also contribute to flares of eczema in certain patients.

Why Dust Mites Love Us

The diet of a mite consists mainly of human skin scales, of which we shed a lot in the course of a day. This is why they love our bedding.

The life cycle of dust mites is related to humidity. They love the humid days of summer and proliferate wildly. Then, when the heat goes on indoors in autumn, the humidity falls and they die off, leaving additional particulate matter to breath in.

If you want to read some of the scientific research on dust mites, Google the name “Thomas Platts-Mills,” who is a world expert on mites and gives very entertaining lectures on the subject.

Diagnosis

There is no way to know if one is allergic to dust mites without being tested. If you tested positive to “house dust” years ago (a test most allergists don’t do anymore), you should be tested again. Since house dust is a mixture of dust mites, animal dander, insect material and other dusts, allergy to any of these components would have resulted in a positive house dust test. Today, we test for the individual components of house dust.

Treatment

1. The treatment for dust mite allergy is, first and foremost, avoidance.

Bedding ­– Various companies market breathable covers that seal the bedding. Mite covers have even been shown to reduce the risk of developing asthma for children born into families with a history of allergic disease.

Humidity – The use of humidifiers in most houses in winter is not recommended, as it encourages mite growth. Optimal humidity in the home of someone with respiratory illness is in the 30% to 40% range; most homes are within that range or higher in winter. If you are not sure, you can measure it with a hygrometer.

2. The second line of treatment is medication for the symptoms of rhinitis, asthma or eczema. These include various combinations of prescription and over-the-counter medications, including pills, nasal sprays, eye drops and, in the case of eczema, creams and ointments. Antihistamines (ocular and oral) are the only medications for rhinitis that are available over the counter without a prescription. Any over-the-counter medications for asthma should be avoided, particularly Primatene, which is not very safe.

3. For patients who do not respond sufficiently to the above measures, or those wishing to reduce their use of medications, immunotherapy (allergy injections) might be in order.

I hope your holiday season is happy, and that you can avoid the sneezin’ and wheezin’!

To find an allergist who is right for you, please call the Physician Referral Service at 1 (866) 804-1007 Monday through Friday, 9 am to 5 pm.

Asthma in the Fall and Winter

I guess Santa doesn’t have asthma, since in all likelihood he would have missed some Christmases given the rates of exacerbation for asthma during the fall and winter. Santa would especially be vulnerable during this worse time of year for most asthmatics since he rides around on a sleigh in frigid arctic air and climbs down a smoke-filled chimney. Santa also laughs a lot (ho-ho-ho). When we laugh (or cry) we breathe in and out rapidly, and our lung airways cool off and cooling of the airways causes asthma. And Santa has been dealing with all these triggers long before asthma controller medications were available! That being said, let’s discuss what the average asthma patient can do to prevent exacerbations of asthma during the fall and winter.

Before we begin, keep in mind that if your asthma is well controlled and/or you are on the appropriate level of controller medications, then you should mostly be fine. There also is a role of the rescue inhaler in preventing some of these triggers, but this should be discussed with the physician who takes care of your asthma. I cannot emphasize enough the need to be clear about the role of your controller medications and rescue inhalers.

On to the cool weather triggers:

Trigger 1: Cold Air

Cooling of the airways of the lung results in bronchoconstriction (narrowing), which leads to shortness of breath and wheezing.

Cold Air Strategies

* Try to avoid real frigid cold air as much as possible, or cover your nose and mouth with a scarf.

* Avoid exercising outdoors in cold air, unless your physician feels your asthma is adequately controlled. Your doctor may recommend you use a rescue inhaler prior to exercise in cold air. But this decision rests with your doctor.

* Keep your rescue inhaler with you whenever you are outside, in any season.

 

Trigger 2: Indoor Smoke and Fumes

Fumes and odors can trigger asthma (especially if the asthma is not well controlled).

Smoke and Fume Strategies

The fumes and odors peculiar to this season that should be avoided include:

* Fireplace smoke.

* Woodstove smoke. While not common in New York City, a lot of country folks heat their homes with woodstoves. They require frequent loading of wood and a lot of fumes escape. If you are visiting relatives over the holidays, you may encounter this.

* Indoor smokers.

* Odors from indoor plants, including Christmas trees. Probably the fake trees are a better option if there is a poorly controlled asthmatic in the house.

* Visitors wearing perfumes and bringing flowering plants and candles all can trigger asthma in the sensitive or poorly controlled asthmatic.

 

Trigger 3: Indoor Allergens

Indoor allergens are a little trickier than the others as they first have to be identified as a problem, which would require consultation with an allergy specialist and involve some sort of testing to confirm a suspicion. I will list the possible allergens but another blog post will deal with them in more detail.

Indoor Allergen Strategies

* Pets. Short of getting rid of them, which is not a realistic option for most people, you might opt for less drastic measures such as keeping pets out of the bedroom, making where you sleep a “pet-free” zone in the house.

* Cockroaches. Use extermination to keep the allergen levels as low as possible.

* Dust mites. Mite-proof encasings for the bedding can significantly reduce exposure to dust mite allergens.

* Mice can be an issue in both urban and suburban homes.

 

Trigger 4: Viral Infections

Viruses are one of the main causes of asthma exacerbations requiring emergency treatments. We are all familiar with the symptoms of a viral infection, which include sore throat, runny nose, fever, headache and cough. Influenza is but one of many viruses that cause illness in the fall and winter. The diagnosis of influenza can only be confirmed by blood tests, but usually a presumptive diagnosis is all that is necessary.

Viral Infections Strategies

* Asthmatics should get the annual flu shot to prevent influenza, which is a more severe disease in people with asthma.

* Always wash your hands thoroughly and appropriately. Use hand sanitizer if you cannot get to running water and soap.

* Avoid exposures to large numbers of people if possible.

* Take good care of your body through proper diet, sleep and exercise, all of which contribute to a healthy immune system.

 

Best Overall Strategy: Use Your Controller Medication!

When I first went into practice taking care of asthmatics in the mid-1980s, I was truly struck by just how busy my office became in October and November. After inhaled steroids and other asthma controller medications were invented, this pattern changed, and there is no longer this extreme seasonal fluctuation in the fall. This only serves to emphasize how important controller medications are in maintaining your asthma in good control in the fall and winter.

Wishing everyone a happy and healthy holiday season!

Bruce S. Dobozin, MD, is an Allergist at Beth Israel Medical Center.

Severe Food Allergy

The ancient Roman poet and philosopher Lucretius observed, “What is food to one is to another bitter poison.” In those times, a violent food allergy was a mysterious and alarming condition. Imagine a healthy guest at a Roman banquet suddenly choking and gasping, then collapsing and dying. It’s easy to understand why many innocent survivors were suspected of poisoning the poor victims.

What Exactly is a Food Allergy?

Today, we have the benefit of recognizing food allergies. A food allergy is a reaction to a food that involves the immune system. Our immune system evolved to protect us from foreign invaders. When a bacteria that shouldn’t be in our body enters, the immune system destroys it by letting the inflammatory system do the dirty work.

Sometimes the immune system reacts against harmless things. In the case of autoimmune diseases such as lupus, the immune system reacts against its own body tissues, causing damage from the resulting inflammation. In the case of pollen allergies, affected people react to harmless pollens, again causing inflammation in the nose (rhinitis, hay fever) and in the lung (asthma). In the case of food allergy, the immune system reacts to normally harmless food proteins. Therefore, the term food allergy does not include conditions like lactose intolerance or heartburn from spicy foods.

Severe Food Allergies

I am only going to cover the most severe form of food allergy, that which causes anaphylaxis. Anaphylaxis is a reaction to something that results in a combination of symptoms including flushing, itching or hives, sneezing or runny nose, lip and/or throat swelling, difficulty swallowing, wheezing, low blood pressure, and in some cases, vomiting, abdominal cramping or diarrhea.

Anaphylaxis can be caused by foods, insect stings, medications and latex, as well as less common things. I have to emphasize that just because someone has hives or swelling of a lip does not mean it is anaphylaxis. If you have had these symptoms, you should discuss them with your doctor to better understand your reactions and how to protect yourself.

Anaphylactic Reaction

Typically an anaphylactic reaction goes something like this:

* A small amount of the offending (but normally, harmless) substance is eaten. Very soon after (seconds to minutes), the mouth itches and there is some sneezing and a little runny nose.

* A generalized itching sensation covers the body and hives appear over the next several minutes.

* There is some abdominal cramping and the person notices difficulty swallowing saliva.

* Some wheezing follows, the person feels a little light-headed (low blood pressure) and the heart races.

* The person might pass out.

This all occurs over several minutes to maybe an hour. The more allergic a person is to a substance, the quicker the reaction might be.

Common Food Allergies

This is the list of the most common foods that cause anaphylaxis in this country:

* Egg

* Fish

* Milk

* Peanut

* Crustacean shellfish

* Soy

* Tree nuts

* Wheat

* Sesame, which I have added to this list, as it is becoming a more common cause, probably a reflection of changing dietary patterns in the United States.

If you think you or a loved one might suffer from food allergies, call 866.804.1007 to find a doctor who can help.

 

Bruce S. Dobozin, MD is an attending physician at Beth Israel Medical Center in the department of medicine.