Allergy and Asthma Source

Pollen Grains

From the AAAI Rhinitis Tips:
Do you have bouts of sneezing and itching, or a runny or stuffy nose that do not seem to go away? If so, you may have rhinitis.

Rhinitis is one of the most common illnesses in the United States , affecting more than 50 million people. It often coexists with other respiratory disorders, such as asthma. Rhinitis has a significant impact on the quality of life of those who suffer from it. In addition, it can contribute to other conditions such as sinus problems, ear problems, sleep problems, and learning problems. In patients with asthma, uncontrolled rhinitis seems to make asthma worse.

Allergic rhinitis
Allergic rhinitis is caused by substances that we breathe called allergens. Allergens are usually harmless substances that can cause problems only in some people. These problems are caused because the immune system of people with allergic rhinitis mistakenly identifies these substances as intruders and generates a reaction against them. During this reaction, the immune system cells release substances such as histamine and leukotrienes that cause the symptoms of allergic rhinitis; these and other substances also cause inflammation in the nasal lining that makes the nose very sensitive to irritants such as smoke and strong odors or to changes in the temperature and humidity of the air.

Causes:

1. When allergic rhinitis is caused by common outdoor allergens, such as airborne tree, grass and weed pollens or mold, it is called seasonal allergic rhinitis, or “hay fever.”
2. Allergic rhinitis is also triggered by common indoor allergens, such as animal dander (dried skin flakes and saliva), indoor mold, droppings from dust mites and cockroach particles. This is called perennial allergic rhinitis.

Symptoms

Sneezing
Stuffy nose (congestion)
Runny nose
Itching in the nose, roof of the mouth, throat, eyes and ears
Diagnosis
If you have symptoms of allergic rhinitis, an allergist/immunologist can help determine which specific allergens are triggering your illness. He or she will take a thorough health history, and then test use to determine if you have allergies. Skin tests or blood tests are the most common methods for determining your allergic rhinitis triggers.

What to Do During Pollen Season:
When outdoor pollens are high, remain indoors, particularly in the late morning. Pollen grains can cause significant allergic symptoms like asthma and allergic rhinitis, particularly during the spring and the fall. It is difficult to avoid pollen because it is windborne and can cover wide distances. Short of moving to a different location, here are some tips for avoiding pollen during the season.

1. The pollen count is usually highest in the late morning and early afternoon particularly during sunny, windy days. The pollen count measures the concentration of a specific pollen like birch tree pollen, in the area in a specific area and time. A pollen count is a useful guide for when it is advisable to stay indoors and avoid contact with pollen.
2. Keep the windows and doors closed during the allergy season.
3. Install a room air conditioner with a special filter.The special filter (High Efficiency Particulate Air or HEPA filter) traps airborne allergens. If the house does not have central air, the best spot to put the air conditioner and filter would be the bedroom. Change the filters frequently. An allergic person should also use the car air conditioner to decrease pollen exposure when commuting. Pollen allergic persons should not have a window fan blowing into their bedroom as this will maintain outdoor pollen exposure all night.
4. Avoid working outdoors, if you must wear a special face mask. The face mask is designed to filter pollen out of the air and keep it from reaching the nasal passages.
5. Consider taking a vacation at the height of the pollen season. Preferably at a location where the pollen exposure is minimal, like the seashore.

Links: Allergy Medications
Info on Allergy Shots

From MedPage Today:

Tale of a ‘Hypoallergenic’ Cat and Standby Antihistamines
	By Crystal Phend, Staff Writer, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. December 29, 2006 SAN DIEGO, Dec. 29 — Feline allergies’ nine lives may be up. A fluffy white cat named Joshua and brethren would have allergic tabby-lovers, long starved of feline companionship, believe the day of the litter box is just $3,950 away. Some allergists are skeptical. Other are taking a wait-and-sneeze approach. Joshua, now 20 months old, is touted by a company here called Allerca as “the world’s first scientifically proven hypoallergenic cat.” Others lacking a key allergenic protein have been bred since Joshua. According to the company’s Web site, “These [hypoallergenic] cats allow some of the millions of people with feline allergies to finally enjoy the love and companionship of a household pet without suffering from allergic symptoms.” Yet some skeptical allergists recommend that anyone who springs for the pricey pets keep their antihistamines at the ready. Allerca says its cats — Joshua was the index cat — are bred to not express the Fel d 1 protein that is primarily responsible for feline allergy in humans. Although Allerca says that an independently conducted exposure trial it sponsored was promising, allergists decry the lack of any published data. The small exposure study found that 10 volunteers with severe cat allergies had little or no reaction when exposed to the “genetically divergent” cats, said Ricardo A. Tan, M.D., of the California Allergy and Asthma Group in Los Angeles. He said that: Two of the participants had significant allergic symptoms with the normal cat but no symptoms with a hypoallergenic cat. One subject had a mild reaction to both types of cat but showed no allergic symptoms to a placebo room where there was a stuffed animal that felt like a cat. Others had either mild symptoms with the normal cat and no symptoms to the hypoallergenic cat or no allergic reaction to either type. Participants were blindfolded during the experiment to control for psychosomatic allergic symptoms. The data have not been peer reviewed or published. The concept seems like it would work, said Thomas A. E. Platts-Mills, M.D., Ph.D., of the University of Virginia in Charlottesville and president of the American Academy of Allergy Asthma and Immunology. Breeding animals for a specific trait, as in this case for the dominant but rare mutated form of a gene to produce modified protein, is easy compared with trying to create a Fel d 1 knockout, he said. Evidence is increasingly pointing to Fel d 1 as the dominant allergen among the many proteins produced by a cat and shed in its dander, Dr. Platts-Mills said. “If you would have asked me two years ago, I would have said that if you take away Fel d 1 [people] would just become allergic to another protein,” he said. “What they’re doing may be more helpful than we expected.” One of the unanswered questions, though, is whether the modified protein expression by the mutated gene is sufficiently dissimilar or causes low enough Fel d 1 expression to prevent allergic rhinitis, asthma and other symptoms. “Even if they reduced it by 50% or 40% or 80%, it doesn’t mean somebody with cat allergy is going to have fewer symptoms or need less medication,” said allergist James M. Seltzer, M.D., of the University of California in Irvine. He cited previous efforts like carpet spray to denature the cat allergy protein and air filters that have clearly shown a reduction in the antigen exposure but been less effective in reducing symptoms. Furthermore, patients may find they are still experiencing allergic symptoms since Fel d 1 exposure can come from outside the home as well–at school or work or by visitors–said Lisa Vailes, M.S., of Indoor Biotechnologies in Charlottesville, a company that isolates cat allergens to produce recombinant protein for research purposes. “Even if they do produce [the hypoallergenic cat], people are still going to be exposed to cat allergen from other sources,” Dr. Vailes said. “It would be very difficult to completely isolate a person from it.” One study in as isolated a location as Antarctica showed that enough cat allergens arrived, presumably on the clothing of staffers, at Scott base to provoke symptoms in allergic individuals (Lancet 1999; 353:1942). Cats produce also other minor allergens, such as Fel d 3, Dr. Vailes said. While Fel d 1 accounts for probably about 90% of cat allergies, some individuals have a reaction to these other proteins and “it’s possible that some patients may react to [the modified protein found in the hypoallergenic cats],” Dr. Tan said. Cats are responsible for the majority of animal allergies, according to the American College of Allergy Asthma and Immunology. For allergy sufferers, it recommends: Washing cats once a week with plain water or a mild veterinary shampoo reduce dander and remove dried saliva. Keeping pets outside or at least out of the bedroom to reduce exposure to pet allergens, and using central air cleaners to help remove pet allergens in the home. For the $3,950 (delivery in 2007), Allerca says it will provide cat-lovers a hypoallergenic kitten, plus: 1 x Home Environmental Allergy Test (to check for existing cat allergen in your home) 2 x Allergy Tests (a complete FDA approved home allergy test) Allerca airline-certified cat transporter Veterinary Health Certificate (required for travel) One set of nail caps already applied (these are vinyl nail caps applied to the kitten’s claws that cover the claws so no damage occurs when the animal scratches) A starter pack (includes premium kitten food, additional nail caps, cat toys and other kitten sundries) The company reports a two-year waiting list. Allerca paid for expenses related to Dr. Tan and colleagues’ study.

For those interested in the “allergy free cat”, play these videos from You Tube:

Allergy Free cat post

Orders are currently being taken for the world’s first allergy- free cat, a pet created by Allerca, the same people who brought us the first glow-in-the-dark fish (the Glo-Fish). The cats are genetically engineered using a “gene silencing technique” so they don’t produce Fel d 1, the protein in cat urine and saliva that triggers an allergic reaction in people. According to CNN, the cats cost $3950 each and will be available in 2007.

If you look at the Allerca website, they say that people with cat allergies who wish to have a cat may not be able to take allergy medications or allergy injections due to lifestyle limitations. 

Allergen immunotherapy requires a weekly injection for several months followed by a monthly injection for 3 to 5 years, after which symptoms to all cat would be significantly diminished or even eliminated. Whereas if you have a $4000 cat, you would still be allergic to other cats and the cat dander on everyone else’s clothes and homes. And what if something happens to your allergy-free cat?

Any one reading this who’s seriously considering getting one of these cats?

See Video

AAAAI Rhinitis Video

After the offending allergen has been identified by allergy testing, avoidance of the allergen, whether it be a food, drug, or airborne protein like dust mites or pollen, is the next critical step. Avoidance can significantly reduce symptoms related to allergies and is of vital importance particularly in food and drug allergies.

 INDOOR ALLERGENS:

• House Dust Mites

House dust mites are the major cause of year-round itchy and runny nose, itchy watery eyes, sneezing, wheezing, and shortness of breath.

What are Dust Mites?

Dust mites belong to the family of 8-legged creatures called Arachnids. They are microscopic and eat particles of skin and dander and thrive in bedding, carpeting, upholstered furniture, clothing, closets, and car seats which are all likely to contain skin particles. They are harmful only to people who become allergic to them. People allergic to dust mites react to proteins in the bodies and digestive waste (feces) of the mites. When allergic people inhale these particles, they start itching, sneezing, or wheezing.

What can be done to avoid Dust Mites?

Taking steps to minimize dust mite exposure in the bedroom often leads to a decrease in symptoms and medication requrements. Emphasis is placed on the bedroom since people spend a third of 24 hours there and because it has the greatest number of dust mites. The mattress, pillows, and boxspring should b encased in zippered, allergen-impermeable covers, and other bedding should be washed frequently in hot water (130 degrees Fahrenheit) every week.

Dust mites grow best at 75-80% relative humidity and cannot live at under 50% humidity. The ideal relative humidity to eliminate them is 40-50%. Use a humidity gauge (hygrometer) and a dehumidifier.

Source: AAAAI Indoor Allergen Tips

• Pet Dander

More than 70% of US households have a dog or cat. An estimated 10% of the population may be allergic to animals. The number of pets in the US is estimated at more than 100 million which increases the likelihood of accidental exposure to animals by people with allergies when visiting pet owners.

The dander, or skin flakes, as well as the saliva and urine of pets, can cause an allergic reaction. Animal hair is not considered a significant allergen but the hair or fur collects pollen, dust, mold, and other allergens.

Those pets that are known to cause allergic reactions should be removed from the home of the allergic person to avoid worsening of symptoms. Keeping the animal outdoors is only a partial solution, since studies show that homes with pets kept in the yard still have higher allergen concentrations than homes without pets. A “trial” removal of a pet for a few days or even weeks is of little value since you need at least 6 months of avoidance for allergen levels to drop to levels in homes without pets.

Short of removing the pet from the house permanently, here are some tips to reduce pet dander exposure:

1. Keep the pet out of the bedroom, if possible, out of the house.

2. Have a non-allergic person bathe the pet weekly to reduce amount of dander released.

4. Remove or reduce carpet floor coverage and replace bedding and carpeting

3. Have a non-allergic person clean the pet’s litter box or cage regularly.[/ that has animal dander in it.

5. Use High Efficiency Particulate Air (HEPA) Clearners.

6. Cover Upholstery or use sofa and seat covers that can be easily cleaned or wiped down.

• Mold:

Molds are microscopic fungi which, unlike plants, are unable to produce their own food from sunlight and air. Many molds reproduce by releasing spores into the air which then settle on organic matter and grow into new mold clusters. Airborne mold spores are more numerous than pollen grains, and when inhaled, can produce allergic symptoms.

Molds can be found wherever there is moisture, oxygen, and a source of the few other chemicals they need. Growth is encouraged by warmth and high humidity. Hot spots of mold growth in the home include damp basements and closets, bathrooms (especially shower stalls), places where fresh food is stored, refrigerator drip trays, house plants, air conditioners, humidifers, garbage pails, mattresses, upholstered furniture and old foam rubber pillow.

Here are a few tips to decrease mold exposure indoors:

1. Keep humidity low, less than 50%. Use a dehumidifier or air conditioner with a hygrometer to monitor relative humidity.

2. Allow adequate ventilation. Use an exhaust fan particularly in the bathroom and kitchen or open windows to remove humidity from cooking or showers.

3. Clean visible mold from walls and ceilings. Wash the shower curtain, tiles, stall, tub, and toilet tank with mold-killing and mold-preventing solutions. (50/50 bleach and water mixture also works well)

4. Correct drainage problems near the house and correct seepage or flooding problems inside the house. Remove water-damaged carpet, if present.

5. Allergic persons should not have their bedroom on the basement level.

6. Do not carpet the bathroom and bedroom and avoid carpets on concrete floors, especially the basement. Tile, hardwood, or vinyl floors are a better choice.

7. Dry shoes and boots thoroughly before storing.

8. Empty water pans in self-defrosting refrigerators and throw out spoiling food immediately. Empty garbage containers frequently.

9. Limit the number of houseplants. Mold also grows on bark, do not store firewood indoors and avoid live Christmas trees.

10. Greenhouses, antique shops, saunas, sleeping bags, summer cottages, and hotel rooms are sources of high mold exposure. Automobile air conditioners may also harbor mold.

11. Keep compost piles away from the main house.

OUTDOOR ALLERGENS

• Pollen:

When outdoor pollens are high, remain indoors, particularly in the late morning. Pollen grains can cause significant allergic symptoms like asthma and allergic rhinitis, particularly during the spring and the fall. It is difficult to avoid pollen because it is windborne and can cover wide distances. Short of moving to a different location, here are some tips for avoiding pollen during the season.

1. The pollen count is usually highest in the late morning and early afternoon particularly during sunny, windy days.
2. The pollen count measures the concentration of a specific pollen like birch tree pollen, in the area in a specific area and time. A pollen count is a useful guide for when it is advisable to stay indoors and avoid contact with pollen.
3. Keep the windows and doors closed during the allergy season.
4. Install a room air conditioner with a special filter.The special filter (High Efficiency Particulate Air or HEPA filter) traps airborne allergens. If the house does not have central air, the best spot to put the air conditioner and filter would be the bedroom. Change the filters frequently. An allergic person should also use the car air conditioner to decrease pollen exposure when commuting. Pollen allergic persons should not have a window fan blowing into their bedroom as this will maintain outdoor pollen exposure all night.
5. Avoid working outdoors, if you must wear a special face mask. The face mask is designed to filter pollen out of the air and keep it from reaching the nasal passages.
6. Consider taking a vacation at the height of the pollen season. Preferably at a location where the pollen exposure is minimal, like the seashore.

Outdoor Mold:

Molds are microscopic fungi which, unlike plants, are unable to produce their own food from sunlight and air. They are made up of clusters of filaments and live on plant or animal matter, which they decompose for their nourishment. Molds reproduce by releasing spores into the air.

Airborne mold spores are far more numerous than pollen grains and can cause significant asthma, allergic rhinitis, and sinusitis.

A.

1. Avoid camping or walking in the woods where mold growth on rotted logs and vegetation is high.
2. Avoid cutting grass, raking leaves, and exposure to soil, compost, sandboxes, hay, fertilizers, and barns.
3. Wear a well fiting mask if outdoor work can not be avoided.

Source: AAAAI Outdoor Allergen Tips

AAAAI video 

Diagnosis or determining whether someone is suffering from allergies or not, begins with the history. The physician or health care provider is interested in knowing the pattern of the symptoms and their relation to any possible allergen exposures. For example in the case of allergic rhinitis one would ask:

• Do you sneeze or get itchy nose/ eyes during a specific season or all year round?
• Is it worse at night or during the day?
• Indoors or outdoors?
• With exposure to pets or other animals?

Tests are performed when the history points to a possible allergic reaction to a specific allergen. Skin tests and RadioAllergoSorbent blood Tests (RAST) are performed to determine the presence or measure the level of the allergic antibody, IgE, to the allergen.

It should be stressed that a positive allergy test alone does not make the diagnosis of an allergic reaction. The results of the test must be correlated with the patient’s history.

1. Skin tests the most commonly used form of allergy testing. In this test, an extract of the allergen is placed on the skin, then a superficial puncture or scratch is made at the site allowing contact between the deeper layer of the skin and the allergen.If a person is allergic to that particular allergen, an itchy wheal with surrounding redness will form within 15 minutes. If this “scratch” or epicutaneous test is negative, in the case of airborne or medication allergies, the patient may then go on to get small doses of the allergen injected under the skin, called “intradermal” skin testing. The intradermal test is not recommended for food allergens.
2. Blood Test or RAST- measures the levels of the allergic antibody IgE in the blood to specific allergens. This test is not as sensitive as the skin test, but is used if a skin test can not be performed because the patient is taking antihistamines, has a rash covering his body, or if he or she had a severe allergic reaction (anaphylaxis) to the suspected allergen.
3. Challenge Test- In the case of food or medications, even if a person has a negative skin test or blood test, there is still a chance that a person may still have an allergic reaction to the suspected allergen.In this case, challenge tests are performed where the person is given small, increasing doses of the suspected food or medication at regular intervals and under close monitoring to determine if he or she develops any signs or symptoms of an allergic reaction. These tests may be open or blinded where the person and/or the physician may or may not know whether the patient is getting the actual allergen or a placebo to avoid bias.