Q&A: Ask the Expert About Allergy Treatments Get Strategies for Managing Symptoms of Allergies

How do symptoms of allergies start? What are the most effective treatments? Can you reduce exposure to allergens? J. Allen Meadows, M.D., an expert in the field, answers your most common questions about allergic reactions... Your eyes water, your nose gets stuffy, and you feel like you’re in a fog. Sound familiar? If so, you’re probably one of the 50 million Americans – roughly 1 in every 5 – who suffer from allergies. Allergies to substances in the air, like pollen and ragweed, can cause annoying but relatively mild symptoms. But for those allergic to nuts, eggs or shellfish, even a speck of the offending food can cause a severe and even life-threatening reaction. “The good news for anyone with allergies is that relief is out there,” says J. Allen Meadows, M.D., a clinical instructor of internal medicine and family practice at the University of Alabama in Birmingham and an allergist at the Alabama Allergy & Asthma Clinic in Montgomery. What causes allergies, which allergy treatments are most effective, and why are some people’s reactions more severe than others’? Read on as allergy specialist Meadows answers these and other common questions. What causes allergies? Allergies represent overactivity in a part of our immune systems, which doctors think originally developed to fight off parasites and other environmental threats. But when the immune system goes into hyper-drive, it starts reacting to things like pollen and dust, causing symptoms of allergies that affect your nose and eyes. Patients with symptoms of allergies often feel like their immune system is wrecked – but it’s actually a sign they have a very active immune system. Is there a difference between having an allergic reaction to something and being sensitive to it? Yes, and this confuses a lot of people. A person can be sensitive to certain odors or foods, but that has nothing to do with the immune system. For example, many people have bloating and diarrhea after drinking milk because they lack the enzymes necessary to digest it. Or cigarette smoke can be irritating to anybody if there’s enough of it in the air. Those aren’t true allergic reactions. But a food allergy, for instance, often causes symptoms even after a person eats just a tiny amount. The reaction is almost always immediate, can be life-threatening and happens every time you eat the food. Does having one type of allergy make you more likely to have other kinds? Yes. Three kinds of allergic illnesses – asthma, eczema and pollen allergies – tend to run on the same gene ([so if you have one, you might also have the others)]. Does that mean symptoms of allergies tend to run in families? Absolutely. If one of your parents has allergies, there’s a good chance you’ll have them too. But it may not be the same exact kind of allergy. Your parent may have asthma, and you may have eczema, while your child may have nasal allergies. We don’t know why family members don’t have the exact same type of allergy, but it may be due to what you’re exposed to early in life. Why do some people seem to develop symptoms of allergies later in life? Allergies don’t usually develop in your 40s or 50s. More likely, the person has always had the predisposition, but never had symptoms because they weren’t exposed to high enough levels of the allergen. Then, after they move to a different area of the country where those allergens are more prevalent, or make some other change in their environment that sets off their immune system, they start to have symptoms. Why do some people have relatively mild symptoms of allergies while others have life-threatening ones, like trouble breathing? We think it may have something to do with early environmental exposures. For example, we know that many cases of severe asthma are connected to the high amount of cockroach allergens in urban environments. But research also suggests that specific genes probably predispose people to having severe allergic reactions. Are over-the-counter medications effective allergy treatments, or do most people need stronger prescription drugs? For many people, it ends up being a matter of trial and error. If OTC products aren’t giving you relief, then it’s a good idea to see an allergist [allergy specialist] so you can explore various options for allergy treatments. You may benefit from taking prescription medications to help prevent asthma attacks, or you may be a candidate for allergy shots that desensitize your immune system so you’ll no longer have any reaction to the allergens. How effective are these shots as allergy treatments? It mainly depends on the kind of allergy. Most research has been done on nasal allergies, and we know shots can be extraordinarily effective for things like grass, tree pollens and ragweed. Roughly 50% of patients who take allergy shots for nasal allergies will be relatively free of symptoms for many years after completing their course of therapy. In terms of pet allergies, shots are much more effective for cats than dogs – because only one allergen causes symptoms with cats, whereas any given dog may have a wide variety of allergens. Shots are thought to be least effective against symptoms of allergies to mildew and mold. And I would advise against trying shots for food allergies. How often are the shots given? That depends in part on the preference of your allergy specialist. Some will give many shots over the course of a few months or even days, or try a rapid desensitization over the course of six weeks. But I believe in taking a more conservative approach to these allergy treatments, and doing a course of immunotherapy that can last as long as 3-5 years. A patient might start by having shots twice a week for four weeks, then once a week for six months, then every other week, and eventually once a month. It [also] depends on the patient’s preference as well as insurance payment issues, because this kind of therapy can often be expensive. How long does it take for patients to get relief? They really shouldn’t expect to see any relief for the first six months. If there’s no change after a year of immunotherapy, then we need to reevaluate the treatment plan. Can you offer some general tips to lessen the risk of developing allergies, or at least reduce exposure to allergens? As far as preventing allergies, there’s not much you can do other than pick your parents. People are often advised to make all these changes to avoid allergens, but universal allergy avoidance isn’t really recommended. For one thing, some tips, like turning up the temperature on your hot water heater to kill dust mites, can be dangerous, because the scalding water could burn a child. It’s better to get properly diagnosed first. That way, if it turns out you’re not allergic to dust mites, there’s no reason to take the time and money to implement a dust mite avoidance plan. And, as an animal lover, it hurts me to hear of physicians telling people to get rid of their pets. We know that 90% of pets given up because of allergy issues end up being euthanized. So my advice is to see an allergist so you can be properly diagnosed and provided with allergy treatments before you start making all kinds of changes. How can someone find an allergy specialist? The American College of Allergy, Asthma and Immunology’s website has a tool where you plug in your zip code to get a list of allergists in your area of the country. For more information, visit our Allergy Health Center. What’s Your Allergy IQ? Ignorance may be bliss, but not when it comes to a stuffy, sneezy, scratchy problem like allergies. Maybe you suffer from seasonal allergies. Or perhaps the bed bugs really are biting.