Allergy Avoidance

Directed allergy avoidance can provide considerable benefit to patients with demonstrated allergies.  No one can avoid all allergens, and we won't ask you to do that.  Fortunately for patients with allergies, even reducing your exposure will decrease your symptoms.  This will help when you are exposed to "allergens" such as cat dander, grass pollen or dust mite.  It will also help when you are exposed to non-specific irritants like cigarette smoke.

Several years ago doctors studied patients with pure grass asthma.  These patients wheezed in June, but they felt fine in January.  They brought them into the laboratory and had them breathe in grass pollen (what they were allergic to) and histamine ( a nonspecific irritant; that's why patients take antihistamines).  They found that it took a lot more histamine to make these patients wheeze in January than it did in June.  That is why reducing exposure can help a lot, even if it is not practical to eliminate dust or pollen exposure entirely.

Many patients get confused because their allergies occur hours after exposure.  This is called a "late phase reaction".  It was originally described in bakers, who would wake up at during the night with wheezing.  When they were brought into the laboratory and challenged with flour, they again woke up during the night.  This late phase reaction, coming on long after the allergen (what you are allergic to) is gone is why  a feather pillow or pet at home, or even sleeping with the window open, can make you worse at work.

We think this is related to inflammation.  Just as your toe can get red and swollen over time from an ingrown toenail, your airways get inflamed when they are exposed to allergens.  Sometimes, for no reason we can identify, this also occurs.  Patients with identifiable allergy are said to have extrinsic asthma, while those without an identifiable cause are said to have intrinsic asthma.  When the problem involves the nose, we call it allergic rhinitis, or vasomotor rhinitis (for those who have a runny or congested nose but no obvious allergy).

There are many new drugs available, and more coming out, designed to treat airway inflammation.  Our best evidence shows that treating this inflammation will make a patient with asthma or allergies healthier in the long run.  A patient with hypertension who keeps their blood pressure controlled will have a lower risk of heart attack or stroke. A patient with asthma will have less problems in the future if they take their properly prescribed medicine and keep their asthma well controlled.  It is important to measure this control, since patients often have difficulty telling if they have a problem until they become "sick".   Periodic evaluation and breathing tests can help determine the right amount of medicine for each patient.  

Allergen immunotherapy (allergy shots) can also help properly selected patients.  Just like antibiotics, allergen immunotherapy must be given to the right patient, in the right dose, with properly selected allergens, and for the right disease, to be effective.  Too low a dose or the wrong allergens just won't help.  Most properly selected patients can have a further improvement in their quality of life with allergen immunotherapy.

Our goal for patients with asthma is that they are able to a maintain a "normal lifestyle", not dependant on "rescue medication" or emergency visits.  With good compliance, most patients accomplish this.

Allergy avoidance depends on what you are found to be allergic to by appropriate allergy testing.  The need for avoidance will vary, based on what you are allergic to, and how sensitive you are.  Allergen immunotherapy (allergy shots) can often decrease your sensitivity so you can tolerate certain allergens you might not otherwise be able to be around.  Helpful suggestions include:

Pollen:  Keep your windows closed and use air conditioning if necessary, especially in the bedroom.  If you are still having problems, avoid exercising outdoors in the early morning when pollen levels are higher.  In this area, tree pollen is most important in the early spring, grass pollen in May and June, and weed pollen in late summer and fall.  The "official start" of the ragweed season is August 15.  It is said to continue until "the first frost", although generally that is just because the weeds run out of pollen in October.  Even though we speak of "rose fever", flowering plants, such as roses, tend not to be a problem.  Their pollen is carried by the "birds and the bees".  It is their less attractive cousins (grass, weeds and trees) that have to throw large amounts of pollen into the wind.

Dust Mite:  Mite-proof encasements for your pillows and mattresses are available at department stores and through on-line allergy supply stores.  They are a priority in decreasing dust mite exposure.  Most people spend more hours of the day in the bedroom than any other single area.  That is the most important area to keep clean of mites.  Bedding should  be washed weekly in hot water.  If possible replace carpets with wood floors, tile or linoleum.

Pets:  Keep pets out of the bedroom, and, if possible, out of the house.  Continued exposure to an animal to which you are allergic can cause long term problems that may not resolve, even after the animal is gone.  Bathing pets on a weekly basis can help reduce allergen in the house. Replace or thoroughly clean bedding and carpeting that has animal dander in it. If you can't or won't remove a pet, careful monitoring of your disease is especially important.  Specific allergen immunotherapy may also be helpful.