Allergic Diseases, S.C.
Steven H. Cohen, M.D.

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Frequently Asked Questions (FAQs)

Why Should I see an Allergist?

Allergists are the Asthma and Allergy experts. We have specialized training and years of experience in treating asthma and allergic illnesses. Allergists offer the most skilled diagnosis and treatment of these conditions. If you suspect that you have either asthma or an allergy-related condition, Dr. Cohen will listen to you, examine you, offer testing and skilled treatment until you feel better!

What is the difference between Food Intolerance and Food Allergy?

Food intolerance is much more common than food allergy and occurs when the body is unable to digest a particular food. This causes symptoms of discomfort including cramping abdominal pain, diarrhea, belching, bloating, and gas. These symptoms may be quite uncomfortable, however, they usually do not pose a great danger to the person.

One common food intolerance is lactose intolerance. People with this problem lack enzymes in the stomach needed to digest milk properly. As a result, undigested milk sugars pass further along the intestinal tract than usual without being digested. This leads to the symptoms of intolerance described above. Using certain preparations such as Lactaid or Lactrase (available without prescription) before ingestion of dairy products may help in the digestion of these milk sugars, thus allowing patients to eat dairy products. Avoidance of those foods which cause discomfort or eating them in very small amounts are other options.

True food allergy such as milk allergy, on the other hand, may be a very dangerous situation for the allergic person. It is an abnormal response by the person’s immune system to a food or component in the food. When a person who is allergic to a particular food ingests that food, the immune system goes into overdrive and releases certain chemicals including something called histamine. These chemicals trigger symptoms in the body which may be life-threatening.

These allergic symptoms range from more mild manifestations such as eczema, itching, swelling and hives to more severe food reactions such as asthma and, possibly, anaphylaxis. Anaphylaxis is characterized by difficulty breathing and a drastic drop in blood pressure. Fortunately, the latter reactions occur more rarely.

Since food allergy causes an allergic reaction, symptoms should occur to some degree on each and every exposure. Some associations are harder to make, but one suggestion in attempting to diagnose a food allergy is for the person to keep a food diary. Foods eaten should be documented in one column along with the time eaten. A list of symptoms and the time they occur should be documented in another column. Using this information, a physician may be able to see if there is a correlation between foods eaten and symptoms.

Other diagnostic methods used by physicians include food skin testing or RAST food testing which can document the correlation between exposure to a food and symptoms. Once a food allergy is diagnosed the only successful treatment is to have the person remove that food entirely from their diet.

The most common food allergies are caused by the following foods:
  1. Cow’s milk (although goat’s milk and sheep’s milk can also be very allergenic)
  2. Eggs
  3. Peanuts
  4. Tree Nuts (Almonds, walnuts, for example)
  5. Wheat
  6. Soybeans
  7. Fish
  8. Shellfish
One additional syndrome that can occur is called the Food Allergy Syndrome. Patients complain of itching lips, tongue, gums, palate and throat after eating a number of different raw fruits and vegetables. Most commonly, these fruits and vegetables have skins such as apples, peaches, pears, plums or carrots. This does not present the same degree of seriousness as true food allergy, and systemic symptoms do not occur. Many patients are able to eat these same foods if they are cooked or canned such as in applesauce, canned peaches or carrots cooked in soup.

Who needs to be on Allergy Shots (“Immunotherapy” or “Allergy Vaccine Treatment”)?

The two most common groups of people who may need to start allergy shots are those with respiratory allergy such as asthma, allergic rhinitis (hay fever), or a combination of both, and those with stinging insect allergy. After evaluating people with hay fever and/or asthma by history, physical exam, and skin testing, we can determine what in their environment the patient can conceivably avoid and what cannot be avoided. Animals and feathers, for example, can be avoided. Pollens, however, cannot be avoided unless the patient is confined to an indoor, air-conditioned existence all summer. This is not good quality of life.

Treatment of respiratory allergy begins with avoidance of what can be avoided by changing the home environment. The second step is medication to aggressively treat the nasal and/or chest symptoms. If the patient cannot avoid the allergy triggers, and medications are not helpful in controlling symptoms, the patient becomes a candidate for allergy shots ("immunotherapy" or “allergy vaccine treatment”).

Treatment by allergy shots involves the injection of very small amounts of the allergens to which the person is sensitive. These are given over a period of several years. The amount of allergen given is gradually increased, resulting in a tolerance to the allergens that cause symptoms. In most cases the symptoms are significantly reduced over time.

Patients with stinging insect sensitivity have symptoms which are distant from the sting site. Non-allergic people may have swelling, tenderness, redness and pain from insect stings. Allergic people have additional symptoms which may be quite severe. They may have skin symptoms such as generalized redness and itching, hives, and swelling; respiratory symptoms such as difficulty breathing or wheezing; gastrointestinal symptoms such as nausea, vomiting, diarrhea, or cramping abdominal pain; uterine cramps like menstrual symptoms; or cardiovascular symptoms such as low blood pressure, cardiac arrhythmia, and sometimes death. These symptoms are called "anaphylactic" or "generalized allergic reactions". Unfortunately, there are about 100 insect sting related deaths each year.

For the person allergic to insect stings a careful history is taken to try to identify the specific insect responsible for the reaction. Skin testing is done to determine sensitivity. Specific venoms are available for testing and treatment. The allergic person can then be placed on the appropriate venom immunotherapy treatment to desensitize them in case of future stings. Response to this form of allergy vaccine treatment may be life saving.

Why is it important to continue Allergy Shots throughout the winter?

1. During the winter months there is no concern about exposure to summer allergens (trees, grass, weeds, ragweed, etc.) so that an allergic person’s symptoms will be reduced. This is the ideal time to be more aggressive in increasing the dose given in allergy shots so that a more positive response from them will be apparent the next spring and summer.

2. By continuing allergy injections year-round the patient can achieve the highest dose tolerated sooner. This should lead to control of symptoms sooner.

3. When symptoms are controlled for two consecutive allergy seasons, using little or no medication in addition to the injections, we are able to consider discontinuing the treatment.

4. Consistent and aggressive treatment throughout the year should lead to improved quality of life and decreased incidence of illnesses that may be associated with allergic disease such as ear infections, sinus infections or lower respiratory symptoms.

5. Patients who stop allergy injection treatment in the winter because they feel better (no exposure to pollen in the winter) usually have a return of symptoms the next pollen season. They will have to begin allergy injection treatment all over from the beginning because of the long break in treatment. This is necessary to avoid potential reactions.

In conclusion, it is more cost-effective and more health-effective to continue allergy injections throughout the winter months. Immunotherapy will decrease allergy symptoms more quickly and will be able to be ended more quickly if long breaks in treatment are not taken.

How do I know if I’m having an allergic reaction?

Allergic reactions manifest themselves differently depending on what causes the reaction and in which part of the body the reaction is taking place. If a patient with allergic symptoms related to cat allergy becomes symptomatic after dander exposure, he may have nasal symptoms like hay fever, chest symptoms of asthma, or hives if skin comes in contact with cat dander or cat saliva from holding the cat.

A patient who is allergic to pollen (such as ragweed) may have itchy eyes, ears, nose or throat, nasal congestion, sneezing, clear watery runny nose, and/or asthma-like symptoms.

A patient who has the severe allergic reaction, anaphylaxis, from a medication such as penicillin or from an insect sting, may show signs in several different systems. Symptoms on the skin include generalized redness, warmth, itching, hives, or swelling (angioedema). Chest symptoms may include shortness of breath, tightness in the chest, difficulty breathing, or wheezing consistent with asthma. Nausea, vomiting, diarrhea, and cramping abdominal pain are typical gastrointestinal symptoms. Women may have uterine cramps similar to a period. The most severe manifestations of anaphylaxis include cardiovascular symptoms including cardiac arrythmias, hypotension and even death. A patient with food allergy may have minor symptoms of hives or eczema, but anaphylaxis may be seen in severe food allergy reactions.

My child coughs a lot when he runs around. Is this an allergy?

The answer to this question is not completely cut and dry. Cough is more likely to be a sign of asthma than a sign of allergy which we think of as being more upper respiratory, for example, nasal congestion, sneezing, and itchy eyes, ears, nose, and throat. If the symptoms occur only when the child exercises outdoors, and only during the pollen seasons, the symptoms may be allergic and a result of post-nasal drainage and nasal congestion causing the cough. If the cough is noted any time the child is active and hyperventilates, it may be asthma and, perhaps more specifically, exercise-induced asthma.

Exercise induced asthma typically begins during the cool down period after exertion. The person is usually able to complete the exercise, running on a treadmill for example, with no more trouble than the average person. In the five to ten minutes after completion of the activity, the person may notice symptoms such as cough, shortness of breath, audible wheezing, and changes of lung function that can be documented by pulmonary function testing. In fact, people with this type of reproducible wheezing are very helpful in evaluating the effect of medications in preventing asthma.

It is felt that this type of asthma is due to cooling and drying of the respiratory tract which causes the irritation that brings on the wheezing. These people may exercise to the same degree breathing warmed, humidified air and not develop chest symptoms. Pre-treatment with medications such as albuterol may control symptoms and allow people to exercise without problems. Obviously, one must be sure that chest symptoms are not related to lack of conditioning or other health problems.

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