Ask the Allergist

 Many patients have headaches. If your pain is easily managed by over-the-counter (OTC) medications, you do not need to see a doctor. When your headaches become disabling either because of frequency or severity, you should be seen. I would say that if you are using OTC medications more than twice per week, a doctor specializing in headaches can offer various options that could improve your life and lessen the frequency of your headaches. 

Similarly, if your headaches are so severe that you have trouble finding relief from pain or require an emergency room visit for headaches, a visit to a headache specialist is warranted. The purpose of seeing a doctor for headaches is to increase your quality of life by reducing your pain and decreasing the effect that headaches, as a chronic condition, have on your life.

Yes, one can outgrow food allergies! The likelihood of this and when depends on numerous factors. The most important factors are specific foods—milk, egg, soy, and wheat allergies are more commonly outgrown, whereas peanut, tree nut, and seafood allergies are less commonly outgrown. Age of onset may also influence the natural history. Infants are more likely, and adults are less likely to outgrow food allergies.

It is an important responsibility of the allergist to determine who has allergies and who has outgrown them. This natural history is evaluated by a detailed history, repeat measurements following the blood allergy antibody (IgE) to the food, skin testing, and when indicated a medically supervised oral food challenge to the specific food.

Many patients will ask their doctor what the difference between asthma and COPD is. Both cause shortness of breath, cough, and wheezing, and many of the inhaler medications used in both conditions are the same or similar.

In their purest form, asthma patients have had symptoms since childhood. Asthma is caused by genetic influences that result in asthma symptoms. Commonly, patients are atopic or have allergies that will exacerbate their breathing problems. COPD patients are generally adults who develop symptoms of shortness of breath, cough, and wheezing later in life like in their 3rd-6th decade. COPD usually can be linked to a history of smoking tobacco.

The FDA in recent years has discouraged the development of long-acting bronchodilators (LABAs) for asthma and has placed a black box warning on medications that contain LABAs. Nevertheless, the most common treatments for both asthma and COPD are medications that contain both inhaled steroids and long-acting bronchodilators (LABAs).

In recent years, the asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) has been discussed more extensively. These patients show features of the asthma phenotype, have substantial exposure to cigarette smoke, and show fixed airflow obstruction. Your allergist at Allergy & Asthma Specialists can discuss your breathing problems with you, further your understanding, and treat your respiratory symptoms.

Reactions to the sting of honeybees, hornets, yellow jackets, and wasps can consist of normal reactions, large local reactions, and systemic (generalized) reactions.

Normal reactions typically include intense pain, itching, and redness with swelling at the sting site up to the size of a quarter. Large local reactions extend out from the site of the sting and involve redness with swelling that can, at times, involve the entire arm or leg. These can be very uncomfortable and may limit the mobility of a joint such as the elbow or knee. Systemic reactions can include generalized hives, swelling of the tongue or throat, wheezing with difficulty breathing, and a drop in blood pressure. These can be life-threatening, and it is estimated that there are about 50 deaths each year in the U.S. from bee stings.

As allergists, we take a careful history of the reaction and examine any E.R. records that resulted from the reaction. We then perform skin tests to look for allergic antibodies that may be present against any of the stinging insect species listed above. If a systemic reaction occurs and skin tests are positive, we can then offer allergy shots against the venom of the offending insect(s) to make it much less likely (95-97% effective) that you will react to stings in the future. You will also be prescribed self-injectable epinephrine until the shot treatment is completed (typically 4 to 5 years). Large local reactions are rarely treated with shots unless they have been severe or very frequent. A short course of oral or injectable steroids, along with antihistamines, can help keep you comfortable and hasten the resolution of the swelling.

Atopic dermatitis or eczema is a condition where there is inflammation and irritation of the skin. Due to this, skin can become itchy, dry, and red. Eczema can affect 2-5% of the population, with children being affected more than adults. In fact, it is the single most common skin condition in children less than 11 years of age. Atopic dermatitis usually starts in early childhood and can range from mild to severe. A large percentage of children with severe eczema will later develop asthma or environmental allergies.

The exact cause of atopic dermatitis (eczema) is unknown. The current thinking is that eczema is caused by a combination of factors that include: genetics, abnormal function of the immune system, environment (with exposure to allergens and irritants), and defects in the skin barrier that allow moisture out and germs in. It is also important to find the triggers that make your eczema worse. A trigger is not something that causes eczema, but it can cause it to flare. Common triggers can include irritants in the environment, such as soaps and cleansers, conditions that cause the skin to dry out, bacterial infections of the skin, and allergies to environmental mold, pollen, dust mites, and pet dander. Less than 1 in 10 children with atopic dermatitis have a food allergy. In general, it is young children less than 5 with severe eczema who may have food sensitivity as a trigger factor.

Although there is no cure for atopic dermatitis, most people can effectively manage their disease with medical treatment and by avoiding irritants. An allergist can help you manage your atopic dermatitis and determine triggers, including possible environmental and food allergies.