Dear Allergy Sufferer:

What is allergy?

Allergy = "Different Reaction." Eight out of ten people are not allergic and pay no attention to pollen grains, cat dander, or mold spores in the air. Allergic people react like they would to a new infection with a cold virus - runny, stuffy nose, "sinus," and/or cough and wheeze. Allergies are carried in the genes and tend to occur in several members of the family. One brother may have asthma at two years of age. His sister may have hay fever at age thirty, and their two sisters with no allergy symptoms could pass allergies on to their children.

How do you make the diagnosis of allergy?

The right kind of story - like

a. Sneezing a lot, especially four times in a row
b. More trouble in the Spring or Fall
c. The family history (since allergy is carried in the genes)
d. Skin tests to different "allergens" like grass, cat, mold, etc.

The skin tests are done with a skin prick or with a very small needle in the skin. They can be "read" in fifteen minutes. It takes two visits to test all of the common allergies.

What can be done?

a. CONTROL - medicines daily or as needed help a lot, but don't "cure"
b. AVOIDANCE - staying away away from certain things may help
c. "CURE" - allergy desensitization (shots)

Very small injections once a week can get your body gradually used to the things you are allergic to and make the symptoms go away. It usually takes nine months to control symptoms. It is the only "cure" as allergies tend to go on for many years.

Nothing will change the genes, but we may decrease or do away with symptoms like runniness, stuffiness, wheezing, and ear and sinus infections in up to 90% of allergic people.

WHAT IS ALLERGY? (Another take)

Allergy is an inherited physical condition of unusual sensitivity which certain individuals may develop to substances that ordinarily do not cause problems. These substances, or allergens, can be taken into the body by eating, inhaling or by direct contact on the skin.

When the body is exposed to an allergen, certain tiny cells on the lymph glands produce antibodies to attack the allergen. The unusual sensitivity (allergic reaction) may not appear immediately, but may develop after the person has been exposed more than once. Once these antibodies are developed, further contact with the allergen produces further antibody-antigen (allergen) reactions, and the release of an irritating chemical called histamine causes irritation in the sensitive tissues of the nose, eyes, skin, bronchial tubes, or digestive tract.

Allergic reactions may involve any part of the body. The most frequently involved areas are (1) respiratory tract with hay fever and asthma, (2) the skin with eczema, poison ivy, hives, and swelling, (3) the eyes and ears.

DRUG ALLERGIES

Drug allergy occurs when a sensitive individual. is injected with, or ingests, a drug, which causes lymph cells in the lymph glands to produce antibodies. Once antibodies have been developed, further contacts with the drug cause more antibodies to form, and the release of chemicals, including histamine, lymphokines,& others. These cause reactions such as fever, skin eruptions, joint pains, weakness, and swelling in various parts of the body. Sulfa drugs, penicillin, and aspirin are three of the most common causes of drug allergies. Physicians must be especially careful not to administer a drug to which a patient is allergic. Drug allergies may result in liver damage, bronchial asthma, inflammation of the heart muscle, and even death.

In treating drug reactions, discontinuation of a suspected drug will usually result in improvement within 48 hours. If the symptoms are extremely severe, other drugs may be used to control the allergic symptoms, such as epinephrine, ephedrine, anti-histamines, or cortisone.

FOOD ALLERGIES

Food allergy can occur when one eats a food which causes the production of antibodies. Once antibodies to that particular food have been developed, further contact causes more antibody production and consequent release of histamine, with symptoms such as nausea, vomiting, cramps, diarrhea, hives, nasal stuffiness, headache,asthma,shock,and in some cases death.

Food allergies are common, especially in early childhood; no age, however, is exempt . '
Shellfish(shrimp,crab), chocolate, nuts, beans, eggs and dairy products are the most common causes. It should be remembered that these common foods may be basic ingredients in other foods or food mixtures.

In management of patients with food allergies, the physician usually asks the patient to try certain foods(excluding life threatening prior reactions) to see if any allergic reaction occurs. Once the offenders are found, treatment consists of avoiding those foods.

ALLERGIC ASTHMA

Asthma is a medical condition of the chest that is often due to allergy. There is difficulty in breathing, with coughing caused by obstruction of the small bronchial tubes, either by swelling of the membrane lining, the tubes, or by contraction of musculature around the tubes, and by plugging of the tubes with mucus. As a result, breathing becanes hard, the chest swells, there are wheezing noises, the neck muscles strain, and the asthmatic patient cannot lie down in comfort. The suffering is severe; it may last for a few minutes,or for days or weeks.

The most cannon allergens causing asthma are pollens, molds, drugs and foods such as eggs or milk. Drugs can cause the most dangerous type of attack.

Asthma is a common condition (5-7% of the population and increasing). Much progress has been made in our knowledge and understanding of asthma, but our knowledge is still imperfect. Asthma (as all allergy-atopy)is genetically programmed
with strong environmental, psychosocial, developmental and other factors
producing a wide variance in the timing, mode, severity of expression
or non expression of these genes. One brother may develop severe asthma
at age 2, while his brother develops hay fever at 30 and sister has
no allergies- but her children do.

THE SCRATCH TEST

The scratch test is one method of determining the offending allergen, as well as the degree of sensitivity to that particular allergen. Before applying scratch tests, the skin is cleaned with an alcohol swab or sponge, and allowed to dry. A special instrument slightly scratches the skin of the back or arm. A different allergen is introduced with each scratch. In about 20 minutes, the allergen test areas are wiped off and the physician or technician checks each test site and notes the reaction of the skin to each allergen.

Intradermal skin testing involves injection of a very small drop of allergen
Solution into the skin with a very small needle. This method is more sensitive
And reproducible than scratch testing.

When the skin reaction correlates with the history, or past experience, of the patient, this indicates the allergen or allergens to which the patient is sensitive. If the allergen or allergens cannot be eliminated from the environment, the process of desensitization, or hyposensitization, should be considered, to relieve the severity of the symptoms. The instructions for the allergic
reaction come from the genes. The symptoms may vary, but tend to be
persistant throughout life. This means that lifetime medication
costs, complications such as sinus infections with possible sinus
surgery, asthma hospitalizations and loss of lung function may
represent a substantial cost- both in dollars and quality of life.

ALLERGY INJECTIONS

Once the responsible allergens are found, desensitizing solutions can be made up to alleviate the symptoms and allow reduction or discontinuation of medications in most cases. These solutions are made from the allergens which cause the problem, and are mixed on an individual basis for each patient. This solution, or vaccine, is given in small volumes at very weak concentrations at first, every five to seven days, with gradual increases dosage injected. With an increase in dosage, and over a period of time,(about a 1,000 concentration range) the tolerance of the body is increased to these particular allergens, with a decrease in symptoms.

This fundamentally alters the expression of the allergy genes resulting in
modification or elimination of allergy symptoms after stopping the injections.
In some cases, long term booster injections are required to maintain effect.

NEW ENGLAND JOURNAL OF MEDICINE REPORTS LONG TERM BENEFITS OF GRASS-POLLEN IMMUNOTHERAPY
NEJM 1999:341:468-475, 522-524

Results of a new study unveiled in the New England Journal of Medicine found that individuals with grass-pollen allergies who went through a complete course of immunotherapy treatment for those allergies, experienced "prolonged clinical benefits" for at least three years after their treatments had ended,

This study shows that going through a complete series of "allergy shots" for grass-pollen allergies can provide relief that lasts at least three years after the treatment is over. This is great news for those who are hit hard by grass-pollen allergies---especiaily now that ragweed pollen is in full bloom.

The study was lead by Dr. Stephen R. Durham of the National Heart and Lung Institute in London, For three years, he and his colleagues followed 32 patients who had received grass-pollen immunotherapy for at least three years. During the three year period of the study, grass-pollen allergy symptoms did not return in the group of patients who had received treatment.

The new study, "...provides the best evidence to date that allergen immunotherapy has long-term, perhaps permanent benefits," said N. Franklin Adkinson, Jr., MD, FAAAAI of Johns Hopkins School of Medicine.

The American Academy of Allergy, Asthma and Immunology supports the use of immunotherapy in appropriate patients. Immunotherapy involves injecting small amounts of the allergen to which a person is allergic. Over time, the concentration is increased and the patient "builds up a tolerance" for that allergen. To be effective, treatment must occur on a regular basis, and typically lasts from 3 - 5 years. It is a big investment of time, but the marked decrease in symptoms can definitely be worth it for some patients. The New England Journal of Medicine study shows that symptoms can be greatly diminished for at least three years following treatment.

To learn more about immunotherapy, ask your allergist. There's also information on the Academy's web site: www.aaaai.org and free Academy brochures obtained through the Physician Referral and Information Line: 1-800-822-2762.

HOW TO REDUCE MOLD IN AND AROUND THE HOME

Allow your home to breathe. Avoid heavy vegetation around and over the house as it encourages dampness and mold growth.

Check stored foods for possible spoilage and mold growth.

Keep yard free of fallen leaves. Mold will soon flourish on them.

Bathrooms are popular havens for mold. Wash tiles and grout frequently. Check corners, behind toilet, wherever moisture is apt to collect.

Damp shoes, boots and sneakers will rapidly breed mold if not allowed to "air out" and dry.

Mold may be abundant in the grass during prolonged wet periods. Indoor plants may breed mold in their potting soil. Dried flowere often contain molds.

Paint basements and other potentially damp areas with a mold-inhibiting paint available at most paint stores.

Dehumidify your cellar. Molds will abound where it is dark and damp.

Since humidifiers, dehumidifiers and air conditioners are constantly exposed
to dampness, check them constantly for a musty smell and spray with a mold inhibitor such as Lysol.

Vent clothes dryer to the outside to help keep basements,or crawl spaces dry.

Don't allow clothing to remain damp. Dry immediately after laundering.

NEW HOME CONSTRUCTION SUGGESTIONS
FOR THE ALLERGY PATIENT

A workshop would be less offensive in the garage than in the cellar where sawdust, paint fumes, etc. can rise through the house.

Don't put garage under house and certainly not on the same side as the allergic patinet's bedroom.

Now is the time to install a well-filtered and humidified central air conditioned system.

Central vacuum system will greatly reduce the risk of recirculating dust. Motor and collection tank should be located in sealed furnace room.

Vinly sheet is best for bathroom walls. Small grouted tiles are hard to clean and will grow mold.

Oil or gas furnace should he in a sealed room accessible only from the outside to avoid circulation of fumes.

Make sure no one is allergic to the insulation materials selected. Clothes dryer should be in enclosed room and vented to the outside.

Con't skimp on kitchen exhaust fan. It must quickly remove all cooking smoke and vaporized oils before they permeate the house.

Plant closets outside allergic person's bedroom. They are gathering places for dust and allergens brought in on clothes.

Hot water or electric heat is best. It won't dry out the house or blow dust around.

Sheet vinyl is better than vinyl squares for floors. A floor of squares has many feet of joining seams to collect dirt and dust.

Cement floors in cellars and garage should be treated with proper paint to water-proof and prevent shedding of cement dust.

Avoid recreation areas below ground level as they are breeders of mold. (No cellar is best.)

INSTRUCTIONS FOR AVOIDANCE OF MOLDS

Molds are everywhere! They will grow on almost anything, anywhere there is sufficient moisture. Molds, also called mildew, are common about the house and can be recognized as the growth that occurs on spoiled fruit or old cheese in the refrigerator. It may also
appear on shower curtains, in shower stalls on stored books and leather goods, in damp base­ments, in storage areas, and in laundry rooms. Mold also occurs outside in damp areas under leaves, in the grass, and in cultivated gardens. Molds produce spores or seeds, which are very light and about the size of pollen grains. They can be spread by air currents inside or outside the house. These spores are the major source of trouble for the individual allergic to mold.

Mold control can be accomplished by the following steps:

1. Use of a dehumidifier in damp weather.

2. Correct all areas of seepage or flooding which may occur after heavy rains.

3. Make sure that concrete or cinderblock basement walls are made as waterproof as possible with appropriate repairs and use of Sta-Dri or other appropriate paint. To further suppress mold growth on painted surfaces, one may add 3 ounces of Dianol (from your paint store) or 1 ounce of Impregon (from your druggist) to each gallon of paint.

4. Keep refrigerators clean; get rid of spoiling food.

5. Keep walls of shower stalls, ceilings and curtains or doors wiped down with Lysol or Chlorox. One may also use Impregon, 1 teaspoon to the pint of water, applied with a wet sponge. Any walls that can be covered with plastic sheets will be much easier to clean and keep clean and free of mold.

6. Keep closets aired or ventilated, or else keep one of the drying agent pack-ages hung in the closet. This applied especially to storage closets. Moth preventives are not sufficient for prevention of mold growth.

7. Various types of mold sprays, designed for use in gardens, may be used to spray certain areas such as cinderblock or concrete walls, some plywood walls, storage areas, crawl spaces, etc., but should be used with caution to avoid any chance of inhala­tion. One may use a preparation called Captan, available at the nearest garden supply house. Properly applied, the effect may last from 3-6 months, before another application is required.

8. Paraformaldehyde crystals may be used in the house as a very effective suppressant of mold growth. These crystals actually appear as a very fine powder, very irritating to the nose if one gets too close and tries to smell it. All contact with the material should be avoided. Used as outlined below, there is no problem.

a. The usual requirement is 1 tsp. of the powder placed in a small flat china or glass dish, placed up high and out of reach. A book shelf or window valence will serve.

b. Use a separate teaspoon dish for each 100 square feet of floor space in the rocm. Spread the dishes out so that the whole room is covered. If no suitable resting place for the dishes can be found, then one may use the inside of a match box, line with aluminum foil, and tacked onto the wall at proper height.

c. Close the room tightly for 24 hours. When the door is opened there will be a faintly acrid aroma, reminiscent of formalin solution. This aroma disappears rapidly, and one is unaware that the chemical is present. Coincidental with this, the musty, mildew smell will also disappear.

d. The powder may last from 1-4 weeks, depending on the degree of dampness of the room. The powder is hygroscopic and literally dissolves in the air. It may be re-placed as it disappears.

e. The powder is most useful in the warmer, damper months, and may not be needed when the heat is turned on.

f. Caution: Do not get closer than arm's length to the powder, as the irritation is very uncomfortable. While all formaldehyde products are poisonous if taken internally, this is unlikely to happen with the powder. Children who put a finger in the powder might receive a local burn, or extreme chemical irritation if the material is sniffed.

All of the above measures are designed to minimize contact with molds in the air. These measures are an adjunct in therapy, along with the administration of mold antigen as a vaccine. Avoidance of contact with the mold is an integral part of the treatment, and while the vaccines are effective, excessive contact may make good results much more diffi­cult to obtain.

Not all mold is airborne. Some can be found in foods which are prepared by the help of mold activity. In other instances the mold may appear as a contaminant. Aged cheeses are a common source of mold, and molds are used in the preparation of wines, beer, breads, and cakes. These are called yeasts. Molds may contaminate foods that are constantly exposed, such as potatoes, onions, fruits and the like.

Other Hints

1. Watch out for old stuffed furniture and old mattresses. Even old foam rubber may harbor molds.

2. Beware of the summer cottage which has been closed up.

3. Watch for molds in potted plants in the house, and in cut flowers brought in from the garden.

4. Watch for mold in stored foods.

5. Throw away anything not used or needed. Don't store things!

TAMING THE OUTDOORS FOR THE ALLERGY PATIENT

Sweetly scented hair tonic and aftershave lotion will bring insects winging.

Mowing the grass can churn up mold spores and arouse bees and yellow jackets. During grass pollinating season, it can fill the air with pollen.

Stinging insects are attracted by bright, contrasting colors in flower designs
and by dark colors. If you're allergic to insect stings, wear light, solid colors.

Plan vacations around the family's allergies, but don't leave one allergen behind only to run into another.

With car air conditioning it's best to recirculate air rather than bring in outside air laden with allergens.

Many plants discharge pollen primarily in the morning and more intensely when the air is dry. Evenings and humid days are best for enjoying the outdoors if humidity itself doesn't produce discomfort.

Pollen concentrations rise sharply close to the source. Cut down ragweed near your home if anyone in the family has hay fever.

A windbreaker, such as a hedgerow or stand of trees, can help reduce the amount of wind blown pollens. But make sure the windbreaker itself doesn't cause allergies.

Smoke from burning poison ivy can cause extremely uncomfortable--and potentially dangerous--respiratory reactions, as well as severe skin reactions. Spray poison ivy to kill it. Cut stems of tall, clinging vines close to the ground.

Don't "freshen" the wash by hanging it out to dry. Damp clothing is a sure trap for airborne pollens.

Avoid outdoor pets; they can be multiple allergy "carriers." In addition to their own dander, they often carry lots of pollen in their coats. Poison ivy sufferers should be particularly careful if the animal roams in the woods or fields.

Going barefoot or wearing sandals invites stings. Bees like clover, and yellow jackets often burrow into the ground.

A fast-acting insecticide kept in a handy spot can prevent a lot of stings.