Plant Allergies: Latex, Carrageenans

One in four or five Americans suffer from a misguided immunologic reaction against inoffensive substances -- allergens -- such as pollens, animal danders, foods, cigarette smoke, industrial fumes, insects and their venoms, and medications. Because these allergens stimulate the immune system at different body sites, they give rise to an enormous variety of symptoms. Allergens in the upper airways cause sneezing and nasal congestion (allergic rhinitis, including hay fever); allergens in the lower airways cause bronchoconstriction and wheezing (asthma); food allergens cause nausea, vomiting, abdominal cramps, and diarrhea; topical allergens cause contact dermatitis.

The most serious form of allergic reaction -- anaphylaxis -- occurs when an allergen enters the circulation and causes an acute, explosive release of mediators from mast cells, resulting in serious symptoms within minutes of allergen exposure. Severe anaphylaxis is a medical emergency; prompt attention is necessary to prevent death from shock or suffocation (caused by swelling of the vocal cords). Pruritus, urticaria, and bronchoconstriction are common allergic reactions, and some patients have gastrointestinal symptoms. In some cases, anaphylactic symptoms are preceded by an aura, and patients who experience recurrent anaphylaxis report that the same constellation of symptoms accompanies each attack. Treatment usually is administered as an injection of epinephrine to inhibit mediator release, open airways, and block vasodilation.

Plants are the most common source of allergens, with pollens and foods (especially tomatoes, onion, garlic, peanuts, and various fruits) heading the list. Approximately 15% of Americans have pollen sensitivity (hay fever), and many of these also have food allergies. For example, people with grass pollen allergy often cross-react to certain foods. Allergies are treated with antihistamines or, when these agents are ineffective, with inhaled corticosteroids. Severe cases are treated with immunotherapy (injection with increasing doses of the allergen). These "allergy shots" can be helpful, although protection is rarely complete. Sometimes pollen immunotherapy can reduce food hypersensitivity in children.

One common and often overlooked plant allergen is latex, an emulsion of rubber globules from the milky sap of Euphorbiaceae plants. The allergy develops when latex protein fragments come into contact with the skin or mucosa, causing contact dermatitis, pruritus, urticaria, conjunctivitis, rhinitis, asthma, and even anaphylaxis. Individuals at increased risk include latex industry workers, health-care personnel who wear latex gloves, patients who undergo frequent surgeries, atopic individuals (who have a general predisposition to allergic reactions), and, in particular, individuals with neural tube defects. Again, cross reactions are common; people with latex allergy often report allergies to avocados, chestnuts, bananas, and other fresh fruits. In some cases, latex-sensitive patients become anaphylactically allergic to fresh fruits; in other cases, the fruit allergy shows up first, followed by latex allergy on exposure to latex. Diagnosing latex allergy requires the utmost care. One patient who tested positive for multiple allergens on skin prick turned out to have latex allergy; the health-care worker who administered the skin-prick test was wearing latex gloves.

Carrageenan allergy is another difficult-to-detect plant allergy. Carrageenans are gelatinous substances obtained originally from seaweed (Irish moss), and now from several marine algae. They are commonly used as emulsifying, suspending, and clarifying agents in manufactured foods (certain dairy products, dressings, sauces), beverages, pharmaceuticals, cosmetics, and polishes. One patient undergoing a diagnostic barium procedure for gastrointestinal symptoms had an anaphylactic reaction to the barium enema solution. At first, the latex in the enema device was suspected, but the patient did not test positive to latex. Instead, she tested positive for the carrageenan used as an emulsifying agent in the barium suspension.
Ref:Tomazic VJ et al. J Allergy Clin Immunol.

asthma medication options

Asthma accounts for more absences from school than any other chronic illness and is a leading cause of visits to the doctor’s office. It is a serious disease—the rate of death from asthma is under l percent among hospitalized children, but it rises to 2 to 4 percent among adults.

Until approximately 10 years ago, asthma was defined as spastic airways or repetitive contractions of bronchial smooth muscle. A major development was the appreciation that a better definition of asthma was hyperreactive or spastic airways with inflammation. In fact, it was convincingly demonstrated that the severity of asthma correlated with the concentration of inflammatory products in the bronchial fluid of patients with asthma. In this regard, one of the most important advances in the treatment of asthma was the introduction of inhaled, or topical, steroids as first-line drugs. Before discussing inhaled steroids, I will put their role into perspective by briefly discussing the roles of other medications in the treatment of asthma.

Effective treatment of asthma entails the following four steps (not all of which are applicable to everyone):

1-Identification of causal agents
2-Avoidance of causal agents
3-Control of appearance of symptoms through medication and other strategies
4-Treatment of symptoms
There are several medications available that keep asthma symptoms from appearing or relieve them when they are present. These medications are beta-agonists, theophyllines, cromolyn sodium, leukotriene inhibitors, and corticosteroids. Except for a few over-the-counter beta-agonists, these are all prescription drugs.

beta-agonists
theophyllines

cromolyn sodium
leukotriene inhibitors
corticosteroids

Beta-agonists for treatment of asthma

Beta-agonists are a major class of medications for asthma. These drugs can be taken orally, but they are most commonly and effectively administered by operating a metered-dose, handheld, aerosol canister. They provide rapid relief of asthmatic wheezing and shortness of breath. Activating the canister releases a puff of drug-saturated aerosol, which is carried directly to the twitchy smooth muscle in the airways. This direct action quells the symptoms rapidly. Because beta-agonists work almost instantaneously, they are extremely satisfying to use, but they treat only the symptoms of asthma, not the underlying inflammation.

Theophyllines for treatment of asthma

Theophyllines are related to caffeine and work by relaxing bronchial smooth muscle, thus opening up the airways and making breathing easier. The amount of theophylline to take depends on body size and has to be determined carefully. Even then there are sometimes significant differences in reactions between like-sized individuals, so when physicians prescribe theophylline, they are likely to order a blood test that measures how much theophylline is in the blood several days after the patient starts to take it.

Cromolyn sodium for treatment of asthma

Cromolyn sodium, a chemical originally isolated from an Egyptian weed, comes in two forms: as a metered-dose aerosol or as a liquid for nebulization. It is not as effective as inhaled steroids.

Leukotriene inhibitors for treatment of asthma

Leukotriene inhibitors, which are given orally, can reduce the severity of asthma in some patients. There are several such products on the market, including Accolate, Zeileutin, and Singulaire. They can be very effective agents in some patients and should be given a serious trial in patients with chronic symptoms. They can also be considered first-line drugs.

The Use of Inhaled Steroids for Asthma

The most-potent drugs for asthma, however, are steroids, or drugs in the cortisone family. Oral or injected steroids are usually prescribed only in cases of severe asthma, especially for those at risk for hospitalization or for patients who are already hospitalized. These drugs can be life-saving; in fact, one common feature of asthma mortality is the failure to take adequate doses of steroids. Unfortunately, systemic steroids have toxicity and therefore should not be used on a regular basis unless necessary.

Approximately 25 years ago, it was found that inhalation of steroid powder in a metered-dose inhaler had significant preventive action in the management of asthma. Initially, these inhaled steroids, of which beclomethasone was the prototype, were used only as secondary or tertiary agents. Asthma specialists now realize that these drugs are first-line agents and can often manage asthma by themselves. They are also important ancillaries to beta-agonists.

Unless used more frequently than recommended, aerosol steroids do not produce the negative side effects of oral or injected cortisone and can be quite effective. While they do not deliver the amount of cortisone required for severe (but unhospitalized) asthmatics, they are extremely helpful in subacute cases. These agents include Beclovent, Vanceril, Aerobid, Azmacort, Flovent, and Pulmicort. All of these agents have advantages and disadvantages over each other, but for the most part, patients end up using the inhaled steroids that are covered by their insurance carriers.

These drugs can be given as infrequently as twice a day and sometimes achieve a better result when a spacer is provided to help in the delivery of the inhaled dose. Pulmicort is also available as a turbuhaler, and Flovent is also available as a rotodisk. Both of these methods of delivery may be more comfortable and effective for some patients. Flovent, one of the newest of these agents, is available in three different concentrations and thus can be adjusted for patients of different ages and sizes. Aerobid is unpleasant to take because it has a bad taste and may induce nausea. I therefore do not recommend it, even in the mint flavor.

Use of low doses of inhaled steroids is hardly ever associated with systemic toxicity. However, long-term use of high doses can have adverse effects. The most common of these adverse effects are local complications, including coughing, horaseness, and an inflamed throat. In addition, patients who are receiving high doses of inhaled steroids should have ocular exams once a year to rule out the development of glaucoma.

One final point about inhaled steroids is that many patients also use a beta-agonist. In such a case, the patient should first use the beta-agonist, followed by the inhaled steroid. This regimen allows the airways to open, therefore allowing better penetration of the topical steroid. Inhaled steroids are to be used for prevention and should never be used to try to manage an asthma attack.

year-round perennial allergies

Perenial allergies can occur year-round, because they are caused by allergens in your living environment�often your home. Common culprits include house dust mites (or more specifically, their droppings), animal dander, cockroaches, and feathers such as those in down comforters and pillows. Allergies can also be caused by certain foods or exposure to irritants such as paint fumes, cigarette smoke, chalk dust, or heavily polluted air.

To tame common indoor allergens, clear out the extra clutter in your bedroom, along with carpets and drapes; encase your mattress; box spring, and pillows in airtight, allergen-proof covers; wash bedding weekly in scalding water; and avoid bedding made of down, kapok, or cotton. Also, consider using a 3 percent tannic acid spray, which causes dust mite droppings to be less reactive, or benzyl benzoate, which kills the critters. Vacuum frequently using a double bag or a HEPA filter; wear a dust mask while cleaning; and use your air conditioner regularly, to reduce the growth of dust mites and mold. You might even consider an air-purifying system. Also, banish pets from the bedroom and careven from the house, if you can. And bathe cats and dogs weekly. To control mold, keep the house dry and well-ventilated and wipe down humid areas, such as bathroom surfaces, with a fungicide or bleach.

controlling allergies during travel

• When travelling, take plenty of medication with you - in a carry-on bag, in case your luggage decides to take its own vacation. Keep a list close at hand of all your family's medications; treatment plans and emergency telephone numbers.

• Be sure to request a nonsmoking room in hotels and motels and a nonsmoking rental car. Be aware of other possible allergens in hotels, such as fresh paint or holiday decorations. It you're staying with relatives, discuss allergy prevention before your arrive. Staying in a hotel can sometimes be more cost-effective than endangering you or your child's health.

• Traveling to other climates and higher altitudes can be stressful to people - especially children - with severe asthma. Cold and dry air can cause bronchospasm if a person's asthma is unstable.

• In the warmer climates, family trips to zoos; circuses, fairs and ranches can be unpleasant for those with animal allergies. Molds are also common.

winter allergies precautions

Schedule enough time for rest, drink plenty of water and don't allow the excitement to get you off your schedule of medication. Prevention is the best precaution. Be sure your asthma management plan is up-to-date.

Wash your hands frequently. Many cold and flu viruses are transmitted hand to hand, then hand to mouth, nose or eye. Washing your hands frequently-especially any time you've been out shopping or at parties-will make a big difference to your health.

Wear a muffler or scarf around your mouth in very cold temperatures. It will trap warmth and humidity and prevent airway discomfort.

Never store firewood in the house. Minimize use of the fireplace and always clean out the ashes after each use. Make certain your chimneys and flues are in proper working order.

types of allergy medications

Many medications can prevent or reduce the symptoms of allergies. These include:

• Antihistamine tablets, available by prescription and over-the-counter (OTC), turn off the tickle and dry up your nose and eyes by blocking the effects of histamine, the chemical responsible for causing many allergy symptoms. Newer, non-sedating prescription products are the least likely to make you sleepy or cause other side effects. Astelin (azelastine) is the first prescription antihistamine in nasal spray form.
• Decongestants, sold OTC in pills, sprays, and drops, open blocked nasal passageways and relieve congestion. These drugs can cause nervousness, racing heartbeat, and rapid pulse. If you have high blood pressure, a heart condition, thyroid disease, diabetes, glaucoma, or prostate problems, talk to your doctor before using. Use of decongestant nasal sprays for more than a few days in a row can cause rebound congestion.
• Combination products contain a decon- gestant, antihistamine, and/or a painkiller. It generally is better to buy a product that targets only your specific complaints, so you don't take too much medicine or experience too many side effects.
• Prescription steroid nasal sprays halt the release of histamine and soothe irritated airways.
• Atrovent (ipratropium bromide) is a prescription nasal spray that blocks the trigger for nasal secretions, helping to relieve runny nose.
• Nasalcrom (cromolyn sodium), which is available OTC, is designed to prevent and relieve itchy, runny nose, nasal congestion, and sneezing by inhibiting the release of histamine and other symptom-causing chemicals.
• Prescription eyedrops such as Crolom (cromolyn sodium) and Alomide (lodoxamide tromethamine) help head off redness and itching in the eyes.
• For those who find insufficient relief with medications, allergy injections (immunotherapy) are tiny doses of an allergen given to desensitize the body until there is no reaction.

allergies - general information

Your eyes are watery, your nose is itchy and runny, and you've got a throbbing headache from the pressure in your sinuses.

You're suffering from allergic rhinitis, and you're not alone. As many as 50 million people of all ages regularly suffer those same uncomfortable symptoms. They're caused by irritants called allergens-normally harmless substances that trigger overreactions in the immune systems of susceptible people.

Perennial allergies can occur year-round because they are caused by allergens in your living environment-often in your home. Allergies can also be caused by exposure to irritants such as paint fumes and cigarette smoke.

Pollens and molds are the main causes of seasonal allergic rhinitis (often called hay fever). In the United States, ragweed pollen prompts most seasonal symptoms. Grass and tree pollens are responsible for the rest.

Food allergies - most common allergies

Food allergies are among the most common allergies observed among the general population. Recent evidence presented during the Scientific Poster Session at the annual meeting of the American Academy of Allergy, Asthma, and Immunology confirms that there is no lack of food allergies being observed in clinical practices throughout the world.

More than a dozen presentations described allergic reactions to a wide range of common and exotic foods. These manifested in various ways, from mild rashes to severe and immediate anaphylactic reactions. There were reports of reactions to common foods, including:

• Kidney and white beans found in chili

• Beef and venison

• Coconut and walnut

• Mulberry fruit

• Corn, and

• Mustard.

Rare food allergies were reported by two patients enrolled in a study on the use of shiitake mushrooms (the second most commonly eaten mushroom in the world) for lowering cholesterol; they developed eosinophilia that was associated with other immunologic changes.

Rambutan (a malay word meaning "hair") is a fruit found in Thailand that can cause an acute allergic reaction.

The Naval Medical Center reported on an American sailor who developed hives and throat swelling while on duty in Thailand after ingesting a fruit called rambutan (the Malay word for "hair") (see photo). Interestingly, he had never eaten the fruit before and had probably cross-reacted with some other pollen.

One patient had used a capsaicin-containing (0.075%) analgesic cream for 4 years with no problems. However, during that time she did notice facial edema and other allergic signs whenever she ate peppers (Capsicum). It is likely that the repeated use of the cream sensitized her to the capsaicin that is naturally found in hot peppers.

Although these cases represent somewhat unique reactions to common foods, it should be remembered that we are all at risk for sensitization to some foods. Allergic reactions to foods may be more common than we think. source:AAAAI

Do Allergy Shots Help Asthma?

Because allergens trigger bronchoconstriction in more than half of asthmatics, investigators at Johns Hopkins School of Medicine studied ragweed pollen immunotherapy in asthmatics with symptoms during ragweed pollination season. Compared with placebo, purified ragweed pollen immunotherapy produced a small but statistically significant increase in peak expiratory flow and reduced the use of asthma medications during the first year. However, benefits were not apparent during the second year of therapy. Because asthmatics usually respond to multiple allergens (including house dust mite feces, which are generally not responsive to allergy shots), immunotherapy for asthma appears to be of limited value.

Sulfites, Allergies, and Asthma

Sulfur-based preservatives -- sulfites -- have been used for centuries to inhibit the oxidation of light-colored fruits and vegetables (the "browning" of apples or potatoes), prevent melanosis on shrimp and lobster, block bacterial growth in fermenting wine, condition dough, bleach food starches, and maintain the stability and potency of certain medications (see side bar). Unfortunately, many people, including approximately 5% of asthmatics, are allergic or sensitive to sulfites. According to a report in the FDA Consumer, the FDA currently prohibits the use of sulfites for maintaining the color and crispness of fruits and vegetables meant to be eaten raw; it also requires manufacturers to label products (including packaged, bottled, and bulk foods) that contain sulfiting agents. However, current FDA regulations do not apply to restaurants.

Sulfites in a concentration lower than 10 parts per million can trigger an attack. The most rapid reactions occur when sulfites are sprayed on food or are used in a beverage, but the most severe reactions occur when sulfites are in the food itself. Asthmatics are probably sensitive, not allergic, to sulfites; exposure occurs when sulfite fumes are inhaled from treated foods. Bronchoconstriction can be severe enough to completely block breathing, causing hypoxemia with brain damage, heart or other organ damage, or fatal arrhythmia. Patients with asthma who are dependent on oral corticosteroids are more apt to be sulfite sensitive, and they have an increased risk of severe reactions. However, in some cases, the very first asthma attack is a sulfite reaction.

Sulfite sensitivity can be difficult to diagnose. A sulfite challenge may be appropriate for patients who react adversely to certain foods. For example, if the suspect food causes hives, a sulfite skin-prick test may be performed. Patients with a positive skin test are more likely to be allergic, rather than sensitive, to the sulfite; they usually are not asthmatic and are at greater risk for anaphylaxis. According to the FDA Consumer, people who have had a serious sulfite reaction should carry an antihistamine and a self-injectable epinephrine when they eat out, and asthmatics should use a bronchodilator. Sulfite-sensitive people should also read food labels, ask store managers or waiters to check labels on bulk foods, avoid foods known to contain sulfites in other forms-and never just assume a food is safe to eat.
source:Medical Sciences Bulletin

Taking cough medicine - treating coughs

As part of simple self-care for your cough, take an over-the-counter (OTC) cough medicine. These medicines work to make your cough more productive or to quiet a disruptive cough. Types include:

* Expectorants cough medicine— The name expectorant comes from the verb "expectorate," meaning "to spit." These cough medicines contain guaifenesin, an ingredient that works to loosen mucus in your airways. As a result, expectorants can help clear your airways of irritants. Taking a cough medicine, drinking plenty of water and breathing moist air offers maximum loosening of mucus.

* Suppressants cough medicine— To temporarily reduce the frequency of your cough, take a cough suppressant. These medications, also called antitussives (from the Latin word for cough), act directly on the cough center in your brain. Some antitussives contain a narcotic such as codeine. Nonnarcotic antitussives, such as dextromethorphan and diphenhydramine, are available in nonprescription cough medicines. These ingredients help relieve coughing without the risk of side effects associated with narcotics. If your cough brings up mucus, it's best not to suppress it. But if your cough is frequent and produces small amounts of mucus, consider using a combination medicine containing both an expectorant and a suppressant.

* Expectorants plus suppressants cough medicine — Some cough medicines contain an expectorant plus a cough suppressant. The expectorant helps loosen mucus while the cough suppressant reduces the frequency of your cough. In combination, these ingredients can make your cough more productive while making you more comfortable.

how can you control coughs? - treating coughs

# Drink extra liquids — Sometimes secretions in your lungs become thick and sticky, making them difficult to remove by coughing. A cough that doesn't bring up mucus is nonproductive (dry). Drinking plenty of liquids, especially water, helps thin and loosen mucus to make your cough more productive. By bringing up mucus, a productive cough helps clear your airways of irritants. Beverages such as juices and hot tea can also soothe and lubricate your throat.

# Breathe moist air — Taking a shower or using a humidifier or vaporizer also helps loosen mucus.

# Soothe your throat — Sucking on hard candy or cough drops, or drinking tea sweetened with honey may help prevent coughing if your throat is dry or sore.

# Try not to cough — Frequent dry coughing can worsen irritated airways. Try to cough as seldom and gently as possible. Taking frequent sips of liquids may help stifle the cough cycle.

Causes of cough - treating coughs

Here are typical reasons for a cough:

* Infection — Cold and flu (influenza) viruses are the most common causes of cough. Coughs from colds typically develop when excessive amounts of mucus irritate your airways.

* Asthma — Various forms of asthma and asthma-like conditions affect up to one in 10 people. Coughing is a common symptom during the night, after exercise or when exposed to irritants.

* Post-nasal drip — An overproduction of mucus can occur with some allergies and sinusitis (inflamed mucous membranes within sinuses). The slow trickling of mucus from the back of your nose down into your throat causes irritation.

* Environment — Irritants include smog, dust, home aerosol sprays, cigarette smoke and cold or dry air. Cigarette smoke irritates the airways of both smokers and nonsmokers. If you smoke, nicotine paralyzes the movement of tiny hairlike projections lining your airways called cilia. When cilia can't help clear excess mucus, the sticky secretions build up and cause coughing.

* Medications — Coughing can be a side effect of inhaled medications, such as corticosteroids. Coughing can also occur with use of some beta blockers and angiotensin-converting enzyme (ACE) inhibitors prescribed for high blood pressure or heart disease.

* Unexplained cough — Sometimes there's no medical explanation for a cough. Some people have a persistent cough after an infection resolves. Others may cough to release tension, gain attention or express anger. Whatever the reason, continual coughing can irritate your throat and set up an exhausting cycle.

coughing as a protective reflex

To cough is normal. If you're like many people, you cough once or twice an hour while awake and may not even realize it. But when a nagging cough disrupts your sleep, embarrasses you or bothers others, getting rid of that cough becomes a priority. Although some coughs need your doctor's attention, many respond to simple self-care and the right medicine.

Coughing: A line of defense

Your respiratory system works nonstop to defend against irritations and infections. Layers of mucus (phlegm) lining your nose and airways trap particles such as pollen or dust, chemicals and infectious organisms that may enter your body from the environment. In response to the irritation or infection, your body steps up production of mucus.

Coughing is a protective reflex that occurs when an irritant stimulates one of several cough receptors in your airways. The receptor sends a message to your brain, signaling your body to cough. Coughing helps clear your airways of mucus, taking with it irritants trapped in the sticky secretions.

Air filters and allergies

question : How effective are electrostatic air filters for the prevention of allergies? Are they worth the high cost?

Using air filters in the ventilation system of a dwelling can reduce allergen exposure. Electrostatic filters are effective in removing dust and small particles from the air. There are a number of other filters that are equally effective. These include the high-efficiency particulate air (HEPA) filters. There also are high-quality paper filters that are quite efficient in filtering dust and small particles from the air.

If the source of allergen remains in the home, however, these air filters are usually not enough to eliminate allergy symptoms. For example, if a person is allergic to a cat that's continuously producing large amounts of sensitizing substances in the home, an electrostatic air filter and other air filters generally aren't going to solve the problem. The only effective remedy in that case is to remove the cat from the home.

The other important factor in considering an air cleaner is that it must be large enough to adequately remove dust particles from the air in a particular dwelling. Generally, air cleaners attached to the main ventilation system of dwelling — usually the furnace system and/or the central air conditioning system — work better than free-standing air cleaners.

allergy asthma linkage

What is the connection between allergies and asthma? We asked James T. Li, M.D., a Mayo Clinic specialist in allergies, asthma and immunology.

Oasis: Who gets allergies?

Dr. Li: Some people have a tendency to develop a variety of allergies. The medical term for this tendency is atopy, and we call these individuals atopic. Atopy tends to run in families.

Oasis: Is atopy always inherited?

Dr. Li: That is a very complex question. There is clearly a genetic component, but the development of allergies is also determined by exposure to allergens during a person’s lifetime. Some people who don’t have a family history of atopy still develop allergies, and some people with a family history of atopy don’t develop allergies.

Oasis: What is the overlap between people with allergic rhinitis (hay fever) and those with asthma?

Dr. Li: Atopic people may have allergic rhinitis, they may have asthma triggered by allergies, and often they’ll have both. If you look at children with asthma, about 70 percent to 80 percent also have allergic reactions to common substances in the air such as pollen, mold, dust mites, animal dander and so on. When they inhale a substance that they are sensitive to, it can trigger an asthmatic reaction.

About 20 percent of children with asthma are not allergic to such things as pollens or molds. Their asthma may be turned on by other factors such as exercise, cold air or respiratory infection.

It’s estimated that 40 percent to 50 percent of adult asthmatics also have allergies. Often, this group has had asthma since childhood. About 50 percent to 60 percent of adult asthmatics do not have allergic triggers for their asthma.

Oasis: Not every child who has allergies will develop asthma?

Dr. Li: That’s right. Not every person, child or adult, who has allergic rhinitis will also have or develop asthma.

Oasis: Is sinusitis involved in any way in this link between allergic rhinitis and asthma?

Dr. Li: An indirect link between allergic rhinitis and asthma is that people with allergic rhinitis are at risk of developing sinusitis or other respiratory infections. In a person with allergic rhinitis who gets sinusitis, the sinusitis in turn can trigger a flare-up of asthma.

Oasis: In what ways is the management of allergies and asthma linked?

Dr. Li: That’s an area of intense interest. Basically, if a person has both allergic rhinitis and allergy-triggered asthma, then avoiding exposure to allergens can be beneficial for both problems. For example, if someone has pollen allergy, one of the things we’ll work on is eliminating pollen from the home by shutting windows and using ventilation systems and air filters. If someone’s allergic to dust mites, then taking measures to reduce dust mite exposure in the home would benefit both the allergic rhinitis and the allergic asthma.

In addition, a regimen of allergy shots is sometimes beneficial for people who have allergic rhinitis and allergic asthma. In many people, treatment with allergy shots will benefit both conditions.

But the area of more intensive interest is whether aggressively treating the allergic rhinitis will directly or indirectly improve the asthma. There is evidence that people who have both allergic rhinitis and asthma benefit from having appropriate and aggressive treatment of both conditions. Since available treatment for allergic rhinitis generally is both effective and safe, it’s important for these people not only to have good asthma care but to have allergic rhinitis and other respiratory allergies treated as well.

controlling exposure of mold allergies

James T. Li, M.D., a specialist in allergy, asthma and immunology at Mayo Clinic, answers questions about mold allergies.

Oasis: What are molds and how do they cause allergies?

Dr. Li: There are many different types of molds, which are fungi that can grow in almost every environment, both indoors and outdoors. Mold particles or spores become airborne like pollen. If someone who is sensitive to a mold, particularly an outdoor mold, inhales the mold spores or mold particles, it can cause either an asthmatic-type reaction or symptoms of allergic rhinitis (hay fever), or both. People who are especially sensitive can have more severe reactions to mold than those who have reactions to pollen. Some people with asthma who are also sensitive to mold are at a higher risk of fatal or near-fatal asthma attacks, especially on days with high mold counts.

Oasis: Are the mold and pollen seasons in North America somewhat close together?

Dr. Li: The outdoor mold season varies. It's not as well-defined as the pollen season. But basically it starts in spring and ends in late fall. Usually the worst months are June, July and August. The mold season is longer, sometimes year-round, in warmer climates.

Oasis: Are there allergy problems with both outdoor and indoor molds?

Dr. Li: Yes, molds can be an indoor problem, particularly in damp environments. If you have a damp basement, it certainly can be a place where molds can thrive. Indoor molds and dust mites often go together. If you have a home with high indoor humidity, dampness and a musty odor, it's also likely to have dust mites and molds that can cause allergy symptoms in sensitive people. In addition, the spores from outdoor molds can enter indoor environments through open windows and doors.

Oasis: As with pollen, is it difficult to control exposure to molds?

Dr. Li: Yes. During the summer months, there are mold spores and mold particles in the air. As long as you're outside there's really no easy way to avoid exposure to outdoor molds. It's possible to reduce the indoor concentrations of outdoor molds by closing windows and doors and running air conditioners. As far as indoor molds go, high humidity is usually the culprit. We advise people generally not to run humidifiers in the home for two reasons. First, by increasing the indoor humidity, you promote mold growth or dust mite proliferation. And second, humidifiers themselves, if they aren't clean, can be reservoirs for mold.

Oasis: What about dehumidifiers?

Dr. Li: Dehumidifiers usually don't cause a problem — if you clean them regularly. I think dehumidifiers may be of some benefit in reducing the indoor humidity. But if the home has a lot of indoor humidity, a dehumidifier probably is not enough to control the situation. Something more may have to be done, such as landscaping around the house (to promote proper drainage) or fixing water leaks.

Oasis: Can people be sensitive to some types of molds and not others?

Dr. Li: Yes. And that's an important issue in the management of mold allergies. There are so many different kinds of molds that we literally can't keep track of them all. We do have some understanding about some of the more common molds, but there are many types of molds which are probably important in causing allergies that we just don't understand very well.

The allergy skin test extracts (given to stimulate symptoms) that we have for molds aren't quite as accurate as those for pollen, dust mites and animals. Part of the reason is that there are just too many types of molds. In addition, allergy shot treatment for mold allergies isn't quite as effective as the allergy shots we have for pollen. That's all the more reason for people sensitive to molds to see their physician to have their allergies carefully reviewed and treated with proper medicines.

Oasis: What other things can people do to control indoor mold exposure besides closing windows and doors, running air conditioners and trying to control indoor humidity?

Dr. Li: The recommendations are similar to those to control dust mite allergies: Remove carpeting from the home, cover bedding with allergy-proof encasements, and make sure there's adequate ventilation.

climate factor in seasonal allergies

Each year, climate and weather conditions play a part in determining how unpleasant seasonal allergy symptoms will be.

Winters that are mild or wet can aggravate seasonal allergies by causing plants to bloom and pollinate early and levels of mold to increase.

A cold and dry winter might decrease allergy symptoms, as it postpones early pollination and won't accelerate mold growth.

Rainy days in the spring, though not helpful to those with mold allergies, can help those allergic to pollens by washing pollens down before they become airborne.

Daily weather conditions also can have an impact on how severe allergy symptoms will be. For instance, rainy, cloudless or windless days are better than warm, windy or dry ones, because pollen and mold spores are less likely to be found in the air under those conditions.

Symptoms od seasonal allergies

Symptoms associated with spring seasonal allergies frequently include:

* Runny or congested nose

* Plugged ears

* Postnasal drip

* Puffy eyelids

* Decreased sense of smell

* Dark circles under the eyes

* Itchy eyes, nose, throat or mouth

* Sinus headaches

pollen and mold allergy

The problem with pollens and mold

Pollen, a microscopic reproductive cell released by trees, grass and weeds, is carried easily by the wind. As soon as plants begin to bloom and pollinate, spring allergy season is officially underway.

Trees pollinate months before grasses and weeds and earlier in warmer climates. For example, in the Northeast and upper Midwest, the tree allergy season generally begins in March or early April, while the tree pollen season can begin as early as January (or even December) in hot climates.

Grass is the next to pollinate. In the West and along the Gulf Coast, this typically begins during March. In the Southeast, it's not until April, and in the North, not until May.

Weeds are the last to pollinate. For most of the nation, this starts in June or July. However, it can begin as soon as April in the West and in Florida. In late summer to early fall, ragweed is a particular annoyance for many, affecting about 75 percent of allergy sufferers.

Mold spores, which grow in places such as damp soil, dead leaves and rotting wood, also can be a nuisance to those who suffer from seasonal allergies. Like pollen, mold spores are carried easily by the wind once airborne. Though always present, these spores increase in number as the temperature rises. "While there's not really a defined peak for outdoor molds, late summer to early fall would tend to be times when they might cause greater problems," Dr. Li says.

seasonal allergies -spring

Whether it's April showers or May flowers, both forecast trouble for the more than 35 million United States citizens who suffer from spring seasonal allergies.

"During the wintertime, especially in the northern climates where it's cold, there's very little pollen in the air. When springtime comes and the weather warms up, trees pollinate and their pollen becomes airborne," says James T. Li, M.D., a specialist in allergy, asthma and immunology at Mayo Clinic in Rochester, Minn.

Spring seasonal allergies (seasonal allergic rhinitis), also commonly referred to as hay fever, include allergies to the various pollens and molds that flood the air during springtime. Allergy tests can illuminate what specific pollens and molds you may be allergic to.

"There are two basic allergy problems that are caused in the spring," Dr. Li says. "They are seasonal allergic rhinitis and asthma, especially asthma in those who are allergic to tree pollen."

allergy and odors

Question: The smell of perfumes, detergents, cleaners-anything that has a smell gives me a terrible sinus headache. If I am around the smell for too long I get congestion in my ear. Over the counter as well as prescription medications do not help. I don't go out much because of all the smells. My allergist doesn't seem to understand how ill I get and it is getting worse. What can I do (my sister suffers from the same type of allergy).

Odors and smells can be irritating, especially if the odor is strong or unpleasant. People who are prone to this kind of irritation may experience headaches, congestion and even nausea when exposed to certain odors. The medical term for this sort of problem is non-allergic rhinitis or vasomotor rhinitis.

Perfumes, fragrances, fumes, solvents and cigarette smoke are common irritants.

This problem is different from allergic rhinitis or hay fever, which can be caused by an allergy to pollen, animals or dust mites. We look at non-allergic rhinitis as a response to an irritant rather than an allergic reaction. Hence, there are no allergy tests for sensitivity to perfumes or fumes.

Oral decongestants or a corticosteroid nasal spray may offer relief in some cases. Otherwise, the best thing to do is to avoid the stimulus.

Phenotypic Expressions of Asthma

Asthma has frequently been referred to as a syndrome, rather than a single disease. There are a number of clinical presentations to support this philosophy. Infants and young children often have wheezing problems. Since a variety of clinical conditions can present with wheezing, this age group is not routinely studied in genetic evaluations.

Children over six years of age with asthma are routinely included in genetic studies of asthma. Atopy (a probably inherited allergy) is an important contributing factor to asthma in the pediatric age group, and most genetic studies have used this associated feature in their definition of an individual with asthma. The issue is whether it is the asthma condition or the atopic status that is identified by the analysis.

Another clinical presentation of asthma is usually seen in adults, in whom a readily identifiable allergic trigger is often absent. To date, the so-called intrinsic asthmatic has not been separately studied using genetic approaches.

Asthma clearly has different clinical expressions. This requires the researchers involved in genetic studies of asthma to select an asthma type that is consistent for each person enrolled in a genetic study. A particular study must also use population, racial, and, possibly, environmental factors.

Source:Bruce Ryhal, M.D., Allergies and Asthma in Sports

Genetics of Asthma

The recent increased rate of published information on the genetics of asthma suggests that the gene(s) for the clinical condition recognized as asthma could be established within several years. Although asthma is a very common disease, it has defied a clear genetic explanation. Older clinical studies of asthma and allergy in twins consistently showed that pairs of identical twins were more likely than pairs of nonidentical twins to have asthma or allergies. Statistical analysis of the twin data has supported a genetic cause for both asthma and allergies. Modern genetic techniques now allow precise evaluation of the causes of diseases that likely have a genetic background; however, a review of the clinical presentation of asthma and the results of the studies published to date indicates the difficulties encountered in the explanation of the genetics of this disease.

source: Russell Hopp, M.D. Genetics of Asthma.

sports and allergy

Hives and Anaphylaxis

Many people experience hives when they exercise. This disorder can be diagnosed by the appearance after exertion of itchy wheals, often small, and often in association with perspiration. Exposure to heat causes similar symptoms in affected individuals. Antihistamines are effective in relieving symptoms.

Perhaps the most serious, though fortunately rare, allergic disorder associated with sports is exercise-induced anaphylaxis (a life-threatening condition where the body stops functioning). After exertion, anaphylaxis symptoms can suddenly emerge. Typical symptoms include itching, hives, wheezing, and hypotension. Exercising within four hours after a meal seems to increase the likelihood of an attack. In some individuals, ingesting specific foods (celery, wheat, and tomatoes, among others) may increase the chance of a reaction. Preventive medication is not helpful; these individuals should tailor their activity to avoid triggers and should carry an emergency epinephrine syringe.

Other Hazards

Allergic sports participants face additional concerns with some activities. The high air pressures associated with scuba diving create risk for people with chronic sinus disease or asthma. Skiing at high altitudes can also cause ear and sinus pain in individuals with allergic mucosal swelling. Equestrians may actually be allergic to their equipment (containing horse dander and dust). Many sports participants take nonsteroidal anti-inflammatory drugs (such as aspirin or ibuprofen) for muscle soreness, and these medications can worsen rhinitis and asthma in some individuals.

Allergy Evaluation

Involvement in sports carries many behavioral and physical health benefits, and nearly all individuals who experience allergies can be helped to participate fully. Many of the problems associated with allergies in sports can be effectively treated by your primary-care physician. For individuals who do not respond easily to therapy, further evaluation by an allergist can help detect and deal with specific triggers. Skin tests and radioallergosorbent tests for allergens, controlled food challenges, and provocative bronchial challenges are some of the specialized tests that are available.

Source:Bruce Ryhal, M.D., Allergies and Asthma in Sports

asthma and sports

Exercise may be a significant trigger of asthma in many individuals. More than one-third of athletes exercising in very cold conditions, such as cross-country skiing, may show evidence of asthma. These individuals experience breathing difficulty, wheezing, and chest tightness several minutes into exercise. Many are able to exercise through the acute wheezing and after 20 to 30 minutes experience a refractory period, during which time breathing is less obstructed. Detailed exercise spirometric testing can be used to diagnose asthma or to suggest other causes, such as breathing difficulties induced by reconditioning or exercise aversion.

There are a variety of options for the prevention and treatment of exercise-induced asthma (EIA). Choice of sport affects the likelihood of experiencing symptoms. Swimming is usually well tolerated, while outdoor winter sports trigger more symptoms. In addition, your doctor may suggest several medications to prevent or treat the symptoms associated with EIA. The beta-agonist albuterol is a frequent first choice of medication and is used throughout the world. Albuterol has the advantage of being accepted by most sports organizations (including the International Olympic Committee), though sometimes its use must be declared in advance of competition by the treating physician. It should be taken 15 to 20 minutes prior to exertion, but it may be used during an event if symptoms are noted. Its effects may last for several hours. Salmeterol, another beta-agonist, has a slower onset of action but may provide protection up to nine or more hours. Cromolyn or nedocromil taken by inhalation prior to exercise is also effective prevention for many people.

Sometimes exercise is simply one of many triggers for a person with chronic persistent asthma, and treatment must be directed at controlling the inflammation of asthma. These individuals should be treated with daily anti-inflammatory medication, according to the guidelines of the National Asthma Education and Prevention Program. Doctors will look for other evidence of more persistent asthma in athletes with exercise-induced wheezing, because the symptoms can be subtle. Chronic nocturnal cough, nonspecific chest tightness, and postviral persistent bronchitis may be clues that airway reactivity is present between periods of exercise. In addition to the treatments noted above, inhaled corticosteroids, leukotriene modifiers, and theophylline are options.

Source:Bruce Ryhal, M.D., Allergies and Asthma in Sports

Allergies and Asthma in Sports

Anyone from the weekend golfer to the elite Olympic competitor can experience problems due to allergies. Symptoms may range in severity from trivial but annoying to life threatening. Treatment involves special considerations because medication for symptom relief can affect sports performance, causing both positive and negative effects. Also, some organized competitions pose additional limitations to treatment.

Allergic Rhinitis and Conjunctivitis

Several aspects of the sports experience can affect rhinitis (inflammation of the mucous membranes of the nose). Many outdoor sports expose the athlete to airborne particles that can trigger allergic symptoms such as nasal discharge, sneezing, and itching. Grass pollen, for example, is airborne in high concentrations during the spring and early summer. Baseball players, golfers, soccer players, and those involved in other field sports face significant exposure, especially on windy days and after a recent mowing. Weed pollens, including ragweed, may cause problems in late summer and fall for those practicing on fields surrounded by uncut weeds. Mold spore counts tend to be high whenever climatic conditions produce heat and moisture, and some molds are also dispersed in high concentrations on windy days. The triggers of allergic conjunctivitis, which may transiently affect vision, follow similar patterns.

In addition to allergenic particles, the nasal passages are also sensitive to temperature. Cold air can cause watery nasal discharge in many individuals and sometimes a degree of congestion. Skiers, ice skaters, and hockey players often notice this problem. Treatment of rhinitis symptoms can involve antihistamines, decongestants, and topical sprays. Nonsedating antihistamines are favored for sports activities requiring quick reaction times, such as most ball sports. However, endurance does not seem to be affected by either sedating or nonsedating antihistamines. Treadmill testing of athletes on both types of medication at the Uniformed Services University did not show impaired performance. A topical antihistamine spray, azelastine, is available; it acts rapidly and causes minimal drowsiness.

Decongestant use is more controversial in sporting events. A healthy weekend tennis player may use a medication such as pseudoephedrine to decongest the nose without problems, but high levels of decongestant medications are banned during Olympic competitions. Decongestants in high concentrations act like stimulants, such as amphetamines, and may both unfairly enhance performance and lead to health risks.

Your doctor may also suggest other methods of treatment, such as topical sprays containing cromolyn or corticosteroids. When used for treatment of allergic rhinitis, these medications must be taken for at least several days prior to exposure to be effective. Topical ipratropium is also available and is effective for decreasing watery nasal discharge during exercise and exposure to cold air.

Allergen immunotherapy is useful for decreasing allergic symptoms, but treatment must be started prior to exposure and needs to be continued for three to five years. Various mechanical devices (such as Breathe Right Nasal Strips) are available for relief of nasal congestion and are used by many professional athletes. These are less effective for many allergic individuals because nasal swelling occurs within the bony vault of the nose, which cannot be expanded by a mechanical device.

Symptoms of allergic conjunctivitis generally will improve with treatment of rhinitis. If necessary, your doctor may also prescribe topical eye medications, such as cromolyn, lodoxamide, or olopatadine.

Source:Bruce Ryhal, M.D., Allergies and Asthma in Sports

Theophylline in Asthma

Theophylline, has in the past been a mainstay in the treatment of moderate to severe asthma, but is less popular than it used to be. Recently, however, there has been a renewed enthusiasm for the use of theophylline in the treatment of asthma, because of newly identified anti-inflammatory and immunomodulatory effects. Several studies have demonstrated that theophylline inhibits histamine release and suppresses inflammatory cell activation. Recent studies have also found evidence of theophylline’s effects in modulating T-cell counts in peripheral blood and biopsy specimens, reducing activated eosinophils in biopsy specimens, and attenuating allergen-induced histamine release from mast cells.

Theophylline is particularly effective in controlling the late-phase allergic reaction of atopic asthma. The late-phase reaction is thought to be the most important reaction involved in the development of airway hyperreactivity, and hyperreactive airways are prone to go into spasm at any insult, from cold air to strong perfume.

At therapeutic blood levels, theophylline reduces bronchoconstriction and associated airway hyperresponsiveness, inhibits both immediate and late bronchoconstriction following antigen challenge, and diminishes the influx of neutrophils. These anti-inflammatory and mucociliary effects—together with the drug’s ability to improve diaphragmatic muscle functions—may also explain theophylline’s beneficial effect in chronic obstructive pulmonary disease. It may be interesting to note that theophylline also relaxes spasms of the lower airways independent of the type of mediator that induces bronchoconstriction.

Maintaining therapeutic levels of theophylline while avoiding wide swings between toxic and subclinical dosage ranges has long been a challenge. However, with the advent of controlled- and sustained-release theophylline preparations such as Theo-24, this challenge has become much simpler.

Sustained-release theophylline preparations require fewer daily doses. This not only enhances patient compliance, resulting in better asthma control, but also permits improved maintenance of therapeutic levels throughout the day and night.

Because asthma has such a strong inflammatory component, most clinicians treat asthma patients with aggressive anti-inflammatory medications in their initial regimens. However, as our understanding of asthma increases, it is important for clinicians to recognize that effective asthma regimens are often idiosyncratic, requiring drug regimens to be individualized to best meet the needs of the patient.

source:M. Eric Gershwin M.D., Allergy and Asthma Magazine
Reference: M. Weinberger and H. Hendeles, "Theophylline in Asthma," New England Journal of Medicine, vol. 334, no. 21 (May 23, 1996).