Nothing to Sneeze At

"This is a war on progress." That's how John Oppenheimer, MD, refers to the prevalence of allergies in today's population. In fact, some researchers theorize that we've done such a good job administering immunizations and "hermetically sealing our homes" against dirt and germs, our immune systems simply have had to seek out other triggers to attack. "Still, I would rather have allergies than infections," Oppenheimer says. "They don't generally cause mortality."

True, but allergies do cause a host of other problems for people who suffer from them, especially this time of year. Oppenheimer, a partner in Pulmonary and Allergy Associates in Summit, explains that upper-airway reactions often happen after exposure to something in the environment, including grass, smoke, and pet dander. Symptoms include a stuffy or runny nose, itching, and sneezing. Lower-airway responses include coughing, shortness of breath, and wheezing; these are often triggered by viral infections, exercise, cold air, and allergic reactions to foods.

Food, Glorious Food?

Unlike environmental allergies, food allergies can be fatal. Reactions can range from mild—eczema, hives, nausea, vomiting, and diarrhea—to life-threatening, with responses that include swelling, tightening of the throat, loss of blood pressure, and, in the most extreme cases, anaphylaxis and death.

Donatella Griffino, MD, also of Pulmonary and Allergy Associates, says she sees one or two patients with brand-new food allergies every week. The biggest culprits—milk, eggs, peanuts, soy, and wheat—account for up to 90 percent of food allergies in children. Fortunately, with the exception of peanut allergy, many kids will eventually develop a tolerance to these foods. Unfortunately, many food allergies are discovered only after there has been a bad reaction; often, you may not even know what has triggered the response.

In those cases, allergists are often called on to channel their inner Sherlock Holmes. Says Oppenheimer, “Allergists need to work with the patient as a good detective. Doing blood and skin tests blindly is not successful. After taking a history, we can use blood and skin tests to confirm. But what the allergist needs to do is listen to the story. Then we reinvent the crime scene in a controlled setting”—meaning medical assistance is nearby, just in case.

In preventing food allergies, it is important to introduce new foods slowly to babies and toddlers and be aware of any potential reactions. Graffino instructs parents to delay introducing certain high-alert foods, like peanuts, tree nuts, and shellfish, at least until after a child’s fourth birthday, when digestive systems are more mature. But in dealing with and preventing reactions to food allergies that you know exist, she stresses the importance of having a plan of action if one is needed. “Parents that have kids with allergies must be comfortable dealing with them,” she says. “Be able to handle a situation for at least the first few hours if something occurs. Have some level of comfort; it’s nerve-racking to worry about every bite they put in their mouth.”
It’s equally important to be able to transfer allergy-alert responsibilities to the child as he or she ages. For a child who has had a bad reaction to a certain food, for example, this can be as simple as telling him that if he avoids that food, it won’t be able to make him sick again.

“Children with food allergies are generally bright and mature,” says Oppenheimer, “and they learn how to avoid the foods that make them sick.”

On the Horizon

As soon as ten years from now, allergies may be a non-issue. “Today we have better parameters for recognizing problems,” says Oppenheimer. “Hopefully in the next decade we will see better tools.”

Among them may be a vaccine that diminishes the risk of anaphylaxis in the case of food allergy. “Today’s shots will be old-school,” says Graffino. “We’re better understanding how to manipulate the immune system.” For many children and their parents, that will be a breath of fresh air indeed.

To schedule an appointment with an allergist, contact the Physician Referral Line at (866) 580-9761.

In the Genes

If your child suffers from allergies, the cause may be close to home.

If you’ve ever racked yourself with guilt, wondering if you’re responsible for your child’s allergies, the answer is … sort of.

“Allergic responses belong to the same system that helps fight parasites,” explains Graffino. “We no longer need that part of our immune system like we used to, but our systems don’t know that. So they turn their attention to harmless things, like cats and dust. If you have a genetic disposition to something that will make you stronger and healthier”—in this case, that old ability to fight off parasites—“of course you’ll pass it down. It’s transmitted through generations.”

And what about a more direct parent-to-child link? “If one parent has allergies, there is a 50 percent chance that the child will,” says Oppenheimer. “If both parents have allergies, there is 70 percent chance. But the rest is Russian roulette: We inherit Immunoglobulin E (IgE), which is to say we inherit the disposition to be allergic or not. Genetics does not determine what we’re allergic to.”

The Buzz on Bees

Doctors don’t know how many people die every year as a result of allergic reactions to bee stings, but they do know that 50 percent of those who die never had even a small reaction to bee stings previously.

• wheezing


• shortness of breath


• tightening in the chest

“If there is something evolving, call 911 immediately,”
cautions Oppenheimer. You just might save a life.

Fight Back!

For many children with run-of-the mill allergic rhinitis,
over-the-counter antihistamines may be enough to manage symptoms. For other kids, more aggressive therapies—including prescription medications and allergy shots—may be necessary. Either way, the best defense is a good offense. These steps can help diminish reactions or prevent them entirely.

• Avoid triggers (pets, pollen, etc.) whenever possible.


• Keep children’s bedrooms fairly easy to clean. “Kids’ bedrooms are cluttered with stuffed animals, canopy beds … These are dust catchers,” says Graffino. “There can be billions of dust mites rolling around in bed with your child.”


• Wash linens weekly in hot water.


• Hardwood floors are preferable to wall-to-wall carpet for keeping allergies at bay, but if you do have carpet, be sure to vacuum at least twice a week. On other surfaces, use a damp cloth to pick up dust and similar irritants.


• Keep home and car windows closed and use air-conditioning. Air conditioners filter out 90 percent of
  pollen, explains Graffino.


• If possible, don’t go outdoors between 5 a.m. and 10 a.m., when pollen counts are highest.


• When your child comes in from the outdoors, have him remove his clothing, dump it in the washing machine, and take a bath or shower. Washing hair at night prevents
  pollen from sticking to bedsheets.

It can happen to you: a situation in which your child faces severe complications as a result of an allergic reaction. Before that happens, it’s important to read these potentially life-saving tips.

• Maintain an accurate, up-to-date list of allergies or groups
  of allergies for every member of the family.


• Have an emergency plan in place. “Feel confident that if a constellation of symptoms occurs, you can deal with them,” says Oppenheimer.


• Learn the appropriate usage of epinephrine if it has been prescribed for emergency situations, and have your child learn too when he or she is old enough. Then be sure to carry it with you. Just remember that Emergency Room follow-up is essential. “Allergic responses may be two-pronged,” cautions Oppenheimer. “There may be a late-phase reaction four to six hours later.”


• Obtain a medic-alert bracelet for a severely allergic child.