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Leonard Bielory, M.D. Stop Sneezing & Wheezing Wednesday, March 15, 2000
Allergy and asthma expert Leonard Bielory, M.D., joined PlanetRx.com for a chat on all aspects of allergies. For the last 20 years, Dr. Bielory has researched asthma, allergies, and the products designed to help these conditions. He specializes in allergies caused by urban environments, asthma, herbal treatments of asthma and allergies, food allergies, and those that involve the eyes. Learn more about Dr. Bielory.
The following is an edited transcript of Dr. Bielory's March 15, 2000, chat.
PRx Host :
Welcome to tonight's chat with allergies and asthma specialist Leonard Bielory, M.D. Dr. Bielory has focused his asthma and allergy research on the effect of city environments, pediatric treatment, allergies associated with immune deficiencies, and allergies of the eye. It is a pleasure to have you with us tonight, Dr. Bielory! We're glad you could join us.
Dr. Bielory :
Thank you very much!
PRx Host :
Let's start with the basics. What are allergies? What's happening inside your body to cause the sneezing, wheezing, and itching?
Dr. Bielory :
Allergies are the immune response to the environment. The immune system can react in three ways. One form is against ourselves. We call that autoimmunity. Examples are rheumatoid arthritis [and] systemic lupus erythematosus, which is also known as SLE. Another form of an immune response is when we transplant something foreign, like an organ, into the body. We call that rejection. The third one is where we have the immune response interacting with the environment. That could be interacting with bacteria as we become infected, or viruses or something as innocuous as pollen, something that floats in the air. The immune system recognizes protein as the primary cause of allergies. We're not allergic to fats or sugars, but we can be allergic to sugars that are bound to proteins or fats that are bound to proteins.
PRx Host :
How are allergies different from, say, common colds?
Dr. Bielory :
Allergies are different than the common cold because the common cold is an immune response to a viral attack on the surface of our nose or throat or lungs. The response that occurs to the pollen that lands on our nose occurs through a very specific allergy antibody. If you don't have the allergy antibody, you don't develop allergies.
The immune response to the virus or bacteria is an infectious cause of inflammation. Allergies are a response to a noninfectious entity, such as mold. You're not infected with the mold; you become hypersensitive to a protein on the mold, the pollen, or the dander on dog hair.
An interesting difference between the two is the symptoms you exhibit when you think you have a cold or you think you have allergies. When you have a viral infection, you develop muscle aches and pains and fever. With allergies, muscle aches and pains are rare to nonexistent. A fever usually develops secondary to a sinus infection that after the swelling closes off the sinuses. Sinusitis is an important feature of many allergies. Many people call allergies rhinoconjunctivitis. It involves the nose ("rhino"), and the eyes ("conjunctivitis"). Some people call it rhinosinusitis, because it involves the nose and the sinuses. Sinuses play an important role because people develop allergy headaches and problems.
PRx Host :
We have a lot of questions from the audience, so I'm going to turn to those:
nelvana1 :
Dear Dr. Bielory, your being here is such a blessing. I am in the process of collecting information to deal with exposure to a dog for my children who have both tested positive to dog, cat, horse, pollen, and molds. My ex-husband and his wife have bought a puppy and cannot see any reason why the children should not continue regular weekend stays there. They refuse to believe anecdotal proof that the girls have walked into houses where dogs were housed six months previously and developed immediate reactions. Is there a way of "desensitizing" the children that doesn't involve prolonged medication or invasive treatment? I was told years ago, when the eldest was dealing with asthma from allergies, that if I were willing to keep her from exposure to the antigens she might not be shackled to medicines for life. Am I wrong to think that avoidance is the best policy for their health? Thank you so much.
Dr. Bielory :
In the treatment of allergies, avoidance leads all other interventions. This includes medication therapy, and even immunotherapy. "An ounce of prevention is worth a pound of cure," and since there are no "cures" for allergies, prevention is very important when it is practical. However, many of the allergies that individuals develop, one cannot avoid, such as pollen. As such, one has to rely on the use of medication to decrease the impact that these allergies may have on one's daily life.
In regards to your specific situation, when children are known to have a clear-cut allergy to specific animals, it is important that they try to avoid them, specifically the dogs and cats. Even though a dog or cat may not be present in the house at the time, the animal dander that contains the protein that the individual is allergic to may last months, even years. Therefore, simply removing the animal may not be good enough to prevent a sudden, acute attack as an allergic response to the protein.
If the child has asthma, I would make it very clear that it is very important that extensive cleaning be done. One should consider the use of allergy shots to further decrease the immune response they have to the specific trigger. One may also take certain medications ahead of a known exposure. This would be considered a "prophylactic" treatment. Due to your extenuating circumstances, namely, the case of children who have to reside in two different homes, I would initially recommend the avoidance route first and then the use of medications prior to being exposed to decrease the amount of problems that may occur.
PRx Host :
Another audience question for you:
MrsRichard :
We are both 78 and are suffering miserably from intense itching in outer ears, scalp, and many body areas. Do you think this could possibly be dust mites causing this, and what is the best and most immediate way to alleviate this problem and to eradicate whatever is causing it? Sincere thanks for whatever help you can offer in the way of suggestions for treatment and whatever is needed to make us comfortable again. This has gone on for several months, night and day. Many thanks.
Dr. Bielory :
As one gets older, the skin becomes extra dry and sensitive to the environment. To state that perhaps you are definitely allergic to dust mites, one would have to go to see the allergist and be skin tested.
By the description of intense itching in the outer ear, scalp, and other body parts, I am suspicious that you may have a mild seborrhea, a form where skin flakes come off and the skin becomes very itchy. As such, one has to maintain a certain body moisture.
In patients with severe eczema, if they have excessively dry skin or dry their skin after a bath, we recommend that they moisturize the skin by adding a little capful of baby oil to the bath water. Then, when they exit a bath, their body is coated with a very fine film of baby oil, which is very pleasant in aroma and moisturizes the skin.
It is unusual for dust mites to cause intense itching per se, without your description of hives or swelling, as well as runny nose, watery eyes, those typical allergic symptoms. In addition, one has to be concerned in the geriatric population that there may be some hormonal problems. The most common hormonal problem in the elderly is thyroid disorders, and this needs to be checked.
PRx Host :
As you're an expert in ocular allergies, here's a good question for you.
jimearl :
What do you do with dry itchy eyes? With swollen cracked eyelids? There are no other allergy symptoms.
Dr. Bielory :
In people who have dry, itchy eyes, it depends upon the age. If your age is over "X" and you are a female, you may be developing menopausal symptoms. The dryness is an early sign, and one needs to consider the use of tear substitutes.
Since the individual who wrote this question said they had swollen, cracked eyelids, that adds another clinical piece of information. The more history you give me, the better diagnosis I'll be able to give.
With swollen, cracked eyelids, one needs to treat that. The question is why this occurs, especially when there are "no other allergy symptoms." If there's no allergy [symptoms such as] runny nose, hives, seasonal type, or allergies to animal, the swollen, cracked eyelids may be a contact dermatitis, such as seen in women who wear nail polish. They develop a contact dermatitis, just like poison ivy, when they touch their eyelid with their nail polish covered nails.
In addition, one should also consider that the area around the eye may have a superficial fungal infection. A treatment with an antifungal shampoo for the scalp, as well as taking a cotton swab and scrubbing the eyelids, will decrease the reactions seen around the eye. Some people can also note that increased ocular hygiene around the eye -- using baby shampoo with a cotton swab, just do lid scrubbing morning and night -- will decrease the inflammation around the eyelids.
sonora :
I have asthma and allergies, allergies to pollens, foods, chemicals, etc. Recently my doctor referred to these as sensitivities rather than allergies. I have tested positive to most pollens, but the facial swelling and itching, wheezing and coughing that I experience from some foods and several different airborne odors are being called sensitivities. What is the difference? Sometimes my eyes swell shut and I lose my voice. I use zyrtec, azmacort nasally, eyedrops, and all of the inhalers for asthma. Thank you.
Dr. Bielory :
The difference between sensitivities and allergies are sometimes none. Hypersensitivity to a substance that [in response to which] your body uses the allergy antibody and the allergy cell is the classic sense of "an allergy." However, someone may be experiencing a sensitivity to sulfites, which can be found as an antioxidant on foodstuffs. This is the substance that prevents Waldorf salads from turning brown, or lettuce from turning brown in salad bars. The exact mechanism of how it interacts with the immune system is not known. It mimics exactly the reaction that uses the allergy cell, the mast cell, or the allergy antibody, IgE antibody. Therefore, it is hard to delineate a difference between sensitivity and allergy in many cases.
However, when someone says they're allergic to ozone, we know that is not an allergic response, but maybe a sensitivity. We have never demonstrated any allergy type chemicals in the human body to ozone. As I stated earlier, one develops an allergy state or chemicals to these things if they are 'proteins.' Many of these chemicals may not be proteins at all.
PRx Host :
Here's a question from the audience about medication for allergies:
Kris29 :
Is there anything safe to use while trying to get pregnant? Thanks.
Dr. Bielory :
There are several antihistamines that are safe. One is one of the oldest antihistamines, known as PBZ, the drug known by the generic named tripelennamine. It's an excellent drug that has been used in pregnancy, can last 12 hours, and is very cheap.
There are other agents that are clearly not threatening to the mother or the fetus. One must realize that if one just has allergies, a simple antihistamine is fine.
The use of nasal steroids in general is safe in pregnancy. However, there is a specific one known as triamcinolone, that is known to truly cause a problem, such as its possible association with cleft palate development in animal studies.
If you have asthma and you have a problem, you need to use prednisone -- you should not be fearful of it. It really has not been shown to have any long-term sequelae on births. The under-treatment of asthma has been clearly shown to have an effect on birth weight and infant mortality when the mother is not taking good prenatal asthma care.
ChrisN :
Can dust mites cause allergic skin reactions, or just nasal allergies? For instance, a rash?
Dr. Bielory :
Dust mites are classically associated with allergies of the nose and eyes and lungs. There has been increasing information to relate that even dust mite "proteins" can cause a dermatitis, which is inflammation at the skin at the site where they're chronically exposed. This has been seen in some patients with upper eyelid dermatitis (seen above both eyes and other patchy skin lesions). In addition, some individuals may even develop hives when exposed to a high dose of dust.
PRx Host :
Here's a question from an audience member who wants to know more about the causes of diaper rash. Can that be caused by an allergy?
Dr. Bielory :
Diaper rash is not a specific allergy. It is more commonly associated with the pH of the feces or urine. The baby's sensitive skin, through a change in pH, becomes irritated. In addition, there are unusual rashes, which are seen in rare children who may have an immune deficiency that mimics diaper rash that never goes away. A persistent diaper rash with an elevated scaly border that seems to be growing needs to be examined by a specialist for consideration. Overall, diaper rashes themselves are rarely due to allergies.
samson :
Hello, doctor. I was wondering what to do about city air? Sometimes it's pretty bad and I really feel it. Should I wear a cloth or a dust mask or something?
Dr. Bielory :
City air is a mixture of a variety of particulate matter that may include diesel exhaust in addition to the pollen. It has been shown that diesel exhaust particles can make one's allergic response increase. Therefore, the irritation that a person normally gets from the "pollution" in city air is augmented and accentuated in a person who has allergies.
If the person does not have allergies, then city air may or may not cause an irritation that goes away at a certain level of exposure.
The need to wear a mask to filter this particulate matter depends upon the sites of irritation. If there is a severe problem with asthma, one is better off taking medication since it is impossible to remove all irritants from the air. There is a very good pollen and mold mask that is made by the 3M company. It looks like a surgeon's mask, which filters out the higher particulate matter, such as pollen or mold. People who jog and who have allergies may need to wear that to prevent excessive inhalation of pollen and mold. To be able to filter out the "bad air," or polluted air, one would have to wear a carbonized filter. This is very impractical and highly unlikely to make a large difference versus properly taking medication to decrease the inflammation in the first place.
In the environment, pollution only makes a person who is already prone to have problems worse. It does not cause the problems in the first place.
PRx Host :
Here's a question on allergy medication:
rfthelo :
About three months ago I was notified that my allergy medication (PBZ) was discontinued. Nothing seems to work as a replacement. I can get no relief with the new medications.
Dr. Bielory :
PBZ is an excellent drug. It's been around since 1946. I use it in my patients who are pregnant. It is available in generic format, and therefore you should look for the generic name tripelennamine vs. PBZ, the brand name. Good luck!
kateahern :
When I have an allergic reaction to mold, I get really, really sleepy. But antihistamines, like pseudoephedrine, make me crazy hyper and keep me up for a long time. Are there any alternative treatments you could recommend?
Dr. Bielory :
Allergies in general can make people a little groggy due to the histamine, and people may develop headaches and sinus congestion. Pseudoephedrine is a stimulant and shouldn't make you drowsy, but the allergies may.
For people who are concerned about becoming drowsy, there are non-sedating antihistamines they can use. They are available from a variety of sources, but predominantly they are prescription only.
For a natural remedy, there are allergy-sinus solutions. One is available from a company in New York City called Advanced Plant Pharmaceuticals Inc. (called APPI). The web site is www.advancedplantpharm.com. They have a solution known as AS2760, Allergy Sinus Solution. They are about to market it, and it's an excellent natural decongestant, which has antiallergic, antibacterial, and antifungal properties that assist in decreasing inflammation and infection of the sinuses. A person can use it many times a day without becoming "hooked."
Non-sedating antihistamines are also available by prescription. Nasal steroids, which are an excellent anti-inflammatory drug, can be applied to the local mucosa via nose spray. If this does not work, allergy shots clearly educate the immune system to decrease its response.
Oxygenaire :
Can allergies produce earaches in adults, or could there be a bacterial infection lurking within my body?
Dr. Bielory :
Allergies are more commonly associated with ear problems in children. Since the tube that drains the ear to the back of the throat (known as the eustachian tube) is poorly developed and does not drain as well in children.
As we get older, the tube becomes more directed downward and therefore drains better as the skull becomes larger due to the development from a child to an adult. Ear infections in adults due to allergies are therefore extremely rare.
If you have ear pain with a temperature and truly think you're infected, it is not allergies. However, if you have sinus problems, I would recommend something like a sinus solution as mentioned above to help clean the sinuses out. The best treatment would be a nasal steroid to decrease the inflammation.
Kris29 :
Do you recommend any particular companies for the mattress and box spring encasements to help with dust mite allergies?
Dr. Bielory :
I do not endorse any single company. I examine all their materials. There are many companies that have a variety of good items. One must be careful, since they are not regulated. Recently, a company recalled a carpet cleaner that allegedly decreased dust mites for severely allergic persons after many patients suffered asthma attacks. Therefore, claims by the individual companies need to be reviewed. Ask your allergist to give you the names of various companies that he considers have integrity.
rose :
Dr. Bielory, my roommate is allergic to cats -- except for some reason she is just fine around my cat. I don't wash the cat particularly often, and my roommate does not try to avoid her. We DO vacuum and clean regularly, but that's it. What could explain our good luck in this case?
Dr. Bielory :
It's not a real cat?
If a person is truly allergic to cat dander, then they're allergic to all cat dander. There are very rare cases where a person may be allergic to something very specific in a single species of a cat and may not have problems with other cats. However, those cases are case reports for the medical literature.
It is a general and commonly accepted rule: Once you are allergic to protein from a cat, which is found in the saliva of all cats, you are allergic to cats. I cannot explain why your roommate has that ability.
Pokey :
I'm thinking of getting a cat for my daughter, but I've heard that children with pets are MORE prone to develop allergies. She hasn't shown any signs of sensitivity to anything yet, but I haven't had her tested. She's 7 years old.
Dr. Bielory :
Allergies take one to two years to develop. There is an increased chance of a child developing allergies if a parent has allergies. If one parent has allergies, it is a 30% chance that a child will have allergies. Both parents -- a 50% chance. This does not mean they will be allergic to the specific thing the parents are allergic to. A mother may have [the symptom of] eczema [as the result of an allergy to] corn. The father may have [the symptom of] asthma [as the result of an allergy to] to cat dander. The child may have [the symptom of] hay fever [as the result of an allergy] to ragweed. It's not the same symptoms and not the same protein that causes the allergy.
Once you have an allergy to one thing, you have a chance to develop more allergies to others. A 7-year-old with no allergies, if there are no allergies in the family, has one of the lowest chances of developing allergies. If within two years, the child seems to sneeze, wheeze, or itch with exposure to the animal, she may have allergies. If there are no allergies in the family, I would have no problem in recommending it.
BlueFly :
I've heard that allergy shots are helpful but I don't want to have to go to the doctor three times a week or even twice. Is there a way I can do the shots myself? What's the least number of shots that I can take that would be helpful?
Dr. Bielory :
Allergy shots are not required to be taken two to three times a week, unless you are doing a rush desensitization (which means you want to become less allergic faster than the routine of doing it once a week to once every other week).
There is a new therapy on the horizon in which the allergy antibody, the IgE antibody, is being attacked by the treatment itself. This is seen in clinical trials for patients who have allergic rhinitis, which is inflammation of the nose, and in asthma, with beneficial effects, and may result in less frequent allergy shots.
The use of allergy shots three times a week is very, very uncommon. Again, it's only used [by those who want] to have rush immunotherapy in order to achieve a quicker response.
MissyX :
I am allergic to all NSAIDs (e.g. ibuprofen), salicylates (e.g. aspirin), and macrolide antibiotics (the mycins). However, when is it considered an allergic reaction versus just a gastrointestinal irritation (a common side effect of NSAIDs and aspirin)? I get very nauseated and vomit violently if I take any of the above.
Dr. Bielory :
Hypersensitivity to aspirin type medication, otherwise known as nonsteroidal anti-inflammatories, are reported in about 5% of asthmatics. They will develop shortness of breath; another subset may develop hives and runny nose. The mechanism is not totally known, but as reflected in your question, cross reactivity from one agent to another is very common, such as from aspirin to ibuprofen to other nonsteroidals. However, it rarely occurs cross-reactive to Tylenol, since it is not in the same family.
Theodora :
I don't know if I'm allergic to bee or wasp stings, but every time I see one I freak out. It's become some kind of crazy paranoia. Is there any way I can be tested to see if I'm allergic? My cousin almost died from a wasp sting.
Dr. Bielory :
Stinging insect allergy is one of the few best studied allergies [and is also an allergy] in which allergy shots are lifesaving. One can be easily tested, even if one does not know exactly what insect stung them. Most individuals do not know which form of stinging insect did the dirty deed. Therefore, the allergist can perform allergy skin tests to a variety of stinging insects and, if positive, can then assess the proper intervention, such as allergy shots if the history warrants it.
If you have a history of reaction that includes hives, asthma, or shock, or a family history of such allergic reactions, then getting screened with the allergy skin test for the stinging insects is warranted and will easily provide more peace of mind since you will know exactly what you are or are not allergic to.
Kimmy :
Whenever I go running in cold weather and start to sweat, I develop a horrible itchy rash. I've actually stopped running because of it. Could I be allergic to the wind? What can I do to prevent this?
Dr. Bielory :
In individuals who exercise, there is something called exercise-induced reactions that may be related to specific foods they may have ingested beforehand or the exercise, in which there's a change in temperature. The fancy term is cholinergic urticaria. This is due to heat exposure or temperature changes and many people who exercise may develop such a reaction.
One of the features of this type of reaction is that the itchy bumps are literally little pimples that occur over the body versus a patch of what people would call hives. Therefore, further evaluation and assessments by an allergist would be extremely helpful. If you have any compromise of breathing, you should certainly see an allergist as a possibility to decrease any major problems.
Joely1 :
Hello, Dr. Bielory. Allergies seem to be more prevalent than ever. Is there any proof that allergies may be related to increasing levels of pollution in the environment? What other reasons might there be for the increase in cases? Thanks.
Dr. Bielory :
There is increasing research focusing on the possibility of environment accentuating our own immune system. Research at the University of California by Dr. Andrew Saxon has shown very suggestive data from test tube-type experiments in which he showed diesel exhaust particles, when mixed with allergy-type cells, will make the allergy type cells more sensitive and respond more briskly to the environment. Therefore, this supports the concept that our environment has increased the general prevalence of asthma.
As seen in many of the studies, it seems to be consistent with the growth of allergies in the industrialized countries. It is only a theory, but very, very suggestive.
erasure1 :
Dear doctor, how do I know whether I have a food allergy or sensitivity to wheat and/or dairy products? What is the difference?
Dr. Bielory :
The differences among toxicity, intolerance, sensitivity, and allergy are as follows:
A toxic response is what we get from a poison. It's reproducible, occurs each and every time, and is known to cause a poison to the system chemically.
An intolerance is the lack of ability to respond to a specific protein that's added to the diet, or to a specific nutrient. An example is lactose. It's not tolerated in many individuals as they get older. As such, they need to have a supplement in their diet. This is due to a deficiency that occurs with age. It leads to increased gas, diarrhea, and acidic stools.
Sensitivity may be due to a non-immunological response that leads to irritation directly. The cause may just be high acid content with some people belching a lot from a certain meal due to irritation from what they ate.
An allergic response occurs within 15 minutes to several hours. [It] is associated with the allergy-type chemicals reacting in the body, such as histamines or the allergy antibody, which can make runny nose, coughing, wheezing, hives -- the classic features.
From history, we can delineate 80-90% of the cases, whether it's toxicity, sensitivity, or a true allergy.
StephanieC :
I'm allergic to dogs but I'm dying to get a puppy. I'd rather not take drugs if I can avoid it. I've heard that some dogs, such as poodles, are less likely to cause allergies. Is that true?
Dr. Bielory :
Regretfully, the only nonallergic pet is the one that you don't own. If you're allergic to dogs, you're allergic not to the hair but to the common protein that usually is in their saliva. Therefore, there are very common cross-reactive proteins between one dog and another. The only thing that we find in short-haired dogs is that they have less protein because they have less hair, which is where the protein sticks. A hairless Chihuahua may [produce less severe reactions] than a full-haired dog of any sort on which the protein will stick to the hair, and therefore you'll be constantly exposed.
I do not recommend that my patients who are allergic to animals get one. Many of my patients who have allergies and animals do not get rid of their animals, and have to take allergy shots to tolerate them and prevent major problems.
PRx Host :
I'm sorry but we've run out of time. Thank you so much for chatting with us tonight, Dr. Bielory. It has been a pleasure and very informative.
Dr. Bielory :
Thank you! One of the important URLs regarding Herbal Treatment of allergies can be found at www.advancedplantpharm.com.
Leonard Bielory, M.D., received his medical degree from the University of Medicine and Dentistry of New Jersey (UMDNJ) in 1980, and interned at the University of Maryland Hospitals. He went on to become a medical staff fellow in Allergy and Immunology at the National Institutes of Health. In 1985 he established the Division of Allergy and Immunology at the UMDNJ-New Jersey Medical School, and founded the Asthma and Allergy Research Center there.
Dr. Bielory has focused his asthma and allergy research on the effect of city environments, pediatric treatment, allergies associated with immune deficiencies, and allergies of the eye. He is the author of Understanding Allergy, Sensitivity, and Immunity: A Comprehensive Guide (Rutgers University Press, 1990), as well as numerous articles.
Dr. Bielory is currently the director of several allergy-related divisions of the UMDNJ, working on multiple grants, including one from the National Institutes of Health. He also maintains a private practice in Springfield, N.J.
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