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Michael S. Blaiss, M.D. Take Charge of Your Allergies this Spring
Expert allergist, Michael S. Blaiss, M.D., joined us for a "beginning of allergy season" chat on Wednesday, March 22, 2000. Dr. Blaiss answered many questions from the audience, covering allergy shots, prescription vs. over-the-counter medication, allergies and pregnancy, children and allergies, tree-pollen problems, indoor allergies such as dust mites, and much more. Learn more about Dr. Blaiss. Read the transcript below and find out what to do about your sensitivities.
PRx Host :
Welcome to tonight's live event. We are happy to have allergist Michael S. Blaiss, M.D., here to answer your questions about springtime allergies. Welcome, Dr. Blaiss.
Dr. Blaiss, spring is here and that means difficult times for many allergy sufferers. What are these allergies and what is it that the change in season brings that causes such problems?
Dr. Blaiss :
Well, with the change in season, we have the beautiful outdoor plants blooming and pollinating. What we see developing in the early spring, starting over the last few weeks, is tree pollen. The area of the country you live in determines the particular types of trees that would be pollinating during the spring. Some of the major trees that pollinate in the spring which cause severe hay fever problems for patients are oak, birch, willow, pecan, as well as many others. These pollens in the air trigger sneezing, nasal itching, runny nose, and watery, itchy eyes. In some patients, these pollens may even trigger asthma.
PRx Host :
What are some of the specific symptoms of tree-pollen allergies vs. other kinds of allergies?
Dr. Blaiss :
In general, the tree-pollen allergies tend to have more involvement of eye symptoms. This time of year, we see many more patients at our office with allergic conjunctivitis, or allergy of the eye. Patients have severe watering, itching, and burning of their eyes from the tree pollen. Along with that, we see the typical symptoms of nasal problems, such as sneezing and nasal itching, along with the triggering of wheezing and chest congestion in some patients.
PRx Host :
What are some ways to treat springtime allergies besides never going outside?
Dr. Blaiss :
There are usually several approaches that we go over with patients to help them better manage their springtime allergies. Obviously, staying indoors all the time is not possible, but it's very important, when they are in the house or in a car, to keep the windows closed at all times, so that the pollens do not come into the house or car. Also, it's important not to dry clothing outside during the spring, as the pollen may attach to the clothing and trigger allergy problems when it is brought indoors.
The next step is medical management. There are many different medications available for the treatment of springtime allergies. Some of the different over-the-counter preparations include antihistamines and decongestants. These include drugs such as Benadryl and Chlor-Trimeton. These medicines can be effective, but can cause significant side effects in many patients, especially sleepiness. Therefore, they can impair the patient at work or at school.
There are many excellent alternatives that are available from your physician that can lead to excellent control of springtime symptoms. You can discuss with your doctor the use of non-sedating antihistamines, such as Allegra, and/or intranasal corticosteroids, such as Nasacort or Flonase. Other medications that may be helpful include anti-allergy eyedrops. There are many of these preparations available over-the-counter, and some excellent preparations only available by prescription, such as Patanol.
Patients with severe springtime allergies who do not get optimal relief from medications can see a board-certified allergist for the possibility of allergy injections. These shots build up an immunity in the body to the tree pollen, over time, that may significantly decrease their allergy problem, or, in many patients, the shots may cure it.
PRx Host :
So the allergy shots can actually build up an independent immunity in a person's body?
Dr. Blaiss :
Yes, that is true. Injecting the particular pollen that the patient is allergic to leads to a change in the immune system, which, over time, makes them tolerant to that particular pollen. In other words, when they are exposed in the next season to the tree pollen, they would not have the same severity of symptoms, and in many cases, no symptoms.
JCMama :
I just started allergy shots. What's the typical success rate for these, and how long before I know they're effective?
Dr. Blaiss :
That's an excellent question, one I get commonly when I start a patient on allergy shots. The medical studies show that patients on proper allergy shots will have a success rate of about 80%, so that the vast majority of patients get marked improvement by these injections. It can take from 12 to 18 months before patients will actually see improvement with their allergies. The average course of allergy injections is from three to five years. It is very important, when you start allergy injections, to stay on the medications prescribed by your physician, because, at the beginning of treatment, you will not show any improvement in symptoms.
PRx Host :
A little bit ago, you were talking about keeping pollen out of the home. Here's an audience question I didn't want to pass up:
pooka :
Do air purifiers work? Is there any kind you would recommend? I'm thinking of getting one for my bedroom and one for my office.
Dr. Blaiss :
In most studies, air-purification systems have not been shown to be very beneficial to patients who have allergies. If one keeps the windows to the house and car closed and changes the filters in air conditioning units regularly, then there probably is no benefit to the use of air filtering systems in the house. Some patients have told me they feel better with the air purifiers in their home. If a patient still wants an air-purification system for their home, the type I recommend is a HEPA filtering system (HEPA stands for high energy particulate air). They can be bought at most department stores.
PRx Host :
Here's an audience question that I'm sure many women wonder about:
ashleyhamby :
I am pregnant and am in need of allergy relief. Any suggestions?
Dr. Blaiss :
That's an important question, because we're always concerned about the side effects of medication given to the mother on the unborn child. Unfortunately, one of the most common problems we see in pregnancy is rhinitis of pregnancy, where many women develop severe blockage and nasal congestion during the months of their pregnancy.
There are many medications that have pregnancy indications of B and C (the safety ratings of drugs for women during pregnancy). These include many of the non-sedating antihistamines, such
as Claritin, and intranasal corticosteroids. Even some of the over-the-counter antihistamines have a good safety record in pregnancy. I would suggest that you talk to your obstetrician or allergist about the appropriate type of medication for you during pregnancy.
nelvana :
Is it possible or beneficial to expose children to the allergen they react to? Or is it best to keep them away from unnecessary exposure?
Dr. Blaiss :
That's an interesting question. As a recent article in one of the allergy journals stated, exposing babies very early in life to pets may decrease their likelihood of developing a pet allergy. This is still unproven, but is very interesting. In general, if a child has an allergy to any animal, it is very important that their exposure to that animal be limited. In other words, if your child already has an allergy to cats, then there should absolutely be no cat in the home, as this may trigger your child's allergy problem.
The first rule in allergy treatment is to try to avoid the thing or things that trigger the allergy, and if one can limit exposure (in this case, if your child is allergic to pets), that is the best treatment.
andreaa123 :
Is it possible to become allergic to a food while you are pregnant that you have eaten before with no problem? And will I always be allergic to this food?
Dr. Blaiss :
Anyone can develop an allergy to a food at any time. It is usually thought that only young people can develop food allergy. But even elderly people can develop an allergy to food. Whether you will lose your sensitivity to the food over time is debatable. We know that some patients will lose, over time, sensitivity to food, especially if they are allergic to milk or eggs. We see this very commonly among children.
However, patients allergic to foods such as fish, shellfish, and peanuts, rarely, if ever, lose their sensitivity over time. Therefore, it's important for you to discuss with your physician the food or foods you are having reactions to and determine if allergy testing is indicated.
Patients with severe allergies to food, characterized by throat swelling, generalized hives, and trouble breathing, should get from their physician an auto-injector of epinephrine, called EpiPen, to carry with them in case of accidental ingestion of the food they are allergic to.
PRx Host :
Many people who visit PlanetRx are interested in alternative remedies. Are there some basic herbs or supplements that can help with allergies?
Dr. Blaiss :
That's a very interesting question, and a lot of people are looking at research with different types of herbs to see if there are any particular ones that may be beneficial for the allergic patient. At this time, it's very controversial as to which ones may have some effect. There has been some interesting work suggesting that, in some patients, especially children with asthma, vitamin C may be efficacious. Most of the data obtained on a scientific basis has not shown herbs or supplements to be highly efficacious. We have seen patients use such things as echinacea, gingko, and ephedra, with minimal improvement in their symptoms.
I have an open mind about these remedies, and I think that further studies need to be done to determine which preparations may be efficacious for allergies.
PRx Host :
Many of the questions we have received are concerned with hives in one form or another:
mackonis :
Could you share your views about ALCAT tests with us? I had one allergist highly recommend them, and another pooh-pooh them. I have been suffering from severe hives for 12 months and am desperate for some answers. I can't stay off antihistamines long enough to do skin tests.
Dr. Blaiss :
What your allergist is suggesting is a type of blood test to look for allergy to different things, such as foods and inhalants. This test can be highly accurate, especially in patients who cannot stop taking antihistamines because of their severe hives.
You have a condition that we call chronic idiopathic urticaria. This occurs primarily in women between the ages of 20 and 50. In most patients with this condition, we do not find a cause. We now understand that many people suffer with this. It is a type of auto-immune condition. Unfortunately, no one has a cure for this condition, but there are many different types of medications, including antihistamines, which can be very efficacious. You may want to talk to your physician about getting the blood test done to determine if you have this auto-immune type of hive problem. This may give you the answer to what is causing your very troubling condition.
Chesslovr :
Is there an antihistamine that doesn't bother your prostate or blood pressure?
Dr. Blaiss :
Yes, there is. The prescription, non-sedating antihistamines do not have any effect on blood pressure or lead to problems with the prostate. These include Allegra, Claritin, and Zyrtec.
It is important that you not take a preparation that has a decongestant in it, because it can increase your blood pressure and lead to prostate problems.
TravisT :
I started taking Allegra for my allergies a while ago. When I forget to take it for a few days, though, my allergies seem worse than they ever were! Can taking allergy medication make allergies worse?
Dr. Blaiss :
No. The medications, themselves, will not worsen your allergy condition. What you're having happen is that these medications control the symptoms, they don't cure the allergy. Therefore, patients with hay fever have to continue them throughout the hay fever season to control their symptoms. Once you stop the medication, since it does not cure the allergy, the symptoms will redevelop.
One of the things we try to stress with our patients who have hay fever is that they make sure they take their medicine on a daily basis, so that their allergy symptoms will not flare up. Allegra is an excellent medication, but for it to work properly, it has to be taken on a daily basis.
JanieMay :
When is the best time to take a once-a-day antihistamine?
Dr. Blaiss :
That's a very interesting question, and it appears, from the data, that it does not matter whether it's day or night. I tell my patients to take it at what time is most convenient for them, so they'll remember to take it on a daily basis.
PRx Host :
We have a few more food allergy questions from the audience that I'd like to get to. Here's the first:
gollum :
I think I'm allergic to cashews. If I am, does that mean I'm allergic to all nuts?
Dr. Blaiss :
We're seeing more and more patients with nut allergies. In general, most of the nuts do not cross-react. What I mean is that if you're allergic to cashews, it doesn't necessarily mean that you're allergic to pecans or walnuts. If there is any question, you should be skin tested to the different nuts by a board-certified allergist to determine if you have any other sensitivities.
It is important to note that peanuts usually do not cross-react with the other nuts because the peanut is in the legume family, and is really more of a pea than a nut. Let me warn you, though, that I do see several patients that have peanut and multiple nut sensitivity, but that is the exception to the rule.
erasure :
I have rosacea, a skin condition. Is this associated with food allergies? I do have to avoid milk and wheat since they worsen my condition. Thanks!!!
Dr. Blaiss :
We know that certain foods can worsen rosacea, a very common skin condition. But rosacea is not a true allergy -- in other words, it is not related to an immunologic reaction to the food. Therefore, allergy food testing is usually not helpful in determining food sensitivities that can worsen rosacea.
It's important for you to eliminate from your diet the foods that you notice worsen your rosacea. One of the most common "foods" that worsens rosacea is alcohol. Therefore, you should try to either eliminate or decrease any alcohol ingestion.
Beerlover :
Does alcohol (beer specifically) make allergies worse? Sometimes I think I can feel a connection, and then other times I am not sure.
Dr. Blaiss :
We know that there are chemicals in beer and in wine that can worsen hay fever symptoms. These are what we call vasoactive amines, and in certain people who drink wine or beer, these vasoactive amines can trigger nasal symptoms, especially nasal congestion, which can mimic or worsen allergy symptoms. So it's not your imagination. Unfortunately, the only treatment is abstaining from beer and wine.
erasure :
What is the difference between food allergies and food sensitivities? Thanks, Doctor!
PRx Host :
That's a great question, because it's something that I think is very important for everyone to understand. When we talk about food allergy, we are talking about an immunologic reaction to a food. In other words, your immune system is producing an antibody called IgE, which on re-exposure to that food can trigger an allergic reaction. The most common symptoms of true food allergy are hives, swelling, wheezing, even diarrhea. These can be, in some cases, life-threatening reactions.
"Food sensitivity" is a more general term for any type of reaction to food. Some of these may be immunologic, though most of these are not. Examples would be patients that get diarrhea from milk, due to lactase deficiency. Another example would be the development of gas associated with peas and beans. These types of reactions are rarely, if ever, life-threatening, and may come and go over time. Hopefully, that explains the difference between these two different concepts.
PRx Host :
Here's a tricky one:
ruths4 :
Dr. Blaiss, I have just been prescribed Beconase AQ nasal spray to be taken year-round to control allergies. I have been constantly congested for eight years, always needing to clear my throat, but with no itchy eyes or sneezing. Does this Beconase seem reasonable and what are the side effects for constant use? Can I become dependent? Also, I feel great outside, better, not worse; is it really allergies?
Dr. Blaiss :
Beconase nasal spray is one of the intranasal corticosteroids. These agents have been around for the use of hay fever since the 1970s. They have been shown to be very safe and efficacious on a chronic basis. No one has shown any type of long-term side effects or damage to the nose with the use of these medications.
The most common side effects with these agents are headache and nasal bleeding. The nasal bleeding is usually mild. We have the patient stop the medication for several days, and then we restart the medication. These agents are not addicting like the over-the-counter nasal spray such as Afrin and Neosynephrine. If you're concerned about long-term use of these agents, you may want to discuss with your physician the possibility of allergy shots to desensitize you to your allergy.
The second part of your question is something that we're seeing more and more as Americans now spend more than 22 hours per day indoors and are developing more and more allergies to indoor problems, such as dust mites, mold spores, cockroach particles, and pets. Therefore, it's not surprising for many patients that they do better outdoors than indoors.
PRx Host :
We've had several questions about house allergies and dust mites. Here's one:
MothaLove :
My allergy tests revealed that I'm allergic to dust mites. What can I do so that I'm not miserable in my own home?
Dr. Blaiss :
Dust mites are one of the most common causes of allergy problems in the United States. They are related to the spider family -- they are eight-legged and microscopic. They grow primarily in carpets and in bedding.
There are several things that I discuss with patients to help decrease dust-mite exposure in the home. In the bedroom, ideally, there should not be carpet on the floor. It should be wood or linoleum. Vacuuming -- even with very expensive vacuum cleaners with filters -- does not remove dust mites. Shampooing carpets does not remove dust mites. Second, the mattress, box springs, and pillows should be encased in zippered plastic covers. These can be bought in many department stores. A new mattress, within one year, weighs 10 pounds more -- from dust mites. Turning the mattress over will not help. Three, all the bedding and drapes should be washed weekly with hot water. Cold water will not kill dust mites. One should not use a ceiling fan in the bedroom, as this will increase the mite level in the air. If there are a lot of books, stuffed animals, and toys on shelves in the bedroom, they should ideally be removed. Good scientific studies have shown that these dust-mite avoidance procedures can significantly reduce your allergy symptoms.
PRx Host :
We have time for one more question from the audience:
jefshelton :
My children are 4 years and 17 months old. They both have allergies during the spring mold and pollen season. Neither wheeze, but both have runny noses with thick, green mucus. They have both had tubes placed in their ears due to ear infections. The doctor indicated that the runny nose was the primary cause of the problem. What would be your recommendation to improve this problem?
Dr. Blaiss :
We see many children at this age with chronic nasal problems. The vast majority do not have allergies. Most allergies do not develop to pollen, dust mites, and pets, until after 2 years of age. The most likely problem is that both children are having numerous viral infections, which are leading to their recurrent ear disease.
Unfortunately, for many children, only time will decrease their symptoms, as their immune systems mature. You may want to discuss with your physician the possibility of having immune studies performed to make sure that the children's immune systems are normal.
You need to know that several things may increase the risk of upper respiratory infection in young children. These include exposure to passive smoke and the children being in daycare. If any of these are occurring, this may explain your children's problem.
PRx Host :
Thank you so much for joining us tonight, Dr. Blaiss. You've covered so many different topics, I'm sure the transcript of this chat will be a valuable resource for a long time to come. Hopefully, we can have you back again!
Dr. Blaiss :
Be happy to!
PRx Host :
Check out Dr. Blaiss at www.breathingzone.com. Thanks for joining us, everyone! We hope to see you next time.
Michael S. Blaiss, M.D., graduated magna cum laude from the University of Georgia and received his medical degree from the University of Tennessee. He obtained his allergy/clinical immunology fellowship at the Ochsner Medical Foundation-New Orleans, where he served as chairman of the Allergy section for six years. From 1990 to 1999, Dr. Blaiss directed the Pediatric Allergy/Clinical Immunology training program at the University of Tennessee-Memphis, where he was professor of pediatrics and medicine.
Dr. Blaiss has held numerous offices in the fields of asthma and clinical immunology, including president of the Louisiana State Allergy Society and president of the Tennessee State Society of Allergy, Asthma, and Immunology. His work has been widely published in the journals of his field.
Currently, Dr. Blaiss is clinical professor of pediatrics at University of Tennessee-Memphis, serves on the board of directors of the American Board of Allergy and Immunology, and acts as secretary of the Joint Council of Allergy, Asthma, and Immunology. He is also the Chief of Allergy at Le Bonheur Children's Medical Center in Memphis, and is on the editorial boards of the Journal of Asthma and the Annals of Allergy, Asthma, and Immunology. In addition to all this, Dr. Blaiss acts as the medical director of Camp Wezbegon, an asthma camp for children in West Tennessee.
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