Scripps Health: Allergy Symptoms, Testing and Treatment
23
December

By Adem Lewis / in , , , , , , , , , , , , , , , , , , , , , , , , , , , , , /


– Hi, I’m Susan Taylor with Scripps Health in San Diego California, please subscribe to our Scripps Health YouTube channel, we’ve got great videos
featuring the latest technology, our stellar doctors, and
inspiring patient stories. Okay, you wake up, you start sneezing. Or maybe you eat some nuts or shrimp, and all of a sudden your
lips start to swell, and you break out in hives. Or maybe the same thing happens when you take penicillin. What you’re having is
an allergic reaction. According to the Centers for
Disease Control and Prevention, allergies cause nearly 17
million doctor visits each year. Joining us to talk about allergies, how to spot them, and how to treat them, is Dr Ronald Simon, who is
an allergist and immunologist with Scripps Clinic in Carmel Valley. Thanks for being with us Dr Simon. – You’re welcome, it’s my pleasure. – Let’s start with the
basics, what is an allergy? – I think maybe let’s
start with what’s not, because so many people
think they’re having allergies, they’re really not. It’s become almost an English word, not even a medical word, people think that something is repugnant to them, if they just don’t agree with it, they’re allergic, I remember
people talking about even being allergic to Mondays, or being allergic to that sort of thing. And there also are intolerances, both in the English language
but also in medicine, like lactose intolerance,
there are sensitivities that are really not exactly allergies, so we differentiate all of
them in a medical sense. So an allergy involves
the body’s immune system. That’s primary and
foremost, and that means that only certain people
actually have them. Irritants bother everybody,
so if there’s enough smoke around, everybody’s gonna
start coughing and sneezing, but with an allergy, it’s an
exquisitely little amount, because it sets off the
body’s immune system, and it’s really to what otherwise would be harmful substances,
so cigarette smoke is an irritant, that’s not an allergy. But something like a flower, or a food, or an animal that is a natural substance, should be harmless in a medical sense, then the body’s immune
system starts to react to it, and it shouldn’t be, and then
tiny little exposures to it trigger the typical allergy reaction. – So what are the most
common types of allergies? – Well definitely foods,
things in the air, we were talking about flowers, pollens, dust mites, animals, and
then medications as well. – So let’s go back and
kinda laundry list them. What kind of food, what
types of food, let’s say name the top five that would
prompt an allergic reaction. – Yeah, so that would definitely be the most common foods that people eat, ’cause you have to have exposure, so it would be things like wheat and soy, milk and eggs, fish, including shellfish, and then nuts, which would
include both peanuts, which really isn’t a nut,
it’s actually a legume, more related to peas,
but we call it peanut, and then the tree nuts. – What about gluten, they
say gluten intolerance, is that an allergic reaction? – Yeah, so again, that’s
why it’s a great example of what is not exactly an allergy, so sometimes you call
it gluten intolerance, and many people think they have that, and probably do, but we
actually have no test for that. Then there’s a much
smaller group of people that are called gluten sensitive, and they have a very
distinct medical disorder for which there is a test,
but they’re a very small minority of people, but
none of those really are the same as being gluten
or really wheat allergic. – So let’s talk about the environment, what kind of allergies would you have to what’s out there in the environment? – Yeah, so definitely, again, pollens, depending upon the season,
it could be grasses, trees, or weeds, molds, and that could be either seasonal or in somebody’s home, we talk about dust allergy, but you know, dust, when you think of dust particles floating in the air,
those are just debris. And you really can’t be allergic to that, they can be irritating,
and a lot of people may sneeze if they’re
around a lot of dust, but not exactly an allergy,
the allergy to dust is actually something called dust mites. They are microscopic but living creatures, and like every living creature, lives where their food source
is, and of all the things to eat, they actually eat dead flaky skin. – (laughs) Lucky them.
– Yeah lucky them. Well at least they take care of it for us. So where would they live,
they would live in pillows and mattresses where our dead skin would tend to collect,
so again dust mites, mold, pollens would be,
and then furry animals, like cats and dogs, yeah.
– Yeah, animal dander, yeah. But not all dogs and cats,
right, certain types? – So what’s interesting,
people come to us all the time and say, well it’s not my
dog, it’s hypoallergenic, or it’s not my cat, it’s
everybody else’s cat, so two different explanations, so for years everybody thought they had these hypoallergenic dogs, and finally, a group did a research
study, and they vacuumed up the dust in homes that
had regular standard dogs, and then they also vacuumed up the dust from homes that had these
hypoallergenic dogs, and they measured the
dust for dog allergen, and the levels were identical. Because it’s not the fur or the dander that’s actually the
allergen, it’s actually secretions and excretions,
saliva, things like that, that get on the fur and the dander, and then when it sheds it’s carrying it, but the allergens are part
of being a dog or a cat. – I see, and what about medications? – Any medication can cause
an allergic reaction, penicillin is one of the most common, antibiotics in general,
aspirin and all the aspirin related medicines like ibuprofen, and even insulin, something
that seems so natural, you can have an allergic reaction to. – So is there such a thing as an aspirin desensitization program? – There is, and it’s really
a very important thing that we do at Scripps,
because if somebody, say, has a heart problem, and their doctor wants them to be on aspirin to prevent even another heart attack, but they’ve had a reaction to it, we
can actually administer very tiny doses of it,
and bring the person up to the therapeutic dose that
the doctor wants to give them, without them even necessarily
having a reaction, and we call that process desensitization. – Interesting, and then what about being allergic to cosmetics and metals? – It happens, a very different mechanism, it involves a whole different part of the body’s immune system
than we’ve been talking about, we call it a delayed
hypersensitivity, but yes absolutely. – And what other conditions are out there that mimic the symptoms of an allergy? – You know we were
talking about that before, like an intolerance, so somebody
who’s lactose intolerant, they’ll eat dairy and get terrible cramps, and even have diarrhea,
which is not an unusual food allergy symptom,
but has nothing to do with being allergic to
dairy, it’s actually a lacking of an enzyme, and then you have the sensitivities we were
talking about before, we mentioned irritant reactions, so somebody who’s around
a lot of cigarette smoke, it’s an irritant, not really an allergen, but the symptoms can be the same with sneezing, and
coughing, and congestion. – So in a couple minutes,
we’re gonna come back and talk a little bit
more in depth about this, how do you test for allergies, because it’s not just
a simple thing, right, so we’ll come back and talk in
a couple minutes about that. Who is most affected by allergies? – So it can be anybody,
but definitely children have it most often, but it is not unusual, and it can certainly happen,
that an adult of any age can develop an allergy for the first time, but definitely more common in children. – And what puts you at risk? – So one of the things is your genetics. If there’s a family history of allergy, then it’s more likely that
you can have allergies, but what’s really important is it’s not a specific allergy that you inherit, just the potential to be allergic. We hear stories about somebody saying, I wanna be tested to insect stings, or penicillin, because my father or mother or brother or
sister was allergic to it, and that’s not the case,
you develop an allergy to what you’re exposed to, not something that you’ve never been exposed to, but if your family just
has allergic background, then you’re more likely
to have some allergy. – Can you have an allergy as a child, and then outgrow it as an adult? – Absolutely, fortunately happens very frequently with foods,
so we mentioned how wheat and egg and soy are amongst
the most common food allergies, you can hardly find an
adult who’s allergic to any of those three, for
reasons that nobody understands, the nuts and fish persist, but definitely you can outgrow that,
and then you hear about a lot of people that
had terrible hay fever when they were younger,
even terrible asthma when they were younger, and
now that they’re an adult, it’s just totally disappeared. – So let’s talk about the
symptoms of an allergy, aside from the sneezing and coughing, and how do you know that it’s an allergy, or that you’re just maybe getting a cold? – Yeah, so the way I like to look at it is think about what
you’re being exposed to. So if it’s something in the air, then you’re gonna have
symptoms where it goes. So you have ocular symptoms,
your eyes will be itchy and watery, it goes into your
nose, you’ll be sneezing, the allergic reaction the
body’s trying to get rid of what it’s reacting to,
so your nose will run, you will sneeze to try to get rid of it, your nose congests to prevent
any more from going in, then if it gets into your
lungs, you can start to cough and wheeze and get short of breath. It’s gonna be somewhat
different for a food, because it doesn’t go there,
it goes into your mouth. So the first symptoms
should be maybe itching inside the mouth, maybe
a little bit of swelling, but then when you swallow the food and it goes into your stomach, you may get an upset stomach,
nausea, maybe even vomit. But then it goes into your
intestines, and you may get cramps and abdominal pain
and bloating, even diarrhea. Then after that, maybe
if the food can make it through the intestine
into your bloodstream, then you can start to get what
we call systemic complaints, and that can be itching, developing hives, which are raised red itchy welts, even getting giant swelling,
and then it can also go to the respiratory tract and
produce the same symptoms that the airborne allergens do. – So how do you know
it’s an allergic reaction and that you’re not
coming down with a cold, the sneezing and coughing? – Yeah, it can be hard
to tell, but usually colds have a season, and it’s
usually the winter season, which is not the allergy season, because nothing is really
growing and pollinating during the winter, usually
when kids go back to school, a lot of times the colds will start, that can be harder to differentiate because there are some late summer and early fall allergens,
symptoms can be very similar, but one thing that is
absolutely part and parcel of an infection would be a fever. Now you don’t always
get a fever with a cold, but if you have a fever,
it can’t be allergy, and then the one thing that comes out during allergic reactions
that won’t come out with a cold or any other infection, is histamine, and
histamine causes itching. So if your nose is itchy, your eyes are itchy, if there’s itching involved, then you also know it’s not a cold. – Interesting, what can you do to control your allergic reaction? – Well, we like to think about avoidance. The number one premise of allergies, if you can avoid it, then you won’t have an allergic reaction,
and we do teach patients a number of techniques for avoiding a number of allergens,
what you can’t avoid, there are medications for, and these days we have amazingly effective medicines that have no side
effects, and many of them are now over the counter at
full prescription strength. If that’s not enough, or if somebody really wants to no longer
be bothered by allergies, we have various ways of
desensitizing patients, we call it immunotherapy, we try to tweak their immune system to
actually stop reacting. – When you talk about avoidance,
what do you mean by that, let’s say in terms of pollen and animals? – Sure, so for pollens it’s interesting that the time when pollen
is gonna be the highest is actually in the
morning, so if you wanna go do some exercise, maybe
just time it to a different part of the day, if it’s really bad and you stay indoors, an
air conditioning filter will actually filter out
about 85% of the pollen, if you have a HEPA filter, it
gets almost all of the pollen, so that’ll work, furry
animals it’s a little bit more difficult, nobody wants
to give up their animals, and I totally get that,
but you would at least like to make the bedroom kind of a sanctuary, ’cause you spend so many hours in there, and not have exposure,
so the animal could just be out of the bedroom, that would be nice, and if the animal’s been
in the bedroom before, the kind of covers that
we use for dust mites can actually take that
mattress and that pillow, which unfortunately is a big reservoir of the animal allergen,
and then just completely exclude it from your nose and eyes. Well let’s go back a little bit, and talk a little bit
more about medication, what do you recommend,
what are the side effects of medication, and what are the
risk factors for medication? – Sure, so for most of
those histamine symptoms that we were talking about, the itching, and watering, and sneezing, you can take an antihistamine, and these days, what I call the big three,
which for many many years were only by prescription,
are now full strength over the counter, so by brand name there’s Claritin, which is a loratadine, there’s Allegra which is fexofenadine, and Zyrtec which is cetirizine. Amazingly effective, some people may get a little bit drowsy
with cetirizine, Zytrec, but most people handle it very well, and the other two are really non-sedating. Now they don’t work
very well on congestion, if your nose is blocked,
you can’t breathe well through your nose, so each of those anti-histamines comes in a D form, the D stands for decongestant, and they basically are adding something like Sudafed, everybody
knows what Sudafed is. So that can be very helpful, but Sudafed can kinda make people
a little bit anxious, and excited, and nervous, so you have to watch out for that, especially
watch out in the evening. But what have been shown to be
the most effective medicines, either used year round,
or during the season, are topical, nasal steroid sprays. So they’re now over the counter
at full prescription dose, there’s three or four of
them that are out there, and they control basically
the whole allergic reaction, and used regularly they
can be amazingly effective. One drawback though is
that if you are congested, the spray won’t go in.
(Susan laughs) So you need to do
something to, what I call make room for it, and we have
various ways of doing that. – And what about an allergy shot? – Yeah, so there’s something that’s called an allergy shot, without the S for plural, that people have kinda gotten used to, and that really is, again, a steroid shot. So I was mentioning they
have these over the counter nasal steroid sprays, steroids
are just the most powerful anti-inflammatory medicines that we have, and they are the best for
allergic inflammation. So some people, where
allergies are seasonal, and when they’re miserable,
they go in to see the doctor, and the doctor just
gives them an injection of a steroid, and it just carries them right through the season, it normalizes their symptoms within a couple of days, and it just carries them
right through the season. That wouldn’t work year
round, because taking steroids into your system can have side effects, but for occasional acute exacerbations, seasonal exacerbations, they are amazing, but as allergists, we also give something that’s called allergy shots, with an S, or immunotherapy, and
that’s actually a program that begins with weekly injections, and then the interval
widens, of the very things that the patient is allergic to. So, a lot of people want
something more natural, there couldn’t be anything more natural than the things we’re already inhaling, getting it as an injection, and again, over a period of time,
it’s a five year program, you can actually control
somebody’s allergies that way, and then you stop the shots, they’re off their medications,
and they just really feel like they don’t
have allergies anymore. – That’s good.
– It’s great. – I like the sound of that. Okay, let’s come back and talk about this. How do you test for allergies, because there’s some very
interesting ways to test for them. – No there are, we have
something that’s called a nasal smear, and we take a little sample of somebody’s nose, look
at it under the microscope, and the microscopic picture is different for an allergy or an
infection or for an irritant, then we know what we’re dealing with, and we can go on to additional testing for the specific allergen,
and for many years it was little tiny pin pricks
with each individual allergen, and then we look at the reaction to that. If somebody has a rash, then
we’re trying to figure out what kind of rash it
is, we can actually do what’s called the skin
biopsy, and take a very tiny little piece of skin and look at that under the microscope, for the cosmetics and metals and things like that, we do what’s called patch testing, and there you put a little
bit of the substance on the skin, cover it with
something like a Band-Aid, and then look at it over the next few days to see if there’s any
reaction underneath that. – And what about testing
for a food allergy? – So food allergies would
be either by skin testing those little skin pricks,
or the blood test. For a while we were
doing some patch testing for the foods, but it just hasn’t really worked out as well as we had hoped. – Seasonal allergies,
spring is a rough time, is it worse in places like San Diego, because we kinda have spring
all year long. (laughs) – Exactly, it’s a trade
off, ’cause we hear people coming from other areas, where they had horrible horrible seasons,
but the season was two weeks. Then they come to San Diego,
and they never get that bad, that’s good, but they’re
also always miserable, because there’s almost
no time in San Diego that we don’t have some pollen, and it seems that the most common thing for people to react to
in San Diego pollen-wise is grass pollen, and that
can start in San Diego even in January or February,
like it did this year with all of the rains,
and it can go sometimes even until November, so
there’s almost no time of year that you’re not affected by it. – When should you say, I’ve
dealt with the over counter medications, I really
need to go see a doctor? – Well certainly if they’re not working well enough, because sometimes we can just give you some hints about
how to make them work better, like I was saying before, if
your nose is really congested, you could spray all you want,
and it’s not gonna work, but what if it turned out
that you were allergic to say, something like dust mite, and all it would take would
be a few avoidance maneuvers, and then you would be fine, you would be off of medication, so if it’s not working, if you’re kinda curious to know what you’re allergic to,
’cause maybe avoidance would be a good way to go, and like I say, if you’ve even been down that road before but you’re saying, I just don’t wanna deal with allergies anymore,
I’m thinking about allergy immunotherapy, or those allergy shots, we didn’t mention, may come back to it, about even, there’s a new treatment called sublingual immunotherapy,
and it’s only available now for three things, grass
pollen, ragweed, and dust mite, but if those happen to be your allergies, you can actually get the medication from a pharmacy, and all you
do is put a little tablet of the medicine under
your tongue every day, and again, over again,
that same five year period, you hope to get desensitized
to those things. – Interesting, any final thoughts, doctor? – No, I just think people need not suffer from their allergies,
our goal as allergists is to make people feel just fine in whatever environment they’re in. – Thanks so much Dr Simon. If you want more information
on treating allergies, just click on the link, or
go to Scripps.org/videos. Want more critical
information about your health? We take care of you from head to toe. Please subscribe to our
Scripps Health YouTube channel, and follow us on social
media at Scripps Health. I’m Susan Taylor, thanks
so much for joining us. It’s our mission at
Scripps to help you heal, enhance, even save your life.


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