You At Your Best

By KArEN riCE NWA DEMOCrAT-GAzETTE Q. What are allergies? Dr. Cashman: An allergic reaction occurs when a usually harmless substance in the environment activates the body's immune system and creates inflammation. This can be thought of as a "case of mistaken identity." The immune system believes that the substance is harmful. The strength of the immune response and the site of contact with the body determine what symptoms develop. For example, if the contact is in the nose from small inhaled particles such as pollen, then the immune response causes nasal inflammation with congestion and drainage. If the contact is to the skin then a rash could form. The most common symptoms of allergy include nasal drainage, nasal congestion, itching eyes and sneezing. The nasal symptoms tend to be the most bothersome for the patients in my clinic. Q: Is there a problem with allergy sufferers taking over the counter medication? Dr. Cashman: About ten percent of people in the U.S. have allergy problems, but not all seek the help of an allergist. Most people struggling with nasal congestion, sneezing and itching eyes probably don't need a doctor to tell them they have allergies. Usually, they can be self- managed with over-the counter (OTC) medications and do not require a formal allergy evaluation. Most people will get adequate symptom control with regular use of an OTC non-sedating antihistamine and nasal steroid nose spray. Patients whose allergies are more severe, and continue to have breakthrough symptoms despite the use of the OTC medications are the ones most in need of an allergy evaluation. It's important to note that decongestant medications, however, are not good for long term use. All decongestants will eventually lose their effectiveness and users will find they have to take more and more of the medication just to maintain symptom control. If decongestants are used, their use should not exceed 5 days, particularly if using the topical nasal decongestant sprays. Q: Have you seen an increase in patients coming in with allergy issues? If so, why do you think that is? Dr. Cashman: There has definitely been an increase in allergy problems over the past several years. One theory that explains this increase is "The Hygiene Hypothesis." This states that a lack of exposure to bacteria and other immunologically active threats in childhood leads to a poorly developed immune system that is more susceptible to develop allergy problems. Our kids are too clean. Q: What about food allergies? Have you seen an increase in them? Dr. Cashman: We have definitely seen an increase in food allergy problems. One reason for this is the increasing awareness of eosinophilic esophagitis or EoE. EoE is a condition that is at least partially related to food allergy problems. As EoE has become more recognized, we have seen many more patients referred for evaluation and testing for food allergy. Food allergy management starts with identifying the food that is causing the reaction and then avoiding that food. Q: How important is it for allergy sufferers to be proactive about avoiding allergy triggers? What are some of the things they can do? Dr. Cashman: Being proactive with allergen avoidance is a key part of allergy management but rarely is avoidance enough to control symptoms all by itself. Some of the more common triggers should be avoided, such as contact with cigarette smoke and pets. There are several options for managing the air quality in the home. Portable indoor air cleaners have limited effectiveness. The best way to manage the air quality of your home is to regularly clean the air filters in the heating and air ducts. Failure to clean the filters regularly actually worsens air quality in the house by providing a reservoir of allergens that get recirculated. Activities like mowing the yard or raking leaves can lead an allergy sufferer into a miserable or even life- threatening allergy crisis. Avoiding those activities will help minimize the risk of having a crisis, but there is no escaping the pollen completely when you are an allergy sufferer. Breakthrough symptoms will usually occur with even the most diligent efforts to keep the environment allergen free. Q: What are the different treatment options for allergy sufferers? Can they make a difference? Dr. Cashman: Allergy treatment can definitely improve quality of life in allergy sufferers! Allergy treatments are broken down into 3 main categories: 1) Avoidance This includes the strategies discussed earlier with avoiding smoke, keeping your distance from pets and changing the filters in the heating and air conditioning ducts. It would also include avoiding foods or medications that are known to trigger a reaction. 2) Non-Specific medical treatment of allergies "Non-specific" means the allergens that are causing the reaction do not need to be identified in order to use the treatment. These medications will help treat an allergic response regardless of the underlying cause. This category includes the Over-The-Counter medications such as the non-sedating antihistamines and nasal steroid sprays. This is where most people will find relief from their symptoms. It doesn't cure the underlying allergy but it can control symptoms. 3) Specific treatment of allergies Treatment is called "specific" when the allergens that cause reactions are specifically identified and treated. This is an extremely effective way to manage allergy symptoms but it has to be done under the direction of a physician. Allergy testing is performed to see which allergens cause a reaction. Once the offending allergens are identified they can be treated with either weekly injections or sublingual drops. Both of these treatments require a long-term commitment to treatment, but they offer the possibility of changing the immune system so that over time the person will no longer be allergic. Allergy trends & treatments Q & A with Steve Cashman, M.D., ENT and Allergy Center 6 | YOU AT YOUR BEST | nwAdg.cOm/YOUATYOURBEST ApRil - AllERgiES | SATURdAY, mARch 30, 2019

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