Advice from your Allergist


You may have allergic rhinitis if …

     You sneeze a lot, often in rapid succession…your nose is runny, congested or stuffy…you’re bothered by itching of the nose, eyes, throat or roof of the mouth…you’re nagged by postnasal drip… your ears pop or are plugged… you have a decrease sense of smell…and/or you get sinus headaches.


What is allergic rhinitis?

     Known to most people as hay fever (see box below), allergic rhinitis is a very common medical problem affecting more than 15% of the population, both adults and children.

     Allergic rhinitis takes two different forms – seasonal and perennial. Symptoms of seasonal allergic rhinitis surface in spring, summer and/or early fall and are usually caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores. Other people experience symptoms year-round, a condition called perennial allergic rhinitis. It’s generally caused by sensitivity to house dust, house dust mites, animal danders and/or mold spores. Underlying or hidden food allergies are considered a controversial cause of perennial nasal symptoms.

     Some people may experience both types of rhinitis, with perennial symptoms worsening during specific pollen seasons. As will be discussed later, there are also other causes for rhinitis.

What causes the sneezing, itchy eyes, and other symptoms?

     When a sensitive person inhales an allergen (allergy-causing substance) like ragweed pollen, the body’s immune system reacts abnormally with the allergen. The allergen binds to allergic antibodies (immunoglobulin E) that are attached to cells that produce histamine and other chemicals. The pollen “triggers” these cells in the nasal membranes, causing them to release histamine and the other chemicals. Histamine dilates the small blood vessels of the nose and fluids leak out into the surrounding tissues, causing runny noses, watery eyes, itching, swelling and other allergy symptoms.

Is allergic rhinitis ever the cause of other problems?

     Some known complications include ear infections, sinusitis, recurrent sore throats, cough, headache, fatigue, irritability, altered sleep patterns and poor school performance. Occasionally, children may develop altered facial growth and orthodontic problems. Allergy treatment can eliminate or alleviate most of these problems.

Are all cases of rhinitis caused by allergies?

     No. Not all rhinitis symptoms are the result of allergies. Below are listed the three most common causes of rhinitis with some of their characteristics.


  • The common cold is a good example of an infectious rhinitis. Most infections are relatively short-lived, lasting from 3 to 7 days.
  • Irritant rhinitis also called vasomotor or nonallergic rhinitis. People with irritant rhinitis develop swelling and congestion of the nose when they are exposed to irritating substances that may not cause symptoms in other people.
  • The symptoms of allergic and irritant rhinitis can be the same. Many people experience a combination of both types of rhinitis.

How is allergic rhinitis diagnosed?

     Your allergist may begin by taking a detailed history, looking for clues in your lifestyle that will help pinpoint the cause of your symptoms. You’ll be asked about your work and home environments…your eating habits…your family’s medical history…the frequency and severity of your symptoms…and miscellaneous matters such as if you have pets. Then, you may require some tests. Your allergist may employ skin testing, in which small amounts of suspected allergen are introduced into the skin. Skin-testing is the easiest, most sensitive and generally least expensive way of making the diagnosis. Another advantage is that results are available immediately. In rare cases, it also may be necessary to do a special blood test for allergens, using the RAST or other methods.

Once allergic rhinitis is diagnosed, what can be done to alleviate the symptoms?

     Avoidance, medication and immunotherapy – or allergy shots – are the main treatments for allergic rhinitis.

  • Avoidance – a single ragweed plant may release one million pollen grains in just one day. The pollen from ragweed, grasses and trees is so small and buoyant that the wind may carry it miles from its source. Mold spores, which grow outdoors in fields and on dead leaves, also are everywhere and may outnumber pollen grains in the air even when the pollen season is at its worst. While it’s difficult to escape pollen and molds, here are some ways to lessen exposure.

-   Keep windows closed and use air-conditioning in the summer, if possible. A HEPA (High Energy Particulate Air) filter or an electro static precipitator may help clean pollen and mold from the indoor air. Automobile air conditioners help, too.

-   Don’t hang clothing outdoors to dry. Pollen may cling to towels and sheets.

-   The outdoor air is most heavily saturated with pollen and mold between 5 and 10 a.m., so early morning is a good time to limit outdoor activities.

-   Wear a dust mask when mowing the lawn, raking leaves or gardening, and take appropriate medication beforehand.

  • Medication – When avoidance measures don’t control symptoms, medication may be the answer. Antihistamines and decongestants are the most commonly used medications for allergic rhinitis. Newer medications, such as cromolyn, inhibit the release of chemicals that cause allergic reactions. Medications help to alleviate nasal congestion, runny nose, sneezing and itching. They are available in many forms, including tablets, nasal sprays, eye drops and liquids. Some medications may cause side effects do its best to consult your allergist if there’s a problem.
  • Immunotherapy – Allergen immunotherapy, known as “allergy shots,” may be recommended for persons who don’t respond well to treatment with medications, experience side-effects from medications or have allergen exposure which is unavoidable. Immunotherapy does not cure allergies but can be very effective in controlling allergic symptoms. Allergy injections are usually given at variable intervals over a period of two to five years.


There are many ways of treating allergies, and each person’s treatment must be individualized based on the frequency, severity and duration of symptoms and on the degree of allergic sensitivity. If you have more questions, your allergist will be happy to answer them.


Filled Under: Sinus/Nasal

When Allergies and Asthma Complicate Pregnancy


Asthma is the most common, potentially serious medical condition to complicate pregnancy. In fact, asthma affects almost 7 percent of women in their childbearing years. Well-controlled asthma is not associated with significant risk to mother or fetus. Although uncontrolled asthma is rarely fatal, it can cause serious maternal complications including high blood pressure, toxemia and premature delivery. Fetal complications of uncontrolled asthma include increased risk of still birth, fetal growth retardation, premature birth, low birth weight and a low Apgar score at birth.

      Asthma can be controlled by careful medical management and avoidance of known triggers, so asthma need not be a reason for avoiding pregnancy. Most measures used to control asthma are not harmful to the developing fetus and do not appear to contribute to either spontaneous abortion or congenital birth defects.

      Although the outcome of any pregnancy can never be guaranteed, most women with asthma and allergies do well with proper medical management by physicians familiar with these disorders and the changes that occur during pregnancy.

What is asthma and what are its symptoms?

Asthma is a condition characterized by obstruction in the airways of the lungs caused by spasm of surrounding muscles, accumulation of mucus, and swelling of the airway walls due to the gathering of inflammatory cells. Unlike individuals with emphysema who have irreversible destruction of their lung cells, asthmatic patients usually have a condition that can be reversed with vigorous treatment.

      Individuals with asthma most often describe what they feel in their airways as a “tightness.” They also describe wheezing, shortness of breath, chest pain, and cough. Symptoms of asthma can be triggered by allergens (including pollen, mold, animals, feathers, house dust mites and cockroaches), environmental factors, exercise, infections and stress.

What are the effects of pregnancy on asthma?

When women with asthma become pregnant, a third of the patients improve, one third worsen, and the last third remain unchanged. Although studies vary widely on the overall effect of pregnancy on asthma, several reviews find the following similar trends:

• Women with severe asthma are more likely to worsen, while those with mild asthma are more

   likely to improve.

• The change in the course of asthma in an individual woman during pregnancy tends to be

   similar on successive pregnancies.

• Asthma exacerbations are most likely to appear during the weeks 24 to 36 of gestation, with

  only occasional patients (10 percent or fewer) becoming symptomatic during labor and delivery.

• The changes in asthma noted during pregnancy usually return to pre-pregnancy status within

   three months of delivery.

      Pregnancy may effect asthmatic patients in several ways. Hormonal changes that occur during pregnancy may effect both the nose and sinuses, as well as the lungs. An increase in the hormone estrogen contributes to congestion of the capillaries (tiny blood vessels) in the lining of the nose, which in turn leads to a “stuffy” nose in pregnancy (especially during the third trimester). A rise in progesterone causes increased respiratory drive, and a feeling of shortness of breath may be experienced as a result of this hormonal increase. These events may be confused with or add to allergic or other triggers of asthma. Spirometry and peak flow are measurements of airflow obstruction (a marker of asthma) that help your physician determine if asthma is the cause of shortness of breath during pregnancy.

Fetal monitoring

For pregnant women with asthma, the type and frequency of fetal evaluation is based on gestational age and maternal risk factors. Sonography (ultrasound) can be performed before 12 weeks if there is concern about the accuracy of an estimated due date and repeated later if a slowing of fetal growth is suspected. Electronic heart rate monitoring, called “non-stress testing” or “contraction stress testing,” and ultrasonic determinations in the third trimester may be used to assess fetal well being. For third trimester patients with significant asthma symptoms, the frequency of fetal assessment should be increased if problems are suspected. Asthma patients should record fetal activity or kick counts daily to help monitor their baby according to their physician’s instructions.

      During a severe asthma attack in which symptoms do not quickly improve, there is risk for significant maternal hypoxemia, a low oxygen state. This is an important time for fetal assessment; continuous electronic fetal heart rate monitoring may be necessary along with measurements of the mother’s lung function.

      Fortunately during labor and delivery, the majority of asthma patients do well, although careful fetal monitoring remains very important. In low risk patients whose asthma is well-controlled, fetal assessment can be accomplished by 20 minutes of electronic monitoring (the admission test). Intensive fetal monitoring with careful observation is recommended for patients who enter labor and delivery with sever asthma, have a non-reassuring admission test or other risk factors.

Avoidance and control

The connection between asthma and allergies is common. Most asthmatic patients (75 to 85 percent) will test allergic to one or more allergens such as: pollens, molds, animals, feathers, house dust mites and cockroaches. Pet allergies are caused by protein found in animal dander, urine and saliva. These allergens may trigger asthma symptoms or make existing symptoms worse.

      Other non-allergic substances may also worsen asthma and allergies. These include tobacco smoke, paint and chemical fumes, strong odors, environmental pollutants (including ozone and smog) and drugs, such as aspirin or beta-blockers (used to treat high blood pressure, migraine headache and heart disorders).

      Avoidance of specific triggers should lessen the frequency and intensity of asthmatic and allergic symptoms. Allergists-immunologists recommend the following methods:

• Remove allergy causing pets or feather pillows/comforters from the house.

• Seal pillows, mattresses and box springs in special dust mite-proof casings (your allergist should

   be able to give you information regarding comfortable cases).

• Wash bedding weekly in 130 degree F. water (comforters may be dry-cleaned periodically) to

   kill dust mites.

• Keep home humidity under 50 percent to control dust mite and mold growth.

• Use filtering vacuums or “filter vacuum bags” to control airborne dust when cleaning.

• Close windows, use air-conditioning and avoid outdoor activity between 5 and 10 a.m., when

   pollen and pollution are at their highest.

• Avoid chemical fumes and, most importantly, tobacco smoke.

Can asthma medications safely be used during pregnancy?

Though no medication has been proven entirely safe for use during pregnancy, your doctor will carefully balance medication use and symptom control. Your treatment plan will be individualized so that potential benefits of medications outweigh the potential risks of these medications or of uncontrolled asthma.

      Asthma is a disease in which intensity of symptoms can vary from day to day, month to month, or season to season regardless of pregnancy. Therefore, a treatment plan should be chosen based both on asthma severity and experience during pregnancy with those medications. Remember that the use of medications should not replace avoidance of allergens or irritants, as avoidance will potentially reduce medication needs.

      In general, asthma medications used in pregnancy are chosen based on the following criteria:

• Inhaled medications are generally preferred because they have a more localized effect with only

  small amounts of entering the bloodstream.

• Time-tested older medications are preferred since there is more experience with their use during


• Medication use in limited in the first trimester as much as possible when the fetus is forming.

  Birth defects from medications are rare (no more than 1 percent of all birth defects are

  attributable to all medications).

• In general, the same medications used during pregnancy are appropriate during labor and

  delivery and when nursing.

Bronchodilator medication

Inhaled beta2-agonists, often called “asthma relievers” or “rescue medications,” are used as necessary to control acute symptoms. Any of the short-acting beta agonists, including metaproterenol (Metaprel, Alupent), albuterol (Proventil, Ventolin), isoetharine (Bronkometer), bitolterol (Tornalate), pirbuterol (Maxair) and terbutaline (Brethaire) are considered safe in pregnancy. Albuterol, metaproterenol and terbutaline have been studied in humans. Injections of terbutaline are sometimes used to control premature labor.

      A new long-acting inhaled beta agonist, salmeterol (Serevent), as well as older oral forms of albuterol (Proventil Repetab, Volmax) are available. No trials of these medications in pregnancy have been performed, and careful consideration is advised with use during pregnancy. These medications may be especially helpful for control of nighttime symptoms to ensure uninterrupted sleep.

      Theophylline has extensive human experience without evidence of significant abnormalities. Newborns can have jitteriness, vomiting and fast pulse if the maternal blood level is too high. Therefore, patients who receive Theophylline should have their blood levels checked during pregnancy.

      Ipratropium (Atrovent), an anticholinergic bronchodilator medication, does not cause problems in animals; however, there is no published experience in humans. Ipratropium is absorbed less than similar medications in this class, such as atropine.

Anti-inflammatory medication

The anti-inflammatory medications are preventive, or “asthma controllers,” and include inhaled cromolyn (Intal), nedocromil (Tilade), corticosteroids and leukotrine antagonists. These medications are recommended for all but mild intermittent asthma patients. Anyone requiring the use of beta2-agonists more often than three times a week, or have reduced peak flow readings or spirometry (lung function studies), usually needs daily anti-inflammatory medications. Inhaled cromolyn sodium is virtually devoid of side effects, but is less effective than inhaled corticosteroids. Nedocromil is a newer medication, similar to cromolyn. Although there is no reported experience with nedocromil during human pregnancy, animal data are reassuring.

      Beclomethasone (Beclovent, Vanceril) is the inhaled corticosteroid of choice because of its length of time in clinical use and good safety profile in humans. Other drugs in this class, which have been available for a number of years, are triamcinolone (Azmacort) and flunisolide (Aerobid). There is limited data during human pregnancy for these drugs. Experience with the newest inhaled corticosteroids, fluticasone (Flovent) and budesonide (Pulmicort), is even more limited. Maximum benefits of all these inhalers may not be evident for several weeks.

      In some cases oral or injectable corticosteroids, prednisone, prednisolone or methyprednisolone, may be necessary for a few days in moderately severe patients, or throughout pregnancy in severe cases. Some studies have demonstrated a slight increase in the incidence of pre-eclampsia, premature deliveries or low-birth-weight infants with chronic use of corticosteroids. However, they are the most effective drugs for the treatment of asthma and allergic disorders. Therefore, their significant benefit usually far exceeds their minimal risk.

      Three leukotrine modifiers, zafirlukast (Accolate), zileuton (Zyflo) and montelukast (Singulair), are available. Result of animal studies are reassuring for zafirlukast and montelukast, but there is no data in human pregnancy with this new class of anti-inflammatory drugs.

Can allergy medications safely be used during pregnancy?

Antihistamines may be useful during pregnancy to treat the nasal and eye symptoms of seasonal or perennial allergic rhinitis, allergic conjunctivitis, the itching of urticaria (hives) or eczema, and as an adjunct to the treatment of serious allergic reactions including anaphylaxis (allergic shock). With the exception of life threatening anaphylaxis, the benefits from their use must be weighed against any risk to the fetus. Because symptoms may be of such severity to effect maternal eating, sleeping or emotional well-being, and because uncontrolled rhinitis may pre-dispose to sinusitis or may worsen asthma, antihistamines may provide definite benefit during pregnancy.

      Chlorpheniramine (Chlor Trimeton), tripelennamine (Pyrabenzamine) and diphenhydramine (Benadryl) have been used for many years during pregnancy with reassuring animal studies. Generally, chlorpheniramine would be the preferred choice. A major drawback of these medications is drowsiness and performance impairment in some patients. Although there have been no reports of harm with the newer non-sedating drugs including astemizole (Hismanal), fexofenadine (Allegra), loratadine (Claritin), cetirizine (Zyrtec) or the nasal spray azelastine (Astelin), human data are very limited. Loratadine and cetirizine have reassuring animal study data and may be useful if older drugs cause performance impairment or excessive sleepiness.

      The use of decongestants is more problematic. The nasal spray oxymetazoline (Afrin, Neo-Synephrine Long-Acting, etc.) appears to be the safest product because there is minimal, if any, absorption into the blood stream. However, these and other over-the-counter nasal sprays can cause rebound congestion and actually worsen the condition for which they are used. Their use is generally limited to very intermittent use or regular use for only three consecutive days.

      Although pseudophedrine (Sudafed) has been used for years, and studies have been reassuring, there have been recent reports of slight increase in abdominal wall defects in newborns. Use of decongestants during the first trimester should only be entertained after consideration of the severity of maternal symptoms unrelieved by other medications. Phenylephrine and phenylpropanolamine are less desirable than pseudophedrine based on the information available.

      An anti-inflammatory nasal spray, such as cromolyn (Nasalcrom), or beclomethasone (Beconas4e, Vancenase), a corticosteroid, should be considered in any patient whose allergic nasal symptoms last for more than a few days. These medications prevent symptoms and lessen the need for oral medications. They have a record of used for many years. Newer corticosteroid sprays including triamcinolone (Nasacort, Tri-Nasal), fluticasone (Flonase), budesonide (Rhinocort), flunisolide (Nasarel) and mometasone (Nasonex) lack pregnancy data, although their absorption into the blood stream is so minimal as to be of doubtful risk.

Immunotherapy and influenza vaccine

Allergen immunotherapy (allergy shots) is often effective for those patients in whom symptoms persist despite optimal environmental control and proper drug therapy. Allergen immunotherapy can be carefully continued during pregnancy in patients who are benefiting and not experiencing adverse reactions. Due to the greater risk of anaphylaxis with increasing does of immunotherapy and a delay of several months before it becomes effective, it is generally recommended that this therapy not be started during pregnancy.

      Patients receiving immunotherapy during pregnancy should be carefully evaluated. It may be appropriate to lower the dosage in order to further reduce the chance of an allergic reaction to the injections.

      Influenza (flu) vaccine is recommended for all patients with moderate and severe asthma. There is no evidence of associated risk to the mother or fetus.

Can asthma medications safely be used while nursing?

Nearly all medications enter breast milk, though infants are generally exposed to very low concentrations of the drugs. Hence, the medications described above rarely present problems for the infant during breast feeding. Specifically, very little of the inhaled beta agonists, inhaled or oral steroids, and theophylline will appear in mother’s milk. Some infants can have irritability and insomnia if exposed to higher doses of medications or to theophylline. Use of zafirlukast and zileuton while breast feeding is not recommended because of lack of data regarding safety.  In general the lowest drug concentration in mother’s milk can be obtained by taking the necessary medications 15 minutes after nursing or three to four hours before the next feeding.


It is important to remember that the risks of asthma medications are lower than the risks of uncontrolled asthma, which can be harmful to both mother rand child. The use of asthma or allergy medication needs to be discussed with your doctor, ideally before pregnancy. Therefore, the doctor should be notified whenever you are planning to discontinue birth control methods or as soon as you know that your are pregnant. Regular follow up for evaluation of asthma symptoms and medications is necessary throughout the pregnancy to maximize asthma control and to minimize medication risks.

      This article ahs be prepared b the following member of the Pregnancy Committee of the American College of Allergy, Asthma and Immunology, an organization whose members are dedicated to providing optimal care to all patients with asthma, including those who are pregnant.


Myron A. Lipkowitz, RPh., M.D., Chair

Michael Schatz, M.D., Co-Chair

Terrance J. Cook, M.D.

Linda Ford, M.D.

Scott J. Frankel, M.D.

Joan Gluck, M.D.

Donald Leibner, M.D.

Joseph G. Leija, M.D.

Allan Luskin, M.D.

Debra Ortega-Carr, M.D.

Sheldon L. Spector, M.D.


The Committee acknowledges the contribution of Paul Gluck, M.D.


ACAAI American College of Allergy, Asthma & Immunology

85 W. Algonquin Road, Suite 550

Arlington Heights, IL 60005

Filled Under: Pregnancy

What is Rhinitis?

Rhinitis is not a disease; it is simply a term describing the symptoms produced by nasal irritation or inflammation. Symptoms of rhinitis include runny nose (rhinorrhea), itching (pruritus), sneezing and stuffy nose (blockage or congestion). These symptoms are the nose’s natural response to inflammation and irritation.


    The nose normally produces mucus, which traps substances like dust, pollen, pollution, and germs such as bacterial and viruses.  Mucus flows from the front of the nose to the back and is swallowed, but when mucus production is excessive, it can flow from the front (runny nose) or become noticeable from the back (post-nasal drip). Nasal mucus, normally a thin, clear liquid, can become thick or colored, perhaps due to dryness, infection, or pollution. When post-nasal drip is excessive, thick, or contains irritating substances, cough is the natural response for clearing the throat.


    Itching and sneezing are also natural responses to irritation caused by allergic reactions, chemical exposures (like cigarette smoke), temperature changes, infections and other factors.


    The nasal tissues congest and decongest periodically. In most people, nasal congestion switches back and forth from side to side of the nose in a cycle several hours long. Some people, especially those with narrow nasal passages, notice this nasal cycle more than others. Strenuous exercise or changes in head position can affect nasal congestion. Nasal congestion is also the natural response to irritation and inflammation. Severe congestion can result in facial pressure and pain, as well as dark circles under the eyes.



What is sinusitis?

    Sinusitis is inflammation or infection of any of the four groups of air sinus cavities in the skull, which open into the nasal passages,. Sinusitis is not the same as rhinitis, although the two may be associated and their symptoms may be similar. The terms “sinus trouble” or “sinus congestion” are sometimes wrongly used to mean congestion of the nasal passage itself. Most cases of nasal congestion, though, are not associated with sinusitis.



What causes rhinitis?

    Arbitrarily, rhinitis lasting less than six weeks is called acute rhinitis, and persistent symptoms are called chronic rhinitis. Acute rhinitis is usually caused by infections or chemical irritation. Chronic rhinitis may be caused by allergy or a variety of other factors.

                The symptoms of allergic rhinitis (called “hay fever” sometimes, but not caused by hay and not associated with fever) are caused by exposure to substances (allergens ) to which the patient has become allergic. Common allergens are tree, grass, and weed pollens, molds, animal hair and dander, and house dust mites. In general, pollen (and sometimes mold) allergy causes symptoms at certain times of the year, while mold, animal dander, and dust mites cause symptoms year round. People with allergies have developed antibodies to these allergens. These antibodies circulate in the blood stream, but localize in the tissues of the nose and in the skin. This makes it possible to demonstrate presence of these antibodies by skin testing, or less commonly, by a special blood test. A positive skin test mirrors the type of reaction going on in the nose. Not everyone with symptoms of rhinitis has allergies, and not everyone with allergies has rhinitis.


    Rhinitis may result from many causes other than allergic reaction. In fact, the most common condition causing rhinitis is the common cold. Colds can be caused by any of more than 200 viruses. Children, particularly young children in school or day care centers, may have from 8-12 olds each year. Fortunately, the frequency of colds lessens after immunity has been produced from exposure to many viruses.


    Colds usually begin with a sensation of decongestion, rapidly followed by runny nose and sneezing. Over the next few days, congestion becomes more prominent, the nasal mucus may become colored, and there may be a slight fever and cough. Cold symptoms resolve within a couple of weeks, although a cough may sometimes persist. Cold symptoms that last longer may be due to other causes of chronic rhinitis or to sinusitis.



What are other causes of rhinitis?

    Not all symptoms in the nasal passage are caused by allergy or infection. Similar symptoms can be caused by mechanical blockage, use of certain medications, irritants, temperature changes, or other physical factors. Rhinitis can also be a feature of other diseases and medical conditions.


    Drug-induced nasal congestion, called “rhinitis medicamentosa,” can be caused by birth controls pills and other female hormone preparations, certain blood pressure medications (beta blockers and vasodilators), and prolonged use of decongestant nasal sprays.


    Decongestant nasal sprays work quickly and effectively, but they alter normal nasal physiology. After a few weeks of use, nasal tissue swell after the medications wears off. The only thing that seems to relieve the obstruction is more of the medicine, and the medication’s effect lasts shorter lengths of times. Permanent damage to the nasal tissues may result. Consultation with a physician to “get off” the medications is often necessary.


    Cocaine also alters normal physiology, causing a condition identical to that produced by decongestant nasal sprays.  If you use cocaine, it is important to tell your physician so that appropriate therapy can be prescribed.


    “Vasomotor rhinitis” is a term used to describe a group of poorly understood causes of rhinitis, with symptoms not caused by infection or allergy. Many people have recurrent nasal congestion, excess mucus production, itching, and other nasal symptoms similar to those of allergic rhinitis, but the disorder is not caused by allergy.



What triggers vasomotor rhinitis?

    Irritants that can trigger vasomotor rhinitis include cigarette smoke, strong odors and fumes (perfume, hair spray, other cosmetics, laundry detergents, cleaning solutions, pool chlorine, car exhaust, and other air pollution). Spices used in cooking can cause nasal irritation, producing a condition called “gustatory rhinitis.”


    Other things that can aggravate vasomotor rhinitis are alcoholic beverages (particularly beer and wine), aspirin, and certain blood pressure medications, such as reserpine and propranolol. Some people are very sensitive to abrupt changes in weather or temperature. Skiers often develop a runny nose – “skier’s nose” – but in some people any cold exposure may cause a runny nose. Other start sneezing when leaving a cold, air conditioned room. These agents are not allergens, do not induce formation of allergic antibodies, and do not produce positive skin test reactions.  Occasionally, one or two positive skin tests may be observed, but they do not correlate with the history and are not relevant or significant.


    The cause of vasomotor rhinitis is not well understood. In a sufficiently high concentration, many odors will cause nasal irritation in almost anyone. Some people, though, are unusually sensitive to irritation, and will have significant nasal symptoms even when exposed to low concentration of irritants. Thus, vasomotor rhinitis seems to be an exaggeration of the normal nasal response to irritation, occurring at levels of exposure which don’t bother most people. It occurs more often in smokers and older individuals.


    Dryness of the nasal tissues can be a normal effect of aging, or a characteristic of “rhinitis sicca,” which may be associated with a foul smelling nasal discharge. Rhinitis can also be a feature of endocrine disease like hypothyroidism or can occur during pregnancy. Rhinitis can be made worse or even improved during pregnancy. Alcoholic beverages can cause the blood vessels in the nose to enlarge temporarily and produce significant nasal congestion.



How do you know what kind of rhinitis you have?

    Consult your physician. Sometimes several of the above conditions can coexist in the same person. In a single individual, allergic rhinitis could be complicated by vasomotor rhinitis, septal deviation (curvature of the bone separating the two sides of the nose) or nasal polyps. Use of spray decongestants because of chronic sinusitis, septal deviation or vasomotor rhinitis may cause rhinitis medicamentosa. Any of these conditions will be made worse by catching a cold. Nasal symptoms caused by more than one problem can be difficult to treat, often requiring the collaboration of an allergist and an otolaryngologist (ear, nose and throat specialist).



How is rhinitis treated?

    Nasal surgery will usually cure or improve symptoms caused by mechanical blockage or chronic sinusitis not responsive to prolonged antibiotics and nasal steroid sprays. Stopping the use of offending medications will cure rhinitis medicamentosa, providing that there is no underlying disorder.


    When no specific cure is available, options are ignoring your symptoms, avoiding or decreasing exposure to irritants or allergens to the extent practical, and taking medications for symptom relief.


    Antihistamines are the most inexpensive and commonly used treatment for rhinitis. They dry excess secretions and reduce itching and sneezing, but may not do much for nasal congestion. There are dozens of different antihistamines and wide variation s in how individual patients respond to them. Some are available over the counter and others require a prescription. Generally, they work well and produce only minor side effects. Persons with nasal dryness or thick nasal mucus should avoid taking antihistamines without consulting a physician. Contact your physician for advice if an antihistamines causes drowsiness or other side effects.


    Non-prescription decongestant nasal sprays work within minutes and last for hours, but can’t be used for more than a few days at a time without a physician’s order.


                Oral decongestants are found in many over the counter and prescription medications, and may be the treatment of choice for nasal congestion. They don’t cause rhinitis medicamentosa, but need to be avoided by some patients with high blood pressure. If you have high blood pressure, you should check with your physician before using them.

    Using an over the counter saline nasal spray will help counteract symptoms of dry nasal passages or thick nasal mucus. Unlike decongestant nose sprays, a saline nose spray can be sued as often as needed. Sometimes, your physician may recommend washing (douching) of the nasal passage.


    Corticosteroids counteract the inflammation caused by release of allergic mediators, as well as that caused by other nonallergic factors. Thus, they generally work for many causes of rhinitis symptoms and are sometimes useful for chronic sinusitis. Corticosteroids are sometimes injected or taken orally, but usually on a short term basis for extremely severe symptoms. Physicians warn that injected or oral steroids may produce severe side effects when used for long periods or used repeatedly and, for this reason, they should be used with extreme caution.  In rhinitis, a corticosteroid is much safer when used topically by spraying it into the nose.


    Cromolyn is a medication that blocks the release of chemical mediators. It does not work in all patients. It must be used at least four times daily, and improvement may take several weeks to occur.


    Atropine and the related drug ipratropium bromide are sometimes used to relieve symptoms of rhinitis; in fact, most antihistamines have a slight atropine-like effect. Atropine can be taken orally, and it is a component of some antihistamine decongestant preparations. Atropine and ipratropium are not yet commercially available as nasal sprays.


    Antibiotics are for the treatment of bacterial infections. They do not affect the course of uncomplicated viral upper respiratory infections (common colds), and are of no benefit for non-infectious rhinitis, including allergic rhinitis.  In chronic sinusitis, antibiotics may help only temporarily, and surgery may be needed.


    One or more of the above medications, accompanied by appropriate avoidance measures, will usually control most symptoms of nasal allergy. If not, immunotherapy (allergy shots, desensitization) may provide additional relief. The treatment program consists of injections of a diluted extract, administered frequently in increasing doses until a maintenance dose is reached. Then, the injection schedule is changed so that the same dose is given with longer intervals between injections. Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms provoked by allergen exposure, and sometimes can actually make skin test reactions disappear. As resistance develops, symptoms should improve, but the improvement from immunotherapy will take several months to occur. Immunotherapy does not help the symptoms produced by nonallergic rhinitis.

Filled Under: Sinus/Nasal



What are molds?

Molds produce spores or seeds, which are very light and about the size of pollen grains.  They can be spread by air currents inside or outside the house. These spores are the major source of trouble for the individual who is allergic to mold.

Where are molds?

Molds are everywhere! They will grow on almost anything with sufficient moisture. Molds, also called mildew, are common around the house and can be recognized as the growth that occurs on spoiled fruit or old cheese.  It may also appears on shower curtains, in shower stalls, on stored books and leather goods, in damp basements, in storage areas under leaves, in the grass, and in cultivated gardens.

How can we control molds in the air?

Create a healthy environment for you and an unhealthy environment for molds by doing the following things:

•  Use a dehumidifier in damp weather. Keep humidity low (35% – 50%).

•  Correct all areas of seepage or flooding which may occur after heavy rains.

•  Make sure that concrete walls are made as waterproof as possible with appropriate repairs and use of   

   “Sta-Dri” or other appropriate paint.

•  Keep refrigerators clean: dispose of food which has spoiled.

•  Keep walls of shower stalls, ceilings, curtains, and doors wiped down with Lysol or Clorox. Don’t have

   carpeting in the bathroom if possible.

•  Keep closets well ventilated, or use a drying agent hung in the closet. Moth preventives are not

   sufficient for prevention of mold growth.

•  Check all water pans in appliances and clean weekly.

•  Keep houseplants to a minimum.

•  Watch out for old stuffed furniture and old mattresses; even old foam rubber may harbor molds.

What about molds in other places?

Not all mold is airborne. Some molds can be found in foods which are prepared by the help of mold activity. In other instances the mold may appear as a contaminant. Aged cheeses are a common source of mold, and molds are used in the preparation of wines, beer, breads and cakes: these are called yeasts. Molds may contaminate foods that are constantly exposed, such as potatoes, onions, fruits, etc.

*All of the previous measures are designed to minimize contact with molds. These measures are an adjunct in therapy, and avoidance of molds is an integral part of effective treatment.

Filled Under: Molds

Understanding Exercise-Induced Bronchospasm


     For some people, physical activity is the only trigger necessary to cause an asthma episode. Exercise-induced bronchospasm (EIB) occurs when the airways in your chest become narrow and constricted within a few minutes after beginning exercise. The episode usually reaches its peak of severity about 5 to 10 minutes after starting exercise, and may continue for another 20 to 30 minutes.

     If left untreated, EIB can prevent you from participating in the activities you enjoy. While an episode may last only a few minutes, it is still a frightening experience and may cause you to put unnecessary limits on your activities.


Recognizing asthma symptoms


     In an asthma episode, the airways in your lungs become swollen and inflamed, and the muscles surrounding them tighten, reducing the flow of air. Excess mucus is also produced, which can make breathing even more difficult. The signs of asthma include rapid and labored breathing, plus a whistling or wheezing sound with each breath. You may also experience a cough and a tight feeling in your chest.


Take action – and stay active


     By working closely with your doctor and following your treatment plan, you can control your asthma and enjoy exercise and other activities without fear.


Steps for effective control


     The goal of treatment for EIB is simple: to allow you to participate in physical activities with out experiencing symptoms. Together, you and your doctor can develop a plan to manage your condition and make this goal a reality.


     Many people find that these strategies are part of a successful program:


  • Activity diary. Keep a record of all your regular activities and make a note of when you experience asthma symptoms. Also keep track of the steps you normally take for symptom relief. Review this diary with your doctor; it’s a very helpful way to track the effectiveness of your treatment program.


  • Medication. In asthma management, when you take your medicine can be as important as what medicines you take. Certain drugs are most effective at certain times, so ask your doctor about the best time to take your medication in relation to your exercise schedule.


  • Activity assessment. Evaluate the kinds of activities you can do, and the length of time you are able to do them without symptoms. For example, can you swim 5 laps or 10? What distance can you walk comfortably? Can you go through a complete workout cycle? How long can you work out before needing to rest? Your doctor can help you increase your ability to participate in these activities, and can also help you find new ways to be active.


  • Pace yourself. It may help to do warm-up and cool-down exercises before and after an activity to help your body adjust to changes in breathing and temperature. Don’t push yourself; stop and rest, if necessary.


  • Communicate. Discuss your asthma with your family and friends. This will help them understand your condition and will enable them to think of activities you can enjoy together without increasing your risk of an asthma episode. In addition, good communication opens the way to understanding and support that can be of value as you work to make your asthma management plan a success.
Filled Under: Exercise

Understanding Asthma Symptoms and Treatments



What is asthma?


Asthma is a chronic inflammatory disease of the lungs and airways affecting more than 15 million Americans. While it can be treated successfully, it is considered a chronic disease for which there is no cure.


Asthma is characterized by inflammation that occurs when your bronchi come in contact with irritants or “triggers”. These triggers cause airways to swell, bronchial muscles to tighten, and excess mucus to build up; as a result, breathing becomes difficult.


Another component of asthma is bronchoconstriction. This occurs when bands of muscles surrounding your bronchial tubes contract, causing your airways to narrow. The result is chest tightness, wheezing, and shortness of breath.


What is an asthma episode like?

 During an asthma episode, the lining of the bronchial tubes that make up the airways in your upper lungs becomes inflamed and swollen. The surrounding muscles become tight, narrowing the airways even more; and a thick mucus is produced, making breathing even more difficult. An acute episode is commonly known as an asthma “attack”.


Recognizing asthma symptoms

 The most common symptoms of asthma are rapid and labored breathing, a whistling wheezing sound with each breath, coughing, and a tight feeling in your chest. These symptoms may be started, or “triggered”, in many different ways.


Many causes and triggers

 While the exact cause of asthma is not known, it does seem to run in families. People who suffer from asthma find that many different things may bring on an episode:

  • allergens: pollen, animal dander, cockroaches, dust, dust mites, and food additives
  • other environmental conditions such as strong odors, cigarette smoke or fumes, air pollution, and changes in air temperature
  • indoor pollutants such as unvented stoves or heaters, perfumes, cleaning agents, and other chemicals
  • stress or strong emotions


Diagnosing and treating asthma symptoms

 The usual starting point is a visit to your doctor for a physical exam. This appointment will probably include:

  • A review of your family’s health history
  • A discussion of your own personal medical history
  • A physical exam, during which your doctor will listen to your breathing
  • Laboratory tests that measure lung function
  • Tests for allergies


Once you and your doctor know what kind of asthma you have, and what your asthma triggers are, you can work together to develop a treatment plan that meets your needs. This plan may include medication, lifestyle changes, and avoidance of triggers.


There are two kinds of medications that are prescribed to treat asthma:

  • Maintenance medications such as anti-inflammatory drugs help to prevent and reduce inflammation and swelling of the airways. They are an important part of long-term management of asthma symptoms. Long-acting bronchodilators are also available for the long-term control of daytime symptoms, nocturnal asthma, and exercise-induced bronchospasm (EIB).
  • Quick-relief, or “rescue”, medications such as short-acting bronchodilators help provide rapid relief to relax muscles around the airways.


Learn how to take control

You can take an active role in controlling your asthma symptoms by working with your doctor, taking your medication regularly, and making the lifestyle changes that can reduce your risks. Follow these guidelines for more successful asthma management:

  • Eat right, exercise, and get enough rest.
  • Know your personal asthma triggers and learn how to avoid them.
  • Watch for warning signs of asthma episodes and take steps promptly.
  • Stay calm when symptoms occur, and don’t hesitate to seek help.


Learn when to get help

 If your medication does not seem to relieve your symptoms, seek medical care immediately. Make sure that your family, friends, and coworkers are aware that you have asthma, and show them how they can assist you if urgent help is needed. Be sure to keep emergency information and telephone numbers handy.


Make the decision to be in control. Remember that asthma is a controllable disease, and that it need not prevent you from enjoying a healthy, active life.



This type of spore is very common in the air from late spring into fall, especially from noon until 3 P.M. daily.  The fungus grows on organic debris in the soil and also parasitized leaves, stems, flowers, fruits, and many vegetables, cereal grains, and ornamental plants (such as tomato, bean chrysanthemum and cabbage).


This is a common soil fungus, and also grows on stored food products under damp conditions. One species is common on wet surfaces in bathrooms and in drip pans of refrigerators and other appliances.


This fungus is a common parasite of grasses, and the spores are easily dispersed into the air by lawn mowing activity. In nature, the highest concentration of spores in the air occurs in the early afternoon.


These spores are fairly common in the air, especially those produced by leaf parasites of grasses and cereal grains. Grain threshing operations release large quantities of these spores into the air. These daily peak of spore production in nature is around 2 P.M.


This type of spore is very common in the air, sometimes making up half of the total spore count. The highest levels occur from mid-summer through December, and the daily peak of spore counts is between 11 A.M. and 3 P.M. The fungus grows on organic debris in the soil and on dead leaves; it may also parasitize living leaves of some plants.


Colonies of this fungus are often blue or green in color, and may be seen of food or other organic materials (citrus fruits, jams, bread, apples, leather) in the home.  The spores are plentiful inside home during the winter, and show up at the highest levels around 2 P.M.


Epicoccum is normally a soil organism and can often be found on decaying vegetative material, plant leaves and uncooked fruit.  Allergic importance: Epicoccum elicits an allergenic response in a moderate number of mold-sensitive plants. Epicoccum sensitive patients appear to have increased symptoms in the late summer and fall.


Fusarium spores are often produced in a slimy mass, and require water-splashing for their dispersal, thus they may be especially common in the air after a rain. Many Fusarium species are parasitic on vegetable and field crops, and spores may be released from infected grasses and cereals and from stored fruits and vegetables such as cucumber, tomatoes, and potatoes.


Mucor is a normal soil inhabitant.  It is frequently found around barns and barnyards where it grows on animal waste. It is widespread in nature.


Found on decaying wood, potatoes and other plant material.


Phoma grows readily on paper products such as books and magazines.  It also grows on certain paints and green plants.  Allergic importance: Extracts of Phoma frequently produce skin reactions in mold-sensitive patients.  It is widespread in nature and isolated frequently from air samples.


The fungus is common on wet, decaying wood, and produces large numbers of spores during the summer months.


This fungus is a common saprophyte growing on organic debris in soil and on sugary food products in storage (bakery goods, fruits, and sweet potatoes).

Filled Under: Molds

Tobacco Smoke In The Home


Tobacco smoke often goes unrecognized as an important aggravating factor in children’s respiratory problems such as allergic hay fever or asthma. Exposure to tobacco smoke in the home presents the greatest problem. When one or two parents smoke, the patient is exposed to relatively high concentrations of tobacco smoke for prolonged periods of time


In some cases, children may actually become allergic to tobacco smoke. They will show positive skin tests and will have allergic reaction in the respiratory tract when the smoke is inhaled. In most cases, the tobacco smoke acts as a respiratory irritant in the patient’s lungs or as an allergen, the result is the same – a worsening of the allergy patient’s condition.


In a recent study, exposure of asthmatic children to parental smoking aggravated the condition in 65% of the cases. Exposure to parental smoking was a major aggravated factor in 10% of the children if one parent smoked, and 20% if both parents smoked. In almost every case elimination of smoking in the home was followed by clinical improvement. A few showed dramatic response.


     REMOVAL OF TOBACCO SMOKE FROM THE HOME OF THE ASTHMATIC PATIENT IS IMPERATIVE. (It may also help patients with hay fever and other respiratory allergies.) Failure to eliminate this allergen/irritant could prevent improvement that would have been accomplished from other therapy (i.e., medication, allergy shots, etc.).


If smoking cannot be eliminated from the home, the following suggestions may prove helpful:


  1. Have a specific smoking room with a window open to the outside and door closed. If this is not practical, at least reduce the amount of smoking at home.
  2. Do not smoke in the patient’s bedroom.
  3. If central heat and air conditioning are in the home, close the air vent in the patient’s bedroom to prevent recirculation of smoke-laden air.
  4. Do not smoke while the patient is in the room.
  5. Avoid smoking in the automobile if the patient is present.


Though the above measures are addressed to the parents of children with allergic problems, they also apply to the adults if they are the allergy patients.

Pets May Cause Havoc for Allergic and Asthmatic Patients


Keeping domestic animals as household pets is a universal activity. Pets provide companionship, security and a sense of comfort. Children often learn responsibility and lessons about life and death from pets. However, people with allergies should be cautious in deciding what type of animal can safely be brought into their home.

Pets can cause problems to allergic patients in several ways. Their dander (skin flakes) can cause an allergic reaction, as well as their saliva and urine. The animal hair itself is not considered to be a very significant allergen. However, the hair or fur can collect pollen, dust, mold, and other allergens.

The best types of pets for an allergic patient are tropical fish, snakes, lizards, turtles, salamanders, ants and certain types of insects, frogs, spiders and tortoises. All of these pets do not shed dander, have hair or fur, nor does their excrements create allergic problems. However, patients should keep in mind that large aquariums can add to the amount of water vapor in a room, thus increasing mold and house dust mite concentrations in their home.


Most Common Pets

The most common household pets are dogs, cats, birds, hamsters, rabbits, mice, rats and guinea pigs. Larger animals such as horses, goats, cows, chickens, ducks and geese, even though kept outdoors, can also cause problems if kept as pets. It is estimated that 25% of children are exposed to horses either by riding them or by being in their barns or pens.

The number of pets in the United States is estimated at more than 100,000,000. This large number also increased the likelihood of accidental exposure to animals by the allergic patient when visiting homes, farms, etc.

Both feathers and the droppings from birds, another common pet, can increase the allergen exposure. The allergic patient should not sue feather pillows or down comforters. If a feather pillow is used, it should be placed in a plastic encasing. An encasing with a zipper is recommended, so none of the feathers can escape.


Bird Droppings

Bird droppings can be a source of bacteria, dust, fungi and mold. This also applies to the droppings of other caged pets, such as gerbils, hamsters and mice.

The ideal situation for an allergic patient would be to have no pet at all. However, many pet owners feel strongly about their pets, and would rather remove the allergic individual from the home than the pet! A pet such as a dog or cat should, at the very least, be kept out of the allergic patient’s bedroom.

The avid pet owner may claim that exposure to his or her pet does not cause them any problems. This, however, should be viewed skeptically, since pet ownership is an emotionally-charged subject. Also, may allergic pet owners are rarely away from their pets, so an accurate reporting of pet-related symptoms may not be possible.

Testing to determine an allergy to animals is not always accurate. Skin tests or radioallergosorbent tests (a blood test for allergens) can give a “false” negative reaction. To gain confirmation about a pet’s significance as an allergen, the pet should be removed from the home for several weeks and a thorough

cleaning done to removed the hair and dander. It should be understood that it can take weeks of meticulous cleaning to remove all the animal hair and dander before a change in the allergic patient is noted.

A frequently mistaken idea is that short-haired animals cause fewer problems. It is the dander (flakes of skin) that cause the most significant allergic reactions, not the length or amount of hair on the pet. As stated previously, allergens are also found in the pet’s saliva and urine. In addition, dogs have been reported to cause acute symptoms of allergic conjunctivitis (inflammation of the eye) and hay fever after running through fields and then coming back in to contact with their owners.


Severe Reactions

Some allergic patients may have severe reactions (wheezing and shortness of breath) after exposure to such pets as cats, rats, horses and guinea pigs. Also, a chronic, slowly progressive feeling of shortness of breath, loss of energy and feeling of fatigue can result from long-term exposure to birds and their droppings. This type of disease is known as hypersensitivity pneumonitis and can result in severe disability. In the event of these severe cases, removal of the offending animal is mandatory.

In summary, pets can cause direct and indirect allergic problems, both from the dander and from pollen accumulated on the fur. Allergic children and adults should not pet, hug or kiss

their pets, because of the allergens on the animal’s fur or saliva. Those pets that are known

to cause allergic reactions should be removed from the home of the allergic patient. If the family is unwilling to do this, the pet should be kept out of the patient’s bedroom and, if possible, outdoors.


Limit Pets to Few Rooms

Indoor pets should be restricted to few rooms in the home if possible. Isolating the pet to one room, however, will not limit the allergens to that room. Air currents from forced-air heating and air-conditioning will spread the allergens throughout the house. Homes with forced-air heating and/or air-conditioning may be fitted with a central air cleaner. This may remove significant amount of pet allergens from the home. The air cleaner should be used at least four hours per day.

Text developed by ACAI members: Gerald L. Klein, M.D., Robert W. Ziering, M.D., Vista, CA.

Filled Under: Pets

Most People are not allergic to insect stings and should recognize the difference between an allergic reaction and a normal reaction. This will reduce anxiety and prevent unnecessary medical expense.

More than 500,000 people enter hospital emergency rooms every year suffering from insect stings. A severe allergic reaction known as anaphylaxis occurs in 0.5% to 5% of the U.S. population as a result of insect stings. At least 40 deaths per year result from insect sting anaphylaxis.

The majority of the insect stings in the United States come from wasps, yellow jackets, hornets and bees. The red or black imported fire ant now infects more than 260 million acres in the southern United States, where it has become a significant health hazard and may be the number one agent of insect stings.

What is a normal reaction to an insect sting and how is it treated?
The severity of an insect sting reaction varies from person to person. A normal reaction will result in pain, swelling and redness confined to the sting site. Simply disinfect the area (washing with soap and water will do) and apply ice to reduce swelling.

A large local reaction will result in swelling that extends beyond the sting site. For example, a sting on the forearm could result in the entire arm swelling twice its normal size. Although alarming in appearance, this condition is often treated the same as a normal reaction. However, because this condition may persist 2 to 3 days, antihistamines and corticosteroids are sometimes prescribed to lessen the discomfort.

Fire ants, yellow jackets, hornets and wasps can sting repeatedly. Honeybees have barbed stingers, which are left behind in their victim’s skin. These stingers are best removed by a scraping action, rather than a pulling motion, which may actually squeeze more venom into the skin.

Almost all people stung by fire ants develop an itchy, localized hive or lump at the sting site, which usually subsides within 30 to 60 minutes. This is followed by a small blister within 4 hours. This usually appears to become filled with pus by 8 to 24 hours. However, the material seen is really dead tissue and the blister has little chance of being infected unless it is opened. When healed, these lesions may leave scars.

Treatment for fire ant stings is aimed at preventing secondary bacterial infection, which may occur if the pustule is scratched or broken. Clean the blisters with soap and water to prevent secondary infection. Do not break the blister. Topical corticosteroid ointment and oral antihistamines may relieve the itching associate with these reactions.

What are symptoms of insect sting allergy?
The most serious reaction to an insect sting is an allergic one. This condition requires immediate medical attention. Symptoms of an allergic reaction may include one or more of the following:

  • Hives, itching and swelling in areas other than the sting site.
  • Tightness in the chest and difficulty in breathing.
  • Hoarse voice or swelling of the tongue.

A severe allergic reaction, or anaphylaxis, can occur within minutes after the sting and may be life threatening. Symptoms may include:

  • Dizziness or a sharp drop in blood pressure.
  • Unconsciousness or cardiac arrest.

People who have experienced an allergic reaction to an insect sting have a 60% chance of a similar or worse reaction if stung again.

How are allergic reactions to insect stings treated?
Insect sting allergy is treated in a two-step approach. The first step is the emergency treatment of the symptoms of a serious reaction; the second step is preventative treatment of the underlying allergy with venom immunotherapy.

Life-threatening allergic reactions can progress very rapidly and require immediate medical attention. Emergency treatment usually includes administration of certain drugs, such as epinephrine, antihistamines, and in some cases, corticosteroids, intravenous fluids, oxygen and other treatments. Once stabilized, these patients are sometimes required to stay overnight at the hospital under close observation.

Injectable epinephrine for self-administration is often prescribed as emergency rescue medication for treating an allergic reaction. People who have had previous allergic reactions and rely on epinephrine must remember to carry it with them at all times. Also, because one dose may not be enough to reverse the reaction, immediate medical attention following an insect sting is recommended.

What is venom immunotherapy?
The long-term treatment of insect sting allergy is called venom immunotherapy, a highly effective vaccination program administered by an allergist – immunologist, which can prevent future allergic reactions to insect stings.

Venom immunotherapy involves administering gradually increasing doses of venom which stimulate the patient’s own immune system to reduce the risk of a future allergic reaction to the same as the general population. In a matter of weeks to months, people who previously lived under the constant threat of severe reactions to insect stings can return to leading normal lives.

Ask your doctor to refer you to an allergist – immunologist, a physician who is a specialist in the diagnosis and treatment of allergic disease. Based on your past history and certain tests, the allergist will determine if you are a candidate for immunotherapy.

How can I avoid insect stings?
Knowing how to avoid stings from fire ants, bees, wasps, hornets and yellow jackets leads to a more enjoyable summer for everyone.

Yellow jackets will nest in the ground and in walls. Hornets and wasps will nest in bushes, trees and on buildings. Use extreme caution when working or playing in these areas. Avoid open garbage cans and exposed food at picnics. Also, try to reduce the amount of exposed skin when outdoors.

Effective methods for insecticide treatment of fire ant mounds use attractant baits consisting of soybean oil, corn grits or chemical agents. The bait is picked up by the worker ants and taken deeper into the mound to the queen. It can take weeks for these insecticides to work.

Allergist – immunologists recommend the following additional precautions to avoid insect stings:

  • Avoid wearing sandals or walking barefoot in the grass. Honeybees and bumblebees forage on white clover, a weed that grows in lawns throughout the country.
  • Never swat at a flying insect. If need be, gently brush it aside or patiently wait for it to leave.
  • Do not drink from open beverage cans. Stinging insects will crawl inside a can attracted by the sweet beverage.
  • When eating outdoors, try to keep food covered at all times.
  • Garbage cans stored outside should be covered with tight fitting lids.
  • Avoid sweet-smelling perfumes, hair sprays, colognes and deodorants.
  • Avoid wearing bright colored clothing.
  • Yard work and gardening should be done with caution.
  • Keep window and door screens in good repair. Drive with car windows closed.
  • Keep prescribed medications handy at all times and follow the attached instructions if you are stung. These medications are for immediate emergency use while en route to a hospital emergency room for observation and further treatment.
  • If you have had an allergic reaction to an insect sting, it’s important that you see an allergist – immunologist.