[Allergy & Asthma Corner]

Molds are found in soil, on rotting wood and any moist surfaces

Well, the good news is, if you live in the Chicago area, the much needed rain we missed in June and July has, in August, made up for the earlier dry spell. The rain has also temporarily washed out the pollens and molds which were climbing in number, according to expert pollen counters.

The bad news is, when dry, windy and cooler weather follows the heat and rain, pollen and mold counts soar. Ragweed season began August 15th but has not yet had a chance to establish itself. Learn more about ragweed on my previous posting (August 5th). Molds are the main topic of the day.

Mold spores begin to invade our Midwestern atmosphere after the thawing out from winter in early spring, and peak in September and October based on weather conditions. Molds are microscopic fungi that have various structures (spores, hyphae, etc.) but unlike plants do not have roots, leaves or stems. They are around, outdoors, throughout the spring, summer and fall. There are hundreds of mold species in our environment. Some of these are capable of surviving indoors and may be found in homes in high quantities. When there has been flooding, leaks in pipes or foundations, or roof damage molds are often more numerous. Homes with unfinished basements or low lying crawl spaces also tend to have higher amounts of mold. Molds are considered perennial (year round) triggers when indoors.

Some people are allergic to mold as well as pollens, pets and other allergy triggers. It is important to do environmental controls in order to reduce the presence of molds in your home.

Here are some allergy tips regarding indoor and outdoor molds:

-If you have mold allergy, take your prescribed allergy medication as directed. My patients are often warned not to prematurely stop (or forget to take…) their prescribed nasal sprays and antihistamines, just because they have had a few good days. Outdoor molds become almost non-existent after the first sustained frost (usually in October here).

-Watch out for mold and pollen counts but remember, the nationally reported counts represent the presence of these allergy triggers 2-3 days previously, on average. They do not reflect the amount of mold and pollen in the air currently.

-Keep all windows and doors shut in your home and cars. Run the a/c as much as possible. Life is much more uncomfortable for mold colonies in cooler, dry environments.

-Keep bathroom tiles, shower stalls and curtains, kitchen garbage containers, and bread bins clean. Appropriate cleaning solutions may reduce the mold build up in these areas, but be careful. Odor and fumes from some sprays touted to kill mold may be toxic and dangerous for you to inhale. Keep these areas well ventilated.

-Consider a Hepa filter for your bedroom to further reduce floating allergy triggers.

-Change the filters on your cooling system monthly or per specifications.

-A dehumidifier may be helpful for unfinished or partially finished basements during the summer months.

-Take steps to prevent flooding (I know…, kind of late advice for some of you) by checking your sump pumps, back-up batteries, gutters and downspouts.

-If you have had seepage or flooding it is important to remove highly soaked dry wall and check areas where water may have been trapped. These areas may over time lead to extremely high mold accumulation.

-Fix any leaky pipes or deficiencies in your roof right away.

-Talk to your allergist about whether you are sensitive to mold spores and which species are identified on skin testing. Certain molds species are more of a problem indoors than others.

Here are a couple of links:

www.mayoclinic.com/health/mold-allergy/DS00773

and

www.aaaai.org/nab/pollen.stm

Well summer is almost officially over. Some collegians have already left by plane, train, bus or automobile for their homes away from home.

This is such a bitter sweet time for parents. As a parent of an 18 and 20 year old (both of whom have asthma) I know the feeling of mixed anticipation; of desperately missing them, and the relief, shipping the little noise makers off to school.

If your child is one of my patients I hope you have prepared for their new environment by following most of the tips provided for home controls, posted previously. For your convenience I have provided a checklist to be used as a guideline for college bound students who have allergic nasal problems and /or asthma.

-Have your allergy medications as well as any other medications listed, including their doses, number of pills or puffs (in an inhaler) and number of refills. It would also be good to check expiration dates on all the medications. This is important if your medicine bag is lost or destroyed during travel (stranger things have happened). Keep the list in a separate place.

-Make certain you have a written action plan for asthma, in the event of worsening symptoms. Establish who to call and where to go if you get sick. If you occasionally required a nebulizer for asthma medications while in high school, you should probably have one at college. Don’t wait until the last minute to check on the nebulizer meds and the status of the tubing and cup (which should be kept clean and changed periodically).

-People who are on inhalers (for asthma) should have a peak flow meter. This allows for some objective information to be given by phone when uncertain about cough or other chest symptoms. I find having peak flow rates in the time of illness very helpful in my assessment of lung function.

-Do not forget your pillow and mattress encasements which should be certified to trap dust mites.

-Hopefully you requested air-conditioning (especially if you are going south) and a smoke free room, floor apartment or house. Whatever you do, avoid active smoking (tobacco as well as anything else). Any kind of smoke inhalation dramatically increases the inflammation in the sinuses and lungs in people with allergic problems.

-Make your appointments for follow-up over Thanksgiving or Christmas holiday, now. This tends to be a highly sought after time since many college students come back home around the same time.

-Remember to bring your inhalers and other medicines home when coming back for breaks. Sometimes after being away from home for several months, the allergens (pets, dust mites, irritant triggers) you are re-exposed to, have a greater impact on you. In other words, soon after getting home you get sick.

-If you are on allergy shots check on the number of shots assigned to your vials so you don’t run out unexpectedly. Have the allergy office number on hand just in case. Even if the school health service doesn’t enforce waiting 20mins after your allergy shots wait anyway (every time).

-Get a flu shot every October if you can (especially if you are on any inhalers or have asthma).

-You should be well versed in how to manage exercise induced asthma if it occurs. Ask about this next time you are in the office if we have not addressed this issue.

-Finally, for my college bound patients, feel free to call one of our offices if you are uncertain about your asthma control or medications, after being evaluated at the health service, clinic or hospital. If you do require medical attention for asthma or allergy problems make an appointment as soon as possible for the next time you come home. Let the receptionist know you recently had problems and are following my instructions.

Don’t worry if you or your child has already made their sojourn to a far away learning center. The above suggestions can still be addressed by email, phone or the next time you or they are in.

Good Luck Students and Parents!

Over the years a number of questions and comments about allergic diseases and treatments have been published and discussed in my office and at national meetings. I have chosen a few of them to present in this posting. First, let's see what you think.

Fact or Fiction?

1) People that have hayfever (allergic nasal and or eye problems) or asthma will often grow out of their allergy problems. 

2) Some breeds of dogs and cats are non-allergic.

3) Children younger than 3 years of age do not get sinus infections because their sinuses have not developed.

4) All people with asthma have allergy problems.

5) Children may inherit drug allergy (such as penicillin allergy) and specific food allergies (egg, peanut etc) from their parents.

6) Allergy shots will cure allergy problems.

7) Contact allergy (for example, reaction to poison ivy) is similar to cat, dog and other environmental allergies.

Well, how many of the above statements are facts (True)?

The answer: They are all fiction (False).

Here is the break down:

1) Can you out grow allergy? Allergy problems are genetic based and are not really out grown. This misconception is often made because people often have friend and family members who claim they have grown out of their allergy problems because they have not had problems for years. It turns out that many of these people experience a return of their nasal or asthma symptoms later in life. They may resurface at any point. It may be during a pregnancy, after a flu syndrome or cold, during a bad allergy season (as I have seen this year with some patients) or with a change in job location or home environment. Although out-growing allergy is not likely, remission is possible with comprehensive allergy treatment or good luck. Remission occurs when one experiences a period of minimal to no symptoms (off all medications or allergy shots). This may persist for months to years, but often is not permanent.

2) There are no non-allergic dogs. There are some breeds that appear to have less of an association with causing allergy problems in given individuals but this is risky. It is difficult to tell beforehand, who may tolerate any particular breed. There are apparently some hairless dogs (and cats) but they still have skin, sweat glands, saliva and urine, all of which contain some allergy protein. Recently the main allergy protein in a breed of cat has been bred out resulting in a possibly non-allergic cat. These cats are very expensive (more than $2000.00) and are not widely available. There has not been enough time to verify (through studies) whether all or many people with known cat allergy will tolerate them over years.

3) Children under the age of three do in fact have some sinus development. Some of their sinuses are clearly not well established (frontals, the ones over the eyes, and the sphenoid which are very early in development). Young children (toddlers) may get sinus infections. The two most common symptoms are cough and nasal congestion which often has lasted two or more weeks. Your doctor will determine whether there are other signs or symptoms to support sinusitis. Sometimes x-rays are required to confirm the diagnosis.

4) Not all people that have asthma have allergy problems. Some people are actually not allergic to anything (skin test all negative). Their triggers may include weather changes, common cold virus, fumes, irritant dust and other indoor pollutants, stress, exercise, cold air and even certain medications (used for other disorders). People with allergy problems and asthma often have these non-allergic triggers as well as the allergic ones.

5) Children, and adults, do not inherit allergy to specific foods or drugs or other triggers. The inherited entity is actually the tendency to develop allergy. In other words there are genes that are passed on to children that promote the development of hypersensitivity to one's own, unique list of environmental triggers. Each allergic individual has their own list of triggers. This is why allergy testing is important. A parent will not pass specific allergy to penicillin or cat to their child; just the increased likelihood of becoming allergic to something in their immediate environment.

6) Allergy shots (immunotherapy) are not curative. They work most of the time (about 70-80%) to reduce allergy sensitivity and sustain the lower level of hypersensitivity but not permanently. Studies have shown an approximate 30% recurrence rate after shots are stopped (after being on shots for 4 or more years). It is uncertain how many patients remain well controlled several years after stopping shots.

7) Contact allergy, also referred to as contact dermatitis, is an immune reaction in the skin following exposure to an organic or chemical trigger. Poison ivy represents one of the most highly reported organic contact triggers. The mechanism of the reaction is quite different from the allergic reaction to food, drugs and seasonal allergens (pollens). No IgE antibody is involved. The reaction is often delayed by a few to several hours. Several other different cell types are involved (Vs the IgE mediated mechanism of environmental allergy).

Rather than going into further detail about contact, poison ivy reaction, I'll refer you to a Chicago Tribune article I contributed to last week.

My comments may be on the second or third page of the article.

This is the link: www.chicagotribune.com/chi-mxa0809tempocoverivyaug09,1,3135509.story?coll=chi_mezz

I postponed my posting on Sickle Cell Disease but stay tuned.

Ragweed  (click on it, but reduce the size or zoom out if possible)

Imagine you are a heavy weight boxer training for an upcoming fight and your trainer tells you to "put your arms up to guard the punches, right after you get hit in the head by the first few punches".

The first punch or two could knock you out right?

What if you were a rancher and you wanted to keep a very feisty horse from escaping the barn. Would you wait to close the barn door only after you saw the horse lunging for it?

Well, waiting to take most allergy medicines (antihistamines, eye drops, prescribed nasal sprays) until sneezing, runny nose, stuffy nose, eye itching and watering has started is not the smartest thing either.

So, how are you supposed to know when to expect a particular allergy trigger to be a problem?

This is an easy answer for people who suffer from ragweed allergy. Ragweed explodes into the air August 15th of every year, in the temperate areas of the Northern Hemisphere (yes that means the Midwest).

Many of my patients know to start their non-drowsy antihistamines, nasal steroid sprays and in some cases, prescribed eye drops the first week of August. These medications are usually started at a time when allergy symptoms are minimal to nonexistent. Having a 1-2 week jump on the allergy season, by such preparation, may result in very mild allergy symptoms for the following two months.

Ragweed  (click on this pic) 

Ragweed pollen infiltrates the air in the middle of August and doesn’t go away until October or after the first good frost. One plant may emit a billion pollens over the season. The pollen may travel 200 miles on windy days. You don’t have to live around ragweed to be exposed to it. It is essentially unavoidable during ragweed season (unless you stay indoors the entire season with windows, doors and vents sealed).

Ragweed is a slender, non-flowery, non-descript plant that tends to pop up in places where the land has recently been disturbed. Suburban and rural roadsides, river banks, abandoned fields, old farm land and poorly maintained parks often contain ragweed.

Ragweed pollen is more prevalent between 5am and 10am in the morning, which is important information for outdoor runners, walkers, bikers and swimmers.

Although you cannot completely avoid ragweed, you can take several steps to reduce your exposure or limit the impact of pollen exposure.

Tips:

-If avoiding outdoor exercise activities in the morning during ragweed season is not possible, taking your prescribed, once daily antihistamine at bedtime may reduce symptoms from exposure the following morning. Taking it the same morning may not allow enough time (often about two hours) for the pill to get into the system and block histamine.

-Regularly take your prescribed nasal spray, with proper technique (see earlier posting on nasal spray technique).

-Keep your doors and windows shut at home. Run the a/c to keep your home cool and remember to adequately change filters on your cooling system.

-Keep your car windows up and run the a/c. Re-circulate inner compartment air if possible.

-Remove or change clothes after coming in from outdoors. Pollen may cling to your clothing.

-Try to avoid line-drying your clothes outdoors in that pollen will infiltrate them.

-More frequent bathing of pets that are allowed outdoors may reduce pollen coming into your house.

-Consult your allergist if you continue to have problems. Allergy shots may be helpful if you suffer from rhinitis despite the medicines, or are not tolerant of the allergy medications.

Here are two other sites for your review:

www.aafa.org/display.cfm?id=9&sub=19&cont=267  

and

www.slu.edu/readstory/more/1384