Fact or Fiction?

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.