Allergies: Seasonal Nuisance or Health Threat?

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An allergy is a reaction of your immune system to something that does not bother most other people. People who have allergies often are sensitive to more than one thing. Substances that often cause reactions are:

• Pollen
• Dust mites
• Cigarette smoke
• Mold spores
• Pet dander
• Food
• Insect stings
• Medicines

How do you get allergies? Scientists think both genes and the environment have something to do with it. Normally, your immune system fights germs. It is your body's defense system. In most allergic reactions, however, it is responding to a false alarm.Allergies can cause a runny nose, sneezing, itching, rashes, swelling or asthma. Symptoms vary. Although allergies can make you feel bad, they usually won't kill you. However, a severe reaction called anaphylaxis is life-threatening. 
Source: National Institutes of Health, National Institute of Allergy and Infectious Diseases

Hay Fever

As we enter the sneezing season, outdoor allergies are on the rise for many Americans. The cost to our healthcare system from all allergies—indoor and outdoor—is becoming truly breathtaking.

If you are one of the 18.2 million Americans who suffer from allergic rhinitis, or "hay fever," chances are you may be sneezing, reaching for a box of tissues or rubbing your itchy, red, watery eyes as you read this. It's May and the start of yet another allergy season, when pollen seems to cover the universe and very little relief is in sight.Each spring, summer, and fall, trees, weeds and grasses release tiny pollen grains into the air. Some of the pollen ends up in your nose and throat. This can trigger a type of allergy called hay fever.

Symptoms can include:

• Sneezing, often with a runny or clogged nose, 
• Coughing and postnasal drip, 
• Itching eyes, nose and throat, 
• Dark circles under the eyes

Taking medicines, using nasal sprays and rinsing out your nose can relieve symptoms. Allergy shots can help make you less sensitive to pollen and provide long-term relief.
Source: National Institutes of Health, National Institute of Allergy and Infectious Diseases

Food Allergy

Food allergy is an abnormal response to a food triggered by your body's immune system. Allergic reactions to food can sometimes cause serious illness and death. Tree nuts and peanuts are the leading causes of deadly allergic reactions called anaphylaxis. In adults, the foods that most often trigger allergic reactions include:

• Fish and shellfish, such as shrimp, lobster and crab
• Peanuts
• Tree nuts, such as walnuts
• Eggs
• Problem foods for children are eggs, milk (especially in infants and young children) and peanuts

Sometimes a reaction to food is not an allergy. It is often a reaction called "food intolerance". Your immune system does not cause the symptoms of food intolerance. However, these symptoms can look and feel like those of a food allergy.
Source: National Institutes of Health, National Institute of Allergy and Infectious Diseases

Latex Allergy

Latex is a milky fluid that comes from the tropical rubber tree. Hundreds of everyday products contain latex. Repeated exposure to a protein in natural latex can make you more likely to develop a latex allergy. If your immune system detects the protein, a reaction can start in minutes. You could get a rash, asthma, and in rare cases shock from latex exposure. Latex products are all around you. Some common ones are:

• Gloves
• Condoms
• Balloons
• Rubber bands
• Shoe soles
• Pacifiers
• Mattresses

If you are allergic to latex, it is a good idea to learn which products contain it. That way, you can reduce your exposure. The most common reactions are to gloves and condoms. Latex-free alternatives exist for both.
Source: National Institutes of Health, National Institute of Allergy and Infectious Diseases 

While many of us endure mild to moderate symptoms, the larger truth is that the world of allergies is a complex and costly landscape. More than 50 million Americans suffer from all forms of allergies, which are the sixth-leading cause of chronic diseases in the United States. In 1996, hay fever alone accounted for nearly 14 million doctor visits and cost the healthcare system approximately $1.9 billion. For unknown reasons, the incidence of hay fever has risen substantially in the past 15 years.

The Allergy Pathway. Simplified diagram showing key events that leads to allergy initiation. A. the allergen enters the body. B. an Antigen-presenting cell takes up the allergen molecule and presents its epitopes, through the MHC II receptor, onto its surface. The activated antigen presenting cell then migrates to the nearest lymph node C. where its activates T cells that recognize the allergen. They then give the decision for the T cell to differentiate to Th2 cell.D. at the same time, B cells recognize the allergen and through the activated Th2 cell E. the B cell would be activated. F.and differentiate into plasma cells, at which point they would actively synthesize antibodies of the IgE isotype. G. the IgE antibody, that now recognizes epitopes of the allergen molecule, circulates around the body through the lymphatic andcardiovascular systems and finally binds to its FcεRI receptor on mast and basophil cells. H. when the allergen re-enters the body at a later time it binds to the IgE, which is on the cell surface, resulting in an aggregation of the receptor causing the cells to release pre-formed mediators. One of these mediators is histamine which causes the 5 symptoms of allergic inflammation: heat, pain, swelling, redness and itchiness. Another mediator is IL-4, which affects more B cells to differentiate into plasma cells and produce more IgE and thus the vicious cycle continues. Source: Sabban, Sari (2011) Development of an in vitro model system for studying the interaction of Equus caballus IgE with its high- affinity FcεRI receptor (PhD thesis), The University of Sheffield .

These are just a few of the reasons why the National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID) is committed to funding ongoing research for new ways to manage and, perhaps, even prevent allergic diseases. In 2005, NIAID awarded more than $116 million in grants and contracts for investigation into the mechanisms, diagnosis, treatment and prevention of allergic diseases, including asthma and allergic rhinitis.

For more than 50 years, NIAID research has led to new diagnostic tests, vaccines, therapies and technologies that have improved the health of millions of people in the United States and around the world. One such NIAID-funded study has shown recently that an environmental intervention program to reduce indoor allergens, especially from cockroach and dust mites, in the homes of inner-city children with moderate to severe asthma is quite effective in reducing allergen levels and asthma symptoms. Since continued exposure to allergens induces asthma's symptoms, avoiding them is an attractive approach, according to Anthony S. Fauci, M.D., NIAID Director. "The NIAID-sponsored Inner City Asthma Study in children demonstrates that environmental interventions reduce wheezing in proportion to the reduction in allergens," he says.

Nuisance or Health Threat?

For most people, hay fever is a seasonal nuisance—something to endure for a few weeks once or twice a year. But for others, such allergies can be life-altering conditions that lead to more serious complications, including sinusitis and asthma.

• Sinusitis, one of the most commonly reported chronic diseases, is the inflammation or infection of the paranasal sinuses, which are four pairs of cavities located within the skull. Congestion here can lead to pressure and pain over the eyes, around the nose or in the cheeks just above the teeth. Chronic sinusitis is associated with persistent inflammation and is often difficult to treat. Extended bouts of hay fever, for instance, can increase the likelihood of development of chronic sinusitis.The annual cost of managing sinusitis has been estimated as high as $5.8 billion.
• Asthma is a disease of the lungs in which the primary symptom is a narrowing or blockage of the airways, resulting in wheezing, shortness of breath, coughing and other breathing difficulties. Asthma attacks can be triggered by viral infection, cold air, exercise, anxiety, allergens and other factors. Allergic asthma is responsible for almost 80 percent of all asthma diagnoses. It presents the same symptoms as nonallergic asthma, but differs in that it is set off primarily by an immune response to specific allergens.

Both sinusitis and allergic asthma are manageable, but the research challenge always is to go beyond controlling the symptoms to address the root causes of disease.

Defending Against Invaders

In a normal immune system, invading bacteria and viruses trigger antibodies, which are "programmed" to remember and defend against these germs in the future. During an allergic reaction, however, the immune system treats generally harmless allergens, such as pollen, mold, animal dander or dust mites, as pathogens and begins producing large amounts of immunoglobulin E (IgE) antibodies.

Allergic reactions are the biological equivalent of a fire drill: The body defends itself against a potential pathogen although none is present. The process is repeated as long as the immune system detects the allergen. Some allergy sufferers are genetically disposed to have a sensitive immune system. In addition, the severity of allergy symptoms can become worse due to illness or pregnancy.

That is what happened to Amy Kindt, a Mt. Clemens, Michigan, mother of two, who always suffered from hay fever when pollen counts rose during the spring and fall. However, since she became pregnant with her first child in 2000, the frequency of her symptoms has gone way up. "Ever since my first pregnancy, it seems I'm allergic to something all day, every day," she says. "I cough a lot from the drainage, and it makes it hard to sleep. Over-the-counter medications don't seem to work any more."

Testing for Allergies

When it comes to allergies, knowledge is power. Knowing exactly what you are allergic to can help determine the best way to lessen or prevent exposure and treat reactions when they occur. There are several tests that physicians use to pinpoint what you are allergic to. For example:

• Allergy Skin Test—The most commonly used allergy skin test, known as a "prick test," this diagnostic procedure involves pricking your skin with the extract of a specific allergen, then observing the skin's reaction. Another test, the intradermal injection, introduces allergens just below the skin's outer layers, is more sensitive than the prick test and is sometimes used when the prick test produces negative results. Allergy skin testing is considered the most sensitive testing method and provides rapid results. However, skin tests cannot be used when a patient suffers from certain skin conditions, such as eczema.
• Radioallergosorbent test (RAST) and Enzyme-linked immunosorbent assay (ELISA, or EIA)— RAST and ELISA are two blood tests that provide information similar to allergy skin testing, namely the levels of allergic (IgE) antibodies to allergens. "Since the introduction of the ELISA test, RAST testing has not typically been used."

Searching for Relief

For allergy sufferers, the best treatment is to avoid the offending allergens altogether. This may be possible if the irritant is a specific food, like peanuts, which can be cut out of the diet, but not when the very air we breathe is loaded with allergens. For example, a single ragweed plant can produce a million grains of pollen a day, and ragweed pollen "has been measured in the air 400 miles out to sea and 2 miles up in the atmosphere..."

Air purifiers, filters, humidifiers and conditioners provide varying degrees of relief, but none is 100 percent effective. Normally, allergy sufferers look to various over-the-counter medications and physician-prescribed therapies.

Hoping for a Cure

Relief may someday come in the form of an allergy vaccine, several of which are in development and show great promise. In one clinical trial, for instance, a series of six injections of a newly developed and specially formulated ragweed vaccine lessened symptoms and reduced the need for antihistamines among study participants. Perhaps more exciting is the fact that this particular vaccine seems to provide benefits for at least one additional year, without the need for booster shots.

For vaccines to be most effective, they must be specific. For someone allergic to ragweed, the new vaccine in development may be good news, but not to one who reacts only to grass pollen. Clearly, more research, development and testing are in order. While effective allergy vaccines are still years away from general release, research funded by NIH shows long-term promise.

External Links

Allergy:

Allergic Reactions - American Academy of Allergy, Asthma, and Immunology.
Allergies - Mayo Foundation for Medical Education and Research.
Allergy: Overview - National Jewish Health.

Diagnosis/Symptoms:
Allergy Blood Testing - American Association for Clinical Chemistry.
Allergy Skin Tests - Mayo Foundation for Medical Education and Research.
Allergy Testing: Tips to Remember - American Academy of Allergy, Asthma, and Immunology.
A Cold or Allergies: Which Is It? - Nemours Foundation.
Is It a Cold or an Allergy? - National Institute of Allergy and Infectious Diseases.
Is It a Cold, Allergy, or Sinusitis? - American Academy of Otolaryngology - Head and Neck Surgery.
White Blood Cell Differential Count - American Association for Clinical Chemistry.

Treatment:
Allergic Rhinitis | Antihistamines - American Academy of Family Physicians.
Allergy Medications: Know Your Options - Mayo Foundation for Medical Education and Research.
Allergic Rhinitis | Allergy Shots: Could They Help Your Allergies? - American Academy of Family Physicians.
Anaphylaxis: First Aid - Mayo Foundation for Medical Education and Research.
Antihistamine Drugs: Summary of Recommendations - Consumers Union of U.S.
Decongestants: OTC Relief for Congestion - American Academy of Family Physicians.
Itching for Allergy Relief? - Food and Drug Administration.
Nasal Wash Treatment - National Jewish Health.

Prevention/Screening:
Allergens and Irritants - National Institute of Environmental Health Sciences.
Environmental Control Measures - Nemours Foundation.
Patient Information: Trigger Avoidance in Allergic Rhinitis (Beyond the Basics) - UpToDate.

Complementary and Alternative Medicine (CAM) Therapy:
Allergy Overview - Asthma and Allergy Foundation of America.
Butterbur - National Center for Complementary and Alternative Medicine.

Health Check Tools:
Pet Allergy Quiz - American Academy of Allergy, Asthma, and Immunology.

Tutorials:
Just for Kids: Camping with Allergies and Asthma - American Academy of Allergy, Asthma, and Immunology.
Virtual Allergist - American Academy of Allergy, Asthma, and Immunology.

Videos:
General Allergic Reactions - eHow.
If I Had - A Runny Nose - Insidermedicine.

Anatomy/Physiology:
Immune System - National Institute of Allergy and Infectious Diseases.
Understanding Cancer Series: The Immune System - National Cancer Institute.

Clinical Trials:
ClinicalTrials.gov: Anaphylaxis, Hypersensitivity - National Institutes of Health.

Dictionaries/Glossaries:
Glossary of Allergy Terms - Asthma and Allergy Foundation of America.
Glossary of Terms - Mold - Environmental Protection Agency.

Directories:
Allergic Diseases Related Links - National Institute of Allergy and Infectious Diseases.
Find an Allergist/Immunologist - American Academy of Allergy, Asthma, and Immunology.

Organizations:
American Academy of Allergy, Asthma, and Immunology.
Asthma and Allergy Foundation of America.
National Institute of Allergy and Infectious Diseases.
National Institute of Environmental Health Sciences.

Statistics:
FastStats: Allergies/Hay Fever (Data are for the U.S.)- National Center for Health Statistics.
National Allergy Bureau (NAB) - American Academy of Allergy, Asthma, and Immunology.

Children:
All about Allergies - Nemours Foundation.
Allergy Relief for Your Child - Food and Drug Administration.
Allergy Shots - Nemours Foundation.
Allergy Testing for Children - Asthma and Allergy Foundation of America.
Back to School with Allergies and Asthma - American Academy of Allergy, Asthma, and Immunology.
5 Ways to Prepare for an Allergy Emergency - Nemours Foundation.
Learning about Allergies - Nemours Foundation.
Prevention of Allergies and Asthma in Children: Tips to Remember - American Academy of Allergy, Asthma, and Immunology.
What Is a Pediatric Allergist/Immunologist? - American Academy of Pediatrics.

Teenagers:
Allergies - Nemours Foundation.
Do Allergies Cause Asthma? - Nemours Foundation.

Hay Fever:

Allergic Rhinitis - American Academy of Family Physicians.
Hay Fever - Mayo Foundation for Medical Education and Research.
Patient Information: Allergic Rhinitis (Seasonal Allergies) (Beyond the Basics) - UpToDate.
Allergies and Hayfever: Insight into Causes, Treatment, and Prevention - American Academy of Otolaryngology - Head and Neck Surgery.
Rhinitis Overview - American Academy of Allergy, Asthma, and Immunology.
Rhinitis (Nasal Inflammation): Overview - National Jewish Health.

Diagnosis/Symptoms:
Is It a Cold or an Allergy? - National Institute of Allergy and Infectious Diseases.
Sorting Out Seasonal Allergies - American Osteopathic Association.

Treatment:
Allergic Rhinitis | Antihistamines - American Academy of Family Physicians.
Antihistamine Drugs: Summary of Recommendations - Consumers Union of U.S.
Rhinitis (Nasal Inflammation): Hay Fever Treatment - National Jewish Health.

Prevention/Screening:
Pollen - National Institute of Environmental Health Sciences.
Pollen Season Chart - InteliHealth, Harvard Medical School.

Disease Management:
Pollen Allergy: Prevent Eye Irritation - National Jewish Health.

Tutorials:
The Virtual Allergist - American Academy of Allergy, Asthma, and Immunology.

Anatomy/Physiology:
Sinus Anatomy - American Rhinologic Society.

Clinical Trials:
ClinicalTrials.gov: Rhinitis, Allergic, Seasonal - National Institutes of Health.

Directories:
Find an Allergist/Immunologist - American Academy of Allergy, Asthma, and Immunology.

Organizations:
American Academy of Allergy, Asthma, and Immunology.
Asthma and Allergy Foundation of America.
National Institute of Allergy and Infectious Diseases.
National Institute of Environmental Health Sciences.

Statistics:
FastStats: Allergies/Hay Fever (Data are for the U.S.)- National Center for Health Statistics.
National Allergy Bureau (NAB) - American Academy of Allergy, Asthma, and Immunology.

Children:
Fact Sheet: Allergic Rhinitis (Hay Fever) - American Academy of Otolaryngology - Head and Neck Surgery.
Seasonal Allergies in Children - American Academy of Pediatrics.

Food Allergy:

ALLERGY ALERT: Shea butter is extracted from the nut of the African Shea Tree Vitellaria paradoxa. The shea butter is obtained by crushing and boiling the harvested shea nuts. People with a nut allergy can react negatively to those cosmetic products containing shea butter. Those sensitive to nuts may "break out" (possibly severely) if they come in contact with shea butter.

Food Allergies: Overview - American Academy of Family Physicians.
Food Allergy: Understanding Food Allergy - National Institute of Allergy and Infectious Diseases.
Food Allergy: Tips to Remember - American Academy of Allergy, Asthma, and Immunology.
Food Allergy - Mayo Foundation for Medical Education and Research.

Diagnosis/Symptoms:
Allergy Blood Testing - American Association for Clinical Chemistry.
Allergy Skin Tests - Mayo Foundation for Medical Education and Research.
Patient Information: Food Allergy Symptoms and Diagnosis (Beyond the Basics) - UpToDate.
Getting the Facts on Food Allergy Testing - American Academy of Allergy, Asthma, and Immunology.
Food Allergy: Diagnosis: Reasons to Do Food Challenges - National Jewish Health.

Treatment:
Patient Information: Food Allergy Treatment and Avoidance (Beyond the Basics) - UpToDate.
Treating an Allergic Reaction - The Food Allergy & Anaphylaxis Network.

Prevention/Screening:
Food Allergies: Reducing the Risks - Food and Drug Administration.

Disease Management:
Egg, Milk or Wheat Allergies: What to Avoid - InteliHealth, Harvard Medical School.
Flying on Commercial Airlines with Food Allergies - Food Allergy & Anaphylaxis Network.
Have Food Allergies? Read the Label - Food and Drug Administration.
Tips for Managing Food Allergies - Food Allergy & Anaphylaxis Network.
Guidelines for the Diagnosis and Management of Food Allergy in the United States - National Institute of Allergy and Infectious Diseases.

Tutorials:
The Virtual Allergist - American Academy of Allergy, Asthma, and Immunology.

Videos:
Can Allergies Play a Role in Acid Reflux? - American Academy of Allergy, Asthma, and Immunology.
e-Learning Center: Educational Webinars - Food Allergy & Anaphylaxis Network.
Food Allergies: Reducing the Risks - Food and Drug Administration.
If I Had - A Child with a Food Allergy - Insidermedicine.
If I Had - A Food Allergy - Insidermedicine.
If I Had - An Allergic Reaction - Insidermedicine.
What is Anaphylaxis? - eHow.

Clinical Trials:
ClinicalTrials.gov: Food Hypersensitivity, Milk Hypersensitivity, Nut Hypersensitivity, Peanut Hypersensitivity - National Institutes of Health.

Research:
Study Reports that Baked Egg Challenges in Outpatient Settings Are Valuable and Safe for Most Patients - American Academy of Allergy, Asthma, and Immunology.
Does Your Birthplace, and Your Parents', Influence Food Allergy Risk? - American Academy of Allergy, Asthma, and Immunology.
Food Allergy - National Institute of Allergy and Infectious Diseases.
Hope for Beating Egg Allergy - National Institutes of Health.
Ingesting Baked Egg May Help Children Outgrow Egg Allergy - American Academy of Allergy, Asthma, and Immunology.
Results of New Study Offers Potential Clues about How Peanut Allergy Emerges - Food Allergy & Anaphylaxis Network.
Severe Food Allergy Reactions in Kids - National Institutes of Health.
Tick Bites: A Common Cause of IgE Antibodies to Alpha-Gal - American Academy of Allergy, Asthma, and Immunology.

Directories:
Find an Allergist/Immunologist - American Academy of Allergy, Asthma, and Immunology.

Organizations:
American Academy of Allergy, Asthma, and Immunology.
The Food Allergy & Anaphylaxis Network.
National Institute of Allergy and Infectious Diseases.

Statistics:
Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations - National Center for Health Statistics.

Children:
Asthma and Food Allergies - American Academy of Pediatrics.
Diagnosing Food Allergies in Children - American Academy of Pediatrics.
Egg Allergy - Nemours Foundation.
5 Ways to Prepare for an Allergy Emergency - Nemours Foundation.
Food Allergies - Nemours Foundation.
Ages & Stages: Food Allergy Reactions - American Academy of Pediatrics.
How a Child Might Describe a Reaction - Food Allergy & Anaphylaxis Network.
Infant Allergies and Food Sensitivities - American Academy of Pediatrics.
Milk Allergy in Infants - Nemours Foundation.
Nut and Peanut Allergy - Nemours Foundation.
Outgrowing Food Allergies - Food Allergy & Anaphylaxis Network.
School Guidelines for Managing Students with Food Allergies - Food Allergy & Anaphylaxis Network.

Teenagers:
Egg Allergy - Nemours Foundation.
Food Allergies - Nemours Foundation.
Milk Allergy - Nemours Foundation.
Nut and Peanut Allergy - Nemours Foundation.
Talking to Your Teen about Food Allergy - Food Allergy & Anaphylaxis Network.

Latex Allergy:

ALLERGY ALERT: Shea butter is extracted from the nut of the African Shea Tree Vitellaria paradoxa. The shea butter is obtained by crushing and boiling the harvested shea nuts. Although it is not exactly the same as the sap-like latex extracted from the Pará Rubber Tree (often simply called Rubber Tree) Hevea brasiliensis, it is very similar in chemical composition. Although the quantities of latex in shea butter are small, this natural form of latex is widely known for its skin-protectant properties. People with a  latex allergy can react negatively to those cosmetic products containing shea butter. Those sensitive to latex may "break out" (possibly severely) if they come in contact with shea butter.

Latex Allergy: Overview - American Academy of Family Physicians.
Latex Allergy: Tips to Remember - American Academy of Allergy, Asthma, and Immunology.
Latex Allergy - Mayo Foundation for Medical Education and Research.
Latex Allergy: Overview - National Jewish Health.

Diagnosis/Symptoms:
Allergy Blood Testing - American Association for Clinical Chemistry.

Prevention/Screening:
Latex Allergy: A Prevention Guide - National Institute for Occupational Safety and Health.
Latex in the Hospital Environment - Spina Bifida Association of America.

Related Issues:
Anaphylaxis Overview - American Academy of Family Physicians.
Natural Rubber Latex Allergy in Spina Bifida - Spina Bifida Association of America.

Directories:
Find an Allergist/Immunologist - American Academy of Allergy, Asthma, and Immunology.

Organizations:
American Academy of Allergy, Asthma, and Immunology.
Food and Drug Administration.

Children:
Latex Allergy - Children's Hospital Boston. 


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