Sneezing, Wheezing, Coughing, Swelling... Is it an Allergy?

Allergies are the sixth leading cause of chronic disease in the US, with more than 50 million people suffering from allergic disease each year. With this many of us affected, it seems we’d know all there is to know about allergy causes and cures – yet we’re still full of questions: Where do allergens come from? What should I do if I suspect I’m allergic to something? How do I know if it’s an allergy or just a cold? How are allergies treated?

Jordan Fink, MD, is a Professor of Pediatrics and Medicine (Allergy and Immunology, Pediatric and Adult Allergy) at the Medical College of Wisconsin. Beginning with seasonal allergies, he explains, “Symptoms of seasonal allergies are like a long cold, with itching, sneezing, coughing, and tearing of the nose, eyes and throat.”

Allergies vs. Colds
The big difference between allergies and colds is that allergic reactions have much more itching and produce clear secretions, says Dr. Fink. These symptoms may last up to several months during particular seasons, such as early fall when the ragweed is in bloom.

For those with pollen allergies, commonly called hay fever, symptoms can occur year-round. In Wisconsin, our hay fever symptoms usually take a vacation in winter, but in milder climates, pollen grains can be dispersed constantly. Although people often associate flowers with pollen, it’s actually trees, grass and weeds that produce the pollens that most commonly cause allergic reactions. There are huge quantities of these plants in our environment, and they manufacture the small, light, dry pollen granules that are custom-made for wind transport. Generally, pollen is most abundant in the morning hours, between 5 am and 10 am. Windy days often make conditions worse; rainy days can wash pollen out of the air for a time.

But allergies are not always linked to particular seasons, or even to specific plants. “We see allergic rhinitis (hay fever), hives, asthma and drug allergies to a wide variety of substances in the environment,” says Dr. Fink. “The most common inducers are pollens, molds, dusts, animals, and mites.”

Job-Related Allergies
Other allergies are also common. Some people develop occupational rhinitis and asthma – allergies to job-related irritants. These allergies affect up to 15% of Americans, according to Dr. Fink. Irritants can include animal products, which most often affect food industry workers; latex, which affects mainly those in the health care industry; and certain chemicals like epoxy resins, formaldehyde and adhesives. Symptoms of occupational rhinitis and asthma are similar to those of seasonal allergies, but might not become obvious until several years after the exposure.

True Food Allergies Uncommon
Food allergies can also be a problem, although only about 3% of children and 1% of adults have an actual food allergy. Food intolerance is a more likely problem. A food allergy is an abnormal response triggered by the immune system. The immune system is not responsible for the symptoms of food intolerance, however, even though symptoms can be similar.

It’s important to have a proper diagnosis of the problem, as actual food allergies can be very dangerous. Common food allergens include shellfish, peanuts, tree nuts, fish and eggs, but less-common foods can also be the culprits.

Symptoms of a true food allergy might include hives, swelling of the face or other body parts, wheezing and shortness of breath, and in some cases, anaphylaxis – a severe allergic reaction in which blood pressure drops and the pulse rate increases. Anaphylactic reactions can include all the allergy symptoms listed above, but they are typically sudden and much more severe. People who show any signs of anaphylaxis should be taken immediately for medical care. If untreated, anaphylaxis may be fatal due to shock or respiratory distress.

Parents and caregivers of children with food allergies must be especially careful that the children are not exposed to the allergy-inducing food. “For many foods, we can use substitutes to replace those that cause reactions – such as soy milk for cow’s milk,” says Dr. Fink.

Some Drugs Also Pose a Risk
Allergic reactions to prescription drugs are also not uncommon. Allergic reactions to drugs account for 5% to 10% of all adverse drug reactions. Skin reaction is the most common form of reaction to drugs, but some are much more serious. Penicillin allergies, for example, cause up to 400 anaphylactic deaths in the US each year.

Allergic Asthma
Asthma can be one of the many types of allergic reaction. The US Centers for Disease Control and Prevention (CDC) reports that asthma affects 14 to 15 million Americans each year, including almost 5 million children. “Asthma can occur as a result of an allergic reaction to something in a person’s environment – a dog or cat, mites, ragweed, etc. – or can be associated with a respiratory infection,” Dr. Fink says. “And some asthma develops from reactions to an irritant, as in chemicals in occupational settings.” The allergic type of asthmatic reaction has a genetic basis, Dr. Fink explains, but asthma itself does not seem to be inherited.

Prevention
There are many types of allergy treatments, depending upon the source of the allergen. Overall, says Dr. Fink, “The most effective treatment for allergic disease is avoidance of the offending agent.” For seasonal allergies like hay fever, for instance, the best ways to avoid an allergic reaction are:

• Staying indoors in the morning when pollen levels are high.
• Keeping windows closed and running an air conditioner.
• Using air filters when inside and wearing face masks designed to filter out pollen when outdoors.
• Avoiding yard work such as mowing the lawn when pollen levels are high
• Avoiding unnecessary exposure to other environmental irritants like smoke, paint and air pollution.
• Reducing the amount of dust in the home.

Obviously these measures won’t always be practical. If an allergic reaction to pollen does occur, drugs are available for treatment. “We use certain drugs to dampen and control the allergic response,” says Dr. Fink. Oral and nasal decongestants reduce the congestion caused by allergic reactions, and antihistamines control most other allergic symptoms. (But remember that nose drops and sprays should not be used for more than a few days at a time, because they can lead to even more congestion and swelling of the nasal passages.)

Also available by prescription are cromolyn sodium, a nasal spray that helps prevent allergic reactions, and immunotherapy shots, which can help reduce the symptoms of seasonal allergies like hay fever. “In some cases we use immunotherapy shots to change a person’s immune system so that there is little or no reaction to the offending allergen,” Dr. Fink reports. According to the National Institute of Allergy and Infectious Disease, about 80% of people with hay fever will have a significant reduction in their symptoms and in their need for medication within 12 months of starting these shots.

To prevent allergy attacks in children, says Dr. Fink, keep bedrooms and play areas as free of dust as possible. Stuffed animals and other toys that accumulate dust should, unfortunately, be eliminated, and substituted with washable toys made of wood, rubber, metal or plastic. (You can find tips for keeping bedrooms dust-free on the website of the National Institute of Allergy and Infectious Disease.)

Another preventive method is to treat related illnesses that might trigger an allergy attack, Dr. Fink notes. “We make sure to treat respiratory infections, especially sinusitis, which can aggravate allergies,” he says.

Treatment
Food allergies can also be prevented by dietary avoidance, although this can be difficult to guarantee. For example, peanuts or peanut products are used as a protein source in many foods in which we wouldn’t expect to find them; eggs or egg products may be included in foods like salad dressings. Since these ingredients might not be obvious, reading all food labels is a must for people with food allergies.

Medications to control or prevent symptoms are available in case an allergen is consumed. These include antihistamines for reducing gastrointestinal reactions, hives, sneezing or runny nose, and bronchodilators to relieve asthma symptoms. It is important, though, to first have definite proof that that the allergen consumed will not cause an anaphylactic reaction. Anaphylactic reactions always require immediate medical assistance.

Asthma treatment often requires a long-term approach, and avoidance of triggers is only the beginning. Patient education, behavior changes, drug therapy and frequent medical check-ups are often necessary. But, Dr. Fink emphasizes, “Asthma is controllable and should not interfere with one’s lifestyle.”

As for the youngest allergy sufferers, Dr. Fink reports, “Children’s allergies are treated similarly to those of adults, except the drug doses may be smaller.”

“Allergic diseases are chronic illnesses and need to be treated chronically and aggressively,” Dr. Fink concludes.“ If you are suffering from seasonal or food allergies, see your health care provider for proper treatment. And if you suspect you are having an allergic reaction to a particular food, chemical or other irritant, don’t wait to get medical attention. Appropriate lifestyle changes and treatments are usually enough to prevent your sneezes, wheezes and coughs.

P. J. Early
HealthLink Contributing Writer

For more information on this topic, see the HealthLink article The Facts about Allergies.

This article includes information from the National Institute of Allergy and Infectious Diseases and the US Centers for Disease Control and Prevention (CDC).