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Cozy Up to an Allergy-Friendly Home

Tips for Preparing Your Home for Indoor Winter Living

Allergy image

Millions of people experience allergy symptoms caused by indoor allergens. These culprits include dust mite droppings, animal dan­der, cockroach droppings, and molds. While avoiding allergens is the most effective treatment approach, strict avoid­ance isn’t always possible. This winter, as temperatures drop and you begin spending more time indoors, consider making the following changes to mini­mize your allergy symptoms.

Dust Mites
Dust mite allergens are a common trigger of allergy and asthma symptoms. While they can be found throughout the house, these microscopic creatures thrive in warm, humid environ­ments, such as bedding, upholstered furniture, and carpeting.

Because so much time is spent in the bedroom, it is essential to reduce mite levels there. Encase mattresses, box springs, and pillows in special allergen-proof fabric covers or airtight, zippered plastic covers. Bedding should be washed weekly in hot water (130 de­grees Fahrenheit) and dried in a hot dryer. Allergen-proof covers are avail­able for comforters and pillows that can’t be regularly washed.

Keep humidity low by using a dehu­midifier or air conditioning. Wall-to-wall carpeting should be removed as much as possible. Instead, throw rugs may be used if they are regularly washed or dry cleaned.

Pet Allergens
Contrary to popular opinion, there are no “hypoallergenic” breeds of dogs or cats. That is because people are not allergic to an animal’s hair, but to an allergen found in the sa­liva, dander (dead skin flakes), or urine of an animal with fur.

Pet allergy symptoms typically occur within minutes. For some people, symp­toms build and become most severe eight to twelve hours after contact with the animal. People with severe allergies can experience reactions in public places if dander has been transported on pet owners’ clothing.

Keeping an animal outdoors is only a partial solution, since homes with pets in the yard still have higher concentrations of animal allergens. Before getting a pet, ask your doctor to determine if you are allergic to animals. If your pet is already considered part of your family, try to minimize contact and keep the pet out of the bedroom and other rooms where you spend a great deal of time. Vacuum carpets often or replace carpet with a hardwood floor, tile, or linoleum.

While dander and saliva are the source of cat and dog allergens, urine is the source of allergens from rabbits, ham­sters, mice, and guinea pigs, so ask a non-allergic family member to clean the animal’s cage.

If you have a pet allergy, talk to your doctor about the potential for allergy immunotherapy. This strategy can often provide long-term relief.

Cockroaches are often found in the homes of densely populated urban areas, schools, or commercial buildings, but these creatures can lurk almost anywhere. This does not mean that you have a dirty house or living area.

Block all areas where roaches can enter the home. This includes crevices, wall cracks, and windows. Cockroaches need water to survive, so fix and seal all leaky faucets and pipes. Have an exter­minator go through the house when your family and pets are gone to eliminate any remaining roaches.

Keep food in lidded containers, and put pet food dishes away after your pets are done eating. Vacuum and sweep the floor after meals, and take out garbage and recyclables. Use lidded garbage containers in the kitchen. Wash dishes immediately after use, and clean under stoves, refrigerators, or toasters where crumbs can accumulate. Wipe off the stove and other kitchen surfaces and cupboards regularly.

Indoor molds and mildew need dampness, typically found in basements, bathrooms, or anywhere with leaks. Get rid of mold growth on hard surfaces with water, detergent, and, if necessary, five percent bleach (do not mix with other cleaners). Then dry the area completely. If mold covers an area more than 10 square feet, consider hiring an indoor environmental professional. For cloth­ing, washing with soap and water is best. If moldy items cannot be cleaned and dried, throw them away.

Repair and seal leaking roofs or pipes. Using dehumidifiers in damp basements may be helpful, but empty the water and clean units regularly to prevent mildew from forming. All rooms, especially basements, bathrooms, and kitchens, require ventilation and cleaning to deter mold and mildew growth. Avoid carpeting on concrete or damp floors and storing items in damp areas.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2014-2015.

The Most Wonderful Time of the Year?

Not if You Spend it Sneezing & Wheezing

Allergy and Asthma image (Photo ©

How to Enjoy the Holidays without the Allergy & Asthma Symptoms

You don’t want to be a Scrooge. You really don’t. But every holi­day season you wonder why your “seasonal” allergies are still bothering you. Why are you stuck sneezing, wheez­ing, and coughing while everyone else is caroling, sleighing, and spreading cheer?

“People don’t realize how many hidden triggers are associated with the holidays and winter season,” says aller­gist James Sublett, md, president of the American College of Allergy, Asthma & Immunology. “Those who suffer from allergies and asthma assume things will ease up once the cold weather hits, but there are other factors which can cause your allergies and asthma to flare. In fact, two thirds of allergy sufferers have year-round triggers and symptoms.”

If the first frost has come and gone but you’re still dealing with seasonal allergies and asthma flares, the follow­ing tips can help you get through the cold-weather holidays with nary a “bah humbug.”

bullet Skip the Seasonal Scents
Many people use candles during the holidays, but scented candles can trigger symp­toms in people with allergies and asthma. Wood-burning fireplaces are also a trigger, as well as aerosols, such as air fresheners and artificial snow. Avoid potpourri and other scents designed to make your house smell good. They might also cause sneezing and sniffling among your guests.

bullet A Feast without Fear
Traditional holiday foods are often a big part of sea­sonal gatherings, including Hanukkah, Christmas, and Kwanzaa; however, some of those dishes may contain potential food allergens. If you have a history of possible food allergies, consult with your doctor to determine if you’re actually allergic or if you’re just intol­erant. If you’re dining at a friend’s house, let your host know about your food allergy, and bring a dish to share that is safe for you to eat. If you’re the host, check labels for common food allergens, and consider putting small labels on foods that contain peanuts, tree nuts, or shellfish, as these are the most com­mon holiday food allergens.

bullet Coughin’ around the Christmas Tree
Both live and artificial trees can trigger symptoms. Some people are allergic to terpene, found in the oil or sap of trees. Others are bothered by mold spores or pollen brought in by fresh trees and greenery. Before bringing them into your house, use a leaf blower to help remove some of the pollen. Wash live trees, especially the trunk, with a garden hose and leave in the garage or on a covered porch to dry. Wear gloves when handling the tree to avoid sap. Artificial trees can harbor dust and mold if stored improperly, so you should wash these trees outside as well to help eliminate some of the allergens. When storing the tree, place it in an airtight container to hinder allergen accumulation.

bullet Ditch the Dust, Then Deck the Halls
Seasonal decorations stored in attics and basements for months often gather dust and mold, which can trigger an allergic reaction when they come out of storage. Clean each item thoroughly before decking the halls, dining room, or tree. After the holidays, when you’re packing decorations away, store them in airtight containers.

bullet Baby, It’s Cold Outside
You may want to exercise to keep holiday pounds away, but exercising in the cold can make asthma symptoms worse. The symptoms of asthma include coughing, wheezing, a feeling of tightness in the chest, and shortness of breath. If these symptoms occur when you exercise in cold weather, they may indicate undiagnosed asthma. An allergist can perform lung function tests to accu­rately diagnose asthma and create an action plan to help identify your trig­gers, as well as ways to avoid them. For example:

bullet Warm up with gentle exercises for about 15 minutes before you start more intense exercise.

bullet Cover your mouth and nose with a scarf or face mask when you exercise in cold weather.

bullet Take medicine as recommended by your doctor to prevent and treat your asthma.

bullet Consider moving your exercise program indoors if the temperature is below freezing.

bullet You Better Watch Out
While stress doesn’t cause allergies or asthma, it can hinder your immune system. The chaos of the holiday season also may distract you from keeping yourself healthy, in­cluding taking your allergy and asthma medication. Carve out time to stay on top of your symptoms so illness doesn’t derail your holiday plans.


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2014-2015.

Coping with COPD

It’s a Family Affair

About COPD

A diagnosis of chronic obstructive pulmonary disease can seem like devastating news. A life with COPD is different from a life without COPD, and coping with these changes is a significant challenge to overcome. The good news is that peo­ple with COPD can continue to live active, full lives.

COPD and Your Family
While you may be the one with COPD, everyone who loves you is also affected by the illness. Your loved ones hate to see you uncomfortable and unable to do the things they know you enjoy. In addition, stress levels can rise as roles change and your family re-evaluates its goals and plans. When challenges arise, having an understanding of the best methods for coping with them can help you and your family deal with the stresses of COPD.

Challenges and Coping Methods
The challenges of COPD typically begin long before the diagnosis. How­ever, when you find out for sure that you have COPD, you will likely experience difficult emotions, such as sadness, fear, anger, guilt, and worry. Share these feelings with your loved ones. Discuss how the diagnosis may change your lives, and then plan how to pursue treatment as a team.

♦ Acute Challenges
One type of chal­lenge you may face is an acute challenge. This is when something happens sud­denly that makes your situation worse. Examples of acute challenges include disease exacerbations, such as lung infections, or trips to the emergency room due to some source of unusual excitement or anxiety. In these situa­tions, you and your family members should rally together to support each other. Usually, a short burst of extra effort by you and by your support net­work can resolve an acute challenge.

♦ Chronic Challenges
The second type of challenge is a chronic challenge, a long-standing, slowly progressive problem that is not likely to go away. Familial role changes are a chronic chal­lenge that can lead to frustration and guilt. You may find it difficult to accept role changes, for instance, if you’re not able to shop or cook for your family like you used to; do as many household chores, like cleaning, yard work, or shov­eling snow; or entertain over the holidays in as elaborate a fashion as in previous years. Having to carry supplemental oxygen and managing medications can also be chronic challenges.

For chronic challenges, the better coping response may be to understand what the situation has meant for you and your family. Once you determine the impact of the situation, try to find a way to recover the value of what was lost rather than the ability to do that exact same activity. Be proactive and creative. For example, if you can’t ski together as a family anymore, maybe you can enjoy family walks. If not walks, perhaps scheduled dinners or game nights will make up for the lost family bonding time.

Managing Your COPD Together Long Term
Over time, managing your COPD will require both types of response – sometimes for the same situation. For instance, if you become acutely ill at a family event, it may require an acute response, maybe even a trip to the emer­gency room. Not only will the family be concerned about your well-being, but also you will all be dealing with the dis­appointment of having to cut short your time together. Once the immediate crisis has passed, you and your family will need to come up with a chronic response to the crisis. Work together to decide what long-term changes can be made in order to avoid similar crises in the future.


Source: National Jewish Health,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2014-2015.

Do You Know What Makes Your Asthma Worse?

Asthma image

An asthma trigger is anything that makes your asthma worse. When you encoun­ter one of your triggers, it can cause a sudden worsening of asthma symptoms, which is often called an asthma attack, episode, or flare-up.

Knowing what causes your asthma symptoms is an important step to con­trolling your asthma. Common asthma triggers include respiratory infections, allergens, irritants, exercise, and strong emotions. Your doctor can help you identify what makes your asthma worse. Once you know what causes your symp­toms, you can work with your doctor to come up with a plan for managing your asthma and avoiding your triggers.

Here’s a breakdown of the most com­mon asthma triggers, along with some tips for reducing your exposure to them.

bullet Medical Conditions Respiratory infections, such as a cold, flu, or sinus infection, are the most common cause of asthma symptoms leading to an asthma flare-up. Washing your hands frequently and avoiding people who are sick will help to reduce your exposure to cold and flu. However, the best way to prevent the flu is to get a flu vaccine every year. Pregnancy hormones and other medical conditions, such as acid reflux, can also worsen asthma symptoms.

bullet Food & Medicines Asthma can be triggered by food allergies and certain medications. Discuss with your doctor any over-the-counter or prescription medicines you take, such as aspirin, fever-reducers, or anti-inflammatories, as well as any alternative therapies or herbal remedies you use, as they may have an impact on your asthma.

bullet Smoke All types of smoke can make it hard to breathe, including smoke from wood-burning fireplaces, campfires, burning leaves, cigarettes, cigars, and pipes. If you smoke, you should make a plan to quit. If you don’t smoke but live with someone who does, ask that he or she smoke outside, and discuss other ways to prevent or limit your exposure to tobacco smoke.

bullet Weather, Pollen, & Air Pollution Changes in the season can bring on an asthma episode due to increased pollen in the air. Limit your time outdoors when pollen counts are high, especially during spring and fall. Extreme temperatures; cold, windy, or stormy weather; high humidity; and air pollution, including smog, vehicle ex­haust, and other fumes, can also cause problems for asthma fighters. Be pre­pared for the weather and outdoor air conditions before you leave your home by checking the pollen counts and air quality index for your area.

bullet Animals Dander and saliva from animals with fur or feathers – includ­ing cats, dogs, ferrets, hamsters, Guinea pigs, bunnies, mice, and birds – are common allergy trig­gers, and for some people, they can cause asthma symptoms. Reduce your expo­sure to pet allergens by vacuuming and damp dusting weekly. Try to keep your pets out of your bedroom and any other rooms where you spend a lot of time.

bullet Pests Dust mites, cockroaches, and rodents aren’t just annoying; these little guys, which can be found in your home, workplace, and school, can trigger asthma symp­toms. To reduce your exposure to these trig­gers, wash bedding regularly, fix leaks, store garbage outside, vacuum and dust weekly, and use allergen-proof pillow and mattress covers.

bullet Mold Mold is another common allergen that can trigger asthma symp­toms. You can reduce your exposure to mold by cleaning any visible mold in your home with mild soap, hot water, and a strong brush. Throw away moldy items that cannot be cleaned. To help prevent future mold growth, run a dehumidifier, fix leaking pipes and faucets, and turn on the ex­haust fan when you take a shower.

bullet Exercise Staying active is very important to your overall health and well-being, especially for people with asthma. If you know that exercising or playing sports triggers your asthma symptoms, use your quick-relief medicine 15 to 30 minutes before engaging in physical activity, if prescribed. Remember to monitor the local air quality if you plan to exercise or play outside.

bullet Emotions Emotional ups and downs are part of life. But before you lose your composure, remember that strong emotions can increase rapid breathing and trigger asthma symp­toms. Stress, both personal and work related, can be a major trigger as well. The same goes for laughing or crying too hard, yelling, and feeling anxious, angry, and afraid.

bullet Strong Odors Scents from perfumes, deodorants, and cleaning supplies can leave you gasping for air. Scents from gas stoves, scented candles, incense, hairspray, and air freshen­ers can also cause asthma symptoms. When possible, choose cleaning and personal care products that are both odor- and fragrance-free.


For more information on lung health, visit or call the American Lung Association’s Lung HelpLine at (800) 586-4872 to speak with a lung health expert.

Source: American Lung Association,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2014.

NFL Legend Jerome Bettis

Gives the Play-by-Play on Managing His Asthma & Severe Food Allergies

by Jessica Webb Errickson

Allergy and Asthma image

As one of the most celebrated players in NFL history, former Pittsburgh Steeler Jerome Bettis knows the importance of staying at the top of his game. For Jerome, whose impressive rushing skills earned him the nickname “The Bus,” keeping in tiptop shape demands more than a healthy diet and exercise routine; he also has to contend with asthma and severe food allergies. But with his asthma under control and his anaphylaxis action plan in place, nothing can stop “The Bus.”

Many years before leading his team to Super Bowl XL victory, 14-year-old Jerome was enjoying some Chinese food with his aunt and uncle when he first experienced anaphylaxis, a life-threatening allergic reaction.

“I ordered shrimp fried rice, and as I was eating it, my throat started to itch. A couple of seconds later, I could feel my throat starting to close up,” Jerome explains in an interview with Coping magazine. “I was familiar with that type of feeling because I have asthma, so it was clear that something was wrong. It didn’t feel like an asthma attack, but I knew I needed to get help immediately. My aunt and uncle rushed me to the hospital, where I was injected with epinephrine. That’s when I was diag­nosed with a shellfish allergy.” From that day forward, Jerome had to adhere to some permanent lifestyle changes to ensure his safety, especially when dining out. This is where his ana­phylaxis action plan comes into play.

"Even if you don’t have severe allergies, by becoming educated on the condition, you could possibly save a life."

“The first step in my action plan is to avoid my allergen,” he explains. “When I’m at a restaurant, the first thing I do is let my server know that I am allergic to shellfish. I also alert the chef. When I look at the menu, I ask about ingredi­ents and how dishes are prepared, and I alert the staff about the possibility of cross-contamination and the importance of making sure that they don’t cook my food in the same pan or the same grease as my allergen.”

However, when it comes to life-threatening allergies, it’s not enough to depend on the restaurant staff to keep you safe. You have to be prepared to handle a potential allergic reaction.

“I always carry two Auvi-Q epineph­rine auto-injectors,” Jerome continues. “This is paramount because I can be as diligent as possible, but someone in the kitchen or on the waitstaff could make a mistake, and I may need to use one of my epinephrine auto-injectors. If so, I know I have a second one available in case of a secondary reaction. I also need to get emergency help immediately.”

Jerome stresses that people should never treat these types of reactions lightly, as they can be life threatening. “If you don’t carry your epinephrine auto-injectors with you, then you put yourself in a very dangerous position,” he says

While his shellfish allergy never posed a problem on the field, the former running back, who barreled more than 13,000 yards through packs of muscle-bound defensive linemen during his 13-year career, did have to take actions to keep his asthma under control come game time.

“I’ve had an asthma attack during a football game. That was a dangerous situation as well,” says Jerome. “After that, I used a nebulizer before every single game that I played, to open my airways and allow me to take those deep breaths you need when you’re playing football.”

Just as he is diligent about manag­ing his allergies and asthma, the football legend and current NFL analyst for ESPN, is also intent on spreading aware­ness about these conditions. Specifically, Jerome has teamed up with the Allergy and Asthma Foundation of America and the pharmaceutical company Sanofi to promote What’s Your AQ?, an educa­tional online quiz that allows participants to test their AQ, or anaphylaxis quotient.

According to Jerome, “The quiz gives you a better understanding of what anaphylaxis is and dispels some of the misconceptions about it. Even if you don’t have severe allergies, by becom­ing educated on the condition, you could possibly save a life. There were even some things about the condition that I didn’t know until I took the quiz.”

The main point Jerome hopes to drive home is that anaphylaxis is life threatening, so if you’re at risk for anaphylactic reactions, you have to have a game plan.

“Have an anaphylaxis action plan – be diligent, educate yourself about severe allergies, and keep two epineph­rine auto-injectors with you at all times,” he stresses. “It could save your life.”


Learn more about anaphylaxis and take the What’s Your AQ? quiz at

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2014.

Say Hello to Fall

… and Goodbye to Allergy & Asthma Symptoms

Allergy and Asthma image

With its cooler temperatures, beautiful colors, and fun activities, fall is a favorite season for many people. But the arrival of harvest season also signals the arrival of fall allergies, causing headaches, stuffy noses, and sneezing that can put a damper on fall fun. If you’re one of more than 50 million Americans with allergies and asthma, the following tips can help you find relief and enjoy fall to the fullest.

Hayrides and Hay Mazes
Contrary to what you might think, the hay used in hayrides and hay mazes doesn’t ac­tually cause hay fever (also known as allergic rhinitis). However, these activi­ties do expose you to the real culprits: outdoor allergens, with weeds (especially ragweed) and mold being the most common fall allergy triggers. “Pollen can build up easily on bales of hay, which can then get on clothes,” says allergist Michael Foggs, md, presi­dent of the American College of Allergy, Asthma & Immunology. “If possible, take a shower, wash your hair, and change clothing after an outdoor outing such as a hayride.”

Weeds and mold are common fall allergy triggers.

While it’s impossible to completely escape pollen and molds, you can take some precautions to lessen exposure:

bullet Keep the windows in your home and car closed, and use air-conditioning, if possible.
bullet Remember to change your home and auto air filters regularly and replace them with high efficiency filters.
bullet Don’t hang laundry outdoors to dry. Pollen may cling to towels and sheets.
bullet Outdoor air usually is most heavily saturated with pollen between 5 a.m. and 10 a.m., so limit early morning outdoor activities. Also be aware that wind gusts and activities like raking leaves can stir up mold spores.
bullet Wear a pollen mask when mowing the lawn, raking leaves, or gardening, and take allergy medication beforehand.

Apple Picking and Baking
Fall is a great time for picking apples and baking pies from your bounty. But if your mouth, lips, or throat gets itchy or you sniffle and sneeze after eating a raw apple, you may have oral allergy syndrome. The condition, which affects about one third of seasonal allergy fighters, causes a reaction in people who are already aller­gic to pollen when their immune system sees a similarity between the proteins of pollen and those of certain foods.

The good news is people affected by oral allergy syndrome can usually eat cooked forms of the same fruits that cause a reaction, because heat changes the proteins. So go ahead and bake the apples into a pie without worry. But before you reach for the cinnamon, one of the key ingredients that makes apple pie so scrumptious, be aware that it can trigger an allergic reaction. Although spice allergy is very rare, it’s believed that many people with the allergy are undiagnosed. In addition to cinnamon, spice allergy triggers include garlic, black pepper, and vanilla.

Taking a Hike
The idea of taking a fall hike and breathing in cool, crisp air is especially appealing after a long, hot summer. You just need to make sure to take the proper precautions before hitting the trail if you have allergies or asthma.

“Asthma triggers are things that don’t bother most people, but can make in­flamed lungs worse if you have asthma,” says Dr. Foggs. “Asthma triggers in­clude pollen, mold spores, animal fur, smoke, and dust (which can contain all of the above) – all things you could encounter while taking a hike. In addi­tion, cold, windy weather or sudden weather changes can be triggers, so asthma sufferers need to take precautions to cope with those triggers.”

Don’t wait until the first sign of symptoms to take your medications. You should start taking allergy medications at least two weeks before your symptoms usually begin and continue taking them for two weeks after the first frost, as your symptoms can linger after pollen is no longer detected in the air. If you have asthma, be sure to take your controller medication as prescribed, and keep a quick-relief inhaler with you in case of an asthma flare.


For more information about seasonal allergies, and to locate an allergist in your area, visit

Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2014.

How Asthma and COPD Can Affect Your Sleep

And What You Can Do about It

by Jay Balachandran, MD, and Mihaela Teodorescu, MD

About COPD

Good quality sleep is important for everyone. However, people with asthma or chronic obstruc­tive pulmonary disease may have sleep issues that can lead to nighttime awaken­ings and daytime sleepiness. This can worsen their symptoms of asthma or COPD. Fortunately, there are a number of steps people with asthma or COPD can take to improve their sleep.

What kind of night disturbances might I experience with asthma or COPD?
Waking up at night, also called nighttime arousal or nighttime awaken­ing, can happen if you have asthma or COPD. These arousals interrupt your sleep and may cause you to feel groggy in the morning or tired during the day. Symptoms of COPD and asthma that may cause you to wake up at night include coughing, wheezing, chest tightness, and breathlessness. People with COPD or asthma may also be at increased risk for sleep apnea and may awaken from symptoms of this sleep problem.

What is sleep apnea? Why can I experience sleep apnea with asthma or COPD?
Sleep apnea is a condition that causes you to have periods when you stop breathing during sleep. These pauses in breathing usually last 10 sec­onds or longer. It is not clear why sleep apnea may occur more often in people with asthma or COPD, but you are more at risk if you have severe asthma, are overweight, have nasal congestion, experience acid reflux, or use high doses of inhaled corticosteroids.

The first step to sleeping better is to make sure that your asthma or COPD is under good control.

How do sleep problems affect my asthma or COPD?
People with asthma or COPD who have a frequent problem waking up at night often have worse respiratory disease. They are also at risk for complications from their asthma or COPD. Sleep apnea can worsen asthma symptoms throughout the day, increase your need for rescue inhalers, and worsen your quality of life. If you have COPD, the pauses in your breathing and low oxygen levels with sleep apnea can make your COPD worse and can be life threat­ening. Moreover, sleep apnea can be a serious condition by itself. People with moderate to severe sleep apnea who do not get treatment have an increased risk for hypertension, heart disease, and stroke.

What can I do to help myself sleep better?
The first step is to make sure that your asthma or COPD is under good control. Your healthcare provider can evaluate your condition to ensure that you are getting the right medical treatment and then develop a series of steps you can take to control your asthma or COPD and guide you through an episode of sudden breathlessness. He or she will also instruct you on when to use your rescue inhaler or pursed-lip breathing technique and give you a set of questions to ask yourself about your condition should you experience any sudden breathlessness.

Also, be sure to tell your healthcare provider if you have nasal congestion or experience heartburn so you can learn how to get them under better control. If you smoke, quitting smoking will not only help your asthma or COPD control, but the quality of your sleep will also improve. Sleep apnea is treat­able, so tell your healthcare provider if you think you may have this condition so you can be evaluated.


Dr. Jay Balachandran is assistant professor of medicine and associate director of the Sleep Medicine Fellowship Program at the University of Chicago Medicine in Chicago, IL. He specializes in pulmonary, critical care, and sleep medicine. Dr. Mihaela Teodorescu is an associate professor of medicine who specializes in pulmonary, critical care, and sleep medicine at the University of Wisconsin School of Medicine and Public Health in Madison, WI.

Reprinted by permission of the American Thoracic Society from the American Journal of Respiratory and Critical Care Medicine, copyright © 2014 American Thoracic Society,

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2014.

The Dish on Dining Out with Food Allergies

by Mireille Schwartz

Allergy image

Aside from the stunning Fog City backdrop against the Golden Gate Bridge, San Francisco is best known as a foodie haven with great local cuisine. When moving to the Bay Area more than a decade ago, I didn’t take into account the overwhelming presence of seafood in the city. Having a seafood allergy, it took some adjustments to be able to enjoy the beauty and culture and still dodge seafood, which seemed to be everywhere.

When dining out, people like me who are living with food allergies must be particularly alert to what’s on their plate. The first step to dining out safely is to perform some preliminary research. Start by calling restaurants you’d like to try in your area. Investigate restaurants’ web­sites and look for either a menu listing ingredients or an email address where you can ask for information about spe­cific recipes.

If you want to find out a restaurant’s policy on serving diners with food aller­gies, you’ll need to call the place well ahead of your din­ner date. Be sure to provide as much notice as possible so the staff will have enough time to assess if they can keep you safe. It’s good to call at the beginning of the workday, long before the hectic lunch rush begins and the end-of-evening fatigue sets in. Another good time to call is be­tween 2 and 4 p.m., after lunch but before the dinner rush. The following are exam­ples of questions to ask when you call:

  • Do you have a formal allergy policy? Is the wait staff educated and trained in handling food allergies?
  • Do you have a book or list of the ingredients in all the foods you serve?
  • Will you custom prepare a meal for a food-allergic individual?
  • How is your kitchen laid out?
  • What kind of oil is used in the fryer? What else is fried in it?
  • Do you have dedicated cooking surfaces that are kept safe for food-allergic cooking?
  • Are cooking utensils for different foods kept separate and safe?
  • Does the wait staff know to keep dishes containing food allergies away from other dishes? Do they know that allergens can’t just be picked off a meal?

When you’re looking over the menu, be mindful of hidden allergens lurking in breading, salad dressing, complex sauces, garnishes, and certain courses.

Mireille Schwartz

If you’re not satisfied with any an­swer you’re given, ask to speak to the manager or the chef, as they have more intimate knowledge of the many aspects of food service. If you’re still not sat­isfied, continue to search for a safe restaurant in which to dine. It’s better to be told no by a restaurant after they have assessed their ability to cope with food allergies than to get a rushed, half­way yes and then succumb to your food allergy in the dining room.

When you arrive at the restaurant, make sure to meet the manager and explain your condition thoroughly. Tell the manager that you would like to brief your designated waiter about your food allergy once you are seated – he or she will be your liaison with the kitchen.

When you’re looking over the menu, be mindful of hidden allergens lurking in breading, salad dressing, complex sauces, garnishes, and certain courses. Sometimes ingredients are listed by alternate names. So if you request that something be left out of a dish, it’s vital to know all the terms, including deriva­tives, under which your allergen may be listed.

I always check with the wait staff and chef to ensure fish is not cooked in the same skillet or in the same oil as other food items. It’s also good to make sure your dishes are not prepared with the same utensils or on the same work surfaces as your allergen or you will be subject to cross-contamination or cross-contact. One savvy chef taught me years ago to tell a waiter, “I am also severely allergic to utensils that have touched fish.”

However, two avenues of cross-contact are difficult to avoid. The first is restaurant grills. Always inquire whether a food marinated in an allergen is cooked directly on the same grill as any grilled dish you may want to order. The second is frying oil. If you are allergic to some­thing cooked in a deep fryer, you have to avoid eating anything else fried in that oil.

When your meal arrives, trust your instincts. If you have doubts about your order after you’ve received it, it’s perfectly fine to politely ask your waiter to double check with the kitchen. Then don’t feel shy or embarrassed about sending food back if a mistake has been made, as simply removing the allergenic items from your plate isn’t sufficient to keep you safe. You should also be sure to have an emergency plan in place in case an allergic reaction occurs.


Food allergy fighter Mireille Schwartz is CEO and founder of the Bay Area Allergy Advisory Board, This article is excerpted from her book The Family Food Allergy Book.

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2014.

Separating Allergy Fact from Fiction

The Greatest Allergy Myths and Misconceptions, Debunked

Allergy image

From gluten allergy and hypoaller­genic pets, to avoiding the flu shot because of an egg allergy, there are a lot of common myths and miscon­ceptions about allergies. Many might be shocking due to a great deal of false information in the media and on the Internet. And some of the misconcep­tions can be damaging to your health if vaccinations are skipped and extreme dietary avoidances are taken.

Where did all these misconceptions come from? According to a presentation given at the 70th Annual Scientific Meet­ing of the American College of Allergy, Asthma & Immunology, previously held medical beliefs and public perception are partially to blame.

“Many early medical beliefs have been proven to be incorrect as research has advanced,” says allergist David Stukus, MD, ACAAI member and pre­senter. “Unfortunately, some of these beliefs are still on the Internet, where an astonishing 72 percent of users turn to for health information.”

At-home allergy screening tests are not reliable
and can often lead to misinterpretation, diagnostic confusion, and
unnecessary dietary elimination.

According to Dr. Stukus, the fol­lowing are some of the greatest allergy myths:

I’m Allergic to Artificial Dyes
There is no scientific evidence to support a link between exposure to artificial coloring and allergies. Controversy exists regarding evidence for artificial color­ing and behavioral changes in children, as well as dyes causing chronic urticaria and asthma.

I Can’t Have Vaccines Due to an Egg Allergy
Egg embryos are used to grow viruses for vaccines such as the flu, yellow fever, and rabies shot. However, it’s now safe for egg-allergic individuals to get the flu shot, which can help prevent serious illness.

At-Home Blood Tests Reveal What You’re Allergic To
These tests might be able to reveal sensitization, but be­ing sensitized to a certain allergen, like milk, doesn’t mean you’re allergic to it. These sort of at-home screening tests are not reliable and can often lead to misinterpretation, diagnostic confusion, and unnecessary dietary elimination.

Highly Allergenic Foods Shouldn’t Be Given to Children until 12 Months of Age
For most children, there is no evidence to support avoidance of highly allergenic foods past four to six months of age. Emerging evidence shows that early introduction of highly allergenic foods may actually promote tolerance.

I’m Allergic to Cats and Dogs, but I Can Have a Hypoallergenic Breed
Unfortunately, there is no such thing as a truly hypoallergenic dog or cat. Allergens are released in saliva, seba­ceous glands, and perianal glands; it’s not the animals’ fur that people are al­lergic to. However, it is true that some breeds are more bothersome for allergy fighters than others.

I’m Allergic to Shellfish and Can’t Have Iodine Imaging
Radiologists and cardiologists often use iodinated contrast for better imaging during CT scans and other procedures. Since shellfish contain iodine, many physi­cians have linked a contrast reaction to shellfish allergy. However, this is false, and a shellfish allergy has noth­ing to do with the reaction. In fact, iodine is not and cannot be an allergen, as it is found in the human body.

I Can’t Eat Bread – I’m Allergic to Gluten
You may have a gluten intoler­ance, but it’s extremely rare to have a true allergy. Most allergic reactions to these types of foods stem from wheat allergy. Many people self-label as having gluten allergy and avoid gluten without any medical indication.

With information being widespread online and via social media portals, how can you know what to believe and what not to believe? “If you think you may have an allergy, you should see a board-certified allergist for proper evaluation, testing, diagnosis, and treatment,” says Dr. Stukus. “Misdiagnosis and inappropriate treatment can be dangerous.”


Visit for more information on allergies, and to find an allergist in your area.

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2014.

Kids Can Breathe Easy at Asthma Camp

by Cynthia Isaacson, MA

Asthma image

Both parents and their kids with asthma can breathe easy this summer knowing they will be well taken care of at asthma camp. Asthma camps are exclusively for chil­dren and teens with persistent asthma, meaning they take daily controller medication. Many of the kids who go to asthma camp are unable to attend a “mainstream” camp because of their chronic disease, required daily medica­tions, or their parents’ discomfort with not knowing the level of care their child will receive away from home.

Asthma camps are organized and staffed around-the-clock by highly trained medical professionals, including specialists, physi­cians, nurses, and respiratory therapists, to ensure that each camper’s asthma is well managed. These camps take added steps to remove, or help children avoid, asthma triggers. Asthma camps allow campers to connect with other kids just like them and experience fun outdoor activities in a safe environment. Recreation varies at each camp, but many offer activities such as swimming, canoeing, kayaking, arts and crafts, outdoor cooking, archery, ropes courses, team sports, and nature walks.

Asthma camps allow campers to connect with other kids just like them and experience fun outdoor activities in a safe environment.

Author Photo

Cynthia Isaacson

Researchers have found that children who attended asthma camps, either day or overnight camps, were more likely to use their daily controller medication. In addition, children who attended asthma camps were 33 percent less likely to be hospitalized for asthma in the following year than children with asthma who did not attend camp. Why? At asthma camp, campers learn about their chronic disease as well as how to recognize signs and symptoms of a flare-up, how and when to take their medications, and how to safely participate in all activities despite their asthma.

Campers’ parents appreciate the positive impact that asthma camp has on their chil­dren’s lives. According to one camper’s parent, “Camp is a place where a child with asthma can still be a child. You don’t have to be concerned, because you know the kids are well taken care of. Camp helped my son improve his asthma care. They showed him proper medication techniques and got him on a regular schedule for taking his medications. He takes his medication himself now.”

Importantly, campers love the experience too. One camper in particular, Matthew, was a shy, reserved child with asthma whose symptoms had kept him from getting involved in sports and other activities, making him feel like an outsider. Matthew attended asthma camp for the first time in 2011. During camp, he learned how to keep his asthma under control by taking his controller medication every day and using the correct technique. With his asthma under control, he no longer had to sit on the sidelines. After camp, he enrolled in tae kwon do. By his third year of camp, Matthew was an outgoing kid showing leadership with the younger campers. He’s now a black belt in tae kwon do.


Cynthia Isaacson is the manager of communica­tions for the Consortium of Children’s Asthma Camps. She also organizes Camp Superkids, a camp for kids with asthma in Loretto, MN, through the American Lung Association in Minnesota.

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2014.

Skip the Allergies, Not the Fun

Get Relief from Your Allergy Symptoms & Enjoy the Warm Weather

Allergy image

Seasonal allergic rhinitis, often referred to as hay fever, affects millions of people worldwide. Symptoms in­clude sneezing, stuffiness, a runny nose, and itchiness in the nose, roof of the mouth, throat, eyes, or ears. These allergic reactions are most commonly caused by pollen and mold spores in the air, which start a chain reaction in the immune system.

Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, your immune system identifies pollen as an invader, or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction.

Tiny grains known as pollen are needed to fertil­ize many kinds of plants. Pollen from plants with colorful flowers, like roses, usually does not cause allergies. These plants rely on insects to transport the pollen for fertilization. However, many plants have flowers that produce powdery pollen grains that are easily spread by wind. These culprits cause allergy symptoms.

Each plant has a period of pollination that does not vary much from year to year. However, the weather can affect the amount of pollen in the air at any time. Seasonal aller­gic rhinitis is often caused by tree pollen in the early spring. During the late spring and early summer, grass pollen often causes symptoms. Late summer and fall hay fever is caused by weed pollen. In warmer places, pollination can be year-round.

During the late spring and early summer,
grass pollen often causes allergy symptoms.

Molds are tiny fungi related to mushrooms but with­out stems, roots, or leaves. Molds can be almost anywhere, including soil, plants, and rotting wood. Their spores float in the air, much like pollen. Outdoor mold spores begin to increase as temperatures rise in the spring. In the United States, mold spores reach their peak in July in warmer states and October in the colder states. Molds can be found year-round in the South and on the West Coast.

Pollen and Mold Levels
Pollen and mold counts measure the amount of allergens present in the air. The relationship between pollen and mold levels and your hay fever symptoms can be complex. Your symptoms may be affected by recent contact with other allergens, the amount of pollen exposure, and your sensitivity to pollen and mold. Before heading out­side, you can check pollen and mold counts for your area at the National Allergy Bureau’s website,

Effects of Weather and Location
Hay fever symptoms are often less prominent on rainy, cloudy, or windless days because pollen doesn’t move around during these conditions. Pollen tends to travel more during hot, dry, and windy weather, causing increased allergy symptoms.

Some people think that moving to another area of the country may help to lessen their symptoms. However, many types of pollen (especially grasses) and molds are common to most plant zones, so moving to escape your allergies is not recommended. Also, you are likely to find new allergens to react to in new environments.

If your seasonal allergy symptoms are making you miserable, see your doctor to determine which allergens are causing your symptoms. This information will form the basis of a treatment plan to help you feel better. Your per­sonalized plan will include steps to avoid contact with your allergy triggers. Your doctor may also talk to you about medications for temporary relief.

If your symptoms continue or if you have them for many months of the year, your doctor may recommend allergy immunotherapy. Immunotherapy helps your immune system become more resistant to the specific allergen and lessens your symptoms.

There are also some simple steps you can take to limit exposure to the pollen or molds that cause your symptoms:

  • Keep your windows closed at night, and if possible, use air conditioning, which cleans, cools, and dries the air.
  • Try to stay indoors when pollen or mold counts are high. If your symptoms are severe, wear a pollen mask if long periods of exposure are unavoidable. When you return in­doors, take a shower, shampoo your hair, and change clothes.
  • Avoid being responsible for mowing lawns or raking leaves, as this stirs up pollen and molds.
  • Avoid hanging sheets or clothes outside to dry.
  • When traveling by car, keep your windows closed.
  • Take medications as prescribed.

Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2014.

Who Gets Asthma?

Asthma image

Asthma is very common, affect­ing more than 26 million people in the United States, including nearly 7 million children. No one knows for sure why some people have asthma and others don’t. However, heredity can play a role. People who have family members with allergies or asthma are more likely to have asthma themselves.

Asthma can occur at any age but is more common in children than adults. In young children, boys are nearly twice as likely as girls to develop asthma, but this sex difference tends to disappear in older age groups. Obesity is a newly identified risk factor for asthma.

What causes asthma?
People generally think of asthma in terms of episodes or attacks. Actually, the asth­matic condition is always present, but symptoms may be dormant until they’re triggered by an allergen, respiratory infection, or cold weather. Other triggers may include aspirin, environ­mental irritants, physical exertion, and less commonly, food additives and preservatives.

Allergens are substances that cause no problem for a majority of people but trigger an allergic reaction in susceptible individuals. Allergens are a major source of breathing problems in both children and adults. Common allergens include plant pollen (tree, grass, and weed), dander from pets and other animals, house dust mites, cockroaches, molds, and certain foods. When an allergic individual encounters one of these al­lergens, a complicated series of events causes the body to release chemicals called mediators. These mediators often trigger asthma episodes.

Environmental irritants , such as cold air, smoke, industrial chemicals, perfume, and paint and gasoline fumes, can pro­voke asthma. They probably trigger asthma symptoms by stimulating irritant receptors in the respiratory tract. In turn, these receptors cause the muscles sur­rounding the airway to constrict, resulting in an asthma attack.

Viral respiratory infections are the leading cause of acute asthma attacks. Surprisingly, bacterial infections, with the exception of sinusitis, do not cause asthma attacks. Some people who ex­perience heartburn can have asthma symptoms when stomach acid backs up into the esophagus.

Aspirin and aspirin-containing products can trigger asthma attacks in susceptible individuals.

Beta-blockers , which often are pre­scribed for high blood pressure, glaucoma, migraine headaches, and angina, are another type of medication that can cause problems. Beta-blockers can cause airway constriction, so it is important for people with asthma to consult a phy­sician about the use of these medications.

Food additives can trigger asthma; however, this is rare. The most common food triggers are sulfites, preservatives used in products such as frozen potatoes and some beers and wines.

What is the difference between allergic disease and asthma?
Asthma is inflammation and obstruction of air­flow in the bronchial tubes. Allergies are just one of the factors that can trig­ger asthma attacks. Not all people with asthma are allergic, and there are many people who have allergies but do not have asthma.


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2014.

Spring Cleaning with Allergies & Asthma

Your Guide to Keeping Tidy and Healthy

Allergy and Asthma image

Spring cleaning can be more than just a daunting chore for people with allergies and asthma. Dust, pet hair, and fumes from cleaning sup­plies can leave you reaching for the tissues instead of the broom. But spring cleaning can also help you avoid al­lergy symptoms.

“Thoroughly cleaning your home can help eliminate allergens and keep new ones from easily entering,” says allergist James Sublett, MD, ACAAI president-elect and past chair of the ACAAI Indoor Environment Commit­tee. “Allergy season can last all year for those sensitive to indoor allergens, but it can worsen in the spring months when pollen becomes an issue. It’s important to remove allergens from the home so you can lead a healthy and active lifestyle.”

To help eliminate spring-cleaning confusion – and symptoms – here are some useful tips for removing allergens in the home while avoiding accidentally letting more in.

A Fresh Breeze Won’t Please
The first sign of balmy temperatures might give you an urge to open your windows to let in fresh scents. But this can also lead to unwanted pollen particles enter­ing the home and making you sneeze long after your spring cleaning is complete. Before you reach for the air fresheners and candles to get your fresh-scent fix, be aware that chemicals found in these items can spur asthma attacks. Your best option is to opt for natural aromas from the oven, or you could try an organic air freshener.

Cleaning the entire house from top to bottom may take days ...
... but you can get a head start by changing your air filters every three months.

Bathrooms, base­ments, and tiled areas can be especially prone to mold. The key to reducing mold is moisture control. Be sure to use bathroom fans, and clean up any standing water immediately. Scrub any visible mold from surfaces with deter­gent and water, and completely dry the area. You can also help ward off mold by keeping humidity in the home be­low 60 percent and cleaning gutters regularly.

Love Your Pet, Not Its Dander
After spending many days indoors during the winter, fur, saliva, and dander from your family pet are likely elevated through­out your home. Remove pet allergens by vacuuming frequently and washing upholstery, including your pet’s bed. Additionally, you should keep your pet out of your bedroom at all times to ensure you can sleep symptom-free.

Whole-House Deep Cleaning
Cleaning the entire house from top to bottom may take days, but you can get a head start by changing your air filters every three months and using filters with a MERV (minimum effi­ciency reporting value) rating of 11 or 12. Also be sure to vacuum regularly to get rid of dust mites. Use a cyclonic vacuum, which spins dust and dirt away from the floor, or a vacuum with a HEPA (high efficiency particulate air) filter. Wash bedding and stuffed animals weekly.

Don’t Neglect the Great Outdoors
As the grass turns green and flowers bud, it’s hard to restrict your spring cleaning routine to the indoors. It’s best to avoid being outdoors when pollen counts are highest (midday and afternoon hours). Remember to take your allergy medication before you go outside. When mowing and gardening, wear gloves and an N95 particulate pollen mask. Avoid touch­ing your eyes, and wash your hands, hair, and clothing once you go back indoors.

Even when you reduce the number of allergens in your home, allergy symptoms can still be bothersome. If you have seasonal and perennial aller­gies, you should make an appointment with a board-certified allergist, who can identify your allergy triggers and develop a treatment plan to eliminate your symptoms.


For more information about seasonal allergies, and to locate an allergist, visit

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2014.

Send Your Child’s Asthma Packing!

Tips for Asthma-Friendly Travel

Asthma image
If your child’s asthma is well controlled, you should be able to enjoy sightseeing, hiking, or other leisure activities.

Your child’s asthma shouldn’t stop you from planning a family vacation or sending your child to sleepover camp or on a trip with friends. With some careful preparation and com­munication, you and your child should be able to enjoy all the benefits of time away from home.

Before you travel, make sure that your child’s asthma is well controlled. If it’s been flaring up, you should check in with the doctor. Your child might need a change in medications or might need to see the doctor before leaving.

Before You Go
When packing, be sure to include your child’s rescue and controller medications. Keep them handy, not buried in the car trunk. And if you’re flying, be sure to take them in your carry-on luggage. That way, you’ll have them if your child needs the medications during the flight or if your checked bags go astray.

You’ll also want to pack a peak flow meter (if your child uses one), health insurance cards and information, and the asthma action plan (that way you’ll have the names of medicines, dosage information, and your doctor’s phone number, just in case).

If you’re traveling abroad, consider taking a letter from the doctor that describes your child’s diagnosis, medi­cations, and equipment. This can help you with airport security or customs. It’s also smart to have the generic names of all medicines, in case they’re called something else in another country.

If your child uses a nebulizer, you might want to invest in a portable ver­sion. Many of these can be plugged into the cigarette lighter in a car. If you’ll be traveling abroad, make sure you have the adapter you need to use it.

Rolling Along
Buses, trains, and cars may contain many of the same poten­tial allergens as your home, including dust mites and mold that are trapped in the upholstery or the ventilation system. You can’t do much about the bus or train, but if you’re traveling by car, try this: Run the air conditioner or heater, with the windows open, for at least 10 minutes. This will help reduce mold and dust mites in the car.

Your child’s triggers will determine what steps you need to take to prevent asthma flare-ups where you’re staying.

If pollen counts or pollution levels affect your child’s asthma and are high during your trip, travel with the win­dows closed and the air conditioner on.

Taking to the Sky
The air quality on planes may affect your child’s asthma. Although smoking on airplanes used to be commonplace, it is now banned on all commercial flights of U.S. airlines. Foreign airlines also must ban smoking on all flights into and from the United States. But smoking is not banned by law on charter flights, so if you’re taking one, ask about their smoking policy and request seats in the nonsmoking section.

The air on planes is also very dry, so encourage your child to drink plenty of water while you’re in the air. Many airlines permit the use of battery-operated nebulizers (except during takeoff and landing), but check on this in advance. Nebulizers aren’t routinely included in aircraft emergency kits due to their bulky size. But inhalers with spacers have been shown to be as effective as nebulizers in treating asthma and might be easier to keep handy during travel.

Your Home Away from Home
Your child’s triggers will determine what steps you need to take to prevent asthma flare-ups where you’re staying. If pol­len or air pollution are triggers – and you’re traveling to a region with high readings – you may want to schedule a trip during times of the year when pol­len counts and smog levels are lower.

If dust mites or mold are a problem and you’ll be staying in a hotel, check to see if any rooms have been allergy proofed. Requesting a sunny, dry room away from the hotel’s pool might also help. If animal allergens are a trigger, request a room that has never had pets in it. And you should always stay in a nonsmoking room.

If you’ll be staying in a rented cottage or cabin that’s near the beach or in a forest, ask that it be thoroughly aired out before you arrive. Make sure any friends or family you’ll be staying with know about your child’s asthma triggers before you arrive. Although they won’t be able to clear away all dust mites or mold, they can dust and vacuum carefully, especially in the room where your child will sleep.

If scented candles, potpourri, aerosol products, or wood fires bother your child, ask your hosts to avoid using them. You should also ask that no one smoke inside while your child is there.

Because it can take months for ani­mal dander to be effectively removed from a room, even if a pet isn’t allowed in it, you probably won’t want to stay with friends or family who have a pet if animal dander is a trigger for your child.

Wherever you’ll be staying, consider bringing your child’s pillow and blan­ket from home to ensure there’s some hypoallergenic bedding.

Time zone changes can be tricky. When traveling, try to have your child take medications at the usual home time. Upon arrival in another time zone, re­member to adjust the dosage times to the local clock.

Activity Smarts
If your child’s asthma is well controlled, you should be able to enjoy sightseeing, hiking, or other leisure activities. Just keep the asthma triggers in mind when planning what you’ll do. For example, avoid lots of walking or hiking when the air pol­lution or pollen counts are likely to be high or if the weather is going to be extremely cold and dry. If you’ll be camping, keep your child away from campfires.

Ski vacations or hiking trips aren’t out of the question. But make sure you plan for plenty of rest (indoors if possible), carry your child’s rescue medication at all times, and be prepared to change your plans if your child is struggling with asthma symptoms.

As at home, if anyone else will be supervising your child, you should make sure that person knows about the asthma and is familiar with your child’s asthma action plan.

Solo Adventures
If your child will be traveling alone (going to sleepover camp or staying with friends or family, etc.), make sure to advise any adults caring for him or her. It’s extremely important that counselors or chaperones be familiar with and have copies of the asthma action plan, list of medications, and emergency phone numbers. Also send written (and notarized) permission for the counselor or chaperone to care for your child in an emergency.

Sit down with your child before the trip to go over the asthma action plan and what to do in an emergency. Your child should be familiar with any asthma triggers, should know how to administer medication, and should be able to recognize the signs of a flare-up.

Explaining that you’ve let the adults in charge know what to do during a flare-up should also help relieve any nervousness your child feels. And of course, offer reassurance that he or she isn’t different from other kids because of the asthma and should be able to join in on all the fun.

If your child hasn’t been taking controller medications and is relying on rescue medication to control the asthma, it might not be wise to allow a solo trip, especially for an extended period of time. You’ll want to discuss this with your child’s doctor.

Most of all, be sure that your child still takes all medications as prescribed and tries to avoid triggers. Ignoring asthma during a trip could send your child to the emergency department – and that’s no place to spend a vacation.


© 1995-2014. The Nemours Foundation/KidsHealth®. Reprinted with permission.

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2014.

Hooray! Spring Is Here

… but So Is Hay Fever

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Spring is in the air, and so are bil­lions of tiny pollens that trigger allergy symptoms in millions of people. This condition is called seasonal allergic rhinitis, commonly referred to as hay fever.

What’s the Problem with Pollen?
Hay fever is caused by pollen carried in the air, which starts a chain reaction in your immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, the immune system identifies pollen as an invader, or aller­gen. Your immune system overreacts by producing antibodies called immuno-globulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction. Hay fever can affect your quality of life. It can lead to sinus infections, dis­rupt your sleep, and affect your ability to learn at school or be productive at work. Hay fever symptoms include:

  • Itchiness in your nose, throat, eyes, and ears, and on the roof of your mouth
  • Sneezing
  • Stuffy nose (congestion)
  • Runny nose
  • Tearing eyes
  • Dark circles under the eyes

Trees generally pollinate in the spring. Birch, cedar, cottonwood, and pine are big allergy triggers.

Know Your Sneezing Season
De­pending on where you live, there are generally three pollen seasons. The start and end dates of these seasons, as well as the specific plants, vary based on the climate.

  • Trees generally pollinate in the spring. Birch, cedar, cottonwood, and pine are big allergy triggers.
  • Grass releases its pollen in the sum­mer. Timothy, Johnson, and Rye grasses are examples of allergens in this category.
  • Weeds cause hay fever in the fall. Ragweed is the biggest offender, as it can grow in nearly every environment.

Take Control of Your Symptoms
Hay fever cannot be diagnosed by history alone. An allergist or immu­nologist can diagnose your allergies, and determine the specific triggers that cause them, through simple tests. Once your allergy triggers have been identified, avoiding those triggers is the best way to reduce your hay fever symptoms. Here are a few simple steps you can take to limit your exposure to pollen:

  • Limit outdoor activities during days with high pollen counts.
  • Keep windows closed (at home and in the car) to keep pollen out.
  • Take a shower after coming indoors for the day. Otherwise, pollen in your hair may bother you all night.

In addition to avoiding your trig­gers, your doctor may recommend medications for temporary relief. Hay fever medications work best if started before allergy symptoms develop. If you start taking allergy medication before you first come into contact with spring allergens, the medication can prevent the release of histamine and other chemicals. As a result, allergy symptoms are prevented from devel­oping or are much less severe.

Allergy shots (immunotherapy) have been proven to provide long-term relief of hay fever symptoms. Ask your doc­tor if immunotherapy is something you should consider.


Learn more about managing spring allergies at

Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2014.

Go with the Flow

Using a peak flow meter can help you keep your asthma in check. Here’s how.

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Monitoring your asthma on a reg­ular basis is an important part of keeping your asthma under control. Keeping track of your symptoms whenever you have them is a good idea. This will help you and your doctor adjust your treatment over time.

Another way to monitor your asthma is with a peak flow meter. This hand-held device shows how well air moves out of your lungs. Measuring your peak flow can help you tell how well your asthma is controlled. It can also alert you to an oncoming asthma attack hours or even days before you feel symptoms. During an attack, it can help tell you how bad the attack is and if your medi­cine is working. The peak flow meter also can help you and your doctor learn what makes your asthma worse, decide if your treatment plan is work­ing well, determine when to add or stop medicine, and decide when to seek emergency care.

It’s a good idea to ask your doctor, pharmacist, or other healthcare profes­sional to show you how to use your peak flow meter. (See sidebar How to Use Your Peak Flow Meter.) The first step is to find your personal best peak flow number; then you can use the peak flow meter to keep an eye on how well your asthma is under control on a daily basis.

Find Your Personal Best Peak Flow Number
Your personal best peak flow number is the highest peak flow number you can achieve over a two-week period when your asthma is under good control; that is, when you feel good and have no symptoms. To find your personal best peak flow number, take your peak flow readings at least twice a day (when you wake up and in late afternoon or early evening) for two to three weeks, 15 to 20 minutes after you take your quick-relief medicine, and any other time your doctor suggests.

Write down the number you get for each peak flow reading. Your doctor will use these numbers to determine your personal best peak flow and create three personalized peak flow zones. These zones are usually set up on your asthma action plan like a traffic light – in green, yellow, and red. Mark the zones on your peak flow meter with colored tape or a marker. What your doctor tells you to do in each zone will help you know what to do when your peak flow number changes.


Use Your Peak Flow Meter to Monitor Your Asthma
Every morning when you wake up, before taking your asthma medicine, take your peak flow. Make this part of your daily routine. Check this number against the peak flow zones on your written asthma action plan. Use the zone that your peak flow is in to help you make treatment decisions.

You should also use your peak flow meter when you’re having asthma symptoms or an attack. First, take your medicine for the attack. Then take your peak flow. This will help you see if the medicine is working for you or if you need more treatment.


Source: National Heart, Lung, and Blood Institute,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2013-2014.

Exercise-Induced Asthma Can Leave You Breathless

Learn how to manage symptoms while keeping active.

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Many people confuse being out of shape with having exercise-induced asthma. Because the symptoms of exercise-induced asthma are similar to poor fitness (shortness of breath and a tight feeling in the chest), it can be difficult to tell the difference between them. The symptoms of exercise-induced asthma may deter people from exercise. However, exercise-induced asthma can be controlled, and you can stay active.

What is exercise-induced asthma?
In asthma, the small airways of the lungs become irritated from various causes and begin to constrict. The bronchial muscles around the tubes go into spasm, and mucus builds up in the tubes. The cells that line the airways also start to swell, closing the airways even more. In exercise-induced asthma, this reac­tion is triggered by exercise. Although people with chronic asthma are more likely to have exercise-induced asthma, the presence of exercise-induced asthma does not lead to chronic asthma.

What causes exercise-induced asthma?
The exact cause of what trig­gers an exercise-induced asthma attack is unknown. One theory is that symptoms may be triggered by drying or cooling of the airways during heavy breathing.

During normal breathing, the airway warms and moistens incoming air, which is usually cooler and drier. In the pro­cess, the airways can sometimes cool down and dry out, which can irritate sensitive tissues. During exercise, the amount of air moved in and out of the lungs increases, which also increases the amount of cooling and drying.

What are the symptoms of exercise-induced asthma?
The symptoms of exercise-induced asthma include:

  • Shortness of breath during or after exercise
  • Tightness or pain in the chest
  • Coughing
  • Wheezing
The symptoms generally start a few minutes into exercise and may last for 30 to 60 minutes. In contrast, if the problem is poor fitness, the symptoms will usually disappear a few minutes after stopping exercise.

The symptoms generally start a few minutes into exercise and may last for 30 to 60 minutes.

What should I do if I think I may have exercise-induced asthma?
Speak with your doctor if you believe you are experiencing exercise-induced asthma. An exercise challenge test can be used to determine whether you have exercise-induced asthma. Many doctors will base their diagnosis on your history and symp­toms. Your doctor also may have you do a trial of bronchodilator therapy prior to exercise. Although chest pain is a symp­tom of exercise-induced asthma, it is important for your doctor to rule out cardiovascular disease.

Additional Workout Strategies

There’s an exercise-induced asthma loophole called the refractory period. This period lasts up to two hours after an exercise-induced asthma attack. During this time, your lungs are less likely to react as strongly. If you warm up 45 minutes to an hour before your workout, you may be able to exercise without too many symptoms. Some athletes have found they can exercise easier by alternat­ing work and rest periods, also called interval training.

How can I prevent an exercise-induced asthma attack?
For starters, breathe through your nose. This will help warm and moisten the air before it reaches the bronchial tubes. Stay out of cold, dry air. If you do exercise outdoors, wear a facemask or scarf to help warm the inhaled air with heat and moisture from your skin. If pos­sible, exercise indoors. You are less likely to have an exercise-induced asthma episode when doing so. Opt for lower-intensity sports, such as golf, baseball, and weightlifting.

No matter what your activity, if high amounts of airborne irritants (such as pollen) increase your chance of an attack, it makes good sense to exercise indoors on days when those irritants are high. Most importantly, don’t stop ex­ercising. Exercise training will improve fitness so that a lower level of breath­ing is needed at a given exercise level. Good cardiovascular fitness will enable you to exercise at a higher intensity be­fore experiencing an exercise-induced asthma attack.

Does exercise-induced asthma require medication?
In some cases, medicine is needed to treat exercise-induced asthma. There are two broad types of medications that your physi­cian might prescribe: bronchodilators and anti-inflammatory medication. Bronchodilators work to keep the airways relaxed and open. They are used before or during exercise. Anti-inflammatory medications include inhaled corticosteroids, which reduce the sensitivity to the airways.

No one medicine works best for everyone, and you may need a combi­nation for best control. If you are an elite athlete, it is important to check that the medication suggested for you is approved for use in your sport.


Adapted with permission from a brochure produced by the Consumer Information Committee of the American College of Sports Medicine ( Copyright © 2011 American College of Sports Medicine.

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2013-2014.

Sinus Headache vs. Migrane

Which One is Causing Your Pain?

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Headaches. About 70 to 80 per­cent of us get them, with half the North American population experiencing at least one headache per month. While the majority of head­aches are not a sign of a serious or life-threatening illness, they can affect your quality of life.

Allergies and sinus problems can sometimes lead to a person having headaches. Headaches with rhinitis, or hay fever, may be due to sinus dis­ease in and around the nasal passages. However, headache specialists consider true sinus headache to be rare. Recent studies have shown that many people who appear to have sinus headaches actually are experiencing migraines.

Types of Sinusitis
Acute sinusitis occurs when there is a bacterial infec­tion in one or more of the sinuses in your head. Sinusitis is often over-diagnosed as a cause of headaches because of the belief that pain over the sinuses must be related to the sinuses. In reality, pain in the front of the head is more often caused by migraines. Migraines are confused with true sinus headaches because of their similar locations.

Headaches attributed to acute bacterial rhinosinusitis are a specific, rare diagnosis. Antibiotics are often used for treatment. Other options include steam, corticosteroids, and deconges­tants. If sinusitis does not respond to medical treatment, surgery may need to be considered.

Allergies and sinus problems can sometimes lead
to a person having headaches.

Chronic rhinosinusitis is one of the most common problems experienced with allergic rhinitis. People with chronic rhinosinusitis may also describe experi­encing “sinus headaches.” However, the jury is still out on whether constant blockage of the nasal passages caused by allergic inflammation can lead to chronic headaches.

People who experience blocked nasal passages should visit an allergist for testing. An allergist can find out what you are allergic to and help you manage your symptoms. Treatment strategies could include avoiding spe­cific allergens, taking medications, and undergoing allergy immunotherapy, or allergy shots.

Sinus Headache vs. Migraine
If you have headaches that seem like they’re originating in the sinuses, you should visit your doctor for a thorough evaluation to determine whether you are experiencing sinus headache or migraine. Making the right diagnosis is important because primary headache disorders, like migraines, and rhinosinusitis re­quire very different treatment regimens.

Doctors use the following criteria to diagnose rhinosinusitis headaches:

  • A headache in the front of your head with pain in one or more areas of the face, ears, or teeth and clinical or laboratory evidence of rhinosinusitis; for example, your doctor might do a nasal endoscopy, which lets him or her see what is happening in your nasal and sinus passages
  • Headache and rhinosinusitis symp­toms that occur at the same time
  • Headache or facial pain that goes away within seven days after decreased symptoms or successful treatment of rhinosinusitis

The majority of people with self-diagnosed sinus headaches are really experiencing migraines, which is why it is important to see a doctor to get a correct diagnosis. Research also supports a link between migraine and allergy, so your physician will consider both migraine headache and sinus headache if you are experiencing headaches along with allergic rhinitis.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2013-2014.

All About the Itch

What You Should Know about Atopic Dermatitis

by Gil Yosipovitch, MD, and Shawn Kwatra, MD

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Atopic dermatitis, also known as eczema, is a chronic skin disorder affecting hundreds of millions of people around the world. It has been estimated that 10 percent of the population will be affected by atopic dermatitis at some point in their lives. Atopic dermatitis often follows a waxing and waning course, filled with periods of disease flares and periods of remission. While atopic dermatitis may persist to adulthood, infants and young children are most frequently affected. The hallmark of atopic dermatitis is the terrible itch it causes.

What Causes Atopic Dermatitis?
Since Researchers do not know the precise cause of atopic dermatitis, but evidence points to an involvement of both heredi­tary and environmental factors. Atopic dermatitis is part of an allergic triad of conditions that also includes asthma and hay fever (seasonal allergies). These conditions are thought to be caused by an inherited predisposition to an overactive immune system. Indeed, substances called cytokines, which are secreted by cells in the immune system, are often more numerous in people who have atopic dermatitis.

Atopic dermatitis features a vicious itch-scratch cycle. The itch causes you to scratch, and scratching worsens the itch.


Dr. Gil Yosipovitch
(Photo by Wake Forest University Creative Communications)

Researchers recently found that people with atopic dermatitis have a genetic defect in filaggrin , a protein that plays a significant role in forming the upper layer of the epidermis, also known as the stratum corneum. With­out sufficient filaggrin, the skin barrier is weakened and becomes accessible and sensitive to germs, allergens, and many other foreign substances. Since a weakened skin barrier increases nerve fibers’ exposure to the environment, people who have atopic dermatitis are more likely to be irritated by exposure to soaps, detergents, and even temperature changes. Because the skin is missing some of its natural building blocks, many people who have atopic dermatitis experience the symptoms of dry skin. This is why people who have atopic dermatitis benefit so much from using moisturizers containing ceramides, substances that are vital to the barrier of the skin because of their ability to replenish it.


Dr. Shawn Kwatra
(Photo by Scott Faber Photography)

Skin Manifestations
Since Atopic dermatitis causes significant inflammation and severe itch and scratching, which in combination lead to skin redness and crusting, scaling, and often oozing skin lesions. These lesions often affect the skin folds of the arms and back of the knees and below the ears. People from different ethnic groups often have different presentations of atopic dermatitis.

Since Itch is the primary symptom of people who have atopic dermatitis. Severe and frequent or constant itch leads to many sleepless nights and severely impairs a person’s quality of life. Itch in atopic dermatitis is aggra­vated by proteases, small proteins that are also secreted by Staphylococcus aureus (a bacterium that is found in the respiratory tract and on the skin) and house dust mites, common triggers of atopic dermatitis flares. Scratching is hard to resist and may lead to thickened and darkened areas of skin, bacterial infections, and worsening rashes. Atopic dermatitis features a vicious itch-scratch cycle. The itch causes you to scratch, and scratching worsens the itch. This cycle keeps repeating itself, leading to damage to the skin barrier as well as breaks in the skin that can lead to infections.

Many people who have atopic der­matitis are not aware of how much they are scratching, particularly during the night, which not only disturbs sleep but further increases skin inflammation.

In addition to interrupting restful sleep, itch in atopic dermatitis can be a contributing factor to psychosocial conditions, including depression, anxi­ety, difficulty concentrating, and poor self-esteem. Similarly, stress is known to be an aggravating factor for itch in people who have atopic dermatitis. Building on this association, a study using brain imaging found that itch in people who have atopic dermatitis significantly differs from itch induced in healthy individuals; that is, itch in people who have atopic dermatitis activated areas of the brain involved in emotion and in the memory of nega­tive experiences. This study highlights the role of cognitive and emotional factors in the exacerbation of itch in atopic dermatitis. Factors aggravating itch in people who have atopic dermatitis can be broadly categorized as follows: environmental triggers, allergens, emotional stress, and infections.

Treatment of Itch
Since The treatment of itch is specialized based on the age and circumstances of the person being treated. However, treatment should focus on two fronts: 1) instiuting measures for prevention of atopic dermatitis-associated itch and 2) providing symptomatic relief for itch associated with current skin lesions.

Preventing Itch
Since People who have atopic dermatitis often have a dis­rupted skin barrier. For this reason, it is important to moisturize the skin as soon as possible after bathing, to replenish the skin barrier and prevent water loss and irritation. (Be sure to select a moisturizer that replenishes ceramide and other lipids that are depleted in the outer layers of the skin in people with atopic dermatitis.)

Indeed, a study found that the amount of water loss in the skin is associated with the intensity of itch. Use low pH cleansers, which are effective at reducing itch because their low pH reduces the activation of nerve fibers that are often overly sensitive to enzymes activated by higher pH cleansers. In addition, you and your family should try to keep a diary documenting the cir­cumstances surrounding episodes of severe itch and use the diary to try to identify an association between itch or increased itch and specific factors.

Relieving Symptoms
Since atopic dermatitis features a hyperactive immune response, drugs that can suppress the immune system (either applied directly to the skin or taken orally) are effective in relieving symptoms of itch associated with atopic dermatitis.


Dr. Gil Yosipovitch is a professor and chair of the department of Dermatology and director of the Temple Itch Center at Temple University School of Medicine in Philadelphia, PA. Dr. Shawn Kwatra is a resident in the department of Derma­tology at The Johns Hopkins School of Medicine in Baltimore, MD.

Excerpted with permission from Living with Itch: A Patient’s Guide by Gil Yosipovitch, MD, and Shawn Kwatra, ME, copyright © 2013 by The Johns Hopkins University Press. All rights reserved.

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2013-2014.

Six Ways You Might Unknowingly Make Your Guests Sick this Holiday Season

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The holiday season can gift you with more than you’ve wished for if you have allergies and asthma. Holiday traditions, such as Christmas trees, menorahs, and poinsettia plants, can cause symptoms. Those hosting holiday gatherings can also unknowingly present guests with the gift of sneeze.

“Allergy and asthma sufferers are bound to come across triggers this holi­day season,” says allergist Michael Foggs, MD, president of the American College of Allergy, Asthma & Immunology. “By ensuring your home isn’t allergen laden, you can help guests relax, feel great, and have an enjoyable season.”

Here are six tips to help you have the least amount of allergens in your home when you invite guests over during the holiday season.

1 Meet Fido, Dusty, and Mold
Dan­der, saliva, and urine from animals can trigger allergic reactions and asthma attacks in guests. It’s best to clean your home thoroughly before guests arrive, ban pets from upholstered furniture, and keep your pets in another room while visitors are present. Don’t forget about the other “pets” that might be in your home, including dust and mold spores. Vacuuming and cleaning hard surfaces can help remove dust mites, and replacing your air filter will help with both dust and dander. Be sure to also clean any visible mold from the bathroom and kitchen, as well as from the rubber seal on your refrigerator.

2 Your Home Smells (Achoo!) Lovely
Candles and plug-in air fresheners may seem like a great way to freshen up your home, but they can be harmful. About one-third of people with asthma report health problems related to air fresheners, which contain volatile organic compounds (VOCs). Store the candles, and let the scents from the oven provide natural aromas.

About one-third of people with asthma report health problems related to air fresheners.

3 Cheers to an Allergic Reaction
Breaking out the bubbly might seem like a great way to toast the holi­days. That is until one of your guests has an upset stomach, trouble breathing, and itchy eyes. Reactions to alcohol can be triggered by naturally occurring ingredients in beer and wine, including barley, ethanol, grapes, histamine, hops, malt, oats, tryptamine, tyramine, wheat, and yeast. Try toasting with a holiday-inspired punch or sparkling juice instead.

4 Spice Isn’t Always So Nice
Spices may be a key ingredient in nearly every holiday dish, but they may also cause your guests to sneeze and wheeze. Spice allergy is responsible for an estimated 2 percent of food allergies. Common spice allergy triggers include cinnamon and garlic, but anything from black pepper to vanilla can cause a re­action. Before you prepare your meal, check with guests about any food allergies they might have, including sensitivities to spice.

5 Share Cheer, Not Viruses
The flu season coincides with the holi­day season, lasting from October to March. Protect yourself from giving and receiving the virus by getting a flu shot and washing your hands regu­larly. Have an egg allergy? Allergists still recommend getting the flu shot because the vaccinations contain such a low amount of egg protein that it likely won’t cause an allergic reaction. Play it safe and have your allergist administer the shot and monitor you for 30 minutes to ensure there is no reaction.

6 Don’t Be a Chatty Cathy
Save long conversations for once you see your guests in person. Cell phones, including smartphones and flip models, can contain allergy-causing cobalt and nickel. These metals can cause redness, swelling, itching, eczema, blistering, skin lesions, and occasional scarring. For allergy fighters who are glued to their phones, allergists advise opting for plastic phone cases, wireless earpieces, and clear film screens to decrease allergic reactions.


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2013-2014.

Get Ready for Indoor Winter Living with Asthma

Watch Out for These Common Asthma Triggers

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Triggers are a part of everyday life. Asthma attacks can be triggered by things like mold growing in your bathroom or tiny dust mites that live in blankets, pillows, or your child’s stuffed animals. Here’s a breakdown of common asthma triggers and what you can do to get rid of them.

This icky asthma trigger grows on damp things such as shower curtains, bath items, tubs, basins, and tiles. If you see mold, clean it up with soap and wa­ter. To prevent mold growth, you need to control the moisture in your home. Use exhaust fans in the bathroom when showering and in the kitchen when cooking or washing dishes. Fix leaky plumbing or other sources of water as soon as possible. Dry damp or wet items within one to two days to keep mold from growing.

Dust Mites
These are tiny bugs you can’t see with the naked eye. They live in sheets, blankets, pillows, mattresses, soft furniture, carpets, and stuffed toys. To rid your home of these pesky asthma triggers, wash bed sheets and blankets once a week. Use dust-proof covers on pillows and mattresses. Vacuum carpets, rugs, and furniture often. And wash stuffed toys regularly.

Secondhand Smoke
Asthma can be triggered by the smoke from the burning end of a cigarette, pipe, or cigar, or the smoke breathed out by a smoker. Steer clear of secondhand smoke whenever possible. Choose not to smoke in your home or car, and don’t allow others to do so either.

The chemical irritants found in some products in your home may make asthma worse.

Wood Smoke
Smoke from wood-burning stoves and fireplaces contains a mixture of harmful gases and small particles. Breathing in these small particles can cause asthma attacks and severe bronchitis, aggravate heart and lung disease, and increase the likelihood of respiratory illnesses. To help reduce smoke, make sure to burn dry wood that has been split, stacked, covered, and stored for at least six months. Never burn garbage, plastics, or pressure-treated wood. Have your stove and chimney inspected every year by a certified pro­fessional to make sure there are no gaps, cracks, or unwanted drafts, and to re­move dangerous creosote build-up. If possible, replace your old wood stove with a new, cleaner heating appliance. Consider using a HEPA filter in the same room as your stove or fireplace. Studies indicate that HEPA filters can reduce indoor particle pollution by 60 percent.

Cockroaches and Other Pests
Asthma attacks can be triggered by cockroaches and other pests, such as mice. To keep these pests out of your home, make sure your counters, sinks, tables, and floors are always kept clean. Wash dishes and clean up crumbs and spills immediately. Store food in air-tight containers, and keep your trash cans covered.

Cats and Dogs
Warm-blooded ani­mals may trigger asthma attacks. Keep pets outside if possible. If you do have pets inside, keep them out of the bedroom and off the furniture. Vacuum carpets and furniture often to reduce the amount of pet dander (small flakes of shed skin) in your home.

Nitrogen Dioxide
This is an odor­less gas that can irritate your eyes, nose, and throat and may cause shortness of breath. This gas can come from using appliances that burn fuels (such as gas) and kerosene. If possible, use fuel-burning appliances that are vented outside, and always follow the manu­facturer’s instructions on how to use these appliances. Never use gas stoves to keep you warm or heat your home. If you have an exhaust fan, use it when you cook. If you have an unvented ker­osene or gas space heater, use the proper fuel and make sure the heater is adjusted correctly. Open a window slightly or turn on an exhaust fan when using these types of heaters.

Chemical Irritants
The chemical irritants found in some products in your home, such as cleaners, paints, adhesives, pesticides, cosmetics, and air freshen­ers, may make asthma worse. If certain products irritate your or your child’s asthma, use these products less often and make sure the asthmatic person is not around when you do use them. You may also consider trying alternative non-irritating products. If you must use these products, try to make sure that windows or doors are open and that you use an exhaust fan. In addition, take great care to follow the instructions on the label.


If you or your child has asthma, or if you think your child may have asthma, make an appoint­ment with a doctor. Your doctor will work with you to create an asthma action plan that will help you learn to prevent asthma attacks.

Source: U.S. Environmental Protection Agency,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2013-2014.

Managing Asthma during Pregnancy

Do You Know What Makes Your Asthma Worse ?

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Most women with asthma do very well during pregnancy. There is good evidence that having asthma does not increase your chances of having a baby with birth defects or of having multiple births. Furthermore, studies show that asthma can be controlled with medication dur­ing pregnancy with little or no risk to you or your baby. Together, you and your doctor will determine the best ways to safely manage your asthma, including weighing the benefits of all medication you take versus the risks of those medications to both you and your unborn baby.

During pregnancy, it is important to know what things may make your asthma worse and how to avoid or cope with them. The following are things that may make your asthma worse, especially during pregnancy.

Do not smoke cigarettes, and avoid exposure to second-hand smoke. Both can make asthma worse and pose major risks for your unborn baby.

During pregnancy, make a special effort to avoid things you are allergic to. Pollen, mold, animal dander, house dust mites, and cockroaches are common allergens.

Continuing to exercise while pregnant is desirable, but if exer­cise makes your asthma worse, talk with your doctor. Using inhaled medication before you exercise can often prevent asthma symptoms while you exercise.

A cold, the flu, or other respiratory infections can make asthma worse. Good hand washing is the most effective way to avoid the spread of common cold viruses. And the yearly flu vaccine is strongly recommended for people with asthma; it may be given during the second or third trimester of pregnancy.

This can make asthma worse, especially at night. Treating the inflammation in the nose and decreasing the post-nasal drip can reduce cough and throat irritation. Sinusitis is often treated with a nasal wash or a steroid nasal spray. It also may be treated with an antibiotic.

Pregnancy can be an in­tensely emotional time. Emotions do not cause asthma, but if a person has asthma, strong emotions can make it worse.

Your asthma may worsen with changes in the weather, especially when they are sudden. You should be prepared to dress accordingly and avoid polluted or cold air. Work with your doctor on keeping your asthma under good control whatever climate you live in, whatever the season.

Gastrointestinal or Gastroesophageal Reflux Disease (GERD)
In some people, the muscle between the esophagus and stomach allows some backflow of stom­ach acid into the esophagus. This can cause heartburn and may also cause constriction of your bronchial tubes, resulting in asthma symptoms. This is more common during pregnancy, but it is treatable.

Hormone Changes
You will experi­ence a variety of hormonal changes during pregnancy. These hormones can affect both your emotions and your asthma. Your asthma may worsen, im­prove, or stay the same while you are pregnant. If you are among the one-third of pregnant women whose asthma worsens, you may need additional medication.


Source: National Jewish Health,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2013.

Your Flu Questions Answered

If you have asthma, it’s especially important to protect yourself from the flu. Here’s how.

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Though people with asthma are not more likely to get the flu, influenza can be more serious for people with asthma, even if their asthma is mild or their symptoms are well-controlled by medication. This is because people with asthma have swollen and sensitive air­ways, and influenza can cause further inflammation of the airways and lungs. Influenza infection in the lungs can trigger asthma attacks and a worsening of asthma symptoms. It can also lead to pneumonia and other acute respiratory diseases. To help you prepare for the upcoming flu season, here are answers to some important flu-related questions.

Should I get a flu shot?
People with asthma are at increased risk of severe disease and complications from the flu, so everyone with asthma who is six months old and older should get a flu vaccine. Vaccination is the first and most important step in protecting against influenza. Even if you don’t have a regular doctor or nurse, you can still get the flu vaccine. Flu vaccines are offered in many locations, includ­ing doctors’ offices, clinics, health departments, pharmacies, college health centers, and increasingly by a number of employers and public schools. People with asthma should get the flu vaccine made with inactivated flu virus (commonly called a flu shot), not the nasal spray vaccine. Addition­ally, adults and children with asthma are more likely to develop pneumonia after getting sick with the flu than people who do not have asthma, so you should also get the pneumococcal vaccine to protect against pneumonia. The pneu­mococcal vaccine may be given at the same time as the flu shot.

What can I do to help reduce the spread of the flu?
Stay home when you are sick, except to get medical care, and stay away from other people who are sick. Cover your nose and mouth with a tissue when coughing or sneezing, and throw the tissue away after you use it. If you do not have a tissue, cough or sneeze into your elbow or shoulder, not your bare hands. Wash your hands often with soap and water, especially after cough­ing or sneezing. Avoid touching your eyes, nose, and mouth; germs are spread that way. Clean and disinfect frequently touched surfaces at home, work, and school, especially when someone is ill.

What should I do if I think I may have the flu?
If you do get sick with flu symptoms, call your doctor, and take flu antiviral drugs if your doctor recommends them. Treatment should begin as soon as possible because antiviral drug treat­ment works best when started early (within 48 hours after symptoms start). Antiviral drugs can make your flu ill­ness milder and make you feel better faster. They may also prevent serious health problems that can result from the flu. However, people with asthma should not use the antiviral drug zanamivir (Relenza) because there is a risk it may cause wheezing in people who already have asthma or other lung problems.


For the latest influenza news and information, visit

Source: Centers for Disease Control and Prevention

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2013.

Former Supernanny Jo Frost Wants You to Be Prepared for Anaphylaxis

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Jo Frost is prepared with her epinephrine auto-injectors.

Professional family expert Jo Frost has a passion for helping families in crisis across the globe, a task she tackles on TLC’s Family S.O.S. with Jo Frost. Recently, Jo teamed with Mylan Specialty L.P., the marketers and dis­tributors of EpiPen, on a campaign to help raise awareness for another cause she’s passionate about – anaphylaxis preparedness.

TV’s former Supernanny was just a toddler when a bite of shrimp sent her into anaphylaxis (a life-threatening allergic reaction). That’s when her fam­ily learned she had severe allergies she would have to deal with for the rest of her life. In an interview with Coping® magazine, Jo (who is also allergic to nuts) explains how she stays vigilant about managing her food allergies, and how you can do the same.

How have your allergies affected your life?
I’ve got to have my anaphylaxis action plan, which includes avoiding all trig­gers that could potentially be harmful for me. So with my work, as much as children love PB&J sandwiches, certain treats are off limits for the families and the crews when I’m filming. And they’re very, very aware of it. You have to communicate with those around you so they’re aware, so that your environment becomes a much safer one for you.

You have to be prepared. I always carry two EpiPens with me, so I’m always prepared with my epinephrine auto-injectors. Then, if something does happen, I would administer one of those and seek emergency help straight away.

You have to dine out a lot when you travel for your show. What advice do you have for dining out with food allergies?
When you have a life-threatening allergy, even if you have your action plan in place and you’re carrying your two EpiPens, you must learn to speak up and to be assertive. Speak to the wait staff. Ask them about the menu. Don’t assume that if you don’t see any particular aller­gens on the menu that they don’t exist. Ask what’s in the actual food. There have been many times when I’ve said, “I feel a little bit doubtful. Could I speak to the chef please? It would really ease my mind.” Most have been very accommo­dating. When you have a life-threatening allergy, you need to do what’s necessary to keep yourself safe.

How can parents encourage their food-allergic children to proactively manage their condition?
I think by making them more assertive, making them aware, and talking about scenarios and circumstances that could put them in danger and how to manage those situations. Help them learn how to manage everyday life so they don’t feel handicapped.

What message would you like to send others with life-threatening allergies?
The more we speak about it and the more we educate people, then the more they understand that this is something we live with every day. We are working and we are living life alongside our life-threatening allergies.

It certainly hasn’t stopped me. I’m doing the things that I want to do in my life, whether I’m climbing Camelback Mountain or flying across the pond trav­eling from one country to another. I go to parties without thinking, “Oh my God, what am I going to eat? What am I going to do?” I would love for adults who have life-threatening allergies and parents of children with life-threatening allergies to have that kind of attitude. Having an action plan in place really empowers you to live your life to the fullest.

What else should people understand about serious allergies?
It affects all of us, whether we have life-threatening allergies or not. My partner doesn’t have any life-threatening allergies, but he certainly knows that if he goes out for Thai food, it has to be when I’m traveling away from home. I have coworkers who know not to bring peanuts into the office. When people are more aware of serious allergies, even if they don’t have any, they can become more empathetic to those that do have them.


In celebration of the 25th anniversary of the EpiPen Auto-Injector and to emphasize the im­portance of being prepared for an anaphylactic reaction, Jo proclaims, “Show Us Your EpiPens!” Log on to to learn more about anaphylaxis preparedness and to upload a photo showing how you take your EpiPen with you everywhere you go. “Upload those photos, and look out for mine, as well,” Jo adds.

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2013.

How Harmful Is the Air You Breathe?

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Air impurities can be bad news for people with asthma. Learn how to protect yourself.

Clean air is an important health concern for all of us. But when you have asthma, air quality indoors and out can make all the differ­ence in the world. Car exhaust, smoke, road dust, and factory emissions can make outdoor air dangerous, while tobacco smoke, dust mites, molds, cock­roaches, pet dander, and household chemicals are just a few of the indoor hazards. Unhealthy air can create a dif­ficult barrier to asthma management.

An asthma trigger is anything that causes symptoms making it difficult to breathe. While an asthma trigger can be many things, from exercise to extreme temperatures to stress, some of the most common triggers are impurities in the air. Being aware of what’s in the air, and the things you can do to reduce your exposure to air impurities, is an important key to living an active and healthy life with asthma.

Protect Yourself Outdoors
People with asthma are particularly sensitive to the health risks of outdoor air pollution. Ozone pollution (smog) and particle pollution (soot), the most common air pollutants, are powerful asthma triggers, as are vehicle exhaust, wood smoke, and fumes.

Because outdoor air quality can be beyond your control, your best defense is knowledge. Knowing the current air quality outside can help you plan your day and make decisions about things like exercise, travel, and outdoor activities. You can’t always see or smell air pol­lution. The best way to stay informed before you leave your home is by check­ing the air quality forecast ( That forecast uses a color-coded air quality index (AQI) that tells you how clean or polluted the air will be.

When the AQI is orange or higher, you should reduce or limit exercise or strenuous activities outdoors. Exercise indoors and save yard work for a day when the forecast is better. If you are unusually sensitive (for example, if you have severe asthma), you may want to reduce prolonged or heavy outdoor exertion if the AQI is at yellow. If the air quality worsens to red or purple, it’s best to just stay inside.

Always avoid exercise near high-traffic areas. Areas within one-third of a mile of a busy highway likely have much more pollution even when the rest of the community has a green air quality forecast. Also, remember that children are at particular risk even if they don’t have asthma. They tend to be more active, breathe faster, and expose their lungs to more pollutants.

Protect Yourself Indoors
Many people don’t know that the air indoors can be even more polluted and harmful than the air outside. Americans spend up to 90 percent of their time indoors. Indoor air can be filled with asthma triggers like cigarette smoke, dust mites, molds, cockroach allergen, pet dander, gases or fumes, household or industrial chemical irritants, and wood smoke.

The best way to protect your family at home is to avoid air pollution in the first place. Make sure no one smokes indoors. Clean surfaces in your home weekly with a damp cloth and a HEPA-filtered vacuum. Eliminate sources of moisture by fixing water leaks and using exhaust fans when showering, cooking, and washing dishes. Keep humidity levels below 50 percent. Put away food, cover trash, and use baits to control pests, like cockroaches. And don’t use scented candles or fragrances to cover up odors.

Ventilation is very important for keeping the air quality in your home as clean as possible. Fresh air needs to come indoors while dirty indoor air needs to go outside. Installing a central air-conditioning unit may be very ben­eficial to people living with asthma. It’s important to maintain your central air-conditioning unit to ensure that it’s bringing fresh air in and removing dirty air to the outdoors. For better ventilation in your home, you should also install and run exhaust fans in the kitchen and bathroom and vent fuel-burning appli­ances, such as gas stoves and heaters, to the outside. Use an exhaust fan or open a window slightly while these appliances are in use. Open windows and use extra exhaust fans when you’re working with paints or chemicals indoors.

By learning how to protect yourself from impurities in the air, you are an­other step closer to better asthma control.


If you have a smartphone, you can check the AQI any time by downloading the American Lung Association’s free State of the Air app. This app gives you current local air quality information and helps you decide what actions to take. For more information on lung health, call the American Lung Association’s Lung HelpLine at (800) 586-4872 or visit

Source: American Lung Association,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2013.

5 Tips for Scaring Away Spooky Halloween Health Hazards

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An unwanted cavity in your child’s sweet tooth isn’t the only health concern that can haunt the Halloween season. Hidden health hazards can be lurking not only in candy but also in costumes, haunted houses, and jack-o-lanterns, especially for little ghosts and goblins who have allergies and asthma. The following is a list of common Halloween health hazards with tips on how to avoid them.

1 From Hair-Raising Screams to Frightening Wheeze
Haunted houses may be scary fun, but they can cause real-life fright if your child can’t breathe easily. Excitement and anxiety provoked by zombies, ghouls, and goblins can sometimes trigger asthma symptoms if your child’s asthma isn’t properly controlled. Run­ning from house to house in search of treats can also trigger symptoms. If your child has asthma or exercise-induced bronchoconstriction (EIB), be sure he or she carries emergency medicine, such as a quick-relief inhaler, and uses it as prescribed to prevent symptoms.

2 Hidden Allergy Tricks in Halloween Treats
Halloween is a tricky time if your child has food allergies, especially to peanuts. But dairy, wheat, and eggs are also com­mon allergens found in different candies and other Halloween treats. Read prod­uct labels carefully before letting your child indulge in his or her sweets. Also, if you suspect your little one has a food allergy, make sure to see an allergist for testing to identify all of your child’s triggers far in advance of Halloween festivities. (See sidebar for more tricks for ensuring your child has allergy-safe treats.)

3 Petrifying Pumpkins
Jack-o-lanterns might be more than just a scary face if your child has an allergy to pumpkin. Although a pump­kin allergy is rare, it can develop at any time, suggests research from the Annals of Allergy, Asthma & Immunology. Anything from carving a pumpkin to munching on its seeds can cause an allergic reaction with symptoms that can include chest tightness, hives, and vomiting.

4 Beware of Costumes
From the dusty clown costume that was retrieved from the attic to the mask made of latex to the nickel in jewelry, swords, and other accessories, Hallo-ween dress-up can be a landmine of allergy and asthma triggers. Dress your allergic child wisely. Some kids also have contact dermatitis that can be caused by the preservatives in Halloween makeup. If you’re not sure what triggers your child’s allergies, see an allergist who can help pinpoint the problem.

5 Menacing Mold
While jumping through piles of leaves can be tempting for your little ones as they are trick-or-treating, it can also be harmful. Molds are commonly found on leaves this time of year and can cause severe asthma attacks. Running through leaves can cause mold to stir into the air, resulting in high exposure. Plan ahead and talk with an allergist about seasonal allergy and asthma triggers and how they can be avoided.


Allergies and asthma are serious diseases that, when left untreated, can be dangerous. If you suspect your child has one of these conditions, make an appointment with a board-certified allergist to develop a treatment plan that may go beyond over-the-counter medications. For more information and to find an allergist, visit

Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2013.

Don’t Let Ragweed Ruin Your Fall Fun

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Pollen from trees, grasses, and weeds floats around in the air where it can be inhaled, causing allergy and asthma symptoms for many people. Pollen may travel many miles in the wind, so even trees, grasses, and weeds beyond your immediate area can be the cause of your sneezing and wheezing. Pollen allergies are often seasonal, and allergy and asthma symp­toms occur when the amount of pollen in the air is high.

A grim sign for some allergy and asthma fighters appears as the summer begins to wind down: ragweed and sage­brush pollens begin to show up for the first time in daily pollen counts. Those pollens are potent allergens for many people, causing them to experience the itchy eyes, runny nose, and sneezes of seasonal allergies, or hay fever, as well as causing their asthma to become worse.

If you’re allergic to ragweed and sagebrush pollens, you can expect your allergies and asthma to flare up during the months of August and September and possibly longer in different parts of the country. Ragweed and sagebrush pollen levels often persist until the first frost or beyond. It is difficult to predict how bad ragweed allergy season will be or how long it will last.

Ragweed season can make allergy and asthma fighters miserable if they don’t take precautions. Here are some simple measures that can significantly reduce your allergy and asthma symptoms.

Start taking your medications early.
Allergy medications work best if you take them before your immune system has revved up enough to initiate irritating allergy symptoms. Once the immune system is in high gear, medications are less effective and take longer to relieve those symptoms.

It may help to limit your outdoor activities during
the times of highest pollen and mold counts.

Keep outside air out.
The key to eliminating or reducing exposure to pollen is to keep outside air out, or filter it before it comes inside. The normal filters on an air conditioning unit are quite adequate for this. Using swamp coolers is discouraged because of the increased potential for dust mite and mold growth, two common allergens that thrive in humidity.

Consider pollen counts when planning outdoor activities.
It may help to limit your outdoor activities during the times of highest pollen and mold counts. Weed pollens are at their highest levels around midday. Do your gardening and other outdoor activities in the early morning, if possible. Outdoor activities also may be better tolerated after a gentle, sustained rain. If you are outdoors during high pollen counts, take a shower and wash your hair when you come inside. Change your clothes (not in your bedroom) when you come indoors, and leave these clothes in the laundry room. Dry your laundry in a clothes dryer only; avoid hanging clothes outside to dry, where they can collect pollen.

Close your windows, even at night.
Although weed pollens may peak during midday, enough weed pollens continue floating in the air during the night to plague people with allergies. If you need some cool air, turn on the air conditioning instead of opening your windows. You should drive with your windows closed as well. If it is hot, use your air conditioner.

Wash your hands frequently.
You can easily pick pollen up on your hands by touching door handles, running your hands through your hair after you’ve been outside, or touching other outdoor surfaces. If you rub your eyes or nose with those pollen-covered hands, you can launch a full-blown allergy attack. Washing your hands reduces the chances that you will get pollen in your eyes or nose.

Beware of melons and bananas.
People who are allergic to ragweed may feel a tingling or burning in their mouths after eating cantaloupe, honey­dew melon, watermelon, or bananas. These fruits may cause these symptoms year-round but are even more likely to do so during ragweed season.

Keep pets that spend time outdoors out of the bedroom.
In addition to ani­mal dander allergens, they may carry and deposit pollen stuck to their fur.


Source: National Jewish Health,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2013.

Beat the Heat!

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Before jumping in the deep end, make sure the pool area is well ventilated and doesn’t have a strong chlorine or chemical odor.

High humidity mixed with high temperatures and air pollution can make breathing difficult for everyone, espe­cially for people with asthma. Here are some easy-to-follow tips on how to protect your lungs during the dog days of summer.

Get a heads up before you head out.
The Air Quality Index is an index for reporting daily air quality. It tells you how clean or polluted your air is, and what associated health effects might be a concern for you. Air quality rankings are divided into six levels – from healthy to hazardous. To check out your local air quality and receive automatic air quality alerts, you can download the American Lung Asso­ciation’s State of the Air app, available at and in Android and iPhone markets, or visit

Pack a bag and be prepared.
Deal­ing with rising temperatures is a little easier if you take a few minutes to prepare. Pack a bag with everything you need to manage asthma symptoms in case they crop up while you’re out. Your quick-relief inhaler should be with you at all times; you never know when you might need it. You should also carry your spacer or valved holding chamber. Use it with your quick-relief inhaler as directed by your doctor.

On really hot days, even regular activity can feel strenuous and cause asthma symptoms.

Your bag should also include a copy of your asthma action plan. Follow the instructions laid out in your plan as soon as you begin to feel asthma symptoms. Your peak flow meter, if prescribed by your doctor, is also good to have on hand. You may have a drop in your peak flow reading before you even begin to feel symptoms. If you do, follow the instructions in your asthma action plan. And make sure to always bring along plenty of water to drink so you can stay hydrated.

Get ready to go.
Using your quick-relief inhaler 15 to 30 minutes before going outside in the heat or exercising will help you avoid asthma symptoms. But asthma medicines only work if you use them the right way. Talk to your doctor about when and how to use your asthma medications.

Take it easy.
On really hot days, even regular activity can feel strenuous and cause asthma symptoms. If possible, schedule outdoor activities in the early morning or late evening. Stay inside where it’s cool as much as possible. When at home or in the car, keep win­dows closed and the air conditioning on. Air-conditioned places like museums, libraries, and movie theaters are cool hangouts for family and friends during the heat of the day.

Splash around.
Splashing around the water park and swimming not only will keep you cool but it also can be great exercise. However, chlorine and other chemicals found in indoor and outdoor pools and water slides can be an asthma trigger. Before jumping in the deep end, make sure the pool area is well ventilated and doesn’t have a strong chlorine or chemical odor. If you can smell the chemicals, you should probably leave.

Go fragrance-free.
Sunscreens, tanning lotion, bug spray, and citronella candles all have fragrances that can worsen asthma symptoms. Choose products that are unscented, and opt for lotions instead of aerosol sprays. You can avoid mosquito breeding grounds by emptying containers with standing water and changing the water in birdbaths every few days.  

This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2013.

Living with Food Allergies

Answers to Questions You May Not Have Thought to Ask

by Scott H. Sicherer, MD

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If you have a fish allergy, it is possible to enjoy fishing by taking a few precautions.

How much food needs to be eaten to trigger a reaction?
The amount of food that can trigger a reaction depends on an individual’s sensitivity. It is not easily predicted by any simple tests. For some people, trace amounts that are not easily visible to the naked eye may cause symptoms, and for others, a meal-size amount of a food or more may be required to trigger a reac­tion. Your doctor may be able to assess your level of sensitivity based on your history or your response to a feeding test.

Can smelling a food cause an allergic reaction?
Yes, but this type of exposure is unlikely to cause anaphylaxis.

When can smelling a food cause an allergic reaction?
When the protein from the food is distributed into the air.

Under what circumstances would food proteins become airborne?
This most often occurs from heating, such as in cooking. For example, the steam from scrambling eggs or frying fish and the vapor from boiling or frothing milk can carry proteins into the air. Another way proteins can get into the air is when the food is in a powdery form and gets disturbed, for example, when preparing foods with wheat flour, powdered milk, or dried egg powder. Last, manipulations of a food might spread some proteins into the air nearby, for example, when peel­ing an orange or cracking peanuts.

Dr. Scott Sicherer

In what settings might there be an abundance of food proteins in the air?
Examples include occupational settings, such as a bakery or food-processing factory; markets where a high concen­tration of the food is being processed or heated, such as a seafood market; and food stands or kitchen locations where foods are being heated, such as roasting nuts, or frothing milk at a coffee shop.

Is smelling a food likely to cause an allergic reaction?
Rarely. Most smells from foods are due to organic compounds and no appreciable proteins. For example, the smell of peanut butter is not from any significant protein in the air. Odors from foods that are not being actively heated are unlikely to expel any appre­ciable allergenic proteins.

What kinds of symptoms might happen from airborne food proteins?
The symptoms would be similar to those from allergens such as pollen and animal dander. Namely, people may experience itchy eyes, sneezing, runny nose, and for people with asthma, a cough or wheeze.

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Although every allergen is in the store, you’re not likely to experience an allergic reaction merely from shopping.

Can touching a food cause an allergic reaction?
Yes, but anaphylaxis is unlikely.

What kinds of symptoms might happen from touching a food?
The most common skin symptoms are red blotches, hives, and itchiness. But touching the food does not usually cause symptoms. The skin barrier pre­vents the proteins from reaching the immune system. Younger children are often more susceptible to skin reactions from direct contact, especially if their skin barrier is compromised by eczema rashes. The eyes are also sensitive to allergens, so an allergen from the fingers rubbed into the eyes can result in sig­nificant redness and swelling. Can a severe reaction happen from touching or smelling a food?
Rarely. If a person with asthma breathes in a large inhalation of a food allergen, he or she might experience a significant asthma attack. If a large area of abraded skin is exposed to an allergen, there may be more absorption, leading to stronger reactions. However, these are unusual circumstances. The primary concern about casual exposure to a food is transferring the food from the fingers into the mouth.

What are some surprising mistakes that have led to allergic reactions?
Studies have shown that sometimes parents or other family members fed an allergen purposefully to a child with allergies, or allergic individuals pur­posefully ate foods they were allergic to, resulting in reactions. The reasons for this include curiosity, thinking a small amount would be OK, and testing to see if the allergy had resolved. If you are unsure you have an allergy, always dis­cuss this with your doctor before trying an allergen at home. Teach caretakers to do the same. Can a person with a tree nut allergy be near oak trees with acorns?
Acorns are tree nuts, and they might be allergens if eaten, but they are too sour to eat, so there is no literature about reactions from eating them. Like other nuts, it is not likely that touching them would result in any significant allergic reactions.

Can a person with a seafood allergy swim in the ocean?
Yes. I am not aware of any reports of a person being allergic to seawater based on an allergy to fish or shellfish. This is ably true for several reasons. The dilution of proteins in the ocean is tre­mendous. The concentration of allergenic proteins in the water becomes irrelevant. Second, the allergenic proteins in fish or shellfish are muscle proteins that would not be directly leaching into the water.

Can a person with a fish allergy own pet fish?
Yes, since the allergenic proteins are inside the fish and are not being eaten. However, the fish food is often made of fish and shellfish. If you are handling the food, minimize skin exposure by tapping the food into the water from a cap or container and washing your hands afterward. The main risk here might be rubbing the fish food on your hand into your eye, causing swelling.

Can a person with a fish allergy go fishing?
Yes, although handling the fish or handling parts of the fish after cleaning could irritate the skin because of local­ized allergic reactions. The main risk would be of skin or eye reactions, and possibly ingestion reactions if there is transfer to the mouth. It is possible to enjoy fishing by reducing direct handling of the fish, rinsing hands afterward, and wearing gloves when possible.

Can a person with a seafood allergy go to a dolphin show or swim with dolphins?
Dolphins themselves do not have aller­genic fish proteins because they are mammals, but they are fed fish and swim in an en­closed area where dilution is less than that seen in the ocean. There­fore, there is some risk that the fish proteins they ingest are in the pool water and may cause symp­toms for a person with a fish allergy. I have had patients develop hives from the water when splashed at shows.

Can a person with a food allergy swim in a pool with others who may have eaten the food?
When young children are snacking and swimming, there is some risk that they may share food, so supervision is needed. A better choice is not to eat while swim­ming. There is a risk of choking, as well! The small amount of residual allergens that might be in a mouth or on the body of a person who is swimming is unlikely to be relevant to the allergic swimmer because of the dilution effect of the pool. This risk might increase if people are constantly eating in the pool and spilling food and if the pool is small. However, in most situations, there should be no significant concern about reacting to re­sidual food proteins in a swimming pool.

Can a person be allergic to seawater, pool water, or any water?
Yes, but usually this is caused by the temperature of the water. There is a problem called cold urticaria, where swimming in cold water, or coming out of a pool and getting chilled, causes hives. This is a kind of physically in­duced reaction where, we believe, the allergy cells respond to the change in temperature. It is rare for this form of reaction to progress beyond the skin. Antihistamines are often used for treat­ment. There is another rare illness, called aquagenic urticaria, where water of any temperature on the skin causes hives, but the person can still drink water.

Can tiny shrimp (copepods) in drinking water cause an allergic reaction?
Get ready to become a little grossed out. Yes, there is a microscopic animal re­lated to shrimp that lives in freshwater and is allowed to remain in safe drink­ing water, especially from sources in geographic areas that have excellent natural water available for drinking. When sources of natural drinking water exceed government standards, the water is unfiltered, leaving these microscopic animals behind. No harmful effects have been related to these creatures. Presum­ably, if they have shellfish-relevant proteins, there is too little to trigger a reaction based on their small size and dilution effects of the otherwise safe and clean drinking water. Thus, they seem not to be a concern. If you are concerned, a home water filter could remove them.

If a cow, pig, or chicken is fed allergens, such as peanut or soy, can I be allergic to that animal’s meat?
This should not be a concern, because the animal’s meat proteins do not change based on its diet. It does not have these food proteins within its meat.

Can a person with a food allergy go shopping in a supermarket?
Although every allergen is in the store, it is not likely that allergic reactions would be elicited merely from shopping. Still, there are a few things to consider. Before seating an allergic toddler in a shopping cart, it is prudent to wipe the surfaces since it is likely that the child might suck on the handle bar or other surfaces. If a person has a shellfish al­lergy, it may be prudent to avoid the area where seafood is being steamed, as the seafood proteins may be forced into the air transiently.


Dr. Scott Sicherer is a professor of pediatrics and chief of the Division of Pediatric Allergy and Immunology at Mount Sinai School of Medicine in New York, NY. He is also a re­searcher in the Jaffe Food Allergy Institute at Mount Sinai.

Excerpted with permission from Food Allergies: A Complete Guide for Eating When Your Life Depends on It, by Scott H. Sicherer, MD, copyright © 2013 by Scott H. Sicherer, MD, published by the Johns Hopkins University Press.

This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2013.

On Vacation with Allergies & Asthma

Here’s what you need to know to keep your symptoms at bay and have a great trip.

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If you’re planning a vacation, and you or your child has allergies or asthma, proper planning can help you keep sneezes, sniffles, wheezing, and coughing under control. Use the following tips to make sure that allergy and asthma symptoms don’t derail your vacation fun.

Do Your Homework
Check weather and pollen forecasts for your U.S. vaca­tion choices, and then plan accordingly. For example, if you’re allergic to rag­weed, New York can be significantly better early in August rather than later.

Consider the beach or mountains. These locations are best bets for allergy fighters any time of year. Ocean breezes are generally free of allergens, and dust mites don’t thrive at elevations above 2,500 feet. Mold spores are killed by snow. Talk to your allergist. This is espe­cially important if you are going to travel abroad and may need vaccinations or immunizations. You also may want to talk to your allergist about where you’re going and what activities you may do. For example, locations with elevations above 5,000 feet may make breathing difficult, and cold weather can be a trigger for people with asthma. Asthmatics also should discuss activi­ties like scuba diving.

Consider the beach or mountains. These locations are best bets for allergy fighters any time of year.

Check access to medical care. If you are going to a remote location or on a cruise, you should inquire about the type of medical care available.

Check Lodging Options
Request a nonsmoking room with air conditioning (a little more difficult when traveling abroad). Check availability of a portable HEPA (High Efficiency Particulate Arresting) air purifier or HEPA filters for your room’s air conditioner. Find out if wood, tile, or seamless vinyl floors are available (a little less difficult when traveling abroad). Carpeting can be a breeding ground for dust mites. Consider renting a room with a kitchen or shipping food ahead if you have food allergies.

Pack in Your Suitcase
Don’t forget to put your medications in your carry-on luggage – and in the original bottles to avoid questions from airport security and customs agents. Make sure you pack quick-relief medications for asthma and an epinephrine kit if you or a family member has food or insect sting allergies. You also might want to bring a topical hydrocortisone cream and an over-the-counter antihistamine.

If you’re being treated with allergy shots, make sure you get your sched­uled shot before you leave. If you will be traveling for more than a few weeks, ask your allergist to provide a treatment dose to take with you, and the name of a local allergist who can give you the shot.

Pack your peak flow meter and nebulizer. These can help you monitor your breathing and deliver medication. Many nebulizers come with an adaptor you can plug into your car. If you are traveling abroad, make sure you bring an adaptor to convert the electrical current.

Consider packing your mite-proof pillowcases to help keep dust mites under control. Bring wipes for trays and tables. This can help protect travelers with food allergies. If traveling abroad, consider bringing translated information on your allergies. This can be shared with a chef when dining out in a for­eign country.

Prepare for the Ride
If traveling by car, keep your windows up and use your air conditioner. Consider getting your automobile’s air conditioner cleaned in advance. Travel during early morning or late evening hours, when air quality is better and traffic isn’t as heavy. If you rent a car, ask for one where no one has smoked.

When you travel by air, take an antihistamine in advance. If you’re congested, use your regular medication and consider using a long-acting decongestant nasal spray before take-off and landing. Notify the airline of food aller­gies ahead of time. Get up frequently and walk around the cabin. Drink plenty of fluids and avoid alcohol to stay hydrated. Use a saline nasal spray once every hour to keep your nasal membranes moist.  

Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2013.

Have Asthma?

You Likely Have an Allergy as Well

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Asthma is becoming an epidemic in the United States. The number of Americans diagnosed with asthma grows annually, with 26 million cur­rently affected. And according to a new study, nearly two-thirds or more of all asthmatics also have an allergy.

The study, which is published in the Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma & Immunology, found that an astonishing 75 percent of asthmatic adults between 20 and 40 years of age, and 65 percent of asthmatic adults age 55 and older, have at least one allergy.

“Allergists have known [that] the prevalence of allergies among asthmatic children is high, at 60 to 80 percent, but it was thought allergies were not as common in asthmatic adults,” says allergist Paula Busse, MD, lead study author. “These findings […] can help lead to proper diagnosis and treatment.”

While asthma is frequently associ­ated with children, it is not uncommon among adults 60 years and older, affect­ing three to seven percent. This number is likely higher, however, because asthma is often underdiagnosed in older adults.

“Both asthma and allergies can strike at any age, and are serious dis­eases,” says allergist Richard Weber, MD, ACAAI president. “Anyone who thinks they may be having symptoms of an allergy or asthma should see a board-certified allergist. Allergists are experts in diagnosing and treating both conditions.”

According to the ACAAI, more than 50 million Americans have an allergy, a number that is also on the rise. Is the link between asthma and allergies a reason for the increase?

“It could be one of many [factors] creating this perfect storm for allergies,” says Dr. Weber. “Other factors, such as the hygiene hypothesis, climate change, and an increase in awareness and education can also be reasons for this growth.”


Those who have symptoms of asthma or allergy can get tested for free through the ACAAI Nation­wide Asthma Screening Program. Screening locations can be found at

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2013.

Don’t Lose Sleep Over Allergies

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Are your allergies keeping you awake at night? Here are some tips to help you get a good night’s sleep.

“The most important thing to figure out is why allergies are causing sleep to be inter­rupted. There could be a number of reasons, and it is best to determine it by working with a physician,” says David Corry, MD, chief of the section of immunology, allergy, and rheumatology at Baylor College of Medicine in Houston, TX.

Evaluate Your Symptoms
Common symptoms of aller­gies can cause sleep disruption. For example, a drippy nose. Post-nasal drip can fall into the back of your throat at night and produce irritation in the throat, as well as a cough, caus­ing you to wake up repeatedly in the night. Inflammation that’s triggered by allergies can affect the membranes of the nose and cause swelling to the point where breathing through the nose is not possible. This forces mouth breathing, which can be irritating and cause dry mouth.

In addition, Dr. Corry points out that those who sometimes complain of allergies disrupting their sleep may not actually have allergies at all, but instead may be experiencing gastric reflux.

Inflammation that’s triggered by allergies can cause swelling to the point where breathing through the nose is not possible.

“When you look at their symptoms, it’s actually that they have acid coming up through their esophagus and then spill­ing all the way into the back of the mouth and into the nose, and that acid can be very irritating and produce that drippy nose. This irritation at night can be carrying forward during the day, and people might think they have allergies, but it’s actually gastric reflux,” he says.

Things that may clue you into the fact that your symptoms are actually reflux rather than allergies include

  • The absence of classic symptoms of allergies, such as itchy, watery eyes, sneezing, and cough
  • No reaction to typical allergens during allergy testing
  • The timing of the onset of symptoms – the symptoms are not seasonal, but rather year-round
  • The timing of symptoms during the day – people with allergies have symptoms during the day and when they go outside, not just at night

For anyone who thinks they have reflux rather than aller­gies, Dr. Corry recommends consulting a gastroenterologist.

Formulate a Treatment Plan
For those who have the classic symptoms of allergies, Dr. Corry recommends dis­cussing the following treatment options with your doctor:

  • Antihistamines
  • Anti-inflammatories
  • Allergen immunotherapy, which involves gradually introducing the allergen to the body and over time reversing the immune response to that allergen

Dr. Corry also recommends using a HEPA filter in the bedroom during the day to remove allergens in the air. Leave the filter on in the bedroom with the door closed throughout the day, and then turn it off at bedtime. This allows you to breathe clean air at night while you are sleeping.

Be sure to look for sources of water intrusion in the home that might cause mold, and check to see if air conditioner vents are clean. If you have severe allergies, consider removing carpets from the home and replacing them with a hard-surface floor.

Dr. Corry points out that those who have sleep apnea independent of their allergies may have even more difficulty sleeping. It’s impor­tant to work closely with your physician to develop a treatment plan that allows for allergy relief and a good night’s sleep.


Source: Baylor College of Medicine,

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2013.

Enjoy the Warm Weather without the Allergy & Asthma Symptoms

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With springtime upon us, many are enjoy­ing warmer weather, flowers in bloom, and more hours of daylight. Although for some, these signs of spring also bring the common frus­trations associated with allergies and asthma. Here are some tips to help you enjoy the budding spring season – with­out the allergy and asthma symptoms.

Identify Your Triggers
Each season comes with its own set of potential asthma and allergy triggers. A trigger can be something in the environment like pollen, a chemical that you are ex­posed to, stress, or emotions. In order to control your allergies and asthma, it is important to know what may trigger your symptoms and how to limit your exposure to that trigger. Dust mite excretion, pollen, and pet dander are all common allergens and are known triggers for people with asthma. Work with your healthcare provider to iden­tify what may be causing your asthma and allergy symptoms.

Warmer weather brings increased outdoor activity and the threat of seasonal triggers.

Get Ready, Get Set, Get Outside
Warmer weather brings increased out­door activity and the threat of seasonal triggers. As flowers begin to bloom, pollen and air quality may play a role in your efforts to control asthma and allergy symptoms. Common springtime triggers found outside may include pollen, flowers, weeds, trees, grass, pol­lution, and even temperature changes.

♦ Check your outdoor air quality If you plan to move your physical activity outside, remember to scope out the environment first and be aware of any obvious triggers. The quality of the air we breathe outdoors can be especially troublesome for people with asthma. Check daily air quality levels and air pollution forecasts in your area at

♦ Lawn and garden maintenance Be­fore working in the yard, check your local pollen count. Consider gardening in the early morning or evening when the pollen count is at its lowest. Fertil­izers and freshly cut grass can worsen asthma symptoms. When working in the yard, consider wearing a particle mask (available at hardware stores) to keep from breathing in tiny particles.

♦ It’s a bug’s life Citronella candles and bug spray may keep mosquitoes at bay, but they can also trigger an asthma episode. It may help to stay several feet away from any strong smelling candles, and when using mosquito repellent, choose lotions that are unscented instead of aerosol sprays. Other tips that may help you avoid using repellent products are to empty flower pot liners or other containers holding water, wear long-sleeved shirts, long pants, and socks when outside, and stay indoors at sunrise and sunset when mosquitoes are most active.

Know Your Hazards from the Inside
Many Americans follow the long-standing tradition of spring-cleaning. Dusting, vacuuming, and cleaning indoor surfaces can help to eliminate many potential asthma and allergy triggers, but it can also introduce new ones into the home environment.

♦ Beware of cleaning products While cleaning the home is important and can eliminate triggers such as mold, ingredients in cleaning products can cause asthma and allergy symptoms. Help to reduce the impact of these chemicals by ensuring that there is good ventilation. This means that you may have to open a window or two to increase the air circulation in the home. Look for the Environmental Protection Agency Design for the Environment (DfE) logo when you shop for cleaning products. For more information on what the DfE label means or for a list of approved prod­ucts, visit

♦ Get rid of pests (or at least decrease exposure) Pests, such as cockroaches and dust mites, can be triggers for many people with allergies and asthma. You may never have a pest-free home, but you can do your part to reduce your exposure to these tiny critters. Regular house cleaning and the use of dust-mite resistant pillow and mattress covers may eliminate the breeding grounds for these common household bugs.

Use Medications as Prescribed
While limiting exposure to triggers can be helpful, you can never eliminate contact from all potential asthma and allergy threats. Always be sure to use your controller medications as pre­scribed, even if you are feeling well. Remember to keep your quick-relief medicine nearby in case of a flare-up. Other tools, such as a peak flow meter and a written asthma action plan, can complement your medications.

Talk with Your Healthcare Provider
Be sure to keep your doctor informed if you begin having trouble controlling your asthma or allergy symptoms. With your doctor’s help, you can create an asthma or allergy management plan to help keep you feeling healthy, active, and symptom-free.


Allergies and asthma shouldn’t keep you from enjoying springtime weather. For more information on lung health, call the American Lung Association Help Line at (800) 586-4872, or visit

Source: American Lung Association,

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2013.

Take Action Against Asthma with an Asthma Action Plan

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If you have asthma, you and your healthcare provider should develop an asthma action plan that gives specific instructions for early treatment of your asthma symptoms. An asthma action plan is a written, individualized worksheet that shows you the steps to take to prevent your asthma from getting worse. It also provides guidance on when to call your healthcare provider or when to go to the emergency room right away.

Your asthma action plan should include

  • Your name
  • Emergency contact information
  • Contact information for your healthcare provider
  • Your asthma severity classification
  • A list of triggers that may cause an asthma attack

Your healthcare provider will use your personal best peak flow rate to calculate the zones in your asthma action plan.

Asthma Zones
An asthma action plan is divided into three zones: green, yellow, and red. The green zone is where you want to be on a daily basis. In this zone, you have no asthma symptoms and you feel good. Continue to take your long-term control medicines, even if you’re feeling well.

The yellow zone means that you are experiencing symptoms. This is where you should slow down and follow the steps for early treatment of asthma symptoms, including using your quickrelief medicine to keep your asthma from getting worse.

The red zone means you are experiencing severe asthma symptoms or an asthma flare-up. Follow the steps of your asthma action plan, and get immediate medical treatment if your symptoms do not improve.

You should work with your healthcare provider to determine your zones. Your asthma action plan can be based on peak flow rate or asthma symptoms:

♦ Peak Flow Rate Peak flow monitoring is recommended for people with moderate to severe asthma. Your peak flow rate can show if your asthma is getting worse, even before you feel symptoms. Your peak flow rate is measured with a peak flow meter. To use your peak flow rate to determine the zones on your asthma action plan, first you will need to spend some time determining your personal best. Your personal best is the highest peak flow number you achieve in a two- to threeweek period. Your healthcare provider will use your personal best peak flow rate to calculate the zones in your asthma action plan.

♦ Symptoms Another way to monitor your asthma control is to track your symptoms. Common asthma symptoms that indicate there is a problem include daytime symptoms (cough, wheeze, or chest tightness), a decrease in activity level (working, exercising, or playing), and nighttime symptoms.

Your asthma action plan will also include your medicines and instructions for what to do when you are feeling well, what to do when you have asthma symptoms, and what to do when your asthma symptoms are getting worse. It should include the names of your medicines, how much to take, and when to take them. The dose and frequency may change depending on your asthma zone.

♦ Long-term control medicines (also called controller, maintenance, or antiinflammatory medicines) help prevent asthma symptoms by controlling the swelling in your lungs and decreasing mucus production. These medicines work slowly but help control your asthma for hours. They must be taken regularly (even when you don’t have asthma symptoms) in order to work.

♦ Quick-relief medicines (also called rescue medicines) relieve or stop asthma symptoms once they have started. These medicines are inhaled, and they work quickly to relax the muscles that tighten around your airways. When the muscles relax, your airways open up and you breathe easier. Quick-relief medicines can be used before you exercise to avoid asthma symptoms.

What to Do in an Emergency
The red zone of your asthma action plan tells you the steps you need to take in an emergency situation. This portion of your plan should include emergency telephone numbers for your doctor, emergency department, rapid transportation, and family or friends to call for support.


If you have questions about your lung health, contact the American Lung Association’s Lung HelpLine at (800) 586-4872 to speak with a lung health expert.

Source: American Lung Association,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2013.

Kick Your Exercise Routine into High Gear

And Kick Your Allergy & Asthma Symptoms to the Curb

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Find relief by using your prescribed inhaler before you begin your workout routine.

Each spring, many people renew their commitment to eat healthy and lose weight. After all, bathing suit season is right around the corner. But as health regimens kick into high gear, many people might find that instead of feeling good they are feeling worse. And the reason might be due to the one thing that should be helping: exercise.

“Not only can new workout routines be difficult for those with asthma, but several allergens can be found lurking in health clubs, making this healthy activity bothersome for the more than 40 million Americans that suffer from allergies,” says allergist Richard Weber, md, president of the American College of Allergy, Asthma & Immunology. “By understanding what triggers symptoms, those with allergies and asthma will be able to feel good and remain active.”

Don’t Overstep Your Boundaries
If you’re experiencing shortness of breath, wheezing, coughing, chest tightness, and unusual fatigue, you might have exercise-induced bronchoconstriction. The condition affects about 10 percent of Americans. Find relief by using your prescribed inhaler before you begin your workout routine. Breathing through your nose, rather than your mouth, can also help. Be sure to track your symptoms with the online journal

If you’re allergic to pollen, grass, and other environmental factors, hit the ground running indoors.

Think Before You Eat
Whether you’ve signed up for a diet plan or are simply opting for foods with fewer calories, you should always read nutrition labels before consuming new items. Many products contain hidden food allergens, such as milk, wheat, and egg. Energy bars can also be loaded with allergens, including soy and nuts.

Choose Equipment Wisely
While most exercise machines won’t cause you to sneeze or wheeze, rubber mats, medicine balls, and some rubber-coated free weights might. Latex can often be found in these items, causing those with latex allergies to develop a rash or hives. Also, beware of disinfectant wipes and sprays used to clean gym equipment. They can contain volatile organic compounds (VOCs), which can spur an asthma attack or cause skin irritation.

Explore the Great Indoors
If you’re allergic to pollen, grass, and other environmental factors, hit the ground running indoors. Not a fan of treadmills and indoor tracks? Take your allergy medication before heading outside, and avoid running outdoors during midday and afternoon hours when pollen counts are generally highest. Be sure to change your clothes and shower immediately after finishing your workout to remove any allergens that might be clinging to your clothes and hair.

Opt for Comfort over Fashion
If your workout leaves you itchy and you’ve ruled out other gym culprits, your clothing might be to blame. Synthetic materials used in everything from shirts to socks could be irritating your skin. Check clothing labels, and opt for Lycra (spandex) over other synthetic materials, as it is higher quality and less likely to irritate your skin. Garments made of natural products can also help. If you have a latex allergy, be wary of athletic shoes and elastic waistbands.


To learn more about what may be triggering your symptoms and to locate an allergist in your area, visit

Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2013.

Chase Away Your Allergy Symptoms for a Carefree Spring

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Chirping birds won’t be the only sound you hear this spring. More than 50 million Americans will be sneezing and wheezing, thanks to seasonal allergies. And if spring comes early again this year, allergy symptoms will be intense and last longer than average.

“Relief might seem impossible as pollen counts soar, but by knowing what triggers symptoms and how to avoid these allergens, sufferers can lead healthy, active lifestyles with minimal side effects,” says allergist Richard Weber, md, president of the American College of Allergy, Asthma & Immunology. “Although symptoms may not always be severe, seasonal allergies are a serious condition that should be properly diagnosed and treated.”

While there are common rules to live by in the spring, such as keeping your windows closed, there are lesser-known spring allergy elements that can actually increase your symptoms. To help those with seasonal allergies cope this spring, we’re unveiling five surprising spring allergy facts you might not know about.

Not only will April’s showers bring more flowers; they might also cause more symptoms for people with spring allergies.

1 One Pollen, Two Pollen, Three Pollen, More
Every year is labeled as the worst for allergy symptoms, and there could be some truth to that. According to a recent study published in the Annals of Allergy, Asthma & Immunology, pollen counts slowly rise annually and are expected to double by the year 2040. This is due to economic growth, global environment sustainability, temperature, and human-induced changes (such as increased levels of carbon dioxide).

2 Home Sweet Hay Fever
Where you live can influence the severity of your symptoms. For example, the Asthma and Allergy Foundation of America has ranked Knoxville, TN, as the Spring Allergy Capital for three years in a row. However, no matter where you live, allergies can be a problem all year long for some people. Talk with your allergist about treatment options and for tips on how to eliminate allergy triggers in your home environment.

3 Treat Before You Sneeze
You should start taking your allergy medication well before the first sneeze. Allergists recommend you begin treating two weeks before your symptoms typically surface. And while there isn’t a cure for spring allergies, there is something close. Immunotherapy, also known as allergy shots, can modify and prevent disease progression.

4 Pollens and Molds and Weeds, Oh My!
A mild winter may cause an early release of pollens from certain trees, and a longer season may be worsened by what is known as the priming effect. Once people with allergies are exposed to this early pollen, their immune system is primed to react to the allergens, meaning there will be little relief even if temperatures cool down before spring is in full bloom. If weather reports call for a streak of warm days, go ahead and begin taking your allergy medication.

5 April Showers Bring More Symptoms
Not only will April’s showers bring more flowers; they might also cause more symptoms for people with spring allergies. Rain can promote plant and pollen growth. And wind accompanying a rainfall can stir pollen and mold into the air, which also heightens symptoms.


Anyone with allergies and asthma should be able to feel good, be active all day, and sleep well at night. No one should accept less. If you suspect you have seasonal allergies, you can locate an allergist in your area by visiting

Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2013.

’Tis the Season for Sneezing and Wheezing

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All during the year, the possi­bility exists for people with respiratory problems to have allergy and asthma attacks. During the holiday season, however, more hidden dangers to health exist. Here are some tips for everyone – especially those who have asthma, allergies, or other respira­tory diseases – to stay healthy during the holiday season.

Close Contact
During the holidays, family and friends gather in celebra­tion. People are hugging and kissing hello and goodbye, and unfortunately, respiratory viruses get passed around. If you have a cold, use good judgment about close physical contact.

Irritating Odors and Cold Air
People with allergies may be exposed to smoke at parties and irritating odors. One person’s fragrant cologne is an­other’s irritant. Also, the cold winter air may affect kids with viral illnesses and asthma. To prevent an onset of respiratory problems caused by breath­ing cold air, encourage children to breathe through their noses instead of their mouths and cover noses and mouths with scarves to keep cold air out of the airways.

Festive Foods
Food preparation is an issue for those with food allergies. During the holiday season, it’s important to know what’s in the food you’re eat­ing. You can eat your own turkey and dressing, but what if you go to a party where the hostess makes hers with walnuts and you’re allergic to wal­nuts? In extreme cases, you may have to bring your own meal. However, it’s usually sufficient to let the hostess know about allergies well before the gathering, especially if kids have food allergies. Call ahead. Take time to be prepared. And don’t leave your medications at home – bring your medications with you so that you’re ready to react in an emergency.

Gifts are seasonal delights, but consider a child’s possible allergies before you bring goodies to the cash register.

Gift Giving
Gifts are seasonal de­lights, but consider a child’s possible allergies before you bring goodies to the cash register. Let parents make the decision about gifts, such as stuffed animals or live pets, that can trigger allergic reactions. Look for toys that don’t have strong odors associated with them.

Frenzied Schedules
Staying up late, eating junk food, and getting excited can all trigger asthma attacks. People who have chronic problems such as asthma should pay attention to their normal pre­ventive measures and make sure they’re taking their preventive medications reg­ularly. It’s important to monitor chronic illnesses around any holidays and when on vacation since normal schedules typically aren’t being followed during these times.

Christmas Tree Allergies
Christ­mas trees are often cited as the source of allergy attacks during the holidays, but molds associated with watering live trees and the chemicals sprayed on the trees are more likely irritants. There are very few cases among people with allergies in which the Christmas tree is the culprit.

Allergic reactions usually occur shortly after an encounter with an allergen, such as dust mites or molds. Unpacking Christmas ornaments can trigger allergic reactions. Decorations stored in a damp basement harbor molds, dust mites, and other allergens. Moving, carrying, and unpacking these Christ­mas ornament boxes stirs up dust and transfers allergens to the hands and the respiratory system. Many people are first aware of these symptoms while decorating the Christmas tree and erroneously assume that the tree is the cause.

Keep ornaments and decorations stored in dry areas, off the floor, and in plastic bags. Also, wash your hands after unpacking decorations. If you’re especially concerned about allergy symp­toms, allow others to trim the tree.

Increased Time Spent Indoors
Even though freezing temperatures bring an end to seasonal pollen allergies, millions of people experience indoor allergy symptoms because of the time spent in­doors during cold weather. Your home can actually contribute to sickness.

Forced-air furnaces circulate air­borne dust containing lint, fabric fiber, bacteria, food material, and animal dander. Three of the most common allergens – house dust mites, animal dander, and cockroach droppings – are worse in winter when there is less ventilation. Changing the furnace air filter regularly can help relieve allergy symptoms.


Source: National Jewish Health,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2012-2013.

What’s Causing Your Asthma?

Could it be one of these non-allergic asthma triggers?

by Stephen Apaliski, MD

Asthma image
Breathing in the fumes that scented lotions give off can trigger your asthma, so seek out unscented versions.

While allergic asthma trig­gers only cause problems for people who are allergic to them, non-allergic triggers can be called equal opportunity offenders. What do I mean by this? When you are allergic, it is like having the key that turns the switch that starts the engine of asthmatic in­flammation. No key (no allergy), no inflammation.

With non-allergic triggers (espe­cially the irritants listed below), no key is necessary. The irritant itself pushes a start button that turns the engine on directly. In short, if you have asthma, any of the triggers listed here can harm or affect you. You need not be allergic.

Chemical Odors Many people with asthma cannot use cleaning agents with strong odors without triggering their asthma. Using lower irritant cleaners or delegating the task to someone else if possible (now that’s a side benefit!) are the two means of avoiding these potent triggers.

There are some individuals, how­ever, who work in jobs and industries where exposure to chemicals happens often. Certain chemicals in the work­place produce occupational asthma. Symptoms associated with occupa­tional asthma are worse when you are at work, and better when you’re away from it. If you discover a connection between worsening asthma and chemi­cals used in your job, you will need to either use a specialized breathing pro­tection device (like a respirator) in the workplace, or you may actually have to change jobs to prevent serious long-term health problems.

Perfumes and Scents Asthma can be triggered by breathing in the fumes that these substances give off. These are not just perfumes or colognes that you spray or daub on your body. Also included are the scents that may accompany the detergents, soaps, and lotions you use to care for your skin or clothes. Unscented versions of these products are plentiful in the market­place, and they are worth seeking out to ensure that you don’t unintentionally trigger your asthma.

Tobacco smoke and asthma do not mix. If you have asthma, you absolutely should not smoke.

Dr. Stephen Apaliski

Of course, sometimes you may end up on the elevator with someone drenched in perfume or cologne. The best approach here is to quickly put as much clean air space between you and the offending agent as you can. This may mean stepping to a new spot in the elevator or exiting the elevator on the next floor.

Smoke Tobacco smoke and asthma do not mix. If you have asthma, you absolutely should not smoke. Similarly, if you live with a smoker, that person should smoke outside the home, and never while riding in your vehicle. Neither rolling down a car window nor cracking open the back door of the house while someone is smoking is going to do the trick.

Other potential sources of smoke exposure include campfires, wildfires, and fireplaces, as well as some bars and restaurants, although over time fewer and fewer commercial establish­ments are allowing smoking indoors.

Air Pollution Here in Texas, espe­cially in the summertime when the air is hot and there is very little wind, we have elevated ozone levels in the air. Unfortunately, this phenomenon is not limited to Texas; elevated ozone levels can be seen in many parts of the nation, especially in urban areas.

Ozone, a gas that cannot be seen or smelled, is a respiratory tract irri­tant, even to people without asthma. For convenience, the government grades ozone levels from green to yellow, orange, and red, where green represents the lowest level, and red, the highest level.

Ozone levels seem to be at their highest levels during traffic rush hour in the late afternoon and early eve­ning. If you have asthma, ozone levels above green – especially above yellow – require your attention. During these times, outdoor physical activity should be limited. In addition, keeping win­dows in your home and vehicle closed with air vents closed or on recirculate should help. Ozone levels and alerts are readily avail­able and are typically part of the weather forecast on local radio and television stations. You can also check the air quality forecast for your area at

Interestingly, ozone gets the most press, but it is only one of many compo­nents of air pollution that can produce problems. Others include sulfur diox­ide and diesel exhaust particles. The total Air Quality Index (which takes into account not just ozone but these other pollutants as well) ranges from green (safe) to maroon (hazardous). Staying aware of this daily reading can guide your decision on whether to go outdoors or stay inside on any given day.

Aspirin and NSAIDs Some peo­ple have asthma triggered by aspirin or aspirin-like drugs, such as ibuprofen or naproxen. This class of drugs is known as NSAIDs (non-steroidal anti-inflammatory drugs).

In some people, asthma is triggered by gastro-esophageal reflux, sometimes just called reflux or heartburn.

NSAIDs are more likely to be a problem as a trigger if you have nasal polyps and chronic sinusitis with asthma. In general, I have my asthma patients – even those without nasal polyps and chronic sinusitis but who have had problems with aspirin in the past – avoid NSAIDs. For most people with asthma and NSAID sensitivity, acet­aminophen is a safe alternative medicine to treat pain. It is best to discuss this issue with your personal physician.

In some cases, aspirin is absolutely required as a medication. In such sit- uations, a procedure known as oral desensitization can be successfully accomplished under the guidance of an allergist. Oral desensitization is the graded ingestion of aspirin, beginning with extremely low doses and progress­ing to higher and higher doses, until one reaches the standard dose, which he or she must remain on without inter­ruption every day to remain desensitized. As one might expect, this procedure does have its risks, and allergic reac­tions can be seen as the dose is raised during the process.

Beta-Blockers These medications are frequently used in the treatment of heart disease, hypertension, migraine headaches, and glaucoma. They work by blocking a cell receptor known as the beta-receptor. If asthma worsens after beginning these types of medicines, an alternative drug needs to be used.

Other Situations
Gastro-Esophageal Reflux (GERD) In some people, asthma is triggered by gastro-esophageal reflux, some­times just called reflux or heartburn. Reflux can irritate the lungs directly or cause nasal disease and sinusitis that worsen asthma.

Most times, GERD is accompanied by symptoms such as heartburn, but not always. Most cases cannot be simply cured by avoidance of certain foods. In severe cases, surgery may be necessary.

Sinusitis Sinusitis, a bacterial in­fection of the sinuses, is a common complicating factor for asthmatics. Sinusitis is treated with antibiotics. Often brought about by allergens, smoke, and other irritants, it can often be prevented by avoiding the offend­ing substance. The use of some form of nasal wash with saline may help as a natural, non-medication method to treat or prevent sinusitis. In the long term, usually medications – and some­times allergy shots – may be needed to successfully treat the allergies that can lead to recurrent sinus infections.

Lastly, one important consideration is to get the influenza vaccination every fall. Influenza infection can cause ma­jor asthma problems; immunization reduces the risk.

Pregnancy While it is in the strict­est sense not an asthma trigger, I wanted to take a few moments to discuss asthma and pregnancy. In two-thirds of pregnan­cies, asthma stays at the same level or improves, but in one-third of women, it worsens.

For pregnant women with asthma, the biggest risk to the unborn baby is not from the medications needed to control it but from uncontrolled asthma itself. An obstetrician and allergist work­ing together as a team is the best way to maximize control of the mom’s asthma and minimize risk to the unborn baby.

Exercise and Asthma Vigorous exertion will produce symptoms in many people with asthma. This is often referred to as exercise-induced bron­chospasm, or EIB for short. Asthma symptoms commonly begin six to eight minutes into a vigorous workout. Typically, the symptoms stop with ces­sation of exertion and administration of medications.

So, is my recommendation to avoid any type of physical exertion in people with asthma and EIB? Certainly not!

History is full of stories of elite athletes with asthma who successfully competed in their sport. Often, the on­set of EIB symptoms can be prevented by the use of a bronchodilator inhaler 15 to 30 minutes before physical exer­tion. If you also use other medications for asthma, it is very important that you take them as directed to help prevent problems with EIB.

The times I do recommend avoid­ing vigorous exertion for asthmatics is when they are already fighting some type of illness or asthma flare-up, or when outdoor pollution levels are elevated. Exercising here may make problems worse and recovery may take longer.

There are many non-allergic factors that can trigger asthma. The most po­tent means of preventing problems is following a path of strict avoidance.


Dr. Stephen Apaliski has been a practicing physician for over 30 years and is board certified in pediatrics as well as allergy and immunology. He practices at the Al­lergy & Asthma Centres of the Metroplex and is on the medical staff at the Arlington Memorial Hospital in Arlington, TX.

Exerpted with permission from Beating Asthma: Seven Simple Principles, by Stephen J. Apaliski, MD, copyright © 2012 by Stephen Apaliski. All rights reserved.

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2012-2013.

Julie Bowen

Gets Serious about Anaphylaxis Awareness

by Jessica Webb

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Emmy award-winning actress Julie Bowen keeps us laughing weekly as Claire Dunphy, the strong-willed but caring matriarch on ABC’s hit comedy Modern Family. But when her oldest son, Oliver, experienced anaphylaxis (a severe, life-threatening allergic reaction) after exposure to pea­nut butter and a simultaneous bee sting, this real-life mother of three learned that allergies are no joke.

Though Oliver, a toddler at the time, had tried peanut butter before with no issues, after this particular exposure, paired with the bee sting, he experienced an anaphylactic reaction. His face swelled up immediately, and it was clear some­thing was wrong. Julie’s family was lucky; sometimes the signs of anaphylaxis are less apparent. Here, in an interview with Coping® magazine, Julie shares her fam­ily’s story and stresses the importance of recognizing and being prepared for an anaphylactic reaction.

How did you react when you found out that Oliver had an anaphylactic reaction?
I was very frightened. My husband was on the phone with me while they were in the emergency room, and the minute Oliver had the epinephrine injected, he was better. It was immediate, so there was no doubt that this was an anaphy­lactic reaction. I had heard stories about this, but I just thought allergies were a “helicopter mom’s” problem. I thought, “Oh, my kids are healthy and strong; that’s not going to happen.” And my other two kids don’t have any allergies.

What daily precautions does your family now take to ensure Oliver’s safety?
We keep an epinephrine auto injector with us at all times, and he has one at his school. If he goes off on a play date, we put one in his backpack. I like la­beling, so I put on a label that says “medicine here.”

We want him to live a healthy, normal, athletic life where he can run around outside and not feel limited.

Have you had to make any major lifestyle changes?
I have to wash my hands after handling certain nuts, but I try not to have those in the house. And we don’t live in a bee-free world, so we just have to be careful and make sure we have his epinephrine auto injector with us and make sure it’s up to date. We want him to live a healthy, normal, athletic life where he can run around outside and not feel limited.

Do you worry about him attend­ing school?
Luckily, his school is very aware of potential life-threatening allergic reac­tions. His preschool is nut free to begin with, but the world isn’t bumblebee free. It’s important that the caregivers, teachers, and coaches – the people who are around kids a lot – know the signs and symptoms of anaphylaxis. Unlike what happened to my child, which was very dramatic and sudden, it can be more subtle, and we need the people who are watching out for our kids to know what’s going on.

Does Oliver understand how serious anaphylaxis is?
He does. We don’t try to scare him with it. We just want him to be aware of it and understand that we know how to treat and avoid it. He has become his own best advocate. Any time there is a new food introduced to him, he always asks what’s in it, especially with cereal bars, cookies, muffins, and cakes – things that nuts are frequently put into. We are always looking out for him, but especially at a birthday party or something like that. It’s im­portant to ask and to check.

What message do you have for parents of children with potentially life-threatening allergies?
It can be frustrating, but with some simple precautions, it certainly isn’t impossible to live with a child who has these allergies. Know what medications your child needs, and don’t introduce a new food to your kid when you are off on a tropical island, away from any kind of medical help. If you suspect that your child has an allergy, you should go see your doctor immediately and discuss it with him. I’m not a doctor; I don’t even play a doctor. All I am is a con­cerned mom who had a bad experience and found out the proper way to treat my child.


Julie Bowen has joined with Mylan Specialty L.P. to launch Get Schooled in Anaphylaxis™, a health initiative aiming to increase aware­ness of and preparedness for life-threatening allergic reactions. “Anaphylaxis is a long, crazy word, and a lot of kids don’t know it or how to say it, but it doesn’t have to be scary,” Julie says. “We want to make sure that peo­ple are educated, aware, and know how to treat it and how to avoid their allergic triggers.” Learn more at

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2012-2013.

Eat Well. Breathe Well.

Nutrition Advice for People with Asthma

An important part of a healthy lifestyle is good nutrition. Good nutrition involves choosing healthy foods that can work to heal and repair your body and make it stronger against disease.

It’s important to include a variety of foods in your diet. Each of the food groups provides nutrients that are important to you, and foods in one group can’t replace those in another. Choose a variety of foods within each food group, and eat small amounts of fats, oils, and sweets. Talk with your doctor or dietitian about your specific nutritional needs. If you have asthma, eating a healthy diet can help you feel and breathe better.

Managing Mealtime
Shortness of breath at mealtimes can make eating hard work. If you use all your energy preparing a healthy meal, you may find yourself unable to eat or enjoy what you have prepared. If you have asthma, it’s important to conserve your energy in order to get the most from your meals.

Many people with asthma feel more short of breath when their stomach is full. This is because the diaphragm cannot work as well when the stomach is full. You can satisfy your nutritional needs, keep your stomach comfortable, and help your diaphragm to work better by eating smaller, more frequent meals. Eating small, frequent meals also reduces the chance of reflux. In addition, plan to eat before you are too hungry or tired. It’s important to refuel before you hit empty.

If you have asthma, eating a healthy diet can help you feel and breathe better.

Relax at mealtime. Breathe evenly while you are chewing and eating. Stop eating if you need to catch your breath.

Use prepared foods to save time and energy in the kitchen. Frozen meals, prepared foods, or take-out meals from a restaurant can make your life easier. However, the sugar, salt, or fat content of these foods may be higher than homemade. Be sure to ask if you are following a special diet. You can also double or triple your favorite recipes when cooking to keep your freezer full for times when you don’t feel like cooking.

When it comes to meal preparation, do the tasks that require the most effort when you have the most energy. For example, many people would agree that grocery shopping is a tiring task. This chore can be done when you feel freshest, in the morning or after a rest. Better yet, have a friend or family member pick up your groceries for you.

Don’t stand in the kitchen when you can sit. Bring your chopping, cutting, and mixing projects over to the kitchen table and sit while you prepare the food, or keep a barstool by the kitchen counter.

Avoid that “too full” feeling by eating less of the foods that cause gas. Common offenders include asparagus, beans, broccoli, Brussels sprouts, cabbage, carbonated drinks, cauliflower, cucumbers, melons, garlic, raw onions, peas, peppers, radishes, rutabagas, sausage, spicy foods, and turnips. Keep a food diary to find out if they are a problem for you.

Steroids and Nutrition
Some people with asthma take steroid pills on a regular basis. Steroid pills are strong medicines that decrease swollen airways. They also have some nutritional side effects to be aware of. Steroid therapy has the potential to interfere with the way the body uses specific nutrients, including calcium, potassium, sodium, protein, and vitamins D and C.

If you take steroid pills for asthma, it is very important to eat a well-balanced diet. A healthy diet can make up for some of the nutritional effects of steroid therapy.

Over a long period, steroid pills can increase the risk of osteoporosis (loss of calcium in the bones). Therefore, you should eat foods high in calcium, such as dairy products. In addition, limit salt and foods that are high in sodium, and decrease the amount of cholesterol and fats in your diet to prevent other side effects. Take certain supplements, such as calcium, and a multivitamin. Talk with your doctor or dietitian about specific concerns regarding steroids and your diet.

Asthma and Reflux
Many people with asthma also have gastroesophageal reflux, or GERD. In this condition, the muscle between the esophagus and stomach is weak, and stomach contents and acid back up into the esophagus. This may or may not cause symptoms. Many people with GERD can experience heartburn, pain, sore throat, swallowing problems, chronic cough, a choking sensation, and aspiration. Excess weight and dietary habits can contribute to reflux. Here are a few recommendations to decrease your risk of reflux and heartburn:

  • Lose weight. Excess pressure in the abdomen can cause stomach contents to back up into the esophagus.
  • Avoid overeating. Choose several small meals rather than three large meals.
  • Avoid eating for two to three hours prior to bending over or lying down.
  • Avoid foods that aggravate reflux, including fatty foods, citrus and tomatocontaining products, chocolate, mint, spicy foods, carbonated beverages, caffeine, and alcohol.

Source: National Jewish Health,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2012.

The Myths and Truths About Fall Allergies

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Just when many Americans are hoping to catch a break from summer’s record heat waves, hay fever season is in full bloom. Each year, ragweed pollens begin surfacing in mid-August. Symptoms of hay fever, or allergic rhinitis, often mirror those of a cold, including a runny nose, sneezing, and nasal congestion.

“Many people mistake their seasonal symptoms for a cold instead of rhinitis due to several allergy myths,” says allergist Stanley Fineman, MD, president of the American College of Allergy, Asthma & Immunology. “Knowing the truth about allergies and how to prevent flare-ups can mean having a comfortable, symptom-free hay fever season.” Here are some myths and truths you should know about hay fever season to help you feel great, be active all day, and sleep well at night.

Myth: I’m miserable all hay fever season, but there’s nothing I can do except suffer through it.
Truth: There are many treatments available to ease your symptoms, including over-the-counter and prescription nasal sprays, medications, and allergy shots (also called immunotherapy). There also are new treatments on the horizon, including one for asthma triggered by ragweed allergies, so stay tuned. In the meantime, track your allergy symptoms with and visit with your allergist to find relief.

Myth: I’ve never had a problem with hay fever, so I must be sneezy and stuffy because of a cold.
Truth: Anyone can develop an allergy – including ragweed allergy – later in life. Scientists think it may be that you’ve always had the allergy, but it might have taken exposure to another allergen to trigger your symptoms. If symptoms are persistent, lasting more than two weeks, you probably have allergies. Colds evolve, usually starting with a stuffy nose, throat irritation, and lowgrade fever. Common allergy symptoms include itchy eyes and nose, as well as sneezing, but the mucus is typically clear.

Myth: I should start taking my hay fever medication at the first sneeze and stop at the first frost.
Truth: Ragweed usually blooms around mid-August (a little later in the south), but it’s best to stay ahead of the itching, sneezing, drippy nose, and wheezing and begin taking medication before symptoms start. The symptoms can linger until the end of the season, so wait until a few weeks after the first frost to stop taking medication.

Myth: My hay fever and pet allergies have nothing to do with each other.
Truth: If you are allergic to ragweed in addition to your dog or cat, you may experience even more symptoms during hay fever season. People with ragweed allergies who also are allergic to cats or dogs develop symptoms faster and more severely, according to a study published in the Annals of Allergy, Asthma & Immunology. Your best bet? Treat pet allergies year round to help make hay fever more manageable. Your allergist might also prescribe allergy shots.

Myth: Hay fever makes me sneeze and sniffle, but my tingly, itchy mouth must be caused by something else.
Truth: Actually, many people who are allergic to ragweed have oral allergy syndrome, also called pollen-food allergy syndrome. It means your body is having an allergic reaction to the proteins that are similar in ragweed pollen and certain fruits, vegetables, and nuts – such as banana, cucumber, melons, zucchini, and sunflower seeds. It’s quite common, and it is rarely serious. Usually it only causes an itchy, tingly mouth, throat, or lips. But sometimes it can cause a stomachache and, very rarely, a life-threatening reaction called anaphylaxis. In the event of an emergency, seek medical attention. Follow up with your allergist, who might prescribe epinephrine.


To learn more about allergies and asthma, take a relief test, and find an allergist, visit

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2012.

Autumn Has Arrived!

Don’t Let Hay Fever Spoil It

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Known to most people as hay fever, allergic rhinitis is a common medical problem affecting more than 15 percent of adults and children. It takes two different forms:

♦ Seasonal
Symptoms of seasonal allergic rhinitis occur in spring, summer, and early fall. They are usually caused by allergic sensitivity to pollens from trees, grasses, or weeds or to airborne mold spores.

♦ Perennial
People with perennial allergic rhinitis experience symptoms year-round. It is generally caused by sensitivity to house dust mites, animal dander, cockroaches, and mold spores. Underlying or hidden food allergies rarely cause perennial nasal symptoms.

Some people may experience both types of rhinitis, with perennial symptoms getting worse during specific pollen seasons. There are also non-allergic causes for rhinitis.

No hay. No fever. So why hay fever?
Hay fever is a century-old term that has come to describe the symptoms of allergic rhinitis, especially when it occurs in the late summer. However, the symptoms are not caused by hay (ragweed is one of the main culprits) and are not accompanied by fever. So the term allergic rhinitis is more accurate. Similarly, springtime symptoms are sometimes called rose fever, but it’s just coincidental that roses are in full bloom during the grass-pollinating season. Roses and other sweet-smelling, showy flowers rely on bees, not the wind, for pollination. Not much of their pollen gets into the air to cause allergies.

Once allergic rhinitis is diagnosed, treatment options include allergen avoidance, taking medications for symptom relief, and immunotherapy.

Is there any escape?
A common question from people with allergic rhinitis is Can I move someplace where my allergies will go away? Some allergens are tough to escape. Ragweed (which affects 75 percent of people with allergic rhinitis) blankets most of the United States. Less ragweed is found in a band along the West Coast, the southernmost tip of Florida, and northern Maine, but it is still present. Even parts of Alaska and Hawaii have a little ragweed.

Allergists seldom recommend moving to another locale as a cure for allergies. A person may escape one allergy to ragweed, for example, only to develop sensitivity to grasses or other allergens in the new location. Since moving can have a disrupting effect on a family financially and emotionally, relocation should be considered only in an extreme situation and only after consultation with your doctor.

Can allergic rhinitis cause other problems?
Some known complications include ear infections, sinusitis, recurrent sore throats, cough, headache, altered sleep patterns, fatigue, irritability, and poor school performance. Occasionally, children may develop altered facial growth and orthodontic problems.

How is rhinitis treated?
Once allergic rhinitis is diagnosed, treatment options include allergen avoidance, taking medications for symptom relief, and immunotherapy.

♦ 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 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, there are ways to lessen exposure. Keep windows closed and use air conditioning in the summer, if possible. Automobile air conditioners help, too. Don’t hang clothing outdoors to dry. Pollen may cling to towels and sheets. The outdoor air usually is most heavily saturated with pollen and mold between 5 a.m. and 10 a.m., so early morning is a good time to limit outdoor activities. Wear a pollen 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. Medications help to reduce nasal congestion, runny nose, sneezing, and itching. They are available in many forms, including tablets, nasal sprays, eye drops, and liquids.

♦ Immunotherapy
Allergen immunotherapy, known as allergy shots, may be recommended for people who don’t respond well to treatment with medications, experience side effects from medications, have allergen exposure that is unavoidable, or desire a more permanent solution to their allergic problem. Immunotherapy can be very effective in controlling allergic symptoms.

There are many hay fever remedies, and each person’s treatment must be individualized based on the frequency, severity, and duration of symptoms and on the degree of allergic sensitivity. It’s important to talk to your doctor about ways to reduce your fall allergy symptoms.


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2012.

Traveling with Food Allergies

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Research local restaurants where you will be staying. Call ahead and ask to speak to a manager about your needs, fully explaining how dangerous your or your child’s food allergies can be.

Whether you’re traveling for business or pleasure, careful preparation can make your trip safe and enjoyable. As always, communication is key.

When making special requests, give as much lead time as you can to trip organizers and airline, hotel, and restaurant staff. Bring a kit with all your medications, including antihistamine, extra autoinjectors, and copies of your emergency medical plan. Let your doctor know you’re traveling, and ask if he’ll be available to fax or call in a prescription for additional autoinjectors should you need them.

On The Plane
Always check the latest rules about what you can carry onboard. There may be different regulations for domestic and international flights. To know before you go, visit

Just as you compare carriers for the most reasonable airfares, it’s also important to find out how accommodating they are to people with food allergies. It’s a good idea to make your reservations directly with the airline – rather than booking through an agent or online – so there’s no confusion later on.

Explain your situation clearly and politely. If you or your child has a peanut allergy, ask if the airline can serve pretzels rather than peanuts on your flight. And ask if it’s possible for the flight attendants to vacuum the area where you will be sitting before anyone boards the plane. This is helpful in case peanuts were served on previous flights. Try to get all communications in writing (ask for faxes, and print out email communications). Confirm and reconfirm, and keep a record of each person you spoke with.

Before booking your stay, call and speak to a hotel manager or director and explain the accommodations you require.

Check in early so you can speak to representatives at the gate as soon as possible. After you have checked in, explain your situation to the gate agent, who can then remind the flight crew about it. Once you board the plane, remind the head flight attendant as well.

Keep an eye on small children with allergies. Even if flight crews clean the area where a child is sitting, food often falls into cracks and spaces not reachable by a vacuum. If children reach for a toy they dropped or are curiously exploring the plane, they risk coming in contact with a hidden danger. Bring wet wipes to wipe down the seat, armrests, window areas, seatbelt clasps, and tray table where you’ll be sitting.

Bring extra medications and carry them with you at all times. When flying, you should always bring extra doses of your autoinjector. Bring a letter for carrying self-injectable epinephrine, signed by your doctor, which will allow you to bring your medication onboard. Keep your medical kit under your seat – if you should need it during your flight, you won’t have to struggle to get it out of the overhead bin.

Bring your own food and pack extra in case flights are delayed. Even if peanuts aren’t served as a snack, the other meal or snack options might contain offending ingredients. It’s best to bring a container of foods that you know are safe to eat.

Research local restaurants where you will be staying. Call ahead and ask to speak to a manager about your needs, fully explaining how dangerous your or your child’s food allergies can be. Can the eatery accommodate you without a risk of cross contamination? Will the person you spoke with be at the restaurant while you’re there? If not, ask for the name of the staff member who is aware of the circumstances.

Let your doctor know you’re traveling, and ask if he’ll be available to fax or call in a prescription for additional autoinjectors should you need them.

If all else fails, ask the restaurant if it is possible for you to bring your own bag of pasta for them to boil. It may not be the most memorable meal you’ve ever had, but at least you’ll be able to enjoy being with family, friends, or colleagues.

Remind a manager or the head waiter about your allergies before you are seated. Present your server with a copy of your food allergy restaurant card so that he or she can share it with the chef. If the wait staff doesn’t seem to understand your situation, always trust your gut and seek out another staff member or manager. In fact, there may be times when the safest choice is to not eat there at all.

All-Inclusive Resorts
Before booking your stay, call and speak to a hotel manager or director and explain the accommodations you require. Try to speak to the same resort manager every time, but make sure that other management is aware of the situation. Find out if the resort has a doctor or nurse on site and if they’re available full time.

Ask that every restaurant, café, snack shop, etc., be made aware that a guest with food allergies is staying on the premises. (However, it is still your responsibility to make your server aware of your food allergies every time you dine.)

Don’t assume that just because one eatery at the location has “safe” food, that they all do. Ask about ingredients and preparations at every restaurant, café, and snack shop every time. Even if you’ve stayed at a resort before and had a safe experience, many things may have changed since your last visit. Take precautions as if this were your first visit.

Traveling Abroad
Find out if there are local doctors in the area who specialize in allergy treatment. Will they be able to write you a prescription for additional autoinjectors or medications if you need them? Where is the closest hospital?

Ask your doctor to write a prescription that you can carry with you. Learn the generic and brand names in the countries you’ll be visiting. Ask for recommendations for restaurants, hotels, and activities. Does your doctor treat others who have had good experiences at certain places?

Bring several copies of your authorization of emergency treatment, emergency medical plan, and food allergy restaurant cards in both English and the language of the countries where you will be. Make sure they are with you at all times.

Language barriers can be tough to deal with, but chances are there is someone who speaks English working at the hotel. With many Internet translation services available, email can be an effective way to correspond.

Bring non-perishable food that is safe for you to eat. Dried pasta and allergen-free snack bars are good options. Don’t assume that the same products manufactured in other countries will contain the same ingredients.


Reprinted by the permission of Food Allergy Initiative from, copyright © 2012 Food Allergy Initiative. All rights reserved.

This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2012.

It’s Summer!

Skip the Allergies, Not the Fun

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Millions of Americans have nasal allergies, commonly known as hay fever. Often fragrant flowers are blamed for the uncomfortable symptoms, yet they are rarely the cause; their pollens are too heavy to be airborne.

Allergy symptoms appear when the immune system reacts to an allergic substance that has entered the body as though it was an unwelcome invader. The immune system will produce special antibodies capable of recognizing the same allergic substance if it enters the body at a later time.

When an allergen reenters the body, the immune system rapidly recognizes it, causing a series of reactions. These reactions often involve tissue destruction, blood vessel dilation, and production of many inflammatory substances, including histamine. Histamine produces common allergy symptoms such as itchy, watery eyes, nasal and sinus congestion, headaches, sneezing, scratchy throat, hives, and shortness of breath. Other less common symptoms are balance disturbances; skin irritations, such as eczema; and even respiratory problems, like asthma.

Many common substances can be allergens. Pollens, food, mold, dust, feathers, animal dander, chemicals, drugs (such as penicillin), and environmental pollutants commonly cause many to experience allergic reactions. Your doctor can help determine the substances causing your discomfort.

One of the most significant causes of allergic rhinitis in the United States is ragweed. It begins pollinating in late August and continues until the first frost. Late springtime pollens come from grasses, and early springtime hay fever is most often caused by pollens of trees. Flowering plants rarely cause allergy symptoms.

Certain allergens are present all year long. These include house dust, pet dander, and some foods and chemicals. Symptoms caused by these allergens often worsen in the winter when the house is closed up.

Mold spores also cause allergy problems. Molds are present all year long and grow both outdoors and indoors. Dead leaves and farm areas are common sources for outdoor molds. Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Mold is also common in foods.

Allergies are rarely life threatening, but they often cause lost workdays, decreased work efficiency, poor school performance, and a negative effect on quality of life. Considering the millions of dollars spent on anti-allergy medications and the cost of lost work time, allergies cannot be considered a minor problem.

For some allergy fighters, symptoms may be seasonal, but for others, allergy symptoms produce year-round discomfort. Symptom control is most successful when multiple approaches are used simultaneously to manage the allergy. They may include minimizing exposure to allergens, desensitization with allergy shots or drops, and medications. If used properly, medications, including antihistamines, nasal decongestant sprays, steroid sprays, saline sprays, and cortisone-type preparations, can be helpful. Even over-the-counter drugs can be beneficial.

If you are experiencing allergy symptoms, schedule an appointment with your doctor. Aside from gathering a detailed history and completing a thorough examination of your ears, nose, throat, and head, your doctor can offer advice on proper environmental control. He or she will also evaluate your sinuses to determine if infection or a structural abnormality (deviated septum, polyps) is contributing to your symptoms.

In addition, your doctor may test to determine the specific allergen that is causing your discomfort and can help you develop a management plan that will help make life more enjoyable. In some cases, allergy shots or allergy drops may be recommended.


Source: American Academy of Otolaryngology – Head and Neck Surgery,

This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2012.

Putting Your Finger on the Asthma Trigger

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If you have asthma, you can minimize your symptoms and improve your quality of life by avoiding your asthma triggers and working with your doctor to develop a treatment plan.

People with asthma have recurrent episodes of airflow limitation, often from inflamed airways that become narrowed, making it more difficult to move air in and out of their lungs. This can cause wheezing, cough, chest tightness, and shortness of breath. It is important to understand what triggers your symptoms and what makes them go away.

Tobacco smoke, which is an irritant, often aggravates asthma. No one should smoke around you, in your home, or in your car. Your asthma may also be irritated by strong odors or fumes, weather changes, and air pollution.

Viral and bacterial infections, such as the common cold and sinusitis, can make asthma worse.

Strenuous exercise or exposure to cold, dry air can trigger asthma.

Acid reflux, even if you do not experience heartburn, is also an asthma trigger. This diagnosis can be hard to make, and treatment is different from most asthma medications, so talk to your doctor.

Some medications can cause or worsen asthma. These include aspirin or other non-steroidal anti-inflammatory drugs (such as ibuprofen) and beta-blockers (used to treat heart disease, high blood pressure, migraine headaches, and glaucoma).

Even eating certain foods can trigger wheezing in some people. If any foods seem to trigger an asthma attack, avoid eating that food and talk to your doctor.

Emotional anxiety may also increase your asthma symptoms and trigger an attack. Proper rest, diet, and exercise are important for your overall health and can help in managing asthma.

Many people with asthma have allergies, which can trigger asthma symptoms. Common allergens include house dust mites, animal dander, molds, pollen, cockroach droppings, and foods. Your doctor can identify what you are allergic to and recommend ways to avoid exposure to your triggers.

Treatment and Management
Asthma has different causes in different people; therefore, individualized therapy is wise. Personalized plans for treatment may include environmental control measures to avoid your asthma triggers, medication, an asthma action plan, and a partnership among you, your family, your doctor, and other healthcare providers.

Many people with asthma have allergies, which can trigger asthma symptoms.

Since asthma is a chronic disease, it requires ongoing management. This includes using proper medications to prevent and control your asthma symptoms and to reduce airway inflammation. There are two general classes of asthma medications: quick-relief and long-term controller medications. Your doctor may recommend one or a combination of two or more of these medications.

Quick-relief medications are used to provide temporary relief of symptoms. They include bronchodilators and oral corticosteroids. Bronchodilators, generally called “rescue medications,” open up the airways so that more air can flow through. Bronchodilators include betaagonists and anticholinergics and come in inhaled, tablet, liquid, or injectable forms. There are some corticosteroids designed for short-term use that are swallowed or given by injection and that work a bit more slowly to help treat particularly bad inflammation in your airways.

Long-term controller medications are important for many people with asthma and are taken on a regular basis (often daily) to control airway inflammation and treat symptoms in people who have frequent asthma symptoms. Inhaled corticosteroids (there are many different ones), cromolyn or nedocromil, and leukotriene modifiers can help control the inflammation that occurs in the airways of most people who have asthma. One medication may work better for you than another. Your doctor can help guide you.

Inhaled long-acting beta2-agonists are symptom controllers that open your airways and may have other beneficial effects, but in certain people, they may have some risks. Current recommendations are for them to be used only along with inhaled corticosteroids. Methylxanthines provide modest opening of the airways and may have a mild antiinflammatory effect. Theophylline is the most frequently used methylxanthine. Leukotriene modifiers are also used for airway opening. Omalizumab is an injectable antibody that helps block allergic inflammation. It is used in people with persistent allergic asthma.

Your asthma medications may need to be adjusted as you and your asthma change, so stay in close touch with your doctor. The better informed you are about your asthma triggers and management, the better your asthma symptoms will be. Together, you and your doctor can work to ensure that asthma interferes with your daily life as little as possible.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2012.

Staying Active with Asthma

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Staying active and exercising has many benefits to your overall health and well-being, but if you have asthma, you may feel the need to limit your activity to avoid symptoms. Understanding your symptoms and how to manage them is the first step to creat­ing an asthma management plan to keep you in the game.

When we exercise, we breathe harder, which causes water loss from our lungs. This water loss drops the temperature of our lungs and can cause asthma symp­toms. Symptoms may include coughing, wheezing, a feeling of chest tightness, and shortness of breath. You may experience symptoms once you begin exercising, or soon after it ends. How­ever, asthma doesn’t have to keep you on the sidelines.

Create an Asthma Management Plan
The first step to starting any exer­cise plan is to talk with your healthcare provider. Let him or her know what sports and physical activities you would like to participate in, and discuss the symptoms you experience during exer­cise. Remember to share any concerns or fears you may have. Together, you can create an asthma action plan that keeps you in the game and not on the sidelines.

Consider physical activities that have periods of inactivity, such as baseball.

Keep medications on hand. Your doc­tor may recommend that you take your quick-relief medicine prior to activity to help avoid asthma symptoms. Keep your quick-relief medicine close by in case you have trouble breathing. Stop activity and use your quick-relief medi­cine as soon as you begin to have asthma symptoms. Make sure to take your med­ications as prescribed.

Assess your symptoms daily, as well as before exercising. The key to keeping your asthma well controlled is to monitor your symptoms every day. If prescribed by your healthcare provider, a peak flow meter reading can show signs of asthma symptoms before you feel them.

Start Exercising
Find the exercise that’s right for you. Consider physical activities that have periods of inactivity, such as baseball. Swimming is often a good choice since the warm, moist air may keep symptoms away. It’s important to warm up and cool down. Ease your body into physical activity with a long warm-up routine and make sure to cool down afterward. When working out in the gym, lower the intensity of your training by increasing the number of rest periods between repetitions and machines. If you begin to feel symptoms, stop activity immediately, take your quick-relief medication, and follow your asthma action plan.

Keep your trainer informed. Share the steps on your asthma action plan with your trainer. Your asthma action plan should specify what to do in case of a breathing emergency, as well as make suggestions to modify your activ­ity depending on your peak flow meter readings. It’s important to communicate with your trainer if you need longer warm-ups and cool-downs or additional rest periods during activity.

Be careful when exercising indoors. Local gyms will keep you warm during your winter workout and cool during the summer, but they may increase your risk of being exposed to asthma triggers, as well as germs. When choos­ing a gym, ask what types of cleaners and disinfectants are used since bleach and strong odors from cleaning chemi­cals can cause asthma symptoms. Make sure the pool area is well ventilated and doesn’t have the strong smell of chlo­rine. A well-ventilated gym will reduce your exposure to mildew, mold, and other asthma triggers.

If you plan to move your physical activity outside, scope out the envi­ronment first and be aware of any obvious triggers. Look for areas that aren’t close to major highways with increased automobile exhaust. Monitor air quality forecasts before heading outside. Air pollution can be very high in the summer, and those with asthma and other lung diseases are at higher risk for being harmed by air pollution.

Stay Healthy
Remember to get a yearly flu shot. One of the main causes of asthma episodes is a respiratory in­fection, like the flu. Make sure to clean your gym equipment prior to use and wash your hands frequently. If you smoke, make a plan to quit.


Source: American Lung Association,

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2012.

Don’t Kill the Birthday Girl

by Sandra Beasley

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There are only two birthdays that stand out in my memory as dis­tinct, chronologically certain events. One: my sixteenth birthday, when we watched Ferris Bueller’s Day Off. That was the year my friend Elizabeth, while using the swing anchored to the underside of our second-story deck, pushed off so hard that the whole she­bang – girl, swing, unhooked chains – went sailing twenty feet out into the woods behind our house. Two: the year I got diagnosed with mononucleosis, too late to cancel an Italian-themed dinner party. So I stood in front of a stove for two hours – achy, glands swollen, stone-cold sober – cooking pasta for two dozen while my friends went through six bot­tles of wine. That was, undoubtedly, my twenty-first birthday.

Beyond that, it blends into a murky party. Which years did we go to Chuck E. Cheese’s? When did I get my Rain­bow Brite doll? Which years were my father home, and which years had the army sent him off to the War College, Saudi Arabia, Bosnia?

There is one constant in my birthday memories. When it came time for a cake, my mother would bring out whatever Sandra-friendly sweet she’d designed. Some years it was sunflower-margarine Rice Krispies treats, and some years it was an applesauce-and-cinnamon-raisin Bundt cake. I’d get my serving. Then we’d dish out the real dessert of cake or brownies or pie a la mode for everybody else. After singing, after blowing out candles, after presents had been opened, after everyone had eaten, someone would say it: “Now, don’t kill the birthday girl.”

When it came time for a cake, my mother would bring out
whatever Sandra-friendly sweet she’d designed.

Which meant no kisses, no hugs, no touch of a hand or mouth. From that point onward, anyone who touched me ran the risk of giving me hives, or worse. Even today, it’s a phrase I repeat as part joke and part prayer. Don’t kill the birthday girl.

It’s the same at every holiday. My uncle Jim is notorious for forgetting about my allergies, holding out a dish of ice cream and asking, “Want a bite?” He’s the fun bachelor uncle, the one who rides a motorcycle and would give a little girl a windup sewer rat, complete with blinking red eyes, as a Christ­mas gift.

Once upon a time, it would fall on my mother to protect me at the end of the night, when the aunts and uncles and cousins were making the rounds for good-byes. Now I step to the side on my own. Everyone understands why I avoid con­tact. Yet I can’t help but wish it wasn’t their last impression of me before the long drive home.

I am allergic to dairy (including goat’s milk), egg, soy, beef, shrimp, pine nuts, cucumbers, cantaloupe, honeydew, mango, macadamias, pistachios, cashews, swordfish, and mustard. I’m also aller­gic to mold, dust, grass and tree pollen, cigarette smoke, dogs, rabbits, horses, and wool. But in particular, I am one of the 15 million Americans who have been diagnosed with food allergies, a figure that includes 8 percent of all children. Even with so many of us in the conver­sation, there are huge disconnects in the dialogue. Parents who have never met a food they couldn’t eat struggle to empathize with their child’s allergies. Those crusading for community accom­modation misguidedly conflate allergies with intolerance and confuse discomfort with anaphylaxis. Advocacy groups focus on youth allergies and largely ignore the complexities faced by those who grow into adulthood, travel, marry, and must figure out how to raise children of their own. There are multiple dimen­sions of data out there, but no one has set the gyroscope spinning.

Allergies are quirky beasts. Unlike many syndromes, they are primarily sorted according to their outside cata­lysts. (Have you ever heard someone claim to have type-peanut diabetes? Eggplant flu?) Allergies are widespread – and widely misdiagnosed. There is a whole range of symptoms and degrees of sensitivity, and these symptoms can change for any given individual at any time. For those with allergies like mine, each day requires vigilance in terms of what we do, the company we keep, and where we sit in relation to that bowl of mixed nuts. One person’s comfort food is another person’s enemy. One person’s lifesaver is another’s poison.

I thought my family’s habit of calling the foods I can eat “Sandra-friendly” was unique, until I saw a book by Emily Hendrix called Sophie-Safe Cooking: A Collection of Family Friendly Recipes That Are Free of Milk, Eggs, Wheat, Soy, Peanuts, Tree Nuts, Fish, and Shellfish. The more I have read, the more I real­ize a whole culture of catchphrases has emerged in addition to the key medical terminology. Safe, friendly, free: these words come up over and over again in literature about allergies.

Don’t kill the birthday girl. Leftover omelet clings to the edge of a breakfast plate. Butter greases the stir-fry. Walnuts go commando in an otherwise tame brownie. There’s a reason they’re called allergy “attacks”; you never know where a food can be lurking.

But those with food allergies aren’t victims. We’re people who – for better or for worse – experience the world in a slightly different way. This is not a story of how we die. These are the sto­ries of how we live.


Sandra Beasley is an author and poet who lives in Washington, D.C., where her prose has been featured in the Washington Post Magazine.

Excerpted with permission from Don’t Kill the Birthday Girl, by Sandra Beasley, copyright © 2012 Broadway Books, a division of Random House, Inc.

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2012.

5 Surprising Summer Allergy & Asthma Triggers

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Summer means barbeques, festi­vals, and other outdoor activities, and if you experience allergic reactions to grass pollens, you might be running for cover. However, seasonal allergies can also affect those without pollen sensitivities due to unexpected summer staples, such as certain fruits and vegetables, campfires, and changes in the weather.

“Although symptoms may not always be severe, summertime allergies and asthma are serious and, in some cases, deadly,” says allergist James Sublett, MD, chair of the American College of Allergy, Asthma, and Immunology Public Relations Committee. “However, these conditions shouldn’t damper summer fun. Proper diagnosis and treatment involves more than just relieving symp­toms; it can find the source of your suffering and stop it.”

By planning, seeing an allergist, and knowing the causes of allergy and asthma, even those with the most sensitive noses and lungs can enjoy summer festivities. Here are five surprising summer allergy and asthma triggers, as well as some sug­gestions for coping with them.

Toasting marshmallows or sitting out at a bonfire is a lot less fun if it results in an asthma attack.

1 Summer Fruits and Veggies
An otherwise healthy snack can mean an oral allergy syndrome for people whose lips begin to tingle after sinking their teeth into a juicy peach – or melon, apple, celery, or other fresh fruits and vegetables. People with common grass allergies can also have this condition, which is a cross-reaction between similar proteins in certain fruits and vegetables and the allergy-causing grass, tree, or weed pollens. The simple solution is to avoid the offending food, or just put up with the annoying but short-lived (and seldom dangerous) reaction. If symp­toms are bothersome, see an allergist to identify the offending pollen and develop a treatment plan to find relief.

2 Changes in the Weather
Be it sti­fling humidity or a refreshing cool breeze, sudden changes in the weather can trigger an asthma attack. Wind can spread pollen and stir up mold, affect­ing those who have grass or tree pollen and mold allergies. Your doctor can help you develop an allergy and asthma action plan to ensure your symptoms are kept in check no matter the season or the temperature.

3 Campfire Smoke
Toasting marsh­mallows or sitting out at a bonfire is a lot less fun if it results in an asthma attack. Smoke is a common asthma trigger. Sit upwind of the smoke and avoid getting too close to help prevent an asthma flare-up.

4 Stinging Insects
As if the pain isn’t bad enough, it is possible to develop a life-threatening allergic reaction to the sting of yellow jackets, honeybees, wasps, hornets, and fire ants. Cover up when gardening or working outdoors, avoid brightly colored clothing, forget the per­fume, and take caution when eating or drinking anything sweet, all of which attract stinging insects. Be especially careful with open soft drink cans. Your doctor might advise carrying epineph­rine for emergency relief in the event of being stung. See an allergist for skin testing to identify the offending insect and ask about allergy shots, which can provide life-saving protection.

5 Chlorine
Although not an allergen, the smell of chlorine from pools or hot tubs can be an irritant and cause flares of either allergy-like eye and nose symp­toms or asthma in some people.


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2012.

Your Guide for Asthma-Friendly Travel

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If you or a loved one has asthma, navigating travel and different environments can be tricky. With a little preparation, your travel can be more asthma-friendly.

Asthma Travel Pack
Create an asthma travel pack to ensure you have all of the medicines and instructions you need in one, easily accessible place. When creating your asthma travel pack, consider including

  • copies of your asthma action plan;
  • an extra written prescription in case medication is lost or destroyed;
  • insurance card and healthcare provider contact information;
  • both quick-relief and controller medications (enough to get you through your stay, and extra in case you get held over unexpectedly);
  • a spacer or chamber, if prescribed by your doctor; and
  • a peak flow meter, if prescribed by your doctor.

Store your asthma travel pack and medicines at the correct temperature. Medicines may be exposed to extreme temperatures if they are stored in luggage checked at the airport or in your car. If your child is traveling without you, ensure his or her caregivers have access to the asthma travel pack and understand its contents, how to follow the instructions on the asthma action plan, how to administer medicines, and what to do during a breathing emergency. If you are prone to frequent asthma symptoms or will be gone for an extended period, it’s important to know where you can get medical attention if needed. Ask your healthcare provider to recommend a doctor or healthcare facility close to where you’ll be staying.

Prepare for Temperature Changes
When on vacation, you may be going from a warm to a cold climate, or vice versa. Extreme changes in temperature can trigger asthma. Try to stay indoors if it’s hot or humid outside, and wrap a scarf around your nose and mouth if it’s very cold.

Whether you are staying in a hotel or at grandma’s house, you may be exposed to the same triggers found in your home, and possibly new triggers.

Fly with Confidence
According to the Transportation Security Administration,, nebulizers are permitted in both check-in and carry-on luggage. It’s best to pack your nebulizer, quick-relief, and other asthma medicines in your carry-on, even during short flights. It’s important to have your medicine with you at all times. You never know when you may get stuck on the plane, or if your suitcase will get lost.

Choosing a Place to Stay
Whether you are staying in a hotel or at grandma’s house, remember that you may be exposed to the same triggers found in your home, and possibly new triggers. Complete this checklist when considering lodging:

Request a Smoke-Free Environment
Choose a hotel that is completely smokefree. Cigarette and cigar smoke can travel through the heating and cooling systems into your room. If a smoke-free hotel is not available, stay in a nonsmoking room on a nonsmoking floor. If you are staying with family or friends, ask to stay with those who don’t smoke. If residents do smoke, ask them to smoke outside.

Reduce Allergens
Some hotels now offer rooms that minimize allergens. They may be furnished with hardwood floors instead of carpet, have shades instead of fabric drapes, and use hypoallergenic linens.

Go Fragrance Free
If strong odors trigger your asthma, ask for a hotel room without scented soaps, lotions, or cleaning products. If you’re a houseguest, ask your host not to burn candles or incense, or use air fresheners.

Staying Warm
If you’re traveling to a colder climate, you may gather around the fireplace or warm your housing accommodations with wood-burning stoves, but their smoke can trigger an asthma episode. Kerosene and gas space heaters can also worsen asthma symptoms.

Reduce Exposure to Pets
If pet dander is a trigger, ask for a hotel room that has not housed pets. If those hosting you have pets, ask that the pet stay out of the room you are staying in to reduce your exposure. Wash your hands after touching the pet to remove any dander.

Bring Your Own Bedding
If you use a special pillowcase or mattress covers to reduce dust mite exposure, consider bringing them with you. Hypoallergenic “sleep sacks” are designed to use when staying in hotels to protect you from allergens, and can be purchased at stores that sell bedding.

Watch Out for Chlorine
Swimming is great exercise, but chlorine and other chemicals found in pools can trigger asthma. Make sure the pool area is well ventilated and doesn’t have a strong chlorine or chemical odor.

Managing Stress
Emotions can run high when you travel. Stress, excitement, anger, crying, and even laughing really hard can trigger an asthma episode. Practice deep breathing to help reduce stress and excitement. Try to stick to your regular exercise routine, eat healthy, and get plenty of rest.


Source: American Lung Association,, 1-800-LUNGUSA

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2012.

Gardening the Allergy-Friendly Way

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For many people with seasonal allergic rhinitis (hay fever), getting their hands dirty in the garden has consequences. Sneezing, itchy eyes, congestion, and other reactions can turn yard work into misery. However, with a few simple precautions, allergies don’t have to stand between you and your garden.

The best times of day to be outdoors are when the pollen levels are lower. This is typically on rainy, cloudy, and windless days. Pay attention to pollen counts in your area by subscribing to the email alerts available from the National Allergy Bureau at The NAB provides the most accurate and reliable pollen and mold levels from approximately 78 counting stations throughout the United States, two counting stations in Canada, and two in Argentina.

Allergy-Friendly Plants
Cherry trees

Allergenic Plants to Avoid
Johnson grass
Rye grass

Avoid touching your eyes or face when doing yard work. You may also consider wearing a mask to reduce the amount of pollen spores that you breathe in.

Leave gardening tools and clothing – such as gloves and shoes – outside to avoid bringing allergens indoors. Showering immediately after gardening may also help reduce symptoms.

Certain flowers, trees, and grasses are better suited for the gardens of people with outdoor allergies (see sidebar). The best way to determine which plants trigger your allergic reactions is through skin testing. Your doctor can help you develop strategies to avoid troublesome plants and pollen and can prescribe medication to alleviate symptoms.

Allergy shots may offer permanent relief from allergy symptoms. Check with your doctor to see if this is an effective treatment for you.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2012.

Ready or Not, Spring Allergy Season is Here

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Allergies are diseases of the immune system that cause an overreaction to substances called allergens. People who have allergies can live healthy and active lives.

Good allergy treatment is based on the results of your allergy tests, your medical history, and the severity of your symptoms. It can include three different treatment strategies: avoidance of allergens, medication options, and immunotherapy (allergy shots).

Avoiding Your Allergens
The best way to prevent allergy symptoms and minimize your need for allergy medicine is to avoid your allergens as much as possible and to eliminate the source of allergens from your home and other environments. For tips on allergen avoidance, talk to your doctor.

Some people don’t take allergy medicines because they don’t take their symptoms seriously. The result may be painful complications.

Some people don’t take allergy medicines because they don’t take their symptoms seriously. The result may be painful complications, such as sinus or ear infections. Don’t take the risk. There are so many safe prescription and nonprescription medicines to relieve allergy symptoms. Following is a brief list of medications taken for allergies. They are available in nonprescription and prescription form:

Antihistamines and decongestants are the most common medicines used for allergies. Antihistamines help relieve rashes and hives, as well as sneezing, itching, and runny nose. Decongestant pills, sprays, and nose drops reduce stuffiness by shrinking swollen membranes in the nose.

It is important to remember that using a nonprescription nasal decongestant spray more than three days in a row may cause the swelling and stuffiness in your nose to become worse, even after you stop using the medicine. This is called a rebound reaction. Some nonprescription “cold” medicines combine an antihistamine, a pain reliever like aspirin or acetaminophen, and a decongestant. Aspirin can cause asthma attacks in some people. Don’t take a chance. If you have asthma, talk with your doctor before taking any nonprescription allergy medicine.

Eye drops may provide temporary relief from burning or bloodshot eyes. Using allergy eye drops that contain antihistamines can reduce itching, tearing, and swelling.

Corticosteroid creams or ointments relieve itchiness and halt the spread of rashes. Corticosteroids are not the same as anabolic steroids that are used illegally by some athletes to build muscles. If your rash does not go away after using a nonprescription corticosteroid for a week, see your doctor.

Corticosteroid nasal sprays help reduce the inflammation that causes nasal congestion.

Cromolyn sodium prevents the inflammation that causes nasal congestion. Because it has few, if any, side effects, cromolyn can be safely used over long periods of time.

Oral corticosteroids may be prescribed to reduce swelling and stop severe allergic reactions. Because these medications may cause serious side effects, you should expect your doctor to carefully monitor you.

Epinephrine comes in pre-measured, self-injectable containers, and is the only medication that can help during a life-threatening anaphylactic attack. To be effective, epinephrine must be given within minutes of the first sign of a serious allergic reaction.

Immunotherapy (Allergy Shots)
When it is not possible to avoid your allergens and treatment with medications alone does not solve the problem, immunotherapy can often prevent allergy symptoms. It involves giving a person increasingly higher doses of an allergen over time. For reasons that we do not completely understand, the person gradually becomes less sensitive to that allergen. This can be effective for some people with hay fever, certain animal allergies, and insect stings. It is usually not effective for allergies to food, drugs, or feathers, nor is it effective for hives or eczema.


Source: Asthma and Allergy Foundation of America,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2012.

Skin Allergy Mobile App Available

CARD app from Preventice uses Mayo Clinic expertise to help allergy sufferers

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For people who suffer from skin allergies, shopping for something simple like laundry detergent, shampoo or lotion can be a gamble that lands them in the doctor’s office. In fact, a National Ambulatory Medical Care survey conducted in 1995 estimated that 8.4 million people visit their doctor because of skin allergies, or contact dermatitis. Furthermore, allergic reactions to skin care and cosmetic products were the second most frequent dermatologic diagnosis.

But thanks to a new mobile health application from Preventice, Inc., life just got easier for people with skin allergies.

Introducing CARD for iPhone, Smartphones and tablets The CARD application is the first publicly available application based on a technology licensed between Mayo Clinic and Preventice. CARD combines the world-class medical expertise and research of Mayo Clinic with the cutting-edge mobile technology and cloud-computing platform of Preventice.

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CARD – which stands for Contact Allergen Replacement Database – gives physicians and patients instant access to information about chemicals, preservatives and fragrances in skin care products that cause allergic reactions. CARD allows patients to:

  • Create safe-shopping lists based on their allergies
  • Use the CARD database to find safe products
  • Print shopping lists
  • Save photos to share with their physician to improve diagnosis and treatment
  • Create personal journals of any reactions
  • Receive notification of product formulation changes

The Preventice CARD application gives consumers access to the world’s most recognized contact allergy database, which contains more than 8,000 known ingredients found in more than 5,500 commercial skin care products. Developed by Mayo Clinic in 1999, CARD is available for the first time to physicians and patients worldwide.

“The occurrence of contact dermatitis is increasing and product labeling remains an issue, despite the growth of all-natural products,” said Jon Otterstatter, Preventice co-founder, president and CEO. “Physician and patient response to the CARD application has been extremely positive, and patient stories reinforce the real-life value that CARD offers.”

“The Preventice CARD System represents an essential clinical tool for discovering and avoiding skin-care products that cause allergic reactions,” said James Yiannias, MD, Mayo Clinic. “Dermatologists at Mayo Clinic have used CARD for years to recommend safe skin care products and have found it typically increases patient compliance and makes patient diagnosis and education more efficient.”

Download CARD from iTunes using “Preventice Card” in the search.


This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Seven Tips to Successfully Quit Smoking in the New Year

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This holiday season, countless Americans will make the New Year’s resolution to quit smoking in 2012. While quitting smoking is extremely difficult – six out of 10 smokers require multiple quit attempts to stop smoking – preparing a quit-smoking plan can greatly improve a person's chance for success. The following are proven tips and resources from the American Lung Association that have helped thousands of people give up smoking for good:

  1. Talk to your doctor or pharmacist about the various types of treatments and different over-the-counter and prescription medications that are available to help you quit smoking.
  2. Look into the different options available to help smokers quit. Visit or call 1-800-LUNG-USA (1-800-586-4872) for suggestions.
  3. Take time to plan. Pick your quit date a few weeks ahead of time and mark it on the calendar. If you can, pick a day when life's extra stresses are not at their peak, such as after the holidays. Mark a day on the calendar and stick to it.  As your quit day approaches, gather the medications and tools you need and map out how you are going to handle the situations that make you want to smoke.
  4. Get some exercise every day. Walking is a great way to reduce the stress of quitting. Exercise is proven to not only combat weight gain but also to improve mood and energy levels.
  5. Eat a balanced diet, drink lots of water and get plenty of sleep.
  6. Ask family, friends and co-workers for their help and support. Having someone to take a walk with or just listen can give a needed boost.
  7. You don't have to quit alone. Help is available online and in your community. Consider joining a stop-smoking program like Freedom From Smoking® ( from the American Lung Association.

"Research shows that people who develop a support system and use programs like Freedom From Smoking® Online have greater success in quitting for good."

“Quitting smoking is the single most important step smokers can take to improve their health,” said Norman H. Edelman, MD, chief medical officer of the American Lung Association. “The start of a fresh New Year is a great time for smokers to implement their plan to quit smoking – and reap the health and financial benefits of a smokefree lifestyle.”

Helping Americans quit smoking remains a public health priority for the American Lung Association. Its Freedom From Smoking® group clinic program #&8211; which began in 1981 and includes a comprehensive variety of evidence-based cessation techniques – has helped hundreds of thousands of smokers quit. The American Lung Association more recently introduced Freedom From Smoking® Online, a highly successful, self-paced online adaptation of the group clinic that is available 24 hours a day.

“Smokers don’t have to go it alone when they attempt to quit smoking,” added Dr. Edelman. “In fact, research shows that people who develop a support system and use programs like Freedom From Smoking® Online have greater success in quitting for good, compared to those who try to quit “cold turkey.”


Source: American Lung Association,

Researchers Engineer a New Way to Inhibit Allergic Reactions Without Side Effects

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Researchers from the University of Notre Dame have announced a breakthrough approach to allergy treatment that inhibits food allergies, drug allergies, and asthmatic reactions without suppressing a sufferer's entire immunological system.

The therapy centers on a special molecule the researchers designed, a heterobivalent ligand (HBL), which when introduced into a person's bloodstream can, in essence, out-compete allergens like egg or peanut proteins in their race to attach to mast cells, a type of white blood cell that is the source of type-I hypersensitivity (that is, allergy).

"Unlike most current treatments, this approach prevents allergic reactions from occurring in the first place" says Basar Bilgicer, assistant professor of Chemical and Biomolecular Engineering and Chemistry and Biochemistry and principal investigator in Notre Dame's Advanced Diagnostics & Therapeutics initiative.

Michael Handlogten, lead scientist on the paper and a graduate student in Dr. Bilgicer's group, explained that among the various chemical functionalities he analyzed to be used as the scaffold HBL synthesis, ethylene glycol, an FDA-approved molecule, proved to be the most promising.

"Unlike most current treatments, this approach prevents allergic reactions from occurring in the first place."

Mast cells are part the human body's defense against parasites (such as tapeworms), and when working normally they are attracted to, attach to, and annihilate these pathogens. But type-I hypersensitivity occurs when the cells react to non-threatening substances. More common allergies are due to ambient stimulants, and an allergic response may range from a mild itch to life-threatening anaphylactic shock.

Tanyel Kiziltepe, a research professor in Advanced Diagnostics & Therapeutics, adds that "anaphylaxis can be caused by certain food allergens, insect stings, antibiotics, and some medicines, and we believe HBL has a very high potential to be developed as a preventative medication".

While many medicines treat allergies by weakening a person's entire immune system, this approach only disrupts the process whereby white blood cells bond with allergens in the first place.

"It also does not leave patients open to an increased risk for infections or the development of cancers," explains Bilgicer. "HBLs may be most useful in situations where it's not possible to speak to or gauge someone's sensitivity."

"For example, in an emergency, on a battlefield, or in a remote location, doctors may not be able to ask a patient about an allergy before administering penicillin. An engineered HBL could be given along with the medicine and perhaps prevent a deadly reaction from occurring."

In a normal allergic reaction, allergens bind to a white blood cell, or "mast" cell, and cause the release of inflammatory molecules. Researchers at Notre Dame have shown how non-allergenic molecules, known as heterobivalent ligands, can be designed to attach to mast cells first, preventing the allergic reaction in the first place.


Advanced Diagnostics & Therapeutics – a Strategic Research Investment of the University of Notre Dame – is dedicated to developing tools and technologies to combat disease, promote health, and safeguard the environment.

Dining Out with Food Allergies

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Do you know what’s in that salad? When dining out, it’s always best to double check your meal for potential allergens before you dig in.

Dining out is one of America’s favorite pastimes, but for peo­ple with food allergies and intolerances, the experience can often be frustrating and stressful. Paul An­tico, founder of AllergyEats, an online source for finding allergy-friendly res­taurants, understands these challenges firsthand from dining out with his three food-allergic children.

“Families with food allergies hope that all restaurants will cater to food-allergic diners, but some restaurants are far more accommodating than others. A growing number of restaurants have extensive food-allergy protocols in place, educating their staff about food allergies and procedures, avoiding cross-contamination, and sharing detailed information about the ingredients in each dish. Other establishments are unable – or unwilling – to prepare meals without diners’ allergy triggers, such as nuts, dairy, eggs, gluten, shellfish, and more,” Paul says.

“Unfortunately, there is no such thing as a completely allergy-safe restaurant. While many restaurants have gone to great lengths to be as allergy-friendly as possible, food-allergic individuals – or their caretakers – still need to take 100 percent responsibility for their own safety,” he adds. As the father of three food-allergic children, the founder of AllergyEats, and a proactive food allergy advocate, Paul offers the following advice based on his personal and professional experience.

Do some homework in advance.
Find dining recommendations from others within the food allergy commu­nity through an online resource like AllergyEats ( Check menus and allergen information on res­taurants’ websites. Call the restaurant with any questions before you leave the house.

Once you arrive at the restaurant, ask your server how the restaurant will be able to accommodate your specific needs.

Try to dine at off-peak hours.
When restaurant staff is less harried, they will be better able to take the proper precau­tions with your order.

Inform the host and server about your food allergies.
Once you arrive at the restaurant, ask your server how the restaurant will be able to accommo­date your specific needs. Be very clear, but polite. If you don’t feel completely confident after speaking to the server, ask to talk to the manager or chef. Most importantly, if after speaking with the restaurant staff, you don’t feel comfort­able, leave and find another restaurant.

Ask questions.
When you speak with the restaurant staff, you should receive confident answers to the fol­lowing questions:

  • What protocols do you have in place to serve food-allergic individuals?
  • Which items on your menu are not safe, given my specific food allergies?
  • How are diners’ allergies communi­cated to the kitchen and other staff?
  • How is the kitchen set up to prevent cross-contamination?
  • Is separate equipment used to prepare orders for food-allergic individuals?
  • What kind of oil will be used in the preparation of my order? Is it safe, given my allergies?
  • Can I see the list of ingredients for a given menu item?

Get reassurance about the safety of your food.
When you receive your meal, politely ask the server if he or she is sure that this food is safe for you and if there was any chance of cross-contamination.

Stop and look carefully at your meal.
Check to see if any of your offending allergens, such as grated cheese, pesto, or nuts, are present. This may sound obvious, but Paul has found that some restaurants follow all of the “rules” to accommodate a food allergy and then mistakenly do something as obvious as grating cheese on top of a dairy-allergic diner’s salad.

Show your gratitude.
If the restau­rant answered all of your questions and accommodated your special requests, be sure to thank them, leave a generous tip, and let them know you’ll return thanks to your positive experience.


Whether your experience was posi­tive, negative, or somewhere in between, log on to and rate the restau­rant. Rating a restaurant is simple and helps other food-allergic individuals determine which restaurants to visit.

Source: AllergyEats,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Home Is Where the Sneeze Is

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When you have indoor aller­gies, it’s hard to feel like “there’s no place like home.” The good news is there are some simple steps you can take to reduce your exposure to indoor allergens.

Don’t Let Dust Get Too Comfortable
If you or someone in your household has allergies, cleaning the home is incredibly important in managing exposure to indoor allergens. Regular use of a cyclonic vacuum or a vacuum with a HEPA filter, washing items in hot water, and using dust mite-proof casings can reduce allergens.

Couches, Curtains, and Cushions, Oh My
Allergens make themselves at home in fab­rics throughout the house, such as upholstered couches and chairs, bedding, curtains, and carpets. If you can’t tear up the carpet or remove the curtains, look for cleaning products that will denature or deactivate dust mite matter and cat and dog dander in fabrics in the home.

Kick the Habit
Don’t smoke indoors at any time. This benefits everyone.

When in Doubt, Air It Out
Clean and disinfect bathrooms, kitchens, and basements regularly, and keep them well ventilated to reduce the growth of mold. Use exhaust fans or open a window when cooking or bathing.

Keep Fido Allergy-Friendly
Can’t live without pets? Bathe them once a week to reduce dan­der, and whenever possible, keep your pet out of the bedroom.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Immunotherapy Can Provide Lasting Allergy Relief

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Immunotherapy treatment (allergy shots) is based on a century-old concept that the immune system can be desensitized to specific allergens that trigger allergy symptoms. These symptoms may be caused by allergic respiratory conditions, such as allergic rhinitis and asthma.

While allergy medications often con­trol symptoms, if you stop taking your medication, your allergy symptoms re­turn shortly afterward. Allergy shots can potentially lead to lasting remission of allergy symptoms, and they may even prevent the development of asthma and new allergies.

The Process
Immunotherapy treat­ment involves injecting the allergen or allergens causing your allergy symp­toms. These allergens are identified by a combination of a medical evaluation performed by a trained healthcare pro­fessional and allergy skin or blood tests.

Some people have lasting remission of their allergy symptoms with immuno­therapy, but others may relapse after discontinuing treatment.

Treatment begins with a build-up phase. Injections containing increasing amounts of the allergen are given one to two times a week until the target dose is reached. This target dose varies from person to person. The target dose may be reached in three to six months with a conventional schedule of one dose increase per visit. Or it may be achieved in a shorter period and fewer visits with an accelerated schedule.

The maintenance phase begins when the target dose is reached. Once the maintenance dose is reached, the time between allergy injections can be in­creased. It generally ranges from every two weeks to every four weeks. Main­tenance immunotherapy treatment is usually continued for three to five years.

Some people have lasting remission of their allergy symptoms with immuno­therapy, but others may relapse after discontinuing treatment. Therefore, the duration of allergen immunotherapy varies from person to person.

Risks involved with immunotherapy are rare, but may include serious, life-threatening anaphylaxis. For that reason, immunotherapy should only be given under the supervision of a physician or qualified physician extender (such as a nurse practitioner or physician assistant) in a facility equipped with proper staff and equipment to identify and treat ad­verse reactions to allergy injections.

The decision to begin immunotherapy is based on several factors, including the length of the allergy season and severity of your symptoms, how well medications and allergen avoidance measures con­trol your allergy symptoms, and your desire to avoid long-term medication use. Immunotherapy will also require a sig­nificant time commitment during the build-up phase, and a less frequent com­mitment during the maintenance phase.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

New Molecular Candidates for Treatment of Asthma and Allergies

Discovery provides new insights on role of histamine releasing factor in asthma and allergies

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La Jolla Institute for Allergy & Immunology scientists have identified the histamine releasing factor (HRF) molecule as a promising target for developing new treatments for a number of allergic reactions including asthma.

The research team, led by Toshiaki Kawakami, MD, PhD, is also the first to clarify the role of the HRF molecule in promoting asthma and some allergies, including identifying its receptor - a major finding that answers a long-held and important question in the allergy research community.

Juan Rivera, MSc, PhD, deputy scientific director at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health (NIH), said the findings provide new insights on HRF's function in allergic diseases. "Importantly, this work advances both the understanding of how HRF contributes to susceptibility of certain individuals in developing allergic disease as well as begins to unravel the mechanisms involved," he said.

"What is most encouraging is the demonstration that the effect of HRF to enhance allergic responses can be blocked, thus suggesting the possibility of new therapeutic strategies in allergic diseases."

"What is most encouraging is the demonstration that the effect of HRF to enhance allergic responses can be blocked, thus suggesting the possibility of new therapeutic strategies in allergic diseases."

The research study points to the development of new therapies based on blocking HRF interactions with certain antibody (IgE) molecules, long known to be central causes of allergies. The new study also found two novel peptides (N19 and H3) as strong therapeutic candidates for blocking the HRF and IgE interactions. Peptides are protein pieces which spur various molecular actions. The two peptides inhibit the interactions of the HRF and IgE molecules, thereby stopping the allergic cascade in mouse models.

"Based on our preliminary studies, we believe these HRF inhibitors may provide a new, innovative therapeutic avenue for the treatment of asthma and some allergies," said Dr. Kawakami, lead scientist on the study, published online in the Journal of Clinical Investigation.

Hannah Gould, PhD, a professor and prominent allergy researcher at King's College in London, said the study advanced scientific understanding in several key ways. "The research community has long believed that the histamine releasing factor (HRF) played some role in triggering allergic responses and asthma in certain individuals," she said. "However, the identity of the primary binding partner, the HRF receptor, the unique characteristics of the IgE in these individuals, and the mechanisms involved in HRF activity have remained elusive until the present study by Dr. Kawakami and his team."

"These findings suggest a potential treatment for allergy and asthma patients who have HRF reactive IgE," she continued. "We can look forward to the future results of pre-clinical and clinical studies in the human system."

The prevalence of asthma has been dramatically increasing for the last few decades and has reached epidemic proportions in the U.S. and other industrialized countries. Twenty million patients suffer from asthma in the U.S. alone, including nine million children. Meanwhile, 10 to 20 percent of the population of industrialized countries suffers from some form of allergies. Both illnesses are immune system disorders.

"There is a huge need to understand these diseases and to find therapeutic interventions," said Mitchell Kronenberg, PhD, president and chief scientific officer of the La Jolla Institute, a world leader in immune system research. "Allergies and asthma are a cornerstone of the La Jolla Institute's research activities dating back to our founding scientists, who were the discoverers of the IgE molecule in the 1960s. Dr. Kawakami's latest discovery is in keeping with our history of innovation in allergy research."

Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment, referred to as allergens. When exposed to an allergen, IgE molecules activate white blood cells called mast cells and basophils. These cells release histamine and other compounds, which produces allergy symptoms that can range from uncomfortable to dangerous. In asthma, inhaled allergens can induce airway inflammation, causing wheezing, coughing and shortness of breath.

Dr. Kawakami said the HRF molecule has been studied for many years and was thought to play some role in the cellular interactions leading to allergies and asthmas. However, its exact purpose and mode of operation was previously not clear. "Nasal drainage, skin blister fluids, and some bronchial fluids were found to contain HRF secretions, so the scientific community suspected that HRF was important, but we didn't know why," said Dr. Kawakami.

HRF studies had been limited by several factors over the years, he added, including the inability to model HRF interactions in mice. In addition, Dr. Kawakami said failure to identify the HRF receptor also slowed progress. "It's very, very unusual for many years to pass between the discovery of a molecule and the identification of its receptor," he said. "In this case, 15 years had passed. Without the receptor, we couldn't understand the role of this protein in asthma and allergies."

Dr. Kawakami and his team were the first to solve this mystery in 2007 -- identifying a subset of IgE and IgG molecules as HRF receptors. This information gave Dr. Kawakami's group the critical missing piece of the HRF puzzle and enabled the researchers to map HRF's role in allergy activation.

Dr. Kawakami's team also previously discovered that tremendous heterogeneity exists in the IgE molecules. The original work, funded by NIH, provided the foundation for the latest findings on HRF's role in triggering allergies. "The differences were big in terms of affecting the activation and survival of mast cells," he said. "That's why we got interested in this molecule (HRF). Earlier studies had suggested that HRF does not bind to IgE molecules. But I was not convinced, so I decided to explore this further."

Their study results showed that 20 to 30 percent of IgE molecules can interact with HRF molecules and produce mast cell activation leading to allergies. "We think HRF is important for amplifying allergic reactions initiated by IgE and an allergen," said Dr Kawakami. The findings were published today in a paper entitled, Proinflammatory role of histamine-releasing factor in mouse models of asthma and allergy.


Source: La Jolla Institute,

10 Things You Should Know about Mold

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Molds produce tiny spores to reproduce. These spores waft through the indoor and outdoor air continually. When mold spores land on a damp spot indoors, they may be­gin growing and digesting whatever they are growing on in order to survive. When excessive moisture or water accu­mulates indoors, mold growth will often occur, particularly if the moisture problem remains undiscovered or unaddressed.

Here are 10 things you should know about mold and how you can keep it under control.

1 Potential health effects and symptoms associated with mold exposures include allergic reactions, asthma, and other respiratory complaints.

2 There is no practical way to eliminate all mold and mold spores in the indoor environment; the way to control indoor mold growth is to control moisture.

3 If mold is a problem in your home or school, you must clean up the mold and eliminate sources of moisture.

4 Fix the source of any water problem or leak you may have to prevent mold growth.

5 Reduce indoor humidity to decrease mold growth by vent­ing bathrooms, dryers, and other moisture-generating sources to the outside; using air conditioners and dehumidi­fiers; increasing ventilation; and using exhaust fans whenever cooking, dishwashing, and cleaning.

6 Clean and dry any damp or wet building materials and furnishings within 24 to 48 hours to prevent mold growth.

7 Clean mold off hard surfaces with water and detergent, and dry completely. Absorbent materials, such as ceil­ing tiles, that are moldy may need to be replaced.

8 Reduce the potential for condensation on cold surfaces, such as windows, piping, exterior walls, the roof, or floors, by adding insulation.

9 Don’t install carpeting in areas where there is a perpetual moisture problem, such as by drinking fountains, by classroom sinks, or on concrete floors with leaks or frequent condensation.

10 Molds can be found almost anywhere; they can grow on virtually any substance, providing moisture is present. There are molds that can grow on wood, paper, carpet, and foods.


Source: U.S. Environmental Protection Agency,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Do You Know the Warning Signs of Asthma?

Asthma image Recognizing the signs and symptoms of asthma is important so that treatment and other interventions can begin early. If severe symptoms are present, it is vital to begin the appropriate treatment immediately. Accurate and timely assessment of symptoms can help you and your doctor decide if treatment should begin in the home, at your doctor’s office, or in the emergency room.

Early Warning Signs of Asthma
Early warning signs are experienced before the start of an asthma episode. By recognizing these clues, early treatment can begin. These signs can be different for each person, and they may even differ for the same person with each episode. Some early warning signs may be noticed only by the individual, while others are more likely to be noticed by other people. In ad­dition, a downward trend in peak flow numbers can be a reliable early warning sign. Additional early warning signs include breathing changes, sneezing, moodiness, headache, runny or stuffy nose, coughing, chin or throat itchiness, feel­ing tired, dark circles under your eyes, trouble sleeping, and poor tolerance for exercise.

Asthma Episode Symptoms
Asthma symptoms indi­cate that an asthma episode is occurring. Changes have taken place in the airways and airflow is obstructed. Asthma epi­sode symptoms include wheezing, coughing, shortness of breath, tightness in the chest, and peak flow numbers in the caution or danger range. Individuals with asthma experience some or all of these symptoms during an asthma episode, and action should be taken to treat these symptoms before they become worse.

Severe Asthma Episode Symptoms
Severe asthma symp­toms indicate a life-threatening emergency. These include severe coughing, wheezing, shortness of breath, or tightness in the chest; difficulty talking or concentrating; experiencing shortness of breath when walking; breathing that is shallow and fast or slower than usual; hunched shoulders; nasal flaring; neck area and between or below the ribs moving inward with breathing; a gray or bluish tint to the skin, beginning around the mouth; and peak flow numbers in the danger zone.

If any of these severe asthma symptoms occur, seek emergency medical treatment right away, as these symp­toms indicate respiratory distress.


Source: National Jewish Health,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Talking with Your Doctor about Allergic Asthma

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If you’re living with allergic asthma, you know what a physical and emotional rollercoaster ride it can feel like. The best way to smooth out the ups and downs is by working with your healthcare professional to identify the precise triggers of your asthma symp­toms. Once these are identified, you can take the appropriate steps toward effective treatment.

To identify your asthma triggers, your doctor will most likely collect your medical history, perform a physi­cal exam, and perform an allergy skin test that will help determine how sen­sitive you are to a specific allergen. If you’re like the majority of people with asthma, your symptoms are triggered by an allergic component that may re­quire special attention. Talking with your doctor about treatments specifi­cally for allergic asthma can offer the opportunity to develop a personalized treatment plan or to fine-tune one that already exists.

If you’re like the majority of people with asthma, your symptoms are triggered by an allergic component that may re­quire special attention.

A good place to start the conversation is by describing your asthma symptoms. Choose your words carefully, however. They can greatly affect your doctor’s assessment of your health and the sub­sequent course of treatment he or she recommends. Blood tests, skin tests, and readings from a peak flow meter all provide valuable information, but it’s your symptoms that point your doc­tor in the right direction.

In fact, you should review your symp­toms before you even enter the waiting room. Make sure you know how you would answer the following questions:

  • What exactly are my symptoms? Have they changed recently?
  • When do I find myself having them? How long do they last?
  • Do they prevent me from doing normal activities like sleeping, house­work, yard work, or going to work or school?

In addition to answering questions about your asthma symptoms, you’ll most likely be asked to describe your living conditions. For example, your doctor may want to know about your home’s location, any surrounding plant life, the type of heating system you have, the type of pillow you use, the type of fabric on your furniture, and so on. De­tails like these provide valuable clues into the cause of your symptoms and suggest possible ways to reduce your exposure to an offending allergen.

The accuracy of the information you provide is essential to finding the right treatment to target the inflamma­tion involved in allergic reactions.

Remember, you are the most impor­tant part of your treatment plan.


Source: Asthma and Allergy Foundation of America,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

The Allergy & Asthma Fighters Guide to Enjoying the Holidays

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Remember that homemade items don’t come with ingredients lists.

Do allergies & asthma threaten to be the Grinch in your hol­idays? Here are some tips to help keep your season merry.

Holiday Stress
The holidays are filled with hustle and bustle, but stress can trigger an asthma attack. Shop early or late in the day to avoid crowds. If “quiet time” isn’t a part of your normal routine, now is the time to start.

Hearth Health
Fires burning in the hearth bring warmth and ambiance to a holiday get-together. However, the smoke and ash can smother the spirit for some, provoking breathing difficulties or triggering an asthma attack. Request the Yule log remain unlit.

Dusty Decorations
Clean dust from artificial Christmas trees and other hol­iday decorations before displaying them. Remember that glass, metal, and plastic decorations are easier to keep dust free than soft, fabric ones.

O Christmas Tree
Some people can be allergic to Christmas trees. Reduce your reaction by shaking your tree thor­oughly – many vendors have a machine that can do this – and allowing it to dry for a few days in a covered area before bringing it indoors.

Fido and Fluffy
Prepare for visits to homes with pets by taking your allergy or asthma medication before the visit. The medication may help reduce your reaction. You can also ask party hosts to keep pets in a separate room. When staying overnight with family or at a hotel, you can reduce allergic reactions to dust mites and pet dander by bringing your own allergen-proof pillow.

Homemade Goodies
Food is a cen­tral fixture in most holiday gatherings. Remember that homemade items don’t come with ingredients lists. If you or your child has food allergies, be cau­tious, especially around homemade treats. Foods can become tainted through cross-contamination in the baker’s kitchen or food storage con­tainers – and even a trace amount can trigger a reaction.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Food Allergies vs. Food Intolerances

by Dr. Stephen Wangen

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The most common example of a food intolerance is a digestive enzyme deficiency, such as lactose intolerance, in which a person cannot properly digest milk products.

The terms food allergy and food intolerance are frequently misunderstood and misused. They cause confusion even among doctors and other members of the medical community. Although they are sometimes used interchangeably, they really refer to two different types of physiological events. With an allergy, the body’s immune system attacks something that it shouldn’t. However, an intolerance doesn’t arise from the immune system at all. It is important that we more thoroughly define these two types of reactions to food.

Allergies are reactions that involve the immune system. The immune system is very complex and is still not very well understood. But basically, it functions like a sentinel standing guard against foreign invaders – in the case of allergies, the invaders are allergens. One weapon it uses against invaders is the production of antibodies, which cause reactions that result in the offending allergens being removed from the body, often via an inflammatory process.

Foods should not normally trigger an immune response. Unfortunately, all too often, they do, and the immune system produces antibodies that target the food and circulate throughout the body, which is why an allergic reaction can show up in such a variety of symptoms just about anywhere in the body. These antibodies in turn trigger inflammation, which can result in pain and tissue damage, leading to further symptoms. The immune response can also produce excess mucous or, in the case of celiac disease, an autoimmune reaction that damages the lining of the digestive tract.

With an allergy, the body’s immune system attacks something that it shouldn’t. However, an intolerance doesn’t arise from the immune system at all.

It is not understood why an allergy to a given substance is expressed so differently in different people. Some people get hives and swelling of the lips and tongue. Others get digestive problems, migraines, or arthritis. Each individual seems to have a unique weak point where symptoms show up first. However, more research continues to be published that demonstrates a connection between various health problems and an immune response to food.

Strictly speaking, food intolerance is any type of non-immune reaction to or problem with a food. The most common example is a digestive enzyme deficiency, such as lactose intolerance, in which a person cannot properly digest milk products.

Some people have an intolerance to fructose, a type of sugar molecule. A person with a fructose intolerance does not digest or tolerate this molecule well. Fructose is found in many foods, such as fruits, and is derived from foods such as corn for use as a sweetener in processed foods. It is often listed on labels as high fructose corn syrup.

Another example is when people experience stomach pain or heartburn after eating spicy food. Although this can be caused by an allergy, in most cases it is simply a negative reaction to these foods that appears to have nothing to do with the immune system. This type of reaction also does not appear to be an enzyme deficiency.

Other intolerances include reactions to preservatives (such as sulfites and nitrites), colorants (FD&C colors), and flavorants (such as monosodium glutamate and aspartame). There are certainly other food intolerances, many of which have yet to be discovered or defined. Medically speaking, we classify these poorly understood reactions to foods or food additives as intolerances; they are also sometimes called sensitivities, another poorly defined word. There is no technical distinction between an intolerance and a sensitivity. Both are catch-all terms.


Dr. Stephen Wangen is a nationally recognized expert in the field of gluten intolerance, a gluten-intolerant physician, and cofounder of the IBS Treatment Center.

Reprinted with permission from Healthier without Wheat: A New Understanding of Wheat Allergies, Celiac Disease, and Non-Celiac Gluten Intolerance by Dr. Stephen Wangen, copyright © 2009 by Stephen Wangen.

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Cold, Allergies, or Sinusitis?

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Cold weather is a prime time for stuffy noses, sore throats, and watery, itchy eyes. But if your symptoms last more than a week, or if they seem to turn off and on based on your surround­ings, you may be battling allergies or sinusitis. Proper diagnosis and treat­ment can lead to a quicker recovery.

Colds are caused by a virus, whereas allergies are caused by exposure to allergens. Colds and allergies can both lead to sinusitis, which occurs when the sinuses become swollen and block mucus from draining, leading to pain­ful pressure and infection.

Sinusitis can last for months, even years, if not properly treated. A doc­tor can diagnose sinusitis through a physical examination, but diagnosis may also require allergy testing, X-rays, or use of a fiber-optic scope.

Colds are the most common cause of sinusitis, but people with allergies or asthma are more likely to develop sinusitis.

Colds are the most common cause of sinusitis, but people with allergies or asthma are more likely to develop sinusitis because their nasal and sinus tissue can become swollen when they breathe in triggers like dust, pollen, or smoke.

When sinusitis is caused by an in­fection, antibiotics are used to kill the bacteria. Other treatments can include decongestants, nasal sprays, hot packs, humidifiers, and saltwater rinses.

If you have allergies, there are steps you can take to reduce your risk of si­nusitis. Your doctor may recommend long-term treatments, such as allergy shots, medication to control inflamma­tion, and avoidance of allergy triggers.

Knowing whether your symptoms are caused by a cold, allergies, or si­nusitis is the first step toward choosing the proper treatment.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Soothing the Symptoms of Eczema

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One common skin condition, especially in some infants and children, is atopic dermatitis, or eczema. Atopic dermatitis is difficult to treat – but it can be controlled. Atopic dermatitis can be triggered by a number of factors, including allergy and emotional stress. It involves high levels of immunoglobulin E (IgE), the major allergy antibody, and is related to the development of other allergies, such as allergic rhinitis and asthma, in most children.

In some people, inhaled allergens (such as dust mites, animal dander, and pollen) can cause flare-ups of atopic dermatitis. A bacterial, fungal, or viral infection also can cause a flare-up. Food allergies may trigger an episode in children, but rarely in adults. Atopic dermatitis is not contagious. Sometimes, though, scratching can lead to a bacte­rial infection.

Treating Eczema
Treatment begins with efforts to reduce the itching and inflammation, hydrating the skin, and removing the “flare factors,” such as infections and exposure to allergens and irritants. To soothe symptoms, bathe in warm (not hot) water for no more than three to five minutes. Use superfatted, unscented soap or a soap substitute. Pat your skin dry, and promptly apply a mois­turizer to help keep the skin hydrated. Trim fingernails to reduce problems from scratching. At night, cotton socks or gloves can be worn to prevent scratch­ing while asleep. If the rash is oozing, your doctor may prescribe a lotion to dry the rash and an antibiotic to treat infection. If the rash is on the face, do not use a corticosteroid product.

Atopic dermatitis can be triggered by a number of factors, including allergy and emotional stress.

Use a humidifier in the winter to keep skin from drying out, and avoid chemi­cals and extreme heat or cold, which can worsen eczema. Use cosmetics lightly and seldom, and avoid products with perfume, dyes, and ingredients such as urea, lactic acid, or other alpha hydroxy acids.

Avoid wool, polyester, wrinkle-resistant, flame-retardant, and scratchy fabrics in clothes and bedding. Instead, wear open-weave, loose-fitting cotton or cotton-blend garments. Wash new clothes before wearing them with mild, unscented liquid laundry detergent. Avoid liquid fabric softeners and dryer sheets. Rinse clothing and bedding thoroughly after washing to remove detergent residue.

Reduce indoor allergens, particularly dust mites, by washing bedding in hot water and removing rugs, upholstered furniture, stuffed toys, and curtains where possible. Wear gloves when doing housework. If a link with food has been diagnosed, eliminate it from your diet.

Avoid stress, which can add to flare-ups. People often feel angry and frustrated by the chronic itching. Know that with proper treatment the condition can be controlled.

Topical steroids are key for control­ling the itching and inflammation of eczema. Used immediately after bath­ing, they also help keep the skin hydrated. Antihistamines and antianxiety medi­cations may also help relieve itching. Antibiotics are used to treat complicat­ing skin infections.


Source: Asthma and Allergy Foundation of America,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Bid Bon Voyage to Allergies & Asthma During Your Winter Vacation

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Preparation and prevention pave the way to successful travel for the millions of people who have allergies & asthma. The following tips can help you keep these conditions at bay while you’re on vacation.

Consider an Allergen-Free Desti­nation
Beaches and mountains are excellent year-round destinations for people with allergies. Ocean breezes are generally free of allergens, dust mites are fewer at elevations above 2,500 feet, and mold spores can’t sur­vive in snow. Check the weather and pollen forecasts of your desired destina­tion, and plan accordingly.

Pack Your Allergy and Asthma Gear
Bring your medications in your carry-on luggage, in their original packaging. Include quick-relief med­ications for asthma and an epinephrine auto-injector if you or a family mem­ber has food or insect sting allergies. Don’t forget topical hydrocortisone cream, an antihistamine, and your peak flow meter and nebulizer. Also, consider packing your own dust mite-proof pillowcases, and bring wipes to clean trays and tables if you have food allergies.

Talk to Your Doctor or Allergist
Checking in before departure is espe­cially important if you’ll be traveling abroad and may need vaccinations or immunizations. Also, discuss where you’re going and what activities you may do. For example, locations with elevations above 5,000 feet may make breathing difficult, and cold weather can be a trigger for people with asthma. Peo­ple with asthma should also talk with a doctor or allergist before engaging in certain activities, like scuba diving.

Check Access to Medical Care
If you’re traveling to a remote location or going on a cruise, you should ask in advance about the type of medical care available.

Prepare for the Ride
If you’re trav­eling by car, travel during early morning or late evening hours, when air quality is better and traffic isn’t as heavy. If you rent a car, ask for one in which no one has smoked. Keep your car windows closed, and use your air conditioner for temperature control. Consider get­ting your automobile’s air conditioner cleaned in advance.

When traveling by air, take an antihistamine in advance. If you’re congested, use your regular medica­tion and consider using a long-acting decongestant nasal spray before take-off and landing. Notify the airline of food allergies ahead of time. Get up frequently and walk around the cabin, drink plenty of fluids and avoid alco­hol to stay hydrated, and use a saline nasal spray once every hour to keep your nasal membranes moist.

To reduce your exposure to allergens when you’re away from home, request a nonsmoking hotel room. When choosing a hotel, remem­ber that air conditioners and portable air cleaners with HEPA filters and tile, wood, or seamless vinyl floors reduce airborne allergens. If you have food allergies, consider reserving a hotel room with a kitchen so you can make your own meals. If you’re traveling to a non-English speaking destination, bring translated information about your food allergies for restaurant chefs.


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Have a Sneeze-Free, Wheeze-Free Winter

Allergy and Asthma image Spring and fall are not the only seasons that prove troublesome for those with allergies & asthma. Winter weather causes people to spend more time indoors, where a host of household allergens can be found. For people with asthma, cold air and out­door winter activities can worsen asthma symptoms. Fortunately, there are things you can do to have a sneeze-free, wheeze-free winter.

Winter Allergies
Even though freezing temperatures bring an end to seasonal pollen allergies, millions of people experience indoor allergies because of the time spent indoors dur­ing cool weather. A home can actually contribute to allergy symptoms. Some common symptoms of indoor winter allergies are sneezing; runny or stuffy nose; coughing; postnasal drip; and itchy eyes, nose, and throat. The following tips can help you keep your home free of wintertime allergens and irritants:

♦ Clean regularly.
There is no widely recognized guideline for how often you should dust and vacuum your home, but a solid cleaning once a week should help keep dust and allergen levels down. Use a damp mop for cleaning hard floors to avoid stirring up dust.

♦ Avoid exposure.
If you are the one who is experiencing allergy or asthma symptoms during the winter months, have someone else in your house do the dusting and vacuuming. When you vacuum and dust, allergens get kicked up into the air, and you can be affected if you’re around. If you can, leave the house while the cleaning is being done.

Winter weather causes people to spend more time indoors, where a host of household allergens can be found.

♦ Crack a window.
It may help to open a window or door on warmer days. Especially try to air out your house right after cleaning so the allergens and dust you’ve kicked up have a place to escape.

♦Watch out for mold.
Mold can be an irritant for some people, so be on the lookout for moisture. Good insulation can help cut down on mold by reducing condensation on cold surfaces, and dry­ing wet surfaces can keep mold from growing. Also, make sure you use your bathroom ventilation fan if you have one or crack a window while shower­ing to let the moisture escape. If you have mold, clean it up using soap and water, and then follow up with a diluted bleach mixture.

♦ Beware of gas ranges.
Using gas stoves and cooktops releases nitrogen oxides into the air. These nitrogen ox­ides can irritate the lungs of individuals with asthma or other lung health issues. If you have a gas stove, make sure you use the ventilation hood in your kitchen or crack a window while cooking.

Exercise-Induced Asthma and Cold Weather Activities
Unfortunately for people with asthma, skiing, snow­boarding, ice skating, and other winter sports have more than snow and ice in common – they also involve exposure to cold air, which is an asthma trigger for some people.

As with most forms of allergies, prevention is the best way to control exercise-induced asthma. This is also true for these winter sports. Fortu­nately, exercise-induced asthma can be controlled in most cases by using your physician-prescribed asthma in­halers before exercising. (Check with your doctor before changing any treat­ment regimen.) These are safe, easy to use, and effective.

Taking the time to warm up before exercise is important, as well. By tak­ing some time to warm up your body with light activity, you’ll have some added protection, because the body produces chemicals that protect against bronchospasm. This is not to be done instead of using your inhaler, but in addition to it. Both of these steps will lead to a better experience in these cold weather sports, as they do in all other sports.

Coughing and wheezing, followed by shortness of breath, are signs a per­son may have exercise-induced asthma. These symptoms usually appear 5 to 20 minutes after finishing the activity. Talk to your doctor if you are experi­encing these symptoms.

Additional tips for preventing exercise-induced asthma during winter sports include wearing a mask or scarf to warm cold air before breathing it; taking asthma medication 15 to 30 minutes before skiing, snowboarding, ice skating, or participating in other winter activities; and warming up 30 minutes before starting any cold-weather exercise or activity.


Source: National Jewish Health,

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

New Product Available for People with Anaphylactic Allergies

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A new line of handbags and accessory cases by Epi-Essentials ( is now available for those who carry epinephrine auto-injectors, more commonly known as the EpiPen;reg;. The collection combines modern style with a medical compartment that organizes a person’s epinephrine auto-injectors and related allergy medicines, such as inhalers and antihistamines.

Keep personal belongings & allergy necessities together, all in one super-cute and organized essential.

Allergy image

Crafted in colorful leather exteriors with the finest attention to details, dual-zip compartments (one personal, one medical) secure 2 EpiPens®, inhaler and antihistamines with instantly visible Allergy Action & Emergency Contact cards. A separate zip section for your "must-have" daily basics makes every day safe, stylish and complete.The prod­ucts are available in several colors and are versatile for the lifestyles of teens, college students, and adults.


This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Free Tool Promotes Adherence, Lowers Cost of Asthma

Online “Asthma PACT" Helps Patients and Parents

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The Asthma PACT™ (Personal Assessment and Control Tool) available at, is a free online program hosted by the Asthma and Allergy Foundation of America (AAFA) that helps patients and parents reduce the cost and suffering from asthma. The concept is simple: individuals with asthma must follow directions from their medical providers, including medications to take, to properly treat this chronic disease. The Asthma PACT helps patients and parents to identify reasons why they may be having difficulty following the treatment plan, and it gives feedback – in written and video formats – about how to manage these problems. Individuals can print their personal assessment and take it to their medical provider for further discussion. Jacqui Vok, AAFA’s Senior Educational Programs Manager, says, "Placing the Asthma PACT personalized assessment in the hands of their physicians empowers patients to get the advice they need to help them manage their asthma symptoms." The Asthma PACT is a validated asthma adherence survey that is currently being used in research projects at the National Institutes of Health (NIH).

"Each patient is their own cost center," says Andrew Weinstein, MD, a Board Certified allergist and President of Adherence Management Systems (AMS), developer of the Asthma PACT tool. "By focusing on why you have persistent symptoms, you can improve your health and reduce your cost of care." Also, according to Weinstein, the Asthma PACT "helps the patients self-identify the ‘rough areas’ and acts as a vehicle to bring potential solutions to the individual and family."

The key to education and counseling is to know why individuals are not following the directions. This is the value of the Asthma PACT in preventing sleepless nights, work and school absence and unnecessary emergency and healthcare costs.

An estimated 25 million Americans have asthma, 7.1 million under the age of 18. The annual cost of care is estimated at $19.7 billion, with 456,000 hospitalizations and 1.5 million ER visits. African Americans are three times more likely to be hospitalized or die from asthma. Inhaled corticosteroids effectively control symptoms and reduce morbidity, mortality, health care utilization and costs.

The Right Tool for a Big Problem
Weinstein treated 59 children with severe asthma in an inpatient rehabilitation setting at the Alfred I. duPont Hospital for Children. The year prior to treatment, the median cost per patient was $10,240. Each child had seven hospital days and four emergency room visits. At all four years of follow-up, median hospital days and emergency room visits were zero. The cost of care fell below $2,000 at the end of the fourth year. The key to the success of the program was the ability of the health care team to identify the difficulties that the family was experiencing following the treatment plan and helping them become successful.

These outcomes were duplicated in the outpatient setting in children with severe asthma at the same hospital and in adult patients with severe asthma referred by Blue Cross Blue Shield Delaware. Weinstein transferred the analytic questions from his adherence care model and, in partnership with AAFA, made it available online as the Asthma PACT at no charge for all asthma patients and parents.

Adherence - The Key to Controlling Healthcare Costs
Despite high-profile discussions to control healthcare costs, there is little emphasis on the contributors to high costs, nor the actions that can be taken to reduce costs. Individuals with chronic diseases such as asthma, diabetes and heart disease are responsible for more than 80% of all health care costs due to medications, physician visits, hospitalizations, emergency care, and disability caused by these diseases. It has long been observed that 45-60 percent of individuals with these chronic diseases do not follow their prescribed medication plans, called "non-adherence" or "non-compliance," which further adds an estimated $600 million to the annual cost of care in the U.S.

Experts have identified more than twenty reasons why so many asthma patients are non-adherent; however, a partial list includes - cost; comprehension of instructions; concern about side effects; lack of support; emotional response to symptoms; disagreeing with the diagnosis; and believing the medication is ineffective.

Asthma PACT Increases Adherence, Decreases Costs
The Asthma PACT includes 75 percent of these "reasons for non-adherence" and presents them in an organized way to the patient and provider. One problem area that is now beginning to be addressed by medical schools and residency programs is the lack of counseling skills by practicing physicians. The personnel in the asthma rehabilitation program mentioned above had psychological training to help the families work through the obstacles that were preventing them from consistently giving the medication. Most individuals with asthma do not have significant psychological issues and can be helped by practitioners with basic counseling skills. But the key to education and counseling is to know why individuals are not following the directions. This is the value of the Asthma PACT in preventing sleepless nights, work and school absence and unnecessary emergency and hospital care and healthcare costs.


Visit for more information. "Asthma PACT™" and "" are trademarks of the Asthma and Allergy Foundation of America (AAFA). .

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2011-2012.

Take Action Against Asthma

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Take control of your asthma and get back in action.

Taking an active role to control your asthma involves working with your healthcare team to create and follow an asthma action plan. It also means avoiding factors that can make your asthma flare up and treating other conditions that can interfere with asthma management.

An asthma action plan gives guidance on taking your medicines properly, avoiding factors that worsen your asthma, tracking your level of asthma control, responding to worsening asthma, and seeking emergency care when needed.

Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or “rescue,” medicines relieve asthma symptoms that may flare up.

Your initial asthma treatment will depend on how severe your disease is. Follow-up asthma treatment will depend on how well your asthma action plan is working to control your symptoms and prevent you from having asthma attacks.

Your level of asthma control can vary over time and with changes in your home, school, or work environments that alter how often you are exposed to the factors that can make your asthma worse. Your doctor may need to increase your medicine if your asthma doesn’t stay under control.

If your asthma is well controlled for several months, your doctor may be able to decrease your medicine.

On the other hand, if your asthma is well controlled for several months, your doctor may be able to decrease your medicine. These adjustments, either up or down, to your medicine will help you maintain the best control possible with the least amount of medicine necessary.

Asthma Action Plan
You can work with your doctor to create a personal written asthma action plan. The asthma action plan shows your daily treatment, such as what kind of medicines to take and when to take them. The plan explains when to call the doctor or go to the emergency room.

If your child has asthma, all of the people who care for him or her should know about the child’s asthma action plan. This includes babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.

Asthma Triggers
A number of common things (sometimes called asthma triggers) can set off or worsen your asthma symptoms. Once you know what these factors are, you can take steps to control many of them. For example, if exposure to pollens or air pollution makes your asthma worse, try to limit time outdoors when the levels of these substances are high in the outdoor air. If animal fur sets off your asthma symptoms, keep pets with fur out of your home or bedroom.

If your asthma symptoms are clearly linked to allergies and you can’t avoid exposure to those allergens, then your doctor may advise you to get allergy shots for the specific allergens that bother your asthma. You may need to see a specialist if you are thinking about getting allergy shots. These shots may lessen or prevent your asthma symptoms, but they can’t cure your asthma.

Several health conditions can make asthma more difficult to manage. These conditions include runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. Your doctor will treat these conditions as well.

Your doctor will consider many things when deciding which asthma medicines are best for you. Doctors usually use a stepwise approach to prescribing medicines. Your doctor will check to see how well a medicine works for you; he or she will make changes in the dose or medicine, as needed.

Asthma medicines can be taken in pill form, but most are taken using a device called an inhaler. An inhaler allows the medicine to go right to your lungs. Not all inhalers are used the same way. Ask your doctor to show you the right way to use your inhaler. Ask him or her to review the way you use your inhaler at every visit.

Most people who have asthma need to take long-term control medicines daily to help prevent symptoms. The most effective long-term medicines reduce airway inflammation. These medicines are taken over the long term to prevent symptoms from starting. They don’t give you quick relief from symptoms.

If your doctor prescribes a long-term control medicine, take it every day to control your asthma. Your asthma symptoms will likely return or get worse if you stop taking your medicine. Long-term control medicines can have side effects. Talk to your doctor about these side effects and ways to monitor or avoid them.

All people who have asthma need a quick-relief medicine to help relieve asthma symptoms that may flare up. These medicines act quickly to relax tight muscles around your airways when you’re having a flare-up. This allows the airways to open up so air can flow through them.

You should take your quick-relief medicine when you first notice your asthma symptoms. If you use this medicine more than two days a week, talk with your doctor about how well controlled your asthma is. You may need to make changes in your asthma action plan.

Carry your quick-relief inhaler with you at all times, in case you need it. If your child has asthma, make sure that anyone caring for him or her and the child’s school has the child’s quick-relief medicines. They should understand when and how to use them and when to seek medical care for your child.

You shouldn’t use quick-relief medicines in place of prescribed longterm control medicines. Quick-relief medicines don’t reduce inflammation.

Emergency Care
Most people who have asthma, including many children, can safely manage their symptoms by following the steps for worsening asthma provided in the asthma action plan. However, you may need medical attention. Call your doctor for advice if

  • your medicines don’t relieve an asthma attack.
  • your peak flow is less than half of your personal best peak flow number.

Call 9-1-1 for an ambulance to take you to the emergency room of your local hospital if

  • you have trouble walking and talking because you’re out of breath.
  • you have blue lips or fingernails.

At the hospital, you will be closely watched and given oxygen and more medicines, as well as medicines at higher doses than you take at home. Such treatment can save your life.


Source: National Heart, Lung and Blood Institute,

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2010.

Are Allergies Making You Fuzzy?

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Sneezing, wheezing, watery eyes, and a runny nose aren’t the only symptoms of allergic diseases. Many people with allergic rhinitis also report feeling “slower” and drowsy. When their allergies are acting up, they have trouble concentrating and remembering.

For instance, allergic rhinitis can be associated with decreased ability to concentrate and function, activity limitation, decreased decision-making capacity, impaired hand-eye coordination, problems remembering things, irritability, sleep disorders, fatigue, missed days at work or school, more motor vehicle accidents, and more school or work injuries.

Many parents of children with allergic rhinitis observe increased bad moods and irritability in their child’s behavior during the allergy season. Since children cannot always express their uncomfortable or painful symptoms verbally, they may express their discomfort by acting up at school and at home. In addition, some kids feel that having an allergic disease is a stigma that separates them from other kids.

It is important that the irritability or other symptoms caused by ear, nose, or throat trouble not be mistaken for attention deficit disorder. With proper treatment, symptoms can be kept under control and disruptions in learning and behavior can be avoided.

Experts believe the top two culprits contributing to cognitive impairment of people with allergic rhinitis are sleep interruptions and sedating antihistamine (over-the-counter) medications.

If you have bad allergic rhinitis, you may waken a dozen times a night.

Secondary factors, such as blockage of the Eustachian tube (ear canal), also can cause hearing problems that have a negative impact on learning and comprehension. Constant nose blowing and coughing can interrupt concentration and the learning process, and allergy-related absences from school or work can cause people to fall behind.

Sleep Disruption
Chronic nasal congestion can cause difficulty in breathing, especially at night. Waking is a hard-wired reflex to make you start breathing again. If you have bad allergic rhinitis, you may waken a dozen times a night. Falling back asleep can be difficult, cutting your total number of sleep hours short.

The average person needs about eight hours of sleep per night to function normally the next day. Losing just a few hours of sleep can lead to a significant decrease in your ability to function. Prolonged loss of sleep can cause difficulty in concentration and ability to remember things, and can contribute to automotive accidents. Night after night of interrupted sleep can cause serious decreases in learning ability and performance in school or on the job.

Over-the-Counter Medications
Most allergy therapies don’t take into account the effects of allergic rhinitis on mental functioning – they treat the more obvious physical symptoms. Some allergy therapies may even cause some cognitive or mental impairment. The most commonly used over-the-counter medications for allergy symptoms are decongestants and first-generation antihistamines, such as diphenhydramine (Benadryl®), both of which can cause sleep disturbances.

Decongestants constrict small blood vessels in the nose. This opens the nasal passageways and lets you breathe easier. Some decongestants are available over the counter, while higher strength formulas are available with a prescription. In some people, oral decongestants can cause problems with getting to sleep, appetite loss, and irritability, which can contribute to allergy problems. If you have any of these symptoms, discuss them with your allergist.

Antihistamines block the effects of histamine, a chemical produced by the body in response to allergens. Histamine is responsible for the symptoms of allergic rhinitis. First-generation over-the-counter antihistamines available in the United States also can cause drowsiness. Regularly taking over-thecounter antihistamines can lead to a feeling of constant sluggishness, affecting learning, memory, and performance. Newer second-generation antihistamines are designed to minimize drowsiness while still blocking the effects of histamine.

The best way to control your symptoms is to avoid your triggers. This is often easier said than done. If your allergens can’t be avoided, your allergist can help you create an allergy treatment plan. Several types of nonsedating medications are available to help control allergies. If medications are not effective or cause unwanted side effects, your allergist may suggest immunotherapy, or allergy shots. Immunotherapy is used to treat allergy to pollen, ragweed, dust mites, animal dander, and other allergens. This process gradually desensitizes you to these substances by changing the way your body’s immune system responds to them.

If allergies are affecting your ability to concentrate or function, several treatment options may be beneficial. Getting allergy symptoms under control can help you sleep at night and function during the day.

If you suspect that you or a family member may have an allergic disorder, make an appointment with your allergist for proper diagnosis. Treating allergies sooner rather than later can help prevent disruptions in learning and behavior.


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Living with Asthma

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Asthma is a long-term disease that requires long-term care. Successful asthma treatment requires you to take an active role in your care. Taking an active role to control your asthma involves working with your doctor and other clinicians on your healthcare team to create and follow an asthma action plan. Children aged 10 or older – and younger children who are able – also should take an active role in their asthma care.

Learn How to Manage Your Asthma
Partner with your doctor to develop an asthma action plan. This plan will help you to properly take your medicines, identify your asthma triggers, and manage your disease if asthma symptoms worsen.

If your child has asthma, all of the people who care for him or her should know about the child’s asthma action plan. This includes babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.

Most people who have asthma can successfully manage their symptoms at home by following their asthma action plans and having regular checkups.

Most people who have asthma can successfully manage their symptoms at home by following their asthma action plans and having regular checkups. However, it’s important to know when to seek emergency medical care.

Learn how to use your medicines correctly. If you take inhaled medicines, you should practice using your inhaler at your doctor’s office. If you take longterm control medicines, take them daily as your doctor prescribes.

Record your asthma symptoms as a way to track how well your asthma is controlled. Also, you may use a peak flow meter to measure and record how well your lungs are working. Your doctor may ask you to keep records of your symptoms or peak flow results daily for a couple of weeks before an office visit and bring these records with you to the visit.

These steps will help you keep track over time of how well you’re controlling your asthma. This will help you spot problems early and prevent or relieve asthma attacks. Recording your symptoms and peak flow results to share with your doctor also will help him or her decide whether to adjust your treatment.

Ongoing Care
Have regular asthma checkups with your doctor so he or she can assess your level of asthma control and adjust your treatment if needed. Remember, the main goal of asthma treatment is to achieve the best control of your asthma using the least amount of medicine. This may require frequent adjustments to your treatments.

If it’s hard to follow your plan or the plan isn’t working well, let your healthcare team know right away. They will work with you to adjust your plan to better suit your needs. You should also get treatment for any other conditions that can interfere with your asthma management.

Watch for Signs That Your Asthma is Getting Worse
Your asthma may be getting worse if

  • your symptoms start to occur more often, are more severe, and/or bother you at night and cause you to lose sleep.
  • you’re limiting your normal activities and missing school or work because of your asthma.
  • your peak flow number is low compared to your personal best or varies a lot from day to day.
  • your asthma medicines don’t seem to work well anymore.
  • you have to use your quick-relief inhaler more often. If you’re using quick-relief medicine more than two days a week, your asthma isn’t well controlled.
  • you have to go to the emergency room or doctor because of an asthma attack.

If you have any of these signs, see your doctor. He or she may need to change your medicines or take other steps to control your asthma.

Emergency Care
Most people who have asthma, including many children, can safely manage their symptoms by following the steps for worsening asthma provided in their asthma action plan. However, you may need medical attention. Call your doctor for advice if your medicines don’t relieve an asthma attack or your peak flow is less than half of your personal best peak flow number.

Call 911 for an ambulance to take you to the emergency room of your local hospital if you have trouble walking and talking because you’re out of breath or you have blue lips or fingernails.

At the hospital, you will be closely watched and given oxygen and more medicines, as well as medicines at higher doses than you take at home. Such treatment can save your life.

Partner with your healthcare team and take an active role in your care. This can help control asthma so it doesn’t interfere with your activities and disrupt your life.


Source: National Heart, Lung and Blood Institute,

This article was originally published in Coping® with Allergies & Asthma magazine, March/April 2010.

New Survey Reveals Emotional Impact of Food Allergy on Children

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A recent survey conducted by the Food Allergy & Anaphylaxis Network and Galaxy Nutritional Foods examined parents’ perspectives on the emotional impact that food allergies have on their children.

Nearly 70 percent of the parents of children with food allergies surveyed said having a food allergy has affected their child’s quality of life, with 40 percent indicating their child’s life was impacted “somewhat,” and 29 percent “a great deal.”

The survey also asked parents about food allergy prevalence in schools and societal understanding of the medical condition. According to the survey, 47 percent of parents indicated that they were aware of one to two other children in their child’s classroom who also had food allergies. This finding is in line with the latest statistics that show 1 in 13 U.S. children have a food allergy. Additionally, the survey found that a majority of parents of children with a food allergy felt that school personnel had an “excellent” or “good” understanding of food allergy.

The survey also explored participation in everyday life events – activities that most of the general population takes for granted. For parents of children with food allergies, common events such as eating out at a restaurant, attending a birthday party, or sleeping over at a friends’ house can be concerning. According to the parents surveyed, they choose not to have their children participate in many of these everyday life events.


This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Get Relief from Sinus Pain

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Your nose is stuffy. You have thick, yellowish mucus. You’re coughing, and you feel tired and achy. You think that you have a cold. You take medicines to relieve your symptoms, but they don’t help. When you also get a terrible headache, you finally drag yourself to the doctor. After listening to your history of symptoms and examining your face and forehead, the doctor says you have sinusitis.

What Is Sinusitis?
Sinusitis simply means your sinuses are inflamed – red and swollen – because of an infection or another problem. There are several types of sinusitis:

Acute, which lasts up to 4 weeks
Subacute, which lasts 4 to 12 weeks
Chronic, which lasts more than 12 weeks and can continue for months or even years
Recurrent, with several attacks within a year

What Causes Sinusitis?
Anything that causes swelling in the nose can block the openings between your paranasal sinuses and your nose, including a cold, allergies, or a reaction to some chemical to which you’ve been exposed. The blockage causes air and mucus to become trapped within the sinuses. This may cause pain and thickened mucus.

If you have nasal allergies along with sinusitis, your doctor may recommend medicine to control your allergies.

The pain of a sinus attack arises because the trapped air and mucus put pressure on the mucous membrane of the sinuses and the bony wall behind it. Also, when a swollen membrane at the opening of a paranasal sinus prevents air from entering into the sinuses, it can create a vacuum that causes pain.

Mucus thickens because it loses its water content as it stays trapped inside the sinuses for a long time. In addition, inflammation leads to extra materials being secreted into the mucus, causing thickening.

How Is Sinusitis Treated?
If you have acute sinusitis, your doctor may recommend antibiotics to control a bacterial infection, if present; pain relievers to reduce any pain; or decongestants. Even if you have acute sinusitis, your doctor may choose not to use an antibiotic because many cases of acute sinusitis will end on their own. However, if you do not feel better after a few days, you should contact your doctor again.

If you have nasal allergies along with sinusitis, your doctor may recommend medicine to control your allergies. This may include a nasal steroid spray that reduces the swelling around the sinus passages and allows the sinuses to drain.

If you have asthma and then get sinusitis, your asthma may worsen. You should contact your doctor, who may change your asthma treatment.

Healthcare professionals often find it difficult to treat chronic rhinosinusitis successfully. They have two options to offer: medicine and surgery.

Nasal steroid sprays are helpful for many people, but most people still do not get full relief of symptoms with these medicines. Physicians occasionally recommend a long course of antibiotics, but results from clinical research do not support this kind of antibiotic use. Saline washes or saline nasal sprays can be helpful in chronic rhinosinusitis because they remove thick secretions and allow the sinuses to drain. Oral steroids, such as prednisone, may be prescribed for severe chronic rhinosinusitis. However, oral steroids are powerful medicines with significant side effects, and these medicines typically are prescribed when other medicines have failed.

When medicine fails, surgery may be the only alternative for treating chronic rhinosinusitis. The goal of surgery is to improve sinus drainage and reduce blockage of the nasal passages. Nasal surgery usually is performed to enlarge the natural openings of the sinuses, remove nasal polyps, or correct significant structural problems inside the nose and the sinuses if they contribute to sinus obstruction. Although most people have fewer symptoms and a better quality of life after surgery, problems can reoccur, sometimes even after a short period.

In children, problems can sometimes be eliminated by removing the adenoids. These gland-like tissues, located high in the throat behind and above the roof of the mouth, can obstruct the nasal passages.

Can Sinusitis Be Prevented?
There are no methods that have been scientifically proven to prevent acute or chronic sinusitis. However, some measures may help.

Keep your nose as moist as possible with frequent use of saline sprays or washes. Avoid very dry indoor environments and use a humidifier, if necessary. Be aware, however, that a humid environment also may increase the amount of mold, dust mite, or cockroach allergens in your home; this is important only if you are allergic to any of these organisms.

Avoid exposure to irritants, such as cigarette and cigar smoke, or strong odors from chemicals. Avoid exposure to substances to which you are allergic. If you haven’t been tested for allergies and you are getting frequent sinus infections, ask your doctor to give you an allergy evaluation or refer you to an allergy specialist.


Source: National Institute of Allergy and Infectious Diseases,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Most States Don't Make the Grade on Asthma & Allergy School Health

Report Finds States Lack Policies to Curb Classroom Burden of Asthma and Severe Allergies

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For over 7 million children with asthma, and 13 million with food allergy or other severe allergies, going to school is a daily risk affecting how well they can – or can't – manage their diseases. Now for the fourth year, the Asthma and Allergy Foundation of America (AAFA) has released its annual report assessing all 50 states and the District of Columbia on their leadership and progress on school-based policies that address student asthma and allergy health in more than 100,000 elementary, middle and high schools across the U.S.

The result: most states still don't make the grade.

Signs of Leadership
Each year, the Foundation's report, the "State Honor Roll™ of Asthma and Allergy Policies for Schools," outlines 18 school-related core policies proven to affect positive healthy school environments, then assesses each state on how many of these policies they have adopted. If a state has enacted at least 15 of the policies, it is listed on the Foundation's "Honor Roll." This year, six states achieved this distinction:

  • Connecticut
  • Massachusetts
  • New Jersey
  • Rhode Island
  • Vermont
  • Washington

AAFA is announcing the results of the study at an international medical conference in Boston this weekend. Full results, including detailed state profiles and charts, are available at The report Web site also has several links to free resources for parents, advocates, schools and policymakers.

Core policies include state-wide standards for appropriate school nurse-to-student ratios, laws allowing students to carry and administer their asthma and anaphylaxis medication, indoor air quality for school buildings, smoking bans, and more.

"New England has been committed to student health, and public health overall, for decades," says Judi McAuliffe, RN, a school nurse in the Pembroke, Massachusetts, school district. "I'm not really surprised that we continue to lead the rest of the country on asthma and allergy health, I just wish others would follow," says McAuliffe. According to the Foundation, these 6 Honor Roll states demonstrate leadership on asthma and allergy school health. "They provide a blueprint for parents and patient advocates around the country," says Tom Flanagan, Chair of AAFA's national Board of Directors, and a parent of a child with severe allergies," but there has been limited progress in too few places for such a huge public health problem."

The Burden on Schools
In the United States, asthma and allergies have a major and growing affect on schools. About 10 percent of kids (7.1 million children) have asthma. It is the #2 chronic disease among children (behind obesity) and the #1 chronic cause of student absenteeism (10.5 million school days missed annually due to asthma in 2008). Last year, 185 children died because of asthma. In addition, severe allergies and anaphylaxis – the most severe type of allergic reaction – are on the rise nationwide, particularly food allergies among children, forcing schools to prepare, manage and react to the problem. Plus, millions of adult teachers and staff in schools have asthma and allergies, as well.

With so many people affected in the school setting, these diseases create a burden on schools and communities, requiring improvements to indoor air quality (IAQ), emergency procedures and prevention training for food allergies, individual health plans for students, notifying parents of pesticide spraying, student access to medications such as epinephrine auto-injectors or albuterol inhalers, campus smoking bans and cessation programs, and more.

Many States Have Few Protections
While thousands of local schools and districts may show innovation and leadership in support of students and staff with asthma and allergies, strong state-wide policies are lacking throughout the U.S., with some rare bright spots. "Four New England states, New Jersey and Washington State have been on our Honor Roll for 4 years," says Charlotte Collins, JD, AAFA's Vice President of Policy and Programs, "but the gap from coast to coast is wide, with most states simply falling short. In fact, twelve states failed to achieve even half of the core policy standards," says Collins.

Even though broad improvements in the states has not yet been seen, AAFA found that overall, most states are at least taking a few steps each to address the needs of students with asthma and allergies in the school setting. For example, most states now protect student access to their own medications, document chronic diseases, and prohibit smoking at school and on school buses. Currently, about half of the states fail to require schools to develop emergency protocols for asthma and anaphylaxis emergencies, and only five recommend that schools provide at least one nurse per 750 students.

Anaphylaxis on the Policy Frontier
"One major positive finding in this year's report is that nearly every state in the U.S. now has a law allowing students to carry and self-administer their epinephrine auto-injectors for allergic emergencies," says Flanagan. This is a major development compared to just 10 years ago when few states allowed – and in fact prohibited – such access. Wisconsin and New York still don't have this law but their legislatures are considering policies, "so those states are behind on this right now while all the other states are leading the way," says Flanagan.

Now that student self-use of epinephrine has near nationwide acceptance, other access issues have emerged. Surprisingly, states do not regulate emergency services consistently. Depending on where you live, some emergency medical technicians (EMTs) may not have access to epinephrine, or may not be permitted to administer the medication, or only permitted to assist administering a patient's own epinephrine auto-injector device. "This is a definite area of concern since school personnel rely on 911 services in these types of emergencies," says Collins.

About the Study
For the State Honor Roll report, AAFA assessed three categories of policies: Medication & Treatment policies, Awareness policies and School Environment policies. Within these categories AAFA research and policy experts, in consultation with leaders in the fields of medicine, education and advocacy, identified 18 types of "core policy standards" relating to asthma and allergies in schools across the U.S. For example, core policies include state-wide standards for appropriate school nurse-to-student ratios, laws allowing students to carry and administer their asthma and anaphylaxis medications in school, indoor air quality improvement policies for school buildings, smoking bans and cessation programs, and more.

The full report, methodology, tables, detailed state profiles, as well as back-to-school tips and tools, are available at The 2011 report is made possible in part by a grant from Dey Pharma L.P., and individual donations to AAFA from patients, families and supporters.


The Asthma and Allergy Foundation of America (AAFA) is a not-for-profit organization dedicated to improving the quality of life for people with asthma, allergies and related conditions through education, advocacy and research. For more asthma and allergy statistics or support, visit or call 1-800-7-ASTHMA.

Obese Asthmatic Children Experience More Complications with Anesthesia

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A study presented at ANESTHESIOLOGY 2011 found that obese asthmatic children were nearly two times as likely to have at least one respiratory complication during or after surgery compared to their lean peers.

“Respiratory problems are one of the major causes of complications and death during pediatric anesthesia,” said the study’s lead investigator, Olubukola O. Nafiu, MD “Obesity and asthma are commonly cited as risk factors for respiratory problems. This study was designed to examine whether complications were more frequent in obese children with asthma.”

"The association of obesity and asthma with an increase in respiratory complications suggests that obese asthmatic children undergoing anesthesia should receive additional evaluation and care to prevent the increased potential for complications."

The study prospectively examined 1,102 children, 107 (9.7%) obese asthmatics, 118 (10.7%) normal weight asthmatics, 309 (28.0%) obese patients and 568 (51.5%) normal weight non-asthmatics. There was no significant difference in age between or within the groups. Children in the obese-asthmatic and obese groups were more likely to have at least one respiratory complication during or after surgery compared to the other groups. Additionally, obese-asthmatic children were more likely to have a longer post anesthesia unit stay.

“The association of obesity and asthma with an increase in respiratory complications suggests that obese asthmatic children undergoing anesthesia should receive additional evaluation and care to prevent the increased potential for complications,” said Dr. Nafiu. “Future investigations into what is directly causing complications in these patients are needed.”

For more information on the impact anesthesia can have on obese patients, please visit For more information on pediatric anesthesia, please visit


The Eyes Have It!

Allergic Conjunctivitis, That Is

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Eye allergy, also called allergic conjunctivitis or ocular allergy, occurs when something you are allergic to irritates the conjunctiva. This is the delicate membrane covering the eye and the inside of the eyelid.

The most common causes of allergic conjunctivitis are seasonal allergens, such as pollen and mold spores. People with seasonal allergic rhinitis, or hay fever, normally notice their symptoms worsen when they go outdoors on days with high pollen counts. Indoor allergens, such as dust mites and pet dander, can also cause eye allergies year-round. If you have this type of allergy, you may notice your symptoms worsen during certain activities, such as cleaning your house or grooming a pet.

Eye allergy symptoms can be very annoying. Yet they pose little threat to eyesight other than temporary blurriness. Unlike conditions such as pink eye, allergic conjunctivitis is not contagious. However, red, itchy, burning, and puffy eyes can also be caused by infections and other conditions that can threaten eyesight.

Eye Allergy Symptoms & Diagnosis
If your symptoms are related to an eye allergy, chances are you will have problems in both eyes. Typical symptoms include watery eyes, itchiness, sensitivity to light, redness, grittiness, and eyelid swelling. These symptoms can occur alone or along with allergic rhinitis nasal symptoms. They typically appear shortly after exposure to the allergen. Symptoms resulting from seasonal outdoor allergens tend to be worse than symptoms due to indoor allergens. Symptoms may be reduced if you are taking allergy medications such as antihistamines, which suppress the allergic reaction.

Unlike conditions such as pink eye, allergic conjunctivitis is not contagious.

The first step toward relief from annoying eye allergy symptoms is a proper diagnosis. An allergist has specialized training and experience to accurately determine what is causing your symptoms and identify the best treatment approach.

Eye Allergy Treatment & Management
If indoor allergens are causing your eye allergy symptoms, avoidance is the key to relief. Use a vacuum with a HEPA filter to reduce dust in your home or try keeping pets out of the bedroom to reduce exposure to their dander.

If pollen and other seasonal allergens are causing your symptoms, medications or other treatments may be necessary to provide relief. Over-the-counter antihistamine pills and eye drops are often used for short-term treatment of eye allergy symptoms. However, prolonged use of some eye drops may actually make your symptoms worse. Your doctor may prescribe stronger medications if your symptoms are long lasting.

Corticosteroid eye drops are effective, but they often have side effects, even when used only for a short time. Use of this medication should be managed by an ophthalmologist due to the risk of side effects, such as glaucoma, cataracts, and infection.

Depending on what is causing your eye allergy symptoms, immunotherapy (allergy shots) can be very effective in providing long-term resistance to the triggering allergens.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Immune Cell Plays Dual Role in Allergic Skin Disease

NIH-funded study in mice enhances understanding of atopic dermatitis

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An immune cell involved in initiating the symptoms of an allergic skin reaction may play an equally, or perhaps more important, role in suppressing the reaction once it becomes chronic. This finding in mice could have future implications for the treatment of atopic dermatitis, a chronic inflammatory skin disease that affects an estimated 10 to 20 percent of infants and young children. The research is by investigators at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health.

The study, published online in the journal Immunity, and led by Juan Rivera, PhD, NIAMS deputy scientific director and chief of the Laboratory of Molecular Immunogenetics, focused on a type of cell called a mast cell. Previous research has shown that early in the course of atopic dermatitis, mast cells produce irritating chemicals, including interleukin-4 (IL-4), interleukin-5 (IL-5) and interleukin-6 (IL-6), which attract inflammatory cells to the site of the allergic reaction.

To better understand mast cells' role, the researchers developed a mouse model. After initial exposure to a chemical allergen, mice are subsequently challenged by having their ears painted with the same allergen multiple times. This model is similar to atopic dermatitis in people. Some of the mice were also engineered to be deficient in mast cells.

"The new study is an important step toward providing researchers with a valuable new insight that could eventually lead to safer, more targeted treatments."

When the scientists painted a chemical allergen one time on the ears of the mast cell-deficient mice, the reaction occurred more slowly, demonstrating that mast cells contribute to the initiation of atopic dermatitis.

"When they applied the same allergen to these mice multiple times, the reaction was considerably worse than in mice with sufficient mast cells," said Rivera. "That tells us that although mast cells may participate early on in the development of the disease, it appears that they are suppressing the late stages of the disease or when the disease becomes chronic."

In fact, when the scientists replaced the mast cells in mast cell-deficient mice, they were able to reduce the severity of the disease. The researchers were surprised that the mast cells did not have to be at the site of inflammation to control inflammation, said Rivera. In fact, the greatest effect was seen with mast cell repopulation in the spleen, a key organ in immune response.

Further investigation showed that, in late stages of disease, the mast cells underwent a change that caused them to produce a different chemical called interleukin-2 (IL-2), needed by cells which are key to suppressing inflammation, known as regulatory T cells.

"What is unusual here is that the same type of cells that can be inflammatory, can also be regulatory," said Rivera.

While Rivera says it's too early to predict the therapeutic importance of these findings, he believes they do provide new information on the understanding of atopic dermatitis and a potential caution against the development of treatments that target mast cells.

"While blocking mast cells has been considered as a treatment for the disease, it may be counter-productive, particularly in the latter stages of the disease," he said.

The researchers' next step is to see if their findings hold true in people, comparing the products of mast cells from lesions in early– and late-stage atopic dermatitis. It's possible, for example, that individuals with very severe chronic disease may not have sufficient mast cells in the skin.

Currently, the most effective treatment for atopic dermatitis is topical corticosteroids, which can have significant side effects, including thinning of the skin, if used long-term.

"In general, we need a better understanding of the disease itself to develop better therapies for it," said Rivera. "The new study is an important step toward that end, providing researchers with a valuable new insight that could eventually lead to safer, more targeted treatments."


Who Gets Asthma and Why?

Asthma image

Asthma is very common, affecting more than 22 million people in the United States. No one knows for sure why some people have asthma and others don’t. People who have family members with allergies or asthma are more likely to have asthma.

Asthma can occur at any age but is more common in children than in adults. Heredity can play a role. In young children, boys are nearly twice as likely as girls to develop asthma, but this sex difference tends to disappear in older age groups. Obesity is a newly identified risk factor for asthma.

People generally think of asthma in terms of episodes or attacks. Actually, the asthmatic condition is always present, but symptoms may be dormant until triggered by an allergen, respiratory infection, or cold weather. Other triggers may include aspirin, environmental irritants, physical exertion, and less commonly, food additives and preservatives.

Allergens are substances that cause no problem for a majority of people but that trigger an allergic reaction in susceptible individuals. Allergens are a major source of breathing problems in both children and adults. Common allergens include plant pollen, dander from pets and other animals, house dust mites, cockroaches, molds, and certain foods. When an allergic individual is exposed to one of these allergens, a complicated series of events causes the body to release chemicals called mediators. These mediators often trigger asthma episodes.

Allergens are a major source of breathing problems in both children and adults.

Cold air, smoke, industrial chemicals, perfume, and paint and gasoline fumes are all examples of environmental irritants that can provoke asthma. They probably trigger asthma symptoms by stimulating irritant receptors in the respiratory tract. These receptors, in turn, cause the muscles surrounding the airway to constrict, resulting in an asthma attack.

Viral respiratory infections are the leading cause of acute asthma attacks. Surprisingly, bacterial infections, with the exception of sinusitis, do not bring about asthma attacks. Some people with heartburn can have asthma symptoms when stomach acid backs up into the esophagus.

Aspirin and aspirin-containing products can trigger asthma attacks in susceptible individuals. Five percent of people with asthma experience a significant decrease in lung function after taking aspirin. Similar reactions can occur with other over-the-counter pain relievers, such as ibuprofen. As a general rule, people with asthma should avoid these products.

Another type of prescription medication that can cause problems is the group of drugs called beta-blockers, which often are prescribed for high blood pressure, glaucoma, migraine headaches, and angina. Beta-blockers can cause airway constriction called bronchospasm, so it is important for people with asthma to consult a physician about the use of these medications.

Although food additives can trigger asthma, this is rare. The most common food trigger is sulfites, a preservative used in products such as frozen potatoes and some beers and wines.

The Difference Between Allergic Disease and Asthma
Asthma is inflammation and obstruction of airflow in the bronchial tubes. Allergies are just one of the factors that can trigger asthma attacks. Not all people with asthma are allergic, and there are many people who have allergies but do not have asthma.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

9 Common Allergy Triggers

An allergen is an otherwise harmless substance that the immune system mistakes as being harmful. There are many types of allergens and conditions caused by them. Some people are allergic to lots of things. Some people are allergic to only one thing or to very few things. What a person is allergic to is determined by many different factors, including the environment, a person’s genes, and the way the immune system works.

Once an allergy has been identified, your healthcare provider may recommend medications or therapies to control symptoms. The next step is to decrease or eliminate exposure to the allergen. This is called environmental control. Evidence shows that allergy and asthma symptoms may improve over time if the recommended environmental control changes are made.

Here are the nine most common types of allergens.

Allergy image Animals
Exposure to animal dander (dead skin that is continually shed), as well as animal urine and saliva, causes human allergic reactions to animals. These reactions can make asthma, rhinitis, and eczema symptoms worse in some people.

The dander, urine, and saliva of feathered or furry animals, such as cats, dogs, birds, and rodents, can cause allergy symptoms. Exposure to other warmblooded animals, such as horses or cattle, or to products made with feathers or down may also cause allergy symptoms.

Allergy image Cockroaches
Cockroach allergies are remarkably common. Cockroach allergies may be dangerous to people with asthma, as exposure may cause severe attacks in over half of those diagnosed. Even if you’ve never seen a cockroach in your home, the allergen may be present. It is not necessarily a reflection of the cleanliness of your home. Cockroaches live in walls and other places you cannot see or easily clean. Cockroaches can congregate wherever food and warmth are present. This can include restaurants, hospitals, and bakeries, as well as upscale urban dwellings.

Allergy image Dust Mites
These are microscopic animals, too small to be seen with the naked eye, that feed on human skin scales. They persist in bedding, carpets, stuffed furniture, old clothing, and stuffed toys. Dust mites are most common in humid climates. If droppings of dust mites are inhaled or come in contact with the skin, they may cause allergic symptoms and aggravate asthma and eczema.

Allergy image Stinging Insects
Although less common than pollen allergy, insect venom allergy is anything but trivial – it can be life threatening. The primary offenders are most often insects that sting rather than those that bite. Stinging insects of concern include yellow jackets, hornets, wasps, bees, and ants.

Allergy image Food
An allergic reaction to a food is an unpleasant reaction caused by the immune system overreacting to a food. For those who are allergic, it is important to diagnose the allergy and identify the food so that serious, and even life-threatening, reactions can be avoided. The most common food allergies are eggs, peanuts, milk, tree nuts, fish, shellfish, soy, and wheat.

Allergy image Latex
A natural rubber made from the sap of a tree, latex can be found in many items, including bicycle and wheelchair tires, toys, some balloons, examining gloves, household gloves, surgical tubing, rubber bands, and condoms. The major exposure of concern is to powdered latex gloves, because latex sticks to the powder and becomes airborne when these gloves are put on, taken off, or snapped.

When someone is allergic to latex, that person is actually allergic to one or more proteins found in the sap from the rubber tree. Interestingly, these proteins – or ones very similar – can be found in banana, kiwi, avocado, potato, strawberries, peaches, and chestnuts. Therefore, people who are allergic to latex may have cross-reactions to these foods.

Allergy image Medication
Allergies to medications are complicated because they can be caused by many different medications, resulting in a wide variety of signs and symptoms that may affect various organs or parts of the body. However, one characteristic of all drug allergies is that similar symptoms will occur every time soon after the offending medicine is taken. Penicillin and other antibiotics are the medicines that most commonly cause allergic reactions.

Allergy image Mold
Many types of molds live in our environment. Mold grows in indoor and outdoor areas that are warm, dark, or moist. Molds reproduce and grow by sending tiny spores into the air. Inhaled spores cause allergy and asthma symptoms.

Allergy image Pollen
When pollen from trees, grasses, and weeds is inhaled, it can cause allergy and asthma symptoms. Pollen may travel many miles in the wind, so trees, grasses, and weeds beyond your immediate area can cause allergy and asthma symptoms. Pollen allergies are often seasonal, and allergy and asthma symptoms occur when the amount of pollen in the air is high.


Source: National Jewish Health,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Brace Yourself: It’s Almost Flu Season

Allergy and Asthma image

The flu is a contagious respiratory illness caused by influenza viruses. Most healthy people recover from the flu without complications; however, some people, such as older people, young children, pregnant woman, and people with certain health conditions (like asthma), are at high risk for serious complications from the flu. If you are at high risk from complications of the flu, you should consult your healthcare provider to learn how to prevent the flu. If you develop flu-like symptoms, seek professional medical help.

Asthma & the Flu Shot
Every year, the seasonal flu is responsible for causing complications for people with asthma. Getting a seasonal flu shot each year is a very effective way to reduce your chances of dealing with complications due to flu symptoms.

If you have asthma, you should get the flu shot when it is available. Do not get the nasal spray vaccine, which could trigger asthma symptoms or an attack. If you have asthma and get the flu, see a healthcare professional promptly because you are at greater risk of becoming severely ill with flu complications very quickly. If you care for children with asthma, get the flu vaccine to protect them.

The single best way to prevent the flu is to get a flu vaccine each fall.

The vaccine is safe. If you have asthma, your health risks are far greater in not getting the vaccine.

Allergies & the Flu Shot
If you have a severe allergy to eggs, or to any other substance that could be in the flu vaccine (such as latex or gelatin), you should check with your physician before receiving any flu vaccine. If a person reports a severe allergy to latex, vaccines supplied in vials or syringes that contain natural rubber should not be administered, unless the benefit of vaccination outweighs the risk of an allergic reaction to the vaccine. For latex allergies other than anaphylactic allergies, vaccines supplied in vials or syringes that contain dry natural rubber or natural rubber latex can be administered. Allergic reactions (including anaphylaxis) after vaccination procedures are rare.

Common Flu Symptoms
The flu usually starts suddenly and may include symptoms such as fever, headache, extreme tiredness, chills, constant cough, sore throat, runny or stuffy nose, and body aches. Diarrhea and vomiting also can occur but are more common in children.

These symptoms are referred to as “flu-like symptoms.” Many different illnesses, including the common cold, allergy symptoms, and asthma symptoms, can sometimes be similar and confusing. Always consult with your doctor to make a proper diagnosis.

If your runny nose, itchy and watery eyes, sore throat, and other common allergy symptoms are combined with an unusually high fever (100 degrees or higher), chills, severe headache, or significant aches and pains, you could have the flu. If you think your allergy symptoms might be indicative of something more severe, including the flu, you should visit your doctor for a diagnosis or treatment recommendation.

Spreading the Flu
The flu spreads in respiratory spraying from coughing and sneezing. It usually spreads from person to person, though occasionally someone could become infected by touching something with virus on it and touching his or her mouth or nose. Adults may be able to infect others one day before getting symptoms and up to seven days after getting sick. So it’s possible to give the flu before you know you’re sick, as well as while you are sick.

Flu Prevention
The single best way to prevent the flu is to get a flu vaccine each fall. A few antiviral drugs are approved for prevention of the flu. These are prescription medications, and a doctor should be consulted before they are used.

In addition, here are some easy things you can do to prevent the spread of respiratory illnesses like the flu:

  • Cover your nose or mouth with a cloth or tissue when you cough or sneeze – throw it away after use.
  • Wash hands often with soap and water, especially after coughing or sneezing. If you don’t have access to running water, use an alcohol-based hand cleanser.
  • Stay away from people who are sick.
  • If you get the flu, stay home from work and school, and limit contact with others to keep from infecting them.
  • Try not to touch your eyes, nose, or mouth. This is how germs often spread.

Treating the Flu
Some antiviral drugs are approved for treatment of the flu. They are prescription medications, and a doctor should be consulted before the drugs are used. If you get the flu, get plenty of rest, drink a lot of liquids, and avoid using alcohol and tobacco. You can take medications to relieve the symptoms of the flu (but never give aspirin to children or teenagers who have flu-like symptoms, particularly fever).


For the most up-to-date flu information, visit

Source: Asthma and Allergy Foundation of America,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Don’t Let Allergies & Asthma Haunt Halloween Fun

Allergy and Asthma image

Halloween can be a frightful time for parents of kids with allergies & asthma. Nut-filled candy isn’t the only bogeyman that can ruin the fun. Allergy and asthma triggers can hide in other, unexpected places, too, from dusty costumes to leering jack-o’-lanterns.

“When people think of Halloweenassociated allergies, they focus on candy and often overlook many other potential triggers,” says Myron Zitt, md, past president of the American College of Allergy, Asthma and Immunology. “By planning ahead, you can ensure not only safe treats, but also safe costumes, makeup, accessories, and decorations.”

Watch out for these six sneaky triggers to keep Halloween sneeze-, wheeze- and reaction-free.

1 Tricky Treats
Food allergy triggers abound on this candy-filled holiday, and it’s not just the usual suspects like chocolate that can hide triggers. Gummy bears and other seemingly innocent candies may contain gelatin, a potential allergen that is a less common trigger. Your best bet? Consider taking your child to an allergist for allergy testing and help in developing a food allergy treatment plan. For Halloween night, have some non-candy treats for your child, such as stickers, pencils, and small toys to swap for sweets.

2 Devilish Costume Details
Watch out for nickel in costume accessories, from cowboy belts and pirate swords to tiaras and magic wands. Nickel is one of the most common causes of allergic contact dermatitis, which can make skin itchy and spoil trick-ortreating fun.

3 Haunted Hand-Me-Downs
Halloween costumes packed away in a box for months can be laden with dust mites, which trigger allergies & asthma. So unless you want your little one sneezing or wheezing from house to house, wash the hand-me-down costumes in hot water. Or consider visiting the store for a new costume.

4 Menacing Makeup
Cheap Halloween makeup may include preservatives that can cause allergic reactions. Instead, opt for higher quality theater makeup. Because it can take a few days for a rash, swelling, or other reaction to appear, test the makeup on a small area of skin well in advance of Halloween.

5 Frightful Fog
If you’re considering renting a fog machine to make your house extra spooky, think again. Fog – real or man-made – can trigger asthma in some people.

6 Perilous Pumpkins
Beware of pumpkin-carving and pumpkin pie if you think you might be allergic. Pumpkin allergies, though rare, can cause everything from itching to chest tightness and can pop up quite suddenly, even if you haven’t had a problem before. And keep in mind that pumpkin patches are often moldy and dusty, allergy and asthma triggers for some. Consider buying a pumpkin from a grocery or discount store.


Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Asthma in Infants and Very Young Children

Asthma image

Asthma is a disease in which the airways become blocked or narrowed. These effects are usually temporary, but they cause shortness of breath, breathing trouble, and other symptoms. If an asthma attack is severe, a person may need emergency treatment to restore normal breathing. Although asthma can cause severe health problems, in most cases treatment can control it and allow a person to live a normal and active life.

How is asthma in very young children different from adult asthma?
Infants and toddlers have much smaller bronchial tubes than older children and adults. In fact, these airways are so small that even small blockages caused by viral infections, tightened airways, or mucus can make breathing extremely difficult for the child.

Asthma symptoms can look like symptoms of other illnesses or diseases. Croup, bronchitis, epiglottis, cystic fibrosis, pneumonia, bronchiectasis, upper respiratory tract viruses, gastroesophageal reflux, congenital abnormalities, or even a foreign body inhaled by the child all have some of the same symptoms as asthma.

Diagnosing asthma in very young children is difficult. Since they are not able to communicate, they cannot describe how they are feeling.

Signs of asthma in a baby or toddler include noisy breathing or breathing increased 50 percent above normal; wheezing or panting with normal activities; lethargy or disinterest in normal or favorite activities; difficulty sucking or eating; and crying sounds softer, different.

How is asthma diagnosed in babies and toddlers?
Diagnosing asthma in very young children is difficult. Since they are not able to communicate, they cannot describe how they are feeling. To help the pediatrician make a correct diagnosis, parents must provide information about family history of asthma or allergies and the child’s overall behavior, breathing patterns, and responses to foods or possible allergy triggers. Lung function tests are very hard to do with young children. Instead, the physician may see how the child responds to medications to improve breathing. Blood tests, allergy testing, and X-rays may be done to gather additional information. Using all this information, the doctor then can make the best diagnosis.

How is asthma treated in very young children?
Babies or toddlers can use most medications used for older children and adults. The dosage, of course, is lower, and the way the medication is given is different. Inhaled medications are preferred because they generally act more rapidly to reduce symptoms and produce fewer side effects.

Medications to treat asthma symptoms in infants and toddlers are usually given in a tasty liquid form or with a nebulizer. A nebulizer is a small machine that uses forced air to create a “medication mist” for the baby to breathe through a small facemask. Nebulizer treatments take about 10 minutes and are given several times each day until symptoms decrease. Although a nebulizer treatment is gentle, babies and young children often are frightened by the mask and fight the treatment at first.

Some toddlers are able to use an inhaler containing asthma medication with a spacer and mask attachment. A spacer is a small tube that holds the medication released by the inhaler fitted into it. The device allows children to breathe in the medication at their own speed.

Most people with asthma, including very young children, use a combination of medications, depending on severity and frequency of symptoms. Work with their healthcare providers to develop an asthma care plan for your child.

Can a child outgrow asthma?
Once someone develops sensitive airways, they remain that way for life, although asthma symptoms can vary through the years. As a child’s airways mature, he or she is able to handle airway inflammation and irritants better, so asthma symptoms may notably decrease. There is no way to predict which children may experience greatly reduced symptoms as they get older. New triggers may set off symptoms at any time in people who have asthma. If your child has asthma, keep quick-relief medications on hand (and up-to-date), even if symptoms are rare.

Tips for Parents
When a very young child has a chronic illness, parents can feel stretched to their limits as they try to manage. Get regular check-ups to help reduce your anxiety. Teach your toddler or preschooler to tell you when they are not feeling well.

It’s important to learn the warning signs for increasing asthma in infants and toddlers. Develop an asthma management plan with your child’s physician. Make sure the plan provides guidelines to follow if asthma symptoms get worse.

Follow your asthma care plan every day! Don’t alter from the plan until you consult your healthcare provider. Even if your child’s symptoms are gone, stick with the plan until you discuss changes with the doctor.

Above all, don’t let your child’s asthma become the focus of your relationship. If you use good healthcare practices to manage your baby’s or toddler’s asthma, you’ll be able to think less about asthma and enjoy your child more.


Source: Asthma and Allergy Foundation of America,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Using Powder-Free Latex Gloves Reduces Latex Allergy Rate in Healthcare Workers

Allergy image

Researchers at The Medical College of Wisconsin investigating latex allergy in healthcare workers have demonstrated that the most effective public health strategy to prevent allergic sensitization is by stopping the use of powdered latex gloves. Previous medical studies pointed out this association of latex allergy to powdered latex glove use but were not able to completely confirm this link in specific workers. Reducing the use of powdered gloves reduced the allergen in the air and in air ducts at two hospitals, and prevented sensitization to latex in healthcare workers at both institutions. These findings are published in the Journal of Occupational and Environmental Medicine.

Kevin J. Kelly, MD, professor of Pediatrics (allergy/ immunology) and Internal Medicine and vice chair in Pediatrics at the Medical College, and his colleagues studied more than 800 healthcare workers at Froedtert Hospital and Children’s Hospital of Wisconsin over a 4.5-year period. Researchers tested the amount of latex allergen in the air ducts of the employees’ primary work areas before and after both institutions switched to powder-free gloves and found a significant correlation between high levels of airborne allergen and healthcare workers with a latex allergy or sensitivity.

The switch to powder-free gloves led to significant changes at both hospitals. The unique study design allowed the investigators to determine that there was a 16-fold reduction in the rate of latex sensitization among the study participants. Among the healthcare workers who were sensitized to latex at the beginning of the study, 25 percent lost that sensitivity and are no longer considered sensitized to latex. Whether these fortunate workers will redevelop latex sensitization if exposed to latex in the future is unknown.

The switch to powder-free gloves led to significant changes at both hospitals.

“This study provides the strongest evidence that allergic sensitivity to latex in healthcare workers is linked to airborne allergen exposure through powdered gloves,” Dr. Kelly says. “I believe these findings provide a roadmap for healthcare institutions that will help minimize the risks of latex sensitization to healthcare workers.”

Dr. Kelly’s team also found healthcare workers who had demonstrated latex sensitization were nearly three times more likely to leave their jobs. This phenomenon has been termed “the healthy survivor” effect and helps explain why there may be an artificial reduction in latex allergy seen in some studies, as the affected workers choose to no longer be employed without receiving workers’ compensation from a work-related exposure.


This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Halloween Scares for Children with Allergies & Asthma

Allergy & Asthma image

Parents of children with food allergies are aware of the dangers lurking in Halloween treats, but little attention is paid to asthma, which can also be frightening for asthmatic children participating in Halloween festivities.

“If your child suffers from asthma and/or allergies, be aware and prepared for potential triggers to ensure a safe and fun time for all during the holidays,” says Clifford W. Bassett, MD, FAAAAI, chair of the Public Education Committee of the American Academy of Allergy, Asthma & Immunology.

The Academy offers these tips to help children with allergies & asthma safely enjoy the holiday and stay out of hospital emergency rooms:

  • Beware of Costumes
    Mold, dust, and latex products can be major allergy and asthma triggers. Don’t recycle costumes from the attic or basement, and wash new costumes before wearing. Halloween masks can trap dust and mold, so keep your child mask free.
  • Don’t Enter Homes
    Keep your child on the doorstep of homes while trick-or-treating. Asthma and allergy triggers in the houses of others may include cigarette smoke and pet dander.
  • Watch for Weather Changes
    Cold air and humidity can make breathing difficult for children with asthma. Make certain your child is dressed appropriately for the conditions.
  • Under the Weather
    If your child is not feeling well, hold off on trick-or-treating. Cold and flu symptoms can severely aggravate asthma conditions.
  • Lurking Food Allergies
    Halloween can be troublesome for those with food allergies. If this includes your child, read every food label and be a “label detective” so that you know what the ingredients are before your child touches or eats the product. This also means avoiding homemade treats.
  • Be Prepared
    When trick-or-treating, be prepared for an emergency. For food allergies, carry an epinephrine pen. For asthma, keep a rescue inhaler nearby.

Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2010.

Back to School with Asthma

Seven Steps to Stay Healthy During the School Day

Asthma image

The start of a new school year is a big transition after the long summer break, especially for families of children with asthma. This back-to-school season, the American Lung Association stresses the importance of preparing and carefully monitoring a detailed action plan to manage asthma and ease the transition to the school environment.

“While new clothes and backpacks are often thought of as back-to-school necessities, it is even more essential for parents of students with asthma to work with their healthcare providers and the school to develop a comprehensive action plan detailing the various elements of good asthma control in the school environment,” says Dr. Norman H. Edelman, chief medical officer of the American Lung Association.

As the most common chronic childhood disorder in the nation, asthma affects an estimated seven million children younger than 18. It is one of the main illness-related reasons that students miss school, accounting for more than 14 million lost school days every year.

Parents should also be aware that cold and flu season is beginning as well. Influenza poses a special health risk to children with asthma, as these children often experience more severe symptoms. All children – especially those with asthma – should be immunized against influenza. Yet surveillance shows that less than half of children with asthma are vaccinated annually against influenza.

“As part of your back-to-school preparation, make sure your child with asthma gets a flu shot,” says Dr. Edelman. “Flu epidemics start and spread in schools, and the flu can lead to a serious asthma attack.

“The good news is that research has shown conclusively that getting a flu shot does not trigger an asthma attack, so there is no good reason not to get one,” he adds. According to the U.S. Centers for Disease Control, yearly flu vaccinations should begin in September, or as soon as the vaccine is available.

Even if your child’s asthma is well managed, asthma action plans should be updated each school year.

In preparation for the school year ahead, the American Lung Association urges parents who have children with asthma to complete the following checklist:

♦ Develop an Asthma Action Plan
All students with asthma should have a written asthma action plan that details personal information about the child’s asthma symptoms, medications, and any medicine required before exercise, and that provides specific instructions about what to do if an asthma episode does not improve with prescribed medication.

♦ Schedule an Asthma Check-up
Even if your child’s asthma is well managed, asthma action plans should be updated each school year, so schedule a check-up with your healthcare provider. This is critical to ensuring your child’s asthma continues to be effectively controlled, and provides an opportunity to evaluate medications and physical activity considerations. Remember to give a copy of the completed asthma action plan to your child’s school.

♦ Vaccinate Yourself and Your Child Against Seasonal Influenza
The CDC now recommends everyone over the age of six months get a flu vaccination. Protecting yourself against influenza by getting vaccinated further helps protect your child.

♦ Visit Your Child’s School Nurse and Teachers
All of your child’s teachers, coaches, out-of-school activity organizers, as well as the school nurse and office should have a current copy of your child’s asthma action plan. Discuss your child’s specific triggers and typical symptoms so that they can be prepared to effectively assist your child should an asthma episode occur outside of your presence.

♦ Know Your School’s Asthma Emergency Plan
Ensure that your child’s school knows how to contact you in case of an emergency. It is also important for parents to know the school’s history of dealing with asthma episodes. Parents should confirm that school staff – including after-school coaches and bus drivers – have attended training to learn how to respond to asthma emergencies.

♦ Advocate for Your Child
In all 50 states, students have the legal right to carry asthma medications while at school. Check with your school nurse or administrator for your school’s individual policy, and meet with your child’s healthcare provider to complete the required paperwork.

♦ Know About Prescription Assistance Services
Don’t let the cost of medicines be the reason that your child doesn’t get the necessary treatment to control his or her asthma. Talk to your local healthcare provider about low-cost or no-cost options that may be available to you. Three organizations are available to help. The Partnership for Prescription Assistance can be reached by calling (888) 4PPA-NOW. Rx Outreach also provides information on their website, Patient Services Incorporated,, also has helpful information available online. Most pharmaceutical companies offer prescription assistance programs as well.


Source: American Lung Association,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

New App to Help People Dining Out with Food Allergies and Intolerances

People with food allergies and intolerances struggle to find restaurants that will accommodate their dietary requirements. Now, there’s an app for that. AllergyEats ( has launched a free app for the iPhone and Android smartphones that provides peer-based feedback about how well (or poorly) restaurants accommodate the needs of food allergic customers. The AllergyEats app can be downloaded from the iTunes app store and the Android market.

Allergy image


This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Making Your House a Healthy Home

Allergy and Asthma image

If you’re like most Americans, you spend much of your time indoors. Have you ever stopped to think about whether the air you’re breathing at home is healthy? Research has found that in some homes across America, the quality of indoor air can be worse than outdoor air. In part, this is because many homes are being built and remodeled tighter. You don’t have to be a building scientist to deal with the quality of air in your home; however, you should understand a few basics to get you started.

Biological Pollutants (like molds and dust mites)
Molds, mildew, fungi, bacteria, and dust mites are some of the main biological pollutants inside the home. Some, such as pollen, are generated outside the home. Mold and mildew are generated in the home and release spores into the air. Mold, mildew, fungi, and bacteria are often found in areas of the home that have high humidity levels, such as bathrooms, kitchens, laundry rooms or basements. Dust mites and animal dander are problematic when they become airborne during vacuuming, making beds, or when textiles are disturbed.

Allergic reactions are the most common health problems associated with biological pollutants.

Molds and dust mites thrive in areas of high humidity. Mold grows on organic materials, such as paper, textiles, grease, dirt, and soap scum. Mold spores float throughout the house, forming new colonies where they land. Dust mites thrive on dead human skin cells and are found in textiles, such as bedding, carpeting, and upholstery. When these textiles are disturbed during vacuuming, making beds, or walking on carpet, the dust particles become airborne. Pollen, plant material that enters through windows or on pets, and animal dander also become airborne when disturbed. Infectious diseases caused by bacteria and viruses are generally passed from person to person through physical contact, but some circulate through indoor ventilation systems.

Health Effects
Allergic reactions are the most common health problems associated with biological pollutants. Symptoms often include watery eyes, runny nose and sneezing, nasal congestion, itching, coughing, wheezing and difficulty breathing, headache, dizziness, and fatigue. Dust mites have been identified as the single most important trigger for asthma attacks.

Addressing the Problem
There are no practical tests for biological contaminants for use by nonprofessionals. However, there are signs to watch for. You can sometimes see and smell mold colonies growing on surfaces. Mold growth should be suspected wherever there are water stains, standing water, or moist surfaces.

Prevent mold growth by keeping basements, bathrooms, and other rooms clean and dry. Use a disinfectant to clean surfaces that have mold on them. If carpeting or furnishings become wet, they must be quickly and thoroughly dried or discarded.

Humidifiers, dehumidifiers, and air conditioning condensing units should be regularly cleaned with a disinfectant, such as chlorine bleach. Keep humidity at acceptable levels (less than 50 percent), and make sure there’s plenty of ventilation, especially in areas where moisture tends to build up.

People who are sensitive to dust mites may need to replace carpeting in their homes with hard surfaced flooring and use area rugs that can be removed and cleaned. Vacuums with high efficiency filters or central vacuum systems can help reduce the airborne dust generated by vacuuming.

Cleaning Up Mold
According to the U.S. Environmental Protection Agency, if the moldy area is less than about 10 square feet, in most cases, you can handle the job yourself, following the guidelines below. If you have health concerns, consult a health professional before starting cleanup.

If you choose to hire a contractor to do the cleanup, make sure the contractor has experience cleaning up mold. For do-it-yourself cleanup, note that the use of a disinfecting chemical or biocide that kills organisms such as mold (chlorine bleach, for example) is not recommended as a routine practice during mold remediation, although there may be instances where professional judgment may indicate its use (for example, when immune-compromised individuals are present). In most cases, it is not possible or desirable to sterilize an area; background levels of mold spores will remain, and these spores will grow if the moisture problem has not been resolved. If you choose to use disinfectants or biocides, always ventilate the area. Outdoor air may need to be brought in with fans. Never mix chlorine bleach solution with other cleaning solutions or detergents that contain ammonia because toxic fumes could be produced.

In instances when a biocide is not used, simply damp-wipe surfaces with plain water or with water and detergent solution (for wood, use wood floor cleaner); scrub as needed. Always dry completely after cleanup is completed.

In order to limit your exposure to airborne mold during cleanup, you should wear an N-95 respirator, available at many hardware stores. In order to be effective, the respirator or mask must fit properly, so carefully follow the instructions supplied with the respirator.


Source: Federal Citizen Information Center

This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2011.

Symptoms of Allergic Rhinitis Result in Sleep Disturbances and Emotional Burdens

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Results from Teva Respiratory’s “Nasal Allergy Survey Assessing Limitations 2010” show that people with allergic rhinitis who had nasal symptoms were more likely to experience sleep disturbances, including difficulty getting to sleep and waking up during the night. Lack of a good night’s sleep can significantly affect a person’s quality of life.

Survey results suggest that the fatigue people with nasal allergies experience may be related to sleep disruption caused by the common symptoms associated with allergic rhinitis. Lack of adequate sleep and increased tiredness may also lead to people feeling “irritable” and “miserable,” which can contribute to other emotional burdens, like anxiety and depression. When nasal symptoms are at their worst, people find it difficult to get a good night’s sleep, which can negatively affect their work performance by reducing productivity, resulting in both social and economic costs.

“The negative impact that allergic rhinitis symptoms can have on a patient’s quality of sleep is considerable, as it not only affects them physically, but also emotionally,” says Gary Gross, MD, FAAAAI, of Dallas Allergy & Asthma Center in Dallas, TX. “It’s important for patients suffering from allergic rhinitis symptoms, like post-nasal drip, to understand how these symptoms can negatively affect their quality of life.”


This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2011.

Vitamin D Deficiency Linked with Airway Changes in Children with Severe Asthma

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Children with severe therapy-resistant asthma (STRA) may have poorer lung function and worse symptoms compared to children with moderate asthma due to lower levels of vitamin D in their blood, according to researchers in London. Lower levels of vitamin D may cause structural changes in the airway muscles of children with STRA, making breathing more difficult. The study provides important new evidence for possible treatments for the condition.

The findings were published online ahead of the print edition of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

“This study clearly demonstrates that low levels of vitamin D are associated with poorer lung function, increased use of medication, worse symptoms and an increase in the mass of airway smooth muscle in children with STRA,” said Atul Gupta, MRCPCH, M.D., a researcher from Royal Brompton Hospital and the National Heart and Lung Institute (NHLI) at Imperial College and King’s College London. “It is therefore plausible that the link between airway smooth muscle mass and lung function in severe asthma may be partly explained by low levels of vitamin D.”

This is the first study to evaluate the relationship between vitamin D and the pathophysiology of children with severe therapy-resistant asthma.

While most children with asthma can be successfully treated with low doses of corticosteroids, about 5 to 10 percent of asthmatic children do not respond to standard treatment. These children have severe therapy-resistant asthma, or STRA, experience more asthma episodes and asthma-related illnesses, and require more healthcare services, than their treatment-receptive peers.

Although previous studies of children with asthma have linked increases in airway smooth muscle mass with poorer lung function and in vitro studies have established a connection between levels of vitamin D and the proliferation of airway smooth muscle, this is the first study to evaluate the relationship between vitamin D and the pathophysiology of children with STRA.

“Little is known about vitamin D status and its effect on asthma pathophysiology in these patients,” Dr. Gupta noted. “For our study, we hypothesized that children with STRA would have lower levels of vitamin D than moderate asthmatics, and that lower levels of vitamin D would be associated with worse lung function and changes in the airway muscle tissue.”

The researchers enrolled 86 children in the study, including 36 children with STRA, 26 with moderate asthma and 24 non-asthmatic controls, and measured the relationships between vitamin D levels and lung function, medication usage and symptom exacerbations. The researchers also examined tissue samples from the airways of the STRA group to evaluate structural changes in the airway’s smooth muscle.

At the conclusion of the study the researchers found children with STRA had significantly lower levels of vitamin D, as well as greater numbers of exacerbations, increased use of asthma medications and poorer lung function compared to children with moderate asthma and non-asthmatic children. Airway muscle tissue mass was also increased in the STRA group.

“The results of this study suggest that lower levels of vitamin D in children with STRA contribute to an increase in airway smooth muscle mass, which could make breathing more difficult and cause a worsening of asthma symptoms,” Dr. Gupta said.

The findings suggest new treatment strategies for children suffering from difficult-to-treat asthma, he added.

“Our results suggest that detecting vitamin D deficiency in children with STRA, and then treating that deficiency, may help prevent or reduce the structural changes that occur in the airway smooth muscle, which in turn may help reduce asthma-related symptoms and improve overall lung function,” Dr. Gupta said.

Before any widespread treatment recommendations can be made, however, larger studies will need to be conducted.

“The determination of the exact mechanism between low vitamin D and airway changes that occur in STRA will require intervention studies,” Dr. Gupta said. “Hopefully, the results of this and future studies will help determine a new course of therapy that will be effective in treating these children.”


Source: American Thoracic Society,

Allergies, Asthma, & Pregnancy

Your Questions Answered

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If you are pregnant and have asthma or allergies, you may feel uneasy about taking medications, but it is very important to keep your symptoms under control. Here are answers to some of the most common questions women have about managing allergies & asthma during pregnancy.

Q: How do you stay healthy and know which medications are best for you during your pregnancy?
A: An allergist can tell you which asthma and allergy medications are the safest and most effective to take throughout pregnancy. Make an appointment with an allergist soon after you discover you are pregnant to develop or review your personal treatment plan and to give you peace of mind.

Q: Can women with asthma have safe pregnancies?
A: Yes. With good asthma management, you can keep your asthma under control and have a healthy baby.

The risks of asthma flare-ups are greater than the risks of taking necessary asthma medications.

Q: How does uncontrolled asthma affect the fetus?
A: Uncontrolled asthma symptoms can cause a decrease in the amount of oxygen in your blood supply. The fetus gets its oxygen from your blood. Since a fetus needs a constant supply of oxygen for normal growth and development, managing asthma symptoms is very important to allow you and your baby to get enough oxygen.

Q: Is it safe to take my asthma medications?
A: The risks of asthma flare-ups are greater than the risks of taking necessary asthma medications. Studies show that most inhaled asthma medications are safe for women to use while pregnant. However, oral medications (pills) should be avoided unless necessary to control symptoms. Knowing which medications to take is a good reason to stay in close contact with your doctor so he or she can monitor your condition and alter your medications or dosages if needed.

Q: Will being pregnant affect my asthma symptoms
A: Pregnancy may affect the severity of your asthma symptoms. One study showed that asthma symptoms were worse in 35 percent of pregnant women, improved in 28 percent, and remained the same in 33 percent of pregnant women. Asthma has a tendency to get worse in the late second and early third trimesters, and many women have fewer symptoms during the last four weeks of pregnancy.

Q: Can I continue to get allergy shots during pregnancy?
A: Immunotherapy (allergy shots) is safe to take while you are pregnant. As always, your doctor will monitor your dose to reduce the risk of an allergic reaction to the shots. These reactions are rare; however, a reaction could be harmful to the fetus. Also, allergy shots should not be started for the first time during pregnancy.

Q: What should I avoid if I have asthma or allergies?
A: Whether you are pregnant or not, you should stay away from things that trigger your symptoms. This might include allergens, such as dust mites and animal dander, and irritants, such as cigarette smoke.

Q: Can women with asthma perform Lamaze?
A: Most women with asthma are able to do Lamaze breathing techniques without any problems. Asthma symptoms are rare during labor and delivery in women whose asthma has been managed during pregnancy.

Q: Can I breastfeed if I am taking medications for my asthma or allergies?
A: Breastfeeding is a good way to increase your child’s immunity, and it is strongly recommended. Medications recommended for use during pregnancy can be continued while nursing, because the baby gets less maternal medicine through breast milk than in the womb. Your doctor can discuss with you the best treatments while nursing.

Although these are common questions during pregnancy, each woman’s individual treatment varies. It is best to visit your allergist regularly during pregnancy so that any worsening of asthma can be countered by appropriate changes in your asthma management plan. Make sure to discuss any specific concerns with your physician to ensure the healthiest pregnancy for your well-being and that of your baby.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

New Online Course Teaches Educators How to Prepare for Anaphylaxis

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Food allergies affect as many as 1 in 13 children, and nearly 40 percent of children with food allergies have a history of a severe reaction. Severe allergic reactions to food can cause anaphylaxis and can be life-threatening.

Educators across the U.S. now have access to a free, interactive online course that provides a comprehensive tutorial on managing anaphylaxis in schools. How to C.A.R.E.™ for Students with Food Allergies: What Educators Should Know is a new, interactive online course that provides education for school personnel anytime, anyplace. This course uses current research evidence and expert consensus to help school personnel understand how to prevent and manage emergency situations due to food allergies. Based on the latest scientific research and expert consensus, the online course enables school personnel the flexibility to complete the program anytime and anywhere that has an Internet connection. The course is the result of a collaborative effort among the Food Allergy & Anaphylaxis Network, the Food Allergy Initiative, Anaphylaxis Canada, the Canadian Society of Allergy and Clinical Immunology, and Leap Learning Technologies.

For more information about the course and about how to let a local school know this new tool is available, visit


This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Study Connects Gene Variant to Response to Asthma Drugs

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A genetic variant may explain why some people with asthma do not respond well to inhaled corticosteroids, the most widely prescribed medicine for long-term asthma control. Researchers found that asthma patients who have two copies of a specific gene variant responded only one-third as well to steroid inhalers as those with two copies of the regular gene.

This genome-wide association study, funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, analyzed data from over 1,000 people enrolled in five separate clinical trials that studied different steroid treatments for asthma.

The study was also funded by the National Human Genome Research Institute and the NIH Pharmacogenomics Research Network. The results appeared in the September 26, 2011, online edition of the New England Journal of Medicine.

"This finding helps to explain the genetic basis for the long-standing observation that some people do not respond well to what is a common asthma treatment," said Susan Shurin, MD, acting director of the NHLBI. "The study illustrates the importance of research examining the relationship between genetic makeup and response to therapy for asthma, and underscores the need for personalized treatment for those who have it."

In this study, people carrying two copies of the GLCCI1 variant were more than twice as likely to respond poorly to ICS treatment as participants with two copies of the regular GLCCI1 gene.

Asthma is a complex inflammatory disease that affects over 22 million people in the United States and roughly 300 million people worldwide. Many factors can influence how severely the disease affects people and how well they respond to treatments. Poor response to inhaled corticosteroids (ICS) often runs in families, suggesting that genetics plays a role in how people respond to asthma treatments.

The study first conducted a genome-wide scan of the DNA of children enrolled in the Childhood Asthma Management Program and of their parents. The genomic scan uncovered a variant in a gene called GLCCI1 that appeared to be associated with poor ICS response. Study researchers then verified this association in 935 additional people with asthma, both children and adults, enrolled in four independent ICS studies. Most of the participants in these studies were white; the results may not be applicable to persons of other ethnicities.

In this study, people carrying two copies of the GLCCI1 variant were more than twice as likely to respond poorly to ICS treatment as participants with two copies of the regular GLCCI1 gene. Those who responded poorly had an average of one-third the level of lung improvement following inhaler treatment as did people with two regular copies of the gene.

About 1 in 6 study participants had two copies of the GLCCI1 variant, which is thought to work in conjunction with other genetic and environmental factors to affect response to ICS.

More studies will be needed to understand how GLCCI1 operates in the lungs and to explore whether it contributes to response in patients of other ethnic groups.


The National Heart, Lung, and Blood Institute (NHLBI) is a component of the National Institutes of Health. NHLBI plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at:

The National Institutes of Health (NIH), the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

How to Handle an Allergy Emergency

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More than 50 million Americans have some type of allergy. While the condition often makes people uncomfortable, it’s rarely dangerous unless it results in an allergic emergency. Then, allergies can be deadly.

The medical term for an allergic emergency is anaphylaxis. The condition is as serious as it sounds. Anaphylaxis is a life-threatening, severe allergic reaction that comes on suddenly and may affect many parts of the body at once. People who have allergies or asthma are at increased risk for anaphylaxis, but anyone can have a severe allergic reaction.

The symptoms of anaphylaxis include

  • hives, itchiness, and redness on the skin, lips, eyelids, or other parts of the body;
  • wheezing or difficulty breathing; h swelling of the tongue, throat, and nose;
  • nausea, stomach cramping, and vomiting or diarrhea; and
  • dizziness and fainting or loss of consciousness, which can lead to shock and heart failure.

Some or all of these symptoms can occur within minutes after exposure, or may develop up to two hours later. Sometimes a second reaction may occur eight to twelve hours after the first. The sooner the reaction is treated, the less severe it is likely to become.

The medical term for an allergic emergency is anaphylaxis.

The most common triggers of an allergic emergency include the following:

Peanuts, tree nuts (almonds, pecans, cashews, walnuts), fish, shellfish, cow’s milk, and eggs top the list among food triggers, causing about half of all cases of anaphylaxis each year. Peanut or tree nut allergies are the most common.

Insect Stings
More than 500,000 Americans go to hospital emergency rooms each year because of allergic reactions to stings from insects such as bees, wasps, hornets, yellow jackets, and fire ants.

Penicillin is the medication that most commonly causes anaphylaxis, but other drugs, such as aspirin, anesthetics, antibiotics, and pain relievers like ibuprofen also can cause a reaction.

Up to six percent of Americans are allergic to the latex used in disposable gloves, intravenous tubes, syringes, and other products, with healthcare workers, other workers who routinely wear gloves, and children with spina bifida at greatest risk of latex-induced anaphylaxis.

Most severe allergic emergencies or anaphylactic reactions are treated with a shot of the anti-allergy drug epinephrine (adrenaline). Other treatments also may be needed depending on the symptoms.

Be S.A.F.E.
If you are at risk of a severe allergic reaction, you should know the four steps to manage your condition and keep you S.A.F.E.

Seek immediate medical help
Call 911 and get to the nearest emergency facility at the first sign of anaphylaxis, even if you have already administered epinephrine. If you have had an anaphylactic reaction in the past, you are at risk of future reactions.

⋄ Identify the Allergen
Think about what you might have eaten or been exposed to – food, insect sting, medication or latex – to trigger an allergic reaction. It is particularly important to identify the cause, when possible, because the best way to prevent anaphylaxis is to avoid allergic triggers.

Follow up with a specialist
Ask your doctor for a referral to an allergist/immunologist, a physician who specializes in treating asthma and allergies. It is important that you consult an allergist for testing, diagnosis, and ongoing management of your allergic disease.

⋄ Carry Epinephrine for emergencies
Kits containing fast-acting, self-administered epinephrine are commonly prescribed for people who are at risk of anaphylaxis. Make sure that you carry an epinephrine kit with you at all times, and that family and friends know of your condition and your triggers, as well as how to use epinephrine. Consider wearing an emergency medical bracelet or necklace identifying yourself as a person at risk of anaphylaxis. Teachers and other caregivers should be informed of children who are at risk for anaphylaxis and should know what to do in an allergic emergency.


The more you know about your condition, the more able you will be to prevent or minimize future reactions. The American College of Allergy, Asthma and Immunology has additional information on anaphylaxis prevention tips, other allergy facts, and an easy-to-use allergist locator at

Source: American College of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2011.

Online Health Information – Can You Trust It?

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There are thousands of health-related websites on the Internet. Some of the information on these websites is reliable; some of it is not. Some of the information is current; some of it is not. Choosing which web site to trust is worth thinking about. As a rule, health websites sponsored by federal government agencies are good sources of health information. You can reach all federal websites by visiting Large professional organizations and well-known medical schools may also be good sources of health information.

As you search online, you are likely to find websites for many health agencies and organizations that are not well known. By answering the following questions, you should be able to find more information about these sites. Many of these details can be found under the heading “About Us” or “Contact Us.”

Who sponsors the website?
web sites cost money. Is the funding source readily apparent? Sometimes, the web address itself may help, for example,

  • .gov identifies a government agency;
  • .edu identifies an educational institution;
  • .org identifies professional organizations (e.g., scientific or research societies, advocacy groups); and
  • .com identifies commercial web sites (e.g., businesses, pharmaceutical companies, sometimes hospitals).

Is it obvious how you can reach the sponsor?
Trustworthy websites will have contact information for you to use. The home page should list an e-mail address, phone number, or a mailing address where the sponsor and/or the authors of the information can be reached.

It’s important to find out when the information you are reading was written.

Who wrote the information?
Authors and contributors should be identified. Their affiliation and any financial interest in the content should also be clear. Be careful about testimonials. Personal stories may be helpful, but medical advice offered in a case history should be considered with a healthy dose of skepticism. There is a big difference between a website developed by a person with a financial interest in a topic and a website developed using strong scientific evidence. Reliable health information comes from scientific research that has been conducted in government, university, or private laboratories.

Who reviews the information?
Click on the “About Us” page to see if there is an editorial board that checks the information before putting it online. Find out if the editorial board members are experts in the subject you are researching. For example, an advisory board made up of attorneys and accountants is not medically authoritative. Some websites have a section called “About Our Writers” instead of an editorial policy. Dependable websites will tell you where the health information came from and how it has been reviewed.

When was the information written?
New research findings can make a difference in making medically smart choices. So it’s important to find out when the information you are reading was written. Look carefully on the home page to find out when the site was last updated. The date is often found at the bottom of the home page. Remember, older information isn’t useless. Many websites provide older articles so readers can get a historical view of the information.

Is your privacy protected?
This is important because, sadly, there is fraud on the Internet. Take time to read the website’s privacy policy – if the web site says something like, “We share information with companies that can provide you with products,” that’s a sign your information isn’t private.

Do not give out your Social Security number. If you are asked for personal information, be sure to find out how the information is being used by contacting the site sponsor. Be careful when buying things on the Internet. websites without security may not protect your credit card or bank account information. Look for information saying that a web site has a “secure server” before purchasing anything online.

Does the website make claims that seem too good to be true?
Be careful of claims that any one remedy will cure many different illnesses. Be skeptical of sensational writing or dramatic cures. Make sure you can find other websites with the same information. Don’t be fooled by a long list of links – any website can link to another, so no endorsement can be implied from a shared link. Take the “too good to be true” test – information that sounds unbelievable probably is unbelievable.

Use your common sense and good judgment when evaluating health information online. There are websites on nearly every conceivable health topic and no rules overseeing the quality of the information. Take a deep breath and think a bit before acting on any health information you find on the web. Don’t count on any one website. If possible, check with several sources to confirm the accuracy of your results. And remember to talk with your doctor.


Source: National Institute on Aging,

This article was originally published in Coping® with Allergies & Asthma magazine, May/June 2010.

Dey Pharma to Offer EpiPen 2-Pak® and EpiPen Jr 2-Pak® Exclusively

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Dey Pharma will exclusively offer the EpiPen® 2-Pak and EpiPen Jr 2-Pak (epinephrine) Auto-Injectors to encourage people to follow recommendations by the National Institute of Allergy and Infectious Diseases, which state that people at risk for or who have experienced anaphylaxis should have immediate access to two doses of epinephrine. More specifically, the guidelines indicate that if a person responds poorly to the initial dose or has ongoing or progressive symptoms despite initial dosing, repeated dosing may be required.

The EpiPen and EpiPen Jr Auto-Injectors (0.3 and 0.15 mg epinephrine) are used for the injection of epinephrine, the first-line treatment for allergic emergencies (anaphylaxis). EpiPen Auto-Injector is used to treat signs and symptoms of an allergic emergency, some of which include hives, redness of the skin, tightness in the throat, breathing problems and/or a decrease in blood pressure. Allergic emergencies can be caused by triggers such as food, stinging and biting insects, medicines, latex, or even exercise.

You never know when an allergic emergency will occur, so it’s essential to be prepared. Make sure you speak with your health care professional about how to identify the signs and symptoms of an allergic emergency. If you, your child or someone you're caring for shows signs or symptoms of an allergic emergency, inject the health care professional-prescribed EpiPen or EpiPen Jr. immediately, then promptly call 911 and seek immediate medical attention.

EpiPen and EpiPen Jr Auto-Injectors are available in single cartons and 2-Pak cartons. It is important that patients at risk for allergic emergencies carry two doses of epinephrine. EpiPen 2-Pak provides an additional dose if needed during an allergic emergency. More than two doses of EpiPen Auto-Injector should only be administered under direct medical supervision. Talk to your health care professional if you need additional EpiPen Auto-Injector 2-Paks to keep at work, school or other locations. Each EpiPen 2-Pak also includes a training device.

While there is no safety issue with the EpiPen and EpiPen Jr single package, Dey will transition away from distributing and marketing these in the United States.


This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

When Your Job Causes Asthma

Diagnosing and Managing Occupational Asthma

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Bakers may develop an allergy and occupational asthma symptoms from exposure to various flours or baking enzymes.

Occupational asthma is caused by inhaling fumes, gases, dust, or other potentially harmful substances while “on the job.” Often, your symptoms are worse during the days or nights you work, improve when you have time off, and start again when you go back to work. You may have been healthy and this is the first time you’ve had asthma symptoms, or you may have had asthma as a child and it has returned. If you already have asthma, it may be worsened by being exposed to certain substances at work.

People with a family history of allergies are more likely to develop occupational asthma, particularly to some substances, such as flour, animals, and latex. But even if you don’t have a history, you can still develop this disease if you’re exposed to conditions that induce it. Also, if you smoke, you’re at a greater risk for developing asthma.

Occupational asthma has become the most common work-related lung disease in developed countries. However, the exact number of newly diagnosed cases of asthma in adults due to occupational exposure is unknown. Up to 15 percent of asthma cases in the United States may be job-related.

The rate of occupational asthma varies within individual industries. For example, in the detergent industry, inhaling a particular enzyme used to make washing powders has led to the development of symptoms in some exposed employees. About 5 percent of people working with laboratory animals or with powdered natural rubber latex gloves have developed occupational asthma.

Allergies play a role in many cases of occupational asthma.

Isocyanates are chemicals that are widely used in many industries, including spray painting, insulation installation, and in manufacturing plastics, rubber, and foam. These chemicals can cause asthma in up to 10 percent of exposed workers.

Irritants in high doses that induce occupational asthma include hydrochloric acid, sulfur dioxide, and ammonia, which is found in the petroleum and chemical industries. If you are exposed to any of these substances at high concentrations, you may begin wheezing and experiencing other asthma symptoms immediately after exposure. Workers who already have asthma or some other respiratory disorder may also experience an increase in their symptoms during exposure to these irritants.

Allergies play a role in many cases of occupational asthma. This type of asthma generally develops only after months or years of exposure to a workrelated substance. Your body’s immune system needs time to develop allergic antibodies or other immune responses to a particular substance.

For example, workers in the washing powder industry may develop an allergy to the enzymes of the bacteria Bacillus subtilis, while bakers may develop an allergy and occupational asthma symptoms from exposure to various flours or baking enzymes. Veterinarians, fishermen, and animal handlers in laboratories can develop allergic reactions to animal proteins. Healthcare workers can develop asthma from breathing in powdered proteins from latex gloves or from mixing powdered medications.

Occupational asthma can also occur in workers after repeated exposure to small chemical molecules in the air, such as with paint hardeners or in the plastic and resin industries.

The length of time you are exposed to a substance before it triggers your asthma varies. It can be months or years before symptoms occur. On the other hand, exposure to a high concentration of irritants can cause asthma within 24 hours.

Finally, inhaling some substances in aerosol form can directly lead to the buildup of naturally occurring chemicals in your body, such as histamine or acetylcholine within your lungs, which leads to asthma. For example, insecticides, used in agricultural work, can cause a buildup of acetylcholine, which causes your airway muscles to contract and tighten.

Diagnosis and Treatment
Many people with persistent asthma symptoms caused by substances at work are incorrectly diagnosed as having bronchitis. If occupational asthma is not correctly diagnosed early, and you aren’t protected or removed from the exposure, it can cause permanent changes to your lungs.

An allergist is the best qualified physician to determine if your symptoms are allergy- or asthma-related. Your allergist can properly diagnose the problem and develop a treatment plan to help you feel better and live better.

Once the cause of your symptoms is identified, you and your employer can work together to assure that you avoid exposure to the substance that triggers your asthma symptoms and to high concentrations of irritants. Also, you may need to avoid or reduce your exposure to irritants that can trigger symptoms in most asthmatics, such as smoke or cold air. In some cases, pretreatment with specific medications to protect against asthma worsened at work may be helpful. In other situations, particularly if you are very allergic to a substance in your workplace, avoiding the substance completely may be necessary.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Allergies Getting Under Your Skin?

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If you have red, bumpy, scaly, itchy, or swollen skin, is it because of a skin allergy? Here is a breakdown of the most common types of allergic skin conditions, what causes them, and how they can be treated.

Hives and Angioedema
Hives (or urticaria) are red, itchy, raised areas of the skin that can range in size and appear anywhere on your body. Most common are acute cases, where food or drug allergies are triggers. These hives usually go away within a few days. In cases of chronic hives, people may have them for months to years.

Angioedema is a swelling of the deeper layers of the skin that sometimes occurs with hives. Angioedema is usually not red or itchy. The areas often involved are the eyelids, lips, tongue, hands, and feet.

Food or drug reactions are a common cause of acute hives and angioedema. Viral or bacterial infection can also trigger hives in both adults and children. Physical urticaria is hives resulting from a nonallergic source: rubbing of the skin, cold, heat, physical exertion or exercise, pressure, and direct exposure to sunlight.

When certain substances come into contact with your skin, they may cause a rash called contact dermatitis.

If the cause of your hives can be identified, you should avoid that trigger. With acute hives, some drugs or foods may take days to leave the body, so your doctor may prescribe antihistamines to relieve your symptoms until that happens.

Contact Dermatitis
When certain substances come into contact with your skin, they may cause a rash called contact dermatitis. Irritant contact dermatitis is often more painful than itchy, and is caused by a substance damaging the part of your skin it comes into contact with. The longer your skin is in contact with the substance, or the stronger the substance is, the more severe your reaction will be. These reactions appear most often on the hands and are frequently work related.

Allergic contact dermatitis is best known by the itchy, red, blistered reaction experienced after you touch poison ivy. This allergic reaction is caused by a chemical in the plant called urushiol. You can have a reaction from touching other items the plant has come into contact with. However, once your skin has been washed, you cannot get another reaction from touching the rash or blisters. Allergic contact dermatitis reactions can happen 24 to 48 hours after contact. Once a reaction starts, it takes 14 to 28 days to go away, even with treatment.

Nickel, perfumes, dyes, rubber (latex) products, and cosmetics also frequently cause allergic contact dermatitis. Some ingredients in medications applied to the skin can cause a reaction, most commonly neomycin, an ingredient in antibiotic creams. For irritant contact dermatitis, you should avoid the substance causing the reaction. You should also avoid spilling chemicals on your skin. Gloves can sometimes be helpful. Since these reactions are nonallergic, avoiding the substance will relieve your symptoms and prevent lasting damage to your skin.

Treatment for allergic contact dermatitis depends on how severe the symptoms are. Cold soaks and compresses can offer relief for the acute, early, itchy, blistered stage of your rash. You may also be prescribed topical corticosteroid creams. To prevent the reaction from returning, avoid contact with the offending substance. If you and your doctor cannot determine the substance that caused the reaction, your doctor may conduct a series of patch tests to help identify it.

A common allergic reaction often affecting the face, elbows, and knees is atopic dermatitis, or eczema. This red, scaly, itchy rash is more common in young infants and those who have a personal or family history of allergy.

Common triggers include airborne allergens, such as cat dander or house dust, overheating or sweating, and contact with irritants, such as wool or soaps. In older individuals, emotional stress can cause a flare-up. For some people, usually children, certain foods can also trigger eczema. Skin staph infections can cause a flare-up in children as well. People with eczema usually have very dry skin and “allergic shiners” (an extra crease across their lower eyelids). They are also more at risk for other skin infections.

Preventing the eczema itch is the main goal of treatment. Do not scratch or rub your rash. Applying cold compresses and creams or ointments is helpful. Also, remove all irritants that aggravate your condition from your environment. If a food is identified as the cause, it must be eliminated from your diet.

Topical corticosteroid cream medications and topical calcineurin inhibitors are most effective in treating the rash. Antihistamines are often recommended to help relieve the itchiness. In severe cases, oral corticosteroids are also prescribed. If a skin staph infection is suspected to be a trigger for your eczema flare-up, antibiotics are often recommended.


Source: American Academy of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, July/August 2011.

Fall is Here!

Are Your Symptoms Under Control?

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Now that summer has come to an end, it’s time to think about the new school year, fall allergies, and cooler weather. This is also a time when people with asthma may notice a change in their condition. Being prepared for these changes can make a big difference in keeping your or your child’s asthma well controlled.

Asthma & The New School Year
It is important for your child and the school staff to be prepared for managing asthma at school. The school staff should have information on how to help prevent symptoms and what to do if your child has symptoms.

Ask your doctor for a written asthma action plan for the school. This plan should include what medicine to use to treat asthma symptoms and changes in peak flow zones and what medicine to use as a pretreatment before exercise. Also include information on what makes your child’s asthma worse, his or her asthma symptoms, and emergency telephone numbers.

Plan a meeting with school staff. Your child also can be involved in the meeting. Take the written asthma action plan to the meeting. Helpful school staff members to have at the meeting are the school nurse, health aide, teacher, and physical education teacher. Topics to discuss at the meeting include

  • What makes asthma worse, especially in the school setting
  • Asthma symptoms, including your child’s awareness of symptoms
  • Peak flow use (if used by your child), including technique and the use of peak flow zones
  • Use of quick-relief medicine at school, including correct technique
  • Who to call if the quick-relief medicine is not improving asthma symptoms or peak flow zones

The written asthma action plan will outline these steps. Discuss whether your child is responsible enough to keep the quick-relief medicine with him or her. If not, the quick-relief medicine should be quickly accessible when asthma symptoms occur at school.

Weeds and molds often cause fall allergies. Some seasons produce more pollen from weeds or mold spores because of weather conditions.

Continue talking with your child and school staff about managing asthma at school on a regular basis, even if everything is fine at school. Talk with your child’s doctor about when to keep him or her home from school due to worsening of asthma or illness. Mild asthma symptoms can often be handled at school. Talk with the school staff if your child misses school or homework.

Freedom From Fall Allergies
Weeds and molds often cause fall allergies. Some seasons produce more pollen from weeds or mold spores because of weather conditions. One of the primary weeds responsible for allergy symptoms is ragweed. A lot of rain in the spring and early summer, followed by sunny, hot days tend to produce more ragweed. Rainy days and piles of wet leaves lead to more mold growth.

If weed pollens or molds cause your allergy symptoms, plan outdoor activities for early in the day, as weed pollens are highest around midday. If you are outdoors during high pollen counts, take a shower, wash your hair, and change your clothes when you come indoors. If possible, keep windows and outside doors shut during pollen season. This is very important when pollen and mold counts are high. These counts are often reported on the TV news and in the newspaper. Stay away from wet leaves and garden trash.

Take the medicine your doctor recommends. Many different medicines are available to help control allergy symptoms when you can’t avoid the things to which you are allergic. Keep in mind that allergy medicines work best when you take them every day, and it is best to start taking them before you are exposed to high levels of pollen or mold. Most doctors recommend that you start an antihistamine when the allergy season begins and continue taking it every day until allergy season is over. When allergy season is in full swing and your immune system is in high gear, medicines are less effective and take longer to relieve symptoms.

Weathering Fall Weather
Fall is a season when a lot of weather changes can occur. Be prepared for changes in temperature and rainy days by having a sweater, jacket, or rain gear with you. With cooler weather approaching, this is also a good time to have your furnace checked and the filters replaced. In addition, it’s almost time for the yearly flu shot, so start watching for locations and times when flu shots will be given. Fall is a very busy time of year for most people. Keeping your allergies & asthma under control can help you enjoy this beautiful season.


Source: National Jewish Health,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2011.

Changes in Weather May Trigger Children’s Asthma

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Changes in humidity and temperature result in an increase in Emergency Department (ED) visits for pediatric asthma exacerbation, according to a report published in Annals of Allergy, Asthma & Immunology.

“We found a strong relationship between temperature and humidity fluctuations with pediatric asthma exacerbations, but not barometric pressure,” says Dr. Nana A. Mireku, an allergist at Dallas Allergy Immunology private practice in Dallas, TX.

A 10 percent daily increase in humidity on a day or two before ED admission was associated with approximately one additional ED visit for asthma. Between-day changes in humidity from two to three days prior to admission were also associated with more ED visits. Daily changes in temperature on the day of or the day before admission increased ED visits, with a 10 degree Fahrenheit increase being association with 1.8 additional visits.


Source: Annals of Allergy, Asthma & Immunology,

This article was originally published in Coping® with Allergies & Asthma magazine, September/October 2009.