Allergies

Definition

An allergy is an exaggerated immune response or reaction to substances that are generally not harmful.

See also:

• Allergic reactions
• Allergy testing
• Allergy to mold, dander, dust
• Drug allergies
• Food allergies
• Hay fever

Causes

Allergies are relatively common. Both genetics and environmental factors play a role.

Allergy is caused by an oversensitive immune system, which leads to a misdirected immune response. The immune system normally protects the body against harmful substances, such as bacteria and viruses. It reacts to substances (allergens) that are generally harmless and in most people do not cause a problem.

But in a person with allergies, the immune response is oversensitive. When it recognizes an allergen, it releases chemicals, such as histamines. This causes itching, swelling, mucus production, muscle spasms, hives, rashes, and other symptoms, which vary from person to person.

What part of the body is contacted by the allergen plays a role in the symptoms you develop. For example, allergens that are breathed in often cause a stuffy nose, itchy nose and throat, mucus production, cough, or wheezing. A food allergen can cause nausea, vomiting, abdominal pain, cramping, diarrhea, or a severe, life-threatening reaction. Allergies to plants often cause a skin rash. Drug allergies usually involve the whole body and can lead to a variety of symptoms.

Some medical conditions, such as eczema and asthma, are linked to allergies.

Common allergens include pollen, mold, pet dander, and dust. Food and drug allergies are common. Allergic reactions can also be caused by insect bites, jewelry, cosmetics, and other substances.

Some people have allergy-like reactions to hot or cold temperatures, sunlight, or other physical stimuli. Sometimes, friction (rubbing or vigorously stroking the skin) will cause symptoms.

See also:

Atopic dermatitis

Contact dermatitis

Symptoms

Allergy symptoms vary, but may include:

• Breathing problems
• Burning, tearing, or itchy eyes
• Conjunctivitis (red, swollen eyes)
• Coughing
• Diarrhea
• Headache
• Hives
• Itching of the nose, mouth, throat, skin, or any other area
• Runny nose
• Skin rashes
• Stomach cramps
• Vomiting
• Wheezing

Exams and Tests

The health care provider will perform a physical exam and ask questions such as when the allergy occurs.

Allergy testing may be needed to determine if the symptoms are an actual allergy or caused by other problems. For example, eating contaminated food (food poisoning

Skin testing is the most common method of allergy testing. One type of skin testing is the scratch test. It involves placing a small amount of the suspected allergy-causing substances on the skin, and then slightly scratching the area so the substance moves under the skin. The skin is closely watched for signs of a reaction, which include swelling and redness. Skin testing may be an option for some young children and infants.

A blood test called RAST (radioallergosorbent) measures the levels of specific allergy-related substances. The blood test may be used if you cannot have or do not want a skin test.

Other blood tests that may help reveal allergies include:

• Antibody/immunoglobulin (particularly IgE) levels
• CBC
• Complement levels

In some cases, the doctor may tell you to avoid certain items to see if you get better, or to use suspected items to see if you feel worse. This is called "use or elimination testing." This is often used to check for food or medication allergies.

The doctor may also check your reaction to physical triggers by apply heat, cold, or other stimulation to your body and watching for an allergic response.

Sometimes, a suspected allergen is dissolved and dropped into the lower eyelid to check for an allergic reaction. This should only be done by a health care provider.

Treatment

The best way to reduce symptoms is to try and avoid what causes your allergies in the first place. This is especially important for food and drug allergies.

The most appropriate medication depends on the type and severity of symptoms. Specific illnesses that are caused by allergies (such as asthma, hay fever, and eczema) may require other treatments. Medications that can be used to treat allergies include:

ANTIHISTAMINES

• Short-acting antihistamines are generally available over-the-counter. They help relieve mild to moderate symptoms but may cause drowsiness. In addition, the short-acting antihistamine diphenhydramine (Benadryl) can affect a child's learning abilities. Loratadine (Claritin) does not tend to cause drowsiness or affect learning in children.
• Longer-acting antihistamines require a prescription. They usually do not interfere with learning. Examples of longer-acting antihistamines include fexofenadine (Allegra) and cetirizine (Zyrtec). Overall, they cause less drowsiness than other medicines, but cetirizine may cause drowsiness in some people.

NASAL SPRAYS

• Nasal corticosteroid sprays are safe and work very well for persons whose symptoms do not go away with antihistamines alone. These prescription medications include fluticasone (Flonase), mometasone (Nasonex), and triamcinolone (Nasacort AQ).
• A newer nasal spray called azelastine (Astelin) is approved for those with seasonal or environmental allergies. It is an antihistamine and not a corticosteroid.
• Cromolyn sodium is a nasal spray (NasalCrom) used to treat hay fever symptoms. (Eye drop versions are available for itchy, bloodshot eyes.)
• Decongestants can help relieve a stuffy nose. However, nasal spray decongestants should not be used for more than several days, because they can cause a "rebound" effect and make the congestion worse. Decongestants in pill form do not cause this problem.

OTHER MEDICINES

• Leukotriene inhibitors are medicines that specifically block the substances that trigger allergies. Montelukast (Singulair) is a prescription medicine approved for those with asthma and indoor and outdoor allergies.
• Allergy shots (immunotherapy) are occasionally recommended if the allergen cannot be avoided and symptoms are hard to control. Allergy shots keep your body from over-reacting to the allergen. Regular injections of the allergen are given, with each dose slightly larger than the previous dose until a maximum dose is reached. They do not work for everybody and require frequent doctor's visits.

Severe allergic reactions (anaphylaxis) require a medicine called epinephrine, which can be life saving when immediately given.

Support Groups

See: Asthma and allergy support group

Outlook (Prognosis)

Most allergies can be easily treated with medication.

Some children may outgrow an allergy. This is particularly true of food allergies. However, as a general rule, once a substance has triggered an allergic reaction, it continues to affect the person.

Allergy shots are most effective when used to treat those with hay fever symptoms and severe insect sting allergies. They do not work well for food allergies. Allergy shots may require years of treatment, but they work in about two-thirds of cases. However, they may cause uncomfortable side effects (such as hives and rash) and dangerous outcomes (such as anaphylaxis).

Possible Complications

• Anaphylaxis (life-threatening allergic reaction)
• Breathing problems and discomfort during the allergic reaction
• Drowsiness and other side effects of medicines

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

• Severe symptoms of allergy occur
• Treatment for allergies no longer works

Prevention

Children who have been breastfed are less likely to have allergies. In addition, a mother who avoids cow's milk, eggs, nuts, and peanuts while breastfeeding can prevent allergy-related conditions, including eczema, in some children.

If there is a family history of eczema and allergies it is wise to discuss the implications for infant feeding with your child's doctor. The timing of introduction of solid foods in general, as well as of several specific foods, can help prevent some allergies.

There is also evidence that infants exposed to certain airborne allergens (such as dust mites and cat dander) may be less likely to develop related allergies. This is called the "hygiene hypothesis" and sprang from observations that infants on farms tend to have fewer allergies than those who grow up in environments that are more sterile.

Once allergies have developed, treating the allergies and carefully avoiding those things that cause reactions can prevent allergies in the future.

Christodoulopoulos P, Tulic MK, Kontolemos M, Hamid Q. Immunopathology of Allergic Airway Inflammation.In: Middleton's Allergy: Principles and Practice. 6th ed. St. Louis, Mo: Mosby; 2003; 501-511.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:1590-1591.