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Why Allergies? An Allergist Offers an Explanation and Advice

By Marybeth Kotrodimos, University Health Partners of Hawaii
Photo courtesy of Gustavo Fring, Pexels

For those of us who suffer from allergies, it sometimes feels like we are being attacked by unseen forces lingering all around us.  The very air we breathe, the food we eat, the beautiful flowers we see and the beloved pets we hold in our arms can be sources of irritation and illness. Yet many of us don’t understand what causes allergic reactions even as we struggle to minimize their effects.  Dr. Dayna Lee Lucuab-Fegurgur (or simply referred by colleagues as “Dr. L”) is an internal medicine doctor at University Health Partners of Hawaii sub-specializing in Allergy and Immunology.  In a recent conversation, she offered some explanations and some advice about how to get help for this medical condition that affects so many of us.

Allergies, she tells us, occur when our bodies “produce an abnormal or over-reactive immune response to a substance.  We call these substances ‘allergens’ and they can be anything from pollen to food or even medications. For the general population, these substances don’t cause any type of reaction, but for someone with allergies, they can cause an over-reactive immune response.  Their immune system will recognize the specific allergen as foreign and its reaction can manifest in different ways ranging from a runny nose and sneezing to, at the severe end of the spectrum, anaphylaxis.” Anaphylaxis can bring about some very severe symptoms such as vomiting, difficulty breathing and shock, and if it is not treated right away may even result in death. 

“Allergies can appear at any time in your life, even in infancy,” Dr. L tells us, “and some can wane with time.” There are various theories explaining why and how allergies develop, “but basically to become allergic later in life, your body has become sensitized to the allergen over time with repeated exposure. Your body just decides to see it as foreign and develops an abnormal immune response for reasons not completely understood.”  And the reverse can happen as well.  “Your body may develop a tolerance to the allergen over time and lose its ability to recognize it as foreign. We can’t predict that.”

Why do some people get allergies and some lucky souls never are afflicted with this condition?  “There’s definitely a genetic component,” Dr. L says. “You may be predisposed to developing allergic diseases like asthma, allergic rhinitis, and eczema if there is a positive family history.  Having one parent who has a history of allergies definitely increases your propensity to develop them as well by about 50%. If both parents have allergies, then there’s an even higher chance that you will inherit some type of atopic condition.”

If you have the allergic type of asthma, allergies can trigger your asthma to flare, Dr. L says. “Not all asthma is allergic, but a large proportion of people with asthma have allergic triggers. Asthma itself is a chronic condition of the lungs generally characterized by airway inflammation and obstruction which causes symptoms such as wheezing, shortness of breath, chest tightness and chronic cough.”  The allergic type of asthma usually develops in childhood, but if you develop it later in life, she says, allergic triggers may not be as prevalent.  “There are other potential etiologies for late onset asthma.” 

There are a number of theories as to why the number of people developing allergies has been increasing over time, Dr. L says. One, she refers to as “the hygiene hypothesis” whereby in industrialized countries children aren’t exposed to as many germs as they would have been in developing regions where the exposure can help train their immune systems to recognize the difference between harmful and harmless irritants. Also, in industrialized countries, “we’ve had increased prevalence of antibiotic use over the years and this might alter the microflora or the flora of bacteria that are naturally occurring in our guts, which might possibly impact the development of allergies.”

Of course the world holds many different types of allergens, so where you live can impact your sensitivity to them due to the amount of allergen exposure, which can vary geographically. “Here we have a lot of Bermuda grass pollen, but if you go to the East Coast, there may be more ragweed pollen, so depending upon where you are, the triggers might be different.”

While there is no cure for allergies or asthma, Dr. L assures us that “there are many, many treatment options and different modes of therapy to help manage the symptoms.” Allergy shots, which have been proven to be quite effective for a lot of people, “give you small amounts of the allergen gradually increasing in dose over time and this procedure kind of changes the way your immune system responds to the allergen, so you don’t have as many of the symptoms that come with it. These shots are specifically for inhalant allergens (things in the air that trigger nasal allergies and asthma).  For specific dust mite allergy, they might also help with eczema.”

Depending on the particular allergens that are triggering your allergies, there are a lot of things we can do in our own environments to limit our exposure to them, such as trying to eliminate as much dust as possible in our homes. “Dust tends to be highly concentrated in carpets, upholstery, and in our beds and pillows.”  

Dr. L urges people who suffer from allergies to see a doctor. “If you have trouble controlling your allergies, or you want to know exactly what you’re allergic to, you should definitely see your local allergist.”  For those wanting more information, she recommends going to the American Academy of Allergy, Asthma & Immunology (AAAAI) or the American College of Allergy, Asthma, and Immunology (ACAAI) websites.

“A lot of people have allergic rhinitis,” she adds, “and while this isn’t a deadly disease, it does bother a lot of people and causes missed work days, missed school days, and can be a large financial burden which definitely impacts the quality of life for many people.”

If you suffer from allergies, avoid triggering an allergic response from these major allergens: 

Dust mitesPut special dust-proof covers on pillows, mattresses and box springs, and remove and clean them frequently.  Avoid bedding stuffed with foam rubber or kapok. 
PollenKeep windows closed during pollen season. Know which pollens you’re sensitive to and check pollen counts in your area.  Take a shower, wash your hair, and change clothing after spending time outdoors.
Pets Don’t allow your pet in your bedroom.  Wash hands after petting, and bathe your pet once a week to reduce dander. 
MoldClean bathrooms, kitchens, and basements regularly and keep them well aired.  Do not use humidifiers.
Cockroaches(Can also trigger asthma.)  Keep your kitchen clean and wash dishes promptly. Make sure food is stored in sealed containers and not left out. Empty garbage and recycling bins frequently. Set roach traps and seal cracks in your home.
IrritantsAvoid smoke, strong odors, and exhaust. Don’t use air fresheners or electronic air cleaners. Cover your nose and mouth with a scarf in cold air. Wash hands often to avoid colds and infections.

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