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Allergy is defined as a “harmful, increased susceptibility to a specific substance,” also known as hypersensitivity, while immunity is characterized as a “protective, enhanced resistance.” The American Academy of Allergy, Asthma & Immunology has an array of resources about allergic disease to help you understand how your allergies affect you, your friends and family. Skin Allergies Red, bumpy, scaly, itchy or swollen skin – any of these signs may mean you have a skin allergy. The most common allergic skin conditions are: Eczema Hives and angioedema Allergic contact dermatitis Symptoms of a skin allergy include: A strange rash Red, scaly or itchy skin A swelling of the deeper layers of the skin, such as the eyelids, mouth or genitals Dry, flaking skin Inflamed or blistered skin Skin allergies are painful and unpleasant, but there are things you can do to treat and prevent an allergic skin reaction. Some people are allergic to latex, a substance often found in rubber gloves and balloons. Signs of latex allergy may resemble those of contact dermatitis. But sometimes latex allergy causes a serious reaction called anaphylaxis. This life-threatening condition requires immediate medical treatment. If you think you are having this kind of reaction, call 911 immediately. Skin allergies can take several forms and have a variety of causes. To find out what is causing your skin condition, talk to an allergist/immunologist – a doctor with special training to manage allergies and asthma. An allergist can also help you develop a treatment plan. Eczema and Atopic Dermatitis Eczema, or atopic dermatitis, is a common allergic reaction often affecting the face, elbows and knees. This red, scaly, itchy rash is usually seen in young infants, but can occur later in life in individuals with personal or family histories of other allergic conditions – such as asthma or hay fever. In infants, eczema usually appears as tiny bumps on the cheeks. Older children and adults often experience rashes on the knees or elbows (often in the folds of the joints), on the backs of hands or on the scalp. Itching is the hallmark symptom and can sometimes be very intense. Eczema can appear very dry, with flaking skin, or can have lesions that ooze – often a sign of a bacterial infection caused by scratching. Identifying the cause of the itch is essential in relieving the dermatitis. Common triggers include allergens, overheating or sweating, emotional stress, eating certain foods and contact with irritants such as wool, pets, soaps or other agents. Urticaria (hives) Urticaria, also called hives, are red, itchy, swollen areas of the skin that can range in size and appear anywhere on the body. The blotches can migrate on body, appearing in different areas throughout the course of the reaction. Usually, the cause of urticaria is readily identifiable—often a viral infection, or allergic reaction to drugs, food or latex. These hives usually go away spontaneously or by avoiding the allergic trigger. However, in some cases, medical intervention is needed to increase comfort or prevent recurrence. Treatment with oral antihistamines is frequently successful, but in severe cases, steroids may be needed. Some people have chronic urticaria that occurs almost daily for months or, in some cases, years. For these individuals, scratching, pressure or stress may aggravate hives. An allergist/immunologist can diagnosis the problem and prescribe treatments for this bothersome condition. Angioedema Angioedema is a swelling of the deeper layers of the skin and often occurs with hives. Angioedema itself is not red or itchy and most often occurs in the body’s soft tissue, such as the eyelids, mouth or genitals. Angioedema is called “acute” if the condition lasts only a short time (minutes to days) and does not recur. This is commonly caused by an allergic reaction to medications or foods. Chronic recurrent angioedema occurs when the condition returns over a long period of time. Chronic recurrent angioedema most often does not have an identifiable cause. Contact Dermatitis Contact dermatitis refers to a broad range of reactions resulting from the direct contact of an allergen or irritant with the surface of the skin. A reaction usually appears after one to three days. This type of reaction can develop at any time in life. The skin becomes red, itchy and inflamed, and will frequently blister. Poison ivy is the most common cause, but other plants, metals (such as nickel), cosmetics and medications can also cause a reaction. Allergic contact dermatitis can be treated by scrubbing the skin with soap and water after exposure to the allergen and using prescribed antihistamine and cortisone medications, depending on severity. Avoidance of the irritant is the most effective prevention.

Sinusitis is a painful, long-lasting inflammation of the sinuses. Sinuses are the hollow cavities around the cheek bones found around the eyes and behind the nose. Symptoms of sinusitis include: Congestion Green or gray nasal discharge Postnasal drip Pressure in the face Headache Fever A cough that won’t go away Sinusitis is common in the winter. It may last for months or years if it is not properly treated. Colds are the most common cause of acute sinusitis, but people with allergies are much more likely to develop sinusitis than people who do not have allergies. Sinuses are empty cavities within your cheek bones, around your eyes and behind your nose. Their main job is to warm, moisten and filter air in your nasal cavity. If your stuffy nose and cough last longer than one or two weeks, you may have more than a cold. Sinusitis (pronounced sine-you-SITE-iss) is a swelling of one or more of your nasal sinuses and nasal passages. It is often called a sinus infection. You may experience pressure around your nose, eyes or forehead, a stuffy nose, thick, discolored nasal drainage, bad-tasting post-nasal drip, cough, head congestion, ear fullness or a headache. Symptoms may also include a toothache, tiredness and, occasionally, a fever. By learning more about sinusitis, you will have a better understanding of your symptoms. An allergist/immunologist, often referred to as an allergist, can make an accurate diagnosis and develop a treatment plan that works for you. Types and Causes of Sinusitis Acute sinusitis refers to sinusitis symptoms that last less than four weeks. Most acute sinusitis starts as a regular cold from the common cold viruses and then becomes a bacterial infection. Chronic sinusitis is when symptoms last three months or longer. The cause of chronic sinusitis is believed to be a combination of swelling and infection. Recurrent sinusitis occurs when three or more acute episodes happen in a year. Allergies or “hay fever” put you at risk for developing sinusitis because allergies can cause swelling of the sinuses and nasal mucous linings. This swelling prevents the sinus cavities from draining, and increases your chances of developing secondary bacterial sinusitis. If you test positive for allergies, your allergist can prescribe appropriate medications to control your allergies, possibly reducing your risk of developing an infection. In rare cases, immune problems that harm your ability to fight common infections may present with chronic or recurrent sinusitis. Problems with the structure of your nose-such as narrow drainage passages, tumors or a shifted nasal septum (the bone and cartilage that separate the right from the left nostrils)-can also cause sinusitis. Surgery is sometimes needed to correct these problems. Many patients with recurring or chronic sinusitis have more than one factor that puts them at risk of infection. So, an accurate diagnosis is essential. Diagnosis To diagnose sinusitis, an allergist will take a detailed history and perform a physical examination. He or she may also order tests. These tests can include allergy testing, sinus CT scans (which take exact images of the sinus cavities) or a sample of your nasal secretions or lining. Your physician may also perform an endoscopic examination. This involves inserting a narrow, flexible endoscope (a device with a light attached) into the nasal cavity through the nostrils after local anesthesia. This allows your physician to view the area where your sinuses drain into your nose in an easy, painless manner. Treatment Sinus infections generally require a mix of therapies. Your physician may prescribe a medication to reduce blockage or control allergies, which helps keep the sinus passages open. This medicine may be a decongestant, a mucus-thinning medicine or a steroid nasal spray. If bacterial sinusitis is present, your physician may prescribe an antibiotic. For people with allergies, long-term treatment to control and reduce allergic symptoms can also help in preventing sinusitis. Several non-drug treatments can also be helpful. These include breathing in hot, moist air and washing the nasal cavities with salt water. If you need surgery to fix the structure of your nose, your allergist may refer you to an otorhinolaryngologist, or an ear-nose-throat physician (ENT). Sinusitis Versus Rhinitis Symptoms of sinusitis and rhinitis are very similar. Rhinitis is a swelling of the mucous membranes of the nose while sinusitis includes swelling of the sinuses in addition to the nasal passages. For this reason, sinusitis is often called rhinosinusitis. Rhinitis may be allergic or non-allergic. Allergic rhinitis is caused by allergens in the air, which are usually harmless but can cause problems in allergic people. Symptoms of allergic rhinitis often are a runny nose, sneezing, nasal congestion and itchy eyes, nose, throat and ears. People with non-allergic rhinitis usually just have a stuffy nose. It may be caused by irritants such as smoke, changes in barometric pressure or temperature or overuse of over-the-counter decongestant nasal sprays. Your allergist can perform simple tests to determine if your symptoms are from sinusitis or rhinitis. The American Academy of Allergy, Asthma & Immunology’s brochure on Rhinitis offers also more helpful advice on allergic and non-allergic rhinitis. Healthy Tips  Sinusitis is a swelling of the nose and sinuses. Acute sinusitis occurs when symptoms last less than four weeks. Chronic sinusitis occurs when symptoms last more than three months. People with allergies are at greater risk of getting sinus infections. Treatment for sinusitis is available. See an allergist for help managing your symptoms.

Rhinitis is an inflammation of the mucous membranes of the nose. Symptoms include: Sneezing Itchy nose, roof of the mouth, throat, eyes and ears Runny nose Congestion Watery eyes Seasonal allergic rhinitis (or hay fever) is caused by allergens like mold and pollen. Some people have symptoms of rhinitis no matter what the season. This is called perennial allergic rhinitis. It can be caused by allergens such as animal dander, indoor mold, dust mites and cockroaches. Sinusitis is a painful, long-lasting inflammation of the sinuses. Sinuses are the hollow cavities around the cheek bones found around the eyes and behind the nose. Symptoms of sinusitis include: Congestion Green or gray nasal discharge Postnasal drip Pressure in the face Headache Fever A cough that won’t go away Sinusitis is common in the winter. It may last for months or years if it is not properly treated. Colds are the most common cause of acute sinusitis, but people with allergies are much more likely to develop sinusitis than people who do not have allergies. Do you suffer from frequent sneezing, congestion and an itchy or runny nose? If so, you may have rhinitis. Rhinitis is one of the most common chronic conditions, affecting 10% to 30% of adults and up to 40% of children in the United States. If this includes you, you don’t have to suffer. By learning more about rhinitis, you will have a better understanding of your symptoms. An allergist/immunologist, often referred to as an allergist, can make an accurate diagnosis and develop a treatment plan that works for you. Allergic Rhinitis There are two types of rhinitis: allergic rhinitis and non-allergic rhinitis. Let’s talk first about allergic rhinitis. Allergic rhinitis is caused by allergens in the air, which are usually harmless but can cause problems in certain people. Allergy symptoms are the result of a chain reaction that starts 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 with symptoms such as sneezing, stuffiness, a runny nose, itching and post-nasal drip. People with rhinitis are prone to itchy, watery eyes (from allergic conjunctivitis), and they may be more sensitive to irritants such as smoke, perfume or cold, dry air. Rhinitis can contribute to other problems such as asthma, sinus or ear conditions or trouble sleeping. Causes When allergic rhinitis is caused by outdoor allergens such as tree, grass and weed pollen, it is called seasonal allergic rhinitis, or “hay fever.” Rhinitis can also occur year-round because of indoor allergens from pets, mold, dust mites and cockroach droppings. This is called perennial allergic rhinitis. You can have either seasonal or perennial allergic rhinitis, or a combination of both. Diagnosis and Treatment of Allergic Rhinitis An allergist can help determine which allergens, if any, are causing your symptoms. He or she will take a detailed health history, perform a physical exam and then test you for allergies. Skin tests show the results within 20 minutes. These results, as well as how frequent and bad your symptoms are, will be considered when developing a treatment plan. Steps to manage your symptoms may include avoiding the allergens you are allergic to, medications and/or allergy shots (immunotherapy). Avoiding allergens. The American Academy of Allergy, Asthma & Immunology brochures on Indoor Allergens and Outdoor Allergens give helpful advice to help you reduce exposure to the allergens to which you are sensitive. Medications. Some medications for allergic rhinitis are best used daily to control inflammation and prevent symptoms, while others are used only as needed to relieve symptoms. Nasal corticosteroid sprays can control inflammation and reduce all symptoms of allergic rhinitis, including itching, sneezing, runny nose and stuffiness. Antihistamines in the form of pills or nasal sprays block histamine and may relieve itching, sneezing and runny nose. But they may not be as effective in reducing nasal stuffiness. Anti-leukotrienes in the form of pills can reduce all the symptoms of allergic rhinitis. Decongestant pills or nasal sprays can be used as needed if nasal stuffiness is not relieved with other medications. Decongestant sprays should not be used for long periods of time because they can cause your congestion to return. Ipratropium nasal spray can be used specifically for a runny nose. Allergy shots, also known as immunotherapy, may be considered if your symptoms are constant, if you don’t want to take medications or feel that they are not enough, or if you want long-term control of your allergies with less need for medications. This treatment involves receiving injections periodically-as determined by your allergist-over a period of three to five years. The end result is decreased sensitivity to allergens. Non-Allergic Rhinitis Some people with rhinitis symptoms do not have allergies. Non-allergic rhinitis usually begins in adults and causes year-round symptoms, especially a runny nose and nasal stuffiness. Strong odors, pollution, smoke and other irritants may cause symptoms of non-allergic rhinitis. Non-allergic rhinitis symptoms can also develop as side effects of medications, including some blood pressure medicines, oral contraceptives or medications used for erectile dysfunction. The most common form of this type of non-allergic rhinitis is caused by nasal decongestant sprays such as oxymetazoline, when used for long periods of time. This type of medication-induced rhinitis is also called rhinitis medicamentosa. Treatment of Non-Allergic Rhinitis If there is inflammation in the nose, the treatment of choice is nasal corticosteroid sprays. Ipratropium nasal spray can relieve a runny nose. Decongestant pills can be used as needed to relieve nasal stuffiness. Other forms of treatment may be considered if you have problems with the structure of your nose, such as narrow drainage passages, tumors or a shifted nasal septum (the bone and cartilage that separate the right from the left nostril). In these cases, an operation may be needed. Healthy Tips There are two

During pregnancy, mothers-to-be may feel uneasy taking medications. However, if a pregnant woman has asthma, it is doubly important that her symptoms be well-managed to increase both her health and that of her baby. Uncontrolled asthma can be a threat to maternal well-being and fetal growth and survival. The goals of asthma management and treatment during pregnancy are the same as for other patients—to prevent hospitalization, emergency room visits, work loss and chronic disability. 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. How do you stay healthy and know which medications are best for you during your pregnancy? An allergist/immunologist, often referred to as 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. In the meantime, here are answers to some common questions. Can women with asthma have safe pregnancies? Yes. With good asthma management, you can keep your asthma under control and have a healthy baby. How does uncontrolled asthma affect the fetus? 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. Is it safe to take my asthma medications? 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 allergist so he or she can monitor your condition and alter your medications or dosages if needed. Will being pregnant affect my asthma symptoms? Pregnancy may affect the severity of your asthma symptoms. One study showed that asthma symptoms were worse in 35% of pregnant women, improved in 28% and remained the same in 33% 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. Can I continue to get allergy shots during pregnancy? Allergy shots, or immunotherapy, are safe to take while you are pregnant. As always, your allergist 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 shot treatments should not be started for the first time during pregnancy. What should I avoid if I have asthma or allergies? Whether you are pregnant or not, you should stay away from things that trigger your symptoms. This might include dust mites and animal dander, and irritants such as cigarette smoke. Can women with asthma perform Lamaze? 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. Can I breastfeed if I am taking medications for my asthma or allergies? 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 allergist can discuss with you the best treatments while nursing. Although these are common questions during pregnancy, each patient’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. Healthy Tips  You can have a healthy pregnancy if you have asthma or allergies. Managing your symptoms is very important during pregnancy. Do not stop taking your medications. An allergist has special training to develop or review a treatment plan that is right for you while you are pregnant.

Millions of Americans take great pleasure in being dog and cat owners; yet many of these owners or potential owners suffer allergic reactions when exposed to these animals. It is a common misconception that people are allergic to a dog or cat’s hair, and it is falsely believed that an animal that sheds less will not cause a reaction. However, allergies to pets are caused by protein found in the animal’s dander (dead skin cells), saliva or urine. These proteins are carried on microscopic particles through the air. When inhaled, they trigger reactions in allergic people. As all dogs and cats posses these proteins, none of them are allergy-free. Though some breeds are considered more allergy friendly, it is likely because they are groomed more frequently – a process that removes much of the dander. While the most effective treatment for animal allergies is avoidance, this is not always possible. Below are some tips for minimizing allergy symptoms: Visit an allergist/immunologist to diagnose the allergy and discuss treatment, which may include maintenance medications or immunotherapy (allergy shots). Keep the pet out of the allergic person’s bedroom. Animal dander will collect on pillows, leading to worsened symptoms at night and morning. Bathe the animal weekly to reduce the amount of dander shed at home. Replace carpeting with hardwood or other solid-surface flooring for easy clean-up. Vacuuming may not be effective in decreasing allergen levels, but using a HEPA filter and double bags may help. Wash bedding and clothing in hot water. While animal allergens are not easily removed by high temperatures, these measures may help. There’s no guarantee that someone who is truly allergic to pets (about 10% of those with allergies) will tolerate living with a dog or cat. If you’re thinking about getting a pet, but are concerned about allergies, consider trying one out on a trial basis. You can also begin allergy treatment before getting a pet, including allergy shots. Tips to remember: • No dog is 100% hypoallergenic. Even hairless dogs produce some allergens. • Keeping pets out of the bedroom can help reduce allergy symptoms. • About 10% of allergic individuals have allergies to pets. It can be as high as one out of five individuals with asthma • Get pet allergy testing and begin allergy treatment (including allergen immunotherapy) before you get a pet can help ease symptoms

Asthma is the most common serious chronic disease of childhood, affecting nearly 5 million children in the United States. Characterized by coughing, chest tightness, shortness of breath and wheezing, asthma is the cause of almost 3 million physician visits and 200,000 hospitalizations each year. In infants and children, asthma may appear as cough, rapid or noisy breathing in and out, or chest congestion, without the other symptoms seen in adults. Children with recurrent cough, wheezing, chest tightness or shortness of breath may have one or more forms of asthma. Left untreated, asthmatic children often have less stamina than other children, or avoid physical activities to prevent coughing or wheezing. Sometimes they will complain that their “chest hurts” or that they can not “catch their breath.” Colds may “go straight to their chest.” They may cough when sick, particularly at night. Asthma has multiple causes, and it is not uncommon for two or more different causes to be present in one child. Asthma is not just “wheezing.” Coughing, recurrent bronchitis and shortness of breath, especially when exercising, are also ways that asthma appears. Diagnosis Diagnosing the precise cause of asthma is sometimes difficult because two or more causes may be present in one child. Unfortunately, there is not a single test that provides all the answers. An allergist/immunologist, often referred to as an allergist, has specialized training and experience to determine if your child has asthma, what is causing it and develop a treatment plan. Your child’s allergist will want to learn how often episodes of wheezing/coughing/other symptoms occur, and how bad they are. It is important to understand what triggers your child’s symptoms, and what (including medications) makes them go away. An understanding of your family history and environment (smoking, pets, etc) is useful, so your physician may ask. Infants may need extra attention during the diagnostic process because asthma symptoms can be caused by many things in this age group, some of which need very different therapies. When an infant has asthma symptoms, it is sometimes called “reactive airway disease.” The two most common triggers of asthma in children are colds and allergens. After infancy, allergies become particularly important, and therefore asthmatic children should have an allergy evaluation to help diagnose and manage their asthma. Avoiding the allergens to which your child is allergic may help improve his or her asthma. If your child is older than 5 years, he or she may be asked to perform pulmonary function testing to learn how air flows in his or her lungs. Other tests that your physician may discuss with you include measures of inflammation, a chest x-ray and tests for some of the less common causes of asthma-like symptoms. Management The most important part of managing asthma is for you and your child to be very knowledgeable about how and when asthma causes problems, how some of the triggers can be avoided and how to use medications. The causes of asthma and best treatment for it in your child may be quite different than for another child. Your allergist will help you develop an asthma management plan, and it is wise to share it with other caregivers. This plan outlines what medications to take, and when and how to increase the doses or add more medication if needed. It also includes advice about when to call your physician. An asthma management plan puts you in control for detection and early treatment of symptoms. Inhaled medications come as metered dose inhalers (sometimes called pumps), nebulizer solutions (delivered as a mist by a machine) and dry powder inhalers. It is important to learn how to use the type of medications prescribed for your child, or they might not work well. Another brochure in this series, Inhaled Asthma Medications, offers helpful information. Asthma medications include inhaled rescue medications (quick relievers) to treat symptoms and long-term controller medicines (inhaled as well as oral) to control inflammation that commonly causes the asthma. If your child’s asthma is more than a rare minor problem, a controller medication will probably be prescribed. Our knowledge about asthma and its therapy is constantly changing. An ongoing relationship with your child’s physician is key to determining what will work best for your child, now and throughout childhood. Answers to Commonly Asked Questions Will my child outgrow his/her asthma? Many babies who wheeze with viral respiratory illnesses will stop wheezing as they grow older. If your child has atopic dermatitis (eczema), allergies or if there is smoking in the home or a strong family history of allergies or asthma, there is a greater chance that asthma symptoms will persist. Can asthma be cured? Not yet. However, for most children and adults, asthma can be controlled throughout life with appropriate diagnosis, education and treatment. Should my child exercise? Once a child’s asthma is controlled, (usually with the help of proper medications) exercise should become part of his or her daily activities. Children with asthma certainly can and do excel in athletics. Many Olympic athletes have asthma. How can symptoms be controlled at school? You, your family, physician and school personnel can work together to prevent and/or control asthma. Share your child’s asthma management plan with the school nurse and any coaches who oversee your child. With the approval of physicians and parents, school-age children with asthma should be allowed to carry metered dose inhalers with them and use them as appropriate. Healthy Tips Asthma is not just “wheezing.” Coughing, recurrent bronchitis and shortness of breath, especially when exercising, are also ways that asthma appears. The two most common triggers of asthma in children are colds and allergens. Diagnosing the precise cause of asthma is sometimes difficult because two or more causes may be present in one child. The most important part of managing asthma is for you and your child to be very knowledgeable about how and when asthma causes problems and how to use medications. An allergist has specialized training and experience to determine if your child has asthma, what

Seasonal allergic rhinitis, often referred to as “hay fever,” affects more than 35 million people in the United States. These seasonal allergies are caused by substances called allergens. Airborne pollens and mold spores are outdoor allergens that commonly trigger symptoms during the spring and fall. During these times, seasonal allergic rhinitis sufferers experience increased symptoms—sneezing, congestion, a runny nose, and itchiness in the nose, roof of the mouth, throat, eyes and ears—depending on where they live in the country and the exact allergen to which they are allergic. These allergic reactions are most commonly caused by pollen and mold spores in the air, which start 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 Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction. Pollen Pollen are tiny cells needed to fertilize plants. Pollen from plants with colorful flowers, like roses, usually do not cause allergies. These plants rely on insects to transport the pollen for fertilization. On the other hand, many plants have flowers which produce light, dry pollen 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. The pollinating season starts later in the spring the further north one goes. Generally, the entire pollen season lasts from February or March through October. In warmer places, pollination can be year-round. Seasonal allergic rhinitis is often caused by tree pollen in the early spring. During the late spring and early summer, grasses often cause symptoms. Late summer and fall hay fever is caused by weeds. Molds Molds are tiny fungi related to mushrooms but without stems, roots or leaves. Their spores float in the air like pollen. Outdoor mold spores begin to increase as temperatures rise in the spring and reach their peak in July in warmer states and October in the colder states. They can be found year-round in the South and on the West Coast. Molds can be found almost anywhere, including soil, plants and rotting wood. Pollen and Mold Levels Pollen and mold counts measure the amount of allergens present in the air. The National Allergy BureauTM (NABTM) is the nation’s only pollen and mold counting network certified by the American Academy of Allergy, Asthma & Immunology (AAAAI). As a free service to the public, the NAB compiles pollen and mold levels from certified stations across the nation. You can find these levels on the NAB page of the AAAAI’s Web site at www.aaaai.org/nab. Effects of Weather and Location The relationship between pollen and mold levels and your 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. Allergy symptoms are often less prominent on rainy, cloudy or windless days because pollen does not move around during these conditions. Pollen tends to travel more with hot, dry and windy weather, which can increase your allergy symptoms. Some people think that moving to another area of the country may help to lessen their symptoms. However, many pollen (especially grasses) and molds are common to most plant zones in the United States, so moving to escape your allergies is not recommended. Also, because your allergy problem begins in your genes, you are likely to find new allergens to react to in new environments. Treatment Finding the right treatment is the best method for managing your allergies. If your seasonal allergy symptoms are making you miserable, an allergist/immunologist, often referred to as an allergist, can help. Your allergist has the background and experience to test which pollen or molds are causing your symptoms and prescribe a treatment plan to help you feel better. This plan may include avoiding outdoor exposure, along with medications. If your symptoms continue or if you have them for many months of the year, your allergist may recommend allergy shots, or immunotherapy. This involves receiving regular injections, which help your immune system become more and more resistant to the specific allergen and lessen your symptoms as well as the need for medications. There are also simple steps you can take to limit your 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 the pollen or mold levels are reported to be high. Wear a pollen mask if long periods of exposure are unavoidable. Don’t mow lawns or rake leaves because it stirs up pollen and molds. Also avoid hanging sheets or clothes outside to dry. Consider taking a vacation during the height of the pollen season to a more pollen-free area, such as the beach or sea. When traveling by car, keep your windows closed. Most important, be sure to take any medications prescribed by your allergist regularly, in the recommended dosage. Healthy Tips Seasonal allergic rhinitis or “hay fever,” causes sneezing, stuffiness, a runny nose and itchiness in your nose, the roof of your mouth, throat, eyes or ears. Pollen and mold in the air commonly cause these symptoms. Treatment from an allergist is the best method for coping with your allergies. This could include medications, limiting exposure or even allergy shots. Monitor pollen and mold levels from the National Allergy Bureau at www.aaaai.org/nab. 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Osteoporosis is a disease in which bones become fragile. With decreased strength, bones have an increased tendency to break or fracture. Since asthma is an inflammatory disease of the lung, continuous use of anti-inflammatory medications is important for most patients with asthma. Cortisone-like medications, called glucocorticosteroids, are the most potent anti-inflammatory medications to treat asthma. There are two types of glucocorticosteroids: oral or systemic, and inhaled or topical. Long-term use of oral glucocorticosteroids, such as the pill prednisone, has been associated with adverse effects, including osteoporosis. As people age, there is often a significant increase in the number of medications they take for medical problems. It is essential that older patients have an awareness of what medications they are taking, how they to take them and what the potential side effects can be. This is especially true for older adults with allergies or asthma. Asthma Medications There are times when a medication can be very beneficial for one ailment, but has the potential to cause concern for another condition. Such is the case with a particular class of asthma medications: inhaled corticosteroids (ICS). On the one hand, corticosteroids are known to contribute to the development of osteoporosis (a condition leading to brittle bones), which is a common problem for older patients, especially women. On the other hand, ICS are the most effective class of drugs in the treatment of asthma. Physicians worry that ICS may lead to osteoporosis because oral and injected steroids are well-known to contribute to this process. You may ask, “Why should I take ICS at all for my asthma if it may put me at risk for side-effects?” The reason why ICS are so important for the management of asthma is that this is the most effective class of medication to control asthma. First, uncontrolled asthma puts you at a high risk for complications requiring hospitalization. Also, if your asthma is uncontrolled, chances are you aren’t sleeping well and exercising is difficult. Reduced levels of activity can also cause osteoporosis. Your physician will weigh the risks of osteoporosis with the risks of asthma, and may prescribe medications to counteract osteoporosis or order bone density testing. Your physician will also suggest things you can do to reduce your risk of osteoporosis. Regular exercise and dietary supplementation with healthcare practitioner prescribed calcium and vitamin D are good ways to reduce the risk. An allergist/immunologist, often referred to as an allergist, has extensive training in the management of asthma and in minimizing the side-effects of medications such as inhaled corticosteroids. Allergy Medications Allergies such as allergic rhinitis (hay fever), allergic conjunctivitis and urticaria (hives) are common problems for older adults and often require the use of H1 antihistamines. Antihistamines are divided into two classes: first generation antihistamines and second generation antihistamines. First generation antihistamines, while very effective at controlling symptoms, are often associated with symptoms in older adults such as anxiety, confusion, sedation, blurred vision, reduced mental alertness, urinary retention and constipation. These side effects are even more common if you are being treated with certain antidepressant medications. The second generation antihistamines do not cross the blood-brain barrier as readily and, therefore, cause fewer side effects. If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine. Physician and allergist prescribed antihistamines currently in use are generally from the second or third generation drugs that have an extremely favorable safety profile for users. Drugs that can Trigger Asthma Beta-blockers These drugs may be used for problems such as high blood pressure, heart disease and migraine headache. They may also be used in an eye drop form for treating the eye disease glaucoma. They are classified in one of two groups: non-specific and specific. Non-specific beta-blockers, such as propanalol, are the most important ones to avoid. Ideally, a person with asthma would avoid all beta blockers, but these types of drugs may be quite important for certain patients’ health and may not substantially worsen their asthma. Your physician may conduct a trial using a “specific” beta-blocker. Remember that even beta-blockers in eye drops may make asthma worse, so be sure to tell your ophthalmologist that you have asthma. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) This group of medications include some common over-the-counter pain relievers, such as ibuprofen and naproxen. Approximately 10% to 20% of people with asthma may notice that one or more of these drugs trigger their asthma. These asthma attacks may be severe and even fatal, so patients with known aspirin sensitivity must be very careful to avoid these drugs. Medications that usually don’t cause increased asthma in aspirin-sensitive patients include acetaminophen (low to moderate dose), propoxyphene and prescribed narcotics such as codeine. ACE Inhibitors These drugs, which may be used for hypertension or heart disease, include lisinopril and enalopril. Although they usually don’t cause asthma, approximately 10% of patients who receive one of these drugs develop a cough. This cough may be confused with asthma in some patients and possibly trigger increased wheezing in others. In addition, any cough can be associated with reflux (acid coming up from the stomach into the esophagus) which can cause more coughing and worsen asthma. The bottom line in avoiding medication-induced asthma is to talk with your physician about what medications are best for you. It is important not to let your treatments become asthma triggers. Healthy Tips Older patients should always know what medications they are taking, how they to take them and what the potential side effects can be. Inhaled corticosteroids (ICS) are the most effective class of drugs in the treatment of asthma, but are known to contribute to the development of osteoporosis. An allergist has extensive training in the management of asthma and in minimizing the side-effects of medications such as ICS. If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine. Some drugs, such as

Occupational asthma is generally defined as a respiratory disorder directly related to inhaling fumes, gases, dust or other potentially harmful substances while “on the job.” With occupational asthma, symptoms of asthma may develop for the first time in a previously healthy worker, or pre-existing asthma may be aggravated by exposures within the work place. 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. Prevalence 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% 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% of people working with laboratory animals or with powdered natural rubber latex gloves have developed 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% of exposed workers. Causes Irritants in high doses that induce occupational asthma include hydrochloric acid, sulfur dioxide or ammonia, which is found in the petroleum or 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 work-related 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/immunologist, often referred to as 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, pre-treatment 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. Healthy Tips Occupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while at work. You may find that 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. 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. Once the cause of your symptoms is identified, talk to your employer and avoid exposure to that substance.

Many patients experience adverse reactions to medications. Only a small percent of these reactions, however, are true allergic reactions. An allergic reaction means the patient’s immune system is programmed to recognize a certain medication and produce a specific reaction whenever it encounters that drug. The most potentially severe allergic reaction to a drug is anaphylaxis. This happens when the patient, unknowingly, has a large amount of an allergy protein (called IgE antibody) in his or her body specific for a drug, such as penicillin. Everyone reacts to medications differently. One person may develop a rash while taking a certain medication, while another person on the same drug may have no adverse reaction. Does that mean the person with the rash has an allergy to that drug? All medications have the potential to cause side effects, but only about 5% to 10% of adverse reactions to drugs are allergic. Whether allergic or not, reactions to medications can range from mild to life-threatening. It is important to take all medications exactly as your physician prescribes. If you have side effects that concern you, or you suspect a drug allergy has occurred, call your physician. If your symptoms are severe, seek medical help immediately. Allergic Reactions Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to a particular medication, your immune system identifies that drug as an invader or allergen. Your immune system reacts by producing antibodies called Immunoglobulin E (IgE) to the drug. These antibodies travel to cells that release chemicals, triggering an allergic reaction. This reaction causes symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin. Most allergic reactions occur within hours to two weeks after taking the medication and most people react to medications to which they have been exposed in the past. This process is called “sensitization.” However, rashes may develop up to six weeks after starting certain types of medications. One of the most severe allergic reactions is anaphylaxis (pronounced an-a-fi-LAK-sis). Symptoms of anaphylaxis include hives, facial or throat swelling, wheezing, light-headedness, vomiting and shock. Most anaphylactic reactions occur within one hour of taking a medication or receiving an injection of the medication, but sometimes the reaction may start several hours later. Anaphylaxis can result in death, so it is important to seek immediate medical attention if you experience these symptoms. Antibiotics are the most common culprit of anaphylaxis, but more recently, chemotherapy drugs and monoclonal antibodies have also been shown to induce anaphylaxis. Rarely, blisters develop as a result of a drug rash. Blisters may be a sign of a serious complication called Steven-Johnson Syndrome where the surfaces of your eye, lips, mouth and genital region may be eroded. Toxic epidermal necrolysis (TEN), where the upper surface of your skin detaches like in a patient who has suffered burns, is another type of severe cutaneous adverse reaction. You should seek medical help immediately if you experience any of these. Certain medications for epilepsy (seizures) and gout are often associated with these severe skin reactions. A number of factors influence your chances of having an adverse reaction to a medication. These include: body size, genetics, body chemistry or the presence of an underlying disease. Also, having an allergy to one drug predisposes one to have an allergy to another unrelated drug. Contrary to popular myth, a family history of a reaction to a specific drug does not increase your chance of reacting to the same drug. Non-Allergic Reactions Symptoms of non-allergic drug reactions vary depending on the type of medication. People being treated with chemotherapy often suffer from vomiting and hair loss. Other people experience flushing, itching or a drop in blood pressure from intravenous dyes used in x-rays or CT scans. Certain antibiotics irritate the intestines, which can cause stomach cramps and diarrhea. If you take ACE (angiotension converting enzyme) inhibitors for high blood pressure, you may develop a cough or facial and tongue swelling. Some people are sensitive to aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs). If you have aspirin or NSAID sensitivity, certain medications may cause a stuffy nose, itchy or swollen eyes, cough, wheezing or hives. In rare instances, severe reactions can result in shock. This is more common in adults with asthma and in people with nasal polyps (benign growths). Taking Precautions It is important to tell your physician about any adverse reaction you experience while taking a medication. Be sure to keep a list of any drugs you are currently taking and make special note if you have had past reactions to specific medications. Share this list with your physician and discuss whether you should be avoiding any particular drugs or if you should be wearing a special bracelet that alerts people to your allergy. When to See an Allergist/Immunologist If you have a history of reactions to different medications, or if you have a serious reaction to a drug, an allergist/immunologist, often referred to as an allergist, has specialized training to diagnose the problem and help you develop a plan to protect you in the future. Healthy Tips Allergic drug reactions account for 5% to 10% of all adverse drug reactions. Any drug has the potential to cause an allergic reaction. Symptoms of adverse drug reactions include cough, nausea, vomiting, diarrhea, high blood pressure and facial swelling. Skin reactions (i.e. rashes, itching) are the most common form of allergic drug reaction. Non-steroidal anti-inflammatory drugs, antibiotics, chemotherapy drugs, monoclonal antibodies, anti-seizure drugs and ACE inhibitors cause most allergic drug reactions. If you have a serious adverse reaction, it is important to contact your physician immediately.