Allergies by Mark B. Levin, M.D. and Louis J. Tesoro, M.D. The Pediatric Group, P.A., Princeton

This is the fourteenth article in a series written for Princeton Online. Click here for an archive of other articles.

The media is replete with articles and advertisements about allergic disease. It is not that we need reminders about how much we suffer from allergies, but that the market for commercial preparations to relieve allergies is so huge. The article that follows is intended to help you understand what causes allergy symptoms and what appropriate measures you can take to deal with them.

Allergy symptoms are caused by an interaction between a protein (allergen) that generates the allergic reaction and the susceptible person's immune system. There is often a family history of allergy suggesting a genetic predisposition to allergies. Those of us lucky enough not to be allergic can tolerate these allergens without adverse consequences. Symptoms reflect the portal of entry of the allergens into the body. So nasal symptoms (itchy nose, sneezing and a runny nose) are usually a result of inhaled allergens. Since the nose and mouth are also the portal of entry for the gastrointestinal tract, food allergies can also cause airway symptoms. More often, however, food allergies cause gastrointestinal symptoms (abdominal pains, vomiting or diarrhea). Airborne allergens can also cause pulmonary symptoms (wheezing, shortness of breath) and itchy, watery eyes. Any allergen that is ingested, inhaled or absorbed through the skin can cause hives. Allergic disease may also masquerade as infectious disease, presenting as recurrent lung, sinus, ear or skin infection.

The causative allergens can often be identified by carefully noting conditions that precede the symptoms. For example, if a person suffers from allergy symptoms repeatedly in the Spring, the source is likely to be grass and/or tree pollens, since these allergens are prevalent during the Spring. The late Summer is pollination time for ragweed and Fall is the leaf mold season. Winter weather promotes accumulation of dust and dust mites in the home because heating decreases relative air humidity and keeping doors and windows shut decreases the mixture of dry indoor air with fresh outdoor air. The variable weather produced by El Nino has made seasonal variation less predictable, so assessment of allergies has become slightly more difficult. Symptoms that arise regularly when at home but dissipate outdoors suggests something in the home, usually dust, a pet or a wet moldy basement. Likewise, repeated symptoms after ingesting certain foods suggests food allergy. Once suspicion has been aroused, confirmation, if necessary, can be done by blood or skin testing. Skin testing is typically performed by an allergist, whereas blood testing can be sent out from any physician's office. Which type of test is most appropriate depends on the specifics of the situation and should be discussed with your doctor.

Because having allergies is hereditary, they can not be cured. Treatment is aimed at preventing and alleviating symptoms to keep a person functional. The mainstay of treating allergic conditions is to eliminate or avoid exposure to the allergen. In the instance of food and animal exposure, this can usually be accomplished once the allergen is identified. The indoor environment can be modified to eliminate most allergens. Your physician should be able to provide you with suggestions regarding how to allergy-proof your home. For outdoor pollen allergy, this may be more difficult. In this circumstance, a variety of medications are available. The choice of which medication or combination of medications to use depends on the individual's symptoms, their response to medication and the severity of their condition. This, too, is an appropriate topic to discuss with your doctor. Because of inherent risks, allergy desensitization immunotherapy (shots) are generally reserved for those who have more severe symptoms, who are not helped by medication or who have unacceptable side effects from medication.

Environmental pollution and cigarette smoke contribute to allergy suffering. One thing we can all do to minimize the impact of pollution on our lives, whether we suffer from allergies or not, is to encourage our legislators to enact environment-friendly regulations. Subsequent articles will expand on the various aspects of allergies and their treatment.

All Rights Reserved 3/99 The Pediatric Group, P.A.

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

Dr. Louis J. Tesoro

Dr. Tesoro has been a member of the staff at The Pediatric Group since 1988. Dr. Tesoro is Chairman, Department of Pediatrics, Medical Center at Princeton, 1996 to present and Attending Pediatrician, Medical Center at Princeton, 1988 to present. He has served on several Departmental and hospital committees, lectured at the Universiy of Pennsylvania and has published original articles both while at The Children's Hospital of Philadelphia and at The Pediatric Group.