May is asthma and allergy awareness month. We all know that the itchy eyes and runny-sneezy nose that affect many of us at this time of year are symptoms of allergies, historically misnamed "hay fever," but now known to be caused by pollens from trees, grasses, weeds and mold spores.
But did you know that:
--Approximately 10 percent of kids and 5 percent to 7 percent of adults suffer with asthma at some point? In other words, there probably are two or three asthmatic kids in your child's classroom. Asthma is the most common chronic illness in childhood, and the leading cause of recurrent hospitalizations in kids.
--A cough lasting more than 3 weeks is often related to asthma?
--A constant runny nose and persistent "cold" that won't go away may indicate allergies?
Because of these issues, allergies have become significant in today's health care environment, and are important to a range of physicians including allergists and your family physician or pediatrician. Allergists play a significant support role for doctors and patients in defining and treating allergies.
Asthma and allergies have become very well understood in the past 20 years, leading to much more effective and successful treatments.
We now know that allergies are the underpinning for many - although certainly not all - cases of chronic asthma. In kids under the age of 5, however, asthma is most typically triggered by colds. That's why so many kids who have asthma outgrow it by age 8 or so. They just don't get as many colds, so that particular trigger is gradually removed. Those who do develop allergies are the ones most likely to continue having allergies into their teen years or beyond. That said, even in older kids and adults with asthma, colds are a very important cause of recurrent episodes of chest symptoms - what we call exacerbations.
How do we treat asthma and allergies?
For that, we need to understand a few things. Allergies and asthma affect the respiratory tract, and are therefore most often related to inhaled allergens, and not foods. Ingested allergens tend to induce stomach or gastrointestinal symptoms.
Allergies are related to an immune system response that is incorrect, or at least unnecessary. If an individual has allergies, his or her immune system attacks things that are innocent bystanders, such as pollen, dust mite particles and mold spores. Those of us without allergies inhale the very same substances and don't respond at all, while our allergic kids and friends suffer from allergic inflammation that leads to stuffy noses, sinus infections, persistent colds and chronic cough.
Therefore, it's important to recognize that allergies and asthma are not caused by a lack of immunity, but by a surplus of immunity. Trying to treat allergies and asthma with immune stimulants (of which there are precious few and none available over the counter) is a misdirected approach from the outset.
Because allergies typically are triggered by substances in a patient's environment, we often can decrease symptoms by identifying and removing, or at least reducing, relevant environmental exposures. Talking to an allergist is often like playing detective, seeking to identify these triggers.
Allergies can be treated quite effectively in most people with a combination of environmental controls and medication. As mentioned above, allergies and asthma are due to an over-active response by a patient's immune system, so our therapies often are geared toward modifying the patient's immune response to minimize the disease and related symptoms.
We often start with over-the-counter medications, including antihistamines. These work for some all patients. More effective therapies usually require a physician's guidance and supervision, and usually are available by prescription. Ultimately, we can utilize immunotherapy (allergy shots). A recent study showed a significant reduction in symptoms and a 52 percent reduction in total health care costs in a targeted patient population receiving allergy shots.
Our aim in treating allergies and asthma is to reduce allergen exposures and use medications as necessary to bring symptoms under control. Good control means little or no daytime coughing, no ongoing cold or sinus symptoms, and few or no hospitalizations or emergency visits for asthma.
Understanding and controlling your allergies can be the key to your good health.
Dr. David Elkayam specializes in allergy-immunology and practices at Bellingham Asthma, Allergy and Immunology Clinic. This column is one of an occasional series on health care issues written by members of the Whatcom County Medical Society. If you have a column suggestion for the doctors, send it to wcms@hinet.org.
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