What is an Allergist?
An allergist is a physician specifically trained to manage and treat allergies and asthma. Becoming an allergist requires completion of at least nine years of training. Allergists who are listed as ABAI -certified have successfully passed a certifying examination of the American Board of Allergy and Immunology.

What is a Nurse Practitioner? A nurse practitioner is an Advanced Practice Nurse specifically trained in a specialty field of choice. Becoming a nurse practitioner requires completion of at least 6 years of training, which includes supervised clinical practice in a specialized field, advanced course work in pathophysiology, pharmacology, physical assessment and nursing science. They are specially trained nurses able to diagnose and manage acute and chronic conditions. They function to promote health and well-being through patient education and counseling. Nurse Practitioners who are listed as certified have successfully passed a certifying examination of a specialty Board in their area of expertise.

What are allergies?
Allergies are the 5th leading cause of chronic disease in the United States. Approximately 50 million adults and children suffer from allergies. Allergies may occur at any age. Usually a person has an inherited predisposition to develop allergies or allergic disease. The estimated risk of a child to develop allergies who has one parent with allergies is 48%. If both parent have allergies, the child's risk increases to 70%. Although you may be born with the genetic capability to develop allergies or allergic disease, several factors influence whether or not you will develop allergic disease. These include: the genes inherited from your parents, your exposure to the allergens you are genetically programmed to respond to, and the degree and length of exposure of the allergen.

Allergies are an overreaction of the immune system to substances (allergens) that usually do not cause reactions in most. people. The substances may trigger symptoms such as sneezing, nasal congestion, runny nose, itching, coughing and wheezing. Types of allergic diseases include:

• Hayfever (Allergic Rhinitis)
• Allergic Asthma
• Allergic Conjunctivitis
• Hives (Urticaria))
• Eczema (Atopic Dermatitis)
• Contact Dermatitis
• Sinusitis (sinus infections)
• Otitis Media (ear infections)
• Food Allergy
• Latex Allergy
• Stinging Insect Allergy
• Drug Allergy
• Allergic Reaction (Anaphylaxis)

Can Allergies Be Outgrown?
It is no longer thought that people outgrow allergic disease, but the diseases may sometimes go into remission. In other words, the person may be free of symptoms for some time. For instance, although allergies and asthma may spontaneously improve, particularly during adolescence, it may also worsen or reoccur later in life, just as any other allergic disease. It is also possible for a person to develop allergies or asthma at any age.

How is Skin Testing Used To Diagnose Allergies?
Skin testing is used to diagnose immediate-type hypersensitivity allergy. This is the most common type of allergic reaction. In this type of allergy, symptoms occur very quickly after exposure to the allergen. The body responds to allergens by producing proteins, or antibodies, called immunoglobulins. Immunoglobulin E (IgE) is the immunoglobulin responsible for allergic reactions. It is produced to fight off foreign invaders, or the allergens. One way to test a person for allergies is to measure the level of the IgE antibodies in the blood. A simpler, more definitive way is to see whether exposure to certain allergens provokes a local response- or a wheal and flare reaction. This is the purpose of skin testing.

Extracts of common allergens are used to determine individual allergies. Extracts are solutions that contain the protein from common allergens such as: trees, grasses, ragweed, weeds, dust products, molds, pets, cockroaches, foods, stinging insects, natural rubber latex, and/or drugs like penicillin. These extracts are utilized in 2 ways to determine a person's allergies:

1. Scratch or Percutaneous Method: This is a method of skin testing in which a tiny amount of allergen is lightly pricked into the skin. The allergen is allowed to rest on the skin for 15-20 minutes. This allows a local reaction to occur at the site of the specific allergen in someone who is allergic.
2. Intradermal Method: This is a more sensitive method of skin testing. The intradermal method is more often positive compared to the scratch method. This type of test involves injecting the allergen extract just under the first few layers of skin, usually on the upper arms. These type of tests are done when there is difficulty in interpreting the scratch test, and /or when the provider suspects that an allergy exists to a particular allergen, and the scratch test was negative. These tests are also assessed after 15-20 minutes, to allow a local reaction to occur at the site of the specific allergen.

A positive test is indicated by a wheal and flare response at the site of the allergen. A wheal and flare response is similar to what is produced by a mosquito bite. A small hive may form in the middle of a larger sized area of redness. The small hives which appear at the site of the testing usually disappear 30 minutes after the testing.

Many people often fear allergy testing. However, skin testing is a fast, reliable method to determine allergy, and is associated with only mild discomfort. Even young children tolerate skin testing fairly well. The testing method used in our clinic is adapted to the age of the patient. The number of tests and the types of allergens used for testing are dependent on the age of the patient and the patient's environmental exposures.

Skin testing is an important part of allergy care. By pinpointing the specific allergens causing your allergy symptoms, several measures may be implemented to control your symptoms. These include medications, allergy shots or allergen immunotherapy (vaccination) and most importantly avoidance measures. Avoidance measures are ways to minimize your exposure to your allergens, the best way to control symptoms. When allergen avoidance is not possible, allergy shots are considered.

Can Allergies Be Prevented?
We know that allergies are inherited. Therefore, several interventions may be implemented to attempt to reduce the occurrence of allergy or delay the onset of allergy in children at risk.

To prevent food allergies or eczema, it is highly recommended that all infants be breastfed for at least four to six months. Breast milk is less likely to cause an allergic reaction and can strengthen the baby's immune system. If supplemental feedings are required, and/ or breast feeding is not an option, the use of hypoallergenic, protein hydrosylate formulas such as Alimentum or Nutramigen. Milk or soy-based allergens should be avoided. Because young infants may be more susceptible to developing food allergies than older infants, it is very important to delay the introduction of foods that are highly allergenic. Infants should not be fed solid foods until 6 months of age. After 6 months of age, vegetables, rice, meat and fruit can be introduced into the diet one at a time. Introducing foods one at a time is necessary to monitor for reactions. Milk, soy, wheat, corn and citrus need to be avoided until the child is a year old. At two, eggs, and fish may be added to the diet. Peanuts should be withheld until three years of age.

To prevent environmental allergies, avoidance of pets and dust mites are important. Recent studies have suggested that exposure to a pet shortly after birth may increase the risk of developing environmental allergies. Allergies to animals are triggered by exposure to proteins found in the skin, saliva and urine of any pet with hair. These pets include: dogs, cats, rabbits, gerbils, hamsters, an others. Keeping pets out of the home is extremely important. To avoid the development of an allergy to dust mites, limiting exposure to the dust mites is helpful. This may be done by keeping the relative humidity in the home between 35-45%. Therefore use of humidifiers or vaporizers is not recommended. Using specially made zippered allergen covers or plastic covers for the pillows and mattress are highly recommended, as dust mites tend to build up in bedding material. Ideally, removing carpeting and collectibles from the infant's room, especially stuffed animals and books, is also helpful.

Prevention of asthma may be helped by avoiding potential allergens, tobacco smoke, and limiting exposure to upper respiratory infections. As it was important with allergy prevention, avoidance of pets and dust are extremely important. Infants exposed to fewer dust mites are less likely to develop allergic asthma. In addition, children exposed to pets in their first few years of life are more likely to develop allergic asthma. Therefore, avoidance is recommended. Keeping pets out of the home is the most reliable way to minimize exposure. Maternal smoking is the number one risk factor for wheezing in infancy. Smoking during pregnancy causes the infants airways to be smaller than normal, thus putting the child more at risk for chronic infections once born. Smoking around the child may also increase risk of asthma and other chronic respiratory conditions such as ear infections and chronic runny nose. Therefore, smoking around children, in a house where children reside, or in a car that the child may travel in is strongly discouraged. Finally, avoiding recurrent respiratory infections is recommended. One may find this difficult, but several factors are encouraged to limit the child's risk of developing recurrent infections: breast feed the child for at least 6 months as this strengthens the child's immune system, and avoid group daycare settings as this may increase the child's risk of developing recurrent upper respiratory infections. Limiting exposure to recurrent infections is important as respiratory infections are thought to induce asthma symptoms in a susceptible persons.

What Is Pollen and Mold and What are Pollen and Mold Counts?
Pollen is a fine powder released by trees, grasses and weeds. It is usually carried to another plant by insects, and or the wind, to produce new seeds. This is what is called pollination. Plants dependent on insect pollination usually have bright colored flowers and are very fragrant, and seldom cause allergic reactions. Plants dependent on wind pollination are the most allergenic plants, and are most capable of producing allergy symptoms. In Michigan, tree pollen is usually high during March through April, with some trees pollinating in Late Spring or Early Summer (May). Grass pollen is typically high in May and June with some grasses pollinating in July. Finally weed pollen is highest in the Fall, beginning in mid-August and ending in October, with ragweed pollen highest beginning mid-August and ending late September. Ragweed pollen is the weed that causes 75% of all hayfever symptoms (sneezing, runny or stuffy nose, coughing, post-nasal drip, itchy nose and throat, dark circles under the eyes, and swollen watery, itchy eyes.). One ragweed plant may produce upwards of 1 billion pollen grains. Mold and mildew are fungi. They grow by producing spores which are spread by the wind. In Michigan, molds typically pollinate Spring until Winter , with peaks in the Spring and Fall. Mold counts change quickly, depending on the weather. Some molds require dry, breezy weather, whereas other requires humidity, fog or dew to release spores. This group is most abundant at night and during rainy periods.

Pollen counts are a measure of the amount of pollen grain in a certain amount of air during a set period of time. Pollen is typically released in the morning, shortly before dawn. High pollen counts occur on warm, dry, breezy days and peak in urban areas mid-day. Pollen counts tend to be lowest on wet, chilly days.

Allergy Avoidance Products

• Allergy Control Products, Inc.
• Gazoontite
• National Allergy Supply, Inc.

More About Environmental Allergies

American Academy of Allergy, Asthma, & Immunology
(800)822-2762

American College of Allergy, Asthma, & Immunology
(847)427-1200

Asthma and Allergy Foundation of America
(800) 7- ASTHMA/ (800)727-8462

National Institute of Allergy and Infectious Diseases
National Institutes of Health
(301)402-1663

National Jewish Medical and Research Center
(800)222-LUNG

More About Food Allergies

Food Allergy & Anaphylaxis Network
(800)929-4040

Ener-G Foods (wheat, gluten and dairy free foods)
(800)331-5222

Miss Roben's, Inc.
(800)891-0083

Medic Alert Foundation
(209)668-3333

More About Pollen and Mold Counts

American Academy of Asthma, Allergy and Immunology
(800)822-2762

The National Allergy Bureau
(800)9-POLLEN