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Allergies

Allergies

Member Discussion & Survey

allergies According to the AAAAI, allergies affect more than 50 million people in the United States, making it the 5th leading chronic disease among all ages.

Allergic rhinitis alone is responsible for approximately 16.7 million physician visits annually!

The media frequently reports a rise in allergies and asthma, with possible causes ranging from excessive hygiene, to dietary changes, to pollution. We’d like to hear YOUR thoughts on this topic. Are you seeing more patients with allergies? What do you think is the cause?

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Do you believe that allergies are on the rise?

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In your opinion, which of the following factors is having the most significant impact on increasing allergies?

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Do you find the OTC availability of former prescription-only antihistamines helpful?

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Do you believe food allergies are over-diagnosed?

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Do you think that as a society we over-treat allergies?

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34 Responses

  1. Ken

    Asthma, allergic rhinitis, atopic dermatitis, food allergies and chronic sinus disease are all increasing.
    Allergy testing both skin testing and RAST testing must correlate with clinical history - Atopic dermatitis is an exception in 37%.
    I am seeing many patients particularly children who are taken off important foods because of a test without any clinical correlation.
    This is asymptomatic sensitization and have ingested these foods previously without difficulty.
    This is also true with inhalant testing.
    History is still very important and must be utilized.
    I am finding pollution in the home secondary to Lysol, PineSol, fragrances and candles very important and ignored previously by history.
    HVAC systems properly maintained and removal of ionizers has been extremely useful.
    Viral infections, outdoor pollution and day care are also becoming extremely problematic as is “centers” in elementary school.
    Too much medicine is also problematic with AE’s.
    All this takes time but majority of patients will understand and make nonmedical changes with at least some improvement.

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  2. Randi Germaine MD

    As a child, I was diagnosed with allergies/ hayfever by my PCP. As a primary care physician, I once had the opportunity to undergo extensive skin testing, and found that I did not have any atopic problems. The underlying cause for my allergy-like symptoms, was gastro-esophageal reflux. This entity is closely linked to obesity, and tends to run in families. It has identical symptoms to allergies, with the exception of GERD not having itchy, watery eyes. Clearly, with obesity at epidemic levels, one can expect GERD to also be more prevalent. I have found, however, that many physicians simpy diagnose allergic rhinitis in these patients. One can also expect that by prescibing anti-histimines (H-1 blockers) to also have overlaping H-2 blocker effects, thus mily relieving some of the nasopharyngeal symptoms that occur in GERD patients. It should be also noted that people with GERD tend to have (intrinsic) asthma symptoms, most often experienced as exercise induced asthma. Allergies/ Atopic individuals experience extrinsic asthma. I have found in my clinical practice that the worst asthmatics have a combination of allergies and GERD. Many of these patients will simply benefit by avoiding large dinners, then laying down to sleep with a full stomach. They also benefit from raising the head of their beds about six inches, sleeping on an incline. One should look for GERD in patients who have type 2 diabetes, sleep apnea, attention deficit disorder, asthma, patients who have frequent sinus infections, or children who have parents with frequent heartburn symptoms/ or already diagnosed GERD. It should be also understood, that most patients will not have the classic symptoms of heartburn or chest pain, until the lining of the lower esophagus begins to wear thin or becomes chronically inflammed. This often occurs in the younger patients, and thus leads to the mis-diagnosis of allergies.

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  3. Clarke McIntosh

    There are increasing data pointing to the frequent use of antibiotics as altering the normal gut flora and contributing to the rise in atopy. Though the tendency to use has been high for a long period, two of the stronger driving factors in this are day cares and schools that both increase the exposures to viral illnesses and then demand use of antibiotics for readmittance. Unless these trends are reversed, I think we will continue to see more atopy.

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  4. SAM SCHIFFMAN, R.PH.

    Dr. Boume said, “Allergy medicines that were previously prescribed is a good thing because some people cannot afford the medications until they go OTC.

    One problem with previous Rx allergy meds that are now OTC is that the retail price is as costly or more
    costly than the co-pay of the insurance company. Also, I find that many insurance companies require
    the MD to call for a “prior authorization” before approving the drug for payment. In some cases the
    insurance company’s formulary does not cover the drug written by the MD and suggest the MD to write
    for a drug that is less expensive, but maybe less therapeutically effective.

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  5. nynah

    Some patients with allergies (often allergies that are difficult to diagnose as the patients do not always respond “normally” to traditional allergy testing) will later be found to have a Primary Immune Deficiency Disease. It is the hope of those of us with these diseases to draw more attention to them especially within the medical community. At this time the average time from onset of symptoms to diagnosis is an appaling nine years. Patients go from doctor to doctor trying to find an answer for their recurrent infections and overwhelming fatigue, among other symptoms. PIDD are not a diagnosis of children only and may be diagnosed even in the 50s and 60s. For more information please see the IDF website http://www.primaryimmune.org
    Thank You, Nynah

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  6. Marianne

    I’ve been a nurse over half my life. Have seen environmental, diagnostic, cultural, and other changes elevating the percentage of all things allergy related. Have come to believe the actual allergy rate is over-reported and over-treated, leading to over-medicating and subsequent treatment related antagonistic effect. I believe less is more the greater amount of the time. Too many patients report too many exaggerated effects of pollutants and medicine. Too much is just too much. Simple allergies are not equivalent to anaphylaxsis. Saline irrigation is effective at times. I don’t dismiss true allergies. In my family practice setting,I do note a correlation with med requests. State afforded reimbursements exceed self-pay or private non-formulary reimbursements. What’s up with that?

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  7. Natalie Pope

    I am very allergic to fragrances and cleaning products with phenol, pine etc. Also had symptoms suggesting food allergies - because I could not figure it out on my own, went to an allergist and discovered that I was allergic to almost all foods. After doing challenge testing and reducing my diet to 6-7 items I noticed that the gnawing pain in my stomach that I have had on and off for years disappeared. Also my reactions to perfumes diminished in severity. Instead of having a violent sprain my back coughing attack requiring an inhaler and running away, I now can tell the offending person to go away (because I can talk now). Interestingly enough I get bronchospasm from Albuterol. Serevent nearly did me in. The inhaler I use Maxair (Pirbuterol) has CFC and the company that bought it from 3M wanted everyone to write to FDA to be allowed to use it after DEC 08. But naturally the company does not want to spend the money to do the research to get a HFA formulation approved.
    I am slowly able to re add some food items to my diet but others give just as violent a reaction as before. I avoid farm-raised seafood as there is a chance that some reactions are due to antibiotics or other chemicals and not the actual fish protein.
    Although according to skin tests, I am allergic to grass and other pollens, I don’t have symptoms when outside but will if I eat something that cross-reacts with these pollens.

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  8. D Snook

    I think that our modern society puts tremendous stress on our immune systems that it has not been genetically selected to handle. This stress comes in food
    additives, environmental chemical and toxins, environmental overcleaning, and other factors. We need to increase our knowledge of our immune system and how to help it cope with our environment in addition to attempting to remove some of the stressors from our environment.

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  9. sheldon m. poretsky

    Since I moved to Nevada, my allergies are worse and throughout the entire year.

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  10. Chris Keil CFNP

    I agree with Kelly Kries, I work in an allergy/asthma office and over the last few months have seen far more viral infections (colds), than allergies. We do nasal smears and can look for eosinophils, which many people don’t have.
    For some reason, it is unacceptable to have a “cold”, but it’s ok to have allergies. We have a physician who was a pediatrician before going back into allergy, and all she sees is little kids with runny noses all day long, in the name of “allergies”. We are not a primary care office, but that is mostly what we’ve become. Kids get sick, adults get sick, viral illnesses are more of a trigger for asthma than allergies. Viruses peak in fall/spring, the same as allergies, and yes the treatment is the same. Unfortunately the pediatricians, PCP’s and other primary care providers or urgent care providers just tell everyone, “it’s allergies”, when they have done no testing to prove/disprove it. It’s frustrating because they are not that common. Approximately half of all the people we allergy test every day have a negative allergy skin test, yet have symptoms.
    My recommendation………don’t just blame everything on allergies, if other family members or co-workers are having symptoms, then it’s a virus.

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  11. Elizabeth C.R.N.A.

    I am 54yo. At age 23, I develloped allergies to every air born irrittant( dust, mold dust mites, all pollen). A few years ago I read a book called: The Enzymatic cure”,written by a Bio-Chemist, who’s name escapes me, now.Her theory was that:the way we grow our fruits/vegetables, with herbecides / pestecides,our soil has become completely void of much needed enzymes.With all the junk added to our diet and all the additives in our food, our bodies have become overwhelmed and unable to detoxify us( confirmed with the great rise in GI maladies) and are protesting by reacting to every thing under the sun. I started detoxifying my body, taking enzymes, added beneficial bacteria in my GI tract, in the form of Kefir/ yogurt and unpasteurized / unhomogonized dairy and I have been allergy free for 8 years,now.

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  12. Elizabeth

    I am 54 yo, starting at age 23, I developed allergies to every air born irrittant known to man.Every season , every house made me sneeze and gave me watery eyes.this went on for 20 years. Then I read a clever book, written by a biochemist( her name escapes me now) called the “Enzymatic Cure”. This author’s theory is that we eat so much junk, the way we grow our fruits and vegetables(with herbicides & insecticides), the soil becomes void of the much needed enzymes, we accumulate so much toxins, over the years, our digestion system is ineffecient(confirmed by the rise in GI maladies) and our bodies are overwhelmed to detoxify us. this same body is protesting by reacting to every thing under the sun. I started to take enzymes, and detoxify my body and limit the junk I eat,& reintroduce healthy bacteria in my GI tract, in the form of Kefir, yogurt & unpasteurized, unhomogonized dairy, and within 3 months, my all year round,27 years of allergies left me.That was 8 years ago.Allergies manifest in rhinitis,but it does not necessarely have an ear nose & throat etiology.We need more research not funded by Pharmaceutical Companies.

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  13. Bill Buckton

    Pollution in our area of Ontario seems to be a big factor

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  14. Laura Mehringer

    Rather than “treating” allergies I recommend eliminating them with energy based treatment modalities–I’ve had all my allergies eliminated and am finally free of chronic nasal congestion that I had for years. There’s a clinic here in Denver, Colorado, called Advanced Health Solutions that is very successful in eliminating allergies and many of my psychiatric patients have improved in psych symptoms also because they are healthier overall from eliminating their allergies.

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  15. Gene

    Starting off in practice in the early ’60s there was some seasonal allergies is the rural area but foof allergies/intolerances were seldom seen.psooibly 3 - 5 times a year. Now in the 2000+ era I see in my consulting practice 6 - 8 per day with severe allergies affecting their quality of life.This is particularly effecting the children and young adults. Also from friends and relatives etc in the area - it is rare not to meet some one who does not have allergies to pets,food, pollen.If this increases the same over the next 40+ years is will become a large economic as well as a medical social problem. We need to find a cure to the problem rather than treating the symptoms!

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  16. ashah

    great

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  17. Lewis Gottschalk

    Bronchospasm is a major concern for all anesthesiologists. Arguably, the most vital part of our job is to maintain the “ABC’s”. Bronchospasm affects all three. Spasm can be so severe that it increases the intrathoracic pressure, limiting venous return and therefore ultimately compromising the “C” from which the patient may never recover.
    Using puffs of bronchodilators early on into the anesthetic circuit can improve the situation before it gets out of hand.
    One aspect of all this moving away from CFC containing bronchodilators is the fact that the new dispensers have changed. This change has now resulted in an incompatibility with the connectors on our anesthesia circuits. It is no longer an easy matter to puff some bronchodilators down the tube or into the circuit to relieve bronchospasm.
    I know of no manufacturers of CFC free bronchodilator dispensers who have maintained the old connectors. I believe that this is a retrogressive step which compromises patient care.

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  18. Lewis Gottschalk

    Bronchospasm is a major concern for all anesthesiologists. Arguably, the most vital part of our job is to maintain the “ABC’s”. Bronchospasm affects all three. Spasm can be so severe that it increases the intrathoracic pressure, limiting venous return and therefore ultimately compromising the “C” from which the patient may never recover.
    Using puffs of bronchodilators early on into the anesthetic circuit can improve the situation before it gets out of hand.
    One aspect of all this moving away from CFC containing bronchodilators is the fact that the new dispensers have changed. This change has now resulted in an incompatibility with the connectors on our anesthesia circuits. It is no longer an easy matter to “puff” some bronchodilators down the tube or into the circuit to relieve bronchospasm.
    I know of no manufacturers of CFC free bronchodilator dispensers who have maintained the old connectors. I believe that this is a retrogressive step which compromises patient care.

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  19. Dr. Noga Askenazi

    As an allergist and immunologist, I can agree with much that is being discussed. Allergies and asthma are on the rise. Certain pollutants increases the allergen concentration we inhale and and in addition trigger asthma attacks. Our immune systems have shifted more towards atopy (being allergic) and producing allergic antibodies (IgE) as we have become more Westernized. Yet, we are also treating allergic diseases more seriously and effectively than ever before. Medications can help but we are at the brink of finding ways to return our immune systems to becoming less atopic, and even preventing asthma, such as with the use of immunotherapy (allergy shots)that do not have to take years to take affect.

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  20. Helen

    60 years ago, before antibiotics, albuterol and corticosteroids, many people with asthma and/or bad allergies died in childhood from pneumonia, mastoiditis, secondary skin infections (on top of eczema), and asthma itself. Now they survive and have children with the same. I think that is why asthma and allergis are increasing. My 81 yo dad barely managed to survive recurrent childhood sinusitis and mild asthma, without modern meds. My ex barely survived severe childhood asthma with prednisone, epinephrine and antibiotics. We have bred a child with mild intermittent asthma, recurrent OM and eczema, who has had pneumonia at least once. I’m glad WE defeated natural selection, but I do think that is why asthma and allergies are on the rise.

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  21. RudyKint

    The simple management of the case is: Drink Plenty of plain water. Then prescribe plenty of exercise that allows the body’s natural waste removal system to do its work.
    This will make the difference.
    Pumping the body with chemicals will just treat the symptoms but not the cause.

    The operetta “Dr. Drinkwater” is a guide.

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  22. Mary Kundert, PharmD

    I agree whole-heartedly with Ange Lobue (May 17th). In fact, I’ll take it a wee bit further and suggest that the stresses she’s mentioned are at the root of many ailments we generally treat with suppressive therapies and the milieu of “anti-” drugs lining pharmacy/otc shelves. Why are we at war with our bodies? Unfortunately, too many people would rather shift responsibility for their own wellbeing onto something external. This tendency can be seen in all areas of our lives. Is it cultural or simply human nature? Here’s a quote that I read yesterday by Kenton Whitman:

    “Are we victims of circumstance, or is there something in us that gravitates toward a lifestyle of ’suffering’?”

    What do you think?

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  23. Brian Burgess

    I agree with Margot.

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  24. kelly kries, md

    While the incidence of allergies may be increasing, I feel that part of that measured increase may be inaccurate. Children in daycare can easily get 12 infections per year. These children keep runny noses that are often diagnosed as allergies. Their parents often get the same runny noses. I may treat them for “allergies” that miraculously disappears when they are taken out of daycare. For whatever reason it is more socially acceptable to have allergies than a cold. Colds and allergies respond to the same treatment. What really frustrates me when I see other physicians/ np diagnose allergies and the child either has a fever or the “allergies” are spreading around the family-IT’S A COLD!

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  25. Ange Lobue, MD, MPH, BSPharm

    The human immune system continues to be compromised by a number of factors, including: increasing varieties and quantities of chemicals foreign to the body via environmental pollution, food and beverage addditives and packaging. Nutrition-poor fast foods, inadequate immunity stimulation via exercise and stress reduction, increasing intensity of competition in business leading to sustained overstimulation (”burning out”) of the adrenal-hypothalamic response. Allergies are part of a constellation of reactions including cardiovascular, metabolic and neuropsychiatric responses to inadequate maintenance of the human instrument. Many of these factors are related to the sustained state of hypervigilance in individuals resulting from the increased use of fear-based communication for political persuasion purposes. As responsible physicians we need to include consideration of the cultural diseases which affect our patients’ neuropsychoimmunological systems. In addition to treating individuals, we should participate in efforts to heal the culture through socially therapeutic actions such as speaking out about the need for proper maintenance of socio-cultural stability as well as individual human instrumental maintenance.

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  26. karla Whittington

    I believe as the population is getting older the immune systems are failing faster because of possible over medicating, more toxins in the foods being eaten, not to mention the increase of fast food diets which are very lacking in the nutrients needed to keep the body healthy.

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  27. Sherry D Ross RN

    We are genetically altering our food and destroying the earth by covering it with concrete. Creating air pollution with cars ,factories and releasing too many antibiotics and antibacterials into the atmosphere. Taking drugs made of engineered chemicals to trick or force our systems to respond and refusing to allow our own bodies to naturally protect us. “Natural” is the minority way of life.
    The only things left that are natural are Humans and our immune systems are in Shock.

    We are slowly killing our species by polluting our own environment .

    My Email address was incorrect when I sent it the first time.

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  28. Sherry D Ross RN

    We are genetically altering our food and destroying the earth by covering it with concrete. Creating air pollution with cars ,factories and releasing too many antibiotics and antibacterials into the atmosphere. Taking drugs made of engineered chemicals to trick or force our systems to respond and refusing to allow our own bodies to naturally protect us. “Natural” is the minority way of life.
    The only things left that are natural are Humans and our immune systems are in Shock.

    We are slowly killing our species by polluting our own environment .

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  29. Barry

    I not only teach in our local PA program but work in an underserved clinic. Believe me when I say that the underserved patients are not “too clean” or underexposed to allergens as they develop. Regardless of the etiology of an individual’s allergic response, it is essential that the symptoms be adequately treated. Sequellae of chronic allergic rhinitis are serious, such as chronic serous otitis media with hearing loss and accompanying speech and development delay; cholesteatoma and accompanying destruction of the middle and inner ear, to name a few. The most significant effect of allergic rhinitis in the developing child is developmental delay due to hearing loss. This is not a trivial clinical issue and needs to be addressed at each visit.

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  30. kim ritola

    I THINK THAT OUR MAJOR PROBLEM IS THE ADDITIVES THAT ARE ADDED TO EVERYTHING MAN SEEMS TO MAKE . WE NEED TO GO BACK TO THE BASICS OF WHAT THE PEOPLE IN THE 40S AND 50S ATE. GO GREEN!

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  31. Kristen

    With all of the environmental changes - climate, pollution, etc - and how contaminated our foods are, I have definitely seen a rise in allergies and multiple chemical sensitivities in my practice. I have seen amazing results with eliminating food allergens and properly educating patients on how to eat, clean and live for healthy, non-overactive immune systems. I’m glad to see I’m not the only one who thinks this way, and is not just throwing histamine blockers at everyone! Well done fellow practitioners!

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  32. Margot

    I beleive we weaken immune systems with too many antibiotics, too many OTC products, poor quality food/air/water, and too little tolerance of life’s normal aches and pains and sniffles. I also believe we treat physical symptoms of emotional syndromes rather than address the emotional etiology to a physical expression; hence the term “dis- EASE”. just an NP’s thoughts, Margot

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  33. Karen Kelly

    I do believe that our society is too clean and that as children are growing, especially within the first year of life, that their immune systems are often not exposed to enough agents to allow them to mature and fight defensively later in life. But, as we learn more we are also dx. allergies more accurately and more quickly. I believe that for the average allergy sufferer, OTC products are a very useful tool Our job should not be to limit that use, but to use all of the resources available to teach appropriate use of these products. Whether it is NP, MD, Pharmacist or nurse, education is vital.

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  34. Shawn

    As a nurse I see people using products that should have Rx only printed on them. As a society Americans are ruining their immune systems by not allowing some good exposure to happen naturally. There is no doubt a generic oversimplification in my next sentence. Some sickness is good within reason and to prevent exposure, causes a decrease in the immunity and more allergies. If you work with your hands a blister will form. The same hands used over and over again will form a callus; take more abuse without pain or blisters. In a generalized way the immune system is the same.

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