Q. I have had this cough as long as I can remember. Antibiotics and cough medications don't seem to help. What is causing my cough?
A. There are several possible causes of a chronic cough, but a common one, bronchospasm (asthma), can be diagnosed fairly easily using a history, physical exam, pulmonary function test, and, if needed, a therapeutic trial of bronchodilators.
Q. What is the RAST test?
A. RAST (radioallergosorbent test) is a test used to measure the number of IgE antibodies in the blood for a specific allergen. The suspected allergen, attached to a small paper disk, is added to a sample of blood. If one is allergic to the allergen, antibodies specific for that allergen will be present in the blood and will attach to the allergen. Radioactive iodine-tagged antihuman IgE antibody is then added, and binds to the allergen-antibody complex. The disk is washed, and the radioactivity precisely measured. Most allergists do not use the RAST as a primary diagnosis test for allergy because it is less sensitive than conventional skin tests, and is more expensive.
Q. Will my seven-year-old daughter "outgrow" her allergies?
A. No, but it is true that some allergies may be less severe at certain times in life. However, many children are denied important medical care when they are young in the hope that their allergies will improve or go away spontaneously. Not treating your child's allergies may make her more susceptible to infections, and may contribute to chronic allergic rhinitis and recurrent middle ear infections.
Q. Can I have a bird?
A. Yes, of course, but you may regret it. Even if a person does not have an actual allergy to feathers, feathers often irritate the allergy-prone individual. In addition, bird droppings are often contaminated with mold, a common and often potent allergen.
Q. I suffer from severe hay fever. Will my children be faced with this as well?
A. There is a good chance that your children will inherit your tendency for allergy. There is a greater chance if allergies are on both sides of the family. Your children could have hay fever, asthma, or atopic eczema, or any combination or no significant allergies at all.
Q. When I eat strawberries, which I love, I break out in hives. Would allergy shots help?
A. No, unfortunately, the only treatment for food allergies is avoidance. Immunotherapy (allergy shots) does not work for food allergies and may be dangerous. If someone is very allergic to a food, he or she must avoid the particular item and, if the reaction has been severe, should always be prepared with emergency medication to treat such a reaction.
Q. In the morning my face is so puffy that my eyes are mere slits. Often my eyes are red and itchy as well. Is this an allergy?
A. It sounds like it. A common cause is bedroom dust allergy. A thorough cleaning of the room, and removing any dust-harboring furniture, heavy curtains and carpets may help. Also use only polyester-filled pillows. Feathers and Kapok are potent allergens themselves, and a major culprit in house dust, the dust mite, is very fond of both. Avoid foam as well. It traps moisture and can provide a happy home for mold, another potent allergen. And cover your mattress with a plastic cover - mattresses are, literally, dust factories.
Q. I have asthma. Will exercise help me?
A. Exercise does not improve the asthma, that is the hyper-reactivity of the bronchial airways. The benefit of regular exercise is in improving overall health and endurance. If exercise aggravates your asthma, try using an inhaled medication before you exercise.
Q. When I go where a lot of people are smoking, my eyes get itchy and I lose my voice. Am I allergic to tobacco smoke?
A. This is both an interesting and a complex question. You undoubtedly have an adverse reaction to tobacco smoke. Whether this is due to the "irritant" effect or to the "immunologic" (antibody-mediated) effect is not clear. Studies have demonstrated antibody response to a number of the many chemicals in tobacco leaves and in tobacco smoke. If you are an allergy-prone individual, you are more likely to have an immunologic reaction. However, thus far, there has not been a connection made between symptoms and antibody response. At any rate, your adverse response, whether "allergic" or not, can only be prevented by avoidance.
Q. I have asthma. Are my lungs being permanently damaged?
A. If you have uncomplicated asthma, probably not. Asthma is a reversible, treatable disease not leading to permanent damage. However, asthma may co-exist with other chronic diseases of the lung, such as chronic bronchitis and emphysema, which do cause damage to the walls of the smaller airways.
Q. During the hay fever season my ears pop when I swallow, and sometimes my hearing gets fuzzy and sort of echo-y. I've tried decongestants but they don't seem to help. What do you suggest?
A. The Eustachian tube joins the middle ear and the back of the nasal cavity, and allows air in and out of the middle ear so that the pressure is the same on both sides of the eardrum. In allergic rhinitis (hay fever), the nasal end of this tube may become swollen and obstructed with secretions, preventing the passage of air. The muscle action of swallowing temporarily opens the tube and allows air into the middle ear. The popping you hear is your eardrum adjusting its position. The hearing loss, especially if temporary, is probably due to the unequal pressure which interferes with the eardrum's ability to vibrate. While decongestants were recommended in the past, nasal corticosteroids have now been found to be more effective for this condition. Oral or injectable corticosteroids are sometimes necessary as well.
Q. I have been taking allergy shots for two years. How do I know if I can stop?
A. We recommend that you continue allergy injections until going through a full year - all four seasons - with no (or few) allergy symptoms. Then there is a much better chance that you will have "burned out" your allergy. On the average, it takes about three years of allergy injections to accomplish this.
Q. The fall is the worst time for my allergies. What can I do?
A. In this area, the major kinds of pollen in the air in late September and early October are ragweed and marsh elder. Staying indoors will help some. Taking an antihistamine regularly starting a few days before the pollen season begins and continuing for 4-6 weeks is often effective, as are nasal inhalers that either prevent allergic rhinitis (sodium cromylyn) or reduce the inflammation (corticosteroids). Severe cases can be helped by starting allergy injections, preferably at least six months before the pollen season. Patients already receiving injections weekly are often helped by increasing the frequency to twice a week beginning two months before the fall pollen season.
Q. I have frequent bouts of bronchitis. A friend asked if I had asthma. Could I?
A. Possibly. People who have recurrent bronchitis not uncommonly have underlying asthma. If this is the case, treatment of your bronchitis may be helped by treating the asthma as well.
Q. What is postnasal drip? Is it allergic? What can I do to stop it?
A. Postnasal drip is mucus draining down the back of the throat from the nasal mucous membranes or sinuses. It can be caused by allergy, or by a viral or bacterial infection. Control of postnasal drip depends on the cause. For allergy, antihistamines, decongestants, mucus thinners, and saline nasal sprays are helpful. For viral infections, one might add to this list "the passage of time," and for bacterial infections, antibiotics.
Q. I'm a 14-year-old girl and must take medications to prevent my asthma. Should I get a flu shot?
A. Yes, you should. You are in one of the "high risk" groups. Individuals with any chronic respiratory disease, including those with asthma, have a higher than normal risk of coming down with the flu, and are more likely to experience serious complications. Other individuals, at particularly high risk include persons over 65 years of age, residents of chronic care facilities, persons with chronic heart disease or a chronic metabolic disorder such as diabetes, and children receiving long-term aspirin therapy. Persons who might transmit the flu to high-risk individuals should also be vaccinated. It takes approximately one month for immunity, which is usually effective for about six months to develop. For those individuals who come down with the flu, or who know they have been exposed and have not been vaccinated, amantadine (an antiviral medication) may be helpful. It prevents the flu in many individuals if taken after exposure, and generally reduces the severity and duration of flu symptoms once one is infected.
Q. I love my cats and I am allergic to them. What can I do?
A. We're sorry, but the only really effective "treatment" is to keep your cats out of your home. Even then, it may take a year or so before the level of cat dander in your home subsides substantially.
Q. I am the mother of a two and one-half year old child. Do you treat children as young as that? Is the testing painful?
A. We do treat children as young as two and one-half years of age. If allergy testing is indicated, then Efron punch tests are applied on the back with minimal discomfort. This is a screening test. If significant airborne allergens are negative on the Efron punch, then we will apply selected intracutaneous tests on the side of the arm.
Q. How effective is your allergy treatment?
A. We get fair to excellent results in 98% of our patients in getting the allergy symptoms under control, preventing permanent damage, preventing new allergies and at the same time weighting all the odds in the patient's favor for "burning out" the allergy and getting over it.
If you have other questions regarding your allergies or asthma, please e-mail us at: