Northern Colorado Asthma and Allergy Clinic

Knowledge is power.

Northern Colorado Allergy and Asthma Clinic hopes that you will find the following topics helpful in managing your allergies or asthma:

Frequently Asked Questions about Allergies

What causes allergies?
The body’s immune system normally defends the individual from harmful substances such as viruses and bacteria. In some genetically predisposed individuals, the immune system identifies harmless substances such as pollen, foods, or animal dander as dangerous and mounts an inflammatory reaction to rid the body of these invaders or allergens. This inflammatory reaction produces the symptoms of sneezing, nasal stuffiness, watery nasal discharge, and eye irritation that affect 40 million Americans and cost $4.5 billion per year to treat.

What kind of problems do allergies cause?
The most common symptoms produced by allergies are allergic rhinitis (hay fever), asthma, and eczema. An allergic person may develop only one of the above symptoms, such as hay fever, or he may have one symptom at one period of life and a different symptom at a later period. A frequent sequence is the onset of eczema during infancy and then the development of allergic rhinitis and/or asthma later in childhood or adulthood. In some individuals, allergic rhinitis, eczema, and asthma co-exist throughout life.

Who will develop allergies and how long do they last?
The tendency to become sensitized or allergic to some otherwise harmless substance is usually inherited. What one becomes sensitive to depends, in part, upon to what one is exposed, as well as the amount of such exposure. Thus, an individual who has inherited this tendency may become sensitive to cow’s milk shortly after birth or to dog dander at the age of 6 years after acquiring a dog. Throughout the individual’s life, new sensitivities may be developed as he or she undergoes new exposures. The previous sensitivities may remain or may be lost gradually. Generally, symptoms wane in older adults.

How are allergies treated?
There are three fundamental ways of treating allergies:

Removal from the environment of those things to which the patient is sensitive. Control of symptoms with medication.
An attempt to build up the patient’s resistance to the things he or she is sensitive to by the injection of increasing amounts of allergens at regular intervals.

Strictly speaking, allergy is not “cured” but only kept under control so that it does not produce symptoms.

back to top

Environmental Control to Prevent Allergies and Asthma

The first method of treatment of allergies is environmental control. Obviously, if all allergens could be completely prevented from entering the body of the allergic individual, the symptoms would cease. This ideal is attempted in many ways. The amount of relief from symptoms that is obtained depends upon the thoroughness with which the allergens are removed.

Indoor Air Quality
In order to keep symptoms at a minimum, allergen exposure in the home should be reduced whenever practical. Ideally, wall-to-wall carpeting should be removed and replaced with tile, wood or vinyl flooring materials. Throw rugs must be washed regularly and upholstered furniture should be vacuumed frequently. Surfaces should be frequently vacuumed or dusted with a damp cloth and kept clutter free. An adequate vacuum sweeper can be purchased at most discount stores for under $150. The vacuum should have a HEPA (high-efficiency particulate air) exhaust filter and double walled exhaust bags. A HEPA air filter device should be used in the bedroom. The size of the air filter will depend upon the square footage of the room. Replace air conditioner and furnace filters frequently and consider duct cleaning.

Pollens
Plant pollens are tiny substances produced by the inconspicuous flowers of trees, grasses and weeds and dispersed by air currents. They are released during various seasons of the year and may be blown for miles. In the Colorado, Nebraska and Wyoming areas, tree pollen is released in the late winter and spring of the year, grass pollen is released in May and June and weed pollen is released in August, September and October. The allergic individual can reduce his or her exposure to pollen by staying inside and using air conditioning in the home and car. If an individual is significantly symptomatic and experiences intolerable symptoms, it is unlikely or impractical that airborne pollens can be avoided. In such a case, medication or immunotherapy must be considered.

Pets
Any warm-blooded, furry animal can cause allergic symptoms. Rather than the actual hair, the protein found in the dander and saliva of cats and dogs causes the symptoms. These proteins are carried into the air as tiny invisible particles and land in the nose and lungs, causing a runny nose, itchy, watering eyes or even asthma.

The removal of the pet to the home of a caring, non-allergic friend or family member may be the best solution, but if this is not possible, minimize the allergic individual’s exposure by keeping the pet out of the bedroom. Washing the pet on a regular basis (weekly for cats and every two weeks for dogs) may help. A non-allergic member of the family should brush the pet outside to remove loose hair and allergens.

Rodent pets such as rabbits, gerbils, and hamsters produce urine, which is the main source of the allergen. The allergic individual should not clean the cage and the animal should not be kept in the bedroom.

Although some dogs and cats produce less allergen than others do, all breeds produce allergens. Even if the allergic individual is not initially allergic to a new pet, symptoms may develop over time. A preferred pet for an allergic person would be a reptile, fish or animals without fur or feathers.

Dust Mites
Dust mites are microscopic organisms that live in carpets, bedding and upholstery. Dust mites require a relative humidity of 50% or more to live so that furniture and beds bought and used only in Colorado generally do not host dust mites. Furniture and bedding brought to Colorado from another more humid environment may contain dust mites. The best protection is to replace the furniture or use zippered and taped vinyl coverings on pillows, and mattresses.

Molds
Indoor mold and mildew cause allergic symptoms by the production of tiny spores, which are spread by, air currents. Mold thrives in damp areas such as on shower curtains, in shower stalls, on stored books and leather goods, in damp basements and storage areas. Mold also occurs outside in damp areas under leaves, in grass and in cultivated gardens. The humidity in the home should be no higher than 40% to prevent the growth of mold. Humidifiers, which are used to maintain a moisture level in the home, should be cleaned regularly according to the manufacturer’s instructions. A cleaning solution containing 5% bleach and a small amount of detergent will clean and disinfect moldy surfaces.

Nasal saline Washes

An important aspect of treatment in allergies and asthma is nasal saline irrigation. The nose is said to be the “beginning of the lungs” since substances, which affect the health of the lungs, first enter the nose. An allergic substance not only causes localized symptoms in the nose such as itching, sneezing and rhinitis (runny nose), but can also cause a cough and wheezing in the lungs. Nasal saline washes are recommended twice daily to wash out the allergens and bacteria and remove the layer of mucus prior to using nasal sprays. If done regularly, symptoms should significantly improve.
Make a solution of 8 oz of warm water, ½ teaspoon of sea salt or noniodized salt and a pinch of baking soda. Mix in a specified mug and draw up the solution in a bulb syringe. Lean over the sink, spray little puffs in each direction, hitting every aspect of the nose. Use all of the solution in the bulb syringe. Repeat and follow the same instructions on the other side of the nose. When finished with the washes, gently blow your nose. Wait a few minutes, then use the nasal spray prescribed by your physician.

back to top

Allergy Medication

Although prevention comes first, medication may be needed if symptoms persist or allergen exposure is unavoidable. Allergies are most commonly treated with antihistamines, decongestants and nasal sprays.

Antihistamines work by preventing the release of histamine. Traditional, older antihistamines cause many side effects including drowsiness, dry mouth and difficulty with urination. Newer antihistamines such a Claritin, Clarinex, Allegra, and Zyrtec produce far fewer side effects. Decongestants help decrease congestion in the nose by their action on blood vessels. Side effects include increased blood pressure, sleeplessness and irritability. Nasal sprays containing steroids are very effective and may generally be used indefinitely. Antihistamine nasal sprays such as Astelin reduce congestion as well as block histamine release. Over the counter decongestant nasal sprays should only be used for three or four days in a row due to rebound congestion. Singulair is a leukotriene modifier, which blocks both allergies and asthma and causes very few side effects.

back to top

Allery Shots or Immunotherapy

Allergy shots or allergy immunotherapy is a vaccination program that can reduce an individual’s reactions to an allergic substance such as animal dander, pollen or mold. Immunotherapy works like a vaccination. By injecting small amounts of a purified allergen, the body produces protective antibodies and prevents or reduces the allergic response. Beginning with small doses, the body gradually builds up immunity until a maintenance dose is reached. Immunotherapy generally lasts three to five years or longer and may greatly reduce or eliminate symptoms.

back to top

Asthma

Asthma is a chronic inflammatory disease of the airways affecting 14 to 15 million people in the United States. Asthma causes wheezing, cough, and difficulty breathing. Symptoms generally come and go and are at least partially reversible. During an episode of asthma, the airways become narrow because the muscles around them tighten (bronchospasm). The lining of the airways may become swollen and excess mucus is produced which can clog the air passage. Breathing gets harder as air is forced through narrower airways and the airflow may make a wheezing or whistling sound. Asthma episodes may be mild or severe. Most often they are mild and the airways will open in a few minutes to hours. Infrequently, asthma episodes can be severe or prolonged and need emergency medical treatment.

It is essential to make the diagnosis of asthma to rule out other medical problems that sometimes mimic asthma. In addition to a careful history and physical exam, pulmonary function testing is performed to measure the airflow in the lungs and the reversibility of the obstruction after the inhalation of a bronchodilator medication.

Although asthma cannot be cured there are many ways to control and prevent asthma attacks, allowing for a comfortable life with minimal interference in daily activities. Furthermore, many children have lessening symptoms as they grow older.

Determining an individual’s asthma triggers is an important step in controlling the episodes. Some of the more common triggers to asthma are allergies to pollen, animals, dust, dust mites and mold; respiratory infections; smoke or air pollution; chemical fumes and exercise.

Asthma triggered by allergic factors can be prevented by avoidance of allergens. Allergy injections or immunotherapy reduce reactivity to the offending allergen. Whether asthma is triggered by allergies or not, medication will help prevent or reduce the symptoms. No one drug is best for every kind of asthma or every person. You and your doctor will work together to find the drug or combination of drugs that will work best for you.

back to top

Asthma Triggers

Allergies
The most common triggers for asthma are allergies. The individual’s immune system over-reacts to common substances in the environment such as pollen, dust and dust mites. These substances cause a hyper-responsiveness of the airways resulting in coughing, tightening of the chest, wheezing and difficulty breathing. If the exposure to the offending substances is significantly reduced, symptoms and the need for medication are also reduced. Allergy skin or blood testing helps the patient and doctor to determine the specific offending substances and make recommendations to reduce exposure. Basing the decision upon test results, the doctor can initiate allergy injections or immunotherapy. Medical research has shown these treatments to reduce asthmatic symptoms.

Irritants
A variety of substances can irritate the nose, throat or lungs. These substances include cigarette smoke, air pollution, gasoline fumes, dust, aerosol spray and strong odors. Do not smoke, and do not allow smoking in your home. Avoid household products and chemicals that cause symptoms.

Animals
All warm-blooded pets, including birds and rodents produce dander, saliva, feces, and urine that can cause allergic reactions and asthma. If possible, remove the animal from the home. If not feasible, keep the animal out of the bedroom, and keep the bedroom door shut. Place filtering material over forced air outlets and an air-filter in the bedroom. Weekly washing of cats and bimonthly washing of dogs may help reduce allergy and asthma symptoms.

Exercise
Exercise is a common trigger for asthma. Symptoms usually begin after a few minutes of sustained effort. The asthmatic may experience coughing, wheezing or difficulty breathing. To prevent exercise induced asthma, warm up for several minutes prior to strenuous exercise and pretreat with medication. If asthma is well controlled, the asthmatic is able to exercise without limitation.

Infection
Respiratory infections (colds, flu, and sinusitis) are likely to aggravate asthma. Your doctor will discuss changes in your usual therapy program to keep your asthma under control. Although viral infections should not be treated with antibiotics, cold symptoms may develop into a bacterial sinusitis, bronchitis or pneumonia that requires antibiotic treatment. See your provider if your upper respiratory infection or asthma is worsening and/or not responding to treatment.

Weather Changes
Asthma is often intensified by a change in the weather. Interestingly, weather factors affect each asthmatic individually. There is no one type of climate that is good or bad for all asthmatics. Cold air or wind may cool and dry airways and trigger symptoms. Cover your nose and mouth with a scarf when exercising on cold and windy days.

Emotions
While asthma is not a psychological disease, emotional stress, crying and laughter can lead to changes in breathing patterns. These changes can trigger asthmatic symptoms.

Gastroesophageal Reflux
Acid reflux from the stomach into the esophagus can cause not only heartburn and belching, but also an exacerbation of asthma symptoms. Treatment includes avoiding meals or snacks prior to bedtime, elevating the head of the bed and taking medication.

back to top

Medical Treatment for Asthma

There are two kinds of asthma medications - those medications that relieve symptoms when present and those medications that control or prevent symptoms.

Relievers or bronchodilators such as Albuterol (Proventil, Ventolin) and Pirbuterol (Maxair) work quickly by relaxing the muscles surrounding the airways. Usually the medication is inhaled into the lungs from an inhaler, nebulizer or similar device for fast relief of symptoms. Patients experiencing daily or increasing symptoms need to begin a controller medication.

Controller medications do not relieve symptoms quickly. Instead, they control or prevent asthma symptoms by reducing airway swelling and the production of mucus. Controller medications include inhaled or oral corticosteroids, long-term bronchodilators, theophylline, and leukotriene modifiers.

Inhaled corticosteroids are the most effective anti-inflammatory medications available. Studies have shown that early use of inhaled corticosteroids can control asthma and prevent permanent airway injury. A possible side effect of higher doses of inhaled steroids in children is growth suppression. Because researchers are still investigating the possibility of this side effect, your physician will monitor the growth of your child on inhaled corticosteroids. All patients using inhaled steroids should rinse their mouth after using the medication to prevent an easily treatable yeast infection in the mouth. Sometimes steroids are given orally for prompt control of exacerbations. If taken for months or years at a time, oral steroids can have serious side effects; consequently, they are rarely prescribed long term.

Long-term bronchodilators such as Serevent or Foradil are used to prevent symptoms, especially nighttime and exercise symptoms. They should not be used for sudden asthma symptoms since they may take fifteen to thirty minutes to start working. The effect lasts twelve hours or more. Side effects are unusual and minimal but may include rapid heartbeat or tremor.

Theophylline provides long-term relief of symptoms, especially nighttime symptoms. Because of the adverse effects such as insomnia, stomach upset, shakiness, and hyperactivity in children, theophylline is rarely prescribed since newer medications have become available.

Leukotriene modifiers such as Accolate and Singulair work on the cellular level to improve lung functions and diminish symptoms. They may reduce the need for other medications including inhaled corticosteroids. They have found to be particularly useful in asthma, which is triggered by allergens. Generally, patients do not have any adverse effects with the use of these medications.

Childhood Asthma

Allergic and asthmatic disorders rank first among children’s diseases. With diagnosis and appropriate treatment, asthma can be a minor inconvenience. The Allergic and asthmatic disorders rank first among children’s diseases. With diagnosis objective of treatment is control of the disease so that a normal life is possible. Overall, the outlook is favorable for improvement as the child becomes older. However, it is impossible to make an accurate prediction for any particular child.

Treatment of the child with asthma involves evaluating the triggers of asthma and changing the environment whenever possible to avoid the precipitating factors. Medication works to prevent or control bronchospasm and allergy injections may be recommended to change the child’s response to inhaled allergens, which trigger bronchospasm. Remember, allergy injections take time to show an effect and do not directly help the asthma, which is triggered by such factors as upper respiratory infections, cold air and exercise. Therefore, a combined program of avoidance, medication, and allergy injections (if indicated) achieves control of asthma. If your child has asthma, you can help in the following ways:

Do not allow smoking in the house or around your child. Use medications prescribed by your doctor to block your child’s exercise-induced asthma so that he or she can live an active life. Remember, many Olympic gold medal winners and professional football players have asthma. Many children fall behind academically due to being sent home for minor asthma attacks, which could be controlled at school, or they miss a day of school for minor wheezing or congestion in the morning. Medicines should be available at school, and the child and the health aid or teacher needs to be comfortable using them. Discipline for the child with asthma should be the same as for any other child. Although it is possible for a child who is upset by a parent’s enforcement of rules to wheeze, it is a far greater harm to allow the child to have his or her own way.

back to top