Northwest Health Summer 2011

Feature

Sniffles, Itchy Nose, Hives, Headache

Do you have an allergy? Surprisingly, these symptoms often have other causes.

Go to: Northwest Health Index

What do bee stings, peanuts, headaches, and hives have in common? The simple answer: It could be allergies.

An allergy is the immune system's response to something that's usually harmless — a type of food, for instance, or pollen from trees and plants. And that response can come in many forms, including hives and headaches.

But figuring out allergies is often not clear-cut. So we asked Group Health allergy experts to de-bunk some of the most common allergy myths.

Myth: A frequently upset or bloated stomach, lack of energy, and headaches are all signs of a gluten allergy.

What's going on: Discomfort associated with your digestive system — especially the stomach and intestine — is very common. It can take the form of heartburn, a bloated feeling or pain from gas, or changes in bowel movements, including constipation or diarrhea. Everyone experiences these at one time or another. Many things can cause these symptoms, including a viral infection or lactose intolerance.

An allergy to gluten — a protein found in wheat and some other grains — is not nearly as common. It occurs in just 1 percent of the population in the United States. About 2 percent of the people with these symptoms are actually allergic to gluten.

A gluten allergy can lead to inflammation in the bowel, which can in turn cause poor absorption of nutrients from food. This might lead to other health problems such as anemia, fatigue, weight loss, or inability to gain weight.

This allergy is associated with other autoimmune disorders as well, so many different clinical symptoms can be seen in individuals with gluten hypersensitivity. Anyone with frequent and persistent symptoms of a digestive disorder should be evaluated. A gluten allergy is just one of the many possible causes.

Myth: Children soon outgrow their food allergies.

What's going on: Some children do outgrow their food allergies by the time they're between ages 3 and 5. However, new reports from Johns Hopkins Children's Center suggest that many more children don't outgrow their allergies until much later in life. Researchers there found that 19 percent of children who are allergic to milk outgrow that allergy by the time they are 4. However, 79 percent don't outgrow it until they are 16. With an egg allergy, 11 percent outgrow it by age 4, and 82 percent by age 16.

Unfortunately some food allergies, including those to peanuts, tree nuts, fish, and shellfish, are more likely to be lifelong.

Myth: Persistent hives are almost always due to allergies.

What's going on: Persistent hives are almost never due to allergies. When someone has hives for more than six weeks, often no cause is ever found. However, it has recently been determined that these hives often have an autoimmune cause. In many people with persistent hives, their bodies create antibodies that target a type of skin cell, causing those cells to release histamine — which causes the hives.

For some people, scratching, vibration, pressure, sunlight, heat, cold, or exercise act as triggers for histamine release and result in hives.

Myth: If you get hives when you go out in the hot sun, it means you're allergic to sunshine.

What's going on: Hives that are caused by ultraviolet rays from the sun — the medical term is solar urticaria — are quite rare.

Hives from sun exposure can arise from many different conditions, such as a pollen allergy, sunburn, a medication, the skin's reaction to light, underlying skin conditions, or hidden metabolic problems. To properly diagnosis a real allergy to the sun's ultraviolet rays, specialized testing in a dermatology clinic is required.

Myth: A sinus infection comes from allergies.

What's going on: This is not true. For a small number of people, it can be a complication from a cold. If you've had a cold and runny nose for 10 to 14 days, and the nasal discharge becomes worse, is thick and discolored, and you have pain and pressure in the sinus area, you may have an infection. Chronic sinusitis, in which the nasal passages are swollen and inflamed for more than eight weeks, is less likely to be caused by an infection. It can be treated by irrigating the nasal passages with a saline solution, and with topical steroids such as a nasal spray.

Myth: If you have never been stung by a bee, you can't be allergic to bee stings.

What's going on: Most people are not allergic to bee stings. However, about 50 percent of fatal reactions to bee stings occur in people without any prior allergic reaction to a sting.

Allergic antibodies to bees and yellow jackets, which increase the possibility of a reaction, can be found in 10 percent to 20 percent of adults. If you have a local reaction such as swelling at the site of the sting, your risk of a subsequent severe reaction is only 5 percent to 10 percent. This is true even if the swelling is significant.

If you have had a previous severe systemic reaction — which included symptoms such as difficulty breathing, throat swelling, light-headedness, a drop in blood pressure, and loss of consciousness — your chance of a severe reaction with future stings is between 35 percent and 60 percent. Anyone who has had this type of reaction should keep an EpiPen nearby for self-administration, and medical alert identification. An EpiPen injects a dose of epinephrine to counter the effects of the sting.

Myth: Sinus headaches are usually caused by allergies.

What's going on: Only a small number of sinus headaches are caused by allergies.

We know that some environmental changes — such as pollens in the spring — can cause reactions in both allergic and non-allergic people. These reactions include nasal congestion, sinus pressure or pain, and increased nasal drainage. Some people identify the pain and congestion associated with these allergies as a "sinus headache."

But population studies have demonstrated that most of these sinus headaches are actually caused by migraines — not allergies. Because of the location of the sinuses — and the nasal blockage and mucus flow associated with allergies — migraine is often overlooked by patients and primary care providers as the cause of the headache.

Myth: Runny nose, nasal congestion, and sneezing are symptoms of an allergy.

What's going on: These are common symptoms of a nasal allergy, but in about one-third to one-half of the time, there's another cause. And in 40 percent to 85 percent of patients with nasal symptoms, there is more than one cause.

A nasal steroid spray such as fluticasone will often give relief. If it doesn't, something else may be going on.

This kind of environmental or seasonal allergy often starts in children and young adults. In middle age to older adults, a runny nose with nasal congestion and postnasal drip is common even in people who have not previously had allergies. They are often caused by an imbalance in nervous symptom control over the nose. The symptoms often respond to a nasal spray with ipratropium.

Myth: When toddlers wheeze, it's because of asthma — not allergies.

What's going on: Wheezing is a high-pitched sound made by air moving through narrowed airways. People with asthma wheeze at times, but there are other potential causes of wheezing, such as a foreign material that's been inhaled into the lung, a heart condition, or a birth defect.

Allergies and infections can also cause the airways to narrow, resulting in wheezing. Respiratory infections, or colds caused by viruses, are one of the most common causes of wheezing in toddlers since they have small airways. This can be severe and frightening, and will need to be treated, but it's not asthma. If the symptoms occur frequently, or last for a long time, a doctor should be consulted.

Although people with asthma may wheeze, they also have many other symptoms, including inflamed airways, an increase in mucus in the airways, narrowed airways, and an increased irritability of the airways. These conditions can vary over time. When they do occur, they can lead to typical asthma symptoms, including coughing, breathlessness, and increased effort to breathe. Asthma can be serious. Anyone with symptoms should be checked by their doctor. Many effective therapies are available to control this problem.

Myth: One allergy shot at the start of the allergy season can provide long-term relief.

What's going on: Some people with allergies receive steroid injections once or twice a year. But these are generally not recommended because of the side effects associated with steroids.

A better option for people with significant allergies is a series of injections called "immunotherapy." These allergy shots act like a vaccination and alter the way your immune system responds to allergens. You are first "desensitized" over several months, during which time you receive shots with increasing doses of your specific allergens. Once you reach your maintenance dose, you need just one shot a month. After three to five years, your immune response will be altered and your allergy symptoms will remain controlled without shots. Many people obtain significant relief from their allergies with this treatment.

Treating Seasonal Allergies

Spring and summer are prime time for allergies caused by pollens. Charles Mayer, MD, who has a primary care practice at Group Health's Downtown Seattle Medical Center, prescribes these remedies.

Method Description Pros Cons
Neti pot, nasal irrigation kitA nasal irrigation kit filled with water and a mixture of bicarbonate and salt that looks like a teapot. It's used to pour water into nasal passagesEffective in cleansing nasal passages of pollen irritantsSome people don't like the feel of water in their nasal passages
Spray nasal irrigationA spray bottle that is filled with water, and a mixture of bicarbonate and saltSprayed into each side of the nose, this method can be more comfortable to use than a neti potMay not cleanse nasal passages as well as a neti pot
Flonase nasal steroidA prescription-only drug sprayed into nasal passagesSprayed into each side of the nose, this method can be more comfortable to use than a neti potNasal irritation
AntihistaminesOver-the-counter drugs that relieve or prevent allergy symptomsEasy to use, and effective for many allergy sufferersDry mouth and drowsiness* with older types such as Benadryl; dry mouth with newer options such as Allegra & Claritin

*Best taken at night. If you take it during the day, consider taking a smaller dose of this medication.

Group Health Medical Centers Allergy Experts

  • William Butler, Capitol Hill and Everett medical centers, board certified in clinical and lab immunology
  • Alan Krouse, Bellevue Medical Center, board certified in allergy and immunology
  • Wayne Sladek, Tacoma and Silverdale medical centers, board certified in pediatrics, allergy, and immunology
  • Albert Tsien, Olympia Medical Center, board certified in allergy and immunology
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