Living With Severe Allergies

Experts share 3 strategies to cope with chronic allergies.

From the WebMD Archives

Allergies affect more than 50 million people in the United States -- the poor souls who sniffle, sneeze, and get all clogged up when face to face with the allergen (or allergens) that set them off.

For many, allergies are seasonal and mild, requiring nothing more than getting extra tissue or taking a decongestant occasionally. For others, the allergy is to a known food, and as long as they avoid the food, no problem.

But for legions of others adults, allergies are so severe it interferes with their quality of life. The allergens -- whatever it is that sets off the symptoms -- may affect them more severely than others and may be harder to avoid.

Defining "severe" allergies, and pinpointing how many people are affected, is difficult even for allergists.

"When we say severe, we mean the allergies basically cause severe enough symptoms that they are interfering with life," says Paul V. Williams, MD, a staff allergist at Northwest Asthma & Allergy Center, Mount Vernon, Wash.

That means, for instance, having to take sick days to cope with symptoms so severe you can't work, or not being able to go outside on a day with a high pollen count, if that's your primary allergen.

If your allergies are this severe, you know who you are. And experts offer these three strategies for coping.

Allergy Strategy 1: Know Your Allergens

The top environmental allergens, Williams and other allergists tell WebMD, are:

"It's most common to be allergic to multiple things," Williams says, "but not necessarily all of them." Some people, however, are highly allergic to just one allergen, such as cat dander.

Whatever the allergen, it can trigger nasal symptoms, eye irritation and stinging, skin diseases or asthma, says Williams.

Sometimes it's clear what your allergen is. If you visit a house with a cat, for instance, and start to have symptoms, you know. If it's hay fever season and your nose starts running when you go outdoors, you know.

But if you can't figure out what the offending allergen is, you can ask for skin tests. A doctor will place a tiny bit of the suspected allergen under your skin and watch for a reaction. The doctor should then be sure that your symptoms match the allergen he used, Williams tells WebMD.

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Allergy Strategy 2: Control Your Allergens

Once you know your target, you can start to eliminate or control it.

Controlling Animal Dander

Lovable as household pets may be, they can create big problems for people with allergies, says Michael M. Miller, MD, associate professor of medicine at the University of Tennessee Health Sciences Center, Knoxville.

The offending allergen is a protein found in the saliva, dead skin scales (called dander) or the urine of an animal with fur, including dogs and cats, according to the American Academy of Allergy, Asthma & Immunology. The protein, when airborne, can land in the eyes or nose or be inhaled into the lungs.

Allergy symptoms can pop up immediately after contact or even up to 12 hours later.

The only way to eliminate the allergen, allergists say, is to get rid of the pets. But the advice often falls on deaf ears, Williams says. "Most of the time, patients won't eliminate the pet from their environment."

Even if an allergic person does part with a dog, the animal's allergens may hang on in the house for a year or longer, according to the Academy.

If parting with the pet is not possible, Williams says: "Keep the pet out of the bedroom and no carpeting in the bedroom." Hardwood or tile floors collect less allergen. Damp mop floors often to reduce allergen levels, he suggests.

"Have at least one 'safe zone' in the house" if you can't part with a pet, advises Neeti Gupta, MD, an allergist in East Windsor, N.J. Your bedroom would be ideal as a safe room that's off limits to your pet.

Brushing a dog regularly -- outdoors, so the allergen doesn't get trapped inside -- can also help, Williams says.

And if you're furniture shopping for sofas or chairs, pick leather over fabric if possible, Williams says. "You can wipe it off," he says.

Controlling Dust Mites

Dust mites feed on common house dust, a mixture of small pieces of plant and animal material. The microscopic creatures also cling to carpets, bedding and furniture. The dust mites' fecal matter contains the allergens, Williams says, and these allergens are airborne for a short time before dropping to surfaces. "Most exposure comes from being up close and personal with the dust mite."

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Put barriers between you and those mites, he says, by buying and using the allergy-proof covers for bedding.

Miller suggests allergy-proof encasings for the mattress, pillows, and box springs. "The mites feed on skin cells, and they live on your bed. They dig down into the mattress. The encasings don't allow them to penetrate into the mattress."

Pay close attention to the cleanliness of your bedding, too, to avoid allergens. Wash it weekly in hot water that is 130 F or higher, Williams says, to kill the critters. Newer models of washers may be capable of heating the water this hot, he says, but "most of the time you have to turn up the water heater."

His advice: "Turn it up and measure the water the next day, 12 to 24 hours later, with a candy thermometer. If there are kids in the home, turn it up a day before you do the wash [and then lower it later, to reduce the risk of scalding]."

Using a dehumidifier to keep the humidity lower than 50% can help control your dust-mite population, according to experts at the American Academy of Allergy, Asthma and Immunology.

Controlling Pollen

While some allergy-prone people take great pains to plant so-called ''low-allergy" trees and shrubs, it's not foolproof. "Pollen can travel great distances," Miller says.

"Even if your yard has 'low allergy' trees, pollen can come from miles away," Miller says.

With pollen, agrees Gupta, "There's only so much you can do without having to live in a bubble. If you are indoors, keep your windows shut, use the air conditioner, drive with the car windows shut."

Controlling Mold

Molds are more an outdoor problem than indoor, says Williams, unless your plumbing indoors is leaking. If the bathroom shower or tub gets a little mold ring around it, he says, it typically won't bother the allergy-prone unless it's disturbed and the spores become airborne.

To get rid of household mold, apply a cleaning solution of 5% bleach and a small amount of detergent, suggest experts from the American Academy of Allergy Asthma & Immunology.

Outdoors, airborne mold from vegetation can trigger an allergic reaction, too. Allergic reactions to mold are most common from July to late summer, according to the Asthma and Allergy Foundation of America.

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Allergy Strategy 3: Obtain Good Treatment

Allergy treatment won’t "cure" your allergies, but they can significantly reduce your allergy symptoms. Key treatments include antihistamines and decongestants. Antihistamines treat the runny nose and itching eyes and nose. Decongestants reduce the stuffiness.

Prescription nasal steroid sprays also help, Williams says. Nasal steroid sprays prevent the release of substances that inflame mucus membranes, thus reducing your inflammation. "For these to be most effective they need to be used on a regular basis," he says.

Another option, says Miller, is to use antihistamine nasal sprays; there are even some prescription-strength sprays approved to treat seasonal allergies.

The asthma prescription drug montelukast can also help allergy symptoms, Miller says.

Immunotherapy, better known as allergy shots, can help, too, he says. "Those are for people whose allergies are difficult to control [even with medication or environmental measures], or people who don't want to continue taking medication all their lives," Miller says.

For some people, the medications may not work as well over time, Gupta says. "Patients often tell me the medications that worked last year don't work this year." Some patients can switch to another medication; other patients may consider immunotherapy.

Immunotherapy can also reduce the risk of developing asthma, Miller says. "It's never too late to start."

Before you start allergy shots, your allergist will do a series of tests to pinpoint which allergens cause your allergies. Then, typically, allergy shots are given twice a week for a few months, tapered to once a week for about six months, then every one to four weeks for up to five years, Miller says.

WebMD Feature Reviewed by Brunilda Nazario, MD on April 23, 2009

Sources

SOURCES: Michael M. Miller, MD, associate professor of medicine, University of Tennessee Health Sciences Center, Knoxville. Paul V. Williams, MD, staff allergist, Northwest Asthma & Allergy Center, Mount Vernon, Wash. Neeti Gupta, MD, allergist, East Windsor, N.J. American Academy of Allergy, Asthma & Immunology.

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