Dealing with Seasonal and Other Allergies
Sponsored by The Children's Hospital at Saint Francis
Dr. Weyman Lam, an allergy and immunology specialist with Warren Clinic, answers common questions regarding seasonal and other allergies. The discussion covers topics like treatment options, whether allergies are really worse in Tulsa than elsewhere in the U.S. and more. Watch or read the interview below.
Q: Many families may be dealing with seasonal allergies right now. What seasonal allergies are most common?
A: Now that summer’s approaching, tree season tends to be tapering off, so grass is probably the major pollen that families are dealing with now. Also, mold is a problem year-round unless there’s a hard frost. Pets are another year-round allergen. But mainly grass and mold, I’d say, for this part of the year.
Q: What are the treatment options for seasonal allergies?
A: If you have mild allergies with a mild runny nose or itchy eyes that don’t bother you very much, then try using an over-the-counter antihistamine like cetirizine (Zyrtec) or fexofenadine (Allegra). If you become more stuffy, you may try over-the-counter nasal sprays. That can take care of most people’s symptoms if they’re not severe.
If you have respiratory symptoms like wheezing, shortness of breath, or if the medicines aren’t helping, that’s the time to see your allergist. We can offer allergy testing to see what you’re allergic to and talk about what avoidance precautions you can take.
The biggest benefit of seeing an allergist is that we can offer allergy immunotherapy to desensitize you to whatever you’re allergic to, so that you will require less medication. Allergy immunotherapy can change the way your immune system reacts to allergens.
Q: Can children take over-the-counter medications?
A: Children can take the majority of them. For children younger than 2, parents need to seek the guidance of a doctor, but typically, for kids older than 2, you can follow the dosing recommendations on the box. If your child is younger than what’s recommended on the box, then talk to your pediatrician or your allergist.
Q: How does a parent know whether their child has a seasonal allergy or a virus?
A: There are many overlapping symptoms between a viral infection and an allergy such as sneezing, stuffy nose, congestion, cough and drainage. If a child has fever, body aches and doesn’t feel well, then it’s probably a viral infection. Symptoms that last for a few days and then get better are probably a virus. Allergies typically last the entire season, or if it’s a year-round allergen, they’ll last all year.
Q: What about the drainage? Are there differences in the sinus/nasal drainage?
A: That’s really hard to delineate because allergic reactions can have pretty severe, thick congestion. Patients love bringing in their tissues and mucus to the office all the time, but really it doesn’t lend that much data for us to delineate whether it’s an allergy or viral infection.
Q: Are allergies really worse here in Oklahoma than in other parts of the country?
A: Yes. Oklahomans are actually not imagining this. There is research and real data on Allergy Capitals, which are the worst places in America for allergies. There’s actually a list of the top 100 most allergenic cities. Oklahoma City ranked number 6, I believe, and Tulsa ranked 21. The score is based on the pollen counts in the area, and also how severe those pollens are. T
hey also looked at over-the-counter medication use and the number of allergists in the area. Are there enough doctors to treat the number of patients? Based on those three numbers, we’re definitely in the top 100.
Allergies exist throughout the country. There isn’t a specific area of the country that is allergy-free, per se, but we’re always on the higher end every year.
Q: How do seasonal allergies affect children with asthma, and what do you recommend for them?
A: Any child with asthma should be allergy tested because more than 90% of children with asthma have allergies. You can address the allergens to reduce the asthmatic triggers.
When you’re diagnosed with asthma, you typically will need inhalers that have steroids. A child can need oral steroids as well, which can improve breathing, but are really not healthy for a child. Inhaled and systemic steroids can suppress growth, meaning a child’s long-term final height can be suppressed. Steroids also can increase blood sugars, creating a risk for diabetes. They can increase blood pressure. There are many negative side effects from using steroids for asthma treatment.
If we can stop the allergic triggers, we can reduce the need for those steroid exposures. Children will be healthier and require less medication. So, it’s very important to have children allergy tested if they are diagnosed with asthma.
Q: Let’s switch to food allergies. This is a big thing for children. We hear about peanuts a lot, but are there other foods that tend to cause allergies?
A: Yes. You theoretically can be allergic to any food, but the common ones that children are allergic to are peanuts, milk and eggs. But we also see tree nut, wheat and soy allergies. Sesame and seafood also are becoming more and more common allergens for children.
The reaction can range from minor to life-threatening. Patients may have hives or an eczema flare-up. But sometimes they may experience severe anaphylaxis, which can be life-threatening. There are cases of death, unfortunately, from food allergens. This is every parent’s worst nightmare, so it’s very important, whenever you have any kind of reaction, to get tested so we can delineate exactly what your child is allergic to and what they need to avoid.
Q: What are the symptoms of food allergies?
A: The main one that we’ll see if children are truly allergic is a severe reaction like anaphylaxis, where you can have throat closing, shortness of breath, hives all over – a severe reaction that would require the emergency epinephrine pen to treat. Even if the initial reaction was a skin hive reaction, the reactions can progress to be severe.
Q: How do you treat food allergies?
A: The current standard of care is making the diagnosis, strictly avoiding the food allergen and keeping the EpiPen as needed in school and at home. That’s been the standard of care for many years. Now we do have an elective option for food allergies. We can desensitize for food allergies with a treatment called food oral-immunotherapy. We expose the child to very tiny doses of the food allergen, and we escalate the dose until we get to a maintenance dose, so the patient can eventually tolerate very large amounts.
To give you some perspective, a child with peanut allergy can have a severe reaction from just a single bite of peanut butter. But the children who go through food oral-immunotherapy can tolerate a peanut butter sandwich daily. We have had good success in desensitizing patients who are very allergic to certain foods.
It’s important to note that we don’t know this to be a cure, but it is very effective. It can impact quality of life. You no longer need to worry about your child going to restaurants, traveling or going to school. You know that they’re tolerating a large dose at home, and they will tolerate additional doses outside if they are accidentally given to them.
Q: Does this have to start at a certain time in life?
A: Theoretically, we can do it for any age from 18 months and up. We can even start this therapy in adulthood. It is time intensive, so typically in older children and adults, it is more difficult to do. There are more reactions. We find that with younger children, those 18 months, 6 years of age, it tends to be a lot more effective, and we have more success. The child is better able to do the therapy, too. So, I would say, any age can theoretically do it, but we typically treat younger children.
Q: Finally, what would you say to parents who are trying to decide whether to treat their child’s allergies at home, get help from their pediatrician or seek care from an allergy specialist?
A: If your child is old enough for over-the-counter medications, that’s always a good place to start, especially if the symptoms only occur occasionally during spring and fall. That’s very common. But if symptoms become more severe, the medicines aren’t helping, there’s any sign of asthma, like shortness of breath and wheezing or bad coughing, I would recommend getting a referral to an allergist. We can provide the allergy skin prick testing that is specific to whatever it is they’re allergic to. We can treat more appropriately and offer more targeted therapies.
Q: If symptoms are severe or interfering with the child’s quality of life, then it might be time to do something more than over-the-counter treatment, right?
A: Absolutely. If it’s affecting their schoolwork, the child is congested all the time, they’re dripping in their classroom and they’re asking to be excused, or they’re embarrassed and their friends make fun of them, these are definitely huge quality-of-life issues for the child. This would be an indication to go get tested and get better treatment options.
Q: So your advice would be to see an allergist because there’s so many things they can do, and these treatment options could help them with quality of life as well as minimizing steroid medications.
A: Absolutely. We can offer the testing to figure out if there’s any changes to the home you can make to minimize allergens. There are some prescription medications that are an option, immunotherapy and desensitization. We have a lot of options at our disposal to help families find the right fit for them.
Dr. Weyman Lam is an allergy and immunology specialist with Warren Clinic. He is board-certified in allergy and immunology and internal medicine. He attended medical school at the Saba University School of Medicine. He completed his residency at Rochester General Hospital and did his fellowship at Buffalo State University of New York School of Medicine & Biomedical Sciences.