By: Dr. Philip LeSueur and Dr. Cindy Salm Bauer
John is an active and enthusiastic 10-year-old boy with asthma who is usually in good health. However, during the spring, he usually ends up making at least one visit to the emergency department because of difficulty breathing.
Jane is a successful 30-year-old mom and business owner who usually does the work of two individuals in any given day, except during the months of March through May when she develops massive severe sinus headaches, “stuffy” nose, and sneezing. These symptoms disrupt her making it difficult to focus and hence reduce her productivity.
“Some would say asthma flares, sneezing, and congestion are the inevitable consequences of pollen allergy. However, there is much we can do to avoid and overcome these triggers each spring,” says Dr. Cindy Salm Bauer, Allergy and Clinical Immunology Specialist at Phoenix Children’s Hospital. “Those who suffer from naso-ocular and respiratory allergy symptoms can identify specific triggers with allergy testing. ‘Skin’ testing is a safe, relatively quick, and noninvasive way to determine one’s allergies, even for children. By knowing your triggers, you can take actions to reduce or eliminate allergy symptoms.”
Common indoor allergens include cat, dog, dust mite, cockroach, and mold. For the outdoors, tree, grass and weed pollens as well as molds are most significant. In contrast, while not true “allergies,” many with asthma will find their triggers include irritants like perfumes, smoke or even cold air. For those who suffer from allergies, these triggers elicit allergic inflammation which may clinically manifest itself in a variety of ways. This can include: itchy, red and watery eyes; runny noses, post nasal drip and sneezing; and flares of atopic dermatitis. Additionally, for asthmatics, triggers may cause bronchospasm, which is narrowing of the airways leading to cough, wheeze and shortness of breath. Asthma can be life threatening; and, uncontrolled allergies can lead to frequent infections like sinusitis.
A primary treatment for allergies and asthma is to avoid triggers. Avoidance may include removing animals from the home, eradicating cockroaches, and keeping windows closed. When avoidance is not possible or is too disruptive to lifestyle, over-the-counter medications such as oral anti-histamines, nasal sprays and eye drops may be necessary. Some of these medications can be used prior to exposure to triggers while others are meant to be used daily. One should always discuss these therapies with a doctor before beginning as some can be habit-forming. Additional prescription medications are also available if over-the-counter medications are not sufficient.
“Another treatment option for environmental allergies is allergen immunotherapy, also known as allergy shots,” stated Dr. Bauer. “This is a series of subcutaneous injections consisting of one’s specific allergenic triggers given at increasing concentrations. The goal is to cause the body to not react to the allergens and the treatment can lead to significant improvement in allergy symptoms and quality of life.” There is also an oral form of this called “sublingual immunotherapy.” There is currently only a few FDA approved preparations of these tablets available and they have only been shown to be effective in patients who are allergic to a single pollen, such as Ragweed. According to Dr. Bauer, “the allergenic preparations and age restrictions make subligual immunotherapy of more limited use here in Arizona.” Allergen immunotherapy should only be done under the supervision of a physician who specializes in the care of allergies as adverse reactions can occur.
Spring in Phoenix is meant to be enjoyed. The weather and beauties of these months account for the population booms and elevated green fees around the valley. If the allergens of these months confine you to the indoors, or worse yet to the emergency department, you might benefit from consulting your doctor. After all, your kids little league games or golfing with your friends are supposed to be fun!
Dr. Philip LeSueur is in his third year of a combined adult and pediatric medicine residency program through Banner University Medical Center-Phoenix. He graduated from University of Arizona College of Medicine-Phoenix. He plans to practice Primary Care in rural Arizona.
Cindy Salm Bauer, MD is the founder of the Phoenix Children’s Hospital Allergy and Immunology Clinic, which opened in October 2013. She is the Co-director of the Phoenix Children’s Hospital Multi-disciplinary Eosinophilic Gastrointestinal Disease Clinic as well as a Co-Director in the upcoming Phoenix Children’s Hospital Primary Immunodeficiency Clinic. She has authored multiple papers/abstracts, enjoys teaching medical students/residents about the specialty of Allergy/Immunology and has a passion for research. Her major areas of interest include: eosinophilic esophagitis, food allergy, asthma, allergen immunotherapy, and medical education. In the community, Dr. Bauer is involved with the American Lung Association’s Camp-Not-A-Wheeze, Arizona Food Allergy Alliance, Arizona Allergy and Asthma Society, and the Arizona Asthma Coalition. Outside of work, Dr. Bauer is married to Dr. Anderson Bauer, a Radiation Oncologist; both are natives of Wisconsin. They have a 3-year old son and a 3-month old baby boy.