What is it?

Overview

What Is It?
An allergy is a reaction of a person's immune system to a normally harmless substance, one that doesn't cause problems for most people.

It's hard to believe that items as unrelated as shellfish, pollen, animals, bee venom, peanuts and mold can all potentially lead to the same type of problem. What these substances have in common is that they are common allergens—they cause allergic reactions in some people.

With so many substances potentially causing so many problems, it's no wonder allergic diseases are among the major causes of illness and disability the fifth leading cause of chronic disease in the United States, and the third most common chronic disease in children under age 18. Allergies affect more than as 50 million Americans, or one in every five adults and children, and are as common in women as in men. According to the American Academy of Allergy, Asthma & Immunology, a recent nationwide survey revealed that more than half of all U.S. citizens test positive to one or more allergens. More specifically, an estimated 35 million Americans are allergic to pollen; up to 10 million Americans are allergic to cats; and 2 million develop severe allergic reactions to insect stings. Food allergies are less common, affecting about 12 million Americans. And while up to one out of three people say they have a food allergy, only about one to two percent of adults and six percent of children have true allergic reactions to foods. Unfortunately, about 150 deaths per year are attributed to food allergies, and 40 result from insect stings.

An allergy is a reaction of a person's immune system to a normally harmless substance, one that doesn't cause problems for most people. In the allergic woman, the offending substance causes the immune system, which functions as the body's defense against invading agents such as bacteria and viruses, to respond to a "false alarm." Her immune system treats the allergen as an invader by generating large amounts of a type of antibody—a disease—fighting protein known as IgE-that attaches to the body's tissue and blood cells. The cells are then triggered to release powerful inflammatory chemicals like histamine, cytokines and leukotrienes. These chemicals act on tissues in various parts of the body, such as the respiratory system, and cause the symptoms of the allergy.

Allergies can be more than just bothersome. Some allergies cause symptoms of rhinitis like sneezing, runny nose and watery eyes; skin irritations like itching and hives or eczema; or gastrointestinal distress. In some people, the allergic response can lead to anaphylaxis or anaphylactic shock—a sudden and sometimes deadly drop in blood pressure. Anaphylactic shock can potentially stop the heart or lead to complete closure of air passages, causing death by suffocation.

Allergies that result in respiratory symptoms can be caused by pollens, molds and fungi, dust or dust mites, animals, medications, foods, latex and other substances. Food allergies, which can cause a wide variety of symptoms and are the most likely to cause anaphylaxis, are most commonly caused by shellfish and other fish, peanuts and other nuts, wheat, soy, dairy and eggs.

Contact allergies are allergic reactions caused by a person's skin touching a substance. They are most often caused by nickel, polishes, rugs, fabric softeners, deodorants, cosmetics, perfumes, preservatives, dyes and foam insulation. And don't forget plants like poison ivy, poison oak and sumac. There is a compound in these plants that can cause severe skin reactions in people who are allergic—up to 85 percent of Americans.

Allergies have a genetic component. If one parent has allergies, each child has a 30 to 40 percent chance of having an allergy. If both parents have allergies, it is much more likely (a 75 percent chance) that their children will have allergies. Adults usually do not lose their allergies, but children can sometimes outgrow them. In addition, while people are born with a genetic predisposition to allergies, sometimes they don't develop them until well into adulthood. Exactly what turns these genes on and when remains a bit of a mystery. Some researchers speculate that the more you are exposed to a potential allergen, the more antibodies to that allergen you can build up, until finally one day, they are released in an allergic reaction. Once you become "sensitized," you're going to get recurring symptoms every time you are exposed to the allergen.

Diagnosis

Diagnosis

The most common allergic responses are breathing problems like congestion, sneezing and wheezing, along with itchy eyes and skin irritation, redness, hives or itch. If you suffer from allergies, you may have only one of these symptoms or several.

The symptoms of allergies to airborne substances include:

• sneezing

• runny or clogged nose and post-nasal drip

• coughing

• itching eyes, nose and throat

• dark circles under the eyes caused by increased blood flow near the sinuses

• children often get a crease mark on their noses from rubbing it in an upward direction

• watering eyes

• conjunctivitis, or an inflammation of the membrane that lines the eyelids, causing red-rimmed, swollen eyes and crusting of the eyelids

• wheezing, shortness of breath, chest tightness from allergic asthma

The symptoms of allergies to food or ingested products may include the respiratory problems above and:

• itching in the mouth

• trouble breathing or swallowing

• a drop in blood pressure

• abdominal pain

• diarrhea or vomiting

• hives, skin itching or eczema

The main symptom of a contact allergy is an itchy rash, a type of contact dermatitis.

Some women develop allergic-type reactions in response to environmental agents, such as cigarette smoke, paint fumes, plastics and perfumes; temperature and humidity changes; and strong smells. These are not true allergic reactions involving antibodies and the release of histamine or other chemicals. Similarly, food intolerances, such as an inability to digest milk products or gluten, or sensitivity to monosodium glutamate (MSG), are not true food allergies. Also, there are several diseases that share symptoms with food allergies, including ulcers and cancers of the gastrointestinal tract.

It's not uncommon for women with allergies to develop asthma. The symptoms of asthma include coughing, wheezing and shortness of breath due to a narrowing of the bronchial passages or airways in the lungs and to excess mucus production and inflammation. Similarly, extended bouts of rhinitis can lead to the more painful and dangerous sinusitis.

If you suspect you have an allergy and it bothers you to the point you'd like to seek treatment, you can see a general practitioner or an allergist. If you have cold-like symptoms that last for more than two weeks, you should seek treatment. These symptoms can lead to sinusitis, which may require more aggressive treatment. Your health care professional will discuss with you your medical history, your symptoms, and when they occur. You should be prepared to answer questions such as:

• Do allergies run in your family? If so, which relatives have them, and what are they allergic to?

• Do you develop recurring symptoms at certain times of the year?

• Does being around pets or eating certain types of foods cause symptoms to flare?

• How long do your symptoms last?

• What seems to make symptoms worse? What makes them better?

• Have you tried any medications to alleviate your symptoms? Which, if any, medications have helped?

• Are you currently taking any medications? If so, which ones specifically? (It's often helpful to bring any medications you're taking to the appointment with you.)

• Are you allergic to any medications?

Your health care professional will examine your nasal mucous membranes, which often appear swollen and pale or bluish in women with allergies. If you have a suspected food allergy, he or she may ask you to keep a food/diet diary.

Health care professionals often use skin tests to determine the exact nature of the allergy. He or she will inject diluted extracts from allergens—particular foods, pollens, dust mites, etc.—under your skin or to a tiny scratch or puncture on your arm or back. With a positive reaction, a small, raised, reddened area with a surrounding flush will appear at the test site, indicating antibodies to that specific allergen are present in the skin.

Your health care professional might also do a blood test, which is not as sensitive as a skin test. Using a sample of your blood, the test looks for levels of antibodies to particular allergens.

If your health care professional suspects a food allergy, he or she may try an elimination diet, but only if your reactions are not severe. This technique involves not eating any of the suspected trigger foods for a week or two to see if your symptoms go away. Then, you eat the food to see if the symptoms come back. The final method used to objectively diagnose food allergy is the double-blind food challenge. You ingest a dried (or otherwise modified) form of suspect food—usually in a capsule form—under clinical supervision to see if a reaction occurs. Neither you nor the health care professional knows which capsule contains the allergen. This test can't be used if your reactions are severe. It's rarely performed because of its high cost and is used more often to rule out a food allergy in cases in which your health care professional suspects the reactions are due to something else.

Treatment

Treatment

It's important to remember that if you suffer any severe allergic reaction—such as anaphylactic shock or asthma that causes shortness of breath or difficulty breathing, or any other extreme discomfort—you should seek medical attention immediately. In fact, if you've ever had a previous severe allergic reaction, you should ask your health care professional about carrying a kit with you to treat anaphylactic shock and be sure you've been taught to give yourself an injection from the kit. If you have to use the kit, be sure you also get medical help immediately. Until help arrives, lie down and raise your legs above the level of your chest to increase the blood flow to your heart and brain.

The first course of treatment is avoiding the allergen. (For more details, see the section on Prevention.) Your health care professional may also prescribe medications, recommend over-the-counter remedies or suggest allergy shots. Although there is no cure for allergies, one of these strategies or a combination of them can provide varying degrees of relief from allergy symptoms.

Your health care professional may prescribe some medications that can be used alone or in combination. These include:

• Antihistamines counter the effects of histamine that is released in response to the allergen. Antihistamines relieve sneezing and itching in the nose, throat and eyes; reduce nasal swelling and drainage; and are used to treat hives. The older drugs (called first-generation antihistamines)—brompheniramine, chlorpheniramine, diphenhydramine, hydroxyzine and triprolidine—cause drowsiness and increase the risk of vehicle and occupational injuries.

Some of the newer (second-generation) antihistamines, such as fexofenadine (Allegra), loratadine (Claritin), desloratadine (Clarinex) and cetirizine (Zyrtec), have fewer side effects. Some people, however, do experience mild side effects including drowsiness, dizziness, headache, nervousness, nausea, diarrhea, abdominal discomfort, dry mouth, dry skin or itchiness, or discoloration of urine with some of these medications. You should always let your health care provider know what other medications you are taking.

In November 2002, the U.S. Food and Drug Administration (FDA) approved Claritin as an over-the-counter (OTC) allergy medication. The product was previously available only as a prescription drug and is indicated for seasonal allergic rhinitis.

Two other second-generation antihistamines are azelastine and ketotifen. Azelastine is approved for use in the nose and eyes, and ketotifen in the eyes.

To treat eye symptoms of allergic conditions, such as inflammation, itching, watering and burning, your health care professional may prescribe antihistamine eyedrops that block histamine release. Don't use any other eyedrops while using these and be sure to remove contact lenses to apply the drops to your eyes. If you wear contacts, you're probably safer switching to glasses during the course of your treatment.

If you are pregnant, keep in mind that some of these antihistamines' effects on an unborn baby are untested; similarly, their effects on breast milk or nursing infants are in some cases not known. Always tell your health care professional if you are, could be or could become pregnant, and discuss your situation with him or her before taking any medications. Both cetirizine and loratadine are category B for pregnancy, meaning they appear to be safe, although they have not been tested specifically in pregnant women.

• Topical nasal steroids are anti-inflammatory drugs that stop the allergic reaction. They decrease the number of the histamine-releasing cells in the nose and reduce mucus secretion and nasal swelling. These corticosteroid nasal sprays include mometasone (Nasonex), triamcinolone (Nasacort ), fluticasone (Flonase) and budesonide (Rhinocort). Although they are generally safe when used at recommended doses, side effects of these medications may include:

• stinging or burning of the nose

• sneezing after application

• bleeding nose

• perforated septum (inside center of nose), extremely rare

• headache or lightheadedness

• unpleasant (or loss of) taste or smell.

Once used only to manage acute symptoms, corticosteroids inhalants are now considered the best medications for long-term control of persistent asthma, according to the American Academy of Allergy, Asthma & Immunology.

• In June 2003, the FDA approved omalizumab (Xolair), a genetically engineered antibody preparation administered by injection. Omalizumab is in a new class of allergy therapy known as "anti-IgE therapy," and it is indicated for adults and adolescents (12 years of age and older) whose allergy-related asthma symptoms are inadequately controlled with inhaled corticosteroids.

• Cromolyn sodium (Nasalcrom) is a nasal spray that in some people helps to prevent allergic reactions from starting. It is in a class of medications known as mast cell stabilizers, which help control inflammation by preventing the release of inflammatory chemicals. Another mast cell stabilizer frequently used to help control allergies is nedocromil (Tilade Inhaler). When administered, cromolyn sodium can safely inhibit the release of chemicals like histamine from the cells. It has few side effects—which may include stinging or burning of the nose, headache, bad taste, runny nose, or postnasal drip—when used as directed and significantly helps some people with allergies. While tests have shown it is unlikely to harm an unborn baby, don't use cromolyn sodium without first talking to your health care professional if you are pregnant. It's not known if this medication passes into breast milk; talk to your health care professional if you are nursing.

• Decongestants, such as pseudoephedrine, help reestablish drainage of the nasal passages and relieve symptoms such as congestion, swelling, excess secretions and discomfort in the sinus areas. These over-the-counter and prescription drugs can be taken by mouth or applied directly to the nose. Be careful not to use nasal sprays and drops for more than three or four days, or you might end up even more congested because of a rebound effect. Your health care professional may advise you to take an antihistamine in combination with a decongestant to relieve other allergic symptoms. Decongestants may produce side effects such as nervousness, insomnia, rapid heartbeat and elevated blood pressure.

  Some over-the-counter products should not be used by people with high blood pressure, diabetes or other medical conditions, or if they've taken an MAO inhibitor in the last 14 days. If you have any medical conditions, be sure to consult your health care professional before self-treating.

• Immunotherapy, also called allergy vaccine therapy, which consists of a series of injections, is the only available treatment that has a chance of reducing allergy symptoms over a longer period of time. Patients receive subcutaneous injections of increasing concentrations of the allergen(s) to which they are sensitive. These injections reduce the amount of antibodies in the blood and cause the body to make a different protective antibody. Many patients with allergic rhinitis (hay fever) will improve within 12 months of starting immunotherapy, but the most noticeable improvement usually takes place in the second year. In addition to seasonal allergies, immunotherapy is commonly used for patients with indoor allergies to dust mites, pets and mold, and stinging insect (Hymenoptera) hypersensitivity. Patients who benefit from immunotherapy may continue it for three to five years and then consider stopping. Although many patients are able to stop the injections with good long-term results, some do get worse again after immunotherapy is stopped.

  A recently developed alternative therapy to traditional immunotherapy is sublingual immunotherapy, or allergy drops. Allergy drops work similarly to allergy shots in that they slowly desensitize patients to the substances that cause their allergic reactions. However, instead of being injected, with SLIT, the antigen is placed under the tongue with a dropper. Allergy drops appear to be both more effective and more convenient than traditional immunotherapy (plus, they don't involve the discomfort of an injection), though they are still being tested in the United States and are not yet FDA-approved. They are offered off-label or as part of trials in some medical centers across the country. Ask your doctor if allergy drops are an option for you.

In the cases of food allergies, while antihistamines and decongestants can help alleviate some symptoms, the best course of action is to avoid the trigger food.

The primary treatment for skin eczema is aimed at alleviating symptoms. To relieve itchiness and eczema, your health care professional might recommend initially a room-temperature bath to remove crusted skin, followed by immediate application of a moisturizer, which helps conserve the skin's natural moisture. Two FDA-approved topical medications, tacrolimus (Protopic) and pimecrolimus (Elidel) are available for treatment of eczema. Note: In 2006, the FDA added a black box warning to topical pimecrolimus cream and topical tacrolimus ointment stating that their use may increase the risk of certain cancers, specifically skin cancer and non-Hodgkin's lymphoma. Talk to your health care professional about this risk. Also tell your doctor if you are pregnant or breastfeeding.

Topical coal-tar preparations also work, but they can be messy and smelly. They should not be used by pregnant women, and their prolonged use may increase the risk of skin cancer. If symptoms persist, your health care professional may recommend application of over-the-counter hydrocortisone cream or, in severe cases, oral corticosteroid medication. Although steroid creams or oral steroids may be appropriate for acute outbreaks or severe episodes of eczema, long-term use is not advisable because of the considerable risk of side effects. Topical steroid creams can cause thinning and spotting of the skin, acne, and permanent stretch marks. If used around the eyes, topical steroid medications can, in rare cases, lead to glaucoma. Eczema patients who take oral steroids for longer than the usual two-week cycle and then stop using the drug face the additional risk of severe relapse. For these reasons, long-term steroid therapy is advised only under a health care professional's supervision.

The oils of mackerel, herring and salmon are high in eicosapentaenoic acid (EPA), may reduce skin inflammation and itchiness, but more research is needed. In the meantime, it probably can't hurt to try increasing your intake of EPA to see if it helps. Talk to your doctor about taking cod liver oil or fish oil supplements to boost your EPA intake, and be sure to inquire about possible adverse interactions with other medications you may be taking.

Prevention

Prevention

Prevention is the best treatment for allergies. By identifying exactly what you're allergic to, you can avoid it if at all possible, sometimes greatly limiting your symptoms without resorting to medical or over-the-counter treatments. In cases of airborne allergens, it helps to use an air conditioner inside your home and car. Special air-filtering devices can be added to your home's heating and cooling systems. In addition, portable air cleaning devices used in individual rooms can be helpful. Ask your health care professional which type would be best. The size of your room is one determining factor; the airflow should be sufficient to exchange the air in the room five or six times per hour. Vacuuming can worsen your symptoms unless the vacuum is equipped with a special HEPA filter (High-efficiency particle arrester). Following are some helpful tips for avoiding your exposure to various allergens.

Pollens

Unfortunately, short of staying indoors when pollen counts are high—and even that may not help—there's no easy way to evade windborne pollen. The pollen granules are so small and light and produced in such huge quantities, they can be carried for long distances. Clearing the offending plants from your own yard does little good. Here are some things you can do:

• Avoid prolonged, close contact with pollens (as well as some molds) by avoiding working outside during allergy season.

• Stay indoors during the time of the highest pollen counts, usually early in the morning on warm, dry, breezy days.

• If you do have to work outside, wear a face mask designed to filter pollen and keep it from reaching your nasal passages.

• Plan your vacation at the height of the expected pollinating period and choose a location where such exposure would be minimal, such as the seashore.

Relocating where the offending substance doesn't grow is not usually recommended simply because the person who is sensitive to a particular pollen or mold may subsequently develop allergies to new allergens after repeated exposure. So a woman who moves to an area of the country where ragweed doesn't grow may end up developing allergies to other weeds, trees or grasses in her new community.

Molds

Mold allergens, too, can be difficult to avoid. Here are some tips to reduce your exposure:

• Avoid places where they proliferate such as moist, shady areas outdoors, garden compost piles, greenhouses, mills, and grain fields or bins. Indoor hot spots include damp basements and closets, bathrooms, places where fresh food is stored, air conditioners, humidifiers, garbage pails, mattresses, upholstered furniture and old foam rubber pillows.

• Keep the lawn mowed and leaves raked up, but have someone else do this for you or wear a tightly fitting dust mask to reduce your exposure.

• Avoid walks through tall vegetation, and avoid travel in the country while crops are being harvested.

• Ensure moldy indoor places, such as summer cabins, are aired out and cleaned before spending time there.

• Use a dehumidifier to dry out the basement, but be sure to frequently remove the water collected in the machine to prevent mold growth there.

• Open a window or use a fan after a warm or steamy shower to allow the humidity to escape.

Dust mites

Dust mites are most effectively reduced by decreasing the amount of dust in your home. You can:

• Dust-proof your home, especially your bedroom, by removing wall-to-wall carpet, blinds, down-filled blankets and feather pillows. Window shades don't trap dust; curtains can be used if they are washed periodically in hot water. Hardwood floors with washable throw rugs are easier to remove dust from than carpets. Fabric on upholstered furniture traps dust much more so than vinyl- or leather-covered furniture. Washable slipcovers are a good alternative.

• Encase bedding in commercially available allergy-proof covers. The more expensive covers are more comfortable and work best.

• Frequently wash washable items using water hotter than 130 degrees Fahrenheit, which kills dust mites. If you do not want to set your water heater that high, you may dry linens at the hottest dryer setting.

• Frequently dust with a damp cloth.

Animals

If you simply can't bear to find another home for your pet, you can try these suggestions:

• Have someone bathe your cat weekly and brush it outdoors even more frequently.

• Remove carpets and soft furnishings that trap animal dander and dried proteins in dust

• Use a vacuum with a HEPA filter

• Use a room air cleaner with a HEPA filter

• Wear a face mask while house cleaning

• Keep the pets out of your bedroom

Foods and other ingested substances

• Ask your health care professional for the various names of different forms of the food that you should avoid

• Read food ingredient labels closely to check for the presence of your trigger food substances. They are often found in places you wouldn't suspect.

• At a restaurant, don't hesitate to ask about ingredients of various dishes.

• If you're allergic to a common medication such as penicillin, wear or carry something with this information, such as a medical alert bracelet or card.

• If you have had anaphylactic reactions, you should wear a medical alert bracelet.

• If you have severe allergies, be prepared to treat an inadvertent exposure at the first sign of a reaction with a syringe of epinephrine (Epi Pen auto-injector), obtained by prescription from your health care professional

Facts to Know

Facts to Know

1. Allergies affect more than 50 million Americans, or one in every five adults and children, and are as common in men as women. Thirty-five million people suffer from upper respiratory symptoms that are allergic reactions to airborne pollen; up to 10 million Americans are allergic to cats; and two million develop severe allergic reactions to insect stings.

2. Food allergies are less common, affecting about 12 million Americans. While up to one out of three people say they have a food allergy, only about one to two percent of adults and six percent of children have true allergic reactions to foods. Unfortunately, about 150 deaths per year are attributed to food allergy.

3. Allergies have a genetic component. If one parent has allergies, each child has a 30 to 40 percent chance of having an allergy. If both parents have allergies, each child has a much higher chance—75 percent—of having allergies.

4. Adults usually do not lose their allergies, but children can sometimes outgrow them.

5. An allergy is your body's response to what it perceives to be a threat. Your body attacks the allergen in a way similar to how it would attack an invading virus or bacterial infection.

6. The pollens of some plants, grasses and trees are so small and light they can travel through the air for miles. Samples of ragweed pollen have been collected 400 miles out at sea and two miles up into the atmosphere.

7. A pollen count represents the concentration of all the pollen or of one particular type, like ragweed, in a certain area over a certain period of time; it is usually expressed in grains of pollen per cubic meter of air collected over 24 hours.

8. Molds, too, are light and can be easily carried by air currents. The mold season peaks in July in warmer states and October in colder ones, but mold can thrive year-round indoors.

9. It's the waste product of dust mites, not the mites themselves, that cause the allergy. Similarly, the waste products of cockroaches are an important cause of allergy symptoms, particularly in some urban areas of the United States. Because dust mites can't be drowned, the only way to get rid of them in washable items like rugs and curtains is to use water that is hotter than 130 degrees Fahrenheit and a hot dryer setting.

10. The major allergen from animals is not their fur, but proteins secreted by skin glands that are found in dander; proteins in the saliva that stick to fur when the animal licks itself; and proteins found in the animal's urine.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about allergies so you're prepared to discuss this important health issue with your health care professional.

1. Could my allergic symptoms be caused by an underlying medical condition?

2. Do I have any medical reasons for limiting my use of over-the-counter anti-allergy medication?

3. What are the side effects of any medications or treatments you are recommending? Will the medications interact with any other medications I'm currently taking?

4. How long will it take for my treatment to work? How do you plan to monitor my treatment to see if it's working?

5. What steps can I take to keep my home allergen-free?

6. Is my condition potentially dangerous? Under what circumstances should I seek professional medical care after an allergic reaction?

7. Will my allergies ever change on their own?

8. What are the chances that my children will also have allergies?

9. Do I have a type of allergy that can be helped with allergy shots? How can I find out?

10. How do allergy shots work, and how many do I have to take for them to work?

11. If I take allergy shots, could I have a bad reaction to them?

12. After I start taking allergy shots, how long does it take before I feel better?

Key Q&A

Key Q&A

1. How can I tell if I have a cold or seasonal allergies?

   First, a seasonal allergy occurs only during a particular time of the year. A cold should subside in about two weeks; seasonal allergy symptoms will continue until the pollen season is over.

2. Are people born with allergies or can they develop them later in life?

   The answer is yes to both questions. Some people are born with a genetic predisposition to allergies, but that allergy gene may not be "turned on" until later in adulthood.

3. Can allergies be cured?

   No, they can't. But depending on what you are allergic to, you can often find relief by avoiding the allergen, taking prescription or over-the-counter medications or getting allergy shots.

4. Do children outgrow their allergies?

   Children who are allergic to peanuts, shrimp or fish generally remain allergic throughout their lives. However, they often do outgrow allergies to milk, eggs and soy.

5. Should I move to a different part of the country to help alleviate my seasonal allergies?

   No. People who are allergic to pollen are often sensitive to other substances. Moving may relieve symptoms of one allergy, only to stimulate a reaction to another allergen, so moving is generally not recommended.

6. I keep my house spic and span. Could I still have dust mites?

   Yes, even the cleanest homes can have dust mites. They can be minimized by removing things that trap dust, like drapes, wall-to-wall carpeting and upholstered furniture.

7. Can I continue taking allergy medications during pregnancy and breastfeeding?

   This is between you and your health care professional and should be thoroughly discussed with him or her, preferably prior to getting pregnant. Generally, during the first trimester, when your baby's organs and tissues are being formed, health care professionals worry about the potential effects of medications. However, after the first trimester, most medications that you might consider giving to a young child should be safe for the mother to take. Make sure you check with your health care professional before taking any over-the-counter medication during pregnancy. Generally this includes topical nasal steroids, such as budesonide (Rhinocort AQ) and some antihistamines such as loratadine and cetirizine. In addition, decongestants like pseudoephedrine are generally considered safe during the second and third trimesters. Careful use of decongestant nasal sprays should also be fine. This advice also holds true during the breast-feeding period. Watch out, however, for traditional sedating antihistamines that can cause drowsiness in the baby.

8. Is it OK to continue allergy shots if I'm pregnant?

   Maintenance doses of shots should be safe during pregnancy. Because the injections contain your allergy triggers, the most likely time to experience a reaction is during the initial build-up period, when you first start allergy shots. A severe allergic reaction in a pregnant woman could affect the well-being of the developing baby, so it's probably not a good idea to start the immunotherapy and build the dose up during pregnancy. If you are taking allergy shots while you are pregnant, your physician should carefully monitor you. In some cases, physicians will lower the dose of the allergy shots during pregnancy to reduce the chance of a reaction to the injections.

Lifestyle Tips

Lifestyle Tips

1. Spotting hidden food allergens—know their hiding places

   One type of allergic response, anaphylaxis, is a sudden and sometimes deadly drop in blood pressure that can potentially stop the heart or close air passages, causing death by suffocation. Avoiding foods that you know you're allergic to is the first step to preventing a serious allergic reaction. The most common food allergens are milk, egg, peanut, wheat, soy, shellfish, fish and tree nuts. But, beware of the hidden sources of your food allergens: unlabeled ingredients in processed food; milk toppings on specialty or bar drinks that can contain eggs; deli slicers used for both meat and cheese products; and ethnic dishes that use peanuts and peanut oil can contaminate dishes prepared without nuts.

2. Mold allergies—some tips for coping

   Damp, shady or dark areas of the home and garden harbor molds, a common allergen for many people. Take these steps to "air out" mold and avoid those damp and musty places if you can: Use a dehumidifier to dry out damp basements. Open a window or use a fan after a steamy bath or shower to allow the humidity to escape. Don't store clothes or other frequently used possessions in damp basements. Avoid moist, shady areas outdoors, garden compost piles and greenhouses.

3. Asthma and allergies can go hand-in-hand

   A high percentage of individuals with allergies also have asthma, a condition in which the airways of the lungs narrow, resulting in wheezing and problems breathing. An estimated 35 million Americans suffer from seasonal allergies. Experts say that allergies should not be treated as a trivial problem. Untreated, allergies can lead to the development of chronic sinusitis (inflammation of the sinuses) and asthma. Once diagnosed, a combination of medications may be recommended to relieve seasonal allergies. These medications include antihistamines, topical nasal corticosteroids, cromolyn sodium nasal spray, decongestants and immunotherapy. See your health care professional to assess your symptoms, if you think you might suffer from seasonal allergies, or if the steps you take to relieve your symptoms aren't working.

4. Love your pet, but can't stop sneezing?

   All pets can cause allergies—except, perhaps, a fish. Pet dander, skin flakes, saliva and urine can cause allergic reactions in people sensitive to these allergens. Another big source of discomfort for pet owners with allergies is the pollen, mold spores and other outdoor allergens brought inside on your animal's fur. If you can't bear to give up your fur-bearing friend, try these strategies to minimize your allergies: Keep your pet out of your bedroom, where you spend the most time. Wash your hands after handling your pet to avoid spreading the dander. Have someone else bathe your pet weekly and brush it outdoors several times a week. Have someone else clean the litter box, and store it away from forced air heating or central air conditioning vents.

5. Asthma and pregnancy—hormonal shifts may improve asthma or make it worse

   It's probably no surprise to women with asthma to hear that hormonal shifts affect their asthma symptoms. Up to 40 percent of women with asthma find that their symptoms worsen just before and during menstruation, then improve once their periods end. Asthma may get worse during pregnancy—a time when hormones fluctuate greatly—but asthma symptoms may also improve or stay the same when you're pregnant. About one-third of pregnant women experience improved symptoms, one-third experience a worsening of symptoms, and one-third experience no change. Some asthma medications can be continued during pregnancy, under the supervision of your health care professional. If you breast-feed, it's best to breast-feed your baby before taking your medicine and then avoid feeding again for three to four hours; nearly all asthma and allergy medication enters breast milk, though infants are exposed only to minute amounts.