Episode 7, Allergies
Allergies affect almost 50 million people in the United States alone. On this episode of “To Your Heath,” Dr. Jim Morrow, an allergy sufferer himself, takes them all on: food, plants, drug, environmental, and contact allergies. Dr. Morrow also talks about Forsyth BYOT, a non-profit established by Dr. Jim and Peggie Morrow to support technology initiatives in Forsyth County Schools.
Dr. Morrow’s Show Notes on Allergies
Allergies
- When you hear someone talk about having allergies, usually they mean rhinitis or upper respiratory symptoms (runny nose, watery eyes, itching eyes and ears and nose, sneezing).
- Allergies also can be due to food, medications, animal dander or plants.
Allergic Rhinitis
- The diagnosis of allergic rhinitis (AR) should be made when history and physical findings are consistent with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa, and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing.
- Individuals with allergic rhinitis should be assessed for the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media.
- Specific testing (blood or skin) should be performed for patients with a clinical diagnosis of allergic rhinitis who do not respond to empiric treatment, or when diagnosis is uncertain, or when determination of specific target allergen is needed.
- Sinus imaging should not routinely be performed in patients presenting with symptoms consistent with allergic rhinitis.
- Intranasal steroids should be prescribed for patients with allergic rhinitis whose symptoms affect quality of life.
- Oral second-generation/less sedating antihistamines should be prescribed for patients with allergic rhinitis and primary complaints of sneezing and itching.
- Intranasal antihistamines may be prescribed for patients with seasonal, perennial, or episodic AR.
- Oral leukotriene receptor antagonists should not be prescribed as primary therapy for patients with AR.
- Combination pharmacologic therapy may be prescribed for patients with allergic rhinitis who have inadequate response to monotherapy. The most effective combination therapy is an intranasal steroid and an intranasal antihistamine.
- Immunotherapy should be prescribed for patients with allergic rhinitis who have inadequate response to pharmacologic therapy
- Avoidance of known allergens or environmental control may be considered in patients with allergic rhinitis who have identified allergens that correlate with their clinical symptoms.
- Inferior turbinate reduction may be considered for patients with allergic rhinitis with nasal airway obstruction and enlarged inferior turbinates who have failed medical management.
Allergy Testing
- Many types of allergies: environmental, foods, drug, contact.
- An estimated 10% to 30% of the global population has an allergic disease.
- Clinical presentations of allergic diseases, respiratory infections, and autoimmune conditions have similar features.
- Allergy and immunologic testing can help clarify the diagnosis and guide treatment. Immediate immunoglobulin E (IgE) and delayed T cell–mediated reactions are the main types of allergic responses.
- The allergens suspected in an immediate IgE-mediated response are identified through serum IgE-specific antibody or skin testing.
- For patients with an inhalant allergy, skin or IgE-specific antibody testing is preferred.
- In patients with food allergies, eliminating the suspected allergenic food from the diet is the initial treatment.
- If this is ineffective, IgE-specific antibody or skin testing can exclude allergens.
- An oral food challenge should be performed to confirm the diagnosis. Results of laboratory testing for food-specific IgE are generally poor, even less helpful than those for percutaneous skin testing.
- Patients with an anaphylactic reaction to an insect sting should undergo specific antibody or skin testing.
- Skin testing for penicillin has a high negative predictive value and can help when penicillin administration is indicated and there are limited alternatives. Testing for other drug allergies has less well-determined sensitivity and specificity, but can guide the diagnosis.
- Patch testing can help identify the allergen responsible for contact dermatitis.
Food Allergies
- Patients with suspected food allergies are commonly seen in clinical practice.
- Although up to 15 percent of parents believe their children have food allergies, these allergies have been confirmed in only 1 to 3 percent of all Americans.
- Family physicians must be able to separate true food allergies from food intolerance, food dislikes, and other conditions that mimic food allergy.
- The most common foods that produce allergic symptoms are milk, eggs, seafood, peanuts, and tree nuts.
- Although skin testing and in vitro serum immunoglobulin E assays may help in the evaluation of suspected food allergies, they should not be performed unless the clinical history suggests a specific food allergen to which testing can be targeted.
- Furthermore, these tests do not confirm food allergy. Confirmation requires a positive food challenge or a clear history of an allergic reaction to a food and resolution of symptoms after eliminating that food from the diet.
- More than 70 percent of children will outgrow milk and egg allergies by early adolescence, whereas peanut allergies usually remain throughout life.
- The most serious allergic response to food allergy is anaphylaxis. It requires emergency care that should be initiated by the patient or family using an epinephrine auto-injector, which should be carried by anyone with a diagnosed food allergy.
- There are no recommended medications to prevent IgE- or non–IgE-mediated allergic reactions to food. Allergen-specific immunotherapy or immunotherapy with cross-reacting allergens is not recommended to treat food allergy.
- Some environmental allergens cross-react with foods, such as:
- Birch pollen: Carrots, celery, fresh fruit (e.g., apples, cherries, nectarines, peaches, pears), hazelnuts, parsnips, potatoes
- Grass pollen: Kiwi, tomatoes
- Ragweed pollen: Bananas, melons (e.g., cantaloupe, honeydew, watermelon)
Nonallergic Rhinitis
- Chronic nonallergic rhinitis encompasses a group of rhinitis subtypes without allergic or infectious etiologies.
- Although chronic nonallergic rhinitis represents about one-fourth of rhinitis cases and impacts 20 to 30 million patients in the United States, its pathophysiology is unclear and diagnostic testing is not available.
- Characteristics such as no evidence of allergy or defined triggers help define clinical subtypes.
- There are several subtypes with overlapping presentations, including:
- nonallergic rhinopathy,
- nonallergic rhinitis with nasal eosinophilia syndrome,
- atrophic rhinitis,
- senile or geriatric rhinitis,
- gustatory rhinitis,
- drug-induced rhinitis,
- hormonal rhinitis, and
- occupational rhinitis.
- Treatment is symptom-driven and similar to that of allergic rhinitis. Patients should avoid known triggers when possible.
- First-line therapies include intranasal corticosteroids, intranasal antihistamines, and intranasal ipratropium.
- Combination therapy with decongestants and first-generation antihistamines can be considered if monotherapy does not adequately control symptoms.
- Nasal irrigation and intranasal capsaicin may be helpful but need further investigation.
Hives (Urticaria)
- Hives are typically large, raised areas on the skin that can itch and spread and coalesce into huge areas of swelling
- They can be caused by many things, including:
- Colds
- Bladder infections or other types of infection
- Allergies to food, particles in the air, or things that touch your skin
- Insect stings or bites
- Medicines
- Heat, cold, or pressure
- Exercise
- A serious disease, but this is uncommon In many cases, no specific cause is found.
About Morrow Family Medicine and Dr. Jim Morrow
Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be. At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!” Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.
Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce. He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.
Facebook: https://www.facebook.com/MorrowFamMed/
LinkedIn: https://www.linkedin.com/company/7788088/admin/
Twitter: https://twitter.com/toyourhealthMD
Forsyth BYOT
In 2013, Dr. Jim and Peggie Morrow found that hundreds of students in Forsyth County did not have the technology necessary to succeed in the highly technical environment that school is today. The county relies on online work a great deal and so many students were having to go to the library or a Starbucks to access assignments because they did not have internet in their homes. Additionally, many did not and do not have internet capable devices that make this work possible either.
So, the Morrows made it their mission to bridge this gap and help these students try to break the cycle of generational poverty that so many of them are born to.
In the last five years, over $300,000 has been raised and donated by Forsyth BYOT to the Forsyth County Schools for this purpose. Forsyth BYOT seeks to raise awareness of the problem and find sponsors to donate or raise money outright through two yearly fundraisers, the BYOT Golf Tournament in May and the iRUN for BYOT 5K & FunRun in October. Donated funds are given to the school district, which has staff in place to first determine which students are in need and then to purchase and distribute internet hotspots or devices to that family.
