Allergies Treatment
There are various ways to tackle many of the allergic disturbances. First, the sources must be identified. This is a difficult but not impossible task. Second, the source needs to be avoided. Third, general health and resistance should be built up to establish immunity against them.

There are two methods to detect disturbing foods. The first method is the trial -and- error elimination diet. This automatically eliminates many hazards and foods. Keep to organic, untreated, unprocessed foods as far as possible and you will eliminate another set of hazards such as pesticides, various sprays and other poisons.

After having eliminated as many disturbing factors as possible, a self-search should be carried out to ascertain any suspicious symptoms from foods. It is advisable to try an eliminary diet, excluding suspected foods for two weeks until the cause is detected. Occasionally, by changing the brand or the type, you can find a food substitute that does not upset you.

Another way to detect the cause of an allergy is the pulse test.  The method is as follows: Check your pulse before a meal. Then limiting that meal to one food only, wait for half an hour after eating and take your pulse again. A slight increase is considered normal, even up to 16 extra beats. If your pulse does not rise above 84, you may be allergy-free. But if your pulse rises beyond that point, and remains high an hour after the meal, you have found your food allergy.

The best way to prevent or overcome allergies is to strengthen the overall physical resistance so as not to fall an easy prey to every allergen that comes along. To start with, the patient should fast on fresh fruit juices for four or five days. Repeated short juice fasts are likely to result in better tolerance to previous allergies. After the fruit juice fast, the patient can take a mono diet of vegetables or fruits such as carrots, grapes or apples, for one week. After that one more food is added to the mono diet. A week later the third food is added and so on. After four weeks, the protein foods can be introduced, one at a time. In case an allergic reaction to a newly introduced food is noticed, it should be discontinued and a new food tried. In this way all real allergens can be eventually eliminated from the diet.

The body requires a large alkaline reserve for its daily activity. The many emergencies of acid formation through the day from wrong foods, fatigue, mental stress and lack of sleep can be met by the competency of the alkaline reserves. 

Boosting the normal body reserve of alkalizes by liberal use of alkaline- forming foods is essential for those suffering from allergies.

The foods which should be excluded from the diet are tea, coffee, chocolate, cola drinks, alcohol, sugar, sweets and foods containing sugar, refined cereals, meats, fish, chicken, tobacco, milk, cheese, butter, smoked, salted, pickled foods and foods containing any chemical additives, preservatives and flavoring. These foods cause either toxic accumulations or over-stimulation of adrenal glands or strain on the pancreatic enzymes production or disturb the blood sugar balance.

For preventive purposes, the entire C complex vitamins - known as the bioflavonoid, are recommended. They gradually strengthen cell permeability to help immunize the body from various allergies, especially hay fever. Often the addition of B5, or pantothenic acid brings great relief to allergy sufferers. 

Multiple allergies may result from poor adrenal gland functioning. In such cases liberal amounts of pantothenic acids help cure them, although the recovery will take several weeks. An adequate intake of vitamin E is also beneficial as this vitamin possesses effective anti-allergic properties, as some studies have shown.

An exciting remedy for allergy has been discovered using five drops of castor oil in a little juice or water taken on an empty stomach in the morning, is highly beneficial for allergies in the intestinal tract, skin and nasal passages.

Buzz Off! What to Do When You Get Stung   By Karen Barrow
They fly around parks and playgrounds, disrupting picnics and baseball games with a low drone and painful sting. Bees are troublesome creatures with a bite worse than their buzz, and for those who are allergic to bee stings, what would be a minor annoyance can turn out deadly.

Allergic Reactions
After a sting, it is important to get the stinger out of your skin as soon as possible. A bee's stinger is covered with tiny barbs, which cause it to break off and stick mercilessly into your skin. At the top of the stinger is a sac filled with venom—squeeze it and all of the liquid inside will seep into your skin, worsening the reaction. One way to remove the stinger without disturbing this sac is to use the edge of a credit card to scrape the stinger out of the skin.

Swelling and redness are common side effects at the site of a sting—a reaction typically abated with an over-the-counter antihistamine. Wash the site of the sting with soap and water and apply ice to reduce swelling. An over-the-counter pain reliever can also help. A severe allergy to bee venom may not appear after the first sting, as it could take several stings to trigger an allergic reaction.

If you do become allergic to bee stings, you will notice symptoms such as swelling and itchiness around your eyes and a cough. This could progress into wheezing and hives and, without intervention, anaphylactic shock.

Anaphylactic shock occurs when the body responds to a foreign substance, here the bee venom, by making immunoglobulin E (IgE). This molecule, which is meant to fight off the invader, releases a chemical called a histamine, which causes blood vessels to relax and airways to narrow.

In severe cases, these changes can cause a person to have difficulty breathing, anxiety, low blood pressure, weakness and even loss of consciousness. Such extreme reactions require immediate medical attention.

Those with a known allergy to bee stings will probably carry a kit containing an EpiPen and antihistamines. The EpiPen is a dose of epinephrine that can be self-injected to reduce the inflammatory response and make it easier to breathe. It should be administered at the first signs of an allergic reaction because the dangers can progress rapidly.

Avoiding the Danger
For severe allergies, or in the case of someone who is constantly in bee-ridden areas, it may be worthwhile to become desensitized to the venom. An allergist can administer increasing doses of bee venom over the course of several weeks until the body develops immunity and can tolerate a large dose of the venom. In one study published in 2000 in Clinical Therapy, this immunotherapy regimen was shown to be effective in up to 79 percent of the people.

Allergies to a bee sting can be severe, so if you know that you are allergic to bee venom, it is recommended that you wear some sort of identification, such as a MedicAlert band. This will help to make sure you get the immediate help you need.

Steering Clear of Bees
Avoiding bees entirely would obviously be the best bet for preventing serious allergic reactions, but these creatures can easily fly through open windows and into your house or car. So, if you want to steer clear of a yellow jacket, a honeybee or some other yellow-and-black beast, here's what experts suggest you can do to prevent a sting:
  • Stay away from hives, garbage bins and fruit trees, where bees are typically found
  • When eating outdoors, keep food covered and clean up well afterward
  • Do not wear bright-colored clothing or floral patterns, which can attract bees
  • Avoid wearing scented lotions, colognes, perfumes, hair spray or deodorant
  • Cover-up as much as possible, avoiding loose clothing that can trap insects inside
  • Keep shoes on so an almost-stepped-on bee doesn't sting your foot
  • If you see a bee, do not run or swat at it; any sudden movements can make the bee feel endangered and trigger an attack. Simply back away slowly and the bee will lose interest and fly back to its hive. 
A Plant Alternative to Antihistamines   By Karen Barrow
For the 20 percent of Americans who suffer from hay fever, an herbal supplement may be a welcome treatment alternative, says a new study.

Butterbur, a plant found in Europe, Asia and in parts of North American, has been used for centuries as an herbal treatment. Only recently, have scientists begun to find that it may truly have a place alongside more traditional treatments for asthma and migraines. The most recent findings show that butterbur may be as effective as antihistamines in reducing the symptoms of allergic rhinitis, also known as hay fever.

The study, published online in August 2005 in Phytotherapy Research, looked at 330 patients who suffered from sporadic hay fever. The research divided the participants into three groups: the first took 8 milligrams of butterbur extract three times a day; the second took 180 milligrams of fexofenadine (Allegra), a common antihistamine, each morning, and the last took only a placebo.

At the end of the study, both groups receiving active treatment reported a significant reduction in the nasal congestion and itchy, watery eyes most commonly experienced with hay fever. Most strikingly, there was almost no difference between taking an antihistamine or the butterbur extract, except that some taking the antihistamine did complain of drowsiness.

Since antihistamines and butterbur work in different ways, study author Dr. Andreas Schapowal of the Allergy Clinic in Landquart, Switzerland, feels that combining the two would be effective. However, no study has investigated how butterbur works in combination with any other medication.

A Potpourri of Purposes

Historically, butterbur has been used to treat a wide range of ailments, including asthma, skin infections and even the plague. But doctors have only recently begun to look into the properties of butterbur, as older studies showed the plant to cause cancer in animals.

The compound responsible for this toxic effect, pyrrolizidine alkaloid, has since been identified, and newer butterbur supplements are made from only the leaves of a plant (roots contain higher levels of the alkaloid) specially developed to be low in the compound. Now experts say that the drug is safe for use.

The active ingredients in butterbur extracts are petasin and isopetasin. Petasin reduces spasms in smooth muscle and vascular walls, while isopetasin acts on the system that reduces inflammation. Together, the two act as an effective anti-inflammatory medication with potential in treating many ailments.

A study published in January 2005 showed that butterbur could help prevent and reduce migraine symptoms better than a placebo. And a few studies have implied that the extract may be useful in treating asthma. But much more research needs to be done to determine the plant's true effectiveness and long-term safety.

It remains to be seen how butterbur will impact the treatment of other conditions, but some doctors are already convinced of its effectiveness for treating hay fever.

"Three randomized, placebo-controlled studies of the butterbur extract, Ze 339, in peer-reviewed journals should convince anybody of the efficacy and safety of the medication in allergic rhinitis," said Schapowal.

Trading Shots for Drops: The New Approach to Allergies   By Karen Barrow

If you suffer from the sneezing, runny nose, watery eyes and congestion of allergies, you may have considered getting allergy shots to help you cope. But the inconvenience of going to a doctor's office for weekly injections, the pain of needles and the bothersome side effects of treatment may have deterred you from achieving long-term allergy relief.

A new form of allergy treatment, which takes the basic science behind the allergy shots and reformulates it in the convenient form of a few drops placed under the tongue, may be coming soon to provide a convenient relief for allergy sufferers.

"Sublingual immunotherapy can be administered at home and it's associated with minimal side effects largely limited to itching of the mouth," said Harold Nelson, MD, professor of medicine, National Jewish Medical and Research Center. "The downside is that it is not as effective as the injections. So while it may not be an advance, it is an alternative."

An allergy occurs when your body overreacts to pollen, dust or pet dander. Thus, when you inhale one of these particles, it sets off a red alert, triggering your immune system to release IgE and other immune substances to attack the foreign particles. Unfortunately, the IgE antibodies also trigger the release of other chemicals, like histamines, that widen blood vessels, leading to hives or the swelling of the nasal membranes, causing discomfort. Allergy medicines work by blocking the action of the histamines, relieving the discomfort of the allergies. However, immunotherapy works by preventing the IgE antibodies from attacking the allergen in the first place, preventing the cascade of events that cause most allergic symptoms from ever occuring.

Immunotherapy taken in the form of allergy shots is based on the idea that if you gradually inject increasing concentrations of the particles that set off your immune system, your body will gradually acclimate to the allergen and block the action of IgE, thus preventing the allergic reaction.

Sublingual immunotherapy, however, isn't quite the same.

"With injection, you're presenting [the allergen] to the regional lymph nodes, whereas with sublingual, you're presenting it to the lining of the gastrointestinal tract. And the gastrointestinal tract handles things differently," said Dr. Nelson.

Thus, the effects of sublingual immunotherapy are not identical to injected immunotherapy. Because there is a limited amount of room under your tongue, smaller dosages are given at a time. The high doses associated with allergy shots, sometimes cause minor allergy symptoms, so a smaller dose may translate to fewer side effects, but it is also a less effective treatment. Several studies, using varying doses, have shown that immunotherapy does work, but only in the second year of use, while allergy shots work within the first year. Patients have to administer a few drops of liquid underneath their tongue and hold their tongue down for a few minutes to ensure that the liquid is being absorbed. This is done every day for about a month to raise one's immune response. After this period, you enter the "maintenance" period, where the frequency of treatment decreases to a level that will keep your immune system levels where they should be to block IgE action. Allergy shots work similarly, shots are given once or twice a week for 4 to 6 months, until the maintenance period is reached, whereupon the frequency of shots is gradually reduced.

There are obvious benefits of this therapy; because a doctor is no longer needed to administer the injections, treatment can be self-administered at home. People who live far from a doctor's office or travel often can still benefit from immunotherapy. And the injection-less treatment also means that kids—and squeamish adults—are more likely to follow through with treatment. Just don't expect the benefits right away.

"I think [a candidate] has to be somebody who's not in a hurry about seeing an improvement," said Dr. Nelson.

Other Reports
Sense and Sensitivity: Understanding Food Allergies in Kids
Does Christmas make you Sneeze and Wheeze

Alternatives for Allergies and Asthma: Proceed with Caution
Running from Ragweed: How to Cope with Fall Allergies
Are You Allergic to the Sun?

Caution at the Cosmetics Counter
Reacting to Rubber: How to Avoid Latex Allergies
The Sweet Spring Challenge: Seasonal Allergies

Allergy or Cold?
Doggone It! Can Pets Improve Your Health?
Pet Allergies
How to Avoid Dust Mites: Some Helpful Tips

Sense and Sensitivity: Understanding Food Allergies in Kids   By Christine Haran
Today, it seems as if every classroom has a little Henry or Jennifer who can't eat peanuts or wheat. So if you are caring for young children, chances are that you are familiar with a food allergy, a potentially life-threatening condition that can cause many families severe distress.

According to the American Academy of Allergy, Asthma and Immunology, about 8 percent of children have food allergies, compared to 2 percent of adults. The good news those figures reflect is that some, though not all, food allergies can be outgrown over time, particularly when they stop eating the food.

Below, Jacqueline Pongracic, MD, division head of allergy, at Children's Memorial Hospital in Chicago, discusses how to recognize the signs of a food allergy, as well as how to ensure proper diagnosis and follow-up, so you can keep your child safe.

What is a food allergy?

It's a food reaction that happens through the immune system. That's important to understand because other types of food reactions exist, such as intolerances. An example of that would be lactose intolerance, which doesn't occur through the immune system but because of a lack of an enzyme in the gut that breaks down lactose.
What is happening in the body when one has a food allergy?

When someone has an allergy the immune system produces an allergy antibody that we call IgE, in response to a particular protein. Once IgE is produced, it circulates in the body until it encounters allergy cells. When the IgE encounters those cells, it attaches to them. Then the antibody waits like a guard watching for that particular protein.

Let's say an individual produces IgE antibody to a egg. When that sensitive individual eats egg again, the egg protein will be absorbed and when it encounters the IgE specific for egg protein, the two join together. When that happens, the allergy cells release a variety of chemicals that can cause the signs and symptoms of an allergic reaction.

When do food allergies first appear?

A food allergy can begin at any point in life, but most commonly it begins in the first three years of life.

What foods are children commonly allergic to?

The most common foods include egg, cows' milk, wheat, peanuts, soy and tree nuts. So that's a list of six foods that account for about 95 percent of reactions in children.

What kinds of reactions do people with food allergy have?

One of the important characteristics of reactions in a food allergy is that the reaction typically occurs within minutes and always within one to two hours after eating the food. Another characteristic is that reactions occur each and every time that particular food is ingested.

The types of symptoms that occur can affect the skin, the gut, the respiratory tract, and even the cardiovascular system. Skin reactions include itching, redness, hives, or swelling. Gastrointestinal tract symptoms include abdominal cramps, nausea, vomiting or diarrhea. They may also include itching of the lips or the mouth. A more severe reaction may lead to swelling of the tongue.

Respiratory symptoms can be hay fever–type symptoms, such as sneezing, nasal congestion, runny nose and itchy, watery eyes. Throat tightness, coughing, wheezing, difficulty breathing or chest tightness may occur. One might have a fall in blood pressure, and an increase in heart rate. People might feel dizzy, or actually faint.

Very severe reactions are generally termed anaphylaxis. Unfortunately, food allergies are potentially fatal and it's estimated that perhaps 150 Americans die of a food allergy reaction each year. The fatalities are usually associated with an accidental exposure away from home to a food that that individual already knew they were allergic to.
How can parents distinguish between a colicky baby and one with a food allergy?

A food allergy may induce colic, but it's not the most common reason for it. If parents have a child who is very irritable or colicky, they should talk to their pediatrician about making a change in the baby's formula to see whether that results in any improvement. Suspicion of a food allergy would be increased if that fussy baby also has not only gastrointestinal symptoms, but also skin problems such as atopic dermatitis, also known as eczema, which is an allergic skin condition that is characterized by red, raised rashes that itch.

Can most food allergies be outgrown?

Children with allergies to cows' milk, egg, soy and wheat usually outgrow their allergy by the time they are five years old. If the children successfully avoid eating the food, they improve their chances of outgrowing the allergy. Other foods like peanuts and tree nuts, as well as seafood, tend to be lifelong food allergens for people. However, there have been two studies that have shown that as many as 19 percent of children outgrow their peanut allergy, particularly if they were diagnosed by their first birthday and if they have sustained successful peanut avoidance since then.

How does an allergist or an immunologist diagnose food allergy?

The approach to diagnosis begins with taking a thorough history focusing on the reactions. Then we do a physical examination to see whether there are other signs of an allergic process, such as the presence of atopic dermatitis.

If we feel that the likelihood of allergy is there, then the next step generally is to proceed with allergy skin tests. Allergy skin tests can be performed in as little as 20 minutes. They aren't painful. We do a test called a percutaneous skin test, which introduces the allergen into the very superficial layers of the skin. We always try to select the allergens that we think are relevant based on the history. With the skin test, we're looking for whether or not there is a reaction characterized by an area of swelling surrounded by redness. Negative skin tests essentially rule out that a food allergy exists. Positive skin tests are harder to interpret, since these tests have a false positive rate of 60 percent.

If the skin test is negative but we have a strong impression that an allergy is present, we may do additional testing by doing a blood test called RAST. That is a way to measure the amount of allergy antibody for that particular allergen.

When do you do a food challenge?

A food challenge simulates the true exposure because it's a procedure where the individual eats the food under medical observation. A food challenge may be performed to confirm the diagnosis. Sometimes we do food challenges where we hide the identity of the food from the individual eating it, their family and even from the physician and nurse so there won't be any bias.
Sometimes we need to do a food challenge if we end up with a lot of positive skin tests, and we aren't sure which one is the culprit. Other times we use a food challenge to assure a family that a particular food is not the culprit.

Once a food allergy has been diagnosed, what steps do you take at that point?

Once we have established a diagnosis, we implement education and counseling for the family, and a medical treatment plan. Education is really critical because it's so difficult to implement an avoidance diet. We also refer the families to national (Food Allergy and Anaphylaxis Network) and local support groups. We also provide families with a written emergency healthcare plan so that in the event of an accidental exposure, they have a reference. We try to review the different scenarios that could play out and how we would like the family to handle those scenarios.

What can be done if someone has a reaction?

An Epi-pen is a device that injects epinephrine, which is a drug that can take away or lessen the symptoms of a reaction. If a child uses an Epi-pen, however, they should immediately call 911 or contact their local EMTs to get to a hospital facility as soon as possible because while epinephrine can be lifesaving, it doesn't always work.

We prescribe an Epi-pen, for the most part, to any child diagnosed with a food allergy who weighs more than about 22 pounds. Children with a history of anaphylaxis, peanut or tree nut allergy, and those who have both food allergy and asthma should receive an Epi-pen. The Epi-pen comes in two dosages: an Epi-pen for adults and a junior Epi-pen. We need to make adjustments and be a little bit more careful in infants who are smaller because the dose is too high.

How can caregivers protect children when they are out and about?

It takes a lot of effort, a lot of teamwork, and really good communication and education to try to keep kids safe. In schools, for example, the teacher, the principal, the school nurse, all should be informed about the child's condition. There should be a copy of this emergency health care plan in the school along with a supply of the emergency medications. It's useful for the child to have a Medic Alert bracelet.

Children need to be taught from an early age to be their own advocate. If somebody offers them something that if they can't confirm is safe for them, they shouldn't try to eat it. Similarly, they shouldn't trade lunches; whatever mom or dad sends in or approves for them is what they should be eating.

Do certain behavioral issues come up with children with food allergy?

The issues that I have seen in kids a with food allergy include aversions to trying new foods. Some develop fairly limited diets because they just want to eat what's familiar to them because they know it won't make them feel sick. Other issues are dependency on the parents, particularly as the kids grow older and start to spend more time away from home. They may also experience anxiety about being in situations where they might be exposed to something, whether that's the school cafeteria, or going out to eat in a restaurant or being at a party.

How would someone know that a child had outgrown their food allergy?
It's very important for people to maintain contact with a food allergy specialist once their child has had a diagnosis. Since the prognosis is often good, you don't want that child to avoid that food indefinitely. Here at Children's Memorial Hospital, we recommend an annual follow-up.

Are there myths about food allergy?
One is that there is a relationship between a food allergy and behavioral problems such as ADHD. Another one is that a rotation diet, in which foods are rotated on a regular cycle according to their "food families," is a way to manage an allergy. Since reactions happen with each and every exposure to the food and since it generally takes only a small amount of food, there is no reason to think that reactions would go away just because you're on a rotation diet.

What is your overall advice to parents?
The guidelines from the American Academy of Pediatrics (AAP) encourage parents to delay introducing cows' milk until the child is one year old; to delay introducing egg until two years of age and to try to defer dietary introduction of peanuts, tree nuts, fish and shellfish until after three years of age. There is no AAP guideline for soy, but I suggest 12 months.

If you suspect your child has a food allergy, talk to your pediatrician. The more foods that you suspect, the more difficult it is for a primary care physician to conduct an evaluation and find the answer, so you may need to see a specialist. If there has been a history of a severe or life-threatening reaction, families should seek out a food allergy specialist. Also, if the child has very severe atopic dermatitis, particularly involving an extensive area of the child's body, that's a reason to see an allergy specialist as well. I would also suggest that the family learn more about food allergy. But parents need to be very careful about their sources of information; the Food Allergy and Anaphylaxis Network is an excellent source of information.. 

Does Christmas make you Sneeze and Wheeze   By Christine Haran

Some people spend the fall eagerly awaiting the piney smell and warm glow of a live Christmas tree. But for others, the Christmas spirit is dampened by allergies to the tree and holiday trimmings. For the millions of Americans living with allergies and/or asthma, the holiday season can be a challenge to get through. But allergists say you don’t have to wait until January to find relief.

When it comes to the tree, there are a few ways to minimize the misery. While you may assume that pollen is the source of your symptoms, mold is the true allergy trigger in a cut tree, according to Dr. Pamela Georgeson, an allergist with the Kenwood Allergy and Asthma Center in Chesterfield Township, Michigan, and a spokesperson for the American Academy of Allergy, Asthma and Immunology (AAAAI).

"Most trees are cut in October and stored, so they have a lot of mold from being out in the rain and slush, and mold can be a trigger for allergies and asthma," Georgeson explains. "The best suggestion is to use an artificial tree, but if you do get a live tree, try to shake it out and then dry it out for a week or so before you bring it indoors."

According to AAAAI, some tree retailers have shaking machines that can help rid your tree of mold. You'll also want to shake and dry out live wreaths and other greenery you might use for decorating.
Mold and dust can also accumulate on artificial trees, wreaths and greenery when they are stored, so make sure you clean these items thoroughly after you unpack them. Wash fabric decorations in hot water and soap, and wipe down plastic, tin, glass or ceramic ornaments and decorations to eliminate dust.

Other potential holiday culprits include strong scents from potpourri and candles. Asthma can also be triggered by smoke from a fireplace in a poorly ventilated room—and, of course, holiday stress.

If you're traveling to a home with decorations, or pets, that might trigger a reaction, take your medicine with you. Holiday parties and an abundance of homemade foods can also pose extra problems for people with food allergies. It's especially important for them to bring along epinephrine to control potentially life-threatening reactions.

"Education and avoidance are the only ways to cope with food allergy," Georgeson says. "So let your hosts know if you have a food allergy and bring your Epi-pen"—a device that injects epinephrine—"in case of accidental exposure."

Georgeson notes that accidental cross-contamination can be an issue with home-baked goods. For example, someone might bake cookies on a baking sheet contaminated with a food allergen, or pack nut-free cookies in a tin that once contained brownies with nuts and wasn't washed out afterward.

But you don't have to skip the holiday season just because you have allergies and/or asthma.

"The biggest piece of advice is to make sure you have your medicines with you wherever you are," says Georgeson. "And if you have an allergy, alert the person who you're visiting, so you can enjoy a safe holiday."

Alternatives for Allergies and Asthma: Proceed with Caution   By Christine Haran

Today, people are almost as familiar with the herbal supplement echinacea as they are with aspirin. So it's no surprise that many Americans are turning to complementary and alternative (CAM) therapies to treat their allergy and asthma symptoms. When it comes to conditions for which people seek out nontraditional treatments, studies suggest that asthma and allergies are second only to lower back pain.

It's estimated that allergies affect 40 to 50 million Americans, and about 20 million have asthma. While herbal supplements and other complementary and alternative therapies, such as hypnosis and acupuncture, may ease some symptoms, experts say people have to be careful about which CAM treatment they choose. Not only are some people with allergies particularly susceptible to adverse drug reactions, but there is also a chance that some alternative remedies may interact with other medications.

Why Go Alternative?

You may wonder why people are turning to alternatives when there are many medications, both prescription and over-the-counter, that successfully treat asthma and allergies. Like many people with chronic medical conditions, those who suffer from asthma and allergies are often particularly interested in trying new, “natural” treatments. However, natural doesn't necessarily mean without side effects, and just like medications made by pharmaceutical companies, “natural” products can be powerful and toxic.

Another driving force behind the move toward alternative remedies may be the high cost of allergy and asthma medicines, says Dr. Gailen Marshall, a professor of medicine and director of the clinical immunology, asthma and allergy division at the University of Mississippi in Jackson. For example, some patients who have both allergies and asthma may choose to only treat their asthma to cut costs. But they may run into trouble quickly because flaring allergies can worsen asthma symptoms. When this happens, Marshall says, people are more inclined to turn to CAM therapies, which are typically less expensive than prescriptions.

Safety Concerns

Unlike drug makers, manufacturers of herbal products and other dietary supplements do not have to demonstrate the safety and effectiveness of their products to the Food and Drug Administration (FDA). So little may be known about the true effects of a particular CAM product.

In a study published in a supplement devoted to CAM therapies in the Annals of Allergy, Asthma and Immunology, Dr. Leonard Bielory of the UMDNJ-New Jersey Medical School in Newark reviewed the medical literature to uncover the possible benefits as well as consequences of popular CAM therapies for asthma, allergies and immune system conditions.

"Many of my patients were taking complementary and alternative therapies," Bielory explains. "I wanted to learn more about what's real and not real. Physicians shouldn't downplay CAM if people feel better, even if it's a placebo effect. However, there are some herbal supplements that have adverse effects."

Bielory found that the most common side effects were various forms of allergic reaction like hives or contact dermatitis, which usually appears as an itchy rash.

But is there a possibility of more serious side effects? Specifically, Bielory found that echinacea, used for the common cold and for upper respiratory tract allergies, carries some risk of liver toxicity. There have also been some reports linking echinacea to asthma attacks, life-threatening anaphylactic reactions, and worsening of asthma and allergies symptoms. People with pollen allergies or sensitivity to sunflower seeds or melons may be more likely to have an adverse reaction to echinacea.

Likewise, bee pollen, a CAM therapy sometimes used for asthma and allergies has been shown to trigger a sore throat and breathing problems. It should never be used by people who are allergic to bee pollen since it could lead to anaphylactic shock.
Ginkgo biloba, which has been shown to expand the air passages in the lungs, is sometimes recommended to people with asthma. But Bielory points out that ginkgo biloba interacts with warfarin (Coumadin), a blood-thinning medication, and can make it less effective. Physicians also caution people about using ginkgo biloba in combination with aspirin, or other non-steroid anti-inflammatories, since it can intensify the potency of these drugs and lead to serious complications.

Asthma sufferers specifically should be wary of St. John's wort, a supplement often recommended for anxiety and depression. It may interact with oral asthma medications such as theophylline.

Stress reduction techniques, such as biofeedback and hypnosis, are relatively safe and free of side effects. Some studies, including one conducted by Marshall, have demonstrated that chronic anxiety and depression play a role in asthma. So stress management, Marshall says, from counseling to CAM approaches, may help certain patients control their asthma and perhaps their allergy symptoms.

Running from Ragweed: How to Cope with Fall Allergies   By Christine Haran
Some people find themselves retreating indoors in late August, not because of the heat and humidity but because of their allergies. In the Northeast, South and Midwest, ragweed begins blooming in mid-August and continues until late October and sometimes longer. This leaves ragweed-allergy sufferers unable to enjoy the fall season.
Ragweed, like other fall allergens such as sage, mugwort, and rabbit brush, usually grows in undeveloped areas such as fields, roadsides, and abandoned lots. But because billions of pollen grains from a single ragweed plant can travel through the air for up to 400 miles, ragweed pollen is found in urban, suburban and rural settings.

"Ragweed is incredibly hardy," says Dr. Christopher Randolph, an associate professor of allergy and immunology at Yale University School of Medicine and a spokesperson for the American Academy of Allergy, Asthma and Immunology (AAAAI). "It can be borne for miles into the air and is found at sea and on every continent."

When someone is allergic to ragweed, the immune system treats the plant's pollen as a foreign invader. First, white blood cells produce IgE antibodies that specifically target ragweed pollen. These antibodies attach themselves to mast cells, which exist in large numbers in the nose, eyes, lungs and digestive tract. When pollen is inhaled, these mast cells release histamine and other chemicals that cause the misery of hay fever: sneezing, an itchy, runny nose, and itchy, red eyes. Such symptoms can lead to fatigue, trouble concentrating, and missed days of work or school.
Compared with certain year-round allergens, such as dog and cat dander, seasonal allergens like ragweed may be less likely to cause asthma symptoms. "Animal allergens, for example, are very small, which means they can get deep in the airway and trigger asthma," Randolph explains. "Pollens don't get much below the windpipe, so they cause nasal symptoms."

Still, worsening nasal allergies can generate asthma attacks and can be an important element in asthma treatment.

Some people with ragweed allergies may notice that they develop itchiness around their mouth and in their throat when they eat melons and bananas. This is due to a protein in fresh fruits that is similar to the one in ragweed. Luckily, this cannot lead to a life-threatening allergic reaction known as anaphylaxis.

While symptoms are often used to diagnose a ragweed allergy in the primary care doctor's office, a more accurate approach is a skin sensitivity test performed by a board-certified allergist. In these tests, the skin is pricked with an extract of ragweed pollen. If a person has a ragweed allergy, the skin will become red and swollen.

Pollen Exposure

While the peak pollen times are between 10 a.m. and 4 p.m., pollen counts vary from day to day. Hot, dry and windy days are often the worst for pollen and, in general, pollen counts over 100 are considered high. According to Randolph, pollen counts can be useful, if not completely precise. "Most pollen counts reflect what's going on over a 24-hour period, not what's going on right now, so use it as a guide," he says.

To minimize exposure to ragweed and other pollens, the AAAAI recommends that allergy sufferers stay indoors with the windows closed and the air conditioning running as much as possible. After spending time outdoors, it's a good idea to shower to remove pollen that's collected on your hair and skin.

Easing allergies If avoidance just isn't doing the trick, people with ragweed allergies may need medication. Nasal sprays, including nasal antihistamines and nasal inhaled corticosteroids can reduce inflammation and ease symptoms. Randolph cautions that certain over-the-counter decongestant nasal sprays can have a "rebound effect" because they do not block histamine, but rather constrict the blood vessels in the nose. After about a week, the nervous system rebounds and dilates the blood vessels, causing increased blood flow and congestion.

Likewise, patients with eye symptoms, also known as allergic conjunctivitis, should seek out prescription eye drops that block histamine or inhibit mast cells, rather than over-the-counter eye drops that just constrict the blood vessels to reduce redness. Randolph recommends refrigerating eye drops for extra relief. Other ways to ease itchy, red eyes include applying cold compresses and using artificial tears to wash away allergens from the eyes.
Over-the-counter and prescription oral antihistamines and decongestants treat multiple symptoms, though Randolph warns that non-sedating antihistamines are safest. People with chronic allergy symptoms who need antihistamines on a regular basis may be candidates for immunotherapy, or allergy shots. This treatment, which is prescribed by an allergist/immunologist, seeks to build the immune system's tolerance to an allergen. Patients receive a series of injections that contain a small amount of the offending substance—usually weekly at first, and then monthly; the therapy may continue for three to five years.

So those with ragweed allergies who are just trying to wait out the end of the season can take heart: With avoidance and treatment, you don't have to sniffle your way from late summer to Thanksgiving.

Are You Allergic to the Sun?   By Christine Haran

Although die-hard sun worshipers continue to oil up to better catch the sun's tanning rays, most Americans choose to slather on sunscreen instead. Sunscreen can help protect them from most of the harmful effects of ultraviolet light, but it will do little for certain sun-sensitive individuals. These would-be sun seekers wind up with an itchy, bumpy rash that is sometimes called "sun poisoning" even if they're wearing SPF 50.

"Sun poisoning" is really an allergic reaction to the sun that occurs when skin is exposed to sunlight for the first time in the early spring, or during a winter vacation. While people with light skin are most susceptible to sunburn, sun allergy affects people of all skin colors.

If people with a sun allergy venture to the beach at all, you can probably find them in a floppy hat, under an umbrella. Or, at least, that's where they should be. Below, Henry W. Lim, MD, chair of the department of dermatology at Henry Ford Hospital in Detroit, Michigan, talks about how to prevent and treat allergic reactions to the sun, as well as rashes triggered by sunscreen ingredients.
Can someone have a sun allergy?

There are certain skin reactions to the sun that have nothing to do with sunscreen or other external factors, which we call an intrinsic type of photodermatosis. People with photodermatosis develop skin rashes following exposure to the sun. Polymorphous light eruption is the most common type of photodermatosis. It is most likely due to an abnormal immune system reaction to the sun. Polymorphous light eruption occurs in approximately 10 to 20 percent of otherwise healthy individuals, so it is a relatively common condition.

Then there is another group of people who develop what they think is a sun allergy because of medications that they have ingested or agents that they have applied, including sunscreen. These people develop an irritant reaction, which is a rash or a tingling, itchy sensation on the skin. The chances of getting a true allergic reaction to sunscreen are actually very low.

What are the symptoms?

People usually develop reactions within a few hours of sun exposure. The typical scenario would be that they get exposed to the sun during the day, and then at the end of the day they start noticing the development of red bumps or blisters in the exposed area. It tends to be somewhat itchy. The polymorphous light eruption produces a rash that looks more like hives or insect bites. Sometimes people have no symptoms. If the reaction is untreated, it usually lasts for a few days, or up to two weeks. Then it would go away by itself.

Does it get worse or better with repeated exposure?

It tends to occur most commonly in the springtime in a temperate climate when people first start getting sun exposure. Typically as the season progresses, the person becomes less sensitive to developing this reaction; the thought is that the skin adjusts to this effect of the sun. But any kind of sudden and relatively intense exposure to the sun would bring this up. A typical scenario in the winter is when patients from Northern climates go to the Caribbean or Hawaii, for example, for their winter vacation.

Can someone develop sun allergy at any time in their life?

It can occur at any time in someone's life, but typically it occurs in people in their 20s and their 30s. And it can occur in people of all skin types. So not only Caucasians but also Asians, Latinos and black people can develop photosensitivity.

Is a sun allergy ever a sign of an underlying condition?

There have been some reports of an association with lupus and with thyroid problems, but those are exceptions rather than the rule. We do evaluate patients for those conditions on a routine basis. We ask them questions and take some blood tests, if necessary. But the vast majority of patients are perfectly healthy otherwise.

What kind of ultraviolet light causes the reaction?

It's usually UVB light, but it could be UVA also. So it varies from person to person and one would have to test for it. The testing is usually conducted in a clinic setting. We can use light sources that emit predominantly UVB or light sources that emit predominantly UVA to see which one would induce the lesion.
That would help to guide the treatment somewhat. Realistically, however, the testing is not that widely available because only specialized photodermatology centers would be able to perform it, and it is not 100 percent positive in all patients.

How can people avoid allergic reactions to the sun?

As a first-line treatment, we usually ask the person to avoid the sun if possible, and if they do go out in the sun to use photo-protective measures. So in addition to staying in the shade, they should wear a long-sleeve shirt if possible and use what we call broad-spectrum sunscreen that has UVB as well as UVA blockers. If someone knows that they are only sensitive to UVB, it's not as essential that they use the broad-spectrum sunscreen.
We ask people to look for a sunscreen that has SPF 15 or above because the probability of having UVB and fairly good UVA protection is quite good. People should specifically look for the word "broad-spectrum" on the label.

How can people avoid sunscreen reactions?

If the reaction is due to irritation secondary to an ingredient in the sunscreen, clearly an avoidance of that ingredient is the first step. Usually, I tell the person to try different types of sunscreens. A lot of the time sunscreens for children or sunscreens for the face tend to be better tolerated because they have less alcohol content, so sometimes I recommend trying those. Another approach is using sunscreen that contains only titanium dioxide and zinc oxide. Those two ingredients have never been reported to cause allergic reactions.

When should you see a dermatologist or a doctor if you think that you might have a sun allergy?

I think if you have more than one episode, or if you have a very severe episode of skin eruption following sun exposure, it would be worthwhile to consult a dermatologist at that time. You might also see a dermatologist if your first-time reaction doesn't go away after a few days, or if it's very itchy, very red, very bumpy, very extensive. If untreated, the area will continue to be uncomfortable and could lead to an infection or skin breakdown.

Caution at the Cosmetics Counter   By Christine Haran
Anyone who has wandered through the maze of cosmetics counters in their local department store, or even just hit their neighborhood drugstore, knows that thousands of products have been developed to cater to people seeking flawless skin. But in certain people, skin care products, including make-up and sunscreen, as well as hair and nail care products, can lead to an allergic reaction on the skin called contact dermatitis. Sometimes it's even difficult for people and their doctors to discern the cause of the allergic reaction because the rash may not appear in the area where the product was applied.

Unfortunately, avoiding allergic reactions isn't as simple as choosing products labeled "hypoallergenic." And products deigned "all natural" aren't any less likely to cause allergic reactions than other products, either. Below, Frances J. Storrs, MD, a professor of dermatology emerita at Oregon Health and Science University in Portland who specializes in contact dermatitis, explains how to wisely choose your skin products.

What kinds of allergic reactions to skin products do people usually have?
They usually develop contact dermatitis, which is the allergic reaction similar to the one you would get if exposed to poison oak or poison ivy. So someone might just have dry skin, and as they begin to use a product, their skin becomes more and more red and they might develop what we call vesicles. These are little tiny blisters on the skin that become crusty and ooze and then spread to other parts of the body. The dermatitis might spread up an arm or the whole face or the eyelids might be involved. Depending on how strong an allergen you're dealing with, you may get an allergic eczema, which is an itchy rash. The allergic reaction just gets worse and worse until the person stops using the product.

Who is most likely to have an allergic reaction to a skin product?

Occasionally allergic reactions occur in people with normal skin, but more often then not, they occur in people in which the barrier has been broken so that the skin is no longer completely intact. This includes someone with a little bit of flaking on their face—something we call seborrheic dermatitis—or someone with eczema or someone who just has dry skin.

What products cause allergic reactions?

Lotions and creams, foundations, moisturizers, sunscreens, shampoos, salon hair care products and nail care products are most likely to cause allergic reactions.

What ingredients in skin care products are most likely to cause an allergic reaction?

It depends on the product you're talking about, but the most common problems are caused by preservatives. Any agent that contains water requires a preservative to keep bacteria or funguses from growing in it. The most common preservatives associated with allergy are those that release formaldehyde. A good example of that is quaternium 15 found in various lotions or creams or even shampoos and cleansing agents. There's also a collection of moisturizing lotions that are preserved with a chemical called methyldibromo glutaronitrile.

If you are allergic to those chemicals, you will need to avoid products that contain them, so you will have to learn to look for them on the label of all skin and hair care products. Parabens are another type of preservative that are used in thousands of products, and they cause fewer allergic reactions.

What ingredients other than preservatives can cause allergic reactions?

In addition to the preservatives, some people think perfumes are common causes of contact dermatitis. I think fragrances are probably overrated, frankly, as a cause of allergic reactions. But fragrances are very complicated compounds that contain hundreds of chemicals that might cause an allergic reaction.

An ingredient we're seeing more and more of right now are the botanicals found in products like shampoos. Botanicals are plant extracts, or the so-called "natural" chemicals. They may have an odor, but they are not officially designated as fragrances on the label. In my office, I've seen three people who were using a deodorant that contained some extracts of lichens who developed severe underarm dermatitis. Lichens are little primitive plants that grow on trees.

Can people have allergic reactions to products that are too old?

They can but I can honestly say I've never seen anybody develop a skin infection from using a product that was too old. When bacteria and fungus grow on the product because the preservative is no longer active, you can see them, and it looks awful. It's like seeing a piece of moldy bread. If you ate the moldy bread, probably nothing would happen to you, but it's going to taste awful and it looks awful.

There is some concern about bacteria and fungus in products that are used around the eye. My advice for using products around the eyes, such as mascara, is usually to replace them every six months to make sure that it's properly preserved and fresh.

Why do sunscreens cause allergic reactions?

In the United States, some sunscreens contain chemicals called oxybenzone and octyl dimethyl PABA, which have been associated with allergic contact dermatitis reactions. Unfortunately, the cosmetics industry does not require that those chemicals be designated by those names on the label, so they may use alternative names for these chemicals. Now there are excellent alterative sunscreens that are advertised as being what they call chemical free. Now they're not chemically free. When they say "chemical free," it means they don't contain the sunscreens that have been most commonly associated with allergic contact dermatitis reactions. Instead, they contain zinc oxide or titanium dioxide, which are pretty inert substances and excellent sunscreens.

Why do hair care products cause allergic reactions?

Far and away the most common cause of allergic reactions to hair care products in the United States are certain kind of hair dyes. These are the two-part hair dyes, which contain a chemical called paraphenylenediamine. Fortunately, there are lots of substitutes for permanent hair dyes. So the semi-permanent hair dyes or ones that don't last quite as long usually don't contain that chemical.

And the second most common hair product to cause allergic reactions is permanent waves that contain a chemical called glyceryl thioglycolate. These are usually three-part permanent waves, or so-called "acid perms." Cysteamine is a new chemical in permanent waves that can cause allergy. However, I think it's going to be a very rare problem. And another good alternative are two-part perms, which contain ammonium thioglycolate. These are the old-fashioned cold permanent waves, and they hardly ever cause allergy problems.

What about nail care products?

We see extremely interesting problems from chemicals in both nail polishes and artificial fingernails. An artificial fingernail problem can actually be quite horrendous because they are caused by complicated acrylate chemicals. These are chemicals that are used by mechanics to use as adhesives on screws when they're putting them in things like motors, and they might be used as sealants for a glasswork.

If you're allergic to some of these acrylates in artificial fingernails, or you're allergic to some of the formaldehyde resins that are used in nail polishes, you may break out in a very interesting way.

You'll break out on your eyelids and around your mouth and on the sides of your neck. So people come in and the skin around their nails and hands looks perfectly normal, and the reason is because the technicians who apply these artificial fingernails are very good at what they do. They don't get any of the acrylate on the surrounding normal skin. However, before these nails get hard, when these clients then touch their eyelids or rub their hands around their mouth or on the side of their neck, they deposit the chemical there and then break out. So people come in and they're broken out on their face and no one suspects their fingernails.

All these reactions are rare, however, so you shouldn't think of these products as containing poisonous or toxic compounds.

What does treatment involve?

Avoiding the allergen is the best treatment. If people don't know what's causing the allergic reaction, a dermatologist will figure out what people are allergic to with what's called "patch testing." We apply chemicals in very low concentration, but high enough concentration to elicit an allergic reaction, so we can tell people what they're allergic to.

Allergic dermatitis is usually treated with corticosteroid derivatives, either by mouth or by a topical application such as a cream.

What does it mean when a product is labeled as hypoallergenic?
That's pretty much meaningless. There's no good cosmetic company definition of hypoallergenic, and the so-called hypoallergenic products are just chock full of botanicals.

What should people look for when they're purchasing products?
Cosmetic products used on the skin have a fabulous safety record, and as we all know, there are many, many products that get tons of use. So when one considers the magnitude of the products out there and the number of reactions we have, it's a real testament to their safety.

But people with underlying skin conditions should try to use products with as few ingredients as possible in it. For example, I encourage people, particularly older people, to use plain 100 percent petrolatum as a moisturizer. People should avoid products with preservatives such as the formaldehyde releasers or methyldibromo glutaronitrile. And as a general rule, products that are preserved with chemicals called parabens and products that are fragrance free tend to cause less difficulty.

Reacting to Rubber: How to Avoid Latex Allergies   By Christine Haran

In the springtime, when people talk allergies, they're usually talking about pollen. But there are other substances found in nature that can cause sneezing and wheezing and, in rare cases, more serious and even fatal reactions. Allergy to natural rubber latex, which is found in stretchy products such as condoms and medical gloves, as well as hard rubber items like pencil erasers, became increasing common during the 1990s. Proteins found in natural rubber latex can induce the formation of antibodies that travel to selected cells called mast cells. Upon re-exposure to latex, these cells release chemicals that cause allergy symptoms in sensitive people.

Because natural rubber latex gloves, particularly powdered gloves, can pose a serious threat to health care workers and patients who have been sensitized to natural rubber proteins, many health care institutions have switched over to synthetic gloves. And the use of these gloves is discouraged in other settings such as food service. But natural rubber latex gloves are still in use, and as people reach for protective gear amid fears of SARS and chemical weapons, it's important to remember that latex poses its own dangers.

Robert Hamilton, PhD, professor of medicine and pathology at the Johns Hopkins University School of Medicine in Baltimore, was a member of the Latex Task Force at the Johns Hopkins Hospital. Below, Dr. Hamilton discusses natural rubber latex allergy and the efforts to minimize exposure to it.

What is latex?

Latex, also known as natural rubber latex, is a white milky substance. Most of the world's rubber comes from the H. braziliensis tree, which is primarily grown in Southeast Asia. This plant, also known as the rubber tree, produces a particular latex that contains polyisoprene, which is essentially rubber.

When we say "latex," I really think we need to focus on the term "natural rubber" because "latex" is also a term used by manufacturers to describe a substance which when put on a surface creates a single layer. Latex paint, for example, doesn't contain natural rubber and therefore it poses no risk for exposure to latex allergic individuals.

What type of products is latex found in?

Most rubber products are one of two different types. One type is dipped rubber products, which are manufactured by a mold that is dipped into a vat of natural rubber latex. Dipped rubber products would include condoms, toy balloons and medical gloves.

The second type of product is a molded rubber product, where the latex rubber is allowed to harden, and then it is rolled out and the components are either stamped or cut out. Molded rubber products would be exemplified by rubber stoppers in pharmaceutical vials.

In terms of other products, you can find small amounts of natural rubber latex in some adhesives on Band-Aids, pencil erasers and rubber bands.

Why are people allergic to latex?

Natural rubber latex contains anywhere between 1 percent and several percent protein. It is the protein that causes the problem in terms of inducing IgE antibody (the antibody associated with allergies) and leading to allergic reactions.

The reaction severity relates to how much allergenic protein the individual is exposed to, how they're exposed, how much allergen gets into either the nose or into circulation. Repeated exposure to an allergenic protein in an individual who is genetically predisposed to allergy disease will, in theory, induce higher levels of IgE antibody and make the allergy worse. It is tough to predict whether an individual will have a reaction or not.

What are different kinds of allergic reactions that people can have?

Latex allergy is like most other allergies. It can cause swelling and redness of the skin, a runny nose and watery eyes, and, in rare cases, a systemic anaphylactic reaction that can be life-threatening. It is referred to as systemic because it can affect the organs, such as the respiratory tracts and the cardiovascular system.

An anaphylactic reaction occurs when a sensitized individual is exposed to a substantial amount of allergenic protein, either by inhalation or by injection. The allergenic protein gets into the system and can make it difficult to breath, and can lead to shock. The symptoms that one gets are identical to the anaphylactic reaction that occurs in an insect sting allergy or in a peanut-induced allergic reaction.

How common is the latex allergy in the United States?

There was an explosion of cases that sort of peaked in the latter 1990s. In the health care community, there are reports that put the prevalence of latex allergy at levels as high as 10 percent. Rates were also high among children with spina bifida, who had repetitive surgeries. The prevalence rates in some studies were as high as 40 percent.

The problem appears to be diminishing because individuals are taking action to minimize exposure to latex allergen in a health care setting. But defining cases clearly depends upon having good diagnostic methods and, at least in the United States, we do not have an US Food and Drug Administration-licensed diagnostic skin testing material and our blood tests for IgE anti-latex antibodies have been less than perfect.

How are latex allergies treated?

The first and primary method of treatment is avoidance. Avoidance needs to be viewed within the context of the individual's life. Each individual case is a little different in terms of how one optimizes their avoidance practices, and precise guidelines can be provided by the individual's allergist. But in general, the rule of thumb is that anyone who has a latex allergy and has to get medical care needs to find a physician and/or a dentist who does not use natural rubber latex gloves in their practice. That's number one. And then, depending upon the relative degree of sensitivity, people have to be educated about the sensitivity. If the individual with the allergy is a child, for example, the parents have to educate the child and the school.

If an individual has had a systemic reaction, they might carry an Epi-pen, which is a small, auto-injecting device of epinephrine. Epinephrine is given to reverse an anaphylactic reaction. If an individual feels they've been exposed, they can self-administer this epinephrine and then get themselves to a hospital. Again, latex allergic individuals should see their allergist for guidance on avoidance practices.

Can certain foods exacerbate a latex allergy?
There are certain proteins in natural rubber latex that are structurally similar to those found in certain foods like banana, avocado and kiwi. So an IgE antibody that would bind to a protein in natural rubber latex and can also cross-react or bind to a similar protein structure in a banana, avocado or kiwi. Blanket avoidance of these foods is not encouraged. Rather, selective avoidance should be conducted if the individual knows that they experience a reaction upon eating a particular food.

Are latex gloves used outside the healthcare environment?
The natural rubber latex glove has been used in food services. But there has been an effort to try to eliminate the use of natural rubber latex gloves in places where they're really not necessary, such as in housekeeping and food handling, where they're basically being used just to protect the hands of the individuals.
If an individual puts on a natural rubber latex glove that contains high levels of allergenic protein, and then they handle food, in theory, the allergenic protein can be transferred onto the food. Now whether the food with the allergenic protein on its surface represents a risk to an individual or not is the issue that's in dispute.

Latex gloves can be used in other settings as well. For example, we had a farmer from a rural area of Baltimore who bought natural rubber latex gloves from the pharmacy down the street and used to wear them in the field to keep his hands clean. There was really no need for him to use latex gloves but those were what he had available. He managed to sensitize himself and when he went into surgery, he had a very severe reaction to the surgeon's gloves. So any area where a natural rubber latex glove is not necessary, alternatives should be used. These are equally cost effective and effective in terms of protecting the individual.

What is being done to reduce or eliminate latex exposure?
Most hospitals in the world ask patients whether they have allergic reactions to rubber products. That farmer, however, claimed three times that he had no problems with natural rubber products, and yet he had a systemic reaction when he was exposed. He later was shown to have a high level of IgE antibody in a blood test. So even individuals who may be sensitized may not know that they have an allergy.

There has also been a concerted effort on the part of many health care institutions in the United States and in the world to eliminate the highly allergenic, powdered latex examination glove and the sterile latex surgeon glove. In the early days, latex gloves were very cost effective. Today, the synthetic gloves, made with nitrile or vinyl, are effective and cost competitive.

Also, manufacturers of medical glove products who continue to make natural rubber latex gloves are taking steps to reduce the allergenic protein, and develop better methods of measuring the allergenic protein in rubber products.
What advice would you people with latex allergy about staying protected?
If someone makes the statement that they have a problem with natural rubber latex products, they should be taken seriously. Sensitive people should avoid exposure by minimizing your contact with anything that you know contains natural rubber.

It is difficult to know the severity of an individual's sensitivity. It's changing all the time depending on the person's exposure. So people should just use common sense. Anything that has a stretchy rubber texture should be considered a question mark, even though it's very difficult these days to know if it really actually contains natural rubber or synthetic materials.

The Sweet Spring Challenge: Seasonal Allergies   Erica Heilman
The blessings of spring get mixed reviews from the estimated 35 million Americans who suffer from seasonal allergies. It's not easy to appreciate the miracles of nature through itchy eyes, runny nose, and uncontrollable sneezing.

But what actually causes seasonal allergies? And which allergens are the worst offenders? Dr. Gillian Shepard is a clinical associate professor of medicine at Weill Medical College of Cornell University. Below, she talks about the arch nemesis of carefree springtime...the seasonal allergy.

What are "seasonal allergies"?
People with seasonal allergies are allergic to something that's in the air for just part of the year. People are often allergic to the pollen of trees in the springtime, for example, and the allergy only occurs when the trees produce their flowers and pollen, which lasts for several weeks in most places.
Some very common seasonal allergies are triggered by tree pollen in the springtime, grass in the spring through summer and then ragweed and other weed pollens in the fall.

Which trees cause the worst seasonal allergies?
Almost any tree is capable of inducing allergic reaction if you're programmed that way. In different parts of the country, people will react to different trees depending on what's there. For example, on the east coast, it is very common to be allergic to birch, oak and maple tree pollen. If you go to the western states, you may find that the cottonwood, poplar, and aspen trees are much more of a problem.

And of course the area where you live will determine when you have a problem. It takes from around February to the end of May for the tree pollen season to work its way up from Florida up through Maine. Allergy sufferers should be careful not to plan trips that take them in the direction of the tree pollen.

How long is the season in the Northeast?
The Northeast is particularly afflicted by tree pollen. There is so much of it that the average person is familiar with the sight of cars covered with yellow pollen during late April and early May.

When an allergic person will suffer depends on which tree they're allergic to. Some of them will pollinate in mid-April, and others will not pollinate until later, toward the end of May approaching Memorial Day.

Some very unlucky people that are sensitive to all these different tree pollens may have a tree pollen season in the Northeast that goes for six weeks. Others, if they're only sensitive to one type of pollen, might have symptoms only for three weeks during that time.

Do all seasonal allergies—grass, ragweed, tree pollen—do they all affect people the same way?
The symptoms one gets from tree pollen allergy are exactly the same as grass, ragweed, even symptoms from dust mite or cat allergy. You breathe the allergy substance in and an allergic reaction ensues, giving you the stuffy nose, sneezing, itchy eyes and so on.

What factors influence day-to-day allergic reactions?
The environment is absolutely critical. First the obvious, there is a lot less pollen inside than outside, assuming that it is tree pollen in the springtime. But it's also important to remember that pollen can be sucked in through filter systems, so that if you have an air conditioning unit, you should change the filters frequently. You should obviously try and keep the windows closed so that there's less pollen inside than outside.

The environment also has a bearing in a lot of other ways. For example, it is now clear that if you live in an area where the ozone level is high, you will be more sensitive to the allergy substance. For example, if you are normally sensitive to 100 units of grass pollen and then the ozone level is high, it may take only 10 units of grass pollen to induce the same level of symptoms.

Another factor that influences when somebody reacts is if they have any sort of a viral infection, like the common cold. The inflammation that results from a cold, when your nose is all stuffy and congested, causes tiny little cracks in the lining of the nose and sometimes in the chest, and that may allow a pollen to get through the lining and encounter the allergy system on the other side of the protective lining of the nose, which may trigger an allergy reaction, or it may rev up an allergy reaction that's already occurring.
What causes oral allergy syndrome?
A lot of people don't realize that there are cross-reactions between plants such as tree pollen and other substances. For instance, in the case of birch tree pollen, there's a direct cross-reaction with various fruits, particularly apples and peaches. When someone has an allergy, the allergy system cannot distinguish between the pollen of birch trees and substances in apple and the peach, plum, cherry, nectarine family. So what happens is, somebody eats apple or a peach, and immediately it encounters the allergy system in the mouth. It induces a lot of itching and tingling in the mouth.

It only happens with the raw fruits, because when they are cooked, either by baking or by sterilization, you break down this allergy protein. So people who have the oral allergy syndrome, particularly to fruits and occasionally to some melons or also carrots and celery, very commonly have allergy to birch tree pollen.

And if you treat those patients with allergy shots to tree pollen, including birch tree pollen, this oral allergy syndrome settles down a great deal. The oral allergy syndrome is also much greater in May. If someone is breathing in a lot of the pollen of birch trees in May, then their immune system and their allergy system revs up at that time and it makes them much more sensitive to eating apples or peaches then.

That's just one example of cross-reactions between pollens and various other food substances. For example, patients who are allergic to ragweed pollen in the fall often will have a cross-reaction allergy to chamomile and may have problems drinking chamomile tea.

When should a person who has seasonal allergies see a doctor?
In most cases, the symptoms of springtime allergies are fairly straightforward; nasal, eye symptoms, and can be handled certainly by over-the-counter medications, or if not, very easily by prescription medications.

Anyone with seasonal allergies should consider seeing a doctor if they're worried about their symptoms, if they seem unusual or if they're not relieved by over-the-counter medications.

Allergy or Cold?   By Marion Richman, MD
As many as 40 million Americans suffer from allergies, and many more suffer from the common cold. Allergies and colds share many of the same symptoms, and effective treatment depends on knowing which one you have. But how can you be sure which one you are suffering from? As a family doctor at New York Presbyterian-Columbia, Dr. Marion Richman has seen her share of both maladies. Below, she answers some fundamental questions about making the distinction between an allergy and the common cold.

Do you find that patients often confuse colds and an allergy?
Definitely. There are just so many overlapping symptoms between the two that it's very easy to confuse them. Doctors confuse them as well.

So what is the difference between what causes a cold and an allergy?
An allergy is an immune response to a substance in the environment that's normally harmless, so it's an inappropriate immune response. A cold is an infection which is contagious. Ninety-nine percent of the time it is caused by a virus, and very rarely by a bacteria.

What are the signs and symptoms of each one?
The signs that are common to the two are runny nose and nasal congestion. More particular to allergies are the itchy, watery eyes, the clear, runny nose, and the itchy throat. With colds you are more likely to have a fever, and you may have some sinus pain, and the mucus discharge may be a different color, like green or yellow.
How can a person tell the difference?
It's difficult. But if you're getting a cold at the same time every year, or after you visit your cousin who has a cat, you might suspect it's an allergy. There are also some other telltale signs of having an allergy, like if the person also has eczema, itchy skin, asthma, or a history of allergies in their family. A cold usually follows a time course of about seven to ten days, usually with a predictable series of symptoms. But it is possible that they have identical symptoms.

What are the treatment options for a cold?
We don't have a cure for the cold, so the treatment options are limited to treating the symptoms. For the congestion there are decongestants. For runny nose there are antihistamines. Cough suppressants can help with a cough

What are the treatment options for allergies?
Before any kind of medical treatment, it's best to try to modify your lifestyle, to avoid what is causing your allergies. For example, if you're allergic to cats, try to avoid them.

Treatment options for allergies are a little broader. You can use the over-the-counter cold remedies. But, the non-sedating antihistamines are a mainstay of an allergy treatment. Steroids, which help reduce inflammation, are also used. They can be sprayed into the nose, and we also have oral steroids for very severe allergy sufferers that can be taken for short courses. We also have allergy shots, or immunotherapy, which are used to inject small doses of substances that you are allergic to. The idea is to try to increase the person's tolerance to that substance. Allergy shots are usually reserved for people who have severe allergies.

At what point should a person with congestion, runny nose and sneezing see a doctor?
If it's a cold, it's usually going to follow a time course of about seven to ten days. If you've had a cold for a month, you should go see a doctor. If you have a temperature of over 101 for three days or more, or if you develop ear pain, throat pain, sinus pain, or pain in your teeth, you could be getting an infection, and should see a doctor. If there's any trouble breathing, you should go to the emergency room immediately.

What are some clues that a child may have allergies?
Allergies are kind of rare in kids under three. But in the over-three crowd, if they're getting recurrent ear infections or hearing problems, and these problems are leading to trouble in school, you might want to see the child's doctor, and inquire if the problem might be related to an allergy.

Children often have similar allergy symptoms to adults, like a clear, runny nose. Often you see them rubbing their nose, and some kids even have a little crease across the bridge of their nose from the constant rubbing and pushing.

What are some signs and symptoms that require a doctor's visit?
Fever is definitely a warning sign. Allergies don't usually cause fever, so if they do have a fever or if they're complaining of any kind of pain in their ears or throat, and certainly if they're having any trouble breathing, then they should see a doctor. If they're not taking in food as much as they usually do, not drinking or not making wet diapers, those are definite reasons to go to the doctor immediately.

What are some of the treatments available for children with cold or an allergy?
I feel that with young children, over-the-counter medicines for colds, and even the prescription ones, are not that effective, and using these medications are not worth the risk of side effects. Toughing it out is a better approach to a child's cold.

In terms of allergies, there are some non-sedating antihistamines that are approved for children as young as two years of age, and they come in syrup form or they come in dissolvable tablets that go under the tongue. For the kids that truly have allergies, those treatments are out there for them.

Doggone It! Can Pets Improve Your Health?   By Karen Barrow
Coming home to find Fido wagging his tail or Felix purring at the doorstep may be doing a lot more for your health than simply warming your heart. A new look at studies on pets suggests that your furry (or scaly, or feathery) friend may be linked to better physical and mental health, especially for the elderly.

Evidence for the health benefits of pet ownership has been conflicting. While early studies concluded that pets help to reduce the risk of asthma in children and cardiovascular disease in adults, more recent data has found otherwise. But researchers in the recent review, published in the British Medical Journal, point to the close relationship between pet and owner that drives the positive benefits.

"The main issue may not be whether pet ownership confers measurable physical benefits, but the role that pets have in people's lives," writes Dr. June McNicholas and colleagues.
Man's Best Friend

Studies have found that pet owners may benefit from their companions in one of two ways. First of all, pets promote social contact with other people. Dogs force individuals who live on their own to get out of the house for walks, while also creating a "social catalyst," aiding interaction with others. 

But the innate exercise involved in owning a dog may confer benefits, too. In fact, one study found that dog owners were more likely to survive one year after a heart attack than cat and non-pet owners, an outcome that may be caused by the physical benefits of dog walking.

Besides helping individuals get out of the house, McNicholas suggests that pets often fill the hole that individuals may miss when living alone.

"Close human relationships have a powerful influence on the well being by providing emotional support," she notes.

Who's Really the Master?

While it is no surprise that having close human relationships seems to be connected to lower anxiety, better reaction to stress and improved recovery from stroke, heart attack and cancer, studies show that having a dog or cat emulates the emotional support found in a close friendship. However, a close relationship with a pet can interfere with proper medical care.

Some studies cite that as many as 70 percent of pet owners would ignore a doctor's advice to get rid of a pet if they were diagnosed as being allergic to their animal. Even worse, some seniors report avoiding medical care altogether, worried that a diagnosis requiring long-term hospitalization or placement in a nursing home would mean giving up their beloved pet.

To counter this, McNicholas emphasizes the importance of doctors being aware of these concerns and offering alternatives to simply abandoning a pet. Losing a pet, for whatever reason, can cause more distress and grief for a patient already coping with an illness.

"People do not own pets specifically to enhance their health, rather they value the relationship and the contribution their pet makes to their quality of life," she adds. 

Pet Allergies   By: Morris Nejat, MD
When it comes to pet allergies, man's best friends may often be his worst enemies. Numerous times a day, I see patients who are concerned that they may be allergic to their pets, and it often turns out that they are. But before you make the family dog the scapegoat for allergy symptoms, you must be sure not to wrongfully accuse an innocent pet.

Diagnosis of an Animal Allergy

If you suffer from symptoms such as sneezing, runny nose and itchy, watery eyes, you can only know for certain you have an allergy by undergoing a specific test. In my practice, I start by asking questions about symptoms, history of allergy, environmental exposures and family history to get a good picture of your situation. To help determine whether an allergy is involved, I usually perform one of two types of skin testing: a skin prick test, which involves making a small break on the surface of the skin to introduce an extract of a specific allergen (any substance, including animal dander, that can cause an allergic reaction); or an intracutaneous test, where an allergen extract is injected into the skin. If you develop swelling and redness in the area, that indicates you have an allergy. On the other hand, if skin testing is negative, a blood test can confirm whether the animal in question is the source of the allergy. Too often I have seen a family get rid of a beloved family pet without adequate confirmation. They find out down the road that they were wrong and it wasn't Fluffy or Rover that was making little Johnny wheeze, but rather his teddy bear.

Treatment of an Animal Allergy

Once an animal allergy has been diagnosed, it is important to understand what aspect of the animal you are allergic to. Below is a list of common animal allergies and the best steps for addressing each.

Cat Allergy: People who are allergic to cats have a reaction to the cat's saliva and dander (dead skin cells). However, typical allergic symptoms do not result from direct contact with your pet. Instead, when the cat grooms itself by licking its fur, it deposits saliva, which dries leaving behind the protein antigen and loosens dead skin cells. These allergens (saliva and dander) are very lightweight and are easily airborne. Once in the air, the antigens can spread to clothes, furniture, carpeting or any other household item.

Once the cat allergy is confirmed, the best way to decrease allergy symptoms is to remove the cat from the home. If you decide to keep your cat, however, you should at least try to keep it out of the bedroom or off the bed.

Washing the cat once a week may help reduce the amount of cat allergen in the house.
However, relatively high concentrations of cat antigen can remain, even months after the cat is removed. Therefore, it is important to clean or replace the carpeting, furniture, and any other material that may harbor the cat saliva antigen. Many of the products available to clean home furnishings have been shown to have little effect on the presence of a cat allergen.
There are less dramatic means to improve or eliminate cat allergy symptoms other than getting rid of your pet. They include the use of medications and allergy immunization.

Dog Allergy: Patients allergic to dogs are allergic to the dog's saliva and dander. However, an allergy to dogs is easier to manage than a cat allergy because dogs are often kept outside, or at least out of bedrooms, and they get regular baths.

As with a cat allergy, the best way to address a dog allergy is to remove the animal from the home, but medications or allergy shots are other options.
Horse Allergy: People with this allergy may often think they are reacting to pollen or mold because their symptoms arise outdoors. These patients are usually allergic to horse hair and dander, and treatment includes horse avoidance, medication and/or allergy shots to decrease the immune system's sensitivity to a horse allergen.

Rodent Allergy: People become allergic to rodents, including mice, rats and guinea pigs, due to frequent exposure to the animals; those most at risk include veterinarians, laboratory technicians and anyone who lives in close quarters with rodents (such as pet owners and those who live in rodent-infested homes).

The rodent's urine has a high concentration of protein, which is the primary trigger for allergic reactions. The urine is often sprayed rather than deposited, thereby increasing human exposure. After the urine dries, its proteins become airborne and are inhaled, leading to allergy symptoms.

Rabbit Allergy: Again, people with continual exposure to the animal—veterinarians, lab workers and pet owners—are at risk. The rabbit's urine is the common allergen.

Cockroach Allergy:
Roaches, especially the German cockroach, are a common pest in crowded cities worldwide. Recent studies have shown that, in inner cities, exposure to roach droppings is a major risk factor for allergies and asthma. Avoidance consists of roach baits and traps, extermination and proper housekeeping. This includes not leaving food or water out in open containers, and washing and drying dishes after each meal. Emptying areas of standing water, such as the refrigerator draining pan, and wiping down sinks can help deny roaches any water source. Though the pests can go for weeks without food, they won't last long without water, which is why they are often found around kitchens or bathrooms. Unfortunately, one can't encourage cleanliness in their neighbors. People who don't improve with avoidance measures can be treated with medications and allergy immunization.

Dust Mite Allergy: Dust mites are too small to be seen with the naked eye. They are eight-legged and sightless, and they eat the dead skin cells we all shed. Most patients allergic to dust mites are actually allergic to the dust mite feces, which release allergens very rapidly. The dust mite fecal pellets are similar to pollen grains in three major ways:

the fecal particles size
the quantity of allergen carried
the rate of protein release

Dust mites become a part of our environment and lifestyle. Since they are entirely dependent on humidity for water, they tend to live in places that "store" moisture, including carpets, sofas, mattresses and clothing. As humidity levels fall, dust mites dig deeper into these sanctuaries, where there is more moisture. So even in very dry conditions, it may take months for dust mites to die and for their allergen dissipate. Protecting you and your family from dust mite allergies comes down to one important rule: make your home inhospitable to the pests! Washing your bedding at least once a week and buying dust mite encasements are important steps.


The medications used to treat animal allergy are similar to those used for other allergies, such as hay fever and asthma. These include antihistamines, nasal steroid sprays and asthma pills and sprays. You and your allergy specialist should discuss which of these medications would best suit your symptoms. Allergy shots, another treatment option, work by gradually building your immune system's tolerance to the culprit allergen. This process usually begins with weekly injections and ends after three to five years of therapy, with a good chance of no recurring allergy symptoms. Although roaches and dust mites may not be your idea of pets, getting rid of these creatures may significantly improve your tolerance of the pets you love.

How to Avoid Dust Mites: Some Helpful Tips   By: Morris Nejat, MD
You might be surprised to learn that microscopic "spiders" are the true cause of your allergy symptoms. But in fact, dust mites are the unseen trigger for millions of people. They are extremely small members of the arachnid class, of the species Dermatophagoides, making them similar to spiders and "cousins" to lice and ticks. People with dust mite allergy are sensitive to both the organism and its feces. Dust mites are found in beds, couches, and rugs, and cause eyes to itch, noses to run, and skin to crawl.

Do You Have Dust Mite Allergy?
Dust mite symptoms include itchy and runny eyes, itchy nose, sneezing, coughing, wheezing and dry, itchy skin. If these symptoms sound familiar to you, it is important to have a skin test done by an allergist in order to pinpoint your exact allergy. If you're going to go through the inconvenience and expense of environmental avoidance, you should first make sure you know what's triggering the allergy. I have seen parents who gave away the family cat only to find out later that their child had a dust mite allergy.

After undergoing skin testing that confirms a dust mite allergy, patients and parents are often defensive about their housekeeping habits. I often hear, "I'm a good housekeeper and I dust everyday." Although this may be true, dust mites can live and thrive in places that dusting can't reach.

Dust Mites: Up Close and Personal
The Diet of the Dust Mite: Believe it or not, the dust mite loves to eat our skin, especially the skin cells we naturally shed from our body.

The Habitat of the Dust Mite: Dust mites tend not to be airborne, primarily because they are too heavy, but also because there is no dead skin in the air (unless you have very bad dandruff or flaky body skin). Thus, we find high concentrations of dust mites in bedding, clothes, upholstered furniture, and, to a lesser extent, carpeting. Jumping up and down on the bed or extensive cleaning may temporarily alleviate the problem (giving those with a dust mite allergy a good excuse to go to the beach while someone without dust mite allergy is vacuuming and/or doing some other anti-dust mite activity).

Dust mites like to live where there is abundant food, moisture, and warmth. This often means our beds. A bed is the ideal spot for dust mites in some of the same ways as it is for us: it's cozy and toasty. But besides that we tend to shed most of our skin cells in bed. And that's good news for our hungry dust mite companions.

However, dust mites prosper anywhere there is warmth and humidity, not just your bed. For example, when you open up your beach house in May (assuming you are lucky enough to own one), you may experience some violent sneezing and wheezing. The place has probably been sealed for six months with little or no circulation, and as a result, any moisture present when the house was closed has been trapped, producing favorable conditions for dust mites, as well as molds.

Keeping Dust Mites Out: The Bedroom Battleground

When planning to battle the dust mite, we must focus our attack. And that means making the bedroom our main battlefield. It is a place where many of us spend much of our time, thinking we sleep safely and snugly—all the while not knowing what we may be actually breathing in. With our heads nestled in the pillow, the dust mite has relatively easy access to our airways.

There are a number of things that can be done to decrease exposure to dust mites in the bedroom. You could sleep in a hammock that is washed weekly in hot water. Although this is highly effective, it is relatively impractical and I don't usually recommend it. Fortunately, there are easy and practical steps that can be taken:

1. Place an impermeable dust mite encasement around the mattress, box spring, and pillow. This type of encasement has vinyl on the inside and cloth on the outside to trap dust mites, but does not crinkle like plain vinyl. It is also less likely than a plastic cover to make you sweat. One note of warning: some of my patients have reported dramatic improvements in their symptoms after using a dust mite cover, while others haven't experienced any improvement, even after a few months.
2. Wash all sheets, blankets, and pillow cases in water over 130 degrees Fahrenheit. Achieving this temperature can be a problem in some apartment buildings where the thermostats on hot water heaters have been lowered to prevent scalding. I would recommend a pot of boiling water to be added to the hot cycle to raise the water temperature. If it is not practical to wash certain types of the bedding, like an expensive down comforter, place it in a bag and put it in the freezer overnight.

3. Remove unnecessary objects from the walls and ceilings.

4. Keep stuffed animals to a minimum. Only let your child sleep with teddy if it can be washed every week in hot water. All other stuffed animal companions should be kept in a closed toy chest.

5. Use window blinds that can be wiped rather than curtains.

6. Remove carpeting, if possible. If your children are allergic to dust mites, they should be encouraged to play on title or hardwood floors.

7. HEPA filters are also used, but I don't recommend them. These "air cleaners" don't do much and are very expensive. Spend your money on dust mite covers; you'll get more bang for your buck.

These steps may seem like a lot of effort, but it will be worth it if you or your child suffers from a dust mite allergy.

Scientific Evidence for Avoidance
There is good scientific evidence that dust mite avoidance works. A number of studies have been published linking the development of nasal irritation congestion (allergic rhinitis) as well as allergic asthma to dust mite exposure. More importantly, research shows that avoiding dust mites will decrease allergy symptoms.

Most of the studies demonstrating the efficacy of dust mite avoidance have involved people with severe asthma. One study, for example, took children with severe asthma caused by dust mites and placed them in an aseptic clinic in the Swiss Alps for six months. All of the children had a dramatic improvement in their asthma symptoms. However, upon returning to their homes, their symptoms returned.

Similar improvements have been reported for dust-mite-sensitive asthmatics who lived in hospital rooms for an extended period of time. This means that if you are allergic to dust mites, your bedroom should be modeled after a hospital room: plastic mattress, tile floors, plastic furniture, and very little clutter. In addition, all of the bedding in a hospital room is washed in extremely hot water every day.

Although dust mites are everywhere, a few simple environmental measures can dramatically improve your allergy and asthma symptoms as well as decrease your need for medication. Dust mite avoidance is the safest and among the most effective ways to treat allergies.

Close Browser/Window To Return To The Main Menu