101 Hints and Tips
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"The practice of allergy has become overly complicated and complex, says Dr. Bookman. It’s essentially a very simple subject, and unfortunately, some of its most effective treatments have been all but forgotten".
Here, then, are a number of those treatments, tips, explanations and opinions culled from a series of interviews and from Dr. Bookman’s excellent book, The Dimensions of Clinical Allergy (Charles C. Thomas, publisher; 1985).
We’re extremely pleased to be able to bring you this small sample of Dr. Bookman’s wisdom as a special treat.
1. Thresholds "Even when people are allergic to a substance, there is a certain level they can tolerate before symptoms will appear. Exceed that ‘threshold’ and up pop the symptoms". "Most people already understand that the same amount of pollen can bother one allergic person and not another. What they often fail to understand is that thresholds can also vary widely in the same person from one day to the next".
2. Nobody ‘Outgrows’ Allergies "The lifetime of the allergic individual is one in which symptoms will wax and wane in intensity and shift from one part of the body to another. This shifting of symptoms is poorly understood and leads many people to mistakenly believe that one can ‘outgrow’ their allergy symptoms".
3. Example: Eczema "An example is the child with a severe case of incredibly itchy eczema who suddenly improves without apparent reason". "The most recent symptom of the child’s allergic nature — the eczema — has disappeared, but it is invariably replaced by another allergy symptom. In most children, the shift is from eczema to nasal symptoms". "But the parents and physician are generally so relieved that the eczema is gone that they don’t even notice the runny, stuffed-up nose that wasn’t there before!"
4. Irritants, Not Allergens "A large number of non-protein substances like Kleenex, paper dust, paint fumes, perfume, newsprint and cigarette smoke are erroneously called allergens, but they’re not. They do produce symptoms in many people, but it’s because they’re irritating, not allergic".
5. Bake Your Paper "Newsprint is a problem for some people because of irritative solvents in the ink. Problems only occur with freshly printed papers and can be avoided simply by putting new papers into an oven set on very low heat for around 20 minutes or so".
6. Growing Up Allergic "An infant’s first exposure to proteins is primarily through foods, which is why food allergies are so common in allergic infants. As the infant grows, his ‘protein world’ expands, and he begins to react to the indoor allergens he’s inhaling". "Exposure to pollen generally comes later, which is why outdoor allergies rarely appear in children before the age of 3. As the child grows older, the food allergies so common to infants gradually disappear — only to be replaced by inhalant allergies". "The food allergies weren’t outgrown — they were replaced!"
7. Positive Reactions Not Positive Proof "The first thing that happens when an allergic person inhales, ingests or physically contacts an allergen is that they become ‘sensitized’ to it. All that means is that their body now recognizes that substance distinctly — it doesn’t mean that exposure is going to cause them to experience symptoms". "But it will cause them to react to that substance when skin tested. These positive reactions tend to convince people that they’re allergic to many more things than they really are".
8. To Understand Allergy, Look Beyond The Symptoms. "In medical school you learn to look for the cause of a disease based upon the location of its symptoms. But allergy is not a disease — it’s an inherited condition that cannot be understood from the medical school point of view". "It doesn’t matter if the symptoms show up in the nose, chest, eyes, ears, skin or somewhere else — the problem isn’t in that one area. Allergy is a lifelong condition that affects the entire individual".
9. Where’s Your ‘Dial’ Set Today? "Generally these changes occur gradually during a person’s lifetime. Without changing a thing around them, some people’s sensitivities to one substance can all but vanish, while other allergies will reappear after years of absence". "I like to say that the ‘dial setting’ of their allergic responsiveness has changed. Most times, this occurs slowly and subtly, but some events can cause immediate changes in a person’s ‘dial setting’".
10. Shots And Sickness Work The Same "Allergy injections don’t get rid of your allergy to a substance — they raise your threshold, so that you can tolerate more of the substance before you experience symptoms". "But a virus will have almost the same effect, temporarily. It’s not unusual to see allergic skin lesions clear or respiratory symptoms disappear during a virus attack. Surgery or a major trauma, such as breaking a bone, almost invariably shuts down allergy symptoms as well".
11. Allergy Symptoms: There Are Only Three "When you do exceed your threshold, symptoms appear. All allergic symptoms are a combination of three basic effects, and nothing more". "There is edema (swelling), particularly of the skin and mucus membrane. There is an increase in the secretion of mucus, especially in the respiratory tract. And there is spasm of smooth muscle where smooth muscle exists".
12. Swelling Tops The List "Edema is the most common result of an allergic reaction, but the actual symptoms it produces depend entirely upon the area where the swelling occurs. In the upper respiratory tract, for instance, swelling can cause nasal obstruction or sinus obstruction, close the ear’s Eustachian tube, or cut off a person’s sense of smell by obstructing their olfactory recess". "Edema near the larynx causes ‘allergic hoarseness.’ In the trachea it leads to an irritating cough. In the bronchial tree it causes asthma".
13. The Most Serious Edema "If you’re lucky enough to have your allergic edema show up in the nose, you can always breathe through your mouth. But when the same edema is experienced in the bronchial tree, there aren’t any breathing alternatives". "That, in a nutshell, is why asthma is so serious".
14. Eczema? Just Abused Edema "The only allergic response the skin can have is edema. It doesn’t have smooth muscle and it can’t secrete mucus". "Atopic dermatitis — or eczema — always begins as simple edema. But most doctors never see the swelling that occurs at the beginning of the condition because the intense itching (caused by the stretching of the skin) makes people tear away at the area and really scratch it up".
15. Smoke: Not Allergic "A lot of people claim to be allergic to tobacco smoke, but the large molecules necessary for an allergic reaction can’t survive the burning heat of a cigarette". "There are cases of true tobacco allergy, but they always involve physical contact with the raw leaf. Cigarette smoke can make you cough, sneeze and wheeze, but it’s not an allergy and allergy treatments won’t prevent it or clear it up".
16. Alcohol Augments Allergies "Alcohol is also not an allergen. But it does act to congest the nasal passages. In someone with allergic rhinitis (a runny, stuffed-up allergic nose) it adds to the edema already present due to allergies". "Some people with allergies are unable to drink at all because of the intense nasal congestion that alcohol produces. I sometimes wonder if a lot of hangovers aren’t the result of alcohol-induced sinus blockage".
17. Allergies And Emotions "It has been a tedious burden to have to constantly explain that emotions have no effect whatsoever on allergy symptoms — especially to people who are absolutely convinced this is true because they read it somewhere or heard it on TV. I am far more impressed by the effect that allergy symptoms have on a person’s emotional state. People who think that allergic symptoms are the result of emotional problems obviously have the cart before the horse! A nose that’s blocked up constantly day and night can’t help but cause a person to be irritable and lessen their ability to cope with life and its daily problems".
18. Pollen Alone? "Probably Not . . ". "Close questioning of patients who insist that they only have seasonal complaints invariably reveals that most of them are not completely symptom-free the rest of the year. Their year-round symptoms may be minor — occasional sneezing, a productive cough, some slight nasal stuffiness — but they are there if you look for them". "These people obtain much more relief when they’re treated for both their year-round (indoor) allergies and pollens than when treated for pollens alone".
19. Too Much Dander And Nothing Works! "The amount of dander deposited on a home’s rugs and furniture by a pet is usually far greater than allergy injections can overcome. The shots won’t help until the pets are moved outside and the dander has been cleaned out of the rugs and furniture".
20. Skin Test Tips "You can’t predict the severity of a person’s symptoms by their skin tests alone. I often see large skin test reactions in people with mild hay fever and small reactions in people who have severe allergy problems. And not all people with allergic disease react when skin tested. Occasionally you’ll see a person with a classic history of spring hay fever whose skin tests are negative. Such people generally respond well to injections of the pollens that are in the air when their symptoms are worst".
21. Seniors Can Be Skin Tested "Some doctors claim that elderly people don’t react at all when skin tested. This is just not so. Older people tend not to flare (the redness that appears around a positive skin test), but the wheal (the actual hive-like welt that springs up when a test is positive) can be read if you look at it in oblique light and feel around to determine its size".
22. When Not To Test "It’s pretty much useless to skin-test someone when their asthma symptoms are severe or when they’re recovering from surgery or other trauma. Just as these conditions temporarily relieve allergy symptoms, they also shut down skin test responses. If you want to really learn what you’re allergic to, wait till you feel better".
23. Bad Marks In History "Taking a person’s history accurately is more important in allergy practice than in any other medical specialty. Many people’s allergies go undiagnosed simply because most doctors don’t ask enough questions, don’t know the right ones to ask and don’t know which answers actually point to a diagnosis of allergy".
24. Medical Forms Miss The Mark "Forms interfere with getting a good idea of a person’s medical history for two reasons. First, they’re created by doctors, using terms that doctors are familiar with but that many patients aren’t. You get a lot of wrong answers simply because most people are going to misunderstand at least some of the words on the form. Second, all forms, no matter how carefully they are written, are extremely rigid in structure. This prevents a doctor from learning of unusual events that may be important for correct diagnosis".
25. Doctors: Ask More Questions!" "A doctor should always ask a patient what they mean when they say they ‘have a lot of colds’ or when they complain of frequent infections. Are these really infections, or just short-term worsening of the person’s allergic symptoms? Most doctors think that the only allergy symptom is sneezing, and if you don't sneeze you don't have allergies. People in cold climates will often report having lots of colds and infections in the winter. The real problem is that they’re spending more time indoors — surrounded by indoor allergens".
26. How To Catch A Mouth Breather" Don’t bother asking people if they’re mouth breathers, because they’re just going to say no. Ask them instead if they wake up with a dry mouth or a sore throat in the morning — both are sure signs of mouth breathing! Hot drinks will relieve the problem quickly".
27. Not All Seasonal Allergies Are Pollen "Steer manure, a popular springtime lawn fertilizer, contains copious amounts of cattle dander, which is a very potent allergen. Because it’s generally only applied in the spring or fall, people often mistake the seasonal symptoms as an allergy to pollens".
28. If The Plant Is Pretty, Don’t Worry "Many people tend to look at a colorful field of flowers as a producer of airborne pollen. But those bright colors are there to attract insects, which carry the heavy pollen from plant to plant. In most cases it’s safe to say that flowers whose blossoms are easily visible and colorful are insect pollinated and won’t cause problems".
29. Pets — Or Pollen? "Cats and dogs that are allowed to roam often play in grassy and weed-strewn areas, where they can pick up quite a bit of pollen in their pelts. The only allergen in cat saliva is dander. Cats are always licking themselves and their saliva is heavily contaminated with the skin scales they’re licking off! Some people who think they’re allergic to pets are actually reacting to the pet borne pollen and not to the pet".
30. Minor League Symptoms Can Cause Major League Fatigue "Constant low-grade allergy symptoms can often be more detrimental than symptoms that are severe, but occasional. Constant, annoying symptoms can really wear away at a person’s sense of well-being. They can destroy their ability to get a good night’s sleep or concentrate at work".
31. Goat Hair? In The White House? "Most people have a lot more animal dander in their environment than they realize. If they have a true Oriental rug, for instance — one actually made in the Orient — then it is certainly loaded with sheep, goat and camel dander. President Reagan tells me he feels much better when he’s at Camp David than at the White House, and I’m not surprised. The White House is full of antique furniture stuffed with animal hair. When someone plops down in one of those old chairs or overstuffed couches, a ton of dander comes blowing into the room. Camp David has all new furniture. And new furniture isn’t filled with dander".
32. Wool Worries "Good quality domestic wool is processed to be dander-free; it is not allergenic. However, it is irritating to many people — and not just those with allergies. Wool from third-world countries is not treated after it’s taken from the animal. This kind of wool can contain a lot of dander and cause serious allergy problems".
33. Outdoor Pets Are No Problem "Pets that remain outdoors at all times can be dismissed as an allergy problem. In fact, the pet itself isn’t the problem at all — it’s the dander that saturates the carpets and furniture, especially in the bedroom, that causes constant, annoying symptoms. But be warned — removing a pet won’t show benefits for a long time; you have to get rid of the leftover dander first. Vacuuming the carpet daily for a month will remove it, and the room will remain dander free as long as the pet never enters again".
34. Women’s Mucus "Women are often relieved to hear that it is not unusual for vaginal mucus discharge to increase when traditional allergy symptoms are most troublesome. This is especially true of seasonal allergy reactions, and it’s a perfectly normal allergy symptom".
35. Is All Asthma Allergic? "Almost everyone in the medical community looks at bronchial asthma and allergic rhinitis (hay fever) as separate and distinct entities. I look at them both as manifestations of respiratory allergy. After all, the same mucus membrane lines the respiratory tract from top to bottom, and the changes that occur in the nose and sinus in allergy are virtually identical to the changes that occur in the bronchial tree during an asthma attack. When you look at the similarities of the conditions instead of their differences, I think you can treat the patient better".
36. ‘Sudden Onset Allergies’ Were Always There "A lot of people will claim that their allergy symptoms have suddenly appeared after a lifetime without allergies. In almost every case, careful questioning will reveal that allergy symptoms may have been minimal and tolerable, but were certainly there in the past. This is important because true allergy doesn’t just suddenly appear".
37. ‘Frequent Colds’ Are Frequently Allergies "Physicians’ offices are filled with patients complaining of frequent colds. It is unfortunate that these people’s symptoms aren’t recognized for what they are: allergic rhinitis that would respond well to specific allergy care. I’ve had patients tell me that they only have two colds a year. But when I question them, I find out that the first ‘cold’ tends to last as long as the spring pollen season, while the second coincides perfectly with the fall pollen season!"
38. Cold Or Allergy? "A cold is an upper respiratory infection, and it displays the typical symptoms of infection: low grade fever, purulent nasal discharge and a general malaise that lasts from 3 to 5 days. It also has a tendency to be transmitted from one family member to another. Continuous episodes of sneezing with a watery nasal discharge, nasal obstruction and head congestion accompanied by a sense of fatigue that lingers for weeks or longer can be reasonably assumed to be allergic".
39. A Little Swelling Can Make A Big Impact "Several areas adjacent to the respiratory tract have one thing in common: They’re so small that very little edema (swelling) is necessary to obstruct them. These include the middle ear and the olfactory recess, which controls our sense of smell. When episodes of sinus pain, middle ear problems and loss of sense of smell occur, look to allergy as the cause".
40. Sinus Infections? Open Up The Nose! "Sinus obstruction is a common result of edema in this crowded area. When the obstruction blocks the mucus flow completely, the stagnant mucus becomes a breeding ground for bacteria. As soon as the obstruction is removed (by a combination of allergy therapy and decongestants), the mucus flow is restored and the condition quickly resolves itself".
41. Allergic Deafness "This is a condition frequently seen in children and, less often, in adults. Fluctuations in the deafness are a clear signal that allergies may well be the cause. The problem is due to sporadic edema of the middle and inner ear. Children who go through varying periods of inattentiveness and withdrawal are often experiencing this intermittent allergic deafness".
42. All Septums Are Deviated! "No biological entity has a body part that is ruler-straight, therefore no one has a perfectly straight septum! They all deviate from the vertical to some degree. The only effect of a deviated septum is to make one nasal passage larger and the other smaller. There is no real effect on total airflow. When swelling occurs, the smaller one will quite naturally block before the larger one, but the final effect on airflow is the same as if both sides were equal".
43. Leave It Bent "I see little reason in most cases to straighten septums, and the temporary improvement you see after straightening is the same allergy-deadening effect you can expect from any surgery. The swelling and obstruction generally return in a few weeks — after your body recovers from the trauma of the surgery".
44. That Stuck-in-the-Throat Feeling "Some people with postnasal drip will develop swelling in an area of the throat called the uvula. Because this area has little sensory discrimination, the swelling feels as if there’s mucus trapped there that can’t be dislodged. Drinking ice water will reduce the swelling and eliminate that feeling of trapped mucus".
45. Allergic Hoarseness "Many people with allergies often experience a painless hoarseness. Look down their throat and you’ll find swelling and pallor rather than the red, ‘angry,’ painful inflammation caused by overuse. Using an epinephrine inhaler (like Primatene Mist) eliminates the edema causing the problem. People who use their voice professionally — singers, actors, announcers, and yes, even the President — often experience gratifying results when they use such an inhaler before speaking or singing. But it won’t help if the problem is non-allergic and just due to overuse".
46. Allergic Vertigo "The term ‘Meniere’s Syndrome’ refers to a poorly understood condition where the patient suffers from recurrent or chronic vertigo (dizziness). You can’t say that the condition is due exclusively to allergy — there are many other causes. But when upper respiratory allergy symptoms are also present, there’s a chance that allergy therapy designed to affect the nose and chest may also ease the vertigo".
47. Antihistamine Advice "If there were one or two reliable antihistamines that worked for everyone, the rest would evaporate and be forgotten. But that, of course, is not the case — their effectiveness and side effects are different in everyone. Patients should be given small starter packs so they can find the antihistamine that works best for them. They should also avoid driving until they are certain of how drowsy a specific antihistamine makes them. Some produce such a powerful sedation that they may help an allergic patient not so much by controlling their symptoms, but simply by helping them get a good night’s sleep!"
48. And A Warning. . . . . . "Antihistamines function well in allergy partly because of their drying effect. But in asthma, the reverse — hydration — is necessary for the control of symptoms. Therefore, antihistamines should never — I repeat, never — be used when asthma symptoms are present. I prefer to use decongestants instead".
49. Decongestant Dependence "There is no question that it is possible to get ‘hooked’ on a nasal decongestant. ‘Addicted’ patients generally have a spray at home, one in the car, one in the office and one in their pocket or purse that they use every hour or so. These are the people most at risk of the ‘rebound’ effect. There is always some ‘rebound’ in the form of nasal swelling with the use of these products, but for most people, the effect is barely noticeable. Abusers, however, can experience severe swelling as the area becomes irritated from constant use of the drug".
101 Tips for Allergies & Asthma Relief continued ....
