Lizbeth Salazar knows all about allergies. At best, they can spell misery. Itchy, watery eyes. Runny nose. Nasal congestion. At worst …
“I was visiting a relative who had a cat and I ended up at Baptist [Hospital],” said the 32-year-old medical assistant. “It was that bad.”
Allergies are our immune system’s abnormal reaction to a usually harmless substance in the environment. Allergens tend to be common items — pollen, mold, animal dander, dust mites — but our body’s response isn’t.
When people are exposed to an allergen by inhaling it, swallowing it or getting it on their skin, the body produces an antibody called IgE to bind the allergen. These antibodies then attach themselves to a type of blood cell called a mast cell, found in airways, intestines and elsewhere. These mast cells, in turn, release certain chemicals into the blood, principally histamine, which cause most of the symptoms in an allergic reaction.
In warm, humid South Florida, where grasses and trees grow year round, allergens are plentiful. In other words, there’s a price to pay for the great weather.
“Our weather tends to make allergies worse,” said Dr. Viviana Sirven, an allergy and asthma specialist with West Kendall Baptist Hospital. “Patients come in all the time and tell me, ‘I’m like the weatherman. The weather changes and my symptoms start acting up.’ ”
Allergies are more common than people think. The American Academy of Allergy, Asthma and Immunology estimates that more than 50 million people nationwide have allergies. Some suffer the symptoms needlessly, without realizing they can get relief from the irritating, and sometimes dangerous, symptoms. Many also confuse allergies with the common cold.
“The symptoms of an allergic reaction can be almost identical to a severe head cold,” said allergist Viviana Temino, assistant professor of clinical medicine at the University of Miami Miller School of Medicine. “Patients sometimes think they’re catching a lot of colds or not getting over them and what they have is an allergy.”
But there ARE differences between the pesky cold and the peskier allergic reaction. A cold will eventually go away. Allergies won’t — at least not permanently and not without treatment.
Allergy testing performed by an allergist, a pediatrician or internist with at least two additional years of special training in allergies, asthma and immunologic disorders, is the surest way to determine the difference and launch a patient on a treatment path.
“People present with different symptoms,” explains Kfir Shamir, an allergist at Broward County’s Memorial Hospital, “so it’s very important to properly identify what’s causing the reaction.”
Before ordering any test, an allergist will begin by performing a physical examination and taking a medical history. “Allergies do have a genetic component,” says Temino. “It runs in families, but it may not be manifested in the same way. “
Allergists use two kinds of tests — skin and blood — to detect allergies, but skin tests are more common because results are immediate. They also tend to be more accurate.
Skin tests have been around since the 1860s and are considered the gold standard. These can be administered two different ways. In a prick (or puncture) test, a diluted allergen is applied to the surface of the skin. With an intradermal test, a very thin needle injects a diluted allergen just below the skin surface. With either test, the skin serving as the test site is observed. A raised, red, itchy bump indicates an allergy. The larger the bump, the greater the sensitivity.
A prick/puncture test is usually done first. If these tests turn out negative but the allergist still suspects allergies, the intradermal skin test, which is more sensitive, is then performed.
Blood tests for allergies are more of a second resort instrument. They’re more expensive and it can take up to two weeks for the physician to get back results. What’s more, they occasionally give back a false positive. But blood tests can be an important option when skin tests might be unsafe or won’t work, such as when a patient has a skin disorder or is taking medications that might interfere with the results.
Testing is essential for a treatment plan because “the first thing we need to find out is what is causing the symptoms,” Shamir said. “Only then can we tailor treatment to the patient.”
Salazar’s skin tests, for instance, showed she was allergic to “pretty much everything,” from weeds to dust mites to cockroaches. She also has asthma. Though she was controlling her asthma, her allergies worsened when she moved here from New York City, so Sirven, her doctor, put her on a regimen of allergy shots to desensitize her to the offensive allergens. Additionally, she took Xolair, an injectable medicine to reduce the number of asthma attacks in people with allergic asthma who display symptoms even when taking inhaled steroids.
“I still have some episodes, but they’re not as aggressive and they don’t trigger my asthma,” Salazar said. “People don’t realize what a relief it [treatment] can be. It feels awesome.”