AAaa...aaa...choo!
Ah, the sound of allergies, accompanied with a runny nose, itchy, watery eyes and other unpleasant problems. When your sneezing is incessant, and loud enough to make a bobblehead wobble, these probably don't feel like mild symptoms. And some allergies are no sneezing matter, since severe reactions can lead to death if not treated immediately.
"Allergies are a sensitivity to certain antigens, such as pollens, tree, grass, weed pollens, dust mites, molds, pet dander, at least on the environmental side," says Chad McCormick, a physician at St. Joseph's Ear, Nose, Throat & Allergy Clinic in Post Falls.
There are also allergies to foods including dairy products, eggs, and of course, nuts.
So how do you know exactly what's causing your symptoms?
"As far as absolute testing we do allergy skin testing, and that way we have accurate results, and we have them right away," says David McGarry, a physician at Advanced Allergy, Asthma & Immunology, located in Spokane Valley. "Within 15 minutes we can know if somebody is allergic and make a plan immediately."
For skin testing, a pricking device with a small needle tip on the end is used to scratch the skin (barely breaking the surface) with an allergen to see if a reaction, similar in appearance to a mosquito bite, occurs.
"Historically people have had to use lots of needles or things like that," McGarry says. "But now we don't have to use those sorts of things because some of the testing devices they're a lot more pain free."
Sensitivity or Allergy?
Some people have an actual food allergy, while others have a food sensitivity. Here's the difference: Dietary allergies can cause immediate, life-threatening reactions. The symptoms include everything from hives to shortness of breath to "a sense of impending doom" — which is when someone feels like they're going to faint (and not the sense that the world is about to end).
Food sensitivities or food intolerances, on the other hand, don't cause anaphylaxis — a severe life-threatening reaction — but may come with a whole host of other unpleasant effects. These include abdominal pain, nausea, bloating and sometimes diarrhea. People who are lactose- or gluten-intolerant fall into the food sensitivity category.
McGarry cautions people against spending money on over-the-counter genetic tests since they're expensive, and tend to focus on food intolerance or sensitivity and not on actual allergies. Worse, the results are often inaccurate.
Treatment Advances
For those suffering from true food allergies, which can be severe, doctors now have a couple novel treatments to offer.
"There are new medications called biologics that can be very helpful," McCormick notes. He warns that they can be expensive, sometimes costing $30,000 or more a year and are not always covered by insurance.
These biologic medications are injected and work to decrease the patient's reaction to an allergy, something that can dramatically improve a patient's quality of life.
A biologic medication called Xolair decreases the risk of anaphylaxis in patients with food allergies. It's a maintenance medication, not a cure, and it works to prevent allergic reactions, not to treat them when they're occurring. Approved for patients 1 year old and older, Xolair is injected every two to four weeks. It's usually administered in an allergist's office due to the risk of an allergic reaction.
There's also good news for treating reactions, especially for people who hate needles.
"Even bigger though, and is a complete change, is what's called nasal epinephrine or 'Neffy,'" says McGarry. "They can now use a nasal epinephrine spray so it avoids them needing to use an epinephrine injector."
Neffy is used for "anaphylaxis due to bee stings or food allergies," McGarry says. "This is something that's completely new."
The FDA approved Neffy in August 2024 for adults and children weighing at least 66 pounds. Neffy is used in situations where someone would normally use an EpiPen. So, if you've ever hesitated to use an EpiPen because of the needle, there's now a less traumatizing option.
Immunotherapy offers the opportunity for long-term change in how someone reacts to allergens and may, in some cases, even eliminate their allergies altogether.
Immunotherapy takes the form of giving the patient a series of shots or oral drops that correspond to various allergens.
McCormick warns that the treatment carries some risk because of the possibility of inducing anaphylaxis, so it has to be administered in a controlled setting, like an allergist's office, where a patient can receive immediate help if there is a serious reaction. The process of desensitization requires many office visits and takes from three to five years. It is often covered by insurance.
"Environmental allergy immunotherapy — where we're giving them allergy shots — nearly 80% of people will be able to sail off into the sunset, live happily ever after, and not have allergy symptoms anymore," McGarry says.
Regrettably for people with food allergies, immunotherapy doesn't offer a cure, though it can reduce the body's response to the allergen.
If you suffer from allergies and the right treatment hasn't come along yet, don't give up.
"It's a very exciting time," McGarry says. "There's lots of research. There's these new products that are available, and there's going to continue to be new things that are available."
Allergy Season
If you're noticing your allergies last longer than usual, you aren't the only person still sneezing.
"As we see environmental changes, changes in weather patterns," says David McGarry, a physician at Advanced Allergy, Asthma & Immunology, located in Spokane Valley, "allergy seasons are longer and a little bit more severe."
"In North Idaho, Eastern Washington," says Chad McCormick, a physician at St. Joseph's Ear, Nose, Throat & Allergy Clinic, "the pollen seasons can start even in late February for tree pollen and can go through early June. Grass pollen can go from April into July. Wheat pollens generally from July through October.
"Indoor allergens and perennial allergens — which are the dust mites, molds and pet danders — are year-round, but sometimes worse in the winter months when we all go inside because of the cold weather," he notes.
Why are Allergies on the Rise?
Even better than being treated and tested for allergies would be avoiding them altogether, if possible. Unfortunately, we're heading in the wrong direction. "We don't understand why food allergies are more common than they've ever been," says David McGarry, a physician at Advanced Allergy, Asthma & Immunology.
One theory on why this may be happening is called the hygiene hypothesis.
"Fifty years ago or more, there was probably a lot more outdoor activity. For kids, playing in a sandbox, in a playground, getting dirty," says Chad McCormick, a physician at St. Joseph's Ear, Nose, Throat & Allergy Clinic in Post Falls. Today's kids may be less likely to experience all that on a regular basis. "The thought is that if people aren't getting their immune system stimulated by being outdoors and exposed to things, that the immune system sometimes just doesn't develop perfectly well and can result in an increased incidence of allergies, which we're clearly seeing."
Though pregnant women were once instructed that avoiding certain foods could decrease the likelihood of future allergies for the child, that advice was rescinded in 2008, when research showed that children of women who frequently consumed peanuts and tree nuts were actually much less likely to develop nut allergies than those whose mothers who didn't.
Similarly, avoiding exposing children under the age of 1 to some food products, like peanut butter, in an effort to avoid future allergies is also no longer what doctors recommend.
Instead, thinking has dramatically shifted. "Introduce things on an earlier basis when [age] appropriate," McGarry says. "Don't shy away from them, and if there's a concern, discuss it with a pediatrician. If the pediatrician has a concern, then they'll refer the patient to an allergist for further evaluation."
But exposure to potential allergens, indoors or out, still isn't a guarantee that someone will become allergy-free.
"At the end of the day, there's those families and individuals that are going to be allergic and those that are not. A lot of that is genetic," McGarry says.
