Allergies and the Family

Allergy is a hypersensitivity to an allergen, a normally harmless substance: in an allergic subject an

allergen may cause an untoward reaction when it comes into contact with the skin or the eyes, is

inhaled, eaten or injected. When an allergic individual comes into contact with specific allergens,

his/her immune system identifies them as dangerous invaders and overreacts. It triggers the release

of histamines and other chemicals, whose task is to expel allergens from the body. The symptoms of

an allergic reaction are precisely the results of the body’s attempts to turn away the allergen: these

symptoms may affect the eyes, nose, lungs, throat, ears, sinuses, skin and/or mucous membranes.

Managing allergy can be very challenging for a patient and his/her family, but by making healthy

behaviors the norm, allergy attacks can be prevented or controlled. The entry focuses on the

measures which can be taken in the family in order to identify allergens, prevent and control allergy

symptoms.

Managing Allergies

In the United States as many as 40 to 50 million people suffer from allergies, and 54.6% of all

inhabitants test positive to one or more allergens. Current research suggests that the prevalence of

allergic diseases has increased since the 1960s, becoming a major public-health concern. Allergies

may affect the nervous, respiratory, digestive, integumentary, and genito-urinary system. The most

common symptoms are: itching in the eyes, redness, swelling, watering; sneezing, coughing,

shortness of breath, wheezing, chest tightness; bloating, nausea, vomiting, diarrhea; skin rashes and

swelling; pain associated with urination, urinary frequency.

Many factors may predispose a subject to allergies: genetics, birth-related factors (for instance

preterm birth, or birth in a high-pollen season), environmental factors (continuous exposure to high

pollen quantities, industrial pollution, dust, insects and/or other allergens, or vice-versa over-

sanitation).
When clinicians diagnose allergy they take into consideration many clinical features (e.g. the

patient’s symptoms, his/her family’s history for atopic disorder), evaluate results of physical exams

and tests, and rule out other diagnoses. For this reason, it is essential that the patient (if a child,

his/her parents, guardians or caregivers) provide the doctor with detailed information about the

symptoms and other events which may be linked with them (e.g. specific illnesses, presence of pets,

dust mites, molds, cockroaches, pollen, insects bites or stings, ingestion of specific food and/or

beverage, assumption of medications).

Correct strategies to cope with allergies are: identifying the allergens which cause allergic reaction,

avoiding contact with these allergens, and consulting a healthcare provider, in order to make an

action plan which can help in preventing or reducing symptoms. The action plan may include

suggestions for healthy behaviors (such as wearing a bracelet which alerts people about the

subject’s allergies) and prescriptions for medications. Allergy medications may comprise

antihistamines, decongestants, bronchodilators, mast cells stabilizers, corticosteroids, leukotriene

modifiers, and epinephrine as emergency medication. If the symptoms of a chronic allergy are

severe, an allergist/immunologist may recommend immunotherapy. In allergen immunotherapy the

patient receives increasingly larger doses of an allergen, with the aim of reducing or suppressing

his/her immune response to it. The administration may be sublingual or subcutaneous.

Allergy attacks can be very serious: anaphylactic shock is a life threatening allergic reaction, whose

symptoms include swelling of the tongue and breathing tubes and consequent difficulty of

breathing, low blood pressure, loss of consciousness. As serious allergy attacks require immediate

emergency treatment, patients need to be able to prevent or at least control allergy symptoms as

much as possible.

Improvement of Indoor Air

An important aspect of allergy prevention and control is the improvement of indoor air quality in

the patient’s home. This goal can be achieved by:

- running the air conditioning when the pollen count is high, and opening windows only after

midmorning

- changing the air filter in the air conditioner and the air furnace once a month

- using polyester-fill pillows and hypoallergenic blankets, and washing them in hot water once a

week

- removing upholstered furniture and carpets

- washing bedding and curtains in hot water weekly

- reducing the number of dust-collecting objects (e.g. books, non-washable stuffed animals, knick-

knacks, houseplants)

- using a vacuum cleaner with a high-efficiency particulate filter once a week

- avoiding humidifiers, repairing water leaks in faucets, pipes, and ductwork, and using clothes

dryers and exhaust fans in order to limit exposure to mold and damp

- avoiding wood fires or ensuring that the doors of wood-burning stoves fit tightly

- finding another home for warm-blooded pets, and selecting low-dander pets, in order to control

animal dander

- sealing holes in walls, floors, and cabinets, storing food in airtight containers and covering trash

cans, in order to limit exposure to cockroaches

Other Measures Aimed at Preventing and Controlling Allergies

Moreover, in order to prevent and control allergies, the patient's family should support him/her in

- identifying food which causes him/her allergic reactions, in order to avoid or limit its ingestion; in

the majority of cases, foods responsible for allergic reactions include wheat, eggs, peanuts, tree

nuts, soy, fish and shellfish, some fruits

- identifying beverages which cause him/her allergic reactions, in order to avoid or limit their

ingestion; in the majority of cases, beverages responsible for allergic reactions include wine, some

fruit juices, milk

- avoiding or limiting contact with nickel-containing metals (present in jewelry, clothing, money,

articles as kitchen utensils and paper clips)

- avoiding or limiting exposure to pollen

- avoiding raking leaves, mowing lawns, working with peat, mulch, hay, or dead wood

- avoiding or limiting contact with and exposure to latex

- limiting assumption of medications as paracetamol, aspirin, beta blockers, penicillins,

cephalosporins

- undergoing allergen immunotherapy, for the purpose of achieving clinical tolerance of the

allergens which cause him/her symptoms

-- taking his/her medication as prescribed.

Alessandra Padula

See also: Asthma Family Issues: Prevention and Control; Chronic Health Problems and

Interventions for the Childrearing Family; Family Histories in Acute and/or Chronic Illness; Food

Allergies and Family Experiences; Immunizations and Vaccinations.

Further readings

Arbes, S.J. Jr., Gergen, P.J., Elliott, L., Zeldin, D.C. (2005). Prevalences of positive skin test

responses to 10 common allergens in the U.S. population: Results from the Third National Health

and Nutrition Examination Survey. Journal of Allergy and Clinical Immunology, 116 (2), 377-83.

Greenberger, G. (2006). Drug allergy, Journal of Allergy and Clinical Immunology, 117 (2),

S464-70.

Grimshaw, K.E.C. et al. (2009). Infant feeding and allergy prevention: a review of current

knowledge and recommendations. A EuroPrevall state of the art paper. Allergy, 64 (10), 1407-16
 Hogan, D.J. (2009, July). Contact Dermatitis, Allergic. eMedicine Dermatology [Online].

Retrieved April 3, 2010, from http://emedicine.medscape.com/article/1049216-overview

Kelkar P.S. and Li J.T.C. (2001). Cephalosporins Allergy, The New England Journal of

Medicine, 345, 804-9.

Primeau, M.N., & Adkinson, N.F. (2001). Recent advances in the diagnosis of drug allergy.

Current Opinion in Allergy and Clinical Immunology, 1(4), 337-41.

Toogood J.H. (1987). Beta-blocker therapy and the risk of anaphylaxis, Canadian Medical

Association Journal, 136(9), 929-33.

U.S. Department of Health and Human Services – National Institutes of Health (2003,

April). Airborne allergens: Something in the air. National Institute of Allergy and Infectious

Diseases. NIH Publication No. 03-7045. 2003. [Online]. Retrieved April 3, 2010, from

http://www3.niaid.nih.gov