Doesn’t it seem like everyone today is allergic to something? We wanted to find out what’s going on. So we sought advice from an allergist. Naturally, we went to the best, Dr. Eli Silver, a pediatric allergist and immunologist at University Hospitals Rainbow Babies & Children’s Hospital in Cleveland, Ohio.
Q: What are the most common allergies?
Silver: For seasonal allergies: oak pollen in the spring, grass in the summer, and ragweed in the fall.
Q: And food?
Silver: Milk, egg, peanut, tree nuts, fish, shellfish, soy, and wheat.
Q: Do you see more seasonal allergies than food allergies in teens?
Silver: Yes, because by adolescence, most teens have outgrown food allergies, though some, like peanut or nuts, might not disappear.
Q: Why do seasonal allergies seem to get worse as our kids get older?
Silver: Allergies are perpetrated by the immune system, and as the immune system matures with age, the allergies become stronger. Environmental allergies, like seasonal allergies, are likely to increase. On the other hand, allergic reactions to food often decrease. Many kids outgrow their food allergies.
Q: Has there been an increase in allergies overall?
Silver: Definitely in food allergies. Peanut allergies have doubled in last ten years. There is an increase in all food allergies, but peanuts get the most airtime because allergic reactions to peanuts tend to be more severe.
Q: Are over-the-counter medications a good way to treat seasonal allergies?
Silver: They are good, but they only mask the symptoms. They don’t really address the underlying problem. The OTC medicine blocks the effects of the chemicals, like histamines. But, there are other chemicals that can make you quite miserable that OTC medicines don’t treat. And there are side effects, though they tend to be fairly mild and may include drowsiness, nosebleeds, or eye irritation.
Q: Are allergy shots effective?
Silver: For 85 percent of patients, the shots eliminate the allergy. In my practice, I give shots for one year. If the patient feels remarkably better, then I continue the treatment for three to five years. If, after one year, there is no improvement, we stop. Allergy shots are especially effective (95 percent) for cat allergies. That said, most teens do not elect to take shots.
Q: When it comes to testing for allergies, what’s better—skin tests or blood tests?
Silver: Both are important and measure different things. The skin-prick test is more sensitive and the blood test is more accurate. I often use both. The skin test can tell whether there is an allergy, but the blood test can measure the severity. A positive skin test does not mean that you are necessarily allergic because the immune system sometimes finds ways to disarm the allergic antibodies. For example, a child can outgrow a milk allergy and eventually drink milk without a problem, but the allergy test may remain positive for the rest of his life. It is not uncommon to find children who are sensitized to milk, but they drink it all the time without any issues.
Q: What is the difference between food allergies and intolerance?
Silver: The difference depends on whether the immune system is involved. If you can’t digest milk, you have an intolerance. If you get a migraine when you drink wine, that is an intolerance. But, if you get hives after you eat chocolate, that is an allergy. Regardless, you need to see a doctor to determine the root of the problem.
Q: Why is it so important for teenagers with serious allergies to carry epinephrine auto injectors?
Silver: They are very important. If the allergic reaction is severe, like anaphylaxis, a dose of epinephrine from an epinephrine auto injector buys time. The shot gives your teenager a chance to get to the hospital. Epinephrine auto injectors are especially important for teenagers because the risk of death from food allergies is higher than for younger kids.
Q: What is the most commonly used epinephrine auto injector?
Silver: The EpiPen no longer dominates the market. The Auvi-Q injector is much smaller and more inconspicuous. It fits in the back of the jeans pocket. Auvi-Q injectors also provide a verbal prompt: they coach you on how to give the injection.
Q: What is anaphylaxis?
Silver: Anaphylaxis is an allergic reaction that spans multiple organ systems (respiratory, skin, digestive tract) and may include wheezing, swelling, and vomiting. The reaction may begin gradually and progress over time. Any of the symptoms could be a sign of anaphylaxis and so we need to minimize the delay in treatment. Because of the severity of anaphylaxis, the teen, parents, and physician should develop a food allergy action plan.
Q: Why do teenagers have more severe allergic reactions?
Silver: There are several factors. The immune system is stronger, so the allergic reaction can be stronger. For example, the risk of dying from a bee sting is much higher after the age of 16. Another reason is that teenagers engage in risk-taking behaviors. They may be less vigilant about avoiding an allergen. Lastly, teenagers may forget to carry their EpiPen.
Q: Do you worry about eczema?
Silver: 80 percent of kids outgrow eczema by the time they are six years old, so teenagers who still have eczema are more severe cases. Eczema starts with a disruption of the skin barrier. When the skin barrier is disrupted, allergens can get through. Once you seal the skin barrier, allergens can’t get through any more. The most important treatment focuses on building the skin barrier with medicated lotions and moisturizing creams.
Q: Is it important to treat eczema?
Silver: It is what it is. If it doesn’t bother the teen, then it doesn’t bother me. I would let the teenager’s decision prevail.
Q: Can you build a tolerance by introducing small amounts of an allergen?
Silver: There is an approach called oral immune-therapy (OIT) that is showing excellent results. Many teens have undergone the OIT and are now able to eat peanuts, tree nuts and any other food allergen and report this therapy to be life changing.
Q: What is the role of parents in an office visit?
Silver: Teens come in my office with their parents. But in order to have an effective treatment plan, the teen needs to be a partner in that plan. I ask the teen how they feel about the medication and whether the plan is realistic. When the teen doesn’t agree to the plan, the plan is ineffective. The best office visits are the ones in which the teen is asking the questions and the parent is just listening.