Cary, RN

Allergy Overview

I have gotten several questions about allergies. Allergies are really complex. That’s why there are entire fields of medicine, research, and drugs devoted solely to this one topic. I’m going to do my best to give a simple overview, and then if I haven’t answered a question to your satisfaction, let me know and I’ll get more detailed.

Allergy symptoms are caused by an immune response to an invader. Colds and flu have similar symptoms, because it is a similar mechanism. Virus, bacteria, pollen or other allergens enter the body, the body says, “Oh, I don’t think so. Get out of here.” The body releases histamine, usually at the entry point, so if you breathe pollen, for example, you develop respiratory symptoms; if it is something you eat, you might have gastrointestinal symptoms or a whole body systemic reaction.

The immune response due to allergies is an overreaction. In most cases, the food, pollen, or other invader is not a serious threat, but your immune system decides it is. No one is 100 percent sure why this happens in some people and not others. It is thought that the problem is partially genetic, and there are some theories about allergies increasing due to fewer immune challenges when we are infants because we live in relatively clean houses and eat and drink cleaner things than we used to as a species. Then if our immune systems encounter any little thing, they freak out.

There are a lot of medications you can take for allergy symptoms, both prescription and over the counter. Many antihistamines cause drowsiness, even the ones that are labeled non-drowsy, so always test them on yourself at home first rather than at work. Decongestants can make some people really hyper, especially kids. Read the labels on both types of drugs carefully, because there are warnings if you have high blood pressure or arrhythmias, as well as glaucoma and a couple of other things.

Antihistamines are the meds that actually help decrease allergy action. Decongestants are more for treating symptoms. Together they can be really helpful if they are safe for you.

Cats. I had a cat allergy question. There are no truly hypoallergenic cats. Some people will tell you this or that hairless cat or cat with less dander is hypoallergenic, but many of the allergies to cats are allergies to a compound in cat saliva. Cats bathe in their saliva, so they’re pretty much covered with it. Weekly cat bathing can help with this, and if you start when they are kittens, they usually don’t mind it that much. However, a lot of bathing can dry out the cat’s skin, so you have to keep that in mind.

If you have allergies to pets in your home, keep them out of the bedroom. Keep things clean, because skin cells and dander can hang around in carpet or dust. Use an electrostatic furnace filter, and run the fan all the time even when the heat or air conditioning is off to help keep the allergens down.

Allergy shots are another treatment for chronic allergies. They help some people a great deal, but they don’t help everyone. They are often given on a weekly basis. Sometimes an allergy is too severe for the shots to be safe.

Allergies can start when you are a kid, and you can grow out of them, or not. They can start any time as an adult. You can be stung by a bee today and not have a reaction, and tomorrow get stung again and have anaphylaxis. The first sting could sensitize you. That goes for any allergen. It is fairly common to develop new allergies in your late 20s or early 30s. Again, no one is really sure why that is.

The best way to know what you are really allergic to is to be tested. There are several ways to do that: the old scratch test, where you have umpteen labeled poke spots with allergens scratched into your skin, the patch test which is less invasive and not always as accurate, and RAST testing which is a blood test that looks for immune reactions to allergens. The fastest, cheapest, and many say the most accurate is the scratch test.

A personal lesson: for years I thought I was allergic to cottonwood trees. When the fluff went flying through the air, I was always miserable. But after testing, we found out I was allergic to something less obvious that blooms at the same time. So sometimes what you think is an obvious connection and a clear allergy really is not.

Allergies can be life threatening. That’s anaphylaxis. This is most commonly heard of related to bee stings, peanuts, and shellfish allergies. People carry epi-pens to self-inject when they’ve been exposed. Sometimes you have to have steroids to settle down a bad allergic reaction as well.

Anaphylaxis usually starts within minutes, with numbness and tingling around your mouth, hives, itching, flushing or paleness, vomiting, diarrhea, a weak and rapid pulse, dizziness or unconsciousness, and your tongue and throat can swell so rapidly you can’t breathe. These symptoms mean you call 911 (or whatever is your emergency number), do not drive yourself to the urgent care or wait to see if it gets better.

Allergies can be mild and annoying or life threatening. When in doubt, always check in with a health care professional.

Some resources:

National Institute of Allergy and Infectious Diseases

Medline Plus

Mayo Clinic

CPT 2 Deficiency Question

We had an infant (approx 9 mos old) that had become restless and the mother was en route to the Dr with it when it became unresponsive.  By the time they had got to the nearest hospital it was DOA.  This is the first time that any of us at the PD had heard of this, I was just wondering if you have ever had any dealings with it.

I have not personally dealt with this, but I have had adult patients with rare metabolic disorders on occasion. There are a zillion different types of genetic metabolic enzyme deficiency problems, and this is one of them. I read up a little to answer you, including the link that you sent, so this isn’t a medical explanation so much as a translation from medicalese to American English. I’m about to oversimplify, so if you are a medical person reading this, please bear with me.

A baby born with this deficiency cannot process fats properly, including fatty acids created by her own body. Your body uses glucose (sugar) for fuel. Glucose is quick energy and is required for brain function in particular. Because it is quick energy, you also use it up kind of fast, which is why you have to eat often rather than say, once a month.

If you haven’t eaten a meal for a while, your body uses fatty acids as fuel. Your body breaks them down into usable form with enzymes. If you are deficient in the enzyme you need to break the fatty acids down, your body and especially your brain will be starving for energy. An extremely low blood sugar can put you in a coma because your brain stops functioning. It has no fuel. That is what happens when you use up the glucose and can’t use the fatty acids.

Your brain and body don’t want you in a coma, so if there is no glucose and no breakdown of fatty acids, your body will start breaking down muscle tissue. Even on a cellular level you want to survive. So your body says the next thing to try eating is muscle, and basically starts shredding it into bits. This is called rhabdomyolysis. Rhabdo, as we lazy people call it, is not that uncommon as metabolic problems go. It can happen to marathon runners, and is an adverse effect of some cholesterol drugs. (Thus the warning about calling your health care provider if you have severe muscle pain, etc.)

When you start shredding muscle for energy, your body has trouble processing it. In an oversimplified manner of speaking the muscle fibers get stuck in your kidneys like pieces of yarn. Your pee turns red, your muscles are breaking down, and your kidneys start to fail because they are full of shredded muscle. Your brain still isn’t working right because you can’t metabolize all this crap properly and turn it into sugar to keep that brain fed.

The baby may have died from a super low blood sugar, or from kidney failure poisoning the body, or both. You can live a fairly normal life with this CPT 2 if you never have a crisis. But if the baby slept all night or went an extra long while between meals, her brain and/or kidneys may have just shut down and it may have happened too fast for anyone to realize what was happening. Parents don’t even always know if the baby has this deficiency. It can go undetected. It isn’t even known for sure how common the deficiency is, because it is not always diagnosed.

I hope that helped explain it for you. For everyone else, this is your link, and here is another that I found. Thanks for sending me the question! I always like to learn something new.

Health Care Provider Selection

How did you find your primary health care provider? Do you even have one?

In the US, most people choose a provider based on location. That means you put your most valuable asset, your health, in the hands of someone because they are the most convenient to your home or work. Most of you ask your insurance company or a friend or neighbor or a hospital website which doctor or nurse practitioner is closest to you and you put your life in his or her hands without any other information.

Are you crazy?

There are a few things you can do to get basic information on a potential provider. The hospital website look up can be helpful, because not only will you find out who is affiliated with the hospital you are most comfortable with, but often the site will tell you where the provider went to school, when he/she graduated, and what type of practice they have.

Another thing to check is whether the person you are considering has a license in your state, and whether complaints have been lodged against them. Most states now have online medical provider license look up capability. You can search nurse, doctor, chiropractor, nurse practitioner, physician assistant and every other category of licensed health care professional. In Illinois, this list is maintained by the Department of Financial and Professional Regulation. These sites often state whether a complaint has been filed against a professional.

If you are going to a specialist, find someone who is board certified in their specialty. Orthopaedic surgeons, rheumatologists and dermatologists are a few examples of specialists who should be board certified. This means they have gone through extra education: classroom, clinical, and work experience and were then tested to achieve this certification. Nurses have specialty certifications as well. It indicates a professional is passionate enough to go through the time and trouble to get certified, and demonstrates a level of knowledge and competency that is important.

Use all the tools at your disposal when choosing a health care provider. Your life may well depend on your selection.

Medical and Financial Assistance Programs

As the US goes through the current recession and the health care industry continues to spasm while we work toward some sort of meaningful reform, many of you have financial issues intertwined with medical difficulties. There are programs out there to help you. Some of them offer free or low cost medical care or medication, others give emergency rent or utility assistance or even assist with car repair, still others help by providing case management services to help you protect your job in case of chronic illness or disability.

These resources are free. Most of them require you to share your financial details, because they are in place to assist those who need help the most. But they are worth looking through if you are living on the edge. You will have to fill out forms, and when you feel down and out you may feel it isn’t worth the trouble. But it is. Set aside some time in the morning or whenever you feel the most energetic and together, and do a little digging through these sites. You may find help for something you thought no one would help you with.

The first site is called 211. Many cities have a 311 number for information on things like warming and cooling centers and other public health information things. 211 has resources for those needing assistance due to low income, no insurance, not enough insurance, senior care, and other related issues.

Just go to the site, enter your zip code, and there will be a drop down menu for services like dental care, emergency rent assistance, among many others services in your specific area.

Another great resource that you may have to look at to understand just how it can help you is the Patient Advocate Foundation. They can lead you to resources to help you find assistance with paying for medications and treatments, dealing with work or being unable to work, supportive type organizations and all kinds of good stuff. They have free case management services as well, and one of the things they can do is help you protect your job while you deal with chronic health problems. Take a few minutes to dig through the website. It will be well worth your time. They have lists of resources for people with and without insurance.

Please send me an email or leave a message here on the site if you have a specific question.