Walking through the park on a sunny spring day, playing with your pet dog, or eating peanuts at a baseball

game represent some of lifes greatest pleasures. However, each of these activities can turn into uncomfortable, or even life-threatening, events if you happen to be allergic. The allergic diseases have a tremendous impact on society, as they are among the most common of all medical conditions and continue to increase each year. During the past 20 years of clinical practice, including work at an academic medical center as well as a private practice, I have diagnosed and treated a large number of patients with these diseases. As my patients learned to live with these chronic disorders, they challenged me with questions, ranging from why they had their particular problem to what the best cure might be. In this book, I present the answers to these questions, based on my experience and lessons learned from the worlds scientific literature. Part One addresses general issues regarding allergic diseases, focusing on definitions of these diseases, what is responsible for recent increases in prevalence, and who is most susceptible to developing them. Part Two turns to the topic of nasal allergy. This section is the largest in the book, as it covers an extremely common condition and one that many patients attempt to treat on their own. The first set of questions revolve around the diagnosis of nasal allergy, including a review of the substances that cause allergy as well as which diagnostic tests are most accurate. This is followed by an analysis of existing therapies, ranging from over-the-counter medications to alternative treatments to therapies offered only by allergy specialists. This section goes on to discuss disorders that often coexist with nasal allergies, such as sinusitis and nasal polyps, as well as1.What The word allergy refers to a reaction to an environmental substance, either by breathing it, eating it, or having contact with the skin. The most common mechanism by which an environmental substance causes this kind of reaction involves antibodies, which are proteins formed by the immune system. The normal function of antibodies is to protect the body from infection by attacking and killing organisms like viruses and bacteria. In the case of allergy, the antibody is called immunoglobulin E, or IgE, and, rather than attaching itself to microorganisms, the antibody binds to normally harmless substances like pollen, dust mites, and animal danders. Once IgE is formed in the bloodstream, it seeks out and binds to a type of cell called a mast cell, which is located in the mucous membrane of the eyes, nose, lungs, and gastrointestinal tract as well as skin. If the person is then reexposed to that same allergen, the mast

is an allergy?

cell is triggered within a few minutes to release a variety of chemicals, including histamines, leukotrienes, and prostaglandins (Table 1). These chemicals, which are also referred to as mediators of the allergic response, are responsible for the symptoms that patients develop after exposure to allergens.

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100QUESTIONS&ANSWERSABOUTALLERGIES

Allergy A type of hypersensitivity reaction to environmental substances caused by IgE antibodies. Antibody A protein formed by the immune system that helps protect the body from infection and is also responsible for certain types of hypersensitivity reactions. Immunoglobulin E (IgE) The antibody that is responsible for allergic responses. Mast cell A type of tissue cell rich in histamine, which is the major cause of immediate allergic reactions. Histamine A compound released during allergic reactions that causes capillary dilation, smooth muscle contraction, and sensory nerve stimulation. Table 1 Chemicals Involved in Allergic Reactions Leukotriene A family of lipid molecules, which are released during allergic reactions and whose most prominent effects are tissue swelling and bronchoconstriction. Chemical Target Organ Effects
Histamine Nose, eyes, lungs Nasal itch, sneezing, nasal discharge, itch and redness, wheezing

Leukotriene D4 Nose, lungs Nasal congestion, discharge, wheezing Prostaglandin D2 Nose Nasal congestion, eye itch, wheezing

8.How can I tell if I have allergies or colds?

Symptoms of allergies and colds can be quite similar, but there are some differences that will help distinguish them (see Table 3).With regard to the types of symptoms, both allergies and colds cause symptoms of sneezing, congestion, and runny nose. However, colds are more likely to begin with fever and sore throat before the gradual onset of these other symptoms, while in allergic rhinitis, these symptoms come on quickly without any fever or throat pain. Specific symptoms may vary as well; colds often cause a yellowish discharge by the seventh day of the infection, while allergies are much more likely to cause thin, watery nasal secretions. In addition, itching of the eyes and nose may be very prominent with allergies but virtually absent with a common cold. With respect to the duration of symptoms, colds generally last from 5 to 7 days, whereas allergy symptoms continue as long as a person is exposed to the allergycausing agent. In addition, allergy symptoms may subside soon after elimination of allergen exposure.