The Burden of Allergic Disease
We as providers can do better for our patients with allergies and asthma.
Allergies are one of the most common diseases afflicting our country– approximately 40% of the US population suffer with allergic rhinitis. In Florida, allergic rhinitis is more common because of our temperate climate. In Burlington Vermont, I practiced for 4 years. Seasons are shorter and patients symptoms were relieved after months. Here, patients have symptoms year round. Common seasonal allergens, including grasses, trees, and weeds, are sustained and therefore our patients suffer longer with more severity. After relocating to Florida, I was thoroughly surprised how severe, how early and how often my patients suffer from their allergies. I now regularly care for 2 year old children with moderate to severe allergic rhinitis; something uncommon in Vermont.
Primary care providers are dealing with many medical issues, such as uncontrolled diabetes and hypertension, which can lead to severe co morbid conditions and mortality. With all the changes to medical reimbursement, there is increase pressure to see more patients and time is of the essence. Understandably, many providers may not be able to completely address their patient’s allergic rhinitis. However, uncontrolled allergic rhinitis certainly leads to a decrease in quality of life and often results in other complicating conditions such as recurrent otitis media, uncontrolled atopic dermatitis, and asthma exacerbations.
One such consequence is the affect on sleep. Sleep is absolutely fundamental to our physical and mental health. Up to 60% of patients feel their sleep is being adversely affected by their allergies. Many studies have demonstrated how allergies detrimentally affect our sleep. It appears nasal congestion is the leading reason for insomnia, micro-awakenings, fatigue, and overall decreased quality of sleep. Lower quality of sleep causes decreased learning ability, decreased work productivity, and a resultant decreased quality of life. Additionally, uncontrolled allergic rhinitis is significant risk factor for sleep apnea. I strongly believe sleep disturbance from asthma, atopic dermatitis, and/or allergies is an indicator of uncontrolled allergies and we should be routinely asking our patients if their asthma or allergies are affecting their sleep in order to take the proper steps to improve their health.
Likewise, at least 30% of allergic rhinitis sufferers have asthma with a significant component of reversible obstruction. Therefore providers treating children with allergic rhinits should ask questions about chest tightness, cough, and wheezing, such as asking parents if their children with rhinorrhea or congestion, cough with exercise or at night. Patients often do not equate these symptoms with asthma because they have never had an asthma “attack”. Each diagnosis requires a very detailed history and often spirometry is needed to confirm the diagnosis of asthma.
In our office, Dr. Rosenberg, Dr. Jacinto, and I educate our patients on the symptoms of their asthma and allergic rhinitis and discuss the definition of control, the etiology, identifying triggers which often include allergens, and finally determine the ideal treatment options for each patient. Encouraging patients to be proactive in their treatment and resolving issues with compliance are key to being successful in control of allergies and asthmatics. Fortunately, treatments, such as immune modulators and allergy immunotherapy, make it possible for effective treatment of allergies and asthma and subsequent improvement in our patients’ quality of life and health.
Food Allergy. A Growing Problem
Food Allergy is on the rise. I have a special interest in the diagnosis and treatment of food allergy. Food allergy is on the rise therefore more questions are being asked. One possible reason for the increase in food allergy is the “Hygiene Hypothesis” The following is a simplistic view on the hygiene hypothesis. Our IgE, our allergic antibody, is now bored in industrial societies because there are less infections to fight. Instead of spending time fighting parasitic infections, IgE spends its time fighting seemingly innocous antigens such as peanut protein and environmental allergens such as mold spores and pollens. There has also been a increase in awareness which could be playing a role in increase rate of diagnosis. As the prevalence and incidence increases research moves rapidly in pathophysiology, diagnosis, and treatment.
We are learning more everyday. In the past we thought delaying highly allergenic foods such as peanut could help delay the developement of food alelrgy but this is not the case. We now do not tell parents to avoid particular foods if there is no history of food allergy.
The average person does not distinguish between food intolerances and IgE mediated food allergy. The diagnosis becomes more complex and it is our job at Allergy and Asthma Associates of Central Florida, to arm our patients with the accurate information. The first step is determining if in fact there is an IgE mediated food allergy and this starts with a very detailed history of food ingestion, symptoms and the temporal relationship between the two. If a misdiagnosis of a child occurs, the child could be unecssarily avoid a particular food, develop food aversions, and can develop anxiety surrounding the diagnosis. The diagnosis of food allergy can lead to a great deal of anxiety on the family as well. Because food allergy can be deadly causing angioedema or anaphyalxis, parents often become anxious about sending their children to school, going out to dinner, or going to someone house to play. It is my mission to appropriately diagnosis patients and address all surrounding issues. One such way to make the proper identification of food allergy is through percutaneous skin testing which is more sensitive and specific than RAST testing. In certain cases a food challenge is neccesary to rule out food allergy. This is done in a very controlled environment with close observation but it allows for the diagnosis to be ruled out and for patients and their families to feel certain it is safe for ingestion of foods in question. If the diagnosis of food induced anaphylaxis, urticaria, or angioedema has been made Dr. Rosenberg, Jacinto and I provide action plan and arm our patients with a life saving epinephrine auto injectors. We want our patients to fully understand their diagnosis.
At Allergy and Asthma Associates, we can make an impact on those who suffer from atopic and immunologic disease.
By Harleen Anderson
Harleen Anderson, MD, is a graduate of Tufts University. She is board certified in allergy and immunology as well as Internal Medicine. She completed her training at Albert Einstein University in New York, New York with an emphasis on pediatric allergy and immunology. She has participated in numerous research trials has presented complex cases at many national conferences. She is active in her community in raising awareness of food allergy and asthma and is on staff at Florida Hospital. She is committed to providing expert care for her patients. Dr. Anderson currently practices at Allergy and Asthma Associates of Central Florida located at1890 SR 435, Suite 215, Winter Park, FL and can be contacted at (407) 678 4040 or by visiting www.aaacfonline.com