misc.kids FAQ on Allergies and Asthma (part 1/4)

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Misc.kids Frequently Asked Questions -- Allergies and Asthma
General Information -- part 1/2
Revision 1.4


This FAQ is intended to answer frequently asked questions on allergies and
asthma in the misc.kids newsgroup. Though the comments are geared towards
parents of children, there is plenty of information for adults as well.

The information in this FAQ is the collected "net wisdom" of a number
of folk. It is not intended to replace medical advice. None of the
contributors are medical professionals. Most of us either have
allergies/asthma or have relatives/children with asthma/allergies, so
this collection represents the experiences and prejudices of individuals.
This is not a substitute for consulting your physician.

To contribute to this collection, please send e-mail to the address
given below, and ask me to add your comments to the FAQ file on
Allergies and Asthma. Please try to be as concise as possible, as
these FAQ files tend to be quite long as it is. And, unless
otherwise requested, your name and e-mail address will remain in the
file, so that interested readers may follow-up directly for more
information/discussion.

This FAQ is posted regularly to news.answers and misc.kids.info.

For a list of other misc.kids FAQ topics, look for the FAQ File Index
posted to misc.kids.info or tune in to misc.kids.

Collection maintained by: Eileen Kupstas Soo
)
This page last modified: April 8, 1997

Copyright 1996-7, Eileen Kupstas Soo. Use and copying of this information are
permitted as long as (1) no fees or compensation are charged for
use, copies or access to this information, and (2) this copyright
notice is included intact.



FAQ Overview:

General Information Part 1/2 -- this page
General Information Part 2/2
Allergy and Asthma Resources

Allergy and Asthma Book Reviews
Allergy Recipes





New material is marked by the | symbol.
new information on rashes, hives, and eczema
new allergy cookbook review

Topic Index:

0) Disclaimer
1) What to look for to suspect allergies

1.1 foods
1.2 inhalants (hayfever)
1.3 asthma
1.4 rashes, hives, and eczema
1.5 insect stings
1.6 children vs. adults -- INCOMPLETE
1.7 views of allergies

2) Allergy treatment

2.1 doctors
2.1.1 why to see an allergist
2.1.2 becoming your own (or your kid's) doctor - TBD
2.2 testing
2.2.1 blood
2.2.2 "scratch test"
2.2.3 elimination diet
2.3 medications
2.4 desensitization (injections)
2.5 avoidance and environmental changes
2.6 children vs. adults - INCOMPLETE

3) Foods

3.1 in general
3.2 milk
3.3 gluten (wheat and other grains) -- INCOMPLETE
3.4 allergy cookbooks
3.5 unknown food allergies
3.6 anaphylactic reactions -- when to call 911 immediately

the following topics are in General Information Part 2/2

4) Insect sting allergies
5) Inhalant allergies
6) Contact allergies (contact dermatitis) and chemical sensitivities
7) Asthma
8) Specific advice on allergies and asthma in children
9) Allergies in relation to ADD and autism
10) Personal stories

Other files:
FAQ Home Page
General Information Part 2/2
Allergy and Asthma Resources
Allergy Recipes




Contributors (in no particular order):


Amy Uhrbach )
Rebecca Crowley
Curt McNamara
Eileen Kupstas Soo
Kate Gregory
Pete TerMaat
Susan Fiedler
Tom O. Barron
Aiko Pinkoski
Donna Kannemann
Andrea Kwiatkowski
Lynn Short
Don Wiss
Tammy Schmidt
Deanne Carp
Lindsay Schachinger
Charlotte Noll
Lisa S Lewis
Tanya Heikkinen
(Please let me know if I missed anyone!)




0) Disclaimer
The information in this FAQ is the collected "net wisdom" of a number
of folk. It is not intended to replace medical advice. None of the
contributors are medical professionals. Most of us either have
allergies/asthma or have relatives/children with asthma/allergies, so
this collection represents the experiences and prejudices of
individuals. This is not a substitute for consulting your physician.



1) What to look for to suspect allergies

Contributors:

Amy Uhrbach )
Eileen Kupstas Soo )


1.1 What to look for - food allergies

Food allergies range from very mild to life-threatening. The mildest
symptoms are vague itchiness in the mouth and throat. Other mild to
moderate symptoms:


- general itchiness
- hives or rash, sometimes all over body
- runny/itchy nose and eyes
- recurrent earaches
- nausea and vomiting
- diarrhea


Some foods can cause a life-threatening anaphylactic reaction. The
mouth, throat, and bronchial tubes swell enough to impede breathing.
The person may wheeze or faint. Often there are generalized hives
and/or swollen face. This is an emergency!! As anyone would, call
your doctor or 911! For breathing trouble or loss of consciousness,
call 911 immediately. See also the sections on insect stings and
anaphylatic reactions.

One severe allergic reaction to food puts you at risk for more.
Discuss with your doctor what to do for repeat reactions.

Common food allergens:

- peanuts: This is often life-threatening.
Call a doctor for
ANY reactions to peanut products! (Peanuts can be a
hidden ingredient in a number of foods.)
- soy --
again can be a hidden ingredient in a number of
foods.
- fish and/or shellfish;
in some people, these reactions can be
severe, ranging from extreme nausea to breathing
difficulties. Watch carefully and call 911 for any
breathing problems.
- berries
- peppers
- milk proteins
(less common than you'd think - most people are
intolerant not allergic).
- wheat (and gluten), as well as some other grains (corn, rye)
- eggs
- many reactions have unknown cause!


Interestingly, some common food proteins are similar enough to
ragweed to cause reactions in sensitive people. These include bananas
and melons.

Allergic reactions may progress from mild to severe, so keep track of
any reactions.

Food allergies may be amount-sensitive. That is, you don't feel the
reaction until you've ingested a certain amount; however, severe
reactions may occur with ANY tiny amount of allergen. This is
especially true of peanut allergies.

1.2 Inhalants

The most common inhaled allergen is dust! More precisely, dust mites
and their wastes (every house has them, no matter how clean).
Other:

- mold
- pollen (ie. hayfever)
- animal dander (especially cats)
- chemicals
- perfumes


Most common symptoms:

- CLEAR runny nose and sneezing
- itchy or stuffed nose
- itchy, runny eyes
- lethargy
- asthma

Symptoms are generally worst in the early morning, for 2 reasons:

1. pollen counts are highest
2. you've been sleeping for hours in a room filled with dust
and/or mold


1.3 Asthma

On asthma: Not all people with asthma have allergies.
Roughly 5% of the population lives with asthma.

A generally accepted definition of asthma is that it is a
disease that is charaterized by increased responsiveness
of the trachea (windpipe) and bronchi (main airway) to
sometype of trigger that causes widespread narrowing of
the airways that changes in severity either as a result
of treatment, or spontaneously.

Acute asthma is what we generally refer to as an asthma
attack. The bronchial tubes suddenly narrow, and the person
is acutely short of breath, and (sometimes) wheezes. An
acute attack may require medical stabalization in a hospital
setting; unless special equipment, medication, and help is
available in the home.

Chronic asthma produces symptoms on a frequent basis, in some cases
almost constantly. It is characterized by frequent symptoms, ranging
from very mild symptoms to full-blown acute attacks. Chronic asthma
generally requires daily medication, and may require the use of oral
steroids, in addition to other medications.

On doctor's: Allergists are not the only physicians who
treat asthma. Pulmonologists are also medically specialized
physicians who treat many people who have asthma.

Not all asthma is triggered by allergies. Not all allergies cause or
develop into asthma.

One main asthma trigger in children is illness. Typically a child has
his first attack 1-2 days after the onset of a respiratory illness.
Symptoms:

-wheezing (no wheeze may mean WORSE asthma, sometimes)
-elevated breathing rate (normal under 25 breaths per minute;
over 40 is cause for calling doctor. Test your child's
normal rate when well, so you can tell when breathing
is elevated. Remember: These numbers are just
ballpark!
-coughing, especially early morning
-longer expiration than inspiration
-retraction


Asthma and reflux often co-occur, although it's not known what the
relationship is.

Attacks may build over days (as with illness-induced) or hit within
seconds. Generally, the more triggers present, the worse the attack.

In little kids, asthma is often misdiagnosed. Many little kids with
recurrent bronchial illness really have asthma. Of particular note is
"cough variant" asthma, in which the main symptom is coughing,
especially early morning. My allergist's rule is "If ventolin [an asthma
medication] helps, it's asthma," no matter what it's called.

| New
1.4 Rashes, hives, and eczema

Allergies can show themselves through various skin reactions. The
main reactions are rashes (small bumps or larger red patches), hives
(also called urticaria; itchy, red raised patches on the skin),
or eczema (also called atopic dermatitis; an itchy, weeping rash).
These symptoms can have various causes. Most often it is allergies, but
some people get hives from heat, cold or sun exposure.

Contact allergies/dermatitis is defined as a skin rash caused by direct contact with a
substance to which the skin is sensitive. Symptoms include a red
rash, swelling, and itching. In more severe cases, blisters can form.
Many substances can cause allergic contact dermatitis: poison ivy and
other plants (such as tomato plants), wool, perfumes and dyes (in
soaps, detergents, lotions, etc.), metals (in jewelry, hair clips,
etc.), locally applied medicinal ointments such as antibiotic creams,
and latex (often used in latex gloves). These can occur at any age
and can appear at any time. It can take years for a sensitivity to a
particular substance to develop, so "I've used this for years" isn't
a reason to exclude anything from the possible allergen list.
Symptoms may appear as soon as 7 to 10 days from first contact. Once
a sensitivity develops, however, the reaction can occur in 24-48
hours.

Treatment of contact dermatitis generally consists of avoiding the allergen. To
determine whether or not something is the cause, patch tests (a small
amount of the substance applied to the skin, then covered and left for
24 hours) can often show whether or not that substance causes the
reaction.

Other allergies can cause rashes, too. Some find that citrus fruits cause
small raised bumps when ingested.

Eczema is often caused by a food allergy, though there may be other
causes. Cow's milk is a particularly common allergen for those with
eczema. Avoiding allergens provides long-term relief, while short-term
relief can be had by using moisturizers on the skin and taking antihistamines.
Some find that using all cotton clothing and bedding makes a difference.

Hives can be caused by a number of factors, not just allergies. Hives
occur suddenly and may end suddenly, though there are chronic cases
where hives are present for a month or more. Other causes of hives are sun
exposure, heat and cold. Again, avoidance is the primary treatment.

1.5 Insect stings

Various insects can cause allergic reactions. Wasps, honey bees,
hornets, yellow jackets and ants are the insects most likely to cause
strong allergic reactions. Some biting insects (mosquitoes, flies,
lice, kissing bugs and fleas) can cause allergies as well because they
inject saliva to thin the blood when they bite. Finally, some
caterpillars are covered with hairs that contain a substance irritating
to human skin and this can sometimes cause allergic reactions.

In general there are three kinds of reactions to insect stings. The
first kind, normal reactions, involve pain, redness, swelling, itching,
and warmth at the site of the sting. The second kind, toxic reactions,
are the result of multiple stings. Five hundred stings within a short
time are considered likely to kill because of the quantity of venom
involved. As few as ten stings within a short time can cause serious
illness. Symptoms of toxic reactions include muscle cramps, headache,
fever, and drowsiness.

Allergic reactions are the third type. They may involve some of the
same symptoms as toxic reactions, but may be triggered by a single
sting or a minute amount of venom. Any non-local reaction to a single
sting should be considered allergic until proven otherwise.

Allergic reactions may be local or systemic. An allergic reaction is
considered local if it involves only the stung limb, regardless of the
amount of swelling. A slight systemic reaction may involve hives and
itching on areas of the body distant from the sting site as well as
feelings of anxiety and being run down. A moderate systemic reaction
may include any of the above plus at least two of edema (swelling),
sneezing, chest constriction, abdominal pain, dizziness, and nausea. A
severe systemic reaction has the symptoms already described plus at
least two of difficulty in swallowing, labored breathing, hoarseness,
thickened speech, weakness, confusion, and feelings of impending
disaster.

The most serious symptoms are the closing of airways and shock
(anaphylaxis) since they can be fatal if not treated quickly and
effectively. Allergic reactions may begin within ten to twenty minutes
after the sting or they may be delayed. Usually, the sooner the
reaction starts, the more severe it will be.

1.6 Children vs. adults -- differences

Allergies can show themselves in a number of ways -- runny noses, ear
infections, digestive disorders, irritability, hyper- and hypo-
activity, and such. Adults are often more sensitive to "not feeling
right" than children are, so look for indicators such as changes in
behavior or chronic/repeated sickness the corelates to exposure to
various substances (foods, air-borne particles, chemicals, etc.).
Recurrent stomach aches, never-ending ear infections, or changes in
bowel habits may indicate that an allergy is present. In infants,
colic, formula intolerance, frequent spitting up, and low-grade fevers
can be signs of allergies. Note that allergic reactions will not occur
on first exposure to the allergen; they require that initial
"priming." Some may occur on second exposure, while others may take
repeated exposure to develop.

For infants, breastmilk is the safest food, in terms of allergies.
Some children are allergic to or intolerant of cow's milk, soy
formulas, and such. The best advice is to experiment until you find
what works for your child. (Some mothers report that the mother's
consumption of cow's milk will cause a reaction in a breastfed
child; this has been confirmed by medical experts, so you may need
to check this if your child is breastfed. References to this and
other infant issues are given at the end of section 8. )

When a child is born, the intestinal track is not fully developed.
Some foods may cause a reaction in babies that will be outgrown as
the child matures. The safest course is to introduce new foods one
at a time over an extended period (say, one food per week) and see if
the child has an allergic reaction. Postponing the introduction of
common allergens (wheat, cow's milk, corn, eggs) and favoring the
introduction of almost-always-safe foods (rice, apples, bananas) is
one sensible approach.

For older children, allergies can have any of the symptoms above. If a
child is extremely reluctant to eat a particular food, there may be an
allergy problem that shows up as a stomach ache (common in milk
intolerance) or other non-visible way. On the other hand, while most
children will avoid foods which make them really sick, some may NOT
make the connections when the allergy is mild. So parents need to
listen to the child and use common sense and detective abilities to
help determine the problem.

Children may outgrow some allergies, or at least become less sensitive
to some allergens. Parents may want to retry foods after a long
period. NOTE: if the allergy is a severe one, do NOT retest the
food on your own! Do this only under the supervision of your doctor!
For less severe allergies, you can first test the allergen by rubbing
a bit on the child's wrist (inside) and see if a skin reaction occurs. If
no reaction occurs, let the child try a very small amount of the
food. Again, if no reaction occurs, let the child try a slightly
larger amount. The child may never be able to eat a lot of the
food but may be able to tolerate small amounts after a "rest"
period away from the allergen.

1.7 Views of allergies

There are a number of views about allergies. Most doctors agree
that not all allergies are "all or none"; you may be able to tolerate a
certain amount of an allergen without reacting. Once you exceed a
certain amount, your body reacts. NOTE: this is not true of all
allergens, especially peanuts and shellfish, which may cause quick,
life threatening reactions. For some allergens, any amount is too
much!

Your doctor may use various metaphors when discussing allergies. Most
have to do with some threshold amount of allergens that a person can
tolerate. Once this amount is exceeded, allergic symptoms appear. (
One common term is "glass of resistance" -- once the glass is full, you
react). The amount of allergens tolerated can depend on a number of
things: stress levels, the particular allergen, the combination of
allergens, illness, etc. As time goes on, an allergy sufferer can
determine just how much, if any, of what is ok. For food allergies,
some recommend a rotation diet in which various foods are eaten in
rotation so that no one food is ever eaten more than once in a
three-to-five day period. (The food juggling gets very complicated, but
some find that the rotation diet helps them. The best thing to do is
read about it [see references section] and decide for yourself.)



2) Allergy treatment

Contributors:

Amy Uhrbach )
Eileen Kupstas Soo )



2.1 Doctors: see an allergist!

For both asthma and allergies, a doctor in general practice may not
recognize allergies. Some doctors do recognize and treat allergies
while others do not. An allergist (sometimes listed as "Allergies and
Immunology") specializes in this particular area and are up-to-date (we
hope!) on treatments. As with any doctor, it is good to get
recommendations from your doctor, friends, or professional
orgnizations. If you are not comfortable with one allergist, try
another. For children, there are allergists who specialize in pediatric
allergies or advertise that they treat children. Though any allergist
can treat adults or children, it sometimes helps to have one who
definitely *likes* children and respects the differences between adults
and children.

ASTHMA: Pediatricians seem reluctant to use the term asthma. This
bugs my allergist (and me), because he feels it precludes proper
treatment sometimes. If you see any asthma symptoms and are poo-pooed
by the pediatrician, see an allergist! This seems most often the case
with an allergic kid who coughs every morning. I've heard MANY stories
of pediatricians who, at most, tell parents to use an antihistamine
(worse, cold medicine; worst, don't worry). Then the child ends up in
acute distress in the hospital!

Allergists are most up to date on asthma treatment, which really
matters. Allergists can often pinpoint particular allergens to avoid,
from testing or only history! Allergists will tell you which
environmental changes to make.

2.2 Tests

Blood tests can be done to look for elevated white blood cell counts,
level of particular antibodies, or for reactions with allergen
extracts. Blood tests are not 100% reliable and, to get good results,
must be done by highly trained lab technicians. Some doctors use these
tests, while others prefer not to. The patient will need to have blood
drawn for this, which may be a drawback for testing children.

"Scratch" test involves scratching the skin, then dropping liquid
allergen on the scratch. It's done on the arm or (for very small
children) the back. It seems to hurt a little, but may be scary to
little ones. [Ed. - it doesn't hurt much; it's just annoying.] Each
slate has up to 6 tests, plus positive (histamine) and negative
controls. Bumps/weals for a reaction appear immediately or several
minutes later. The patient must remain in the office in case of severe
reaction (rare).

A positive reaction is reliable, but a negative reaction may not be;
that is, you may be allergic but not react. Skin tests are more
reliable for airborne allergies than for foods.

Elimination diets are the only guaranteed way to determine food
allergies. The patient goes on a *very* restricted diet, composed only
of foods that rarely cause allergy problems. A new food is added each
week. If the patient does not have any allergic symptoms to the new
food during that week, then it is not considered an allergen. A new
food can be added the next week. If the patient has a reaction to the
food, the food is considered an allergen and removed from the diet. The
patient then goes back to the previous diet until all symptoms are gone
for three days; then a new food can be added. This is a very slow way
to build up much of a varied diet, but it is certain. In adding foods,
you must be careful that it is only one food that is being added. This
means no processed foods (may have additives), no pre-packaged foods
(may have additives), no seasonings (except salt), etc. This can be
very difficult to follow if you eat out for any meals. Generally safe,
non-allergenic foods usually include apricots, peaches, pears, beets,
sweet potato, rice, distilled or spring water, cane sugar, salt,
tapioca, olive oil, lamb and chicken. (Not very exciting..) Your doctor
may give a different list, based on your personal situation. It is
fairly easy to put a young baby on an elimination diet, but it gets
harder as the child gets older. For very young children, this should
only be done under a doctor's supervision (unless the child is
exclusively breastfed) to insure a balanced diet.

If the original allergic reaction was moderate or worse, you must
challenge test when adding a suspected new food. That is, you start
with a pea-sized piece. If no reaction, on day 2 try a 3-pea-sized
piece. No reaction, day 3 try a 9-pea-sized piece. Discuss this with
your doctor. ALWAYS get instructions beforehand (and medicine, if
necessary) on what to do for a severe reaction. If the original
reaction was severe, your doctor will want to do this at his office or
at the hospital.

2.3 Medications

OTC antihistamines - most are sedating but may overexcite kids or cause
hallucinations (in me, some do). For example, benadryl,
brompheniramine. Benadryl is the drug of choice for an acute allergic
attack because it is effective within 20 minutes, reaches maximum
effectiveness at an hour, and wears off in 6 hours.

OTC decongestants - only help stuffy nose. May excite.

Other antihistamines such as seldane (12 hour) and hismanol (24 hour) -
for adults only! May or may not work. May have severe side effects -
talk to your doctor. Some, such as Guaifed, are available in dosages
for children; your doctor will have to decide whether these are
appropriate.

Sodium cromolyn (nasalcrom nosespray for allergies, intal by nebulizer
or in- haler for asthma). Prevents mast cells from reacting,
preventing allergic reactions. Takes at least a week for enough to
build up in body, so needs to be taken regularly as preventative. Not
useful for current symptoms. No known side effects. Won't work for
some people.

Steroid nasal sprays [beconase, rhinocort] also prevent and reduce
inflammation, but need several days of use before they are fully
effective. They must be used daily in order to remain effective. Great
preventative! Often works better than nasalcrom in adults.

Antihistamine eyedrops (optcon-a, vasocon-a) - immediate relief for 8
hours. Works, but stings.

Bronchodilators [Ventolin, Bricanyl] - to open bronchial tubes for
immediate relief from attack. Nebulizer most effective in acute
attacks, then turbuhaler [not yet available in the US], then
metred-dose inahlers and dischalers/rotohalers. Oral preparations
[syrups, tablets] are least effective, requiring higher dosages to
achieve the same effect as mDIs, and having generally significant
side effects [because of the oral route]. These can makes kids
hyper, grumpy; they make me shake. Great for occasional use. Most
often used to treat acture asthma flare-ups, although some asthmatics
must take them daily in addition to other medications. If you need
to use bronchodilators more than twice a week , discuss with your
doctor the use of an anti-inflammatory medication or other
appropriate medication (Ex. intal, steroid, or theophyline).

Epipen/AnaKit (epinephrine autoinjector) - an autoinjection (shot) most
commonly given for anaphylactic reactions. Carry this with
you at all times if you've ever had this severe a reaction!

Nebulizer vs. inhaler (puffer, MDI) for intal and ventolin:
Some individuals have poor reactions to [including having asthma attacks
triggered by] the propellants in MDIs and cannot use them.
Also, most children can't manage them until age 5, though some can manage at a
younger age (some as early as 3). Children should use them with a spacer.

The nebulizer is a machine which drives air through liquid medication
to make mist for a patient to breathe. Treatment takes 10-20
minutes. This is the most effective delivery system. Adults use a
mouthpiece. Kids use a mask; if they refuse, you can blow the mist
at them by mouthpiece.

Other alternatives to MDIs include rothalers and dischalers, which are powder
inhalers, and a turbuhaler [not yet available in the USA], which is a
breath-activated inhaler containing a very fine powder form of the drug.
Turbuhalers contain ONLY the pure drug; there are no propellants,
preservatives or other compounds present. Turbuhalers are more effective
than MDIs, and some Paediatric ERs have switched to using Turbuhalers in
the place of mask treatments for non-severe attacks. Turbuhalers should
be available in the US within the next year; both inhaled corticosteroids
and bronchodilators are available in turbuhaler form [e.g. Bricanyl and
Pulmicort].


2.4 Desensitization (injections)

One treatment for inhalant allergies is desensitization. This
is not available for food allergies.

In desentization treatment, the patient is injected with small,
dilute extracts of the inhalant allergens. The dosage is gradually
built up, until the body is less sensitive to the allergen. This is a
slow process, involving months to years for a complete treatment,
though there is benefit even after a few months for many. Initially,
the patient receives two shots per week. This is reduced to one shot a
week, then one every other week over time. The initial treatment,
however, involves visits to the doctor (or a medical place that will do
the injections) rather regularly. The actual time to get the injection
is about 20 minutes -- the injection is quick, but the patient is
usually asked to wait in the office for about 20 minutes to see if a
reaction develops. These reactions occur in a small percentage of
patients but they need to be treated promptly.

Desentization can also be used for insect sting allergies.
Your doctor will know whether this is an appropriate treatment in your
particular case.

2.5 Avoidance and environmental changes

For most allergies and asthma, the best treatment is to avoid
the allergen. This is easier for foods and more difficult for inhalant
allergens.

For food allergies, a number of books have been written with
recipes and advice. The list of resources below give some ideas.
Altering the diet to exclude certain foods can be easy if the food is
relatively uncommon or is easy to spot. For example, shellfish,
melons, citrus, and bell peppers are usually easy to spot and avoid.
Foods like eggs, wheat, corn, peanuts and milk are harder to spot as
they may be hidden ingredients in a number of foods. Many recipes are
available that are easy, tasty, and avoid the allergen. Although some
change in diet is inevitable, it is not a death sentence; most people
do not have to cut out social events or change their lives radically.

For inhalant allergies, avoidance requires more work. For
seasonal allergens (pollens), try to stay indoors as much as possible
and avoid going out during peak pollen times ( usually early
mornings). Filter masks are available to prevent breathing in
allergens if you must be out. For year-round and household allergens
(mold, dust, dander), the best approach is minimizing places for the
stuff to gather. Patients are usually advised to remove curtains,
carpets, and unnecessary clutter. If anything is left :-), make sure it
is easily washable and wash it frequently. Vacuum often; once a day is
recommended by some. Make sure allergy-prone people (especially asthma
sufferers) are out of the house before any painting, waxing, or other
heavy-duty fume- producing activity occurs. Air filtering systems are
available for individual rooms and as whole-house systems. (See
resources section).
Furry pets are a big source of dander, so it is
best not to have pets or, next best, keep them outside. Absolutely keep
pets out of bedrooms at all times. Tobacco smoke is irritating to many
allergic people, so this should also be eliminated or kept outside.

2.5.1) From: Susan Fiedler )

My son and I have asthma and allergies, these ideas have helped us
tremendously.

=====================

Cleaning the Home Environment:

Invest in an electrostatic filter (plastic frame $27.00, metal frame
$60.00 up to $100.00) if you have a heating system that accepts
changeable filters. It saves on the throwaway filters, trips to the
doctor, allergy medications and misery for several months a year. But
you MUST wash it out once a month to clean the pollen and keep your
pump working at top efficiency.

It may pay to have your air circulation ducts professionally cleaned,
to get out old dirt, pollen, pet dander. Use the phone book, call
heating/cooling specialists for recommendations. This may be especially
useful if you are moving into a used house.

If you take prescription allergy medications like Seldane (.92 each
pill) take that when you need to be awake, but take a cheaper, over the
counter medicine at night (if it has the effect of making you drowsy,
not irritable). Suggested by my pharmacist.

Suggested by my doctor: During the allergy season buy one bottle of
nasal saline spray and then make the refill solution yourself. By
spraying the nasal passages, you rinse out the irritating pollens. This
can cut down on the need for medication and overall discomfort. But you
must remember to do it after every time you go outside. The refill is
just one teaspoon of salt into 1-2 ounces of water, stirred until
dissolved.

If you have forced air vents, put cheesecloth or air conditioner filter
in each one. Keeps dirt from the vents and air system from entering the
house.

=====================
Health Insurance:

If a Health Insurance provider with whom you have a prescription
payment plan excludes a medication, challenge them. I have done this 3
times and each time won (over $200.00) for some time on the phone using
their 800 number. On two occasions the data entry person just hit the
wrong key. On the other my pharmacist spoke with them and proved that
my four year old could not take the over the counter equivalent they
said he should be getting. (Wrong dosage for his size, not chewable).
Just remember to stay calm and polite and have all the facts and policy
numbers at hand when you call.

=====================
Sources for Products of Interest


Allergy Control Products Inc.
96 Danbury Road
Ridgefield CT 06877
1-800-422-DUST


Provide free (with orders?) pamphlets on Cat Dander, House Dust/Mites,
Understanding Vacuum Cleaners Vacuum Exhaust and Allergen Containment,
Mold Spore Allergy. Products include: special mattress/pillow covers,
blankets (Vellux), room cleaners (filter room air), face masks, vacuum
filters (don't let the dust/dirt back out of vacuum), high filtration
vacuum cleaner bags, Miele canister Vacuum cleaner, filters for A/C,
and central heating systems, Allergy Control Solution (neutralizes dust
mite and their feces, a primary allergen for many people).

I have used their vacuum filters, Allergy Control Solution and mask.
All very good and extremely helpful.

=====================
Information on Food Allergies


The Food Allergy Network
10400 Eaton Place Suite 107
Fairfax, VA 22030-5647
703-691-3179
800-929-4040
fax 703-691-2713


Non-profit organization that puts out a newsletter ($24.00 US 6
issues/year) on food allergies, that covers allergy-related subjects
such as eczema, allergen-free recipes, drug updates, news updates, a
dietician's column. They also sell a number of reasonably priced
booklets and cards to help you cope with schools, information on
anaphylaxis (potentially lethal allergic reactions), how to read food
labels so as to avoid allergens (ex. soy products go by many names in
packaging). Sample newsletter and information sent on request.

=====================
Sources of Food Products for Special Diets, Allergen Free (or Substitute) Products


Ener-G Foods
P.O. Box 84487
Seattle, WA 98124-5788
206-767-6660
800-331-5222
in Washington State 800-325-9788
Fax 206-764-3398


You can call them for their free Allergy packet of information. They
manufacture and sell baking mixes, ready-made baked items, recipes
(sorted by 45 dietary criteria) and specialize in products for those on
gluten-free, wheat-free, egg-free, corn-free, soy-free, milk-free or
low protein diets. The order form groups products by what they DON'T
have (ex. wheat, eggs) and tells you the ingredients for each item.
Sold by single package or by the case. Some of their products can be
found in good health food stores. But if you want to buy it in bulk and
save a decent amount of money, try one package from either a store or
the manufacturer to see if you like it, and then place a bulk order
with Ener-G. They also sell products for people with renal failure and
malabsorption syndrome (Celiac-Sprue).

2.6 Children vs. adults - TBD


3) Foods

Contributors:

Rebecca Leann Smit Crowley )
Eileen Kupstas Soo )
Andrea Kwiatkowski )
Tammy Schmidt )


3.1 Overview

Allergies are an immune system reaction to substances that don't
harm most people. This can include pollens, dust, foods, cosmetics,
and such. The body produces antibodies to neutralize the foreign
substance, which triggers the release of histamine, which produces
what we see as allergies or asthma. Treatment can work on any part of
the process: avoiding the allergen, reducing the production of
histamines, etc. Allergies should be taken seriously; most allergic
reactions are merely annoying but some can be life threatening.

A number of people find that the most likely food to cause a problem
is one that you eat the most frequently. In fact, some people report
that they have an almost addictive craving for that food.The craving
may be more intense if you have had the food in the past day or so.
The more of it you have, the more intense the craving becomes. This
can be a clue as to the foods to suspect in your initial search for
allergens. Common foods to think about are milk (and milk products),
wheat (and wheat products), corn (and corn products), and eggs. These
are common foods in Western diets to which many people are
allergic.

3.2 Adverse Reactions to Milk

When the term allergy was coined, it referred to a broad category of
adverse reactions to substances. Today, allergy specifically refers to
an immunologic interaction between an allergen and an antibody. Other
adverse reactions are now typically referred to as intolerances.
Extreme food allergy leading to anaphylaxis or asthma requires special
treatment; otherwise, for both intolerances and "true allergy", the
only real solution is avoidance (with a couple exceptions). This
section of the FAQ deals specifically with milk sensitivity, whether
lactose intolerance or milk allergy.

LACTOSE INTOLERANCE

Lactose intolerance is the inability to digest lactose, found in animal
milk (including human milk, which, in fact, has about twice has much
lactose as cow's milk). An enzyme called lactase is required to digest
lactose. When this enzyme is missing, the following symptoms may
occur: abdominal cramps, diarrhea, gas, a feeling of bloatedness.
Symptoms may occur within an hour, or up to several days later. The
intensity of symptoms varies widely.

DIAGNOSIS

Lactose intolerance can be self-diagnosed by eliminating milk and dairy
products from your diet for two weeks, then reintroducing milk (a glass
or two), and seeing what happens. Your doctor can administer a couple
of tests to confirm lactose intolerance (basically involves drinking a
sweet drink containing a lot of lactose on an empty stomach and
monitoring blood levels of glucose -- no rise in glucose means the
lactose is not being absorbed; the other involves checking breath
levels of hydrogen).

TREATMENT

If you are diagnosed with lactose intolerance, you have a variety of
options. Lactase is available by prescription (Lactaid), and can be
added to milk (drops) or taken with food containing dairy products
(tablets). Some people may have adverse reactions to this medication,
however (in tablet form -- the reaction is believed to be allergic.
Drops seem to be ok.). Lactose reduced milk and cheeses are available
in some areas. Aged cheeses, yogurt and sour cream may be tolerable
(most of the lactose has already been converted). You can find your
level of lactose tolerance by either cutting out dairy products
entirely and slowing working them back into your diet, or you can
slowly eliminate them until you stop having difficulties. Tables
indicating lactose content for milk and milk products are available
(see Zukin below).

Some believe that lactose intolerance is, in fact, the human (and
mammalian) norm, rather than an aberration, citing in support
statistics that indicate most of the world's population is lactose
intolerant (Europeans and those of European descent being the
exceptions), and the tendency to lactose intolerance with increased
age.

MILK ALLERGY

Milk allergy, on the other hand, involves an allergic reaction to one
or more of the proteins in milk (casein, lactalbumin, lactoglobulins).
An allergic reaction to milk may include: eczema, rash, mucous
buildup, wheezing, asthma, rhinitis, pneumonia, anaphylaxis. The type
and severity of symptoms varies widely. Because a true milk allergy
may involve mast cells in the mouth and throat, it is possible to have
an allergic reaction to milk or milk products before they are
digested. It is possible to be both lactose intolerant AND allergic to
milk.

DIAGNOSIS

The bad news is, diagnostic tests for milk allergy -- for food allergy
in general -- are hit or miss. One source I have claims that a
negative is accurate, but false positives are common. Another states
that the extracts used in allergy tests tend to lose potency quickly so
you might test negative on a test and STILL be allergic. Elimination
diets are the best test you have available to you. If you suspect milk
allergy, eliminate milk and milk products for two or more weeks, and
see what happens. If you can convince your physician to conduct a
double-blind test on you, you may be able to confirm the diagnosis.

TREATMENT

The worse news is, no cure is available -- avoidance, and symptom
control via antihistamines, etc. are the best you can do. (For now, at
least, this is true of all food allergy, at least according to the
conservative medical community -- but research is ongoing. I have a
reference to a study by the National Jewish Center for Immunology and
Respiratory Medicine in Denver which claims successful desensitization
to peanuts in people who had a life history of allergic reaction to
them. There's a dim hope, at least.)

[The National Jewish Center for Immunology and Respiratory Medicine
in Denver has prepared a report about successful desensitization to
peanuts in patients with a life history of allergic reaction to them.

The address for that group is:

National Jewish Center for Immunology and Respiratory Medicine
Public Affairs Department
1400 Jackson Street
Denver, CO 80206
303-398-1079, 800-222-LUNG (5864)]


NUTRITIONAL IMPLICATIONS OF A DAIRY-FREE DIET

That enough? No? The primary source of calcium for most Americans is
milk or milk derived. If you discover you are unable to consume milk
or milk products -- whether because of lactose intolerance or milk
allergy -- you should seriously consider calcium supplementation.
Unfortunately, you may discover (as many do) that these, too, cause
intestinal distress (read: pain). If so, experiment with different
types of calcium (calcium citrate was the least distressing of all the
ones I tried). If you discover none of them work well, you may want to
cut down your meat consumption; some studies suggest that too high
levels of dietary iron may be a more important factor in osteoporosis
than lack of dietary calcium (mechanism speculative -- this also
implies not supplementing iron unless you have an actual deficiency.
Talk to your doctor about all supplementation, of course). You may
also need to supplement vitamin D.

You may need/want to check with a dietician or nutritionist
about your or your child's diet. One suggestion is choose a
calcium supplement with a 2:1 ratio of calcium and magnesium.
S. Rogers, Tired or Toxic?, considers this ratio VERY IMPORTANT.
Other nutritionists have also backed this ratio.

WHERE TO FIND HELP

If you are lactose intolerant or allergic to milk and choose
to stay on a no-dairy diet, there are cookbooks out there to
help you. The most readily available seems to be:



The Milk-Free Kitchen: Living Well without Dairy Products
by Beth Kidder (1991, ISBN: 0-8050-1836-0 )

Dairy-Free Cookbook by Jane Zukin

|New
Raising Your Child Without Milk by Jane Zukin


While Ms. Kidder devotes some pages to discussion of allergy,
intolerance, and eating out, Ms. Zukin's commentary extends to
70 pages, and is very informative. Many of the recipes included
call for "milk substitute" -- but, to be fair, you're also told
where to find rice and soy milk, among other things. The two
cookbooks are complementary.

Vegan cookbooks can also be very useful, if you can find one.
If you have Usenet access (and it seems likely, if you're
reading this!), you might consider hanging out on
rec.food.veg or rec.food.veg.cooking
a fair number of vegan recipes are posted. Also, vegetarians
typically have some good advice on coping with a non-standard
diet.
(See the essays
AARS essays and guides page , especially
AARS cooking,
food, and nutrition page
and
The Recipes Folder
on the Web.) There is now a mailing list for people following a milk/casein/lactose-free diet.

Both Zukin and Kidder emphasize that eating out -- whether
at restaurants or at the homes of friends or relatives -- can
be difficult, and provide information and suggestions to
help you cope. They also emphasize the need to read the labels
on everything you buy or eat -- milk derivatives are found in
the most unexpected places (e.g. the batter on fried chicken),
masquerading under bizarre names (e.g. sodium caseinate).
While the lactose intolerant may be able to cope, the results
for the milk allergic can be severe.

So while you may not have any difficulty digesting milk,
if someone asks you whether a food item contains milk or milk
products and you are not certain, please, please, please answer
honestly. Some people react very strongly to very small exposures.
This is not a preference. When a person declines to eat a certain
dish on the grounds of allergy, don't waste your time or their
patience with arguments about how good it is, or how little
(insert allergen here) is contained within. They know their
problems best; it is no insult to you.

3.3 Gluten (wheat) and grain allergies

Allergies to grain products can be hard to pin down. Grain
products are ubiquitous. Most allergic reactions are quite mild, but
some can be quite severe. Usually the symptoms are a runny nose, red
eyes, and such, but grain allergies can also cause digestive
troubles.

A common allergy is to gluten, a mixture of proteins found in wheat
and other grains (rye, oats, barley etc.). Gluten is the portion of
flour that gives a porous, spongy texture to bread. It is also used
as a base in cosmetic powders and creams. Reactions range from runny
nose and itchy eyes to upset stomach to severe gas. In children (and
adults!), personality changes can be a symptom -- inability to
concentrate, irritableness, crankiness, difficulties with mental
alertness and memory. Some research indicates there may be a connection
between attention deficit disorders and undiagnosed gluten allergies.

Gluten allergies can also cause dermatitis herpetiformis (D.H.), a
chronic benign, skin disorder characterized by an intense burning and
itching rash. A new unscratched lesion is red, raised, and usually
less than 1 cm in diameter with a tiny blister at the center.
However, if scratched, crusting appears on the surface. The "burning"
or "stinging" sensation is different from a "regular" itch, and can
often occur 8-12 hours before a lesion appears. The most common areas
are the elbows, knees, back of the neck and scalp, upper back, and
the buttocks. Facial and hair-line lesions are not uncommon; the
inside of the mouth is rarely affected. The rash has symmetric
distribution. Medications are available to treat the problem, but
elimination of gluten is a long-term answer.

Severe reactions to wheat occur in the condition known as
Celiac-Sprue [note: this may not be a true allergy, but I will
include it here.] For people with this condition, the intestine
reacts strongly to gluten products. The small cilia on the intestinal
wall gradually flatten, reducing the ability of the intestines to
absorb nutrients. This is a serious condition leading to
malnutrition. The treatment consists of avoiding wheat and gluten in
any form. In Western cultures, this can be VERY difficult. Remember
that other grains such as rye and oats can cause problems, since they
contain small amounts of gluten. It is unknown whether a child will
outgrow this condition, but the current safe opinion is that gluten
must be avoided for life. More information is available from
several support organizations. (See resources list for a

mailing list .)

It can be difficult to avoid gluten in processed foods. It's used as
a starch, binder, bulking agent, formulation aid, stabilizer, shaper,
thickener, emulsific filler and as a glaze. Some foods labeled
"wheat free" may still contain gluten. Even things like lip gloss,
make-up, shampoo and hand cream can contain gluten.

It is possible to have good food without eating a wheat based
diet. You will have to investigate the various options and see which
suits your situation best. A number of cuisines are not based on wheat
and provide alternatives around which to center your diet. Chinese,
Indian, and other Asian countries often center the diet around rice.
Some Eastern European countries use other grains such as millet, barley
and buckwheat.

A number of substitutes for wheat in baking are available. If
you can tolerate some gluten, rye and oats can be used. These do not
make a baked product exactly like wheat, but do make an acceptable
one. For gluten free baked products, a mixture of rice flour, potato
starch flour, and tapioca flour can be used. (Recipes given below.)

Any baking done without wheat will take practice; you have to
learn a whole new way of doing it. The products are not exactly like
wheat products but are tasty and satisfying. Most are as easy to make
as the wheat version (after a few initial failures while learning). For
many cookies and cakes, the results are very good. For breads, the
results are better termed satisfactory but still quite good in their
own way.

Corn is another potential allergen, distinct from gluten
allergies. As with wheat, corn products are found in any number of
products. Corn starch is used as a thickener for many foods, as a
base for cosmetics, and to prevent sticking. Corn sugar is used as an
ingredient in many sodas, bottled fruit drinks, baking mixes, and
such. It is also used in the glue for envelopes and stamps, in
cosmetics, as a pill coating, in processed foods, and spice mixes.
Symptoms range from skin rashes, runny nose and itchy eyes, to
asthma.

3.4 Allergy Cookbooks


This is a partial, somewhat selective list -- descriptions, along with
other books, are listed
in a separate file,
Allergy and Asthma Book Reviews .
Feel free to send reviews /opinions /books-to-be-considered, etc.



_The Food Allergy Cookbook_
The official cookbook of the Allergy Information Association
St. Martin's Press
New York, New York 10010
ISBN 0-312-90185-2
Paperback $4.95



_The Allergy Self-Help Cookbook_
by M. Jones
Rodale Press Inc.
ISBN 0-87857-505-7
$19.95 Hardback



|New
_The Complete Food Allergy Cookbook_
by Marilyn Gioannini
Prima Publishing
PO Box 1260BK
Rocklin, CA 95677
ISBN 0-7615-0051-0




_The Gluten-Free Gourmet" Living Well without Wheat_
by Bette Hagman
H. Holt & Co.
ISBN 0-8050-1835-2
$12.95 paperback.


There are two more gluten-free books by the same author that many people also recommend.

3.5 Unknown food allergies

Some food allergies are very hard to pin down. An
elimination diet (described above) is the only sure-fire
way to determine the specific cause. Some items to
consider when trying to track allergies down a


wheat
milk
seafoods
peanuts
eggs
corn (includes corn syrup and corn starch)
citrus fruits
yeast
molds (includes cheeses, etc)
mint
tomatoes
green peppers
also look out for:
preservatives
food colors
additives


Remember that almost anything can be a potential allergen to
somebody.

A number of other illnesses can be related to the diet or the
environment. Various claims have been made about yeast, sugar,
and other foods as causes of various illnesses. This has not
been accepted by some physicians, but the ideas can be kept in
mind if untreatable, chronic symptoms occur. Some air borne
compounds affect some people more than others. Again, this can
be kept in mind if untreatable, chronic symptoms occur.
DISCLAIMER: Any treatment should be under the direction of a
physician!

3.6 anaphylactic reactions -- when to call 911 immediately

Anaphylactic reactions are general, dramatic reactions that can
result in collapse and possibly death. It is caused by a sudden
release of histamines and other chemicals that overwhelm the body. The
onset is usually quite rapid and symptoms occur within minutes. Death
can potentially occur immediately or within two hours.

The first sign may be swelling and redness of the skin or may
be a non-visible internal reaction such as swelling of the airway, a
drop in blood pressure, shock, or nausea. The allergic person may also
have a feeling of great anxiety.

Immediate action is needed. Persons who know they are prone to
these reactions (allergies to peanuts, shellfish, and insect stings can
be of this type), should consult with their doctor about a small
emergency kit to carry with them. For this type of reaction, call for
medical help immediately. Minutes are vital.

Standard treatments used to control the reaction are
epinephrine, oxygen, and intravenous fluids. Antihistamines and
corticosteroids can also be used. The person needs to be under medical
supervision until the reaction is under control.