Dialog; Allergies

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I sorry I can do it again, and see you next week anymore. Support Winons 후 allows you to participate in a amazing Good evening, and thank you for tuning in to A discussion about something that Ranges from my bothersome annoyance to a life -threatening condition allergies. I'm Lin Waters, welcoming you to dialogue and welcoming our studio guest this evening to talk about allergies, what causes them, what can be done for them, and what I want to look out for in terms of treatment on the

horizon. I'd like to introduce first, Dr. Alan Wang, who is with the Honolulu Medical Group. He specializes in adult and pediatric asthma, allergies, and disorders of the immune system. He has a particular interest in effective management of asthma, food allergies, and patients with recurring infections. He's a member of the American and Hawaii Medical Associations, is a graduate of the University of California at Berkeley and the John Burns School of Medicine, and did his fellowship in Allergy Immunology at Children's Hospital and Brigham & Women's Hospital at Harvard Medical School. We also have with us Dr. Aparna Shah, who is a colonel in the U .S. Army, currently practicing at Tripler Army Medical Center, where she is chief of the Allergy Immunology Service. Dr. Shah is also an assistant clinical professor at the University of Hawaii's John A. Burns School of Medicine. She received her education in Baroda, India, and the United States, and completed her fellowship at Walter Reed Army Hospital in Washington, D .C., and she's been a commissioned officer since 1977. And an allergist immunologist, Dr. John McDonnell, has been in private practice in

Kaniohae since 1981, specializing in adult and pediatric allergy and immunology. He's also a clinical assistant professor at the John Burns School of Medicine, a graduate of the New Jersey School of Medicine. Dr. McDonnell received his fellowship in allergy immunology from Fitzsimons Army Medical Center in Denver, Colorado. And also Dr. Jeff Kamm, an allergist with the Department of Allergy Immunology at Straub Clinic and Hospital. Dr. Kamm received his medical degree from the University of the East and his fellowship in allergy immunology from the National Jewish Hospital for Immunology, Respiratory Medicine in Denver, Colorado, also. Dr. Kamm is an assistant clinical professor at the Department of Pediatrics, Division of Allergy Immunology at the John A. Burns School of Medicine. Thank you all for giving up some of your Friday evening to be with us and a reminder to those of you who are watching that we are live here on Hawaii Public Television. We're also being simulcast on Hawaii Public Radio, K -I -F -O -A -M. So if you have a question or a comment about allergies, please give us a call at 955 -7878. We're waiting to hear from you. Neighbor Islands, watchers, please call us,

collect at the same number 955 -7878. Our telephone volunteers are waiting to take your call and they are from the Wildlife Ahala branch of Bank of Hawaii. Thank you all for being with us this evening. And our interpreter for the hearing impaired is Loretta McDonald. As with most medical shows, I know we're going to get a lot of questions tonight because a lot of people are going to be affected by what you say and are going to have a lot of questions and comments about the topic that we bring up tonight. So I'd like to start by getting some general information out to our viewers. Dr. Wang, first of all, are people in Hawaii more or less allergic than on the mainland? Do we have special problems here in Hawaii in terms of allergies that say we don't see on the mainland? Well, certainly one of the most attractive things about being in Hawaii, the warm weather, really adds to the allergen burden in that some allergens tend to be of a higher concentration and production in warm and humid weather like ours. Also we don't have the freezes that some

climates do and so because of that, that also doesn't eliminate certain allergens during the year. So yes, a lot of people do have worse allergies and there's probably a higher incidence of some kinds of allergies in this state. You were telling me that a lot of times people move here from the mainland and haven't had any allergy problems where they live before and all of a sudden. Right. It's a bad news. Yes, so people will commonly say that they've moved here and after several years they've noticed that their symptoms which were sort of seasonal on the mainland or elsewhere would become progressive in year round and really quite annoying. Dr. McDonald, what are some common misconceptions or misunderstandings people have? About allergies. Well, Gully, there's a number of them then but the most important one is that allergies are somehow understandable or mystic and magical and in point of fact they're really not and what those of us in the allergy community would like people to do is to understand that things like an educational show like tonight or any means of educating themselves will help them to choose not to be a victim of the condition and we think that that's most important that they understand that

allergies are manageable with a little education and a little help on their part. Are there any really common allergies, Dr. Shah, or what do we see here, are there ones that are more prevalent than others? We see a lot of what common people call he fever symptoms which are basically sneezing runny nose, echinose. People have a lot of problems with asthma where they get shot of breath, weezing cannot sleep often at night time. It can also manifest in the form of food allergy. Some people have a skin allergy which is, you know, you get a rash, which is very itchy. As Dr. Wang mentioned, yes, we do have more problems with certain allergies, he fever, maybe even in asthma in Hawaii. And what about allergies with seafood? A lot of people have problems with that. Yes, seafood and nuts, especially peanut are the two top common allergies in adults and in children it's a milk and egg. So yes, we do have a basic question. That's probably number one killer of, you know, due to food allergy.

Dr. Kim, we know that allergies are not curable generally, is that correct? That's correct. How treatable are they these days? Have we made some advancements? Well, they're very treatable and each year there's just better and newer medications, better and newer devices to administer these medications. And I guess the main thing is that people are becoming more aware of allergies and how to treat them. Before asthma used to be thought of as a cough and treated with cough medicines and now we know that asthma is a condition that can be treated using correct medications. And just recently, over the last couple of years, we now have a better understanding of what is asthma and what causes it. And so we know better how to treat it and use better medications. And to say on his table, all the devices we have available to help us manage our allergies in asthma. Now, we mentioned that some allergies can be life threatening and that's a good example asthma is. Absolutely. In fact, I guess the death of that supermodel, Chrissy Taylor, recently has brought death from asthma to everyone's mind. And specialists like all of us here are very aware of what we call the asthma paradox, where there's

more specialists who know about asthma, people are more aware of where about asthma, we have better medications yet people are dying. In 1989, the estimate was approximately 5 ,000 deaths nationwide, despite our understanding of medications. Can you outgrow asthma? Isn't there a difference between childhood asthma and... Well, asthma can occur at any age, certainly most asthmatics occur before the age of 5. But even adults can have adult onset asthma. The childhood asthma will wax and wane and use the bit period at time, usually after the age of 40, where it will get better and the patient will require less medication. The patients who have adult onset type asthma usually do not have that period of relief. Want to remind our viewers that we are live, if you have a question or a comment about allergies, we have four very knowledgeable medical professionals here that can answer your question. So please give us a call at 955 -7878, and I'm going to get to as many of those questions as I can. And this viewer wants to know regarding anti -histamines, which cause drowsiness, are there any alternative treatments? Yeah, well, indeed,

there's been a lot of progress made in the development of anti -histamines over the last years, and the earliest anti -histamine suffered from the fact that they did cross the blood brain barrier and did have an effect on the central nervous system. There are newer alternative anti -histamines that are available now that we prescribe commonly our practice that are not sedating, and will in most cases allow people to maintain a good state of alertness and yet get good relief from their symptoms. But those are prescription, right? Can you purchase them over the counter? There are some over the counter that have a lower incidence of sedating side effects. So like clomastine is a little bit lower incidence of sedation than say, diphenhydramine, which is commonly benadryl. So there are, you know, there's one or two that chlorotrimatin is another that's a little less sedating. But some of the most effective in terms of ameliorating symptoms and causing lack of sedation are mostly prescribed. Okay.

Any other comments on anti -histamines recommendations were the non -drowsy type? I think you said it all. He named the ones. Okay. Can people develop an immunity to mango tree sap? I had a friend that was very allergic to mangoes. I remember a few years ago, what's the situation with that kind of condition? Well, sap is very interesting because the mango tree that was related to poison ivy, so that the sap actually leads to a contact type of rash. So you can be allergic to the sap, but eat the fruit and have no problem. So I suppose if you were chronically exposed to it in small amounts, you could gain, quote, an immunity or tolerance to it. This collar has apparently had been stung by a bee 30 minutes ago. I guess this is tonight. What do you do about a bee sting if your hand is beginning to swell? Well, you know, that's considered a local reaction, and you can put some cool compresses, put some pressure over that, and take some anti -histamine immediately that we cut down on the swelling and allergic reaction. The local reaction, you don't

worry that much, but if somebody gets stung and starts having difficulty in breathing or breaks out with highs, feels dizzy, then they should be immediately evaluated in an emergency room because they may need some treatment right away. And also, these are called systemic reaction, which puts them at a much higher risk of developing similar or more severe reaction in future. So this patient should be evaluated by an allergist, close with a systemic reaction. So an anti -histamine that you would normally take when you have a mole, is good for it. Yes, you can take a binary. If you don't have a binary, you can dim a tip, activate whatever you have at home, does eventohistamines, and you can use that. How do you know when you should go say to an emergency room? I mean, what point, what are the symptoms that are serious enough that should tell you? Should go seek some attention? Well, if the local reaction, if we're continuing the discussion of a bee sting, if it is just staying in one area and just swelling, no matter

how much it's swelling at one point, you're probably okay. But if there's any difficulty breathing or any breaking out in hives that are discreet and distant from the sting, then you probably should start making tracks to get to an emergency department. While the difficulty breathing may be, in some cases, simply anxiety, it's probably better to make the decision to overcompensate and be very safe and get yourself in for some treatment, or at least evaluation then, rather than tough it out, if you're not sure, better to try them. Okay. Good advice. Caller from the Big Island wants to know what your opinion is about the Vogue situation. How serious is that for asthmatics or people who have any type of allergies when we do have the Vogue? Is that a real problem? It's a big problem. Actually, in the Vogue, there's lots of chemicals, pollutants, and people who have asthma and nasal allergies already have very hypersensitive nasal passages and hypersensitive breathing tubes. So when they inhale these chemical irritants, it can lead to a very severe

reaction very quickly. It's akin to a severe air pollution situation, so that kind of hypersensitive airway, getting more irritated from noxious air is obviously going to worsen the clinical situation. So what can they do when air is like that? You can air condition the big island that would be good, but unfortunately, the best way is avoidance to avoid the kind of noxious air that is around, and one way to do that is to try to stay indoors in an air circulated situation, to try to not breathe in as much of the polluted air that's coming through as possible. I think the same criticism comes up every year when there's talk of limiting the use of fireworks on New Year's Eve, Chinese New Year. It seems like I'm always reading about people with asthma and respiratory problems having the same concerns. This caller wants to know what about E .I. or environmental

illness. What about the quality of our environment today, has it affected us noticeably in terms of your experience with treating and dealing with allergies? That question is maybe loaded more with things than you've alluded to. The environment, certainly environmental illness exists and people can become injured and affected by their environment as we just discussed with the things like the VOD. I'm not quite certain, but I suspect that the environmental illness is oftentimes implying another condition that suggests that with infinitesimally low amounts of molecular levels that can't even irritate your eyes or your nose, that you could be exposed to it and then somehow find yourself where your brain doesn't work as well or you can't think right or you're chronically exhausted and unable to perform your duties. That has been called

a host of different things from clinically ecology through the multiple chemical sensitivity syndrome. Those things have been looked at and by conventional allergists and finally recognize that most of the things that people have said about those are simply testimonials and there's other explanations and not really that they were injured or paralyzed or crippled by the very low exposures and while we like to help those people we sometimes have to dissuade them from what might be held with a very strong zeal that they want to have that diagnosis made sometimes for ulterior motives. Agreement? Disagreement? Yes. I agree strongly. Okay. This caller wants to know can there be a relationship between attention, deficit, disorder and allergies? This is what you see in or in a situation you see in children a lot, attention, deficit or disorder, any connection there? That's actually a very

common question I guess the pediatric alias like Dr. Wing and Dr. Madeline I .C. The child we brought in who has been diagnosed to have attention, deficit disorder and mother wants to know both commonly is it some food and sugar is one of the common ones or milk products and whatever. While certain allergies can influence the attention deficit really there's no real strict correlation but if the child had allergic rhinitis or the allergic nose or asthma and certainly he has asthma is flaring or is allergic rhinitis is flaring it can affect his sleep patterns and therefore affect his behavior in school. Okay. This caller wants to know and I want to remind our viewers that we are live so if you have a question or a comment about allergies please call us at 955 -7878. What percentage of the population is allergic to dairy products? Is this a large problem and our figures affected by lobbyists in these areas? I think when you talk about reaction to dairy products we have an enzyme in our body called lactase which helps digest the

sugar in the milk and lactase deficiency this enzyme deficiency is fairly common I would say maybe up to 80 % of oriental Asians and they have this deficiency so many of these people when they drink milk within half an hour to hour they get cramps, diarrhea, a lot of cats which is not a true allergy and that can be overcome there are some enzyme supplements available. The true milk allergy where you start visiting or break out with hives that's more common in children and milk and egg are probably the two most common allergies in infants and the good news is majority of them outgrow these allergies. You do see a lot of advertising for lactose intolerant tablets or whatever they work on their products so they're fairly effective. Well so this question brings up an interesting point in that a true allergy is very different say a food allergy is very different from a

food intolerance or a side effect and so some people may not be tolerant of the lactose sugar in dairy product and have the reaction there of because they can't digest it whereas people who have a true allergy or have an immune mediated reaction which can be life threatening that is a true allergy and is a different kind of topic. Thanks for making that distinction this caller wants to know that as you get older is it true that you are more prone to becoming allergic and why is that true or is that not true? Well actually it's not very true I think that the younger you are the more hyper sensitive your immune system is and when you have a hyper immune system then you're more prone to developing allergies. In fact a lot of allergies are have a genetic basis and in fact it's been reported that if one parent has allergies any form of allergies the child has about a 25 % chance of having allergies it both

parents have allergies goes up to about 75 % chance so there's a heavy genetic load then you have your environmental exposures but certainly allergies can occur at any point in life and I think that's what the caller is asking you some people get it when they're older and some people get it when they're younger. Most people seem to feel that allergies tend to wane in the older population many times we will not pursue are more aggressive forms of allergy treatment such as immunotherapy or allergy shots and people who are older than 65 -70 because the cost benefit ratio just isn't there and a lot of people's allergies tend to wane actually as they're much older. Is that true that you do outgrow or at least if the effects have you can sort of have minimizing symptoms although we don't seem to see it enough I guess. So if you look forward to in your old age yes so many things that's just another one on the list. This caller says I believe I have an allergy to corn syrup that causes migraines but my internist is skeptical do you know of this link you've ever heard of anything like that Dr. McDonald. Well I've

certainly heard of it and a very good friend of mine fell by the name of Lyndon Mansfield in El Paso, Texas. Please rather strongly that foods can cause and or at least worse in migraine symptoms of all kinds they can be ocular as well as headaches but there's not a whole lot of people that really substantiated or concur. However while corn syrup is difficult to avoid it can be avoided and that would be a reasonably simple test to do while they would have to stay away from even hard candies or anything else that were made with corn syrup they would then be able to eliminate that for a period of a week or two and then the important thing is you must challenge that you must not let yourself be led down the primrose path of eliminating something and then never really knowing if it caused a problem or not you simply have to have some scientific discipline and come back and challenge it you run the risk of getting the

migraine but a few challenge that with say the suspected food in this case corn syrup and you don't get the symptoms that's not the problem and we wind up we as allergists try to sometimes dissuade people from going down those pathways because they limit their lives rather significantly sometimes certainly migraines are very very painful and so they don't want to have them but we see people who have started to affect their nutritional intake because of the fear of things like this so while it's possible it's a question that can be answered and they should really discuss that with either their internist or their allergist. It's almost like you should do your own medical research and prove whether you have it or you do it's not really experimenting it's it's it's answering a question and you know the proof of the pudding is in the eating the proof of the allergy is in the eating also and the point that we try to help people understand is that sure you don't miss this particular food at this time and

sure you don't miss the next one but if you start eliminating several over a period of years I had a patient who was a pediatrician when I was in the service some 20 years ago in Denver and this fellow was eating only a immediately slaughtered beef and and broccoli and and Brussels sprouts and was drinking simply deionized water to the point where he had lost some 40 pounds and and was starting to show signs of some vitamin deficiencies this was a physician you know I mean he had to carry two extremes you sure can and and the thing is you can challenge it and it's not magical and mystical you can choose not to be a victim and you need to do something the worst thing to do is nothing so it's reasonable to ask those questions next question we've had a lot of questions about what can be done about food allergies and obviously you said people tend to just decide not to eat the food and that may not be that that's one of the major problems with food allergies is that we don't have really good testing for it we can do skin testing we can do a draw blood and

look for the allergies in the blood but it's only about 30 percent accurate the true test is what dr. Madonna was alluding to you you have to sort of figure out yeah I think it's the corn syrup or the rice and I stop eating the rice and my symptoms go away I eat the rice again and the symptoms come back and it really controlled sense in some of the major centers maybe even triple you can do the double -blind placebo controlled food challenge where the food is actually hidden in a capsule and then administered to the patient with placebo sugar capsules and then you watch for any type of reaction both the administrator and the patient aren't aware what is being given and so the reactions are looked for objectively and finally after a numerous a number of trials then this kind of test is unmasked and it actually is seen what was given at what time and if there is a true reaction then it should correlate so once you've identified let's say you go through that process and you do discover that you're allergic to a specific food is there anything you can do short of never eating that food again I mean are there some treatments or something that will allow you to do? treatment is avoidance but you have to be very

specific whether it's a true allergy or not because the perception that many people they have food allergies extremely high and many of there's maybe just intolerance and not in a true form of allergy if somebody comes to me and says I'm allergic to 30 foods that's very unlikely that they're allergic to most of the people are allergic to very few selective food and I know there are some controversial practices in allergy where people put the drops under the tongue and you know give the shots for the food but at least in none of us I don't think my colleagues will agree that we don't think it works and the only treatment is avoidance and some of them can be life -threatening so you have to make sure that you know if it's a life -threatening reaction you read labels because people get very scared they don't go out to eat their life -beacups very you know the homebound so it's so once it's identified as a true food allergy not an intolerance then there really is no treatment just avoidance. Well I do have some patients that will take their benadryl and they go out and eat their crab.

I think it sounds pretty scary to me. No but there are a lot of ways that allergy immunology physicians can help you avoid specific foods I mean we have training and teaching about how to really avoid once you correctly diagnose true food allergy which is very rare a true food allergy can be managed very successfully with information that you know our specialty can give special diets and cookbooks and networks of people who have such allergies to provide a lot of information and support for these people to live normal lives. So talk to your allergists. Let me answer to that. What is the role of allergies and rheumatoid arthritis? Is there a connection there? Did anybody knows of? Well there's there's not a clear tie in now both allergies and rheumatoid arthritis are probably dysregulations of the immune system. Certainly

doing rheumatology in in Boston we would often see people who were having rheumatoid arthritis in the pediatric population who would flare up when their allergy season actually comes into play. Now that is probably a non -specific kind of generalized inflammatory situation where their immune system because it's being triggered and activated by their allergies in their season. It is also simultaneously expressing itself in another way in the activated immune system which is their arthritis. But per se I don't think there's a lot of data yet that ties together a link of allergies and arthritis. All right. Question from the caller who wants to know if you're familiar with air cleaners and do they help reduce allergies? This is probably stemming from our discussion about Vogue and Firework smoke etc. Do air cleaners work for specific things? I guess Dr. Dr. McDonald knows of

Dr. Howard Nelson at Denver he did most of the research on the air filters and if you're going to invest in air filter it must be a HEP or HEPA filter. All the other ones really don't work they can maybe purify odors out and maybe large particular matter but when you're looking for pollens and other allergen -borne triggers you need the HEPA filter. Now with respect to dust smite and cockroach allergies which are the major things here that people allergic to on a year -round basis HEPA filters do not really work because these particles are actually very heavy even though they're microscopic so we don't see them but yet they're very heavy. So unless you're using a fan all the time or someone's continually vacuuming the room or dusting these particles are going to be on the ground. In order for an air purifier to work it must stay suspended in the air. Air purifiers do work very well for cat and dog animal dander which floats around in the air for hours and can be filtered. I think the problem in Hawaii is we have windows open so they're not very effective because you clean them and the next blow of air brings all the pollens and moles from outside so I frequently recommend put an air condition in the

bedroom or if you have a central air condition which is ideal but most of us cannot afford it so if you have a window in air condition especially in the bedroom or living room where you spend lot of time it does help filter out lot of outer pollens moles plus it does control indoor humidity and temperature and does help with the growth of dust might moles it does cut down. So air filter probably are not very practical in Hawaii. I normally don't recommend I don't have Dr. McDonnell. I agree completely. I think they're probably a waste of money. The tragic thing that's happened in Hawaii over a number of years is that we've disregarded the beautiful trade winds that we have and some of our bigger buildings now don't have windows that can be opened and they're simply glass walls and we can't really ventilate which would be the best thing for a whole lot of things. It's really quite for the bag for the buck. There are other ways like specifically for dust might allergy. I mean you're putting your head into the bed where most of the dust

mites are in their easier ways than to blow the air around. And on that note we're going to take a brief break this would be a good time for you to phone in your question or comment for the last half of dialogue with our doctors who specialize in allergies. The number is 9557878 and we'll be right back. Finally tonight the story of the Shia Muslims of Southern Iraq. The Shia tried to declare their independence from the Saddam Hussein regime and Baghdad. Saddam's republican guard and their tanks have been left intact by the Allies and in the end the rebels were hopelessly armed. They were no TV cameras here to record what happened. Only this extraordinary amateur video took shot by two brothers one of whom is killed. Desperate women and

children can only call on guard now to help them. Most of these people are about to die. This casual brutality has been justified by the Iraqi President throughout his career in politics. Welcome back to Dialog's Health Information Show on allergies with doctors Alan Wang, Aparna Shah, John McDonnell and Jeffrey Cam. Our telephone volunteers are waiting to take your call at 9557878 and they are from the Wildlife Kahala branch of Bank of Hawaii. We certainly thank them for being here tonight. And we are going to get to as many of your questions and comments as we can during the next half hour. But before I leave our phone volunteers, I want to remind you that if you know someone who's interested in becoming a volunteer, please give our volunteer coordinator Jennifer Thomas Akal here at Public Television at 9557878. Neighbor Islanders remember you can call us collect. Okay, a bunch of questions on these topics. So let's go over them. One, are there

alternatives to anti -histamines? We talked about that briefly earlier, but any alternatives to anti -histamines? Well, certainly avoidance of the allergen is always the best. We talked about, and I think we left for the break on the idea of house dust mites being a problem. They exist to really what they do is they eat our sloughed skin scales, which are found then in areas where we slough them the most. And we don't often think about it, but we spend if only six hours a day sleeping that's a quarter of our lives in one room on one piece of furniture on the bed. So if we can protect ourselves from the dust mites that are found in the beds and if we could cover our mattresses or even if nothing else cover our pillowcases or excuse me, cover our pillows with a dust impermeable pillowcase, then we would save ourselves a lot of problems. There's another treatment called immunotherapy or allergy desensitization shots, which can make people over a long period of time of treatment can make their allergies much less severe. It's a humbug thing to undertake, and

one needs to really weigh the risks versus the benefits of that. I think Alan was going to say something. Definitely the best alternative that well -trained allergists will first recommend is avoidance. So avoidance of truly identified allergies. We can help people learn how to avoid contact with these allergies and hence oftentimes get great relief without any medication at all. So our office is just first to try to control your exposure to the allergen. If you can get rid of it, you don't need any medicine. And then second after that, there are other ways to help you maybe with judicious medication. All right. Several questions also on allergies to MSG, which is of course the ingredient found in show you and other popular island foods. Are there any treatments for that? Or can you comment on the prevalence of it? Avoidance. There's not a lot of good solid data on the nature of this phenomenon. I was involved in a study recently, which is about to be

published another double -blinded placebo controlled study on people taking what was not MSG and what was MSG. And a lot of the other studies that have been done like that were both the people administering the MSG or the non -MSG and the people receiving it who don't know what they're receiving. Don't conclusively show sometimes that there is actually an allergy. There might be some other side effect or some other kind of item in the food that they ate that people can be sensitive to. So it's not exactly clear yet what the nature of this sensitivity to MSG is. So is it not true that if you have a sensitivity to it, you'll have headaches whenever you consume too much of it? That's one of the most common things that have been described. So certainly in some people, it does seem to occur. In most cases, we would recommend avoidance, which is very easy. I mean, MSG is a flavor enhancer. It doesn't have to be in food. Natural food tends to be very flavorful. So avoidance again is the most

natural way to treat that. Also, several comments or questions about the validity of vitamin and herbal treatments. Are they effective with allergies? Well, you know, allergies, what we are describing as mahe fever, those are true diseases. And personally, you know, I don't think that herbal medicines have much role in that, you know, the amount of maybe some of the beneficial things which may help is so minute. We don't even know how much they contain. So I don't think when you talk about treating a real disease, which can be a life -threatening and serious disease, which people should just stick with herbal medicine and not go with the traditional medicine, as we say, avoidance and medication and maybe shots are way too good depending on the severity. I don't think herbal medicine would hurt anybody. I mean, they can take it and it's a harmless thing, but I'm not sure about the benefits.

Hearing a recurring theme here that you can't cure an allergy, so you should avoid avoid what it is that you're allergic to. Question, do allergy shots work? Are allergy shots, I remember hearing about allergy shots a lot when I was younger, are they still used or are they still effective? For our severe cases, people who do not respond to traditional medications that allergies to prescribe or are just non -compliant with the medications, the immunotherapy, I don't like to use shots, but immunotherapy desensitization could be their answer. Unfortunately, as what Dr. Madonna say, it's humbug, it really is, it's a pain in the arm literally, and it's not a complete cure all. In fact, what will usually happen is that most people, when they get up to maintenance on their immunotherapy, can decrease their medications. They're still going to have their good days and their bad days and still might need some medications now and then. The problem with shots is that you have to go into the allergy's office, maybe once or twice a week, as you build up, and then in a couple of months, four to six months, you build up to what we call maintenance and you've got to go

in once a month. And then that once a month continues for about three to five years if you're getting an effect, so it's a very long -term treatment. So they do really work. In most studies, three -quarters probably of populations do respond to allergy shots or desensitization, but it takes a lot of commitment on the part of the patient. It's a fair amount of discomfort and you may not get off of medication, although most of the time you do have minimizing of your needed medication. Second half of this question was how many shots do you need to be effective, and I guess the answer is a lot. Over a long period of time. This person is allergic to shellfish. Does that mean he or she will never be able to eat shellfish? I won't say never, but the hope is minimal. There are very few people who outgrow it, but shellfish and as I mentioned, nerds are some of the foods people usually don't outgrow that. They develop many times as an adult, and it stays with them, and then the question comes if you're allergic to crab, can you eat lobster? And you will find people who are

selectively just allergic to crab and not lobster. So I think if there is any doubt, they should be seen by an allergist, and sometimes I challenge them in the clinic and see whether they react or not. So that would be the safest way I won't have them challenged at home, but we can help them. The important thing is that most people actually, I think, have a perception of an allergy, and maybe they don't actually have a true allergy, so they may be avoiding something for no good, medical, or dangerous reason. And so I think it's important to get it scientifically evaluated to be sure that they indeed have an allergy instead of suffering having for good, you know, never having a main lobster. Just what Dr. McDonald was talking about earlier in the show, limiting yourself and avoiding foods that you don't have to avoid. Collar wants to know what type of allergies are contagious? Are any allergies contagious? No, there's no. It's not something that you don't catch it. Catch. It's like Jeff had mentioned

early on. It's an interplay between a genetic predisposition and exposure that brings it out. A couple of interesting questions along the same lines. I'll read both of them. How much is an allergic reaction psychological versus physiological, and could allergies be mined over matter? Well, an allergic reaction is real. When we allergists talk about it, we are talking about the immune system being involved and antibodies being created and a response that specifically occurs in the body. It's reproducible. It could happen in your sleep. We can take some of the serum from your body if we could and inject it from one patient to another. For example, you know, Dr. Wang's serum could be injected in my skin. If he were allergic to something and I could eat it, that'll allergen. And just even a little area of my skin would flare. That's a very old test that proves it's a, you know, it's a real transferable thing by a certain antibody. But it's also true that people's psychological

makeup is involved in the whole thing. Nothing happens in a vacuum and we're all rather complex organisms so that the emotional aspect is something that we don't discount. It's real. But to say that allergies are all in your head is probably wide of the mark. Okay. Can you mention a prescription in a histamine that does not cause drowsiness? We went over this already. But what are the ones that you recommended that by their over -the -counter names? Oh, true. Oh, well, that are over -the -counter. Oh, a prescription. It does not. Oh, this is prescription. I'm sorry. So prescription ones are like by their generic names, lyratidine, trphenidine. Those are very commonly used over -the -counter medications that are non -sedating. A stem is all. I think you've said over -the -counter in the prescription. Oh, I mean prescription, those are common. Those are ones you have to see a doctor again. Right. You have to see a doctor so that the brand names are salving, claritin, and hismenol. Okay, it's very common. Regarding nasal allergies, is there any other over -the -counter remedy for a renny nose other than

pills? Similar to what we're talking about. Avoidance is first and foremost the best thing. You know, if you could cover your pillow cake ever, we've been through it. I don't want to repeat the thing, but that's the easiest thing to do is to find out what the problem is and see if you can somehow modify your environment to a reasonable extent. I just love you. I mean, we're all saying avoid, avoid, avoid, but that what brings the allergies back in. You can get tested by your allergies to see what you're allergic to. Right. So you can avoid it. Right. So you don't have to clean up. That's okay. No, no, no, no. You know, we can prescribe some nose sprays which are very effective and which do work, you know, along with the environmental control, not only the pills, but you can use some regular nose sprays and which are not habit -forming. I'm not talking about over -the -counter, like, after you know, at risk, but deserve prescription sprays. And if patient is compliant, they're very effective and they do work. If somebody doesn't want to take the shots, this would be another way to treat their... Or pills. It's an alternative then. This collar red in a journal that in January of 97, inhalers will be eliminated or banned due to the release of fluoro

carbons. Is that true and what will take their place? Actually, from what I understand that law was things that were medically necessary would not be banned so that the inhalers, especially for asthma, would get a reprieve. And the companies are all working on non -fluor carbon -containing devices that would administer the medication without the effect or environment. Yeah, so it's very likely that they'll be progress made in that to have a substitute propellant that won't be harmful to the environment by that time. And this collar wants to know, are there any negative long -term effects of using inhalers such as proventol? Proventol. Proventol has a medication, albuterol, which is a mainstay of asthma therapy. Over the last decade, it's become pretty clear that albuterol is medication that's very good, but it should be used for acute situations where someone really is having spasm or tightness. Now,

there is some data that suggests if you overuse that medication, not only does it indicate your asthma is out of control or bad, but that it could become less effective with time. So, per se, that medication is in danger to you and it won't per se directly harm you, but it could, if you're using it over much, indicate your asthma needs better control. This collar says moderate amounts of red wine is known to be good or are known to be good for the heart. Why does she get hives from red wine? Now, what is it? Red wine have histamines in it? Is that right? Some people are so white. Also, have histamine content is high and some people do get flushing. Have some day reaction from it. I've seen one patient who was a very difficult, increasing throat tightness whenever drank red wine. So, that's a type of reaction. It's particular to that particular person and the only treatment is avoidance. So, that is an allergy. Hives after drinking red wine. Or can we make that assumption? Maybe more of a pharmacologic response

to either the products in the skin of the grape that makes mimic histamine. But also, as Dr. Kams said, if the wine was made with a cork that was dipped in a preservative in order to keep the cork from coming apart over a period of years while the wine aged, then that's a meta -bysulfide and that has to be listed on the label of the wine bottle. But that too is it. There's chemical reactions that are really a little different from an allergic reaction in the point of the meta -bysulfide. Okay. Any side effects from long -term use of steroid medication for asthma? Is that a common treatment? That's a very common treatment and a very common problem, actually, in very severe asthmatics who require the oral form of the steroids or injectable form and they need it quite often. They run into severe side effects. It is a very strong hormone, but obviously it's necessary to keep their lungs open so they can breathe. So what we've been using as allergies and other doctors obviously can use

this too would be the topical forms of the steroids which come in little inhalers. And the idea behind that is if you topically apply medication it's put where you need it for one thing and you get away with lower dosing whereas in the shot or pill form it's dosing the whole body and more systemic side effects. This caller says I live near a golf course where they are spraying grass with pesticides or when they are spraying grass with pesticides they wear masks. Should I also be wearing a mask? It's more of an environment for slash pollutant question rather than an allergy question, but any comments? If he's far away and you know not indirect, you know, he's the environment, the wind and it's going to blow away so I'm not, I don't think the risk is that high unless he has underlying asthma or some problem and in his like we talk about vulgarly or it may act as an irritant and make cause problem if you're underline sensitive lining. Please express your opinion on allergic reactions to mercury and dental fillings. Is this a problem? It's a perceived problem but it is

probably not real. There was a movement about a decade ago where people were being advised to have their old what people called silver fillings which really contained a lot of mercury. To have those all taken out and have a new polymer of some sort re -inserted in the place of the filling, there are no studies that corroborate that and none that really would recommend someone doing that. If the fillings are poor and need to be changed, one might want to consider you know replacing them with a newer or better type of filling if nothing else for the cosmetics of it because it would look more like the natural tooth. But as far as there being any substantiated allergy or adverse reaction to the mercury from the fillings, while there are claims about it none of that has been proven to be true. All righty caller from the Big Island wants to know what is chronic allergic rhinitis? What causes it and what treatments would they recommend? Well chronic allergic rhinitis is

probably one of the most common problems that we see in our pursuit of people getting healthy. It's a allergic response of the mucus membranes of the person's nose to something they're sensitive to. So typically an allergic person is sensitive say to the dust mite or the pollen that comes into their nose. It lands on their nose and causes inflammation. So if this goes on long enough it's called a chronic inflammation and allergic rhinitis means you have an allergic reaction in your nasal membranes. The treatments that are available are number one like we mentioned avoidance so we can try to eliminate the things that are causing your rhinitis or allergic nose to develop. Number two judicious medication. So anihistamines will block the allergic response of the nasal membranes. The topical medications that were mentioned will turn off your nose membranes to have such a reaction. And then last there's immunotherapy or shots like Dr. Kim mentioned. All right this

caller wants to know can hives be stressed related and who should treat them? A dermatologist or an allergist? Hives being itchy welts on your skin right? Well stress can certainly bring out hives. Hives basically is sensitive allergy cells of the skin and through either food triggers or even flaring of other allergies like your nasal allergy asthma can bring out the hives and certainly a dermatologist can treat hives just like an allergist can treat hives correctly so either or. Either way is it possible to be allergic to allergy medicines? I think it can be it's possible especially one medication I mentioned we use Benadryl to treat allergies but if Benadryl is used in the form of the cream like Caladryl has a Benadryl it can

sensitize you through skin and can develop allergies so we frequently recommend not to use in the skin form. Sometimes some of the inhalers people may have some ill allergic reaction to the medications. If they use the medicine and immediately notice worsening of the symptoms I think they should contact their physician. It's not very common but yes it is possible. Okay several questions we've gotten tonight about the relationship of or between chronic ear infections and allergies. Is there a relationship? Is there a cause and effect? Well we've always thought that because the ear tubes or your station tubes drain into the nasal throat area that if your nose is all plugged up and stuffy it can easily block the openings to the ear tubes so that things back up into the ears. They've been several studies and nothing is conclusive at this time but as allergies we sort of we find that our patients that we do treat the nasal allergies their frequency of ear infections to go down. This caller wants to know what does it mean when an allergist says that you are not allergic to anything in the air but you are sensitive

instead. Is there a difference? I mean I hear you folks using the word sensitivity. If you have a sensitivity I would assume that means you have some sort of allergy. Is that not correct? Well I think the difference is in an allergy the persons or the patients immune system is the active agent. It's their antibodies trying to protect them probably over protecting in a rather primitive vestigial antibody system that we probably don't even need. We pull at the IgE system but that in that part it's the persons immune system or there are antibodies that are causing the problem but in the same way that if someone is shot with a bullet for example they don't die from an allergy to lead. You know the the bullet is the active ingredient. If someone throws sand in your face it doesn't you're not allergic to it. You'll certainly get the symptoms of itchy eyes and if it gets up your nose you'll sneeze. In that point it's the foreign body that's the irritant and if you reduce that to a molecular or a particular level like with smoke we

cigarette smoke one thing that we recommend that our patients never be exposed to. The cigarette particles can actually contain so many irritants that the patients can be sensitive and injured by it but they're not allergic to it and that's the difference because their immune system is not involved. Okay this caller wants to know is it possible to receive shots for allergies to dogs and cats in some day be able to have a pet without taking shots. Obviously an animal lover we've got here. That kind of takes our general premise that if you if you're allergic to a cat or dog you shouldn't own one. This is a stubborn person. Well there may be like a veterinarian or someone good that really has to have someone help work. Right so in the very most good allergists will not recommend someone who's allergic to an animal to have such an animal by choice as a pet because if you think about it it's really contradictory to good health it really is trying to like sweep back to sea and we will not recommend in

most cases immunotherapy for dogs or cats for dogs or cat dog or cat owners who are allergic to their pets just because it's not good medicine. It increases their likelihood they could have a reaction or not a good outcome for the shot therapy. We're almost out of time but we've had lots of questions regarding according to this caller long -term effects of medication. It doesn't say what medication but I'm assuming can you well I should let you answer that question. You're not in your head like you know what the question is about. I mean that's the common question. What if I take these medicines for years? What's going to happen? Certainly these medicines have been around. Even the newer medicines always have been based on older medications that have been around for many many years. The bottom line is that if you have a problem and the problem is causing medical symptoms and you can block these symptoms using medications to make your life better than you should take the medications. This caller wants to know what's the best first -aid remedy to treat a jellyfish or

Portuguese man of warsting? A little bit off the allergy question but is that an allergic reaction or is that just a... It's not allergy in the sense that we've been talking about allergy. It's a direct venom response much like in the typical person who's not allergic to a bee sting when you get a sting you have a reaction at the site. It's an injection of venom that causes an inflammatory response at the site of injection. There are different remedies. Yeah meat tenderizer or papaya juice is a common one. The enzyme in papaya and meat tenderizer will break down to some degree the venom that has been injected at the site and might lessen the reaction. Okay this caller says when she or he wears a plumeria la and their skin starts to burn. Is this a chemical reaction or an allergic reaction? Have you ever heard of that? Is that an allergy to plumerias or... Actually the parlance of this pretty flowering trees are pretty big parlance and they usually don't cause allergy frequently people wear a la, especially picake.

It's pretty flowers and they're same they're like an irritant when you talk about allergen we talk about cat and dog and parlance but these are any strong smell perfume picake smell these are all irritant and some people have an intolerance you know they have a sensitive lining and we bother them. This caller also says became sensitive to flowering plants and Hawaii has been using over the counter medications. Can you suggest any better treatments? Well if it is you know like picake and there was sensitive lining they have to basically avoid and sometimes they take can take anti -histamine or something and that may help deal with the problem. Yeah the prescription medications probably are more effective than a lot of the over counter stuff that people can get easily which is why sometimes it's worthwhile to talk to your doctor you might need a referral to an allergist if the doctor can't prescribe specific medication that you might more effective and less side effects than what's over the counter. What's the best way to differentiate between a cold and an allergy?

I mean basically allergies you know ongoing symptoms and the typical symptoms of allergies you know sneezing, itchy nose, itchy watery eyes and those may be ongoing for several days or sometimes they can pinpoint that exposed to something and they have these symptoms with the cold, they may have a sore throat, they may have a fever, some other associated symptoms. In children sometimes it becomes difficult because they get frequent colds so you don't know whether it's an allergy or whether it's a cold and if there is doubt we can help them evaluate and do skin testing and help them deal with it. This caller's daughter has allergies and the pediatrician said they need to get rid of all her stuffed animals. Is this necessary? Well it would certainly help the stuffed yes the stuffed animals are good reservoirs for dust mites but there is a very good option. This child should I mean not I'm not trying to plug a particular brand but there's there are some lines of stuffed animals that are very very beautiful cute well designed and that can be washed. The important thing is that they can be washed and they should be

washed every couple weeks in hot water just like the bedding should be washed. The temperature of 130 degrees that's very important so we'll get out the allergen and allow the child to have stuffed animals and there's a brand that you can find that one. You can say the brand. It's a good brand that G -U -N -D the German brand. Okay that's good for children who are allergic to stuffed animals and believe it or not we're out of time but I would like to thank our guests Dr. Alan Wong, Aparnasha, John McDonnell and Jeffrey Cam for joining us and thank you for watching. Next week Dan Boylin will be here for a dialogue on consumer information and we hope that you'll tune in and join his guest from the Department of Commerce and Consumer Affairs. That's next Friday at 8 o 'clock and until then I'm Lynn Waters wishing you a good evening and a good weekend from dialogue. Thanks for watching. Dialogue is brought to you by Hawaiian Electric

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