If you have atopic dermatitis (AD), you’ve probably heard the terms “atopic march” or “atopic triad.” This is when people with AD also develop asthma, an allergic condition that causes the airways to become swollen and inflamed, or allergic rhinitis, or hay fever, which is inflammation in the nose and sinuses. These are known as comorbid conditions or comorbidities of AD.
Each year, the Asthma and Allergy Foundation of America declares May to be National Asthma and Allergy Awareness Month. Not-so-coincidentally, this happens to be peak season for most asthma and allergy sufferers.
And while blowing your nose or using an inhaler throughout the day aren’t exactly causes for celebration, think of National Asthma and Allergy Awareness Month as a good time to focus on symptom management. By identifying the allergens that trigger these inflammatory responses in your body, you’re one step closer to getting your AD under control.
So, without further ado, we bring you five environmental allergies (and how to manage them) with help from Dr. Michael Wein, an allergist-immunologist in Port Saint Lucie, Florida, who is a professor at Florida State University College of Medicine and is affiliated with multiple hospitals in the area.
“Molds are tiny fungi, and the spores float through the air. They seem to cause problems in humid and damp environments and can be found outdoors, in homes and in other buildings. It is a real problem in Florida where I practice,” Wein said.
“If you are allergic to mold, your immune system is overly-sensitive to specific mold spores and treats them as an allergen. There are hundreds of types of molds, most common allergy-causing molds include Alternaria, Aspergillus, Cladosporium and Penicillium.”
Wein suggests staying indoors in an air-conditioned building as much as possible and buy a hygrometer, which measures moisture content in the atmosphere. “In exceptional cases in which asthma is unusually severe, such as Alternaria species–induced asthma in the Midwest, it might be advisable to chat with your doctor [about treatment options],” he suggested.
Pollen, the airborne allergen behind hay fever, is one of the most common aero-allergens and also one of the most difficult to avoid. “Pollens in Florida are most numerous in January through March and, wow, do we have tree pollens,” Wein said.
“Many patients find wonderful relief with over-the-counter treatment (OTC) options. If they cannot avoid the allergen, the FDA has approved several previously ‘prescription only’ medications for OTC use and they include Flonase, Rhinocort, Claritin and Zyrtec”
Other treatment options include allergen immunotherapy or allergy shots that work like a vaccine. “The body responds to injected amounts of a particular allergen, given in gradually increasing doses, by developing immunity or tolerance to the allergen,” Wein said. “Patients should base a decision regarding allergy shots on how much time each year is spent suffering with allergy and how well medications and environmental controls are helping.”
3. Dust mites
Dust mites are microscopic creatures or tiny bugs found in house dust that can live everywhere indoors from mattresses and pillows to upholstered couches and carpets. Cleaning your home regularly can help reduce your exposure to dust mites. It’s important to remember to change furnace and air conditioner filters regularly, and use high-quality pleated filters. Consider purchasing dust mite covers made specifically for mattresses and pillows that can help fight allergy symptoms. More NEA Tips here.
“In 2012, on the basis of several studies of dust mite immunotherapy, newly published guidelines suggested that doctors consider allergen immunotherapy in selected patients with atopic dermatitis if they have aeroallergen sensitivity, but it is not FDA approved,” Wein said.
The pharmaceutical manufacturer Merck collaborated with Danish company ALK to develop an immunotherapy tablet for house dust mite–induced allergic rhinitis. The medication, called Odactra, is an alternative to allergy shots and was approved by the FDA in March 2017.
4. Pet dander
“Animal dander is extremely light-weight and tiny in size and can stay airborne for hours. Levels in homes without animals are generally much lower but can still be detected. Occasionally, high pet allergen levels can be found in households or in schoolrooms without a pet,” Wein said.
If you have a cat or dog, it is not always practical to bathe or shave your pet and expect to be rid of allergens completely. “The proteins are found not simply in the fur, they might also be in a pet’s dander, flakes that come off the skin, saliva and even urine,” Wein explained. “Interestingly, sometimes the pet fur can collect pollen or dust mite allergens and act as a vector for another allergen, but my experience is that this is much less common.” Wash pets at least weekly and consider buying a high-efficiency particulate air (HEPA) filter, he said.
Exposure to cockroaches is an important asthma trigger, particularly for children with asthma living in inner cities, Wein said. “The use of a single intervention, insecticidal bait, to reduce cockroach exposure in the home of children with asthma in New Orleans showed intervention homes had significantly fewer cockroaches than did control homes,” he noted, referencing a study published in the Journal of Allergy and Clinical Immunology in January 2017.
“Children in control homes that did not try to eliminate cockroaches had more asthma symptoms and unscheduled health care utilization compared with children living in intervention homes. The strategic placement of insecticidal bait – which is inexpensive, has low toxicity and is widely available – resulted in sustained cockroach elimination over 12 months and was associated with improved asthma outcomes.”