Occupational Lung Diseases

 Friends today we will touch one of the very important aspects concerning the respiratory health -- The Occupational Lung Diseases!

There are various occupational lung diseases. Among them are: Asbestosis, a chronic, progressive inflammation of the lung; it is a consequence of prolonged exposure to large quantities of asbestos, a material once widely used in construction, insulation, and manufacturing. It is not contagious.
Black lung disease is the common name for coal workers' pneumoconiosis (CWP)or anthracosis, a lung disease of older workers in the coal industry, causedby inhalation, over many years, of small amounts of coal dust.
Silicosis is a progressive disease that belongs to a group of lung disorderscalled pneumoconioses. Silicosis is marked by the formation of lumps (nodules) and fibrous scar tissue in the lungs. It is the oldest known occupational lung disease, and is caused by exposure to inhaled particles of silica, mostlyfrom quartz in rocks, sand, and similar substances.
When asbestos is inhaled, fibers penetrate the breathing passages and irritate, fill, inflame, and scar lung tissue. In advanced asbestosis, the lungs shrink, stiffen, and become honeycombed (riddled with tiny holes).
Legislation has reduced use of asbestos in the United States, but workers whohandle automobile brake shoe linings, boiler insulation, ceiling acoustic tiles, electrical equipment, and fire-resistant materials are still exposed tothe substance. Asbestos is used in the production of paints and plastics. Significant amounts can be released into the atmosphere when old buildings or boats are razed or remodeled.
Asbestosis is most common in men over 40 who have worked in asbestos-relatedoccupations. Smokers or heavy drinkers have the greatest risk of developing this disease. Between 1968 and 1992, more than 10,000 Americans over the age of 15 died as a result of asbestosis. Nearly 25% of those who died lived in California or New Jersey, and most of them had worked in the construction or shipbuilding trades.
The risk of having black lung disease is directly related to the amount of dust inhaled over the years; the disease typically affects workers over age 50.Its common name comes from the fact that the inhalation of heavy deposits ofcoal dust makes miners lungs look black instead of a healthy pink. Althoughpeople who live in cities often have some black deposits in their lungs frompolluted air, coal miners have much more extensive deposits.
In the years since the federal government has regulated dust levels in coal mines, the number of cases of black lung disease has fallen sharply. Since theFederal Coal Mine Health and Safety Act of 1969, average dust levels have fallen from 8.0 mg. per cubic meter to the current standard of 2.0 mg. per cubic meter. The 1969 law also set up a black lung disability benefits program tocompensate coal miners who have been disabled by on-the-job dust exposure.
Despite the technology available to control the hazard, however, miners stillrun the risk of developing this lung disease. The risk is much lower today,however; fewer than 10% of coal miners have any x ray evidence of coal dust deposits. When there is such evidence, it often shows up as only small black spots less than 1 cm. in diameter, and may have been caused by smoking ratherthan coal dust. This condition is called "simple CWP" and does not lead to symptoms or disability.
It is estimated that there are 2 million workers in the United States employed in occupations at risk for the development of silicosis. These include miners, foundry workers, stonecutters, potters and ceramics workers, sandblasters, tunnel workers, and rock drillers. Silicosis is mostly found in adults over40. It has four forms:

• Chronic silicosis may take 15 or more years ofexposure to develop. There is only mild impairment of lung functioning. Chronic silicosis may progress to more advanced forms.
• Patients with complicated silicosis have noticeable shortness of breath, weight loss, and extensive formation of fibrous tissue (fibrosis) in the lungs. These patients areat risk for developing tuberculosis (TB).
• Accelerated silicosis appears after 5-10 years of intense exposure. The symptoms are similar to those ofcomplicated silicosis. Patients in this group often develop rheumatoid arthritis and other autoimmune disorders.
• Acute silicosis develops withinsix months to two years of intense exposure to silica. The patient loses a great deal of weight and is constantly short of breath. These patients are at severe risk of TB.

Occupational exposure is the most common cause of asbestosis, but the condition also strikes people who inhale asbestos fiber or who are exposed to wasteproducts from plants near their homes. Family members can develop the diseaseas a result of inhaling particles of asbestos dust that cling to workers' clothes.
It is rare for asbestosis to develop in anyone who hasn't been exposed to large amounts of asbestos on a regular basis for at least 10 years. Symptoms ofthe disease do not usually appear until 15-20 years after initial exposure toasbestos.
The first symptom of asbestosis is usually shortness of breath following exercise or other physical activity. The early stages of the disease are also characterized by a dry cough and a generalized feeling of illness.
As the disease progresses and lung damage increases, shortness of breath occurs even when the patient is at rest. Recurrent respiratory infections and coughing up blood are common. So is swelling of the feet, ankles, or hands. Other symptoms of advanced asbestosis include chest pain, hoarseness, and restless sleep. Patients who have asbestosis often have clubbed (widened and thickened) fingers. Other potential complications include heart failure, collapsed (deflated) lung, and pleurisy (inflammation of the membrane that protects thelung).
Since the particles of fine coal dust, which a miner breathes when he is in the mines, cannot be destroyed within the lungs or removed from them, builds up. Eventually, this build-up causes thickening and scarring, making the lungsless efficient in supplying oxygen to the blood.
The primary symptom of the disease is shortness of breath, which gradually gets worse as the disease progresses. In severe cases, the patient may developcor pulmonale, an enlargement and strain of the right side of the heart caused by chronic lung disease. This may eventually cause right-sided heart failure.
Some patients develop emphysema (a disease in which the tiny air sacs in thelungs become damaged, leading to shortness of breath, and respiratory and heart failure) as a complication of black lung disease. Others develop a severetype of black lung disease called progressive massive fibrosis, in which damage continues in the upper parts of the lungs even after exposure to the dusthas ended. Scientists aren't sure what causes this serious complication. Somethink that it may be due to the breathing of a mixture of coal and silica dust that is found in certain mines. Silica is far more likely to lead to scarring than coal dust alone.
The precise mechanism that triggers the development of silicosis is still unclear. What is known is that particles of silica dust get trapped in the tinysacs (alveoli) in the lungs where air exchange takes place. White blood cellscalled macrophages in the alveoli ingest the silica and die. The resulting inflammation attracts other macrophages to the region. The nodule forms when the immune system forms fibrous tissue to seal off the reactive area. The disease process may stop at this point, or speed up and destroy large areas of the lung. The fibrosis may continue even after the worker is no longer exposedto silica.
Early symptoms of silicosis include shortness of breath after exercising anda harsh, dry cough. Patients may have more trouble breathing and cough up blood as the disease progresses. Congestive heart failure can give their nails abluish tint. Patients with advanced silicosis may have trouble sleeping andexperience chest pain, hoarseness, and loss of appetite. Silicosis patients are at high risk for TB, and should be checked for the disease during the doctor's examination.
Screening of at-risk workers can reveal lung inflammation and lesions characteristic of asbestosis. Patients' medical histories can identify occupations,hobbies, or other situations likely to involve exposure to asbestos fibers.
X rays can show shadows or spots on the lungs or an indistinct or shaggy outline of the heart that suggests the presence of asbestosis. Blood tests are used to measure concentrations of oxygen and carbon dioxide. Pulmonary functiontests can be used to assess a patient's ability to inhale and exhale, and acomputed tomography scan (CT) of the lungs can show flat, raised patches associated with advanced asbestosis.
Black lung disease can be diagnosed by checking a patient's history for exposure to coal dust, followed by a chest x-ray to discover if the characteristicspots in the lungs caused by coal dust are present. A pulmonary function test may aid in diagnosis.
X rays can detect black lung disease before it causes any symptoms. If exposure to the dust is stopped at that point, progression of the disease may be prevented.
Diagnosis of silicosis is based on:

• A detailed occupational history.
• Chest x rays will usually show small round opaque areas in chronic silicosis. The round areas are larger in complicated and accelerated silicosis.
• Bronchoscopy.
• Lung function tests.

It should be noted that the severity of the patient's symptoms does not always correlate with x-ray findings or lung function test results.
The goal of treatment is to help patients breathe more easily, prevent coldsand other respiratory infections, and control complications associated with advanced disease. Ultrasonic, cool-mist humidifiers or controlled coughing canloosen bronchial secretions.
Regular exercise helps maintain and improve lung capacity. Although temporarybed rest may be recommended, patients are encouraged to resume their regularactivities as soon as they can.
Antibiotics may be prescribed to combat infection. Aspirin or acetominophen (Tylenol) can relieve minor discomfort and bronchodilators that are swallowed or inhaled can relax and widen breathing passages.
Diuretics (drugs that increase urine production and excretion) or digitalis glycoside (Digitalis purpurea) are prescribed for some patients. Othersmay need to use supplemental oxygen or use less salt.
Anyone who develops symptoms of asbestosis should see a family physician or lung disease specialist. A doctor should be notified if someone who has been diagnosed with asbestosis:

• Coughs up blood
• Continues to lose weight
• Is short of breath
• Has chest pain
• Develops asudden fever of 101°F (38.3°C) or higher
• Develops unfamiliar, unexplained symptoms.

There is no treatment or cure for black lung disease, although it is possibleto treat complications such as lung infections and cor pulmonale. Further exposure to coal dust must be stopped.
Likewise, there is no cure for silicosis. Therapy is intended to relieve symptoms, treat complications, and prevent respiratory infections. It includes careful monitoring for signs of TB. Respiratory symptoms may be treated with bronchodilators, increased fluid intake, steam inhalation, and physical therapy. Patients with severe breathing difficulties may be given oxygen therapy orplaced on a mechanical ventilator. Acute silicosis may progress to complete respiratory failure. Heart-lung transplants are the only hope for some patients.
Patients with silicosis should call their doctor for any of the following symptoms:

• Tiredness or mental confusion
• Continued weight loss
• Coughing up blood
• Fever, chest pain, breathlessness, or new unexplained symptoms.

Patients with silicosis should be advised to quit smoking, prevent infections by avoiding crowds and persons with colds or similar infections, andreceive vaccinations against influenza and pneumonia. They should be encouraged to increase their exercise capacity by keeping up regular activity, and tolearn to pace themselves with their daily routine.
Asbestosis can't be cured, but its symptoms can be controlled. Doctors don'tknow why the health of some patients deteriorates and the condition of othersremain the same, but believe the difference may be due to varying exposuresof asbestos. People with asbestosis who smoke, particularly those who smoke more than one pack of cigarettes each day, are at increased risk for developing lung cancer and should be strongly advised to quit smoking.
Those miners with simple CWP can lead a normal life. However, patients who develop black lung disease at an early age, or who have progressive massive fibrosis, have a higher risk of premature death.
Silicosis is currently incurable. The prognosis for patients with chronic silicosis is generally good. Acute silicosis, however, may progress rapidly to respiratory failure and death.
Workers in asbestosis-related industries should have regular x rays to determine whether their lungs are healthy. A person whose lung x ray shows a shadowshould eliminate asbestos exposure even if no symptoms of the condition haveappeared.

Anyone who works with asbestos should wear a protective mask or a hood with aclean-air supply and obey recommended procedures to control asbestos dust. Anyone who is at risk of developing asbestosis should:

• Not smoke
• Be vaccinated against influenza and pneumonia
• Exercise regularlyto maintain cardiopulmonary fitness
• Avoid crowds and people who haverespiratory infections.

A person who has asbestosis should exercise regularly, relax, and conserve energy whenever necessary.
The only way to prevent black lung disease is to avoid long-term exposure tocoal dust. Coal mines may help prevent the condition by lowering coal dust levels and providing protective clothes to coal miners.
Silicosis is a preventable disease. Preventive occupational safety measures include:

• Controls to minimize workplace exposure to silica dust
• Substitution of substances--especially in sandblasting--that are less hazardous than silica
• Clear identification of dangerous areas in the workplace
• Informing workers about the dangers of overexposure to silica dust, training them in safety techniques, and giving them appropriate protectiveclothing and equipment.

Coworkers of anyone diagnosed with silicosis should be examined for symptomsof the disease. The state health department and the Occupational Safety and Health Administration (OSHA) or the Mine Safety and Health Administration (MSHA) must be notified whenever a diagnosis of silicosis is confirmed.

ref:

http://www.faqs.org/

Hurricane hits Mumbai, India- does it have any implications?

So why are we discussing it here?
Well the reason is that there's a relationship of hurricanes with Asthma!

Hurricanes do have an affect on asthma patients, and the 2005 hurricane season has gotten off to a busy start.
In 1992, after Hurricane Floyd, the CDC established a link between hurricanes and an increase in asthma severity.
After a hurricane there is increased particle matter in the air, there is no electricity and an increase in mold grow months afterward.
While cleaning up debris, asthma patients should use a mask that fits securely over the mouth and nose. If at anytime during the cleanup an asthma patient starts to feel short of breath, begins to cough or experiences chest tightness, the asthma patient needs to sit down and rest immediately. Asthmatics may need to find another way to aid in the cleanup besides digging through debris.
With electricity out, possibly for days, asthma patients need to make sure they have a battery operated nebulizer. If they do not, asthma patients who use a nebulizer on a regular basis to control asthma symptoms need to check with their doctor or local hospital.
After a hurricane, mold will grow. Make sure all standing water, wet carpet, wet ceilings, etc. are dried thoroughly. If wet carpet, ceilings, furniture, etc. are not replaced immediately make sure these items as well as others are monitored closely for mold growth.
Hurricanes are part of our weather. With hurricanes comes an increase in possible triggers for asthmatics.

source:
http://www.asthmanow.com/

Exercise & Sports in Asthma

Having asthma does not mean that you cannot exercise. However, if you have any limitations in your ability to exercise because of your asthma, your asthma is not being controlled properly.

If your asthma is not controlled and you exercise, you may experience worsening symptoms. If this it the case, you need to take steps to first regain total asthma control prior to resuming your exercise program. The inability to exercise without symptoms is a sign of poor asthma control. Talk to your doctor about this. Once you have total control, you will be able to exercise without asthma symptoms.

If your asthma is under control and you experience asthma symptoms five or 10 minutes after exercising, this is probably due to exercise-induced asthma.

Exercise-induced asthma occurs because the airways are sensitive to temperature and humidity changes, especially when breathing in cold, dry air through the mouth. Air that passes through the mouth is bypassing the nose, which normally humidifies and warms the air prior to its reaching the lungs.

The diagnosis of exercise-induced asthma is made by performing a breathing test (spirometry) at rest and then again following exercise. If there is a measured decrease in the speed of air that can be breathed out following exercise, this indicates exercise-induced asthma, or EIA, is present.

Contributing factors to exercise-induced asthma include:

How long you exercise
How hot or cold it is
How humid it is
Whether allergens, air pollution or other possible triggers are present while you exercise
It's important to note that the benefits of regular exercise almost always outweigh the risks associated with exercise-induced asthma.

These benefits include:

Improved efficiency of the heart and lungs
Increased muscle strength and endurance
Improved flexibility and posture
Improved ability to relax
If you're unsure whether your symptoms are due to exercise induced asthma, or are the signs of worsening asthma control, talk to your doctor.

Once you and your doctor have established what your exercise regimen should be, keep the following in mind:

Take your medication before starting to exercise if advised.
Start your regimen slowly. Take your time before attempting more demanding exercises.
Always warm up before exercising, and cool down after.
If you develop symptoms while you are exercising, stop and rest. Take your reliever medication.
If you usually exercise outdoors and it's cold out, opt for indoor exercise.
If you usually exercise outdoors and the pollution or pollen counts are high, exercise indoors instead.

source:
http://www.asthma.ca/

Laughter-induced asthma: It’s no joke

More than half of people with asthma report that their symptoms are brought on by laughter, according to a study to be presented at the American Thoracic Society International Conference on May 24.

The study of 235 patients with asthma found that 56% had laughter-induced asthma (LIA). Asthma that is triggered by laughter doesn’t seem to cause more asthma flare-ups requiring emergency room visits or hospitalizations compared with other types of asthma, according to study author Stuart Garay, M.D., Clinical Professor of Medicine at NYU Medical Center in New York. "But patients did report that during times when their asthma is well controlled they can laugh for longer without getting asthma symptoms. That suggests that laughter-induced asthma may be a sign that a person’s asthma isn’t as well controlled as it could be. People with asthma should be allowed to laugh."

Nobody knows how laughter brings on asthma, but it might involve hyperventilating, Dr. Garay said. He noted that exercise was the only trigger more common in people with laughter-induced asthma compared with asthma not induced by laughter (61% of people with LIA vs. 35% of asthma patients without LIA).

Dr. Garay was struck by how common laughter-induced asthma is. "It’s as common as some of the most well-known asthma triggers, such as grasses, trees, pollen, fumes and odors, and it’s even more common than dust mites, allergy to animals and molds," he said. "It’s a little-appreciated frequent trigger."

The study found that the most common symptom in patients with laughter-induced asthma was coughing, which generally starts within two minutes. The next most common symptom was chest tightness.

How much laughter can set off breathing problems? "It depends on the patient," Dr. Garay said. "For a majority of patients, mild laughter or even a chuckle will set off coughing. For others, laughing hard will bring on asthma symptoms."

 Source: EurekAlert!
Further information: www.thoracic.org/

 

Vaccination Helps Guard Against Swine Flu

The World Health Organisation has cautioned people to continue to protect themselves against swine flu and vaccination may greatly help in this exercise.

"At the WHO we remain quite concerned about the pattern we are seeing, particularly because a sizeable number of people do develop serious complications and death," said Keiji Fukuda, special adviser on pandemic.

"Again, we are seeing most of this develop in people who are younger than 65 years, a picture which is different from seasonal influenza," he explained.

Fukuda reiterated that the cases of serious complications were largely found among the chronically ill, pregnant women as well as some otherwise healthy younger people.

He also countered signs of public scepticism about the vaccine revealed by surveys in several countries, despite the resurgence of swine flu in the northern hemisphere with the onset of the colder season.

"WHO believes that these vaccines are very useful against the pandemic virus," Fukuda said in a telephone news conference.

Vaccination against A(H1N1) influenza has now started in more than 20 countries and were demonstrably safe, according to the WHO.

"What we are seeing is that these vaccines are highly safe and have been received by a significant number of people without any problems," Fukuda said.

Swine flu has differed from seasonal flu in persisting in the northern hemisphere during the summer period and in a pattern of occasional serious illness affecting under 65-year-olds.

However, Fukuda acknowledged that it was as transmissible as seasonal flu, showed the same pattern of spreading more widely in winter and was "self limiting" in that the large majority of people who caught it got better without the need for special treatment.

More than 5,700 people have died worldwide since the pandemic

virus was first discovered in April, with most deaths 4,175 reported in the Americas region, according to WHO data.

source:

http://www.medindia.net/news/

Attack Asthma learn more. Here are the Asthma triggers!

Triggers in Your Home

Mold

Mold grows on damp things such as shower curtains, bath items, tubs, basins and tiles. What you can do? If you see mold, clean it up with soap and water. Use exhaust fans or open a window in the bathroom when showering and the kitchen when cooking or washing dishes. Fix leaky plumbing or other sources of water as soon as possible. Dry damp or wet items within 1-2 days to avoid mold growth.

Dust Mites

Dust mites are tiny bugs you can’t see. They live in sheets, blankets, pillows, mattresses, soft furniture, carpets, and stuffed toys, such as stuffed animals.

What you can do?

• Wash bed sheets and blankets once a week. Dry completely.
• Use dust-proof covers on pillows and mattresses.
• Vacuum carpets, rugs and furniture often.
• Wash stuffed toys. Dry completely.

Secondhand Smoke

Asthma can be triggered by the smoke from the burning end of a cigarette, pipe, or cigar, or the smoke breathed out by a smoker. Choose not to smoke in your home or car, and don't allow others to do so either.

What you can do?

• Don’t smoke in your home or car.
• Don’t let anyone smoke near your child.
• Pledge to make your home and car smoke-free

Cockroaches

Cockroach body parts and droppings may trigger asthma attacks.

What you can do?

• Keep counters, sinks, tables, and floors clean.
• Clean dishes, crumbs, and spills.
• Store food in air tight containers.
• Cover trash cans.

Cats and Dogs

A warm-blooded animal's urine and saliva may also trigger attacks.

What you can do?

• Keep pets outside if possible.
• If you have a pet inside, keep them out of the bedroom and off the furniture.
• Vacuum carpets and furniture often.

Nitrogen Dioxide

Nitrogen dioxide is an odorless gas that can irritate your eyes, nose, and throat and may cause shortness of breath. This gas can come from the use of appliances that burn fuels, such as gas, wood, and kerosene.

What you can do?

• If possible, use fuel-burning appliances that are vented outside. Always follow the manufacturer's instructions on how to use these appliances.
• Gas cooking stoves: Never use these to keep you warm or heat your house. If you have an exhaust fan, use it when you cook.
• Unvented kerosene or gas space heaters: Use the proper fuel and keep the heater adjusted the right way. Open a window slightly or use an exhaust fan.
• Wood stoves: Make sure the doors are tight fitting. Follow the maker's instructions for starting, burning, and putting out the fire.
• Fireplaces: Always open the flue.

Chemical Irritants

Chemical irritants found in some products in your house, such as scented or unscented products, including cleaners, paints, adhesives, pesticides, cosmetics, or air fresheners, may make your child's asthma worse.

What you can do?

• Use these products less often and make sure your child is not around when you use the products. Also, consider trying different products.
• Take great care to follow the instructions on the label. If you use these products, try to make sure that windows or doors are open and that you use an exhaust fan.

Source:
http://www.noattacks.org/triggers.html

Create Better Breathing Space for Asthmatics

Quick Tips

• Ventilation is crucial.
  
  "The building of tightly-sealed houses over the last two decades has made it much easier for moisture and dust to collect in homes," Harvard professor Dr. Douglas Dockery notes. Many vapors trapped indoors, from perfumes and air fresheners to formaldehyde from particleboard, irritate asthmatics. When it’s fresh or even cold outside, keep windows open a crack to circulate air. On hot days, close windows and use air conditioners to ventilate and filter out smog.

• Don’t harbor dust mites.
  
  Microscopic dust mites and their droppings are a potent allergen and asthma trigger. One of the best ways to limit the amount of dust mites in your homes are to encase mattresses with impermeable covers. 

• Eradicate cockroaches and keep clutter to a minimum.
  
  Piles of dirty clothes make a growth environment for mildews and mites; piles of paper attract cockroaches. Remember, you can eliminate household pests without using toxic pesticides.

• Maintain humidity below 50 percent.
  
  "Dehumidifying is enormously important, as many asthmatics are highly allergic to mildews and molds," says Harriet Burge, Ph.D., associate professor at Harvard School of Public Health.

• Minimize pet dander.
  
  "Cat dander is everywhere, even if you wash the cat," Centers for Disease Control Dr. Ruth Etzel says. "The only real solution is not to have the cat." Or, wash every two to three weeks, Los Angeles pediatrician Harvey Karp advises.

• No cigarette smoking in the home or car, or anywhere in asthmatics’ presence.
  
  Furnace and heating duct filters should be replaced periodically as they collect dust and molds. Some businesses provide duct-cleaning services.

• Keep asthmatics away from gas stoves.
  
  "Open the oven door and you get a blast of NO2," says University of British Columbia professor emeritus Dr. David Bates. "The asthmatic child should not sit in the kitchen doing homework if the oven is being used." Make sure that stoves are well-ventilated, too.

• Ask your pediatrician about allergenic foods.
  
  If there is a family tendency to allergy, Dr. Ruth Etzel from the Centers for Disease Control says, parents might limit foods associated with allergies, such as cow’s milk, from the child’s diet in the first two years. She and other pediatricians recommend that mothers try to breastfeed their infants for at least the first year.

• Check your local air quality index daily.
  
  Asthmatic children should not exert themselves outside in hot, smoggy weather, or when a dusty wind blows; smog counts tend to be highest between 3pm and 6pm. Air Now, a site provided by the U.S. Environmental Protection Agency, allows you to check your local air quality, get ozone maps and more.
  
  
• Try air cleaning and purifying machines.
  
  Consumer Reports says a good air cleaner can help those allergic to dust and mold spores, citing the fan/filter models as most effective in removing airborne dust. The machine will help most in the asthmatic’s bedroom; but keep it at least six feet from the bed (it creates draft), and don’t place on carpet (it can kick up dust). But, "They can only help if you’ve gotten rid of the risk factors first, like dust mites, mold and danders," Harvard School of Public Health associate professor Dr. Harriet Burge warns. Warning: many asthmatics experience irritation from the ozone type of air purifier.

101 Hints, Tips and Bits of Wisdom from President Ronald Reagan’s Allergist

Timely Help For People With Allergies And Asthma

President’s Ronald Reagan's former allergist,  Ralph Bookman, M.D., has earned the respect of doctors and patients by developing effective ways to minimize allergy problems. He is an ‘old school’ scholar with a tremendous amount of valuable information for allergy sufferers.

While Governor of California, Ronald Reagan came looking for Dr. Bookman for some allergy relief. Ronald Reagan liked what he saw With Dr. Bookman it’s not hard to like, what you see is what you get.

"The practice of allergy has become overly complicated and complex, says Dr. Bookman. It’s essentially a very simple subject, and unfortunately, some of its most effective treatments have been all but forgotten".

Here, then, are a number of those treatments, tips, explanations and opinions culled from a series of interviews and from Dr. Bookman’s excellent book, The Dimensions of Clinical Allergy (Charles C. Thomas, publisher; 1985).

An associate clinical professor at the University of Southern California School of Medicine and a member of the Advisory Council of the National Institute of Allergy and Infectious Diseases, Dr. Bookman still makes his own allergy extracts and still dispenses his highly opinionated advice to a select group of patients — including the former President — four days a week.

We’re extremely pleased to be able to bring you this small sample of Dr. Bookman’s wisdom as a special treat.

1. Thresholds

"Even when people are allergic to a substance, there is a certain level they can tolerate before symptoms will appear. Exceed that ‘threshold’ and up pop the symptoms".

"Most people already understand that the same amount of pollen can bother one allergic person and not another. What they often fail to understand is that thresholds can also vary widely in the same person from one day to the next".

2. Nobody ‘Outgrows’ Allergies

"The lifetime of the allergic individual is one in which symptoms will wax and wane in intensity and shift from one part of the body to another. This shifting of symptoms is poorly understood and leads many people to mistakenly believe that one can ‘outgrow’ their allergy symptoms".

3. Example: Eczema

"An example is the child with a severe case of incredibly itchy eczema who suddenly improves without apparent reason".

"The most recent symptom of the child’s allergic nature — the eczema — has disappeared, but it is invariably replaced by another allergy symptom. In most children, the shift is from eczema to nasal symptoms".

"But the parents and physician are generally so relieved that the eczema is gone that they don’t even notice the runny, stuffed-up nose that wasn’t there before!"

4. Irritants, Not Allergens

"A large number of non-protein substances like Kleenex, paper dust, paint fumes, perfume, newsprint and cigarette smoke are erroneously called allergens, but they’re not. They do produce symptoms in many people, but it’s because they’re irritating, not allergic".

5. Bake Your Paper

"Newsprint is a problem for some people because of irritative solvents in the ink. Problems only occur with freshly printed papers and can be avoided simply by putting new papers into an oven set on very low heat for around 20 minutes or so".

6. Growing Up Allergic

"An infant’s first exposure to proteins is primarily through foods, which is why food allergies are so common in allergic infants. As the infant grows, his ‘protein world’ expands, and he begins to react to the indoor allergens he’s inhaling".

"Exposure to pollen generally comes later, which is why outdoor allergies rarely appear in children before the age of 3. As the child grows older, the food allergies so common to infants gradually disappear — only to be replaced by inhalant allergies".

"The food allergies weren’t outgrown — they were replaced!"

7. Positive Reactions Not Positive Proof

"The first thing that happens when an allergic person inhales, ingests or physically contacts an allergen is that they become ‘sensitized’ to it. All that means is that their body now recognizes that substance distinctly — it doesn’t mean that exposure is going to cause them to experience symptoms".

"But it will cause them to react to that substance when skin tested. These positive reactions tend to convince people that they’re allergic to many more things than they really are".

8. To Understand Allergy, Look Beyond The Symptoms.

"In medical school you learn to look for the cause of a disease based upon the location of its symptoms. But allergy is not a disease — it’s an inherited condition that cannot be understood from the medical school point of view".

"It doesn’t matter if the symptoms show up in the nose, chest, eyes, ears, skin or somewhere else — the problem isn’t in that one area. Allergy is a lifelong condition that affects the entire individual".

9. Where’s Your ‘Dial’ Set Today?

"Generally these changes occur gradually during a person’s lifetime. Without changing a thing around them, some people’s sensitivities to one substance can all but vanish, while other allergies will reappear after years of absence".

"I like to say that the ‘dial setting’ of their allergic responsiveness has changed. Most times, this occurs slowly and subtly, but some events can cause immediate changes in a person’s ‘dial setting’".

10. Shots And Sickness Work The Same

"Allergy injections don’t get rid of your allergy to a substance — they raise your threshold, so that you can tolerate more of the substance before you experience symptoms".

"But a virus will have almost the same effect, temporarily. It’s not unusual to see allergic skin lesions clear or respiratory symptoms disappear during a virus attack. Surgery or a major trauma, such as breaking a bone, almost invariably shuts down allergy symptoms as well".

11. Allergy Symptoms: There Are Only Three

"When you do exceed your threshold, symptoms appear. All allergic symptoms are a combination of three basic effects, and nothing more".

"There is edema (swelling), particularly of the skin and mucus membrane. There is an increase in the secretion of mucus, especially in the respiratory tract. And there is spasm of smooth muscle where smooth muscle exists".

12. Swelling Tops The List

"Edema is the most common result of an allergic reaction, but the actual symptoms it produces depend entirely upon the area where the swelling occurs. In the upper respiratory tract, for instance, swelling can cause nasal obstruction or sinus obstruction, close the ear’s Eustachian tube, or cut off a person’s sense of smell by obstructing their olfactory recess".

"Edema near the larynx causes ‘allergic hoarseness.’ In the trachea it leads to an irritating cough. In the bronchial tree it causes asthma".

13. The Most Serious Edema

"If you’re lucky enough to have your allergic edema show up in the nose, you can always breathe through your mouth. But when the same edema is experienced in the bronchial tree, there aren’t any breathing alternatives".

"That, in a nutshell, is why asthma is so serious".

14. Eczema? Just Abused Edema

"The only allergic response the skin can have is edema. It doesn’t have smooth muscle and it can’t secrete mucus".

"Atopic dermatitis — or eczema — always begins as simple edema. But most doctors never see the swelling that occurs at the beginning of the condition because the intense itching (caused by the stretching of the skin) makes people tear away at the area and really scratch it up".

15. Smoke: Not Allergic

"A lot of people claim to be allergic to tobacco smoke, but the large molecules necessary for an allergic reaction can’t survive the burning heat of a cigarette".

"There are cases of true tobacco allergy, but they always involve physical contact with the raw leaf. Cigarette smoke can make you cough, sneeze and wheeze, but it’s not an allergy and allergy treatments won’t prevent it or clear it up".

16. Alcohol Augments Allergies

"Alcohol is also not an allergen. But it does act to congest the nasal passages. In someone with allergic rhinitis (a runny, stuffed-up allergic nose) it adds to the edema already present due to allergies".

"Some people with allergies are unable to drink at all because of the intense nasal congestion that alcohol produces. I sometimes wonder if a lot of hangovers aren’t the result of alcohol-induced sinus blockage".

17. Allergies And Emotions

"It has been a tedious burden to have to constantly explain that emotions have no effect whatsoever on allergy symptoms —  especially to people who are absolutely convinced this is true because they read it somewhere or heard it on TV. I am far more impressed by the effect that allergy symptoms have on a person’s emotional state. People who think that allergic symptoms are the result of emotional problems obviously have the cart before the horse! A nose that’s blocked up constantly day and night can’t help but cause a person to be irritable and lessen their ability to cope with life and its daily problems".

18. Pollen Alone?

"Probably Not . . ".

"Close questioning of patients who insist that they only have seasonal complaints invariably reveals that most of them are not completely symptom-free the rest of the year. Their year-round symptoms may be minor — occasional sneezing, a productive cough, some slight nasal stuffiness — but they are there if you look for them".

"These people obtain much more relief when they’re treated for both their year-round (indoor) allergies and pollens than when treated for pollens alone".

19. Too Much Dander And Nothing Works!

"The amount of dander deposited on a home’s rugs and furniture by a pet is usually far greater than allergy injections can overcome. The shots won’t help until the pets are moved outside and the dander has been cleaned out of the rugs and furniture".

20. Skin Test Tips

"You can’t predict the severity of a person’s symptoms by their skin tests alone. I often see large skin test reactions in people with mild hay fever and small reactions in people who have severe allergy problems. And not all people with allergic disease react when skin tested. Occasionally you’ll see a person with a classic history of spring hay fever whose skin tests are negative. Such people generally respond well to injections of the pollens that are in the air when their symptoms are worst".

21. Seniors Can Be Skin Tested

"Some doctors claim that elderly people don’t react at all when skin tested. This is just not so. Older people tend not to flare (the redness that appears around a positive skin test), but the wheal (the actual hive-like welt that springs up when a test is positive) can be read if you look at it in oblique light and feel around to determine its size".

22. When Not To Test

"It’s pretty much useless to skin-test someone when their asthma symptoms are severe or when they’re recovering from surgery or other trauma. Just as these conditions temporarily relieve allergy symptoms, they also shut down skin test responses. If you want to really learn what you’re allergic to, wait till you feel better".

23. Bad Marks In History

"Taking a person’s history accurately is more important in allergy practice than in any other medical specialty. Many people’s allergies go undiagnosed simply because most doctors don’t ask enough questions, don’t know the right ones to ask and don’t know which answers actually point to a diagnosis of allergy".

24. Medical Forms Miss The Mark

"Forms interfere with getting a good idea of a person’s medical history for two reasons. First, they’re created by doctors, using terms that doctors are familiar with but that many patients aren’t. You get a lot of wrong answers simply because most people are going to misunderstand at least some of the words on the form. Second, all forms, no matter how carefully they are written, are extremely rigid in structure. This prevents a doctor from learning of unusual events that may be important for correct diagnosis".

25. Doctors: Ask More Questions!"

"A doctor should always ask a patient what they mean when they say they ‘have a lot of colds’ or when they complain of frequent infections. Are these really infections, or just short-term worsening of the person’s allergic symptoms? Most doctors think that the only allergy symptom is sneezing, and if you don't sneeze you don't have allergies. People in cold climates will often report having lots of colds and infections in the winter. The real problem is that they’re spending more time indoors — surrounded by indoor allergens". 

26. How To Catch A Mouth Breather"

Don’t bother asking people if they’re mouth breathers, because they’re just going to say no. Ask them instead if they wake up with a dry mouth or a sore throat in the morning — both are sure signs of mouth breathing! Hot drinks will relieve the problem quickly".

27. Not All Seasonal Allergies Are Pollen

"Steer manure, a popular springtime lawn fertilizer, contains copious amounts of cattle dander, which is a very potent allergen. Because it’s generally only applied in the spring or fall, people often mistake the seasonal symptoms as an allergy to pollens".

28. If The Plant Is Pretty, Don’t Worry

"Many people tend to look at a colorful field of flowers as a producer of airborne pollen. But those bright colors are there to attract insects, which carry the heavy pollen from plant to plant. In most cases it’s safe to say that flowers whose blossoms are easily visible and colorful are insect pollinated and won’t cause problems".

29. Pets — Or Pollen?

"Cats and dogs that are allowed to roam often play in grassy and weed-strewn areas, where they can pick up quite a bit of pollen in their pelts.  The only allergen in cat saliva is dander. Cats are always licking themselves and their saliva is heavily contaminated with the skin scales they’re licking off! Some people who think they’re allergic to pets are actually reacting to the pet borne pollen and not to the pet".

30. Minor League Symptoms Can Cause Major League Fatigue

"Constant low-grade allergy symptoms can often be more detrimental than symptoms that are severe, but occasional. Constant, annoying symptoms can really wear away at a person’s sense of well-being. They can destroy their ability to get a good night’s sleep or concentrate at work".

31. Goat Hair? In The White House?

"Most people have a lot more animal dander in their environment than they realize. If they have a true Oriental rug, for instance — one actually made in the Orient — then it is certainly loaded with sheep, goat and camel dander. President Reagan tells me he feels much better when he’s at Camp David than at the White House, and I’m not surprised. The White House is full of antique furniture stuffed with animal hair. When someone plops down in one of those old chairs or overstuffed couches, a ton of dander comes blowing into the room. Camp David has all new furniture. And new furniture isn’t filled with dander".

32. Wool Worries

"Good quality domestic wool is processed to be dander-free; it is not allergenic. However, it is irritating to many people — and not just those with allergies. Wool from third-world countries is not treated after it’s taken from the animal. This kind of wool can contain a lot of dander and cause serious allergy problems".

33. Outdoor Pets Are No Problem

"Pets that remain outdoors at all times can be dismissed as an allergy problem. In fact, the pet itself isn’t the problem at all — it’s the dander that saturates the carpets and furniture, especially in the bedroom, that causes constant, annoying symptoms. But be warned — removing a pet won’t show benefits for a long time; you have to get rid of the leftover dander first. Vacuuming the carpet daily for a month will remove it, and the room will remain dander free as long as the pet never enters again".

34. Women’s Mucus

"Women are often relieved to hear that it is not unusual for vaginal mucus discharge to increase when traditional allergy symptoms are most troublesome. This is especially true of seasonal allergy reactions, and it’s a perfectly normal allergy symptom".

35. Is All Asthma Allergic?

"Almost everyone in the medical community looks at bronchial asthma and allergic rhinitis (hay fever) as separate and distinct entities. I look at them both as manifestations of respiratory allergy. After all, the same mucus membrane lines the respiratory tract from top to bottom, and the changes that occur in the nose and sinus in allergy are virtually identical to the changes that occur in the bronchial tree during an asthma attack. When you look at the similarities of the conditions instead of their differences, I think you can treat the patient better".

36. ‘Sudden Onset Allergies’ Were Always There

"A lot of people will claim that their allergy symptoms have suddenly appeared after a lifetime without allergies. In almost every case, careful questioning will reveal that allergy symptoms may have been minimal and tolerable, but were certainly there in the past. This is important because true allergy doesn’t just suddenly appear".

37. ‘Frequent Colds’ Are Frequently Allergies

"Physicians’ offices are filled with patients complaining of frequent colds. It is unfortunate that these people’s symptoms aren’t recognized for what they are: allergic rhinitis that would respond well to specific allergy care. I’ve had patients tell me that they only have two colds a year. But when I question them, I find out that the first ‘cold’ tends to last as long as the spring pollen season, while the second coincides perfectly with the fall pollen season!"

38. Cold Or Allergy?

"A cold is an upper respiratory infection, and it displays the typical symptoms of infection: low grade fever, purulent nasal discharge and a general malaise that lasts from 3 to 5 days. It also has a tendency to be transmitted from one family member to another. Continuous episodes of sneezing with a watery nasal discharge, nasal obstruction and head congestion accompanied by a sense of fatigue that lingers for weeks or longer can be reasonably assumed to be allergic".

39. A Little Swelling Can Make A Big Impact

"Several areas adjacent to the respiratory tract have one thing in common: They’re so small that very little edema (swelling) is necessary to obstruct them. These include the middle ear and the olfactory recess, which controls our sense of smell. When episodes of sinus pain, middle ear problems and loss of sense of smell occur, look to allergy as the cause".

40. Sinus Infections? Open Up The Nose!

"Sinus obstruction is a common result of edema in this crowded area. When the obstruction blocks the mucus flow completely, the stagnant mucus becomes a breeding ground for bacteria. As soon as the obstruction is removed (by a combination of allergy therapy and decongestants), the mucus flow is restored and the condition quickly resolves itself".

41. Allergic Deafness

"This is a condition frequently seen in children and, less often, in adults. Fluctuations in the deafness are a clear signal that allergies may well be the cause. The problem is due to sporadic edema of the middle and inner ear. Children who go through varying periods of inattentiveness and withdrawal are often experiencing this intermittent allergic deafness".

42. All Septums Are Deviated!

"No biological entity has a body part that is ruler-straight, therefore no one has a perfectly straight septum! They all deviate from the vertical to some degree. The only effect of a deviated septum is to make one nasal passage larger and the other smaller. There is no real effect on total airflow. When swelling occurs, the smaller one will quite naturally block before the larger one, but the final effect on airflow is the same as if both sides were equal".

43. Leave It Bent

"I see little reason in most cases to straighten septums, and the temporary improvement you see after straightening is the same allergy-deadening effect you can expect from any surgery. The swelling and obstruction generally return in a few weeks — after your body recovers from the trauma of the surgery".

44. That Stuck-in-the-Throat Feeling

"Some people with postnasal drip will develop swelling in an area of the throat called the uvula. Because this area has little sensory discrimination, the swelling feels as if there’s mucus trapped there that can’t be dislodged. Drinking ice water will reduce the swelling and eliminate that feeling of trapped mucus".

45. Allergic Hoarseness

"Many people with allergies often experience a painless hoarseness. Look down their throat and you’ll find swelling and pallor rather than the red, ‘angry,’ painful inflammation caused by overuse. Using an epinephrine inhaler (like Primatene Mist) eliminates the edema causing the problem. People who use their voice professionally — singers, actors, announcers, and yes, even the President — often experience gratifying results when they use such an inhaler before speaking or singing. But it won’t help if the problem is non-allergic and just due to overuse".

46. Allergic Vertigo

"The term ‘Meniere’s Syndrome’ refers to a poorly understood condition where the patient suffers from recurrent or chronic vertigo (dizziness). You can’t say that the condition is due exclusively to allergy — there are many other causes. But when upper respiratory allergy symptoms are also present, there’s a chance that allergy therapy designed to affect the nose and chest may also ease the vertigo".

47. Antihistamine Advice

"If there were one or two reliable antihistamines that worked for everyone, the rest would evaporate and be forgotten. But that, of course, is not the case — their effectiveness and side effects are different in everyone. Patients should be given small starter packs so they can find the antihistamine that works best for them. They should also avoid driving until they are certain of how drowsy a specific antihistamine makes them. Some produce such a powerful sedation that they may help an allergic patient not so much by controlling their symptoms, but simply by helping them get a good night’s sleep!"

48. And A Warning. . . . . .

"Antihistamines function well in allergy partly because of their drying effect. But in asthma, the reverse — hydration — is necessary for the control of symptoms. Therefore, antihistamines should never — I repeat, never — be used when asthma symptoms are present. I prefer to use decongestants instead".

49. Decongestant Dependence

"There is no question that it is possible to get ‘hooked’ on a nasal decongestant. ‘Addicted’ patients generally have a spray at home, one in the car, one in the office and one in their pocket or purse that they use every hour or so. These are the people most at risk of the ‘rebound’ effect. There is always some ‘rebound’ in the form of nasal swelling with the use of these products, but for most people, the effect is barely noticeable. Abusers, however, can experience severe swelling as the area becomes irritated from constant use of the drug".

50. The ‘Cold Turkey’ Cure

"Such people must take a 72-hour break from decongestants. It’s a trying experience for many of them, but almost all will experience significant relief when the rebound swelling and obstruction subside. People with true allergic rhinitis can avoid abuse by limiting themselves to a single daily spray or by using decongestant drops at nighttime. At other times they should rely on antihistamines".

51. Instant ‘Allergic Ear’ Relief!

"Eustachian tube block can often be dramatically relieved with nasal sprays containing a strong decongestant, such as Neo-Synephrine (0.5 percent). Tilt the head back and to one side, turn the spray bottle upside-down and get enough of the spray into the nasal passage so that you can actually taste some of it in the back of your throat. Then turn your head the other way and repeat, using the other nostril. This technique is often dramatically effective at ending allergic ear problems, because it passes the decongestant directly over the entrance to the Eustachian area located in the nasopharynx.   During plane flights, this should be done one-half hour before a scheduled descent. For children, it should be done at the first sign of pain or discomfort, repeated in 4 hours and then repeated again if symptoms reappear. This will often abort painful episodes of otitis media. Drinking more fluids on a regular basis will greatly reduce the unnecessary use of antibiotics.

52. Tissues, Not Allergies, Shred Noses

"Red, raw and chafed noses are thought by many to be a sign that allergies are present. They may be, but the actual chafing damage is invariably due to the excessive use of paper tissues. All tissues are made of wood pulp and are extremely irritating. "Children often suffer heavily fissured, even infected, noses because mothers, in their zeal, insert the tissue into the nostril and twist vigorously. "The condition is easily cured by using handkerchiefs or other cotton cloths and greasing the nostrils with Vaseline".

53. Nasal Bleeding

"Streaks of blood mingled with nasal mucus are a common occurrence. Medical texts and some physicians warn that such bleeding can be due to malignancy, but I have never encountered such a case. So far, it’s always been due to trauma caused by fingernails. "Children admit this habit, although adults rarely will. The proof in either case is that you can generally see the abrasions on the inside of the nostril after the bleeding stops".

54. Allergic Styes

"Occasionally, people with allergies will develop recurrent styes that are attributed to their condition. "The real cause of the infection that has developed in the irritated hair follicles of their eyelashes is constant itching and rubbing. Treat the allergy and the eye symptoms will clear".

55. Wash Your Hands To Prevent Eye Problems!

"The skin of the fingers is notoriously resistant to allergy reactions, but the thin skin around the eyelids is extremely reactive. And the area of our body most often touched with the finger is the area around the eye. "Washing hands immediately after handling pets, foods and other problem substances can greatly reduce eye symptoms in allergic individuals".

56. Asthma? See An Allergist!

"Asthmatics treated by a good allergist are hospitalized much less frequently than those under the care of other types of physicians. That’s because all asthma is allergic. If more physicians realized this, asthma would be treated much more efficiently in this country".

57. Moderate Asthma The Worst

"It’s the person with low-grade, moderate asthma who benefits the most-from competent medical help. These people suffer constant low-level wheezing and shortness of breath that makes them irritable, miserable and tired all the time. "I believe that the additional muscular effort each breath takes for these people is a very common cause of fatigue".

58. Prescription: 40 Winks!

"The difficulty some of these people have in coping with life is due entirely to the fatigue their condition is causing. Nothing produces a more positive response in such people than allergy therapy that allows them to get a good night’s sleep".

59. A Slap On The Back For Nighttime Panic

"A somewhat rare but extremely frightening event can occur with asthmatic children at night: They awaken terrified and unable to breathe. If someone strikes them sharply on the back, however, they will cough and almost immediately begin to breathe again. "The explanation is relatively simple. The child has developed a large mucus plug that has been loosened by a cough but is so large that it becomes stuck in the trachea and obstructs their breathing. The slap on the back dislodges it so that it can be coughed up and swallowed harmlessly".

60. How To Fight Frequent Infections

"Many asthmatics are treated for long periods of time with antibiotics, generally in response to the appearance of grossly purulent sputum. "Almost all of these infections are due to dehydration and can be easily prevented. Fluids will loosen the bronchial secretions, and this almost always results in dramatic improvement. Antibiotics should be used only when necessary".

61. Improve A Cough To Relieve Fatigue

"Asthma basically consists of swelling and hyper-secretion of mucus inside the bronchial tree. Coughing is the most effective way to dislodge and raise thick mucus, but an ‘ineffective cough’ that requires a lot of energy can be exhausting. "The physician’s primary obligation in asthma is to improve a tight, rasping, ineffective cough until you can hear the rumbling, rattling sound of a productive one. This frequently relieves chronic fatigue".

62. Keep Your Cough Awake

"Don’t ever suppress a cough with antihistamines or codeine. You need to be aware of the need to cough and you need to be able to cough productively. You don’t ever want to relax that cough reflex. It will improve with better hydration and allergy treatment, and a productive cough will cease when there is nothing left to produce".

63. Liquids Are Medications!

"Unquestionably, the single most important element in the treatment of asthma and other bronchial allergy symptoms is hydration. Unless adequate fluids are available to the mucus glands in the bronchial tree, their secretions will be tenaciously hard to raise. In asthma, liquids are medications. They are a prerequisite for any other medications to be effective".

64. 10 Glasses A Day!

"Liquids make mucus liquid. They change it from a troublesome solid that makes breathing difficult to an easy to cough up liquid. I demand that my patients drink 10 full glasses of liquid every day, and I question them constantly to make sure they understand how important it is. "Lack of fluids will lead to chronic fatigue, irritation — even family problems. "

65. Any Fluid Will Do!

"Yes, I’m forceful about my patients getting fluids! I’ve been doing the same damn thing for so many years with good results that I see no reason to be flexible now! They can drink anything they want. Water is best, of course, but I tell them to drink what they like: iced tea, soda — Jell-O is basically water. Any fluids will work but you must make a fetish of it".

66. Women Are The Worst!

"Women as a group are especially bad at this — they just don’t drink enough fluids! I lecture them about the dire effects of dehydration and get real dramatic about it — I have to! Some of them actually have to be harassed into it! But they soon learn that fluids are the best way to help a productive cough accomplish its purpose".

67. Inhaler Tips

"Over-the-counter (nonprescription) inhalers that contain epinephrine can be a tremendous help for people with asthma. There are a lot of ‘new’ inhaled medications for asthma on the market today, but I find that epinephrine alone provides excellent relief. It’s often the best medication to help get a good night’s sleep. "But danger lies in the abuse of these products. Taken too frequently, they can have a drying effect on the bronchial tree. They must be used sparingly. In addition, epinephrine will be practically useless for the dehydrated asthmatic. The drug cannot provide relief if the bronchial mucus is all dried out. But it will provide excellent relief after the patient has been rehydrated".

68. The Most Common — And Least Treated — Allergy Symptom

"The cough is the single most common symptom encountered in the practice of medicine, yet precious little consideration is ever given to its origin or treatment. The overwhelming majority of coughs are allergic or irritative in nature. The allergic ones are productive coughs trying to clear mucus. Irritation produces a nonproductive cough, and both are major causes of fatigue".

69. That’s Right — Fatigue

"All coughs require muscular effort, and fatigue is the inevitable consequence of continued coughing. When the cough is severe enough, the fatigue will be accompanied by irritability and emotional problems. A severe cough can disrupt the tranquility of almost any home. "But remember — it’s important not to suppress a productive cough, because it is productive. It’s removing mucus plugs that must not remain where they are".

70. The ‘Hack’ Of Irritation

"The irritative, nonproductive cough has a ‘hacking’ quality and is generally in response to some form of irritation in the throat. The most common cause in allergic individuals is irritation caused by mouth breathing and postnasal drip. "This tends to get worse at night simply because the drip increases when you lie down. The condition improves greatly when you sit up, and many people with the problem simply sleep sitting up".

71. Morning Cough The Most Productive

"Since the cough reflex generally shuts down during sleep, a large amount of mucus can accumulate in the bronchial tree. This explains the morning cough that many people with allergies and asthma experience. The morning cough serves to ‘uncork’ much of the mucus obstructing the bronchial tree, and the result is a significant improvement in breathing".

72. Severe Irritative Cough

"A severe, sometimes explosive, cough that originates in the larynx or the trachea is almost always due to allergic swelling of the area — especially if traditional cough suppressants such as codeine provide no relief. "Not surprisingly, it typically responds well to an epinephrine inhaler, whose only effect is to relieve such swelling".

73. If It Don’t Itch, It Ain’t Eczema

"A rash that doesn’t itch enough to keep you awake at night is not atopic dermatitis, whose hallmark is exquisitely intense itching. More likely, such a rash is an indication of a drug reaction and will vanish when you stop taking the drug that caused it".

74. To Stop The Itch

"Two factors increase the itching in atopic dermatitis — exposure to the air and the presence of crusts and scales. The best treatment attends to both factors. "Soaking in a tub filled with a handful of Epsom salts dissolved in comfortably warm bath water for 15 to 20 minutes several times a day will remove crusts and scales. Ocean bathing can achieve the same result. Open lesions may sting a bit at first, but relief will come rapidly. "After the bath, get dry and immediately apply boric acid ointment. In children, use Vaseline instead. It may seem messy, but it will greatly reduce itching by protecting the skin from exposure to the air. "If the grease appears to inflame the skin further, use a water-soluble ointment like Aquaphor instead".

75. Antihistamines And Long Sleeves

"Sedatives should be used cautiously in eczema, as they may actually make the itching worse. Antihistamines not only control the itch, but their side effect of drowsiness can help people with the condition get a good night’s sleep without scratching. "Children with eczema should wear long sleeves and long pants day and night. This reduces exposure to the air and offers some protection against scratching, especially during sleep".

76. Habit Scratching

"Even after successful allergy therapy many patients will continue to scratch out of habit. Keeping the area well lubricated with Vaseline and covering it with an elastic bandage will disrupt the habit and allow the area to heal".

77. Could ‘Chronic Hives’ Be Bug Bites?

"I find it odd that so many pediatricians and dermatologists report seeing patients with chronic hives when I’ve never encountered such a person. I have seen the persistent itchy little bumps these physicians describe, but they are invariably the result of insect bites. "Their appearance on the legs is a strong clue that the culprit is fleas. These little creatures are tenaciously hard to eliminate from the home and rarely jump higher than 18 inches to bite their prey.

78. Hives Or Bites?

"Hives are generally widespread, affecting almost all of the body at-once. Insect bites tend to be confined to limited areas, such as the legs, and appear in isolated clusters".

79. Bee Careful When Swimming!

"The most common location where people are stung today is in swimming pools. The bee falls in the water, the swimmer brushes up against it, and the bee does what comes naturally".

80. Bee Sting: When To Worry

As long as the reaction to the sting remains close to the actual area stung, there is no need for concern. But hives, nasal symptoms or asthma are the alarming signals of bee sting allergy. People who have so reacted must carry emergency epinephrine and know how to use it".

81. Allergic Headache

"It is unfortunate that this common allergy symptom receives so little attention, since it responds to treatment more readily and more successfully than any other form of recurrent head pain. "So-called ‘cluster headaches’ that appear in the spring and fall are inevitably allergic responses to pollen. Indoor allergens are also a common headache cause".

82. Migraine? — Or Allergy?

"Both allergic and migraine headaches tend to appear early in life. Migraines, however, decrease in intensity as one gets older. Allergic headaches do not. And while migraines have a classic, distinctive appearance, allergic headache is characterized by the total absence of any specific pattern. Pain can occur anywhere in the head".

83. Head Pain? How’s Your Nose?

"There is a strong association between head pain and nasal congestion in allergic individuals. Many notice that their head pain is relieved at the same time as their congestion. Others notice considerable nasal discharge or a ‘bubbling’ noise in the head as their headache improves, strongly suggesting that a sinus obstruction has been relieved".

84. Pass On Pillows For Headache Relief

"Of 75 headache patients I tested, all but a very few were found to be strongly allergic to environmental (indoor) allergens. "A few ended their headaches with such simple environmental controls as removal of a down comforter, feather pillows or a pet. One patient’s head pain was relieved by the removal of a bedroom chair found to contain goat hair".

85. A Positive Mistake

"Sometimes a person will inadvertently receive an injection that is too strong during allergy therapy. The headache that quickly develops is the final diagnostic proof that their headaches are allergic in origin and that the correct allergen is being used. "Many patients will also note that their headaches return if they wait too long between injections".

86. Pack Your Nose For Head Pain!

"When head pain is definitely caused by blocked sinuses, there is a technique that brings quick relief. Saturate tufted cotton with a strong nasal decongestant, pack as much into each nostril as the person can tolerate, using a twisting motion, and leave it there for 5 minutes. "There’s often dramatic relief of the pain, especially if you catch the headache early on. You can’t do it more than once a day or it’ll be too irritating, and you have to use tufted cotton in order to hold enough of the decongestant fluid. Q-Tips won’t do the job".

87. Kids: Teach Fluids Early

"Fluids are even more important in young children. Try to get them used to drinking fluids when they’re free of any symptoms. Young children will always balk at forcing fluids when they don’t feel well".

88. The Shot Glass Solution

"If you ask a child to just ‘take a sip’ from a full glass, they know you really want to get them to finish it. But you can easily ‘trick’ them into drinking more fluids than the full glass contains by giving them the liquid in a whiskey shot glass and repeating it every 10 or 15 minutes. No child has a problem drinking that small an amount, and they’ll do it frequently".

89. Allergy Treatment Improves Personality!

"Parents tend to take their child’s stuffy nose and constant sneezing for granted, but these chronic symptoms have a marked impact on a child’s personality and their ability to perform well in school. "After successful allergy therapy, parents and teachers often comment on how much brighter and less irritable the child has become".

90. Down Or Dog, It’s Still All Dander

"In all reactions to animals, only the dander is significant. The hairs and feathers have no allergic potential themselves, but are always contaminated by dander, which is nothing more than an animal’s old skin scales. "Each feather, if examined carefully, will show the presence of dried dander at its base. This dander will remain despite commercial cleaning, which is why ‘down’ can be highly allergenic even when old".

91. Puppys No Problem

"Very young animals have no old skin to shed, and therefore have no dander. It usually takes a couple of months before such pets produce their allergen, which may explain why some people ‘suddenly’ become allergic to a dog or cat they got as a pup or kitten".

92. Pet Myths Myth The Point

"Legend has it that poodles don’t cause allergy problems. The fact is that they may have less dander to give off because they are the breed that is washed and groomed the most frequently. "Likewise, Chihuahuas are thought to be a ‘safe’ pet because they are hairless. But hair is not the problem! It probably just takes a long time for such a small dog to give off sufficient quantities of dander to put a person over their allergic threshold".

93 . Fun Fur No Fun

"Rabbit, when used as a ‘fun fur’ or in an angora sweater, can be a source of allergy symptoms because the fur is too delicate to clean all the dander out. "Most other costume furs are ‘dander free, but contact allergy symptoms sometimes develop from the lacquer used to color the fur".

94. Mow A Wet lawn

"Mowing the lawn, frequently a symptom-producing chore, can be made safer by wetting the lawn first to keep pollen and molds from flying around. It does make the job more difficult, but truly allergic souls won’t mind if it prevents their symptoms".

95 . Olive Tree Not Too Pretty . . .

"The olive tree, commonly found in the western states, can produce intense allergic reactions during the first four or five weeks of spring. It produces a lot of heavy pollen, most of which stays close to the tree. "Since it is often used as a decorative tree around homes, allergic people would do well to identify such trees and keep that side of their house closed up during its pollinating season. Hosing the tree down daily is also helpful".

96. Allergy Relief Begins In The Bedroom

"Since we spend half our lives in the bedroom, this is the area where controls will be the most effective. "Of course the living room contains allergens! But the short time that we spend there generally doesn’t justify the expense and inconvenience necessary to remedy its faults. "Time and energy spent in allergy proofing the bedroom, however, will be well returned in reduced symptoms".

97. Pillow Power

"All pillows must be synthetic. I’ve found Dacron to be the most comfortable substitute for feather pillows. "Forget allergy encasings. They don’t work well on pillows unless the zipper is airtight, and that makes the pillow like a balloon, since the air can’t escape".

98. Blanket Protection

"Wool blankets are not only irritating, they’re notorious dust collectors. Turn off the lights in the bedroom, shine a flashlight across the bed and slap down on the blanket with your free hand. You’ll probably see a very convincing cloud of dust. "Synthetic blankets should be used since they don’t collect dust as readily. Down comforters, of course, must be removed".

99. Forego Furnishings

"Overstuffed furniture should be removed from the bedroom. Analysis has found cattle dander, goat hair and burlap, which contains highly allergenic hemp and jute, in such furniture".

100. Rugs Are Okay — Just Not On The Floor!

"Rugs hanging on walls for decoration are harmless, even if they are ‘real’ Orientals laden with goat and camel hair. Symptoms only occur when allergens are kicked up as rugs and furniture are disturbed — not when they just hang on a wall".

101. Victory Through Ventilation

"Many patients observe that they feel bad in the morning, but not until they get out of bed and start moving around. "That’s because dust has settled during the night and they only react when it’s disturbed. High efficiency filtration of incoming fresh air and of recirculating air can help lessen exposure to allergens".