Q. When will my allergy shots begin to work?

A. Clinical improvement with allergy shots usually occurs by the end of the  first year.  Some people may begin to notice an improvement within the first six months on allergy shots.  However, it can take up to one year for symptoms to improve after one begins allergy shots. 


Q. When starting shots should I continue my antihistamines?

A. Yes.  Antihistamines help provide control of your symptoms until the allergy shots begin to work.


Q. I heard that I don’t have allergies, but that my symptoms are caused by an irritant? What is the difference?

A. When your allergy tests (either skin tests or blood tests) are negative, it means that you don't have allergies.  However, irritants (such as smoke, fumes, cold air, dust, etc) can cause similar symptoms to those who experience allergies.  When the irritiants come in contact with the mucus membranes (for example in the nose, eyes, and chest), these irritants can  trigger local swelling, mucus production, sneezing and sometimes itching.  The affected person will then begin to have symptoms similar to those seen with allergies.  Some allergy treatments are helpful, while others such as shots, are not, and there are other treatments used more specifically for this non-allergic condition.


Q. What allergens are in Maryland? What trees?

A. Great question! See our Mid-Atlantic Allergen chart here to see the breakdown of regional allergens.


Q. Should I receive the “pneumonia vaccine” if I have asthma?

A. Yes.  The proper name for the pneumonia immunization is  Pneumovax 23.  This immunization contains 23 components of the pneumococcal bacteria which is a common cause of pneumonia (lung infection).  The vaccine can be given to children and adults but the typical indication is for adults 19 years and above.  

Q. How often should I receive the Pneumovax 23?

A. If you have asthma or other medical problems the Pneumovax 23 should be received prior to 65 years of age and again when you 65 or older.  If you received the vaccine just prior to 65 years, for example at the age of 62, then you must wait 5 years between vaccination.  In this case the second dose would be received at 67 years of age or older.

Q. Are there other vaccinations or immunizations that would be helpful if I have asthma?

A. Yes, a yearly flu shot would protect you against Influenza A & B viruses and is the most effective method of preventing Influenza infection.(click here for more information)  It has been shown to decrease both the illness and complications from Influenza and since viral infections are a trigger for asthma you will have reduced your risk of an asthma exacerbation.

Q. But I have an egg allergy and have been told not to get the Flu shot, is that true?

A. That was true at one time but the manufacturers of the Influenza vaccine have reduced egg content (the virus is grown in chicken embryos), and recent studies in egg allergic individuals have shown the vaccine to be safe for almost all egg allergic individuals.  If you had a life threatening allergic reaction to egg, I still suggest you receive the vaccination in a setting where physicians and medical personel are familiar with the signs and symptoms of an allergic reaction and have the proper equipment to treat.  The Asthma and Allergy Center at Johns Hopkins is offering the immunization and is prepared for any allergic reaction.

 Q. I do not like getting injections and I hear there is an Influenza vaccine that can be sprayed in the nose.  Can I get that form of the immunization?

A. As of now, an individual with asthma should not receive this form of Influenza vaccine.  You may come down with a mild case of Influenza which could trigger your asthma.  This continues to be studied and may change in the future.  Concern or lack of concern about egg allergy should be the same with the nasal spray Influenza vaccinations as it is with the shot.

Q. Ok, I have received the Pneumovax and Influenza vaccine this fall.  Are there any other immunizations that I need to know about? 


A. Yes.  The other immunization that may  prevent a respiratory disease is the pertussis vaccine.  Pertussis causes “whooping cough” and there has been a resurgence of this disease.  Typically considered a childhood disease it can effect adults and more importantly it may help prevent the spread of this disease to the unimmunized child.  As an adult, pertussis immunization should be received once.  It is not specifically indicated for individuals with asthma but is part of the normal adult immunization schedule. If interested please go to the Center for Disease Control web site at www.cdc.gov to learn more.  

Every ten years adults should receive a tetanus and diptheria immunization (diptheria is an  upper respiratory illness) so the vaccine manufacturers combine tetanus and diphtheria in one immunization.  In order to receive the one time pertussis booster, the vaccine manufacturers have added this to the tetanus/diphtheria shot.  This should not be confused with the pediatric formulation for this immunization and one way to tell is it’s abbreviation.  The pediatric form is TDaP (note the capital letters) and the adult form is Tdap or the brand name is Adacel.  Discuss this with your primary care physician or with your allergist at Johns Hopkins Asthma and Allergy Center.

Q.  What is food allergy?

A.    Food allergy is an adverse reaction to a food by the immune system.  The immune system is part of the body that normally fights germs through the use of various cells and antibodies. In the case of food allergy the immune system reacts to the food causing symptoms from red itchy skin, hives, stomach upset, difficulty breathing to the most severe immediate reaction called anaphylaxis.

Q.  What is the difference between food allergy and a food intolerance?

A.    Food allergy occurs because of the immune system versus a food intolerance which does not involve the immune system.  Examples of food intolerance is an upset stomach from milk because of a lactase deficiency, an enzyme that breaks down the sugar in milk called lactose; becoming jittery or having heart palpitations after a cup of coffee because of a chemical (caffeine) in the coffee;  becoming violently ill after eating spoiled food (food poisoning) because of a toxin produced by bacteria.


Q.  What types of medical illnesses are caused by food allergy other than anaphylaxis?

A.    Anaphylaxis is an immediate type allergic reaction that is caused by the allergic antibody (IgE). Symptoms may include flush, itch, hives and swelling, cough, wheeze or choking, stomach upset and vomiting, loss of consciousness or a feeling of impending doom.   Other allergic illnesses from food include oral allergy syndrome also known as the pollen-food syndrome, eczema, food protein induced enterocolitis syndrome, eosinophilic esophagitis, contact hives, and celiac disease.


Q.  Can food allergies be prevented?

A.    Medical expert opinions have changed in regards to prevention of food allergy in the past decade.  It was once thought that avoidance of allergenic goods like milk, egg, wheat, and peanut until a certain age would prevent food allergy from occurring.  This thinking is changing because of studies that show increased food allergy with delay in introduction of wheat, milk and egg and other studies that show early introduction of certain food allergens may reduce food allergy.  Presently there are no recommendations to withhold any foods to prevent food allergy.  Complete avoidance (ingestion, touch or inhalation) of a food is the only way to prevent an allergy from occurring but this is impractical.  Probiotics have been suggested as a means of food allergy prevention but there is no good studies showing their effectiveness.


Q.  What is the best way to diagnose food allergy?

A.    There is no test that is perfect.  The medical history is still the best way to make the diagnosis.  Skin tests and blood tests, known as RAST or Immnocap, are available for confirmation. These tests detect the allergic antibody (IgE) that is responsible for an immediate type allergic reaction versus a delayed immune response in the case of Celiac disease (immune reaction to wheat).  Overzealous testing without a good history, using the tests noted above, leads to many falsely positive tests.


Q.  How can I treat my food allergy and will they ever go away?

A.    The only sure way to treat food allergy is to avoid the food and be prepared to treat an allergic reaction.  Be a good label reader and ask a lot of questions when you eat out.  Where a medic alert bracelet so if there is a reaction others around you can identify that you are allergic.  Do not delay in treatment after an accidental exposure to a known food allergen and keep epinephrine available for treatment.  There are ongoing studies to treat food allergy by desensitization.  The studies administer small amounts of the offending food to alter the immune response.  This is not ready to be used in clinical practice and should not be tried at home.  Food allergy will resolve, in certain individuals, without any treatment.  Do not try to reintroduce the food allergen on your own.  This should be done in a medical facility and under the supervision of a physician. 


Q.  What is eosinophilic esophagitis (EoE) and what role does food play?

A.  This is a chronic illness in which allergic inflammation occurs in the esophagus, the tube that lets food pass from the mouth to the stomach.  Eosinophils are an immune cell that is present in allergic inflammation and are seen in other allergic disease such as hay fever or asthma.  The typical symptoms are pain with food going down or food may get stuck going down.  There may be vomiting and because of inadequate nutrition, especially in young children, there may be poor growth.  It occurs in all ages but it appears that foods are a common trigger in children.  The relationship between food and EoE in adults is not as clear but they probably play a role. 


Q.  What is the difference between wheat allergy and celiac disease (sprue or gluten sensitive enteropathy?

A.     Wheat allergy is an immediate immune response.  Allergic antibodies (IgE) are made by the immune system to wheat and cause symptoms of itch, rash, hives, swelling, cough, wheeze, runny nose, shortness of breath, nausea, vomiting and sometimes loss of consciousness.  The most severe allergic reaction to wheat is called anaphylaxis.  Celiac disease is caused by an immune reaction to gluten found in wheat but not through IgE nor does it cause an immediate type allergic reaction. Instead, it is an inherited disorder that affects the gut and sometimes other parts of the body.  Individuals allergic to wheat can still eat barley and rye but in celiac disease these cannot be ingested because they also contain gluten.  The term “wheat sensitivity” has been used recently which does not refer to either wheat allergy or celiac disease.  There is ongoing research to better define this condition that mostly affects the gut and does not have the consequences of either an acute allergic reaction or the chronic symptoms of celiac disease.


Q.  Peanut allergy, how much and what type of exposure will cause a reaction or a life threatening event?

A.   Peanut allergy is an immediate type allergic reaction that is caused by the immune system when the allergic antibody (IgE) recognizes peanut protein and causes a cascade of allergic chemicals in the body to be released and cause itching, rash, hives, vomiting, difficulty breathing and in the worst case scenario death.  So, how much exposure will put a peanut allergic individual at risk.  This is what we know.  Ingesting peanut is what causes life threatening reactions.  The smell of peanut or peanut butter is not from any significant protein in the air but rather from organic compounds that are not allergenic.  Peanut dust will contain protein and it may cause a reaction but unlikely to be life threatening but rather symptoms similar to exposure to pollen or animal dander.  Touching peanuts or peanut butter may cause a reaction but again not life threatening unless there was a significant amount of exposure to damaged skin.  More likely there will be a skin reaction when touching the peanut to intact skin.  Finally, peanut allergy is from peanut protein and not peanut fat so there is the question if a peanut allergic person can ingest peanut oil.  If the peanut oil is properly processed then there should be no peanut protein exposure and it can be ingested without symptoms.  Typically, cold pressed peanut oil is not fully filtered so this should be avoided.  Discuss this, and any other concerns with your allergist.

© JHAAC 2012