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Ask The Allergist
Ask the Allergist Home Frequent Answers Question Submission Form
Frequent Answers
Click on a topic to read brief information based on commonly-asked questions:
Air Filters Americans with Health Insurance
Airlines Disabilities Act Moving
Allergy Shots Carpets & Flooring Pets
Allergy Testing Cleaning Schools
& Diagnosis Clinical Trials Temperature
 
Air Filters
Air filters should only be considered a small part of a total allergen avoidance and prevention plan. Before you decide to buy, talk to your physician about whether or not air filtration is right for you, and about the best type of filter for your home.

A HEPA filter is a type of filter-not a product name. Many different devices or products can contain a HEPA filter. To qualify as a true HEPA filter, a device must be able to capture at least 99.97% of all particles 0.3 microns or more in diameter that enter the filtering system. Insist on a system that meets true HEPA filtration standards.

When you shop for air filters, you will find several rating systems that compare filters, but these are not health-related rating systems. They are standards used by manufacturers and provide little guidance for the health-conscious shopper.

Beware of machines called "ozone generators" which directly produce ozone molecules-not as a byproduct, but as a direct product-and blows it into the room to "clean" the air. Unfortunately these "ozone generator" machines can produce ozone up to 10-times more than the acceptable EPA standard. AAFA and other groups recommend that you do not use "ozone generator" machines in your home.

No air filter can fully protect you from the dangers of secondhand smoke. The most effective way to get rid of "secondhand" smoke is to eliminate the source: get smokers in your family to quit.
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Airlines
The two types of allergies that appear to generate the greatest passenger concerns on commercial aircraft are sensitivities to peanuts and animal allergens.

In the case of life-threatening allergies, your doctor may advise you to carry an epinephrine auto-injector and oral liquid diphenhydramine to immediately and aggressively treat a reaction. If you choose to carry an epinephrine auto-injector, make sure that you have a professionally printed pharmacy label with the device to satisfy the Transportation Security Administration (TSA) airport security requirements.

There are some airlines that do not serve peanut snacks and there are some airlines willing to accommodate your request to serve a non-peanut snack on your flight. You can also carry peanut-free food with you. You should call an airline's reservation number to get specific information for that airline. Even if no peanuts are served on your flight, no airline can guarantee a peanut-free flight.

The Food Allergy & Anaphylaxis Network (FAAN) discusses airlines that do and do not serve peanuts. Those that say they don't include American, United, Northwest, Jet Blue, AirTran, US Airways, America West and ATA. Continental has no peanut-free policies. Delta asks passengers to choose among five snacks-one is peanuts-but says it provides a peanut-free buffer zone. Alaska Airlines says it serves peanuts but will also provide peanut-free buffer zones. Southwest promises not to serve packaged peanuts upon request. According to FAAN, the international carriers that do not serve peanut snacks include Aer Lingus, Al Italia, and British Air.

Virtually all major airlines allow pets in the cabin provided customers meet certain requirements. You can reduce the chance that there will be an animal in the cabin by asking the reservations agent for your airline if another passenger on the same flight has made reservations to travel with a pet. You will, however, still be exposed to animal dander on every flight even without any animals in the passenger cabin. This is because most animal allergens are carried into the cabin on the clothes of other passengers.

The Department of Transportation (DOT) has rules that require airlines to allow passengers to fly with their service animals in the cabin on all U.S. airlines. DOT operates a toll-free hotline to assist air travelers with disabilities. Air travelers who experience disability-related air travel service problems may call the hotline at 1-800-778-4838 (voice) or 1-800-455-9880 (TTY) to obtain assistance.

The DOT's Aviation Consumer Protection Division (ACPD) operates a complaint handling system for consumers who experience air travel service problems. Consumers can send an e-mail to airconsumer@dot.gov. E-mails will be reviewed and acknowledged and will be forwarded to an airline official for further consideration.
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Allergy Shots
According to the American Academy of Allergy, Asthma and Immunology (AAAAI), age five is the youngest recommended age to start immunotherapy, or allergy shots, in the United States. However, you should discuss this with your allergist as doctors can differ on their approach depending on you and your child's specific situation.

There is no upper age limit for receiving allergy shots, though for older persons consideration must be given to additional medical conditions (such as a heart condition) that could potentially make immunotherapy more risky.

Allergy shots should always be provided by trained personnel in a clinical setting under the medical supervision of a physician.
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Allergy Testing & Diagnosis
Allergies can develop at any age and people can be allergic to a wide range of substances. There is no master list of everything that might cause an allergic reaction. Keep in mind that reactions can take different forms depending on the allergen and the situation.

Whether you suspect a certain food/animal/plant/medicine might be the cause of your misery, don't just guess - find out what is really causing the problem by visiting an allergist. Once you know what triggers your allergies, you can take steps to manage them effectively.

Allergy testing can be performed on people of all ages, but is not recommended before showing symptoms because accurate diagnosis depends on your medical history. Your complete medical history is essential in determining factors that may be triggering an allergic response. Be prepared to discuss your symptoms, including when they occur, how often, what you were doing at or around the time symptoms appeared, any medications you have used and their effects, and so on.

Skin tests are the most accurate of all tests for confirming an allergy. These tests can be used to gauge sensitivity to many allergens. The skin is pricked with a minute amount of allergen extract to expose the patient to the allergen. Results are available within minutes. As many as 20-30 allergens can be tested at one time (usually done on your back, which offers a large surface area).

Radioallergosorbent testing (RAST) is a blood test done to confirm whether your body is making allergen-specific antibodies. RAST is used if you have a skin condition that makes it difficult to do skin testing or if you use medications that interfere with skin testing. RAST is not as sensitive as a skin test and may be more costly.

Your blood also may be tested to determine the eosinophil count. Eosinophils are a type of white blood cell. A high concentration of eosinophils in your blood indicates allergy activity. A nasal smear or sputum sample also may be used to get an eosinophil count.

An elimination diet is often used to help isolate sensitivity to specific foods. Your child's physician can help set this up so that certain foods are avoided for four to seven days. If symptoms persist, then more foods are eliminated until the allergy symptoms stop. Once the symptoms disappear, foods are added again one at a time until symptoms reappear. Keep in mind many foods these days are not "pure" in the sense that many packaged or processed foods have hidden ingredients - you'll need to be vigilant and check ingredient labels for the elimination diet to be successful.
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Americans with Disabilities Act
The Americans with Disabilities Act (ADA) is a set of laws designed to ensure equal opportunity for persons with disabilities. Public entities and public accommodations must, under this law, ensure that individuals with disabilities have full access to and equal enjoyment of all facilities, programs, goods, and services.

The ADA applies to anyone who is disabled in some way, which is described as someone who has a physical or mental impairment that substantially limits one or more major life activities or who is regarded as having such impairments. This includes, for instance, breathing, eating, working, and going to school, all of which are considered to be major life activities and can be substantially impacted by asthma or allergies. Even when symptoms are controlled by medication, asthma and allergies are considered disabilities under the ADA.

The ADA requires changes be made in public accommodations, except in cases where an undue burden would result. The law does not define what undue burden means. Rather, each situation depends on numerous factors. If you feel you or another person have been discriminated against by an entity covered by the ADA, contact the Department of Justice (DOJ) with: your full name, address, and telephone number; the name of the party discriminated against, the name of the business, organization, or institution that you believe has discriminated; a description of the act or acts of discrimination, the date or dates of the discriminatory acts, and the name or names of the individuals who you believe discriminated; and any other information that you believe necessary to support your complaint.

The DOJ Disability Rights Section will consider your complaint and inform you of its action. Please note, the DOJ does not necessarily make a determination on each complaint about whether or not there is an ADA violation. Also, any legal action taken by DOJ would be taken on behalf of the Unites States-the DOJ does not act as an attorney of, or representative for, you.
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Carpets and Flooring
Carpet is an ideal home for allergy triggers such as dust mites, mold and pet dander. Use hardwood, vinyl, linoleum tile, or slate instead of wall-to-wall carpeting. Bare floors with small, washable area rugs are much easier to keep free of dust mites than wall-to-wall carpeting or large, non-washable area carpets.

Chemicals known as volatile organic compounds (VOC's) can be emitted from certain types of new materials used in homes, including synthetic carpeting, padding, and adhesives.
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Cleaning
Choose cleaning products that are proven to remove allergens, not just dirt and dust. And, choose cleaning products that don't have very harsh chemicals and odors. Wipes or hand sanitizing gels are not completely effective on their own for eliminating food allergen residue from surfaces. However, cleaning agents and liquids are also not always necessary, either. Soap and water is typically effective. If you're on an airplane or anywhere else where soap and water is not a realistic option, disposable wipes are better than nothing.

Vacuum once or twice weekly. Use a vacuum with a HEPA filter or special double filter bags if possible. Also, use a damp or treated cloth for dusting furnishings. If you have allergies, wear a dust mask while vacuuming or dusting. Leave the house or office for several hours after the cleaning is done to allow dust to settle and cleaning product fumes to dissipate.

Vacuuming will not get to dust mites, which are deep in carpets, upholstered furniture, or mattresses. Reduce dust mites by minimizing use of carpeting and upholstery, and encasing mattresses.

Dog and cat allergens can last for up to 6 months. Professional steam cleaning can help remove pet dander from carpets. You should also consider dry cleaning drapes, changing furnace filters, buying vent covers, keeping humidity levels at less than 50%, and using a vacuum cleaner with a HEPA filter. Washing clothes 2-3 times will help rid clothing of pet dander.

It is still not clear whether regular cleaning of air ducts in the home can improve the quality of the air in your house; however, cleaning air ducts may be a good idea when you first occupy an older home. Steam cleaning carpets (sometimes twice) and drapes, wiping down floors and walls with soap and water, and cleaning air ducts is especially recommended if you are occupying a home whose previous owners had pets.

In outdoor areas around the home, use a water hose instead of a leaf blower to remove suspected allergens.
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Clinical Trials
Those who volunteer for Phase II and Phase III clinical trials can gain access to promising drugs long before they are approved for the marketplace, they will typically get excellent care from the physicians during the clinical study, and this care may be free.

Phase II trials are generally small group studies (up to several hundred patients) lasting six months to two years to establish relative safety and effectiveness of a drug. Once these are established, the sponsor of the drug moves on to conduct much larger Phase III clinical studies (with thousands of patients) that last several years. In both Phase II and Phase III trials, patients are randomized into different groups, which means some may receive the experimental drug while others will receive a placebo (if the study is blinded, patients and physicians will not know which they are getting).

In clinical research, the patient's rights and safety are protected in two important ways. Any physician awarded a research grant by a pharmaceutical company or the National Institutes of Health must obtain approval to conduct the study from an Institutional Review Board (IRB). The IRB is charged with examining the study's protocol to ensure that the patient's rights are protected, and that the study does not present an undue or unnecessary risk to the patient. Also, anyone participating in a clinical trial in the United States is required to sign an "informed consent" form. This form details the nature of the study, the risks involved, and what may happen to a patient in the study. The informed consent tells patients that they have a right to leave the study at any time.

Patients considering participating in clinical research should talk about it with their physicians and medical caregivers. They also should seek to understand the credentials and experience of the individuals and the facility involved in conducting the study.
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Health Insurance
When choosing a health insurance plan, there are special circumstances that should be considered by those with asthma or allergies. In addition to the general rules about what treatment for asthma or allergies is covered, many plans may have other rules, which are applied in certain circumstances. A pre-existing condition limit means that if you already have a medical condition when you sign up for an insurance plan, the plan rules will limit payment for that condition for a certain period of time. Some individual or small group plans have this rule, and it can be a major problem. Government plans usually don't have this limit, and if you change plans that are employer-sponsored, the rule for pre-existing conditions generally can't be used if the employer has at least 50 workers.

In some plans, a medical condition that is not expected to show improvement within a certain time period (in other words, a chronic condition) will not be covered. In rare cases, this limitation may apply for asthma or allergy patients.

Many patients are treated for asthma or allergies by a generalist-a pediatrician, an internist, or a family physician. However, if your asthma symptoms are not under control or if you have severe persistent asthma, or if you are having asthma episodes that need emergency treatment, you should see an asthma specialist such as an allergist or pulmonologist. Most HMO and POS plans require all non-emergency services from a specialist to be pre-approved by the plan and the primary care doctor. You also may need a referral if you switch plans and need to continue to see a specialist for your asthma or allergies.

We encourage you to discuss your health insurance needs with a knowledgeable representative from your company's human resources department or with a customer service representative of the insurance plan. Local organizations, such as senior citizen associations, also may be able to provide consultation services as you weigh the pros and cons of various health care options.

If a plan refuses to enroll someone, denies a claim, or if there are other problems with coverage, every health insurance plan has its own rules for appealing a denied claim. Claims may be denied for a variety of reasons. When you sign up for your insurance, you should receive some kind of printed material outlining the terms of the coverage. You should take time to read this material closely and know the rules.

If your claim is denied, sometimes the explanation for denial is that the treatment was not "medically necessary." This is a poor explanation, and many times it can be reversed. Your doctor or hospital office also may be able to help you with a denied claim.
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Moving
Since allergies and asthma are treatable conditions, we do not generally suggest moving as a solution. In fact, ensuring you have access to good healthcare services in your vicinity is more important.

If you are moving, it is important that you work with an allergist to understand what exactly you are allergic to as conditions vary nationwide. In fact, we recommend you maintain with the help of your allergist a yearly asthma/allergy management plan.

In the US, the north has shorter growing seasons. Areas of the country with lower humidity are generally better. Areas with lush vegetation are generally worse for allergies.

Please keep in mind that when you move to a new area, you can become sensitized to a new allergen. If you have had allergy shots in the past, and you move to another part of the country, you may need shots again if you develop sensitivity to allergens found in the new location.
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Pets
Dogs, cats and many other animals secrete fluids and shed dander (dead skin) that contains allergens. The allergens stick to the animal's fur or feathers as well as carpet, furniture, bedding, clothing, and many other surfaces. Animal hair or fur is not an allergen itself, but can collect dander and harbor other allergens such as dust or pollen.

Length of hair or fur does not affect the amount of dander. Researchers say there are no "hypoallergenic breeds" of dog or cat, and there is very little if any evidence that one breed may be better than another. Visit an allergist to confirm your allergies to specific types of the more uncommon pets, such as guinea pigs.

Animal allergens can be found everywhere including schools. Pet dander is even present in homes without pets because the dander is carried around on people's clothing. The allergens get in the air with petting, grooming, or stirring of the air where the allergens have settled. Once airborne, the particles can stay suspended in the air for long periods of time.

The best treatment for allergies to animals is to avoid contact altogether, which may make it impossible for you to have pets with fur or feathers at home. If this is unacceptable, make sure you have a treatment plan for your asthma/allergies, keep pets out of the bedroom, vacuum regularly, cover upholstery, and keep the animals clean (specialty shampoos are available in pet supply stores).
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Schools
Asthma is a leading cause of school absenteeism and the school setting is an important place to help protect children with asthma and food allergies from life-threatening reactions. A variety of comprehensive educational materials are available to help parents and guardians, school staff, and administrators with school policies and procedures that can be implemented. Please contact AAFA to receive these free resources.

Section 504 is the abbreviation for Title 34 Section 504 of the Rehabilitation Act of 1973, a civil rights law that prohibits discrimination on the basis of disability. The law applies to all institutions, including public schools, which receive financial assistance from the federal government.

Section 504 covers any individual if her physical or mental impairment results in a substantial limitation of one or more major life activities. This includes breathing. The impairment needs to be documented by a health professional.

Schools must give children protected under Section 504 an individualized educational program with reasonable accommodations in the form of a 504 Plan. The 504 Plan lists the accommodations that will be made to ensure the least restrictive learning environment.

Some disabilities fall under Section 504, while others fall under the Individuals with Disabilities Education Act (IDEA), which is a series of amendments to the original disability legislation. In general, if a disability does not affect a child's educational performance, then it falls under Section 504. If the disability does affect a child's education performance, then it falls under IDEA.

Most children with asthma and/or food allergies are covered under Section 504. Some children with very severe asthma and allergies can be protected under IDEA.

Schools cannot use money as an excuse not to provide a child a 504 Plan. Most schools receive federal financial assistance to cover the costs of complying with IDEA. But schools must be in compliance with Section 504 regulations to receive such federal assistance. Parents that request a 504 Plan in writing and are denied have a number of options, including the right to a hearing with the school district, the right to contact the Office for Civil Rights for assistance, and the right to hire a lawyer and sue on the basis of discrimination. Parents should formalize in writing all the decisions and conversations made between themselves and the school regarding their child's 504 Plan.

504 Plans for children with asthma and food allergy often focus on increasing awareness, staff training, preventing an allergic reaction, and steps to follow in the event of an emergency. The 504 Plan should be in writing as a road map for all school personnel to follow, but the law does not require this to be in writing. If a school district decides not to maintain written documentation of the Plan, parents can tape record 504 meetings for documentation purposes.
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Temperature
With asthma, high heat and humidity can make it harder to breathe and can be associated with higher levels of outdoor ozone.

Keep your indoor living area between 60 and 80 degrees Fahrenheit for maximum comfort, and keep humidity levels between 30% and 50%. If you can cut down on the amount of humidity, you can decrease mold growth and dust mite population. Hygrometers can be used to measure humidity accurately.

Air conditioners help reduce the humidity as well as prevent your exposure to outdoor allergens (because windows are kept closed).

Dehumidifier units will help reduce both mold and dust mites. Electric dehumidifiers work well to remove moisture from basements. Dehumidifiers should be drained regularly and the condensation coils and collection buckets cleaned. Humidifiers have no benefits for asthma/allergies and tend to make mold and dust mite problems worse.

If you use sources of heat for your home besides a furnace, be aware that they may pollute your indoor air. Avoid using un-vented stoves of any kind (kerosene, wood, or coal burning), or gas space heaters. Using an electronic ignition on a gas stove is one way to help eliminate fumes from being released.
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