VCU news

By Anne Dreyfuss
C. Kenneth and Dianne Wright Center for Clinical and Translational Research

Earlier this year, Richmond was designated as the country’s “sneeziest and wheeziest” city according to a report released by the Natural Resources Defense Council, an environmental action advocacy group. This news came one year after Richmond topped the Asthma and Allergy Foundation of America’s list of “allergy capitals” in 2014. Richmond was also at the top of the list in 2010 and 2011.

Theodore Schuman, M.D., is the director of the otolaryngic allergy program at the Department of Otolaryngology in the Virginia Commonwealth University School of Medicine. During a Twitter chat on Friday, Schuman answered questions about the causes of allergies in the spring and summer, treatment options and more. 

VCU will host a variety of Twitter chats with medical experts in the coming months. Stay engaged with the conversation by following @VCUMedical on Twitter and searching for the hashtag #VCUHealthChat.

Below are Schuman’s replies to some of the questions raised on Twitter.

What are the most common environmental causes of allergies in the spring and summer?

In the spring, it tends to be tree pollen. In Richmond, oak trees are a particular trigger. In the summer, grass pollen like Timothy, Johnson or Bermuda grasses are triggers. A lot of people that have symptoms when they mow the law may actually be sensitive to mold in the soil.

Why do allergies seem to have become a bigger problem?

One hypothesis is that living a more hygienic lifestyle predisposes us to allergies. One study found that kids raised on farms had fewer allergies. Pollution may also play a role; however, a lot of research needs to be done to truly understand the increase.

Why do some people suffer more from allergies than others?

It’s partially genetic. Fifty-to-70 percent of kids with two allergic parents will develop allergies versus 13 percent with nonallergic parents. Environmental exposure also plays a role.

What treatment options are available for allergies?

The first step to allergy treatment is environmental avoidance. If symptoms continue, numerous medications are available, such as antihistamines, nasal sprays, saline rinses, and more. We use a step-wise approach, adding medicines until the symptoms are controlled. For those with significant symptoms despite other treatments, immunotherapy (allergy shots) is a good option.

How do you know if you’re a good candidate for allergy shots?

Someone would be a good candidate for shots if allergy symptoms have a significant impact on quality of life multiple times a year despite medications and environmental avoidance. Many studies show immunotherapy (allergy shots) improves allergy symptoms, but a minimum of a three-year time commitment is required. Oral immunotherapy can also be very helpful, although it is unclear if that is equivalent to shots.

Sneezing and stuffy nose are well-known effects of allergies. What about shortness of breath and other lung issues?

In 50 percent of patients with asthma, sensitivities to allergens can be a trigger for wheezing and shortness of breath. Interestingly, studies have suggested that allergy shots can delay progression to asthma in kids.

Are there any at-home remedies to help curb the effects of allergies?

Nasal saline irrigation is a great home remedy for sinus and allergy issues.

Are there particularly interesting trends or new findings in allergy research on treatment, causes and prevention?

One new development is the availability of grass and ragweed tablets that can be taken daily to improve symptoms.

Does eating a tablespoon of local honey once a day really help to treat some people’s seasonal allergies?

There isn’t great data to support this, but many people feel it helps. It probably cannot hurt.

What are the most common allergens in Richmond and in Virginia? I hear a lot about “allergy season” – when is that?

Ragweed pollen is a major offender in the fall. Mold, dust mite and dander cause symptoms year-round. Allergy season refers to the spring and fall when tree and weed pollen is highest, respectively.

Some studies have blamed climate change for longer allergy seasons. Is there any substance to that here in Virginia?

I have not read these studies, but it sounds interesting.

If your kids show symptoms of seasonal, indoor or food allergies, what is the best age to test them?

It depends on the severity. Blood testing is well-tolerated in children of any age. For severe food allergies, I’d recommend testing early (as a baby or toddler). For environmental allergies, we usually don’t test until the kids are older (school age) unless the allergies are very severe. 

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