Pennsylvania Allergy Associates Joseph P Rudolph MD FACEP

Pennsylvania Allergy Associates Joseph P. Rudolph MD FACEP All Rights Reserved Copyright 2007 Pennsylvania Allergy Associates Inc.

Histamine is produced by a special blood cell called a MAST cell. The letter H represents a Histamine molecule. HHHHH HHH

Histamine When your MAST Cells are Irritated They release Histamine. H H H H H

Histamine is the chemical That causes your symptoms. These symptoms include:

Histamine Symptoms • Itchy Eyes

Histamine Symptoms • Itchy Eyes • Nasal Congestion

Histamine Symptoms • Itchy Eyes • Nasal Congestion • Sore Throat

Histamine Symptoms • Itchy Eyes • Nasal Congestion • Sore Throat • Wheezing

Histamine Symptoms • Itchy Eyes • Nasal Congestion • Sore Throat • Wheezing • Hives

Histamine Symptoms • Itchy Eyes • Nasal Congestion • Sore Throat • Wheezing • Hives • Eczema

Histamine Symptoms • Itchy Eyes • Nasal Congestion • Sore Throat • Wheezing • Hives • Eczema • Headaches

Histamine Symptoms • Itchy Eyes • Nasal Congestion • Sore Throat • Wheezing • Hives • Eczema • Headaches • Diarrhea

Histamine Symptoms • Itchy Eyes • Nasal Congestion • Sore Throat • Wheezing • Hives • Eczema • Headaches • Diarrhea • Cough and chest constriction

An Extreme Reaction Bee Stings A bee sting may release massive amounts of Histamine. This is a fatal event. Fortunately – very rare!

Histamine Continuous release of Histamine produces more intense and prolonged symptoms. Tissue swells and symptoms worsen.

Histamine • Nasal Passages Swell

Histamine • Nasal Passages Swell • Ears become clogged

Histamine • Nasal Passages Swell • Ears become clogged • Lungs become inflamed causing coughing and wheezing

Histamine • Nasal Passages Swell • Ears become clogged • Lungs become inflamed causing coughing and wheezing • Sense of smell decreases

Histamine • Nasal Passages Swell • Ears become clogged • Lungs become inflamed causing coughing and wheezing • Sense of smell decreases • Taste is lost

Histamine • Nasal Passages Swell • Ears become clogged • Lungs become inflamed causing coughing and wheezing • Sense of smell decreases • Taste is lost • Sinuses become swollen and infected

Histamine produces mucous. Mucous is liquid sugar. Bacteria love sugar. Constant mucous provides an environment for repeat infections.

There are three reasons (triggers) why your MAST cells release histamine.

MAST Cell triggers The first reason is Allergies

Allergens enter your body through your nose, lungs or other areas. Allergen H HHH H

Allergens The allergens attach to the MAST cell and Histamine is released. Allergen H HH H H

MAST Cell Triggers - Allergens There are many different types of allergens

MAST Cell Triggers- Allergens • Pollens

MAST Cell Triggers - Allergens • Pollens • Mold spores

MAST cell triggers - Allergens • Pollens • Mold spores • Animal dander

MAST cell triggers - Allergens • Pollens • Mold spores • Animal dander • Peanuts

MAST cell triggers - Allergens • Pollens • Mold spores • Animal dander • Peanuts • Bee venom

MAST cell triggers The second cause of histamine release is: Airborne Irritants

Irritants cause MAST cells to release histamine just like allergens

Irritants Histamine is again released by the MAST cells Irritants H H HHH H H H H

MAST cell triggers - Irritants • Cold air

MAST cell triggers - Irritants • Cold air • Air pollution – ozone and particulates

MAST cell triggers - Irritants • Cold air • Air pollution – ozone and particulates • Chemicals

MAST cell triggers - Irritants • Cold air • Air pollution – ozone and particulates • Chemicals • Cigarette smoke

MAST cell triggers - Irritants cause the same symptoms as allergens.

MAST cell triggers - Irritants • Nasal congestion • Eye irritation • Sore throat • Cough • Wheezing • Hives

MAST Cell Triggers The third cause of histamine release is: Leaky MAST Cells

MAST Cell Triggers Leaky MAST Cells release Histamine without any environmental triggers. H HH HHHH HH H

MAST Cell Triggers Leaky MAST Cells Histamine from Leaky MAST Cells produce the same symptoms as allergens and irritants.

MAST Cell Triggers Leaky MAST Cells • Nasal congestion • Cough • Wheezing • Eye irritation • Hives

Our Goal Today • Why do you release Histamine? • What can we do to provide symptom relief?

Our Goal Today Is the cause Allergens Irritants Leaky MAST Cells or A combination of these

Your Evaluation Today • The history questionnaire

Your Evaluation Today • The history questionnaire • The physician interview

Your Evaluation Today • The history questionnaire • The physician interview • The physical examination

Your Evaluation Today • The history questionnaire • The physician interview • The physical examination • Testing

Your Evaluation Today • The history questionnaire • The physician interview • The physical examination • Testing • Diagnosis

Your Evaluation Today • The history questionnaire • The physician interview • The physical examination • Testing • Diagnosis • Treatment plan

Your Evaluation Today • The history questionnaire • The physician interview • The physical examination • Testing • Diagnosis • Treatment plan execution

Testing What causes you to release histamine? Skin testing provides the answer

Testing A small amount of allergen is placed on your skin. A positive response is red and swollen

Testing We can use the arms…

Testing Or your back.

Testing This small red bump is a negative reaction for this patient.

Testing This bump surrounded by red skin is a positive skin test.

Testing This is a larger reaction which means the patient is more sensitive to this allergen.

Testing This area has a total of eight antigens tested.

Testing Seven of the allergens are positive…. Some more than others.

Testing You will hear us read the size of the red area and the size of the swollen area.

Testing Other tests include • Sinus x-rays

Testing • Sinus x-rays • Pulmonary Testing

Testing • Sinus x-rays • Pulmonary Testing • Blood tests

Testing Your doctor will explain the significance of each test.

Treatment has three parts

Treatment • Avoid allergens and irritants • Immediate relief of symptoms • Long term relief of symptoms

Treatment - Avoidance The best treatment is elimination of allergens and irritants from the environment.

Treatment - Avoidance • Close up the house • Use air conditioning • Remove animals • Use a three cycle air cleaner

Treatment - Avoidance • No smoking by the patient • No smoking in the patient’s home or work place • Patronize non smoking businesses

Treatment - Avoidance Avoid foods that cause symptoms

Treatment - Avoidance Do not eat foods or drink beverages with known histamine releasers

Treatment - Avoidance • Beer • Aged cheeses • Mono sodium glutamate

Treatment - Avoidance • Wear a mask when cutting grass • Cover your nose and mouth with a scarf when outside in the winter months • Close your windows at night – most pollens are released in the early morning hours

Immediate Symptom Relief • Histamine Blockade

Immediate Symptom Relief One molecule of antihistamine blocks (AH) one molecule of histamine (H). H AH

Immediate Symptom Relief If you take five molecules of antihistamine and release three molecules of histamine – you have no symptoms AH H AH AH

Immediate Symptom Relief If you release more histamine – then you get symptoms. AH H AH AH Histamine molecules Reach tissue and Cause symptoms

Immediate Symptom Relief Examples of antihistamines Fexofenadine (Allegra) Loratadine (Claritin) Diphenhydramine (Benadryl) Hydroxyzine (Atarax) Cetirizine (Zyrtec)

Immediate Symptom Relief Many of our patients need several antihistamines to prevent and relieve symptoms.

Immediate Symptom Relief We work with you to develop an effective antihistamine protocol.

Immediate Relief of Symptoms Other medications help to relieve symptoms.

Immediate Relief of Symptoms • Nasal steroids decrease inflammation • Nasal antihistamines block histamine on the surface of the nose • Eye drops decrease histamine release and reduce inflammation

Immediate Relief of Symptoms Inhaled medications: • Reduce wheezing and cough • Decrease lung inflammation • Lessens chest restriction.

Immediate Relief of Symptoms Steroids by injection or pills suppress your immune system. They are used sparingly because of the side effects from the medications.

Long Term Symptom Relief Allergies

Long Term Symptom Relief Allergies are effectively treated with immunotherapy.

Long Term Symptom Relief Immunotherapy uses micro doses of your allergens and inject them under your skin.

Long Term Symptom Relief Your body then creates antibodies against these allergens called Ig. G H HH HHHH HH

Long Term Symptom Relief The Ig. G will neutralize allergen which is absorbed into your body. Pollen Ig. G H HHHHHHH HHH

Long Term Symptom Relief Now – MAST cells are protected from allergens and patients symptoms improve.

Long Term Symptom Relief Immunotherapy (allergy shots) is a slow process

Long Term Symptom Relief You are allergic to the injections Only small amounts of allergen may be administered each week.

Long Term Symptom Relief The concentration of the injections increases each week. During this time you continue to take your medications.

Allergy Injection Schedule Allergy injections stay weekly until: 1. You have reached a maintenance dose.

Allergy Injections Schedule Allergy injections stay weekly until: 1. You have reached a maintenance dose. 2. All allergy symptoms are controlled.

Allergy Injection Schedule Allergy injections stay weekly until: 1. 2. 3. You have reached a maintenance dose. All allergy symptoms are controlled. You no longer need daily medication.

Allergy Injection Schedule Allergy injections stay weekly until: 1. 2. 3. 4. You have reached a maintenance dose. All allergy symptoms are controlled. You no longer need daily medication. Your allergy tests are negative.

Pennsylvania Allergy Associates Remember: Every patient is different. Your treatment plan is created for you. Adjustments will be made to meet your goal.

Pennsylvania Allergy Associates Joseph P. Rudolph MD FACEP 412 653 4900