Persistent, unpredictable and sometimes lifelong: An allergy is difficult to treat. Is it not? 20 questions from everyday life – with answers and insights from experts.
I get strange blisters on my hands – an allergy?
Watery, itchy “pimples” on the hands are symptoms of an allergy only in some cases, according to Prof. Uwe Gieler, doctor for psychosomatic medicine, dermatologist and allergist and at the Giessen University Hospital. These so-called “dyshidrotic vesicles” can be triggered by many things, such as infections, medication or psychological conflicts. However, it makes sense to have a dermatologist specializing in allergology (on the practice sign) tested to see whether a contact allergy is involved or whether other clear causes can be found. This is how you can prevent chronic eczema from developing.
I have an allergy to house dust. Should I clean all the time, or is a little more dirt even healthy?
A little dirt does no harm to anyone. A house dust allergy sufferer, however, reacts specifically to the excrement of house dust mites: It is sensible and not too difficult to do something against their spread, especially in the bedroom. Because if you sleep calmly and with clear airways, you are doing something for your immune system. Special plastic bed covers (so-called encasings) offer protection against mites. The most effective method is to bag the mattress. Otherwise, a low-textile home furnishing with smooth floors helps.
I would like to be hyposensitized. How does it work?
Depending on the type of allergy, there are different ways of immunotherapy. In each case it is important to continue the treatment for a sufficiently long time, i.e. over three to five years. First of all, it is important to identify the actual allergy trigger. In hyposensitization with injections, the allergenic substance is then injected under the skin in increasing doses, initially once or several times a week, later once a month.
The treatment is particularly effective against grass pollen and against bee and wasp toxins. For the latter, the treatment is often started as part of an inpatient stay. Only a doctor experienced in allergology is allowed to give the injections. After the injection the patient remains under observation for half an hour. Severe allergic reactions up to allergic shock are rare, but cannot be excluded.
With the so-called SLIT (sublingual immunotherapy), the allergen is not injected, but drizzled under the tongue in drop form. The treatment is started at the doctor’s and can be continued at home. Slight allergic reactions such as itching in the mouth or throat are common, really severe side effects are very rare. The drops are very effective, but it is not yet clear whether the long-term success is as good as with the injections.
The therapy with so-called “grass vaccination tablets” can also be done at home. So far, the tablets, which are placed under the tongue to dissolve, are only available for allergies to grass and rye pollen. Effectiveness and risk are similar to those of the drops.
Could it be that the symptoms are more severe when you know you have an allergy?
Yes and no. “Knowing about an allergy can help you to better deal with an allergy and thus to control it well”, says Prof. Uwe Gieler, expert for psychodermatology at the University Hospital of Gießen. But strong fear of allergic symptoms can also make the reactions worse. Just the indication in the allergy test by the allergologist that the reaction could be bad already reinforces this. And when people start to avoid more and more substances, such as food, for fear of allergic reactions, further health and psychological problems can develop. Therefore, it makes sense to narrow down very precisely what one is reacting to and should only avoid these substances.
I recently had anaphylactic shock. How can I protect myself from it?
Anaphylaxis is an allergic reaction that affects the entire body. It ranges from mild symptoms that are not perceived as such (such as skin reactions, dizziness and nausea) to life-threatening shock, in which the circulation collapses and organs fail. Although rare, anaphylaxis can occur in people without known allergies. Those who have had a severe allergic reaction before are particularly at risk. It is important to have a comprehensive diagnosis by an allergologist to find out the cause of the anaphylaxis.
The most common triggers are insect venoms or food. “Some reactions also only occur in combination with physical exertion,” says allergologist Erika von Mutius. And in rare cases, no cause is found at all. All the more important to be prepared for emergencies at all times. The doctor prescribes a set with a cortisone preparation, antihistamine and an adrenaline auto-injector.
I am allergic to scented candles. What could be the reason?
This does not have to be an allergy. Scented candles emit a strong odor, even when they are not burning, and this irritates sensitive mucous membranes and causes coughing, among other things. Anyone who has ever had such a reaction can also be “conditioned” so that the mucous membrane irritation then occurs as a psychosomatic reaction to the smell.
Why do I have problems with nuts and other unprocessed foods, but not when they are part of a dish?
“Probably there is no allergy behind the different reactions, but an intolerance, where the symptoms depend on the dose”, says allergologist Prof. Erika von Mutius. The reaction to nuts is rather a “real” allergy. Many of the allergenic properties are destroyed when they are heated – for example during baking. The heat cuts through the long molecular chains of the proteins, so that the immune system can no longer recognize them so easily. But be careful: In the case of severe allergies, such as to peanuts or fish, even tiny traces of the allergen are sufficient, regardless of the form.
Is my hay fever psychological?
Pollen that causes hay fever flies around in varying quantities depending on weather conditions and plant growth, so this already influences the severity of the symptoms. Allergies can also have psychological causes. In many cases the symptoms are intensified by stress.
Uwe Gieler reports on studies in which psychological conflicts are the main cause of allergic reactions in 30 to 40 percent of cases, and explains: “Psychotherapy is particularly helpful if you notice for yourself that the allergy symptoms – be it skin reactions, hay fever or asthma – worsen mainly due to psychological tension or stress situations or chronic conflicts”.
The field of psycho-allergology represents a different approach. It assumes that allergic symptoms are a physical reaction that has been wrongly conditioned in the brain and can be corrected by autosuggestion. A study has shown that the method, which is also described as “psychic vaccination” or “thinking away from allergy symptoms”, at least works in some cases.
I have had the dog for a long time, the dog hair allergy only now. The family doctor says I should press my face into his fur every day. Isn’t that dangerous?
Yes, such a confrontation is risky. “Something like this can provoke the first asthma attack,” says allergologist Prof. Susanne Lau. Although there are observations that a massive strain increases the tolerance of the immune system, such effects are not reliable and above all permanent. Also a hyposensitization by injection has unfortunately no very good chance of success with animal hair allergies. If the dog is to stay, in some cases thorough hygiene helps. However, since not only the hair is allergenic, but also skin scales, saliva, urine and excrement of the animals, the home can never be kept completely free of them.
Can allergies disappear by themselves?
“Fortunately, many allergies subside in the course of life,” says Uwe Gieler. With three of four children with a food allergy this disappears already up to the school entrance. Also physical changes can change the polarity of the immune system. For example, some women lose existing sensitizations during pregnancy. Puberty or menopause can also mark a turning point in allergies. Unfortunately, it is not possible to predict whether and how allergies will change in the course of life.
Allergy medications make me tired – is that necessary?
Modern so-called antihistamines should actually not make you tired anymore. The active ingredient cetirizine belongs to the second generation of antiallergic agents, and there is now also a third. The “calming” side effects nevertheless occur in up to ten percent of cases. It is worth testing whether one tolerates another preparation better. If you want to get by without antihistamines, you should switch to externally applicable drugs such as eye drops and nasal sprays. Only in extreme cases are corticosteroids (cortisone) an alternative to antihistamines.
According to the test I am allergic, but I don’t notice anything. How do I deal with it now?
An allergy test is actually a sensitization test. In this respect, a positive result does not automatically mean that you are allergic. It only means that the body has produced IgE antibodies against an allergen. How and under which circumstances the step from sensitization to a real allergy takes place is still largely unknown. There are therefore no recommendations for prevention. A “real” allergy diagnosis is only possible by a provocation test, which should be carried out by an experienced allergologist. This allows to determine which substances are actually responsible for the symptoms.
Do I definitely have to see a doctor with allergy symptoms?
Yes, this is also better for mild symptoms in order to avoid late effects such as allergic asthma. In adults, however, this so-called change of levels – from the nose to the bronchi – is not very frequent. “Especially with children, allergic complaints should definitely be clarified”, advises Prof. Albrecht Bufe. In 60 percent of children with hay fever, hyposensitization can prevent the development of asthma.
Is it true that a caesarean section increases the risk of allergies?
Yes, in the womb the child develops in a germ-free environment. During birth, its mucous membranes come into contact for the first time with bacteria from the mother’s vagina and intestines, which lay the foundation for its own intestinal flora. Children born by Caesarean section, on the other hand, have other bacterial first contacts, and this is obviously less favorable for the immune system: allergy and asthma risks increase. Nevertheless, no child develops hay fever just because of its delivery. “A caesarean section is only one factor of many, which can contribute to the emergence of an allergy , knows Allergologin Susanne Lau.
I react to cut flowers in winter. Does it help if I wash them off?
Probably the reaction is less due to the fact that the flowers have different characteristics in winter. Rather, many indoor rooms are poorly ventilated when it is cold outside. Often the air is dry, so the sensitivity of the mucous membranes can increase. On the other hand, humidifiers and regular airing rather than washing the flowers will help.
I have heard of new, aggressive flower pollen. Should I be worried now?
Especially the pollen of the plant Ambrosia artemisiifolia is considered a very aggressive allergen. In rare cases, they can trigger asthma even in non-allergic people because they are very small and reach deep into the respiratory tract. The plant blooms very late in the year, so that the hay fever season extends into the winter. Ragweed originates from North America, but has spread to southern and eastern Europe. The good news: an allergy to ragweed can be treated well by hyposensitization.
I want to dye my hair. Is there an allergy risk?
Many hair dyes are strong allergenic substances, especially for women with sensitive skin. Especially aggressive is the black dye PPD (paraphenylenediamine), which is contained in all dark and reddish shades. Plant dyes are generally less risky, although one can also react allergic to substances such as henna.
Are there allergies to detergents?
Rarely are there genuine allergies, for example to enzymes contained in detergents. Much more common are direct skin and mucous membrane irritations caused by fragrances, enzymes and washing powder dust. Who already has an allergy or neurodermatitis, often reacts more sensitively to detergents and should buy a brand that contains as few additives as possible.
Intolerance or allergy – how do I find out?
Behind some symptoms that look like an allergy, there is actually none at all. In the case of intolerances, for example to lactose, there is only a lack of certain digestive enzymes, and in the case of so-called pseudoallergies the messenger substance histamine plays a role, but the immune system itself is not involved. Pseudoallergic reactions are often triggered by additives such as colorants or preservatives.
One way to get to the bottom of them is to follow a diet of three or four weeks in which the suspected causes are completely avoided. But beware: even if the symptoms improve or disappear, the mystery is still not solved. “Some skin diseases come and go as they please,” says allergologist Prof. Erika von Mutius. The trigger is therefore only found when the reactions occur again and always when you are exposed to the substance again.
My husband and I are both allergic. What can we do to spare our newborn child the disease?
The tendency to allergies is based on a genetic predisposition. 15 percent is the allergy probability of a child whose parents are not allergic. If against it mother and father are concerned, develops more than each second child also an allergy. For such risk children in such a way specified however hardly still special precautionary measures are recommended: All babies should be fully breastfed in the first four months (if this is not possible: give hypoallergenic food to at-risk children), for the subsequent supplementary food there are – unlike in the past – no more prohibitions.