Health Chats
Wednesday May 19, 2010, 01:00PM - 02:00PM (EST)
Cleveland Clinic
Allergy and Immunology, Respiratory Institute, Cleveland, OH
Allergic disorders affect an estimated 1 in 5 adults and children (40 to 50 million people) and are the sixth leading cause of chronic illness in the United States, according to the Allergy Report from the American Academy of Allergy, Asthma and Immunology (AAAI). With allergy season right around the corner, take this opportunity to chat with an expert on how you can properly manage your allergies so you can find some much-needed relief this season. Allergists in Cleveland Clinic’s Department of Allergy and Immunology have unparalleled expertise in the diagnosis and treatment of all diseases encompassed by their specialty. Their expertise and experience attracts patients from all over the world who seek a definitive diagnosis or state-of-the-art treatments, from respiratory diseases allergy problems. Dr. Pien, a Cleveland Clinic allergist will provide answers to your questions about allergies during this online chat. Lily C. Pien, MD, is Staff Attending in the Department of Allergy and Immunology in the Respiratory Institute. She is also a Faculty Development Associate for the Educational Institute at Cleveland Clinic. She is certified by the American Board of Internal Medicine and the American Board of Allergy and Immunology. Her areas of expertise include allergic rhinitis, asthma and drug allergies.
Hello Everyone! The health chat is going to start at 1pm EDT and 10am PDT.  Please feel free to start submitting your questions.
Welcome to the Allergies Health Chat.
A  special Thank You to Dr. Pien and all members for joining us here today!
Dr. Lily Pien:
Thank you for having me. I am very excited to be here. Lets get started.
As my allergies have worsened over the years, so have the dark circles or "allergy shiners" and bags.  I am currently taking allegra, which helps with other symptoms, but not so much with my eyes.  Any treatments or tips for that?
Dr. Lily Pien:
Allegra is a good medication for allergic rhinitis. Nasal steroid sprays are also considered beneficial.
Dr. Lily Pien:
Allergic shiners can be related to nasal congestion, we sometimes further evaluate with simple CT scan of the sinuses.
My 18 year old son has allergies but his main problem is year round, continuous, non stop post nasal drip with large amounts of mucus dripping down his throat causing him coughing spells and constant blowing nose with no end in sight. Is there anything that can lessen mucous discharge?
Dr. Lily Pien:
I would suggest determining what allergies your son might have been seeing if he can identify any triggers or exposures that cause nasal symptoms immediately.
Dr. Lily Pien:
This can be accomplished by skin testing by a board-certified allergist.  If you believe your son's symptoms are allergy-related, over-the-counter antihistamines may be helping in controlling some of the nasal symptoms.
Does Elevated Eosinophils and IgE always mean allergies or could this be indicitive of something else?  Also are the lab allergy profiles as reliable as the test performed in an allergist office?  I had the lab profiles done and they were all negative except the IgE and elevated Eosinophils.
Dr. Lily Pien:
This is a complex question.  Eosinophils are considered an allergic type cell and IgE is the allergic antibody.  Depending upon the clinical symptoms, and which specific organs are involved, increased eosinophils and increased IgE can be allergic.  These levels can also indicate inflammation.
If immunotherapy (for ~1yr) failed to control severe seasonal allergies to grass pollen, tree pollen, and dust mites, is it healthy and acceptable to take medication for the rest of your life or as long as is necessary to relieve symptoms? I currently take Clarinex (5mg) and use Rhinocort Aqua nasal spray and have been doing so for about two years, but I'm only 24 and I'm wondering if this is safe for me to continue doing. Is there anything else I can do to relieve my symptoms of allergic rhinitis and somewhat frequent sinus infections? I will start using a nasal lavage soon, as recommended by my ENT, but other than this and prescription medication, I'm at a loss for controlling these horrific environmental allergies!
Dr. Lily Pien:
Medical studies have shown safety with long-term use of antihistamines and nasal steroid sprays.  Studies have followed patients up to 4-5 years.  
Dr. Lily Pien:
I would ask your allergist how long to continue immunotherapy before saying it was a failure.  The other consideration is to see if there are other contributing factors for nasal drainage and nasal symptoms.
For about 45 years I've suffered with allergies in the springtime, however, only 1/2 of head is involved.  It is very strange - my right eye and nostril will be bright red and running constantly. My left eye and nostril will be clear and fine.  Is this a common occurrence?  
Dr. Lily Pien:
Have you had any x-ray studies of your nose?  Sometimes a deviated nasal septum can contribute to one-sided symptoms.
Opinion on use of homeopathic meds or saline nasal wash for allergies?
Dr. Lily Pien:
We do advise some patients to use nasal saline rinses to help with nasal secretions.  There are medical studies showing benefit with saline rinses.
Can you develop seasonal allergies as an adult? Alot of people tell me they have allergies for the first time.  If yes, why does this happen?
Dr. Lily Pien:
Yes it is possible to develop seasonal allergies as an adult.  The manifestations of clinical allergies are a complex set of interactions between immunology, physiology, genetics and environment.
Why do some antihistamines work better than others for severe seasonal allergies?  My teenage daughter , who has severe seasonal allergies, has been through Zyrtec, Clariten and now is on Allegra with success.  
Dr. Lily Pien:
This is a very good question and I'm not sure we have definite answers.  One thought is whether or not the antihistamine is a combination medication, meaning that it is paired with a decongestant.  
Dr. Pien:  Have you had any x-ray studies of your nose?  Sometimes a deviated nasal septum can contribute to one-sided symptoms.  ANSWER:  No I have not had any x-rays of my nose, but will ask my FP about that.
My children have allergies and I would like to avoid giving them medication for allergy relief if possible.  Do you have any suggestions?
Dr. Lily Pien:
Avoidance measures are always recommended to help decrease allergy symptoms.  I would suggest determining what your children are allergic to as the first step and then implementing measures to decrease exposures.
Is it possible to develop a tolerance to nasal sprays like Nasacort? Or get a rebound effect from them? I feel like my allergy medications are not controlling my symptoms any more and wondering if that could be the case.
Dr. Lily Pien:
We have not seen much tolerance or rebound effects to nasal steroid sprays.  If allergy symptoms are increasing, consider if there has been a change in the environment.
Hi - I've heard that this is one of the worst allergy season's on record.  My question is I've had severe congestion, scratchy throat and watery eyes since October.  My doctor  put me on 10-day Z-Pak in December, but my symptoms persist.  Could this be something other than allergies?
Dr. Lily Pien:
Hi Jack 615.  Having symptoms since October is a long period of time to be suffering-sorry to hear that. I would let your doctor know and see if there are some additional tests or evaluations to be performed.
Well i recently got invitro allergy test, and i have a yeast allergy of 2.30IgE level which shows it as high allergy, what foods should i avoid ?
Dr. Lily Pien:
I am sorry - we do not perform tests for yeast allergy at the Cleveland Clinic at this time.  Perhaps you might ask the doctor who ordered the test what is best for you to do.