Allergy injections for sensitivity to animal dander are not advisable except in unusual circumstances. One circumstance is the blind person who becomes allergic to a seeing-eye dog; another is the small-animal veterinarian who becomes allergic to house pets. The most effective course of action is to remove the pet from the environment.
Dock and knotweed plants are common in acid soil throughout North America. They are mainly of local importance as causes of hay fever.
Mixed asthma is a form of asthma caused by both extrinsic-allergy and intrinsic-nonallergic factors.
A macrophage is a scavenger white blood cell that plays a role in destroying invading bacteria and other foreign material. It also plays a major role in the immune response by processing or handling antigens and as an effector cell in delayed hypersensitivity.
Bagassosis is a form of allergic lung disorder caused by exposure to moldy sugar cane fiber. See also Hypersensitivity Pneumonitis.
Mercaptobenzothiazole, widely used in manufacturing shoes, is used in processing all leather. For a complete cure, contact with leather should be avoided. When this isn’t possible, the condition can be alleviated by keeping the feet as dry as possible, using a powder such as Zea-sorb, or by applying creams and lotions to heal active lesions and using nonmedicated creams or ointments to keep the skin soft. A dermatologist or an allergist can advise you further.
We now take an overview of knowledge recently acquired through research, and glance at projects for the near future. We will discuss population studies, basic laboratory work, and human research in specific allergic conditions. Epidemiologic Population studies reveal that 17 percent of the American people are affected by at least one allergic disease. Approximately 5 percent of American children suffer from asthma. Although allergic disease does not prevail in any particular socioeconomic class, it does affect some families more than others. Inheritance definitely plays a role in the occurrence of asthma and allergic rhinitis among close relatives of some family members; the specific characteristics of inheritance, however, are as yet poorly understood. Also, people with one allergic disease are more likely than the general population to have other allergic conditions. The cost of allergic disease in the United States exceeds $1 billion a year. This figure includes physicians’ fees, hospital care and medications, and such indirect costs as earnings lost because of time away from work. Asthma is one of the leading causes of visits to physicians. Meanwhile, it has been shown that outpatient care by allergists significantly reduces both the incidence and the duration of inpatient care, or hospital stays. Allergic disease is also a major cause of friction in families. An asthmatic child who suffers from frequent episodes of bronchospasm at night may disturb the family’s sleep while arousing the worry and fears of the child’s parents and brothers and sisters. Much more information is needed concerning environmental influences on allergic disease. Although scientific knowledge of the influence of environment on people with asthma is incomplete, scientists do know that even normal individuals suffer from smaller air passages caused by exposure to smoke. This suggests that asthmatics suffer even more from such exposure. The influence of inheritance in allergic disease needs to be better understood, in addition to gaining a better understanding of the interaction of environment and inheritance. More large-scale population studies, in which groups of Americans in varying geographic and socioeconomic settings are observed, should help.
When maximally tolerated doses of the medications discussed above are inadequate to control symptoms, corticosteroids might be used. As with any other medication, though, one must weigh the beneficial effects against possible side effects, and both benefits and side effects should be explained to the patient. Weight gain is a side effect that is often overlooked. Other side effects are given in Table 9.1. Although all the effects listed are possible adverse ones, they are also related to the duration of treatment, the dosage, and the timing of steroid therapy, as well as to the type of preparation given. Patients fear—sometimes irrationally—corticosteroids more than any other asthma medication. This medication can be lifesaving if carefully administered. By giving corticosteroids every other morning, and in small doses, the side effects can be almost totally eliminated. Long-acting preparations such as triamcinolone acetonide and dexa-methasone, and sustained-action intramuscular preparations, are not given in an alternative-day program. By contrast, short-acting preparations such as prednisone, prednisolone, and methylprednisolone (Medrol) are preferable to long-acting preparations and are ideal alternate-day corticosteroid regimens. If a physician wishes to change the daily dosage schedule to an alternate-day schedule, three to four times the normal daily dose may initially be required. During an upper respiratory infection or other stress, a larger amount of prednisone or methylprednisolone can be administered for a few days; then the previous alternate-day schedule should be resumed. With such a short-term boost, side effects are minimal and temporary, and the alternate day program can be reinstated immediately. If a patient has taken corticosteroids during the past year or has been on maintenance doses corticosteroid supplements such as those mentioned above should be given during periods of stress—for example, during surgery. ACTH, a hormone secreted by the pituitary gland to stimulate the body to secrete its own steroids from the adrenal glands, has not proved an advantage over corticosteroids. Although commonly used in Europe, ACTH has certain disadvantages that make its use in the United States undesirable. 