(00:00:01) Dr. Malcolm Blumenthal is our studio guests today. He is president of the American chapter of a group called The Asthma and Allergy Foundation of America. He is a doctor who specializes in the treatment of allergies. He has a private practice in Minneapolis and we'll be giving you a chance to find out about that subject during our broadcast today. Dr. Blumenthal welcome pleasure to have you here. Thank you. Asthma allergy. Hay fever all are connected at least in my mind, but there must be some distinctions between them. What are they? So asthma by definition is someone who wheezes coughs gets short of breath supposedly. It's due to some spasm as well as swelling involving Airways down in the lung. Hay fever are allergic rhinitis is strictly the know where you get swelling of the no with dripping and sneezing allergy by definition is one of the causes of hay fever asthma if you take say a hundred patients with asthma Your own 20 to 40 percent of them will have allergy as being one of the triggering factors. Therefore allergies a mechanism by which you get various disease processes or what triggers the problem in the other 80% of it can be many things all the way from infections various chemicals. Some people emotional factors can trigger it off air pollutants many things can trigger off someone who already has what we call Twitchy lung or Twitchy nose. How common are these problems are extremely common depending upon how you define allergy? Probably one out of four people in the United States at some time during their life will have a manifestation of an allergy with the guards. Asthma probably one to five percent will have asthma and hay fever 5 to 15% are these are the sorts of things that are confined primarily to Childhood or can a person develop them almost at any time in their life. Develop allergies apparently any time of life typically the hay fever asthma due to allergies and the younger age group. Although you can get it at any age group. How are these diseases treated you more or less try to figure out what factors are triggering them off in other words if they're wheezing. You've tried to figure how many are allergic and what allergic factors are if due to other factors to determine that then you try to interrupt our interrupt the pathway that's making the disease other words. If it's an allergy you would get rid of the dog or cat or give specific medicines to counteract the allergy. Okay. It's about three minutes three and a half minutes past noon. Dr. Malcolm Blumenthal Our Guest today. And if you have questions about Allergy Asthma, hay fever if you suffer from them or have a friend who does or a child, perhaps we welcome your questions on the general topic, obviously. Dr. Blumenthal is not here to diagnose specific ailments, but generally speaking if you have a question by all means Two seven six thousand in the Minneapolis st. Paul area 2276 thousand for Minneapolis st. Paul area residents in other parts of Minnesota. The telephone number is 1-800-695-1418. Of course is toll-free and those of you listening in the surrounding states or in Ontario are welcome to call us directly in the Twin Cities at area code 612 2276 thousand think our first caller is already on the line. So we'll take you go ahead please you're on the (00:03:31) air. Yeah. I have a question and a comment and would you believe I'm not calling from st. Louis Park but the Softail area. I'm a dermatologist and I get into this area because people conclude that they are allergic to something which I can't prove and as it turned out last evening. I was reading an article or a review of it from the Lancet which Called food allergy how much in the mind and they could only prove that maybe for out of the 23 patients had something that by double-blind testing they could prove had this kind of a reaction. I think one of the most difficult things is to disabuse an individual of the conclusion that they are allergic to this substance. I have a physician friend whose mother could not tolerate onions and he can't tolerate onions and he's not turn his own mind whether it's a hereditary trait or whether he was taught this as a child. The other comment is that in one family set up when looking for a pattern which is the way I approach the problem. The guests at family gatherings would smoke and the father who had asthma would get all choked up and even would end up in emergency Ward situations. And finally I said, you people can't you see that when you smoke this is what happens to Papa. So when you're in this house don't smoke. So I'd be interested in hearing. Dr. Blumenthal's comments. (00:05:31) Thank you very much. The main point to make is have alluded to initially that asthma hay fever hives is a condition that can be caused by many different things allergies are merely one of many things that can trigger it off. Even if you find let's say a food that can make someone wheeze. It doesn't mean that they're allergic to the food. It could be due to a chemical reaction with regards to this lately as you know, and the Press have been lot of information with regards to buy sulfites. Substances that they put on some foods that keep them fresh and so they don't break down people can have adverse reactions to these that looked like asthma that are asthma but there's no evidence that it has an allergy. In other words are no evidence. It involves what we call the immune system. Hmm. Well, what about the hereditary aspect of it? There's a large hereditary component in the development of some types of allergies if you look at asthma or hay fever if both parents have say allergic rhinitis to drag weight approximately 40 to 60 percent of the offsprings will have some evidence of allergy if one parent is allergic and the other one isn't with regards to respiratory allergy around 10 to 30% of The Offspring were have allergies. If neither are it would be the general incidence of the population around 10 to 15% One more follow-up question on his comment regarding the reaction that is relative had to the cigarette smoke a lot. People have that that's why I guess we have that that law in Minnesota that requires segregation of smokers and non-smokers in in restaurants and so on would you describe that as an allergic reaction or if not, why do people have that reaction around smoke? We're really not quite sure there's several theories on it. I think most of the evidence points out. It is not an allergy. It's a nonspecific irritant type reaction that will make someone who already have the tendency to wheeze to wheeze as I mentioned. Some people will have what we call Twitchy lung may be triggered off by many nonspecific things. Okay eight minutes past the alright, here's our next listener. Go ahead, please. (00:07:41) Yeah, I received allergy. I received allergy Visa sensitization year-round. I get how stars and Ragweed injections and sometimes momentarily or a day or so after I hit the injection I get a swelling at the Right where the injection occurred. Could you tell me what exactly the physiology is what's going on? And if that is bad to have the swelling why (00:08:11) he first thoughts very common to have a positive our local reaction after an allergy shot. And in essence you're injecting into yourself what you're allergic to therefore. It's kind of like a skin test but sometimes it's deep skin tests. It's not uncommon to have it immediately. It's not uncommon to have it made me a day or two afterwards the ones immediately we think are due to what we call High GE Aria genic mechanism. In other words it involve a immediate type of release of chemicals the ones that occur a little later are due to other chemicals being released at the site of injection of the antigen. It's part of the process are there various ways to try to cut down on it, but it is not dangerous unless it obviously gets too big. Are you get systemic symptoms? Basically you're getting In reaction to what you're allergic to. Here's our next listener with a question for dr. Blumenthal. Go ahead (00:09:04) please I'm calling from Duluth and I would like to hear comments on visual motor rhinitis its core causes and possible treatment and I'll hang up in this (00:09:15) thank you. What is it? First of all, dr. Days of motor I notice is what I consider wastepaper basket term that I use all the time and Athens to me. It's the same as idiopathic or I don't know why you know the drippy and our onions. Well, the I see an Essence people have this will get swelling of the no of and dripping and many times will look like an allergy but you can't identify that antigen or the thing triggering it off second of all nonspecific things were triggered off weather change emotional stress son barometric pressure changes exposure to smoke for many times trigger off the nose to be drippy a classic example in Minnesota is someone who goes outside and they get the drippy nose from the cold air. Hmm. I can recall people. Walk outside from a darkened room into the sunlight and sneeze this again falls in the area of I don't know it occurs. I think we see it a great deal. The exact mechanism isn't well delineated. There's not much you can do to treat these kinds of symptoms I would guess is they're the treatment is mainly symptomatic these people have swelling of the nose and dripping so you give antihistamines and decongestants. Usually hmm. Here's our next caller with a question. Go ahead (00:10:25) please I have an orgy. But it's from Kenalog once a year. Now, then they gave me what they called epilady and not every six weeks. I get a shot of deferral Medrol whatever that is. And I wonder if this is harmful. (00:10:43) This is extremely difficult to say depends upon the condition and how you're getting and what dose and essence you all all the medications you mentioned. I believe our cortisone type compounds. I would suggest you check with your physician about what we call the risk-benefit ratio of the drug versus the condition. Alright, let's move along to our next listener. Go ahead, please. Hi, you're on the air. Hello, are you there? Hi, are you there? Well, let's try our next line then Bill. Okay, your next go ahead, please. (00:11:16) Thank you. I have two questions, please. I understand that people are seldom allergic to one thing, but it usually have a set of allergies. And is that true? And secondly is it true that allergies can really abruptly come and go to one or another item? (00:11:31) First of all, it's usually are more common to have people sensitive to multiple things especially with regards to inhalants allergens as opposed to one other words it unusual to just be allergic to Ragweed are just be allergic to grasses, but it's not unusual with the guards antibiotics to just have a reaction to penicillin in other words just because you have one reaction to a drug Devon mean that you're set up to have more reactions deep down. I feel that is the increase frequency but practically and clinically it's not of a great significance so we can detect it on individual basis 13 minutes past 12:00 o'clock. Dr. Malcolm Blumenthal is our guest today. He is president of the Minnesota chapter of a group called The as Asthma and Allergy Foundation of America. And here's our next listener. Go ahead please. (00:12:17) Yes, I have what you call a twitching lungs. And I miserable today if you're in Minneapolis and why you want we've had a change in the atmosphere conditions is this happened to quite a few people are just me. (00:12:38) It's not you matter of fact many times. We can tell how the weather is and going to be depending upon how often the phone rings and Clinic many things can trigger off the Twitchy lung as I mentioned allergies can do it where the change can do it are pollute skidooed emotional stress can do it and factions can do it chemicals can do it smoke can do it. In other words. The list is very long and you're a common person. We see this a lot. Is there anything the person like that can do? I mean you can one try to avoid other things that seem to trigger it off in other words rarely. Are you allergic to only one thing and rarely will you only get it from cold air exertion. Usually it's a allergic person. Exercises, although it can be any combination. So therefore you try to cut down on the things you can cut down in other words, if you know the weather is going to change are you know, you could be exposed to pollutants. Maybe you should avoid other things that may make you worth like fatigue or avoid eating certain food are staying in cleaner atmosphere are avoid running around the block and sub degree weather. Let's take another listener with a question. Go ahead please you're (00:13:47) next. Hello. I'm calling from st. Cloud for over 30 years. I've had this chronic cough and diarrhea. And it's a year-round thing heat and cold will bother it. Sometimes you never know. What causes it. I'm just wondering if there's anything that can be done. I've never had any says section for many doctors that I've gone to (00:14:14) this extremely difficult to answer I think over the phone and again symptoms like you mention are compatible with allergies, but the compatible with many other things and I could do suggest to our see your private physician and see what he says. All right. We'll try another listener with a question. Go ahead please (00:14:31) yes, please. My daughter has asthma she gets shots, but it's also necessary for her to take Theodore, which is a form of Theophilus. She takes it twice a day and I would like to know what the risk is for her to take this for many many years over the long (00:14:48) term. The Uplands are relatively safe medications. A matter of fact, one of the first ones we use for the treatment of asthma basically the four major groups of drugs. Were you even asthma first are the Theophylline Czar aminophylline slow villain theater. These are medications. And it will cause relaxation of the muscles in the lung and enable the person to breathe better side effects can be nausea vomiting upset stomach jumpiness. It's relatively safe. Although no drug obviously is a hundred percent safe, but it has been given for many years and if watched and monitored without much problem Do you think that there are some serious consequences of some of the treatments for allergy? We've talked a little bit about you mentioned that one people sometimes have shots for various things. What are the side effects? What are the consequences especially long-term treatment with some of these products the side effects can be many and this is why I think anybody on any medicine be an aspirin or allergy Tech medicine needs to be watched but to mention a few that we see at the University one allergy shots, you're giving the person what they're allergic to. So obviously if you give too much or too fast, you can make him worse and we get embarrassed periodically to see someone on shot and getting worse and we find out that hey it's due to the fact that were probably giving too much in their shots. Some of the medicines like cortisone have been well known to cause many side effects softening of the bones high blood pressure diabetes cataracts increased risk to infections gaining weight all with are significant and For with all these medicines you have to weigh the risk versus the benefit and the quality life you wish to have. All right. We'll take more listeners with questions now. Go ahead please your next (00:16:36) thank you. I have a son who's 14 years old and allergic to poison. Ivy. We live out in the country and are therefore in the woods quite frequently and he gets it before it actually comes up in the spring. I mean, you can't identify the plant yet. What I'm wondering is are there shots available for this and are they effective and are there any side effects and how often would you take a shot? If you had this (00:17:03) problem number one? It's an allergy what we call contact type of dermatitis. Number two, there are shots and medicines available You Take by mouth number three, there's no evidence showing the shots and medicines you take by mouth such as called various poison ivy medications are effective in the treatment of poison ivy dermatitis. So most of the time the treatment of poison ivy is avoidance plus symptomatic treatment with various ads ointments and pills. How does anybody managed to sell pills that don't work? It's some of them get through what we call the grandfather clause and many of these that I don't want to mention any brand names have poison ivy in them. And a matter of fact, I don't even know if they're on the market the past year or so, but they were a couple years ago where you took the poison ivy by mouth and supposedly this build up a resistance for it many medications. As I mentioned that have been given for many years have not been studied by the strict criteria. We have nowadays for a New Drug coming on the market there for the new drugs go through a lot more than the older drugs. Okay. Here's another listener with a question. Go ahead, please. (00:18:19) Yeah, obviously when we're when we're dealing with things like asthma and allergies, we use a lot of simple terms to describe what's going on one that we're using today is Twitchy Twitchy lung. We're not spending a Time trying to to determine what causes these things what causes this Twitchy lung or the body's reactivity or hyper reactivity to these environmental factors. It appears to me that because of the complexity of what we're dealing with the complex interaction between the pituitary and adrenal hormones and whatever that are being produced in the body and the effects that they have on the immune system and and the basophils and eosinophils and other factors that play in the allergic syndromes. We have a tendency to write off trying to discover what what the basic underlying current of this allergic reaction is and treat just the symptoms and look for simple environmental factors that that Cause these symptoms to (00:19:40) occur. All right, let's get dr. Blumenthal's reaction to that if he has one. Okay, first of all, I think it's extremely important to find out the basic mechanism to clarify issue when I say Twitchy long. I just mean Twitchy long. I'm not implying allergy allergy is a specific what we call immune mechanism involving a substance and the substance of body makes to cause an adverse reaction. We do not know why in most cases people get what we call the Twitchy lungs. The basic mechanism is being studied very vigorously by many centers. And because you don't know the basic mechanism, it's very hard to do anything about why people get the Twitchy long second of all you try if you can't do anything about the basic mechanism you have these can try to prevent it and you can prevent it by avoiding what you think you're allergic to and I guess if you believe in genetic counseling you should avoid marrying another allergic person practically the sound Impossible and I think it is third of all you then try to identify the specific allergy that is giving the trouble and you do this by history. You do it by skin testing you do this by various challenge methods if you identify what's causing the problem you then can avoid it or else possibly give shots and selected situations. Let me ask you what you think may happen in this whole field in the next 10 years or 20 years. It sounds like there's really a lot yet to be learned our researchers coming close to unlocking some of these Mysteries or not. Very close. I think we're at a very exciting place with regards to knowledge about allergy. First of all, we do know I think the basic mechanism in many cases out why people develop allergy we are now at the University getting information about finding out the particular Gene that would turn on the person and make them allergic obviously in Minnesota. We all get exposed to Ragweed but only 10 to Percent of us really develop a clinical picture there for around 10 to 15 percent of us have this Gene that can be turned on supposedly for ragweed. We are now getting information about identifying this this obviously I brought implications with regards to avoidance are what we call genetic engineering or doing something with the basic mechanism. We have lot of information with regards to after you get sensitize how people get the reaction antibodies in the chemicals involved. Therefore many of our treatments can be specifically directed against the particular pathway that makes a person wheeze or makes them go into shock. Third of all nasty with a broad question. I'm just trying to get a pure point is we think now we will have methods to turn off the ledge response what it wants his produce and I think this will be coming in the next five ten fifteen years. So in answer to your question is the very exciting and rapidly moving area. It sounds like possibly even curing some of these things not just treating symptoms but curing Getting close to their controlling who 23 and 1/2 past the alright. Here's our next listener. Go ahead, please (00:22:44) good afternoon. I'm calling from North st. Paul for many years. I've observed in elderly people that part way through a meal they become very drippy in the nose. Now that I'm in my 70s. I find I have it also part way through a meal I get a very profuse discharge of clear fluid from the nose. It doesn't seem to be associated with any particular food. It occurs. Every time I eat what are the doctors comments on (00:23:10) that this falls in the group of what we called. This other woman called before our vasomotor are idiopathic or I don't know what's happening to you type of rhinitis. It occurs. We don't know the reason why is it more common among elderly people? We see it in all age groups. Alright, here's our next listener. Go ahead, (00:23:29) please. Yes. I have a couple questions. I'll ask the questions that I'll hang up. First question is how do you treat and test for food allergies? And the second question is how do you feel about sublingual testing and sublingual treatment? Thank you. (00:23:45) Those are two very loaded and involve questions. I'll try to answer them just briefly first with regard to food allergies the no question they do occur. The usual method is to take a history and a few cases. If you want to confirm the history you can do skin, testing or wrath testing as well as provocative testing because of the problems with the food allergies. Actually, we've just started a food allergy clinic at the University of Minnesota to investigate this particular type of problem the sub during your Technique would you mention is one that has been used and the American Academy of allergies have made a position statement that they can find no scientific basis for it. So at the present time we do not use it. About twenty-five minutes past 12:00. Dr. Malcolm Blumenthal as our guest today president of the Minnesota chapter of The Asthma and Allergy Foundation of America 2276 thousand is the telephone number for Minneapolis. St. Paul area listeners who have a question. The lines are pretty busy this noon. But if you get a busy signal dial back because there's a good chance that you will get in in other parts of Minnesota. The toll-free number is 1-866-560-4440 call that 2276 thousand number if you have a question for dr. Blumenthal today, all right your next go ahead, please. (00:25:06) Yes. I have a question about our two-year-old son this fall. He developed giant eyes and we had some limited allergy testing done on him and we had a positive result for tomatoes but negative for a couple of other fruits and he still gets hives from both routes and several others in addition to all things like cough medicine and color, you know pop and things like that so I won't leave To comment on this apparently not allergic reaction. And is this common in children? Will he outgrow it and the second question? I ask another question is what about testing the blood directly for allergies versus a scratch test, sir skin test. Thank you. (00:25:45) Okay. Thank you first year with regards to the hives or the carrier reaction. If you take a hundred people coming in with hives or to carry on if I can diagnose over 1 or 2% I think I'm doing good. And this I think of general information I think in most allergists if you push maybe we can go up to 10 percent, but what I'm saying is a majority we cannot find the cause and the reason being the easy ones you diagnosed before you go to the doctor and the tough ones are extremely difficult. Hives can be caused by many things and they begin caused by different things and the same person. So one day it may be due to an allergy another day. It may be triggered off by emotions the third day. It may be triggered off by chemicals. It's extremely difficult to evaluate cases of this sort luckily and age group of your child moved to these will go away despite us and therefore I would say the Outlook is probably fairly good the diagnosis is essentially what you're doing. You have to get a good history watch and then you do other tests to try to confirm and you mentioned skin testing and blood tests skin testing is probably the most sensitive way to detect what we call rear genic our immediate type of allergies. However, if I take a hundred people that have no history of allergy and no family history of allergies and skin test and Ragweed we will get probably owned 25% giving a significant positive reaction. And other hand it would be extremely unusual with someone with a good history and you identified what's causing it to have a negative skin test their foreskin tests are usually done to confirm the say okay. This person looks allergic. We've now on History identified what's causing it. Let's make sure it is a definite allergy involve an engine antibody then you do skin tests, but for a fishing Expedition lot of times a good to pick up skin test and may not be meaningful. Clinically. I think this car want to know about blood tests directly. The blood tests are the main one used is called the raft has re St. And this measures the antibody specifically that interact with say the pollen are the allergen or whatever you're thinking about. It correlates very good with clinical history, but not as good as contest's just make this very quick if someone has a positive history to Ragweed and you do skin test as I mentioned almost all of them will be positive but Around 60% of them will have a positive blood test and other hand if someone has a positive blood test almost all of them are good percentage than will have a positive skin test. So measure the same thing but it's not a sensitive. Okay, let's take our next listener with a question. Go ahead, please. (00:28:35) Hi. I wanted to thank the doctor for talking about this Twitchy lung syndrome because it explains something. I've been trying to understand about my son for a long time who had severe and constant bronchitis when he was younger and now has occasional difficulty breathing but from widely varying problems. And so this explains it and makes me certainly a great deal easier in my mind about it. Um, the other thing that I wanted to ask is I found out recently that I have a gluten allergy and I have had the fall type of asthma and A fever for quite a few years and since I stopped since I cut gluten entirely out of my diet and then in the fall, I don't eat any chocolate or any milk products. I found I've managed to get the asthma under control. I still haven't gotten the heath here under control. I wonder if he would have any suggestions for a direction that I could go in to try to get rid of the whole business and I'll hang up and listen. Thank you. (00:29:43) I really don't sound like you have a very complicated interaction of several different immune systems here and the gluten type of allergy is, you know can be several types with several different types of symptoms. And again, I would suggest about to be checking with your family doctor are talk to someone more detail. I think it would need a more intense investigation are there are some types of foods that seem to cause more problems among the population at large than others all this is extremely difficult because of the difficulty in defining what an allergy is with regards to food. Thinking our clinic at the you and I think in other centers where you study food allergies the common foods, we see our Seafood Lobster shrimp and he will cause hides and shock like syndromes milk the no question. You can get a milk reaction, especially in little kids certain freshwater fish can cause and we see people that gets bad reaction to meeting freshwater. Fish wheat has been reported to cause it you notice I'm not mentioning chocolate have really no evidence that solid with regards to chew allergy to Chocolate. Although chocolate can cause reaction because of various chemicals in it peanuts is other one. I should mention which is extremely common and can you be very important as well as soy because of food being adding having these Foods added to Him and peanuts and soy bean added to Foods sure and so common in the oils that are made from to here's another listener with a question for dr. Blumenthal. Go ahead, please. (00:31:17) Hello by the one inside you sure are I'm calling from Rochester Minnesota and I had a question changing the subject a little bit. I missed the first part of it if you talk about smoking. I apologize for calling on it now, but the questions I had were twofold one is just the presence of smoke either in the individuals history or as a household contact and it's aggravation of allergies or respiratory really derived and we're comment on that and the second one is just the question of just a so-called smoke allergy itself. If you could comment on that I'll just hang up. (00:31:56) Well, you have talked about that some doctor, but maybe you want to amplify a little that's I just quickly that move to the evidence points out. That smoking is a nonspecific irritant for the lung. Are not usually allergic to smoke. I should mention there be a public meeting down at Rochester by the Minnesota Allergy and Asthma Foundation tonight. And if you're interested to answer some further questions, I'm sure you'll be welcome. Where would he find out where that is hot to call probably either Miss Grandy and unfortunately don't have her number or possibly to called the Rochester in the Mayo Clinic the allergy section and I'm sure there have the information. Okay, we'll move on to another listener with a question. Go ahead (00:32:35) please. Yes, sir. If you could have the doctor defined the term exercise-induced asthma and in the adult causes and cures and please go ahead and go to the biochemical level. (00:32:47) Okay. Thank you exercise induced. Asthma is something we recognizing more and more. It's asthma that starts after you exercise. And typically it comes on after you exercise to while our when you stop and the thing that differentiates it from other conditions is after you stop you keep on wheezing. It doesn't go away the minute you stop. Matter of fact get worse for about 15 to 30 minutes. Then it gradually will get better. It seems that cold air and low humidity are two of the major triggering factors for exercise-induced. Asthma there for cross-country skiing are running around outside in winter time is worse in will trigger it off more often than say swimming or running around the track inside the exact mechanism of it. We do not know and it would be strictly speculation is it should people avoid the activity that causes that or doesn't it make that much difference if it subsides after half an hour what harm does it do well can do harm if you keep on exerting yourself and you get worse, although some people obviously somehow breakthrough when they keep on exerting themselves and they get better, but typically they will get worse. They won't get it all the time. So it's not a consistent thing. I think it's important to keep in physical shape. Therefore. I think if you do have exercise-induced asthma you should possibly go to another activity that won't trigger it off such as swimming are somehow bike riding seems to be relatively good for this or you can always take some medicine to prevent it. So if you know you're going to do an activity that will give you trouble you can take a pill or take a inhaler to see if you can avoid it. Okay at 25 minutes before one. Here's our next caller. Go ahead, please (00:34:27) I have some allergy testing done by a practitioner of Homeopathy. She tested me by putting a substance under the tongue and then testing my muscle strength. Her recommendation was to give up the things I was allergic to for a month and then she retested me and they tested. Okay some other things showed up though, and we're going to go through the same process. I'm wondering what you think about this testing and recommendation of giving things up. (00:34:53) I do not know of any Studies that have stated shown that this method is effective again, it has not been studied a great deal in the scientific literature and to my knowledge. There's no good studies showing it's effective. Another listener has a question for dr. Blumenthal. Go ahead, please. (00:35:16) Yes technical himself. First of all, I'd like you to thank you for being on today. I think it's obvious from the number of calls A lot of people are interested in the subject. My question concerns. Asthma I've had asthma for a number of years now and one of the things I've read is that there is a pretty high correlation between asthma and stress and I've also read some place that there is a higher than average correlation between asthmatics and being the oldest child and I'd like your comments on that and just the stress related nature of asthma. (00:35:46) Yeah. I'll take the last one first since I was interested in this for a while, huh? We can't show it it's in the literature and people talk about it. But we're having difficulty showing that oldest child does have asthma more likely than the others. The relationship between emotions stress and any allergy always comes up then no question emotional stress can trigger off asthma like emotional stress can trigger off many other diseases if I started to wheeze if I didn't get uptight or emotionally under stress something would be wrong with me. And therefore this is a normal reaction to an abnormal situation. Unfortunately, if you get uptight this can sometimes aggravate the asthma therefore it gets to be a vicious cycle one of the common misconceptions that we see a lot unfortunately still in the medical field also that you see someone who's wheezing they're uptight and it's easy to say. Hey, it's all in your head. It's all motion all you have to calm down. It's kind of a neat reversal of cause and effect. In other words emotions are one of many non specific factors that could trigger off this condition. Here's another caller with a question. Hi, you're on the air. (00:36:55) Hi hat. First of all, I'd like to note the doctor Blumenthal has undergone a hundred eighty degree turn on his belief in food allergy. Congratulations. Secondly. I'd like to ask him whether he himself has observed a significant increase in ige levels with administration of any particular food or food substance. (00:37:23) Okay, in answer to I guess your comment food allergies have been described it all the way from Early times. It's very difficult to Define. What a food allergy is are not ige levels again depend upon the type of food reaction you're talking about if you're talking about what we call the ige or eugenic one. We have seen in situations where the ige level is elevated. And obviously if someone has a allergy of ige type to the food you would expect the IG level to be elevated with the guards of this particular food for the total ige levels to be elevated again, since you're dealing many time in allergic people. There's too many things. The ige levels may be elevated this phrase came up before but for those of us who have short memories what is ige mean again? Okay ige is one of the one of their proteins made those by the body in which an antibody one of our antibody groups in other words a person will Take this in response to a foreign substance. Therefore if you get exposed, let's say to penicillin. All right, we let's take Ragweed the person will then say hey, this isn't my normal substance Ragweed and will produce ige against it. Then once you have our G, this IG will then attach the various cells that contain chemicals. The person will then get exposed to Ragweed the second time. This Ragweed would then attached to the ige that's attached to maybe a cell and then will cause the release of chemicals that will make you wheeze and make you sneeze. I give you the allergic reaction. So if you have a lot of ige your more allergic in general, but the many exceptions to this. All right. Well, I don't want to go into this anymore because it's too complicated for me. Let's take another caller. Go ahead, (00:39:11) please. I have a comment for the mother of the Presumably is allergic to poison. Ivy. She mentioned the woods and a lot of people don't know that there are two kinds of schumak poisonous and non-poisonous and if he just covers up and thoroughly removed the sap before it combines and produces allergic reaction. He can maybe avoid this kind of thing and you can't tell by looking whether it's poison ivy or schumak. Let's doing the damage. (00:39:49) Any reaction doctor? No, thank you. All right. We'll take another caller. Go ahead, please. (00:39:54) Yes. I've got a question. I'm an asthma sufferer and I take aminophylline but it gives me a real upset stomach and nervousness and that sort of thing so I've been avoiding it and I've been using just a primatene mist from the drugstore and I was wondering whether there was any app, you know alternative alternate drug than aminophylline. And also what kind of harm the primatene Mist can do. Thank (00:40:17) you. First I am an Allison is you can cause side effects you mentioned. Usually it's dose related. So many people that would get these side effects. If you take a lower dose, you can tolerate it and indeed there are blood tests you can do to see what your blood level is to see if you're getting too much or too little second of all, some people just can't tolerate it. They have low level and they can't tolerate it. Therefore you can go to other medications and one of the other medications are what we call sympathetic agents are beta-2 Agonist. Primatene Mist being one of them primatene mist is a dilator. It's a stimulant there are now what we call second generation drugs out that we think our little more specific than the primatene. Mist and therefore will affect mainly long and not affect the other parts of your body. Therefore. We usually encourage people to use these newer drugs. The third drug on just mentioned is chromel and sodium which is a powder that you inhaled in that prevents the chemicals that make you wheeze from being formed in some people it's very effective and it's very low on side effects. I would suggest you check with your physician about these her question. Of course reminds me that when you go to the drugstore, you see just shelves and shelves and shelves of over-the-counter medicine for allergy and all kinds of other problems. What is your view about those those tablets that are available across the counter are they harmful or for whom should they be used nowadays are all getting fairly good because of I Government regulations are the antihistamines and decongestants are essentially the same as prescription are used to be prescription and many times in low doses would be quite adequate like with any medications. I think if you follow the directions and don't abuse it there be okay. Okay, 17 minutes before one here is another listener. Go ahead, (00:42:07) please. Yes. I'm wondering if there's a lot of belief around that food allergies and the specifically lactose intolerance is tied to early giving up a breastfeeding or introducing foods too early or too suddenly, and I'm wondering if you agree with that or if you've seen any studies about that and I'll hang up and listen to your answer. (00:42:29) Okay? Well, this is a very what we call Hot area and Allergy and we've been involved in studying this at the University in general. It's a consensus that breastfeeding is better than bottorff bottle-feeding to prevent eczema as well as milk allergies is some some of the other allergies the data for this is not firm it. Two we recommended but it is not firm. Here's another caller with a question for dr. Blumenthal. Go ahead (00:42:55) please hello. Dr. Blumenthal my father-in-law lives in Texas and has gone through a lot of testing the skin tests and they found that he had mold and food and Airborne allergies, but he also has a slight asthma and some bronchitis. He can't take the Theophylline type drugs. He's taken across the board and they haven't worked for him because they cause extreme nervousness. I'm wondering is there a regional center that can help people who are getting desperate because their diseases cannot be identified and held thank you. (00:43:34) There are Regional centers throughout the United States and I suggest you check with the physician down there which one is closest to you, but most University will have centers for the difficult problems. 15 minutes before one o'clock another listener is waiting. Hi, you're on the air. (00:43:49) Thank you about two years ago. I developed some symptoms. I'll just list them quickly red watery eyes runny nose ready skin around the eyes and nose and stuffy feeling in the years and the temples and the came on during the summer but then through the years they would appear in fall winter spring didn't really have any pattern and I never got any satisfaction going to doctors are clinics. They would say well if it gets worse come back or I give me some antibiotics or they didn't didn't really seem to think is very serious. So I did some reading on my own I started taking vitamin C and in the past year and a half every day. I've taken the 1500 CC time of these pill a vitamin C and these symptoms have absolutely disappeared and my comment of my question is do you think that that's result taking vitamin C or you think the And just working on its own and you have any comments about vitamins in general. Thank you. (00:44:52) I usually can answer that question. It's tough to say whether to went away by itself on our weather at the vitamin C. Did any good there is some evidence that you know in the literature of using vitamin C for the common cold and dead people talk about it an allergy. I don't think again it's firm. It's what we call interesting information that I have not been well established to my knowledge it is we're going on in some of these areas sort of Fringe areas. Yes. There are the problem with lot of so-called Fringe areas. There's so many ideas. It's hard to study all of them with research funds Limited in all that here's another listener with a question. Go ahead, please. (00:45:34) Yes. Have you ever heard of an allergy to the cold? My sister who is 30 years old in the last five years has developed symptom where she goes outside and her skin swells are no swells and different parts of as well. And if she swims and cold water the same things happen. Is there anything that can be done about this besides curtailing outdoor activity? I'll hang up and listen. (00:46:01) Unfortunately. It is a not uncommon Condition. It's not an allergy another Devon involved an antigen combining with antibody anything of the sort. We do not know the exact mechanism of it. It can be serious because obviously especially living in Minnesota you fairly well curtailed and indeed there have been some very bad reactions of people jumping in the cold swimming pool or cold lake where they get a severe reaction. A matter of fact, there has been some deaths reported from it. Unfortunately, there have no satisfactory treatment of it it can occur for no good reason, but some may occur with other diseases Again, I think it's important for one to have a good General checkup to make sure they don't have these other conditions that are associated what we call cold. Urticaria are called angioedema. There are some drugs that some people say work fairly well in preventing this and again, I would suggest she checking with her physician. All right more listeners are waiting with questions. Dr. Malcolm. Blumenthal's Our Guest today. He is the president of the Minnesota chapter of The Asthma and Allergy Foundation of America. Go ahead please you're on the air. (00:47:09) Well, I joined the other callers and thanking dr. Blumenthal for coming to this program. It's a monthly informative. I have a friend who has a severe allergies and controls them quite well without any kind of shots and so on but I'm concerned about her because of a crisis situation that arises with increasing frequency. And that is that she will have just a smell maybe from ironing something or chemical smell of some kind that will actually promote a This is where her throat closes. What do you recommend to a person who experiences that sort of Crisis? (00:47:45) It's extremely difficult and we see people like this frequently depends upon the cause whether it's a allergic reaction or whether it's a nonspecific reaction whether other factors are going on. It's one I would have difficulty answering over the radio and I think again it would need a detailed work up to see what's going on. And again, I would suggest GIC her allergist. Let's move on to another listener with the question. Go ahead please (00:48:11) buy a late bloomer. I just got a couple years ago, but you were mentioning eczema. And I've also this year had some problems with eczema. I wasn't aware that that was an allergic condition. Is there anything you can get treated besides a courtesan products? I'm sort of various court has mmm (00:48:34) Okay, eczema has been included in allergy mainly because it's Associated many time with people that have asthma and hay fever and also you find certain things like ige being elevated in people with eczema at the present time. We do not know the basic cause of eczema. We don't know what factors will trigger it off probably is due to several factors in view of this the treatment mainly is symptomatic at the present time under cortisone based drugs. The most of them are very Savvy and ointments all the way from lubricants cutting down on the itching and some cortisone Salve and ointments and antihistamines sometimes also help do these Sam's have a bad side effects like you were mentioning earlier about cortisone their risk is much less but indeed the savs. If you do you've a high concentration can sometimes cause some skin damage. And again if you use a lot of it and what we use Occlusive type dressings that can get in the blood system and therefore also caused some systemic effects. Here's another caller with a question for dr. Blumenthal. Go ahead (00:49:43) please. Yes, dr. Blumenthal. I have asthmatic bronchitis and I have had it for most of my life. I went through a particularly bad period when I lived out in the country and owned a couple of large dogs and during that time, I received the aminophylline type drugs and became more and more sensitized to them where they made my heart have palpitations and when I would be brought into the emergency room, they would give me an epinephrine type drug and I started developing reactions to that. My heart would go into some kind of a thick hearty or something. Anyways, they changed me to a pressurized breathing machine with bronchus all solution and saline solution and that was really a turning point for me because I didn't have the problems with the heart palpitations anymore. And I'm wondering why doctors are so reluctant to give that type of treatment instead of the aminophylline type of things that trigger the heart to go so fast (00:50:46) right after he well again, I think this has to be on the individual basis. I think we live in we and the general term give it if we try simple stuff and that didn't work. The inhalers are various inhalants of world of pills are the two bases. Some people will give inhalers to others will give pills to depend upon the particular person. Eight minutes before one o'clock. Another listener is waiting go ahead please. (00:51:12) Hi, dr. Blumenthal. I realized there's a variety of different types of testing that can be done for allergies particularly food allergies. There's one the cytotoxic testing which apparently looks for changes in cell morphology based on exposure to various food allergens. And my first question is do you feel that's a legitimate way of assessing for food allergy. Second question is in particularly at multiple sclerosis. Do you feel that? There's any connection between the fact that people with Ms. Seem to have a higher incidence of food allergies or is that just a coincidence? Thank (00:51:46) you. Hey, there's no evidence of the cytotoxic test has any validity whatsoever. That's kind of a blanket statement. I think the studies on it have shown. It's really haven't been efficient multiple sclerosis the data on this as far as to my knowledge is not clear and I really can't comment on it. I wanted to ask you as we get down towards the The our if there are any particular common allergies that crop up this time of year. I know that we're away from the Ragweed and the pollen and all that but are there some things that do crop up in the wintertime? The winter time for Respiratory allergies are mainly when the heating system goes on and you have dust blowing around the house sometimes when you start using a humidifier, they may grow mold in it. And therefore these may give you trouble Christmas decoration. Some people may have trouble with various types of Christmas decorations around the house typically for the asthma and hay fever that should be a good time of year for with regards to the specific allergy since the grasses and weeds are all gone. But the nonspecific things get more in winter time the cold air the dry air sometimes some of the pollutions can give people trouble burning wood in the house therefore, even though you have asthma and summertime due to Ragweed these nonspecific things can aggravate it in the wintertime. Well, the phone lines are still Jam. Let's see how many cars we can take care of in the last two minutes. Go ahead please you're next. (00:53:12) Hi doctor. I am a senior citizen and He many years ago after several bouts with pneumonia. I was advised to have the skin test theology test and I was found to be allergic to several foods and tobacco and many many other things. Now the last several years. I haven't had any trouble until two months ago after visiting on the farm. I developed a severe bronchitis and blamed it on probably something on the farm to fridge day may have been allergic and also after many medications I was giving a given tennis own now. I'd like to know if you put to think of this condition and what you think of giving the elderly prednisone (00:54:02) to me. It makes no difference whether you're young or old with the guards of Prednisone. I think you have indications for it and you give it one indications are there when someone starts having trouble again, you obviously can think of many things all Way from allergies to infections to nonspecific irritants. And again, it's a type of question. I really can't answer on the radio. All right. Here's another caller. Go ahead, (00:54:24) please. Hello. Hi there. I'm calling from Garrison Minnesota. And I'd like to have dr. Blumenthal comments on my personal studies as an asthmatic my whole life. I finally discovered something that works which might be a little different than what he's used to it's vitamin B5 or pantothenic acid and of are really good a serious attack. I use Little Billy Herb in an extract form. All right, hang up in here is comments, please (00:54:58) again this I think goes along with the comments. I said about vitamins before I don't think they have been well studied and I really can't comment on it. Four minutes before one high you're (00:55:07) next. Thank you. I have a penicillin allergy but it was diagnosed when I was like four years old and I have just always avoided it and I'm wondering one time a doctor suggested that possibly the allergy would not to penicillin but the way it was packaged now is it the reaction was extremely severe as a child. Is it worth trying to find out if it really was Penicillin or not? Thank (00:55:38) you. First of all penicillin or any drug reactions are extremely difficult to evaluate especially when it occurred at age four and you probably don't remember what the reaction is if it was a shock like type reaction you obviously would get more excited about it. If it was a mild rash I can just make some general comments. First of all, you can be allergic to the drug. You could be allergic to a breakdown product of the drug. You could be allergic to a packaging or chemical in the drug. You could be allergic to a contaminant in the drug. All these things can cause a reaction on a non-allergic basis. Also, therefore it could be due to number numerous things second of all, it's a long time ago and they're very poor studies on how long allergies to drugs last in general. Most of the common ones. We see within two years. But again, I would be hesitant to say even 20 years to go ahead and get it. The last question. I do not feel that skin tests are indicated just to see if you're allergic to it for the fun of it. If you need the drug. This is the time to be evaluated because allergies do change and I would suggest ideally taking an alternative drug, but if you don't have an equally good one be evaluated for penicillin allergy. I think we have time for one quick question and equally short answer. Go ahead, (00:57:00) please. Okay. I have a six-year-old son who has Twitchy Airways discovered a year ago and they had them on Theodore and in school. Now this fall he was they were wondering if he was a little bit jumpy from it. So they switched him to a yoga pant and I'm wondering if what he thinks of the safety of long-term usage and Elliot Penton whether it would be better to do episodic treatment for that (00:57:21) depends upon the case both are relatively safe and I If the child is a monitored I have no problem with that a lot of people who called with questions that they shouldn't be afraid of discussing with their with their doctor. Should they that's correct. Yeah. Well, thank you. Dr. Blumenthal for coming in and visiting with us today. Dr. Malcolm Blumenthal is president of the Minnesota chapter of The Asthma and Allergy Foundation of America. We have 15 seconds. What is that group? It's a group that's interested in finding out more about Allergy Asthma as well as putting forth and trying to develop research and knowledge to the Population if anybody's interested to join I would be very happy to have them call that I give a phone number. Sure 3/7 34328 and I would encourage anybody interested to give me a call. It's not just for doctors for no. It's actually it's for the general public not doctors. Oh very good. Well, thank you, sir. We obviously covered a lot of ground today during the arc.