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Triggers of Allergic Disease

Asthma, rhinitis and other allergic disorders are usually “triggered” by specific substances called allergens—specifically, the proteins found in these allergens. People who have these reactions have an antibody calledimmunoglobulin E, or IgE. This antibody attaches to mast cells, causing a release of powerful chemicals, including histamine. The result is sneezing, itchy nose, eyes and ears, and rarely a life-threatening reaction called anaphylaxis. Asthma can also be triggered by non-allergic factors, which are listed in this section. Following are the most common triggers of allergic reactions:

Pollens
Pollens are small, round-shaped male cells of various flowering trees, grasses and weed plants. The average pollen particle is under 50 microns in size and is less than the width of an average human hair. Pollens can travel as far as 400 miles and up to two miles high in the air.

Plants have pollination cycles which are consistent from year to year, though weather conditions can affect the amount of pollen in the air at any one time. Pollination season occurs earliest in the south and starts progressively later in more northern regions. Trees pollinate earliest, followed by grasses. Weeds pollinate last. Pollens vanish after the first hard frost.

Molds
Molds are parasitic, microscopic fungi without stems, roots or leaves. As many as 250,000 spores can fit on one pin head. These small spores float in the air like pollen. They are found outdoors and indoors and their levels peak in the late summer and fall months.

Outdoor molds commonly grow in moist, shady areas such as in soil, decaying vegetation, leaves and rotten wood. Cladosporium and Alternaria are common outdoor molds. Indoor molds are found in dark, warm, humid areas inside the home including basements, cellars, attics and bathrooms. Mucor, Aspergillus and Penicillium are common indoor molds.

Furry Animals
Proteins found in the saliva, dander (dead skin flakes) or urine of furry animals can cause allergic reactions in 15% of the general population and 20-30% of those with asthma. These proteins are carried in the air on very small, invisible particles which can land on the lining of the eyes or nose, or be inhaled directly into the lungs. Contrary to popular belief, there are no specific hypoallergenic breeds of furry animals, including cats or dogs. Recent studies have shown that those severely allergic to pet dander may even experience reactions in schools and other public places from dander carried on the clothing of pet owners.

Dust Mites
Dust mites are microscopic, sightless, eight-legged arthropods that are natural inhabitants of indoor environments. Dust mite droppings are the most common trigger of perennial allergy and asthma symptoms. The droppings break down to an extremely fine powder and stick to indoor materials. Dust mites are found throughout the house and thrive in high humidity and in areas where human dander is located, such as on mattresses, pillows, bed covers, upholstered furniture and carpeting.

Cockroaches
Cockroaches have been around for more than 300 million years. Various species of urban cockroaches dwell in the offices and homes of people who inadvertently provide them with the water and food they need to survive. The protein in their droppings is a primary trigger of asthma symptoms, especially for children living in densely populated urban neighborhoods.

Mice and Rats
The protein found in the droppings and urine of these rodents has recently been proven a common trigger of asthma symptoms. Similar to cockroaches, they are found in urban neighborhoods where food and water is easily accessible to them.

Food
Food allergy occurs when a person’s immune system overreacts to an ordinarily harmless food. Up to two million, or 8%, of children in the United States are estimated to be affected by food allergy and up to 2% of adults.

The most common food allergens (the parts of the food that cause allergic reactions), responsible for up to 90% of all allergic reactions, are proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts. The most common symptoms of food allergy are hives, eczema, asthma and gastrointestinal symptoms such as vomiting, diarrhea and abdominal cramping.

The most severe reaction to food is anaphylaxis, a systemic allergic reaction that can sometimes be fatal. The first signs of anaphylaxis may be a feeling of warmth, flushing, tingling in the mouth or a red, itchy rash. These symptoms can be reversed by treatment with injectable epinephrine, antihistamines and other emergency measures, with follow-up care by an allergist.

Latex
Latex is a milky fluid produced by rubber trees and processed into a variety of products. Those with latex allergy experience reactions triggered by dipped latex products. Products that commonly cause reactions include gloves, balloons and condoms, although some latex allergic individuals may also react to rubber bands, erasers, rubber parts of toys, various medical devices, latex clothing and elastic in clothes, feeding nipples and pacifiers. Most latex paints are not a problem since they do not contain natural latex.

Stinging Insects
Insect stings are responsible for inducing severe allergic reactions in an estimated one to two million people in the United States. An estimated 3% of the population is susceptible to allergic reactions to stinging insects (yellow jackets, honeybees, paper wasps, hornets and fire ants) and about 50 deaths occur each year as a result of their stings.

For a small number of people, stings may be life-threatening, resulting in anaphylaxis. Symptoms may include itching and hives over large areas of the body, swelling in the throat or tongue, difficulty in breathing, dizziness, stomach cramps, nausea or diarrhea. In very severe cases, a rapid fall in blood pressure may result in shock and loss of consciousness.

Non-Allergic Asthma Triggers

Irritants
Irritants have been proven to aggravate the nose and airways, thus stimulating asthma flare-ups. Following are examples of irritants:

• air pollutants such as tobacco smoke, wood smoke, diesel exhaust, chemicals in the air and ozone;
• occupational exposure to allergens, vapors, dust, gases or fumes;
• strong odors or sprays such as perfumes, household cleaners, cooking fumes, paints or varnishes;
• other airborne particles such as coal dust, chalk dust or talcum powder;
• changing weather conditions, such as changes in temperature and humidity, cold, dry air, barometric pressure or strong winds.

Infections
Viral and other infections such as colds or viral pneumonia can trigger or aggravate asthma, especially in young children. These infections irritate the airways, nose, throat, lungs and sinuses causing asthma episodes.

Exercise
Strenuous physical exercise can also trigger asthma attacks in most asthmatics. Mouth breathing, exercising in cold, dry air, or prolonged, strenuous activities such as medium-to long-distance running can increase the likelihood of exercise-induced asthma. Other forms of rapid breathing such as laughing can also aggravate asthma.

Gastroesophageal reflux disease (GERD) is a condition in which stomach acid flows back up the esophagus. It affects up to 89% of patients with asthma. Symptoms include severe or repeated heartburn, belching, night asthma symptoms after meals or exercise, or frequent coughing and hoarseness.

Medications
Some people with asthma may experience asthma episodes from taking certain medications. Medications that can trigger asthma include aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen; and beta-blockers used to treat heart disease, high blood pressure and migraine headaches.

Emotional Factors
Emotional factors alone cannot provoke asthma. However, anxiety and nervous stress can cause fatigue and hyperventilation, which may also increase asthma symptoms and aggravate an attack.