ALLERGIES ON THE RISE: UNDERSTAND AND COPE!

ALLERGIES 101: by Dr. Myron J. Zitt, MD FAAAAI

Interview & Transcription by: Melyssa Reizian

On Long Island, and in fact throughout the United States, an increase in allergic conditions of all types is currently being experienced.  While the basis for this is hypothetical, global warming, overuse of antibiotics, an overly clean environment, inadequate exercise and the delayed introduction of allergenic foods in infancy have been put forth as theoretical explanations.   Respiratory and skin allergies are most prevalent in our practice, as is food allergy, which is increasing at alarming rates.

RESPIRATORY SYMPTOMS

From early spring until the first frost, our patients are often troubled by exposure to OUTDOOR ALLERGENS, including tree, grass and weed pollens, and molds. “Allergic rhinoconjuctivitis” (affectionately known as “rose fever” in the spring and  “hay fever” in the late summer and fall), is most common and is characterized by itchy, tearing bloodshot eyes, runny, itchy, stuffy nose and sneezing. Studies indicate that in this country, up to 40% of children and 30 % of adults suffer from allergic rhinoconjuncitivitis.  These numbers are high and continually increasing. 

In the late fall and winter, as the pollen diminishes, folks may experience respiratory symptoms from INDOOR ALLERGENS like dust mites and animal dander.   Because we are on an island, where humidity tends to be high, mold growth is prevalent and mold allergy is quite common.  As a result of damage from hurricane Sandy, mold exposure has increased significantly.  In the inner city, cockroach and rodent allergens have also been found to be significant causes of respiratory symptoms.

Our patients are often troubled by symptoms of asthma, which is characterized by cough, wheeze, chest tightness and/or shortness of breath.  Asthma prevalence is also increasing.   It is estimated to affect about 10 % of the population, but occurs with greater frequency, in children.  Of great concern is that asthma has been reported in up to 25% of inner city children.   As many as 85% of children with asthma have an allergic basis for symptoms, while in folks diagnosed with asthma later in life, allergy plays a significant role in only about 40 to 50%. 

Asthma can be triggered by heavy allergen exposure, and in our area, tends to increase most commonly in the fall, after kids return to school. Of interest is that the so-called  “wheezin’ season” peaks on Long Island over Halloween weekend, when emergency room visits for asthma flare-ups are greatest.  Exposure to late fall pollens, to mold growth from rotting leaves that have fallen from the trees, and to indoor allergens like dust and animal dander, heightened by decreased air circulation when windows are closed, all contribute to this uptick in symptoms.  Of additional importance at this time of year are rapid shifts in weather conditions and viral upper respiratory infections, which are easily transmitted during close contact with others at school and work.    

Viral infections in asthma patients heighten the sensitivity of the airways to allergens and non-specific irritants, which may lead to coughing and wheezing that can persist for many weeks after the infection has cleared.  Persisting cough may be the earliest and perhaps the only symptom exhibited by patients with asthma.  In those in whom a definitive diagnosis has not been made, appropriate studies should be done to determine if cough is due to asthma.  It is important to recognize that most asthma flare-ups do not require antibiotic therapy and are best treated with an aggressive anti-inflammatory asthma regimen.   To prevent further increase in the reported rising incidence of bacterial resistance to antibiotics, the inappropriate use of these agents should be avoided whenever possible.   In addition, the use of “cough medicines” to treat chronic cough, in the absence of a diagnosis, to explain the cause of symptoms, should be discouraged. 

ALLERGY THERAPY

Patients with respiratory allergies should make every effort to avoid their allergenic triggers whenever possible.  This is particularly important in the home, where humidity should be maintained at optimal levels (30 to 40%) and exposure to mite, mold and animal dander minimized.   Immunotherapy, commonly known as allergy shots, has been extremely helpful in improving the tolerance of patients with respiratory allergies to both indoor and outdoor allergens.  Nonetheless, one must not diminish the importance of proper diet, sleep and exercise, as well as adhering to a medical regimen provided by a trained and qualified health care provider to achieve optimal allergy control.

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DR. MYRON ZITT has been serving the Long Island community for over 35 years, initially as the Chief of Allergy and Immunology of the Queens – Long Island Medical Group and currently with the Mid Island Allergy Group with offices in Plainview and Babylon.  He also serves as Director of the Adult Allergy Clinic at Nassau University Medical Center and holds an appointment as Associate Professor of Clinical Medicine at the State University of New York at Stony Brook.  He received his medical degree from the State University of New York Downstate Medical Center in Brooklyn, New York. He completed a residency in Medicine at Long Island College Hospital and a fellowship in Allergy-Immunology and Chest Disease at Duke University Medical Center in Durham, North Carolina. He is Board Certified in Internal Medicine and Allergy and Immunology.


Dr. Zitt is an active Fellow of the American College of Allergy Asthma and Immunology where he is Past President and has served on its Executive Committee, Board of Regents, and ACAAI Foundation. He is also a Fellow of the American Academy of Allergy Asthma and Immunology, where he has served on numerous committees.  Locally, he is a Past President of the Long Island Allergy Society.

Dr. Zitt has also served on the Board of Directors for the Asthma and Allergy Foundation of America where he acted as Vice President of Research, on the Board of Directors of the World Allergy Organization where he chaired the Emerging Societies Committee.  and on the Board of Directors of the Joint Council of Allergy Asthma and Immunology.

For more information, visit: http://www.midislandallergy.com

What Kinds of Health Issues Can Be Contracted from Mold?

The unwanted fungi, which accumulates in the corners of a house, is scientifically called mold. Mold and mildew actively grow in moist environments. The most commonly known side effect of mold is the damage that it causes to furniture, carpets, or any other thing that it lives on. However, molds are doing more harm than the perceived damage. They are causing serious harm to your health and the health of your family. 

The effect of mold on human health is not equal in all cases. Elderly people, children, infants, people with respiratory problems, and people with immuno-compromised diseases tend to be easy victims of mold influence.

Asthma and Allergies

The Environmental Protection Agency conducted a research on children from 1-7 years of the age. According to the study, children who grow in an environment with mold at young age (one year) are prone to respiratory disorders by the age of seven. The study was conducted by Reponen and colleagues and published in 2011. 

Mold has been associated with respiratory disorders and respiratory allergies. However, it is essential to undergo medical diagnosis to determine pre-existing allergies and respiratory disorders. Molds aggravate the pre-existing respiratory disorders. In maximum cases, molds uninterruptedly trigger the respiratory problems, even if the patient is undergoing authentic medical treatment. The solution lies in mold eradication followed by proper medical care.

Diseases Related with Mycotoxin Molds

Mycotoxins are small toxic elements. These are lipid-soluble and more dangerous than other toxins as these are easily absorbed by skin, airways, and the intestinal lining. Some indoor molds produce mycotoxins. The effect of these mycotoxins starts from symptoms like coughing and skin irritation. If left untreated, these mycotoxic molds lead to fatal diseases including cancer, pulmonary fibrosis, neurotoxicity, immunologic and Hematologic disorders, hepatic and renal toxicities, and more

Mold Effect on Pregnant Women

The endocrinal or renal toxicities of pregnant women, who inhale or absorb mycotoxins produced by molds, increase and lead to gastrointestinal or cardiac problems. 

Pulmonary Hemorrhage

The effect of mold related with pulmonary hemorrhage was unknown until 1994. From 1993 to 1994, a child died in Cleveland, Ohio in a strange case. Further studies revealed that the children who had died had been brought up in houses with mold history or contained mold contaminated water, leading to pulmonary hemorrhage. 

Fungal Infections

Apart from the respiratory disorders, the fungal infections are also common cause of mold. Indoor mold may grow inside shoes, wardrobe, and other common items of use. Athlete’s Foot is a common fungal infection caused by mold infections. 

Aspergillus is a common fungal infection caused due to respiratory disorders. Molds do not directly trigger Aspergillus but it is indirectly activated when mold triggers respiratory disorders. Similarly, many infections and allergies triggered by respiratory disorders may be caused in moldy environments.

Mold control is a process that starts from identification of mold colonies to their complete eradication. A proper health examinations and mold examination is highly recommended to treat aforementioned disease. 

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References

http://enhs.umn.edu/current/5103/molds/harmful.html

http://www.cdc.gov/mold/dampness_facts.htm

http://www.cdc.gov/mold/faqs.htm

http://www.poison.org/articles/2011-oct/mold-101-effects-on-human-health

What is Mold (Article 2)

A living organism from the Kingdom Fungi, molds grow in moist, warm, and humid environments. Molds may grow indoors and outdoors. They  may grow on a peach in a refrigerator or on garden walls. Mold spores directly affect human health by targeting the respiratory system. According to modern studies, mold-related allergies might lead to fatal diseases like cancer. 

Signs of Indoor Molds

You can easily identify the existence of molds in your house. Following are some common signs of molds:

·        Moldy smell

·        Sinus, respiratory allergies and runny nose (If these symptoms vanish when you leave the house then these are triggered by mold existence in your house)

·        Fungus on fruits and vegetables inside the refrigerator

·        Fungus in the pantry

·        Unusual colored growth on walls and other areas of the house (This part is descriptively discussed in the next section)

·        Water stains or discoloration on walls

How to Identify a Mold

Apart from the aforementioned mold signs, understanding the common types of indoor molds and their signs could be helpful in identifying the molds.

Aspergillus

Lungs, intestinal lines, and respiratory tract easily absorb microscopic Aspergillus. People with cystic fibrosis, respiratory disorders, elderly people, infants, and children are at greater risk of Aspergillus influence. It is identified as small black spots on walls, pipes, cabinets, and ceilings. 

Alternaria

Another common type of indoor mold, Alternaria fungi is white in color, which gradually turns black if left untreated. It may easily spread from one area to other and cause serious harm to respiratory system and lungs. 

Aureobasidium

The pink mold that grows inside the bathrooms is Aureobasidium. It mostly grows in very damp places like bathrooms, lower section of the refrigerator, and gardens. 

Penicillium

This blue or green colored mold grows on water-damaged items like mattresses, carpets, wallpapers, furnishings, and insulations. 

Stachybotrys chartarum

This black mold contains mycotoxins. These small toxic molecules are directly absorbed by the intestine, skin, and the respiratory system. It may lead to severe respiratory disorders, chronic sinus infections, allergic reactions, and psychological disorders like depression and chronic stress. 

Cladosporium

Apparent as black spots, it does not require dampness or humidity to grow. Cladosporium may grow in cool places like carpets, garments, and inside the wardrobe. 

Common Causes of Molds

Molds grow in humid and damp environments. The common causes of indoor molds include these:

·        Humidity

·        Leaking roof

·        Leaking pipes

·        Poor ventilation

·        Condensation

·        Damp basement

·        Flooding

·        Wet clothes

·        Wet area under the basement

·        Water accumulated in the foundation of the house

Molds require a source of food, temperature between 40-100 Fahrenheit, and oxygen to survive. 

Common Diseases Related with Molds

From mild allergies to fatal diseases, mold are directly or indirectly associated with human health. Following are the common diseases related with molds:

·        Hay fever

·        Asthma

·        Chronic cough

·        Rash

·        Post-nasal drip

·        Chronic rhinitis

·        Cold/flu

·        Runny nose

·        Sinus

·        Night sweats

·        Interstitial pneumonitis

·        Fungal infections

·        Cancer

·        Pregnancy problems

·        Lung disorders

Molds can be easily identified with its symptoms. Molds become stronger as they grow older. Therefore, it is important to identify their existence and treat them as a priority. 


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References

http://www.cdc.gov/mold/faqs.htm

http://www.intuitiveenvsol.com/What_Is_Mold_.html

http://www.medicinenet.com/mold_exposure/page2.htm

http://study.com/academy/lesson/what-is-mold-definition-types-causes-examples.html

What is Mold? (part 1)

Have you experienced horror when you opened a container of your favorite food products only to find out a patch of disgusting looking fuzz (usually in grey or green color) resting conveniently on the top?

Like most people, your reaction is reasonably understandable. 

Mold, by definition is a living organism from the family of fungi. The hairy organism is one of the types of fungus that is different from plants, bacteria, and animals. Technically, molds are decomposers of non-living organic material such as wood, plants, and leaves. Mold is heterotrophic in nature. It means that molds cannot produce food on its own, but retrieves it from the surroundings. However, mold does not practically eat food, it only absorbs nutrition. For this, mold enzymes break down the substance of food into smaller molecules (organic) particles to absorb them.

This type of fungi is dominated by a composition called hyphae. These are thread like fibers which mixes to form mycelium, hence, the hairy appearance of mold. It can grow indoors and outdoors, thrive in water, damp and humid environments. Mold can be found in almost any kind of environment.

Mold: What they need to grow

Water is an essential factor for the growth of molds. Besides water, mold needs food sources, temperature that is between 40 to 100 F degrees and oxygen. As mold decomposes on dead biological material, it can therefore grow on  anything made of materials made of wood and paper.

While mold cannot get food (nutrients) from inorganic material such as plastic, metal, glass, and concrete, it can grow on dust layers of organics available on the non organic surfaces. A damp or wet material is perfect for mold to grow.

Mold: Different Types

There are many varieties of mold, a few of them are:

·        Rhizopus Stolonifer

It is one of the most common types of mold. They are usually found on bread and are commonly known as black bread mold. It is also found on other various foods and vegetables.

·        Penicillium

It is commonly found in water damaged structures and moist foods.

·        Aspergillus

It has a considerable variety of carcinogenics, and is one of the reasons of respiratory problems in homes when found indoors.

·        Xerophilic

They relatively grow in salty, dry, or sugary environments where the activity of water is less than 0.85, while other mold needs higher amount of moisture to grow.

Mold: Where do they come from?

When tiny root hair, hyphae extend, they help in growing molds. Through this, small colonies of mold can spread out to cover a large square feet of material. Mold can also give birth to spores that are like tiny looking seeds.

These spores are able to survive any kind of weather environment for mold to grow. Spores can be carried to new locations by water or air, once they are released. When these spores travel to land on a damp surface which has oxygen, food and temperature that suits, these spores will start to grow. The ubiquitous nature of mold spores allow them to be present almost everywhere. 

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References:

http://www.niehs.nih.gov/health/topics/agents/mold/

http://www.cdc.gov/mold/dampness_facts.htm

Top 10 Solutions to Clean Indoor Air

Do you know that pet dander is now called a community allergen? It is because you may have pet dander in your home even if you don’t have any pets. This is one of the many ways how outdoor air enters your indoor air and contaminates it. While the outdoor contaminants pollute your indoor air, pollutants from inside your home can wreak havoc on the health of your family. Here are top 10 solutions to filter indoor air.

1.    Plants

Air fresheners contain phthalates, which contaminate the air. However, you may put NASA approved ait filtering plants to filter your indoor air. Following are the NASA approved plants. 

·        Aloe Vera

·        Spider Plant

·        Peace Lily

·        Boston Fern

·        English Ivy

·        Heart Leaf Philodendron

·        Eucalyptus

·        Chinese Evergreen

·        African Violets

·        Chrysanthemum

2.    Increase Ventilation in Your Home

Most of the outdoor pollutants enter your home through doors and windows. This is one of the few reasons for insulating the windows and doors. Then how will you ventilate the house, you ask? You can increase ventilation by installing trickle vents in ceilings and near basement. 

3.    Eliminate the Pollutant Sources

Eliminate all sources of pollutants including air fresheners, detergents, nonstick utensils, carpets, and such from the house. Use natural and healthier alternatives. For example, put one teaspoon juice and a few lemon slices in the water before soaking white shirt in it. Lemon will work as a bleach without causing any harm to your health. 

4.    Keep Your Floors Clean

Floors are the first to capture free radicals and toxins. Make sure to keep your floors clean with natural ingredients. 

5.    Avoid Biomass Fuels and Manufacturing Materials

Upholstery furniture, press wood furniture, wood fireplace, and synthetic woolen carpets are some examples of biomass fuel and manufacturing materials. For healthier living, eliminate all these items from our house. 

6.    Himalayan Salt Lamps

Himalayan salt is 200-million years old salt. The bulbs installed inside these lamps heat up the temperature of salt, which releases negative ions in the air. These ions neutralize the free radicals and contaminants. Himalayan salt lamps are known for not only purifying the air but also treating respiratory problems triggered by poor air quality, like sinus. 

7.    Beeswax Candles

Other types of candles release smoke and scent as they are produced from petroleum extract. Beeswax do not release any smoke or scent. The only thing the candles release are negative ions that work like ions from Himalayan salt to neutralize the free radicals and harmful gaseous molecules in the air. 

8.  Mold Removal

The effect of molds on respiratory system has been scientifically proven. Along with professional mold removal, make sure to install dehumidifier to prevent mold growth.

9.  Regular Maintenance of HVAC

Pollutants, pollens, contaminants, allergens, and other such molecules trap in the pipes of HVAC. These pollutants enter your house through the vents. Therefore, make sure to clean and maintain HVAC pipes and vents on regular basis. 

10.  Create a No Smoking Zone

Make your home a no smoking zone for everyone including guests. Avoid fireplaces lit with wood. Avoid gas heaters and barbecue stands in the house.

With few simple and precautionary steps, you can greatly improve the indoor air quality of your home. 

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References:

http://www.arb.ca.gov/research/indoor/cleaning_products_fact_sheet-10-2008.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3230460/

http://www.ctahr.hawaii.edu/oc/freepubs/pdf/of-39.pdf

Symptoms of the Effect of Indoor Air Quality on Human Health

Indoor air quality is one of the fastest growing health concerns across the U.S. According to the studies, indoor air quality is often worse off than outdoor air quality. This is because indoor air is more concentrated and people have greater exposure to the air. 

Immediate Effects

The immediate effects of poor indoor air quality include:

·        Irritation in nose, eyes or throat

·        Dizziness

·        Fatigue

·        Headache

·        Asthma

·        Difficulty in breathing

Long Term Effects

The effects of frequent or long-term exposure to poor indoor air quality may lead to following long-term effects:

·        Chronic asthma

·        Chronic allergies

·        Fungus

·        Poor pregnancy

·        Premature delivery

·        Cancer

·        Heart disease

·        Lung diseases

Quick Look on Symptoms of Immediate and Long-Term Health Effects

According to the World Health Organization, poor indoor air quality has led to problems including minor upper respiratory tract disorders and fatal diseases like acute respiratory diseases, cardiovascular disorders, lung cancer, stroke, and more.

In WHO Western Pacific and South-East Asia Pacific, around 88% of the deaths occur in low-income areas due to poor indoor air quality. Around 3 million people use biomass fuel  and coal to light up their homes, cook food, or keep the homes warm. 

Sick Building Syndrome

The term Sick Building Syndrome was coined in 1982 by the team of experts at World Health Organization. Sick Building Syndrome reflects a set of symptoms caused by poor indoor quality. These symptoms include dry mouth, dry throat, dry skin, erythema, and sensation of dry skin. The study reports were based on US and Scandinavian population. Work-related symptoms were reported in Danish Town Hall Study. The symptoms were not reported in U.K. However, a cross-sectional study of Swedish population revealed SBS symptoms on hands and face. 

The skin reactions of SBS studied in dermatological clinics include skin problems like itching folliculitis, scaling on face, ears, and scalp, erythema, and rosacea. These skin problems are considered psychosomatic in nature. The clinical practice of these skin-related issues is linked with the impact of environmental, physical, and chemical factors in complicated environments.

Problems and Symptoms Due to Chemical Pollutants

Nitrogen oxides, environmental tobacco smoke, pesticides, formaldehydes, carbon monoxide and phthalates are included among chemical pollutants. Their common indoor sources include household cleaning products, combustion products like stove, cigarette and cigar smoke, malfunctioning gas equipments, wood stoves, gas heaters, air conditioners, durable press fabric, paints and wallpapers, air fresheners, glues, and more. 

Their potential problems and their symptoms include skin irritation, confusion, dizziness, irritation in eye, nose and throat, fatigue, poor memory, headache, bronchitis, loss of coordination, frequent fever.

Problems and Symptoms Due to Biological Pollutants

Biological pollutants include pets, dust mites, humidifiers, mold, mildew, insects, pollen, animal dander, animal saliva, fungal materials, bacterial endotoxins, dehumidifiers, and furnishings. The symptoms include coughing, influenza, humidifier fever, fatigue, shortness of breath, asthma, irritation in throat, nose and eyes, digestive problems and itching.

Problems and Symptoms  Due to Asbestos and Respirable Pollutants

Wood materials, fireproofing, cigarette, decorating hazards, insulation, and wood stove release dangerous gases and chemicals. The symptoms of their effects include irritation in nose, eyes, and throat, respiratory disorders, lung cancer, infections in bronchitis, and mesothelioma. 

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References

http://www.atsjournals.org/doi/abs/10.1164/ajrccm/136.6.1486#.V1f1M9J97cs

https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality

http://www.who.int/mediacentre/factsheets/fs313/en/

http://www.ccohs.ca/oshanswers/chemicals/iaq_intro.html

http://www.inive.org/medias/ECA/ECA_Report10.pdf

Prevention: How Do You Control Mold?

Mold is part of the nature and plays an important role in decomposition of matter. This can be found both indoors and outdoors, but if it grows inside your house, it begins to cause health problems that often go undetected. Furthermore, people with allergies and asthma are more likely to fall sick due to indoor mold.

Mold occurs due to moisture and in order to control mold, one must control moisture within their homes. So, here’s a few prevention tips that will help you control mold inside your home and live in a healthy environment.

Conduct Home Inspection

The first thing you need to do is to inspect your home to find problem areas. You need to look into areas that gather moisture like basement, water stain on the ceiling, walls, gutters, etc. Mold mostly develops in areas that are not in your sight, which is why you need to check hidden areas like ceilings, small spaces, attics, and behind the walls.

If you detect any wet area, that’s where the mold must be. However, it is best to interrupt the mold growth and keep it from spreading. If there is damp carpet in the basement, you can get rid of the mold by ripping up the carpet. If you find a leaky gutter, it is best to get it repaired before it continues to offer breeding ground for mold.

Repair Problem Areas

The best thing to do is get the problem fixed before the mold grows any further. There are certain areas of homes that are prone to developing mold including HVAC systems, furnace humidifiers, and bathrooms.

Get your HVAC systems checked before mold from the ventilation systems spread to the entire building. If there is a leakage in the toilet, then get it fixed as soon as possible so that moisture doesn’t build-up on walls. If you notice signs of water damage in your toilets and bathroom, call a professional plumber immediately to get the problem fixed.

Consider Proper Ventilation

Sometimes your routine activities like taking a bath or cooking can cause mold to develop. This happens due to poor ventilation, which results in the build-up of moisture that attracts mold. In order to avoid chances of mold build-up, it is better to take preventative measures like keeping the air flowing in while you cook, shower, or wash the dishes. An exhaust fan also works well for getting rid of trapped moisture. Installing ACs and humidifiers is another way to keep moisture from developing in the indoors. However, you will need to check on these systems to ensure that they are not producing moisture by conducting regular maintenance and cleaning.

Invest in Mold-Resistant Products

A great way to ensure that your home is safe from mold is to invest in mold-resistant products. Make use of drywall which is coated with fiberglass, keeping the wall surface dry and safe from moisture. These walls are perfect in areas like the bathroom, kitchen, and laundry.

By following the prevention tips given above, you can reduce the chances of mold build-up inside your home, which will keep you feeling fresh and healthy.

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Resources:

https://www.epa.gov/mold/mold-course-chapter-9-prevention

http://www.cdc.gov/mold/dampness_facts.htm

http://extension.missouri.edu/p/GH5928