Take charge: Keep symptoms under control

If you have bothersome allergy and asthma symptoms, talk to your doctor about treatment. Recognizing the relationship between the body's immune system and how the airways react has led to improved treatment of asthma symptoms for many people.
Knowing your triggers, taking steps to avoid them, and working with your doctor to find the right treatment to manage your symptoms will help keep both your allergy and asthma symptoms under control.
Last Updated: September 20, 2008
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How does an allergic reaction cause asthma symptoms?

An allergic response affects the lining of the nose and the lining of the airways in a similar way. Symptoms occur when antibodies in your blood are exposed to an allergy-causing substance (allergen). These antibodies can trigger allergy symptoms such as nasal congestion, scratchy eyes or a skin reaction — and for many, inflammation of the airways associated with asthma.
For example, if your immune system produces allergy antibodies when you're exposed to cats, you're said to have a cat allergy. Proteins in cat fur or cat dander trigger the release of chemicals that cause inflammation and swelling in the lining of the nose. If you have allergic asthma, your reaction to cat fur or dander can also cause the lower airways to become inflamed, triggering asthma symptoms.

Allergies and asthma: They often occur together

You may wonder what allergies and asthma have in common besides a maddening ability to make you miserable. A lot, as it turns out. Allergies and asthma often occur together. In fact, allergic asthma (allergy-induced asthma) is the most common type of asthma in the United States.
If you have both allergies and asthma, the same substances that trigger your allergy symptoms can also inflame your airways, leading to asthma symptoms such as shortness of breath, wheezing and chest tightness.
For many people with asthma, their asthma symptoms are triggered by an allergy to airborne substances such as pollen, dust mites or pet dander. In some people, skin or food allergies can cause asthma symptoms.
James Li, M.D., a Mayo Clinic allergy specialist, answers your questions about the link between allergies and asthma.

10 Things You Didn't Know About Allergies

Allergies of every kind, from mold to milk to metal, are becoming increasingly common in the United States. With a sympathetic nod to those of you bracing yourselves against this spring's burgeoning pollen count, here are 10 allergy facts that don't come up as regularly or reliably as seasonal symptoms do.
1. Allergies can give you a shiner. When hay fever strikes, pressure from nasal congestion can be so great that it causes blood vessels in the face to become constricted. The blood can't flow freely and may pool under the eyes. Blood draining back toward the heart, or venous blood, appears blue in color (compared to arterial blood flowing from the heart, which is red) and, when trapped, results in the appearance of an allergic shiner, sometimes known as "black-eye syndrome."
2. Any organ in the body can be affected by allergies. Sufferers of hay fever (allergic rhinitis) will attest that allergies can cause a runny nose, irritated eyes, and an itchy throat. Some allergic reactions can cause the skin to break out in hives or the intestines to cramp, and allergy-induced asthma takes a toll on the lungs.
"These are the common 'end organs' for allergic disease," explains Asriani M. Chiu, M.D., associate professor of allergy and immunology at the Medical College of Wisconsin. "In a severe allergic response, there can be a systemic reaction that affects multiple body systems. A bee sting, for example, can affect the cardiovascular system and send the body into shock." Consequently, any organ could potentially shut down as a result of reduced blood flow. An anaphylactic response affecting the respiratory system is similarly threatening.
In very rare cases, Dr. Chiu notes, an allergy cell called the eosinophil can target and cause isolated damage to an organ like the esophagus or heart. However, when organs such as the liver or kidneys are affected by an allergy, it's far more likely to be the indirect result of a system-wide reaction.
3. It's not pet hair that gets your dander up. Contrary to popular belief, pet hair is not an allergen—though it's still no fun to clean the sheddings of cats and dogs from your wool coat. Rather, it's the particles of pet dander (dead skin), saliva, and urine trapped in the hair, or airborne in your breathing environment, that prompt allergic reaction.
4. "Allergy-addiction syndrome" lacks credibility. Like a drug addict who craves a chemical that's bad for the body, some people claim to have an addiction to foods to which they are allergic. But paradoxical cravings are most likely explained by a typical psychological trick we play on ourselves: We always want something a little more when we know we can't have it. As Dr. Chiu notes, a child with a food allergy will instinctively spit out food that causes her mouth to itch or her lips to swell. Electing to override that natural survival instinct may be a mild form of masochism, but it's not an addiction.
5. The sharp rise in peanut allergies is still not well understood. The rate of peanut allergies in the U.S. has doubled over the past 10 years, currently affecting between 1 and 2 percent of the population. Prevalence in the U.S. may be explained by our method of processing; dry-roasting is not as popular a method in countries where the allergy is less common. Another prevailing theory is the hygiene hypothesis: Now that we're living in an increasingly sterile environment where diseases are eradicated and bacteria vanquished, the immune system may be seizing on harmless foreign antigens—essentially, protecting our system against a false threat.
A new study reverses recent health strategies. Rather than delaying an introduction to peanuts, the research suggests we might increase tolerance by introducing peanuts earlier and more

Spring Allergies

Does the approach of spring make you flinch in self-defense? True, the days grow longer and warmer, the breezes blow gently, and more birds gather around the feeder. But what about those blooming trees and grasses? If your eyes tear and redden, if your nose drips or grows stuffy, if you sneeze and feel drowsy in the daytime yet lie awake gasping at night, you may have seasonal allergic rhinitis, often called “hay fever.” Caused by dust, mold, pollen and other airborne culprits, it is the most prevalent type of allergy, though hay fever is just one of many reactions to foods and environmental factors that plague people who have sensitive systems.
An allergic reaction happens when a person’s immune system aggressively fights irritants that might cause no problem at all for other people. Three-quarters of Americans have no allergies whatsoever. Pity the rest of us: One allergy can prime the pump of sensitivity, causing reactions to other environmental aggravations. About 40 percent of asthma is caused by allergies, according to Dr. Pamela Georgeson, an allergist at the Kenwood Allergy and Asthma Center in metropolitan Detroit.
Potential irritants include foods, dust and mold, medications, latex, animal dander, insect stings and bites

Health Topics: Allergies

common questions
Are Allergies Different in the Spring?
Allergies: 10 Did-You-Knows?
Are Food Allergies on the Rise?
What's the Link Between Asthma and

Aging Well

Common Medication Mistakes
6 Stealth Health Foods
Best & Worst Cholesterol Foods
12 Signs You Probably Don't Have Alzheimer's

Best & Worst Foods for Your Cholesterol

While nutritionists and researchers may disagree about how certain foods and fats affect our overall cholesterol levels, one universal truth that everyone can agree on is that trans fat is an ultimate evil lurking in our food chain, proven time and again to lower healthy HDL cholesterol, raise artery-clogging LDL cholesterol, and put us at increased risk for cardiovascular disease. In fact, this artificial fat is so hazardous to our bodies that in 2007 the New York City Department of Health banned its use in restaurants.
Which of course led to the destruction of all the city’s restaurants and caused New York to drop into the sea. Oh no, wait ... that didn’t happen. In fact, the effect on New York’s restaurants—including its fast-food joints—was pretty much zilch. That’s because there are plenty of suitable, and much healthier, options out there and plenty of industry titans are using them. But to this day, many chain restaurants and food manufacturers in most parts of the country are still clinging to hydrogenated oils and shortening, and putting you, the consumer, in danger as a result.
What’s so unfair about this ongoing disregard for our health is that many fats are actually good for us—having a positive impact on our cholesterol profiles while also helping us stay fuller longer. Monounsaturated fats, like those found in olive and canola oils and healthy foods like avocados and nuts, can be used to make most any food better for us.

6 Stealth Health Foods

Consider celery, for example—forever the garnish, never the main meal. You might even downgrade it to bar fare, since the only stalks most guys eat are served alongside hot wings or immersed in Bloody Marys.
Tip: There is something about Mary: The brunch beverage is loaded with nearly five times as much heart-healthy antioxidants as a large tomato. Enjoy a guilt-free glass with these creative takes.
All of which is a shame, really. Besides being a perfect vehicle for peanut butter, this vegetable contains bone-beneficial silicon and cancer-fighting phenolic acids. And those aren't even what makes celery so good for you.
You see, celery is just one of six underappreciated and under-eaten foods that can instantly improve your diet. Make a place for them on your plate, and you'll gain a new respect for the health benefits they bestow—from lowering blood pressure to fighting belly fat. And the best part? You'll discover just how delicious health food can be.

Are you ready to quit?
Maybe you have already taken your last puff or are ready to quit today. That's great. This information will help you stick to your resolve to kick the habit for good.
Or maybe you want to plan ahead before you quit. How ready are you to quit? To find out, use the Interactive Tool: Are You Ready to Quit Smoking?
It's okay if you aren't ready now. But you may want to quit at some point. So keep learning and preparing yourself. Many smokers do quit. You can too.
Why do you want to quit?
Think about why you want to quit. Maybe you want to protect your heart and your health and live longer. Or maybe you want to be a good role model for your kids or spend your money on something besides cigarettes. Your reason for wanting to change is important. If your reason comes from you—and not someone else—it will be easier for you to try to quit for good.
Use these tools to find your risk of heart attack based on how much you smoke and to find out how smoking affects your lifespan:

Kicking the Smoking Habit

Nicotine is the drug that keeps people smoking. While each cigarette contains about 10 milligrams of nicotine, a smoker only absorbs 1–2 milligrams, as not all of each puff of smoke is delivered to the lungs. However, this is still a big dose and ends up reaching the brain within eight seconds. The end result is an alteration of brain chemicals that triggers the desire for more nicotine.
To put this into perspective, a smoker usually gets at least 10 "hits" of nicotine per cigarette. Multiply this by 20 for a person smoking one pack per day, and the end result is over 200 hits of nicotine per day. Needless to say, this cycling of nicotine highs (while smoking) and lows (between cigarettes) hooks the smoker into a desire for that nicotine high, stimulating cigarette cravings, as well as symptoms of withdrawal, between cigarettes.
How does nicotine replacement therapy work?NRT has helped many people decrease or even stop their dependence on cigarettes. In fact, incorporating nicotine gum or some other form of NRT almost doubles the chance for success in a person who is truly addicted to smoking cigarettes. What these forms of therapies have in common is the slow release (compared to the rapid release from the "hits" of cigarettes) of a reduced strength of nicotine, whose aim is to reduce nicotine cravings. However, it's important to realize that the separation from you and the tobacco habit is best achieved by the dual approach of NRT and behavioral modification.
First, the craving for cigarettes must be controlled. This is where NRT comes in handy. Since everyone is different and smokes at various levels, the use of "continuous" (patch) or "as-needed" (lozenge, gum, etc.) nicotine delivery systems helps to control or suppress withdrawal symptoms like these:
Nervousness
Difficulty concentrating
Headaches
Dizziness
Fatigue
Difficulty falling asleep or maintaining a restful and full night's sleep
Irritability
Increased appetite
Moodiness or depression
Next, the behavorial aspect of smoking should be addressed. You may be programmed to smoke when you wake up, when you meet friends socially, or when you drink alcohol. Psychological triggers like nervousness, depression, or anxiety are common. Using support groups, friends, family, or tobacco "quit" telephone support lines can be helpful in minimizing the need for a cigarette. The "weaning period" is when the use of NRT is slowly decreased until the "need" for a tobacco product is more easily avoided.
Fortunately, there are different forms (and dosage strengths) of nicotine replacement therapy since one size does not fit all. For example, while the nicotine patch may help some, the nicotine lozenge may be more beneficial for others. That said, it's important to remember that these products should only be used as directed, and only used for the shortest length of time needed to break the nicotine habit. Also, check with your physician or pharmacist, as the product you choose may require you to completely quit cigarette smoking before its use.
NRT options
When looking for a NRT, consider these options:
Nicotine lozenges are often used as part of a 12-week program. Nicotine is slowly released as each lozenge dissolves in the mouth.
Nicotine patches are applied to the skin on a daily basis and commonly used over a two- to three-month time frame.
Nicotine nasal spray is sprayed into the nostrils every few hours as needed over a three-to six-month period.
Nicotine inhalers that are puffed into your mouth may be used over a three- to six-month period. The dosage is usually higher over the first three to six weeks, then gradually reduced as the cigarette cravings subside.
Nicotine gum is chewed about 10–12 times when the gum is new, then once or twice as needed. Basically, just enough should be used to gradually release nicotine. Absorption occurs through the tissues on the inside of the mouth, eventually reaching the bloodstream.
Nicotine gum is especially helpful for smokers who:
Smoke more than 10 cigarettes per day
Get very anxious or agitated if they do not have a cigarette every few hours
Cannot use other smoking cessation products such as the nicotine patch, lozenge, nasal spray or inhaler
Like the independence of being able to control the amount of nicotine they receive while using NRT
Like the convenience of receiving their nicotine replacement from a chewable product
Utilize behavioral therapy and/or support systems (family, friends, 24-hour smoking cessation hotlines, etc.) in combination with nicotine replacement in their smoking cessation program
There are also non-nicotine smoking cessation options such as the prescription products bupropion hydrochloride (Zyban), which helps reduce cravings, and varenicline (Chantix), which decreases the perceived pleasurable effects of smoking as well as reduces the symptoms of nicotine withdrawal.
For further information, please speak with your physician. Also, check out the American Heart Association and the American Lung Association as well as the American Cancer Society Quit Line at 1-800-QUIT-NOW.
Find all articles by Dr. Rob
Find a variety of smoking cessation products on MSN Shopping

Find Support & Tips on MSN Health & Fitness:
Readers Share Tips on How to Handle Nicotine Cravings
How to Quit Smoking
Smoke & Lose Weight?
Smoking When Pregnant
Lung Cancer Support
More on Smoking Cessation:
Interactive Tool: How Much Does Smoking Cost You?
The High Cost of Smoking
Do you have a health question you'd like to ask Dr. Rob? Send e-mail to experts@microsoft.com. Please include Ask Dr. Rob in the subject line.
Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.
Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)

The Truth About Painkillers

Celebrity magazines all too often feature stories about overdose deaths and rehab admissions, and the Office of National Drug Control Policy is running an advertising campaign about the dangers of prescription drug abuse.
But when taken as prescribed, just how risky are drugs like OxyContin and Vicodin?
The truth might surprise you. Myths and misinformation about opioid painkillers are widespread. Here are the facts.
Myth No. 1: Toughing it out is always better than relying on painkillers.
Although Americans pride themselves on their toughness, those who refuse medications despite severe pain may be putting their health— and their jobs and relationships— at risk.
“Uncontrolled pain is associated with adverse consequences in terms of daily functioning, mood, sleep, overall quality of life, energy level, the ability to work and marital relationships,” says Russell Portenoy, chair of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City.

Treating Teenagers’ Drug Habits

The number of adolescents abusing prescription opioids, such as the painkillers Vicodin and OxyContin—and, to a lesser degree, heroin—is increasing. In response, mental health experts are retooling their treatment strategies to meet the unique needs of teens. Until recently, most opioid treatment programs were designed for older clients, and little was known about teenage users.
Prescription narcotics are the second most commonly abused drug in the United States, second only to marijuana, said psychiatrist Ramon Solhkhah, director of the Child and Family Institute at St. Luke’s and Roosevelt Hospitals in New York. He was speaking at the American Psychiatric Association meeting in May in Washington, D.C. By 12th grade, more than 13 percent of high school students in the U.S. have tried prescription opioids, up from a little more than 1 percent in 1989, according to national studies. From 1995 to 2002, the rate of heroin use among 12- to 17-year-olds increased from 0.1 to 0.4 percent (see http://monitoringthefuture.org/ for more stats).
Where opioid use starts
Adolescent opioid users, most often white males, typically start using drugs, including nicotine and alcohol, as early as age 10. Compared with marijuana and alcohol users, they are more likely to be victims of physical, sexual and emotional abuse. They generally end up in treatment, courtesy either of their parents or the juvenile justice system, researchers reported at the APA meeting.
Teens start taking prescription opioids in part because they don’t recognize the risks, says Solhkhah’s colleague, psychologist Lisa Marsch. The drugs are readily available, as doctors prescribe them more frequently than in past years. “A big factor is how easy you can get them,” she says. Kids steal their parents' or grandparents’ painkillers, then pass the drugs on to other adolescents. They get addicted in a matter of weeks.
More teens are using heroin, in part because the drug is cheaper than in past years, Marsch says. It’s also much more pure, which means users can snort it to get high, instead of having to inject it. The purity of heroin in the U.S. has increased from about 7 percent a couple decades ago to just less than 70 percent. “It should be called a different drug now,” she says.
Fighting opioids with opioids
To help prevent withdrawal symptoms and cravings, treatment centers and doctors in private practice can now prescribe the drug suboxone, an alternative to methadone. ”Me and my fiancé call it the miracle drug,” says Alex, a former (he hopes former) heroin user who completed the St. Luke’s outpatient treatment program at the end of March. “You take it [suboxone] and for 24 hours you’re fine, so then you just take it every day.” Almost 19, Alex (not his real name) began using heroin when he was 16. He and his girlfriend “were smoking a lot of weed but we wanted something to get us more high,” he says.
Suboxone is a combination of buprenorphine (pronounced byoo-pre-NOR-feen) and naloxone (NAH-lox-own). Buprenorphine is a weak opioid that reduces withdrawal symptoms. If users inject suboxone in an effort to get high off of the buprenorphine, then the naloxone kicks in, quickly causing withdrawal symptoms.
“We were the first group to do a clinical trial of behavioral and pharmacological treatments for teens addicted to opioids,” Marsch says. “We had some really exciting results showing that buprenorphine with behavioral interventions is very safe and effective.” In that study, almost two-thirds of the participants went on to taking just naltrexone, which blocks the effects of narcotics, after withdrawing from opioids.
“We stabilize [patients] on the medication then gradually reduce the dose,” Solhkhah explained. Buprenorphine “gets them to a place where … we can focus on life style changes,” he said.
Adds Marsch: “There’s a lot of reluctance among providers to give teens drugs to get over their addictions, probably because we haven’t had the research on how to do it effectively.”

Diseases & Conditions

Although addiction and alcoholism treatment research has advanced tremendously since Alcoholics Anonymous was founded in 1935, many people do not know that equally effective alternatives to 12-step programs exist—nor do they know how to find them. In popular culture, AA is often portrayed as the only way.
Worse, while reality TV spotlights tough family “interventions” as a way of getting people to enter treatment and often shows rehab as a “boot camp” or exercise in humiliation, research finds that both these approaches have significant risks, and other less risky tactics have equivalent or superior benefits.
So, how can you find evidence-based addiction and alcoholism treatment for yourself or a loved one instead of—or as an addition to—12-step approaches?
Here are five “dos” and five “don’ts” that can guide you to the best treatment.

And The Heavyweight Title Goes To ...

The sound of my 10-week-old baby-to-be's heartbeat filled the room, caroming off the walls, as percussive as a marching band. The nurse practitioner who'd strapped the fetal monitor to my belly smiled. "Wow, that child is already so strong," she said. "The next few months of your life are going to be very interesting." I didn't pay much attention. I was too enraptured with this raucous new life sparking inside me—the first science project I had ever, to my knowledge, performed correctly. But I soon discovered the truth in my nurse's veiled warning. The next 6 months were plenty interesting. I experienced elation, despair, indigestion, fluctuating blood sugar, and a mad craving for pineapple juice—not to mention the vomiting. It was the loveliest and most disagreeable time of my life.

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