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Misconceptions About Asthma And Allergies

By Neil Gershman, M.D.

For some reason, misconceptions about allergies abound. Some of these allergy "myths" are almost a part of popular culture. I will try to dispel some of them below.

One misconception is that South Florida is a bad place for people who are allergic to pollens. Perhaps the misconception stems from the fact that our environment is so green all year round. The fact is, according to a recent pollen survey, South Florida has quite low pollen counts relative to other parts of the country. There really is no such thing as a "pollen season" -- grass season, for instance, consists of low pollen counts for almost the entire year. The reason for these low counts is unknown, but may have to do with coastal winds and high humidity. It turns out that dust mite is probably the biggest problem for allergy sufferers in South Florida.

Allergy patients might believe that they are allergic to perfume or smoke, but that too is another misconception. Irritants like perfume, paint fumes or smoke can be very bothersome, causing an "irritant rhinitis". These substances can lead to nasal congestion, runny nose and other "allergic"-type symptoms, but they do not contain proteins that can be recognized by the body's immune system. A true allergic reaction can only occur if the immune system is involved. Allergic people tend to have the most problems with such irritants, and treating the underlying allergies can make them more tolerant to the irritant.

There are many misconceptions about pet allergies. One is that there are certain breeds of dog that are less allergenic than others. To my knowledge, this has never been shown scientifically. The main source of dog allergen protein is dander (saliva and urine also contain allergen), which is particles of skin from around the hair follicle. So, short-haired dogs shouldn't be better than long-haired ones. In general, smaller dogs should be better because they have less surface area. Also, one particular dog can have low allergen levels. That is, one bulldog, for instance, may produce 100 times more allergen than another bulldog - this is how someone might say, "My dog (or cat) doesn't bother me as much as others."

The last misconception I'll mention is by far the most important, because I believe it may be responsible for a great deal of suffering and even death. The misconception that so-called "topical" steroids (nasal spray and inhaled steroids for asthma) are unsafe for children is a major problem for those of us treating allergic and asthmatic children. The problem is the confusion of these drugs with oral steroids (pills like prednisone), which circulate throughout the entire body and have many bad side effects when given for more than a few weeks at a time. The topical steroids work only where you put them: in the nose or the bronchial tubes. First, the newer nasal steroids have been shown to be free of growth slowing or any other significant side effects in children as young as 2 years old. Inhaled steroids for asthma at low dose have also been shown in long term studies to be extremely safe in children and adults. The shame is that inhaled steroids are underused, yet they are the most effective drugs for asthma, and the only drug ever shown to be able to prevent asthma deaths. Perhaps 2000 or more asthma deaths per year could be prevented if these drugs were used more often. Also, the nasal steroids are definitely more effective than antihistamines, but less often used perhaps because of this "steroid-phobia". I hope that the media one day picks up on this particular misconception which causes a great deal of suffering.

Published in Oct-Nov 2002 Newsletter of the Florida Asthma, Allergy & Immuniology Society

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