Is It Allergy or Not?
- Thursday, August 27, 2009, 12:06
- Allergy
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- Dr. Lieberman:
- In our practice at least 30 percent and perhaps as high as 60 percent of certain ages of patients who come for an allergy evaluation – either on their own or at the referral of another physician – actually don’t have allergies: they have the symptoms of allergy. They have sneezing, they have runny nose, they have nasal congestion, they have nasal drainage, they feel pain over the sinus areas, and for all practical purposes, they think they are allergic.
Those symptoms are often considered synonymous with allergies. But indeed, they’re not. Especially in adults, a large percent of patients have the symptoms, but don’t have allergy.
The important concept for people to understand is when you present with those symptoms, what you’re expressing is a process in the nose called inflammation.
Inflammation produces swelling, weeping, and sneezing. And that weeping can either run out the front or go down the back. Now, what people don’t understand is that allergy is only one cause of that.
[Some] people are totally non-allergic and have those symptoms and quite often [their] symptoms [are] more severe than the allergic patients.
When they come to see us for an allergy evaluation, they’re quite surprised to find that they have no allergy at all. We evaluate them with very sensitive tests that are 100 percent accurate, [and] we find that they’re allergic to nothing.
They have a condition known as rhinitis, “rhin” meaning nose, “itis” meaning inflamed, but they don’t have the allergic variety. They have what we call chronic non-allergic rhinitis. Irritants worsen [their condition], not allergens.
The distinction between [allergens and irritants] is the most important concept that you need to understand, Andrew, to be able to understand the differences in these conditions.
An allergen is, by definition, a substance that is non-irritating. [So] if you were exposed to large amounts of that substance and you didn’t happen to be an allergic individual, you wouldn’t even notice its presence. These are things like pollen, feathers, dust mite, mold spores and animal danders.
If you take a non-allergic person, for example, and you put him in a room with a dozen cats, they will have no adverse effect. Allergens are all organic – that means [theyíre] alive or have been alive – and they’re all non-irritating. We can’t detect them with our senses of smell, sense of taste. They have no irritating property.
An irritant is a substance, which would bother anyone if present in large enough amounts.
- Andrew:
- It’s like paint fumes. If you went by and they were painting a room, everybody would say, “Oh, I can’t stay in here. I can’t breathe.”
- Dr. Lieberman:
- That’s exactly right. There are some of us who are much more sensitive to these irritants than what we would call the “normal” population so that infinitesimally small amounts of, for example, a strong perfume, cigarette smoke, paint fumes, particulate dust in the air – give these patients symptoms of rhinitis. And since the symptoms are identical to those produced by allergies, patients think they are “allergic” to perfume.
- Andrew:
- Right. So, it’s not seasonal allergies [either]. That’s the main thing.
- Dr. Lieberman:
- It is entirely different.
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