Every day, I see patients that are having trouble with their allergic symptoms. For some individuals, over the counter medications such as antihistamines help but does not give sufficient relief for the comfort of the patient. Others have tried prescription medications which include stronger antihistamine and medications that reduce the inflammatory process, such as montelukast or steroids, with varying results and side effects.

Understanding seasonal allergy triggers. To achieve effective treatment, it is important to understand the cause or triggers of the symptoms you are experiencing. Avoidance or reducing exposure is the first step in treatment.

In Texas, that is almost impossible. There are airborne pollens year-around, differing in spring, summer, fall and winter. Winter brings Mountain Cedar in December, January and February. In spring, pollens are in grasses and trees. Summer has carryovers from spring and then ragweed begins in August thru October. Fall pollen contains different trees from spring tree pollen and weeds.

The most significant weed is ragweed that carries over from late summer. Molds are present year around with levels elevating with wind and damper conditions. Additional allergens that may add to the individual’s allergic load are dust mites and animal dander, such as dog, cat and feathers (birds or pillows).

Reactions for some individuals may be very specific, such as dust mite or ragweed. Others may have more extensive allergies and have symptoms year around.

Reducing your allergic reactions. Blood tests for IgE allergy (Type 1 allergic response) can define the worst offenders. Skin tests also define those reactive substances and may be more sensitive picking up the less reactive but troublesome items.

Once a person knows what specific items are causing them problems, reducing exposure is important to decrease symptoms during that individual’s high pollen season. Staying inside during peak pollen times, exercising indoors and traveling with windows up and air conditioner on recirculate helps reduce exposure.

Many newer cars have cabin filters that help reduce the in-vehicle pollen. If your vehicle has one, be sure to change it on a regular basis. Home air purifiers, especially in the room where sleeping, helps also. This gives the person six to eight hours of cleaner air.

Another simple process to reduce exposure is to use nasal saline to rinse out the pollen in the nasal passage before going to bed and after being outside.

Natural substances may be helpful in reducing symptoms. Vitamin C, taking at least 3 grams a day, is reported to have antihistamine effects. Quercetin also is reported to help.

Steroids either by shot or oral administration generally reduce symptoms quickly. Long term use may have significant side effects and are generally only given by physicians once or twice a year for a short period of time for symptoms not resolving with antihistamines.

Immunotherapy, allergy shots or sublingual drops (called SLIT- sublingual immunotherapy) builds up your body’s tolerance to the specific pollens. This therapy is specifically designed for you from your blood or skin testing results and administered on a frequent basis, usually weekly, over three to five years.

Consulting a physician for additional treatment options. If over the counter medication is not helping and you are miserable, consulting a physician to discuss additional treatment options is important to improve your health in a safe and effective manner.

Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com.

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“Peoples Pharmacy” had a recent article in The Dallas Morning News reporting that dietary intake may increase acne. This stimulated me to add additional information on foods and the potential adverse health effects.

The CDC has numerous articles and guidelines on Food Allergy and Digestive Allergy from foods. The most dramatic and life threatening are the anaphylactic shock reactions such as acute asthma, laryngeal edema, body swelling and hives.

Ninety percent of these reactions are produced by eight foods: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat. The main treatment is avoidance and to be prepared to treat with Epinephrine injection and antihistamine with immediate transportation to the hospital for stabilization.

Food allergies link to other conditions. Individuals with this type of food allergy are two to four times more likely to have other allergic conditions like asthma, eczema and seasonal allergies. In this situation often tolerance can be developed over time to the seasonal allergies by using allergy shots called allergy immunotherapy. This is done thru skin testing by physicians to determine the item you are sensitive to and then preparing a specific formula for your treatment protocol. Tolerance to allergic items is achieved over time.

Digestive Allergy involves foods that trigger abdominal pain, swelling, cramping, constipation or diarrhea. Secondary effects of adverse food reactions may also include fatigue, less mental clarity (“brain fog,”) joint pain, rash and itching. The eight foods listed above may be the trigger or other commonly eaten foods such as corn, rice, garlic, onion, pepper and peppers, potatoes, tomatoes, and all the grains that contain gluten. Elimination is again the treatment.

Figuring out which foods are causing you issues. Defining which foods are the trigger is often difficult. The quick onset reacts can generally be determined by skin tests or IgE blood tests. Delayed reactions are harder to be isolated.

One method is the “4 Day Rotation Diet” involving eating two to three foods per meal and not repeating any of the foods in the four-day time period. While doing this it is important to keep a diary of the foods eaten and how you feel recording the reactions. Reactions can be delayed by hours or extend into the next day. (There is help with this diet on the internet).

Celiac Disease is the absolute intolerance to gluten which is in all grains except corn and rice. Individuals with this Disease must strictly avoid all gluten containing foods to avoid the severe symptoms experienced by an exposure, severe abdominal pain, cramping and diarrhea that may go on for days.

Other individuals may have gluten intolerance and experience milder symptoms of bloating, constipation or diarrhea, fatigue, poor mental clarity, generalized aching, headache, rashes and swelling. Often these individuals have additional foods intolerances or allergies that make the job of getting relief difficult due to the many food variables.

Skin and blood testing for foods can help to define the specific foods. However, this testing often misses many reactive foods and it is necessary to use the “4 Day Rotation Diet” as a challenge method to define which foods for you are causing your symptoms. Then avoid those triggering foods for optimal health. For those individuals with many food allergies/intolerances staying on a rotation with avoidance is the best treatment.

Additional help for digestive allergies.

Help for individuals with Digestive Allergy is available through genetic testing, especially for gluten intolerance and Celiac Disease. Enterolabs at enterolabs.com offers a buccal swab test that will define your specific genetic makeup defining how you handle gluten. You acquire one set of genes from your mother and one set from your father. The combination of these two gene sets determines how your body will potentially handle ingested gluten, true celiac verses intolerance. With a physician’s guidance this can be a big help in how you regulate your diet for optimal health.

Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com.

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With school out and government restrictions lifting, many of us are slowly getting back to our new “normal.” While many of our kids are excited to get out of the house and potentially back into sports, it’s important that we stay focused on safety. Whether it’s running, playing games in the neighborhood or participating in school activities, hitting our heads, falling, or colliding with someone in a contact sport can be a risk. In severe cases, that collision can result in a concussion, which is technically a form of Traumatic Brain Injury (TBI).

A sudden impact to the head may produce injury manifest feeling confused or having memory problems, sensitivity to light and loud noises, nausea and vomiting, problems maintaining balance, feeling groggy, foggy or sluggish, feeling pressure in the head or headache and blurry vision or balance issues.

If you or your child has any of these symptoms and seems to be a little “off” the normal, questioning them about recent activity and the possibility of being struck in the head is important. If the symptoms are not resolving within a couple of hours or are getting worse you should seek medical evaluation immediately. The CDC has recommended rest, light activity, moderate activity and then back to regular activity.

Rest. You or your child should rest the first few days after being injured while symptoms are severe. Physical activity as well as thinking or remembering activities should be limited in order to avoid worsening symptoms. Lastly, allow naps throughout the day if needed and make sure to get a good night’s sleep.

Light activity. Once you or your child starts to feel better, you may gradually return to regular activities, as long as they are not strenuous. Kids may also return to school and activities. If symptoms do not worsen, it is OK for your child to participate in that specific activity. However, if symptoms do worsen, time spent on that activity should be cut back. Screen time and loud music should be limited before bed and fixed sleep schedules should be followed. Naps can be reduced or they can return to their regular napping schedule, depending on their age.

Moderate activity. When symptoms are almost gone, you or your child can return back to most regular activities. Breaks are only needed if concussion symptoms worsen. At this stage, kids can also return to a regular school schedule.

Regular Activity. Recovery from a concussion is when you or your child are able to complete daily activities without experiencing any symptoms. Regular activity may resume at this point.

More information on concussion recovery can be found at cdc.gov.

Treatment can vary depending on injury and person. In general, the focus is to limit activity, stay in a low light and sound environment, and get as much rest as possible. In mild cases, symptoms can resolve within hours to a few days. Keep in mind, the length of time of recovery is not related to the severity of the impact and careful observation is necessary. If you’re feeling that symptoms and discomfort are persisting, additional medical attention is recommended and, in many cases, needed.

In fact, the CDC states that 20 percent of people suffering concussions have symptoms after 30 days. Many athletes injured are out of school for days to weeks recovering unable to tolerate bright lights, loud noises, physical activity or cannot concentrate. While this isn’t always the case, and others may have headaches, lethargy and cognitive difficulties that only last for a few weeks.

Using technology to monitor concussion recovery. As technology in the health and wellness industry is advancing, there are some exciting things on the horizon in terms of technology to help with concussion monitoring and recovery.

For example, a new mobile app is now available for free called HitCheck. Users can download this app and do a baseline concussion assessment right on their phone or other mobile device. When an athlete has a suspected injury, repeating the testing will pick up symptoms and signs that may not be easily recognizable indicating a concussive event probably happened. This app can be used also to determine when abnormalities have resolved.

Speeding up recovery with hyperbaric oxygen treatments. Luckily, there are alternatives for those trying to get on their feet quicker. A recent study, presented at the Hyperbaric Medicine International Meeting in Charleston, SC, showed that hyperbaric treatments speed up recovery with 80 percent of the individuals being symptom free after five daily one-hour sessions in a hard-sided chamber. For an individual with continuing problems following a concussion, Hyperbaric Oxygen has also been helpful in longer recovery.

For those new to Hyperbaric Oxygen, this treatment involves breathing pure oxygen in a pressurized chamber. In this condition, your lungs can gather more oxygen than under a normal air pressure, which ultimately can help promote faster healing.

Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com.

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