Avoidance

Avoidance

Summary

Allergies are exaggerated reactions of the immune system to certain foreign substances that it mistakes as a threat to the body. Avoidance is the first choice of treatment a physician recommends to patients diagnosed with allergies. It is a strategy in which the patient tries to limit exposure to allergens (any substance that the body mistakenly perceives as a threat, triggering an allergic reaction) that cause symptoms. Avoidance is frequently the only treatment necessary to treat allergies related to foods, medications, animals and other allergens. It is also effective at preventing asthma attacks in people with allergic asthma (an allergic reaction to a particular substance, resulting in asthma symptoms).

In some cases, avoidance is a one-time decision that requires little ongoing maintenance. For example, people allergic to penicillin simply avoid using that drug. In other cases, avoidance requires much more effort. People allergic to dust mites, for example, must stay on their guard to keep dust levels in the home as low as possible.

Avoidance may not be possible or practical. Sometimes, medications or allergy shots (a form of allergy and asthma treatment in which increasing, controlled doses of an allergen are injected into a patient over a period of time to increase the patient’s tolerance to the allergen) are necessary to keep symptoms at bay. People with allergy symptoms should always consult a physician who can help them formulate the best treatment plan.

Before implementing allergy avoidance, be certain that the diagnosis of an allergy is founded and true. If a misdiagnosis is made, no benefit will be seen.

Identifying triggers

Allergies are exaggerated reactions of the immune system to certain foreign substances that it mistakes as a threat to the body. Avoidance is the first approach used to treat a patient’s allergy symptoms. By controlling the environment and minimizing exposure to known allergens (any substance that the body mistakenly perceives as a threat, triggering an allergic reaction), an individual can greatly limit the number and severity of allergic reactions. Individuals with allergic asthma (an allergic reaction to a particular substance, resulting in asthma symptoms) can also lower their risk for asthma attacks by practicing avoidance.

The first step in any allergy treatment program is to identify the allergens that trigger symptoms. This can best be determined by visiting a physician, who will likely perform a physical examination and compile a complete medical history and list of symptoms in trying to make an accurate diagnosis. The means of identifying triggers will differ from allergy to allergy, and will include:

  • Allergic rhinitis. Also known as hay fever, allergic rhinitis is an inflammation of the inner lining of the nose that occurs when an allergic individual encounters an airborne allergen such as pollen, mold, dust mites or animal dander. Identifying triggers is usually accomplished through skin testing, which involves exposing the patient’s skin to possible allergens to see if a reaction (rash) occurs, but may include blood tests as well.

  • Food allergies. Food allergies are the body’s hyperresponsiveness to proteins found in food. The first step a physician is likely to take in the diagnosis of a food allergy is to create a detailed medical history and dietary history of the patient. Skin allergy tests and blood allergy tests may also be performed. Other methods of identifying triggers include food challenge tests (in which the patient consumes suspected foods and is monitored for a reaction) and elimination diets (in which suspected foods are eliminated, and patients are observed to see if symptoms disappear or diminish).

  • Medication allergies. A physician is likely to first investigate whether or not an individual’s symptoms are the result of a drug’s side effect or of an actual allergic reaction by taking a very detailed history. For some medications an allergy skin test or blood test might be recommended. If a patient suffers a reaction to one drug, and an alternative is available, a physician will likely instruct the patient to simply avoid taking the medication that is the suspected allergen.

  • Latex allergy. Latex allergies are a reaction to the flexible, elastic material used in many rubber products. A history of certain conditions such as food allergies and eczema (an inflammatory skin disease with lesions that usually appear very dry, thickened or scaly) makes latex allergies more likely. Hospital personnel and those who have undergone multiple surgeries are at greatest risk. An allergy skin test or blood test might be recommended if an allergy to latex is suspected.

  • Chemical, fragrance and cosmetics allergies. In diagnosing a chemical, fragrance or cosmetic allergy, a physician is likely to perform a physical examination. A complete medical history, as well as a history of the patient’s exposure to various chemicals, fragrances or cosmetics, will also be taken. In addition, a skin test may be performed to try to uncover the allergen responsible for the reaction.

  • Insect sting allergies. These conditions are diagnosed through a medical history and physical examination. Physicians may also perform an allergy skin test to pinpoint the type of insect responsible for the sting. This is usually unnecessary, unless allergy immunotherapy is being considered, because it carries a small risk of a severe reaction to the testing.

Patients can aid their physician by providing answers to the following questions:

  • Do symptoms occur year-round, or are they worse at particular times of the year (seasonal)?

  • Are symptoms worse indoors or outdoors?

  • Do symptoms get worse around pets or other animals?

  • Are symptoms worse in one particular area? For instance, at a neighborhood park, at night in the bedroom or at a friend or relative’s home?

  • Is there a family history of allergies?

  • Is the patient frequently exposed to tobacco smoke?

Sometimes the information compiled by a physician is adequate enough to make an accurate allergy diagnosis. In other cases, allergy tests may be necessary to further pinpoint troublesome allergens.

Practicing avoidance

Avoidance strategies will be slightly different depending upon the nature of the allergy. Common allergies and their associated avoidance suggestions include:

  • Allergic rhinitis (hay fever). Patients should take steps to minimize exposure to dust mites, molds, pollen, animal dander and other airborne allergens (any substance that the body mistakenly perceives as a threat, triggering an allergic reaction) in the home. They should also try to minimize time spent outdoors in areas and during seasons where allergen levels are high. Tips to avoid exposure to airborne allergens include:
    • Remove carpets and drapes, which collect allergens such as dust mites.

    • Use allergen-proof covers for mattresses, box springs and pillow cases.

    • Wash bed linens and stuffed animals in hot water that is at least 130 degrees Fahrenheit (54 degrees Celsius).

    • Remove pets from the home if they are the source of allergies. If this is too difficult emotionally, try to limit areas in the home where the pet is allowed to roam. Be especially careful to keep the pet out of bedrooms.

    • During allergy season, try to keep windows and doors closed at home and use air conditioning if necessary.

    • Use an air filter that can remove allergens from the air, such as HEPA filters. Also, regularly replace filters in heating and cooling systems.

    • Use a dehumidifier to reduce humidity and prevent conditions ripe for mold, mildew, bacteria and dust mites. A device called a hygrometer measures the relative humidity in a room. Patients can take several measurements throughout the day and note if and when relative humidity rises to above 50 percent. Dehumidifiers can then be placed in areas where relative humidity frequently crosses the 50 percent threshold. Exhaust fans in kitchens and bathrooms also reduce humidity.

    • Shower frequently to wash airborne allergens from hair and skin.

    • Rinse eyes and use sinus rinse to remove allergens from mucous membranes.

    • Stay indoors as much as possible during the pollen season (when there are high pollen counts), especially on windy and humid days.

    • Use air conditioning in the car, which cleans and dries out air.

    • Avoid yard work that could stir up pollen and molds – such as mowing the lawn or raking leaves.

    • Avoid hanging laundry outdoors to dry because pollen can collect on fabrics.

    • Wash pets frequently to minimize the amount of allergens on their skin and coats.
     
  • Food allergies. Avoidance is the only effective treatment option for food allergies. Once a troublesome food allergen has been identified, the patient must be careful to avoid the food or ingredient. Patients must read food labels closely and ask about preparation methods in restaurants. Patients should be aware of food ingredients that are unfamiliar. Steps that can be taken include:
    • Using a Food Allergy Card to keep track of troublesome foods and ingredients. These cards can be printed out and given to wait staff at restaurants to ensure that meals are prepared with ingredients that are safe to eat.

    • Check out restaurants beforehand to make sure safe meal options are available. Also, frequent the same restaurants once safety has been established.

      Even very careful individuals can occasionally come into contact with food allergens. Therefore, people with food allergies should be prescribed an injection of epinephrine to carry with them, especially when eating out. Epinephrine is a drug that, when injected, reverses severe allergy symptoms such as breathing difficulty and lowered blood pressure.

  • Medication allergies. As with food allergies, avoidance is the only effective technique in most cases. Occasionally, a patient may undergo desensitization therapy, where small amounts of the drug allergen are introduced to the body until reactions no longer occur. However, this therapy can produce dangerous reactions and is not recommended unless there is no alternative to the drug that causes symptoms. 

  • Latex allergy. Latex is found in thousands of commonly used products, so complete avoidance is often difficult. However, several steps can be taken to reduce exposure. These include:
    • Check labels to determine which products contain latex.

    • Inform healthcare professionals, such as physicians and dentists, about latex allergies so they are aware and can avoid using latex-based gloves and equipment.
    • Choose alternatives to latex gloves when practical. Although they do not match latex’s ability to protect against disease, vinyl gloves work well for many tasks.
    • Avoid inhaling latex when possible. Try to avoid areas where people work with latex gloves or ask that they not use gloves powered with cornstarch. Scheduling physician or dental appointments to be the first patient of the day can also help minimize exposure to airborne latex particles.
    • Ask if latex-based gloves are used during food preparation in restaurants or other food preparation settings.

  • Chemical, fragrance and cosmetics allergies. Some chemicals can be found throughout the environment and may be difficult to avoid completely. However, several steps can still be taken to reduce exposure. They include:
    • Do not use products that contain fragrances, including air fresheners, potpourri, cosmetics, grooming products and cleaning products.

    • Ask family members and co-workers not to wear strong perfumes and colognes.
    • Avoid tobacco smoke as much as possible.
    • Never use pesticides indoors.
    • Do-it-yourself projects or other activities involving chemicals should always be completed in an open-air setting.

  • Insect sting allergies. These are allergies to the venom released in the stings of bees, yellow jackets, hornets, wasps and fire ants. Steps that can be taken to avoid being stung include:
    • Avoid disturbing sites that might host hives, such as large trees, stumps, logs and large rocks.

    • Hire an exterminator to destroy hives or nests.
    • Do not slap at bees. This may provoke them.
    • Do not drink from cans or straws unless you can see inside them. Yellow jackets often hide in these places.
    • Wear long-sleeved shirts, pants and closed shoes when possible. Do not wear flowery or bright-colored clothing, or dark clothing; whites and light colors are better. Avoid loose-fitting clothing, which can trap insects between the material and the skin.
    • Do not walk barefoot outdoors.
    • Avoid wearing perfumes or colognes, which may attract stinging insects.
    • Do not use insect repellent to avoid stinging insects. It is more likely to attract them.

Questions for your doctor

Preparing questions in advance can help patients have more meaningful discussions with their physicians. Patients may wish to ask their doctors the following questions about avoidance:

  1. What steps can I take to avoid contact with allergens in my home?

  2. What steps can I take to avoid contact with allergens at work/school?

  3. What steps can I take to avoid allergens when outdoors?

  4. What steps can I take to avoid food allergens at a restaurant?

  5. Is it possible to completely avoid the allergen I am reacting to?

  6. Will I require allergy shots as well?

  7. What steps should I take if I am accidentally exposed to an allergen?

  8. What is the best way to teach my child about avoidance?
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