By Ashley PatokaApril 3, 2017
Each year the World Allergy Organization observes World Allergy Week. The initiative is a way to raise awareness of allergic diseases and related disorders. This year, World Allergy Week is observed April 2-7 and the theme is chronic hives.
We sat down with Col. Kirk Waibel, Allergy/Immunology Consultant for Regional Health Command Europe and the Army Allergy Consultant to the Surgeon General, to learn more about Chronic Urticaria and Allergies.
Q: Before we get into the topic of this year's World Allergy Week -- We've all heard of allergies or allergic reactions, but can you explain what an allergy is?
A: Allergies represent a reaction from your body's immune system. Some of the most common allergy reactions can present as environmental allergies, food, medication, insect stings, and vaccines.
Q: The topic of World Allergy Week this year is chronic urticaria. Can you explain what chronic urticaria is and what the symptoms are?
A: Urticaria is the medical word for hives or welts. About 20-25 percent of the population will have a day or week with hives without a known reason. Sometimes these are due to a viral illness but there may be times the reason is unknown. The good news is if the hives go away within a few weeks it is likely to never return. However, about 2 percent of the population has hives that once they start do not go away and can persist for years or even decades. Chronic urticaria or chronic hives is the term we use for individuals who continue to have these hives after two months and are unable to find the reason -- such as new medication, detergent, soap, etc.
Q: Are there specific causes that can trigger chronic hives?
A: First of all, patients who have hives or swelling due to unknown reasons should see their health care provider. If they are unable to determine the cause it is recommended that the patient be referred to an allergist for further evaluation. Unfortunately, in many instances we cannot find the reason. Most patients worry it could be a food or pollen allergy, but these are extremely rare causes of chronic hives. However, there are some tests we can perform in addition to taking the time to provide educational materials and treatment plans for these patients.
Q: Is there one demographic that this affects more often?
A: Chronic hives can affect any age, although studies show that adult women are the group that is affected the most. Patients with chronic hives -- particularly those who are not well controlled -- are often miserable. Their quality of life is really affected. This is not a contagious medical condition but patients with chronic hives rarely want to be out and about with relatives, friends, or in the public when they have welts all over their body.
Q: Is there a treatment for chronic hives?
A: Definitely. The first step is to ensure the proper diagnosis and our staff in the Landstuhl Regional Medical Center allergy clinic is fully prepared to do this. The initial step is reviewing the different medication options, usually starting with ensuring the patient is taking an oral antihistamine, such as Claritin, Zyrtec, or Allegra. The dose often needs to be increased above the usual once a day dose to control chronic hives. Second, the United States Food and Drug Administration has approved a medication called Xolair ("zo-lair") in 2014 which has been a tremendous aid for patients.
Q: Why is this important and why do you want to share this information?
A: On average chronic hives can last for two to three years during which time patients just want to live their life and not be limited from hives. We hope that the World Allergy Organization awareness week will continue to reach more and more of the population to let them know there are specialists here at LRMC and safe treatment to help individuals who are out there struggling with not understanding why they are breaking out in hives all the time for no reason.
Q: Changing gears slighting, since its world allergy week and spring has officially started, which for a lot of people also means allergies, can we talk about seasonal allergies a bit? Can children have season allergies?
A: Allergies can start at any age, but in general seasonal allergies take two to three seasons to develop and the peak age to start is from age 7-10 years old. The risk for a child to develop environmental allergies when one parent has seasonal allergies is 40-50 percent while it is 70-80 percent if both parents have seasonal allergies. The other misconception is the child is too early to perform allergy testing -- we can perform pollen or food testing at any age.
Q: Are allergies different in Germany than what we are used to in the states?
A: Allergies are slightly different here in Germany. Some things like mold, pet dander, and dust mite are the same but we see mainly birch tree and northern grasses here in Germany while most of the U.S. is oak tree, southern grasses and ragweed.
Q: If someone is suffering from seasonal allergies would an allergy shot be helpful?
A: The approach to seasonal allergies is first to talk with your health care provider. Most patients can be managed with simple medications -- many of which, like oral medications and nasal sprays, can even be found over the counter. However, those patients who have severe or persistent allergy symptoms, or what I like to call, "feel like a walking pharmacy," to control their allergies, should talk with their provider. There is a basic allergy pollen blood test any provider can order, but if the patient is on the more severe end or is interested in allergy shots, then we recommend they talk with their provider to have a referral to see us. Allergy shots can really help a person who is suffering from allergies when a combination of allergy medications is not significantly improving their allergy symptoms. For both urticaria and seasonal allergies we are evaluating patients both in-person and via virtual health. Virtual health is like video chat with the patient in their own clinic which can prevent a lot of time and travel-related costs (if traveling from locations such as Vilseck, Germany, Italy or Belgium) but there is a nurse with the patient making the visit often seem just like they were being seen in-person at the allergy clinic.
Q: Another topic people generally think of when they hear the word allergy is food allergies -- especially in children. When kids are first trying new foods what should parents keep in mind? And how common are food allergies?
A: There has been a huge change in how we approach introduction of foods in the past 12 months. There was a landmark study in a major medical journal that showed the delay in introduction of certain foods led to an increased risk for food allergy by age 5 years. In the U.S., the latest data shows that about 8 percent of children and 4 percent of adults have a food allergy -- this adds up to 15 million people in the U.S. alone. If a parents suspects their child could have a food allergy they should talk with their child's health care provider.
Q: How can someone get an appointment with an allergist?
A: The first step, if you believe you have an allergy or are really suffering from seasonal allergies, is to visit your primary care provider. They will be able to evaluate you and determine the best plan and if you should see an allergist. In Europe, the only Army health facility with an allergy clinic is LRMC. While sometimes patients worry about access to specialty clinics, the LRMC Allergy clinic has been open to all classes of beneficiaries since I arrived in 2013 and we don't expect any change to our access for years to come. But like I said before, we can see patients who are located farther away in Germany, Belgium, and Italy through Virtual Health or remotely-located patients always have the option to be referred to a host nation provider.
For more information about the LRMC Allergy Clinic or Virtual Health, visit https://rhce.amedd.army.mil/landstuhl.