Discussing Allergies and Sensitivities with Dr. Corinna Bowser, MD

Corinna S. Bowser, MD, FAAAAI, FACAAI, is an allergist and founder at Suburban Allergy Consultants in Pennsylvania. Her board certification is in adult and pediatric allergy and immunology and pediatrics. She is also a fellow of the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology.

In her practice, Dr. Bowser treats both adults and children who have food allergies or sensitivities, allergic dermatitis, hives, or airborne allergies. Her understanding of the respiratory system gives her the ability to manage asthma in patients of all ages, using either rescue inhalers or long-term control measures.

We reached out on our Asthma.net Facebook page to ask our community members what questions they have for an allergist. Many of you mentioned wanting to learn more about allergies and sensitivities and how they compare to one another. Dr. Bowser was kind enough to answer some of these questions.

Interview on asthma, allergies, and sensitivities with Dr. Bowser

Many people with asthma also experience allergies and sensitivities. How would you compare allergies vs sensitivities?

The difference between allergies and sensitivities is the mechanism. In allergic reactions, there is a specific IgE antibody that binds to the allergen and causes a very specific and usually reproducible reaction. Testing for specific allergies is possible with skin testing (pricks on the surface of the skin with results within 15-30 minutes) or allergy blood tests. Only a few individuals are allergic to allergens.

In comparison, sensitivities are caused by an irritant effect due to certain substances and are not immunologically specific. This happens, for example, with pepper or strong spices. Many individuals will react to those irritants. People with pre-existing allergies and already inflamed tissue may react stronger or to a lower dose (this often happens when allergic/asthmatics are exposed to scented candles, strong smells, etc).

Sensitivities can cause similar symptoms like sneezing, coughing irritation, but they usually don't cause full anaphylaxis with a life-threatening outcome. Sensitivities are similar to "side effects": Many people experience increased heart rate after coffee - that's sensitivity. Many people get itching in their mouth with aged cheese - a sensitivity...

How frequently should patients be retested for allergies and sensitivities?

There is no standardized testing for sensitivities - the only way to test is exposure and observation of reaction.

Allergy testing for airborne allergens (pollen, dust mite, animals, mold) needs to be done once to identify triggers and establish a focused avoidance and treatment regimen. It does not have to be repeated regularly. A reason to repeat the test would be NEW symptoms, new exposures (move to a different region with different allergens, new dog, new cat), or changes in health/allergy status. Re-testing may also be necessary if the patient wants to start allergen immunotherapy or to evaluate if allergen immunotherapy could be stopped after being on it for years.

In the case of food allergies, re-testing may be necessary on a yearly basis in the first few years of life. There is a chance for "outgrowing" food allergies or, if the test results show less response to the allergen, a food challenge could be attempted. In adults, repeat testing for foods is usually not necessary unless a new food allergy develops.

What are some lesser-known symptoms of allergies?

Respiratory allergens:
Typical symptoms include cough, congestion, sneezing, itchy eyes/nose and increased mucous, asthma symptoms are common. Some patients with pollen allergies can develop itchy mouth and irritation when eating certain fresh fruits and vegetables (e.g. birch allergy- symptoms when eating raw carrots, apples, pears, plums, peaches, potatoes, ragweed allergy - problems with melons). These symptoms don't happen when the fruits are boiled, cooked, or otherwise processed.

Food allergens:
Typical symptoms include hives, throat swelling, lip swelling, vomiting, nausea, diarrhea, hives, shortness of breath within 30 min-2 hrs of eating the allergenic food.

Less frequent symptoms include delayed symptoms 2-8 hrs later in the case of sensitization to alpha-gal in mammalian meats (pork, beef) with severe vomiting, hives, anaphylaxis. This is a very rare syndrome that occurs mainly in the southern states of the eastern US (including TN, WV, Georgia where tick-borne disease transmitted by the lone star tick is common). Patients usually have had a tick bite previously and have been sensitized to alpha-gal through this.

If someone decides to start getting allergy shots, can the shots help their asthma, too?

Yes, allergy shots are extremely effective for both allergic rhinitis and allergic asthma. If the right patient (with significant allergic sensitization) is identified allergen immunotherapy is more effective than medications in the treatment of allergies and asthma. In addition, there is evidence in children that allergen immunotherapy may reduce the risk of developing asthma.

How can people protect themselves from allergy triggers this spring?

The best way for protection during pollen season is to avoid pollen exposure. This means staying indoors, keeping windows closed, washing hair and clothes after outdoor exposure, and not drying clothes outside.

Of course, this imposes a lot of limitations on the patient and probably reduces the quality of life. Particularly during this pandemic where more and more events and social gatherings are outdoors, it is nearly impossible to avoid pollen exposure. I often advise my patients to wear baseball caps and sunglasses to reduce the pollen exposure to eyes and face.

What questions would you like to ask an allergist about asthma, allergies, and sensitivities? Share in the comments below!