Dear Doctor…..


Dear Doctor,

Thanks for all your help with my #allergies, but I have a bone to pick with you.  A few minutes into my visit and you’re talking about “rhinitis” and “IgE” and “desensitization”.  By the time my brain catches up with you, our visit is over and I don’t feel like I really understand what condition I  have.  Could you slow down and explain what you mean by all that medical riff-raff?


Confused and a bit rushed

Dear Confused and a bit rushed,

I certainly understand the world of medical terminology is pretty overwhelming most of the time.  I’ll explain why some patients have #allergy and many think they have allergy, but really don’t have the same type of allergy that you may have been expecting. Most TV advertisements want to sell their antihistamine products and never mention why some patients have allergies and others don’t even with the exact same symptoms. Having allergy comes down to whether or not you have the molecule IgE.

What is IgE?

Here’s the Wikipedia definition of #IgE for the scientific approach:

IgE structure

#Atopic individuals can have up to 10 times the normal level of IgE in their blood (as do sufferers of hyper-IgE syndrome). However, this may not be a requirement for symptoms to occur as has been seen in asthmatics with normal IgE levels in their blood – recent research has shown that IgE production can occur locally in the nasal mucosa.

IgE that can specifically recognize an “allergen” (typically this is a protein, such as dust mite Der p 1, cat Fel d 1, grass or ragweed pollen, etc.) has a unique long-lived interaction with its high-affinity receptor FcεRI so that basophils and mast cells, capable of mediating inflammatory reactions, become “primed”, ready to release chemicals like histamine, leukotrienes, and certain interleukins. These chemicals cause many of the symptoms we associate with allergy, such as airway constriction in #asthma, local inflammation in eczema, increased mucus secretion in allergic rhinitis, and increased vascular permeability, it is presumed, to allow other immune cells to gain access to tissues, but which can lead to a potentially fatal drop in blood pressure as in anaphylaxis.

Where Does IgE Come From?

It’s true that not everyone has IgE in their system. You are born with a genetic make-up that switches on the production of IgE.  This is why allergy is a genetic condition and a family history of allergy is so important in predicting your allergies. Many events occur in order to make IgE such as WHEN you get exposed to allergens (early in life is protective) and what DOSE of allergens you are putting in your body.  Studies now show that early peanut butter ingestion, for example,  before one year of age actually REDUCES your risk of developing peanut sensitivity.

Who Cares About IgE?

Let’s look a bit closer at how important IgE is in order to determine what treatment is best for your allergies. Inflammation in the nose is called “rhinitis” and simply means your nose doesn’t work like it should.  (either stuffy or runny all the time).  Unfortunately, you can’t tell the difference between allergy or “non-allergic” conditions based on your symptoms alone.  Look down the left hand side of the chart below and if IgE is present you have allergy; if IgE isn’t there based on skin testing, you have non-allergic rhinitis and allergy shots won’t help.

IgE picture 1.0


Positive skin tests look like this....
Positive skin tests look like this….

What Can You Do With Your IgE level?

Picture of IgETreatment of allergy requires three things:

  1. 1.  It’s best to avoid all allergens such as pets, dust, all foods that cause an allergic reaction.
  2. 2. Medications can reduce the effects of IgE and give you less allergy symptoms. Keep in mind, however, that once you stop your medications, symptoms are likely to return.
  3. 3.  #Allergy shots contain your allergens that are injected back into your body under your skin.  How does this work?  You have specialized cells under your skin that identify this allergen and tell the rest of your body to ignore its effects. Pretty slick way to fool the body into developing tolerance to your allergens.

So, next time your doctor tells you “it must be allergy”, make sure you have evidence of IgE to back up the claim.

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