By Brian Morris, MD

Allergy problems have become much more common in recent years. Allergy issues can include classic types of allergies (itchy eyes, runny nose, hives, etc.) as well as sensitivities (which can manifest as skin reactions or intestinal symptoms). Some of the recommendations in this section may not apply to every type of allergy issue. However, these tools form an “allergy protocol” that will help you combat many of the most common problems. When I started out in practice in 1995, most patients told me they did not have any allergy problems. However, now about half of the patients I see at UCLA report that they’re experiencing an allergy problem in certain situations or certain times of years. If you, or someone you know, experience such problems, it is usually best to consult with an allergist or internist for testing and treatment. In conjunction with medical management, there are five strategies that can help minimize the risk of having problems.

1. Allergy proof your floor: Carpet is Grand Central Station for dust and other allergy-causing triggers. No matter how well you vacuum your carpets or rugs, significant amounts of dust will continue to make a home there. In addition, every time you vacuum, large amounts of dust will enter the air and can circulate for a significant period of time. If you have allergy problems (especially dust-related nasal/sinus/asthma problems), you should strongly consider removing carpets and rugs from as much of your environment as possible, particularly in your bedroom and other heavily trafficked rooms. After that, be sure to regularly clean floors and shelves to prevent the accumulation of dust.

2. Allergy proof your bed: Have you ever noticed that many allergy problems happen at night or during sleep? This is because some of the most common allergy exposures are found right in the bedroom. I’m referring to mattresses, pillows, and sheets. In particular, mattresses and pillows can be a haven for dust and other exposures so it is important to protect allergy sufferers by using a mattress encasement and pillow encasements. These are specialized barriers that seal the mattress and pillows to reduce the risk that you will be exposed to allergy triggers during sleep. Encasements have become much easier to find these days and can usually be found at stores such as Target and Wal-Mart or at many online retailers. Sheets and pillowcases can then be used on top of these encasements like you normally would do. It’s also important to remember is to wash sheets and pillowcases in hot water once a week. This is important to keep these items clean and as allergy-free as possible.

3. Shower before sleep: There is another major reason why sleep is a common time for allergy problems. You may not realize this, but many parts of the environment accumulate on your skin and hair as you go through your day. This includes remnants from trees, grass, dust, and makeup. When you go to bed with this accumulation still on your body, you can transfer these allergens to your sheets and pillowcases. Thus, it can help to shower before bedtime.

4. Consider eliminating common allergy-inducing foods: Food allergies are very common. Most of us know people with sensitivities and allergies to certain foods. While many foods and chemicals in the food chain (colorings, preservatives, etc.) can trigger allergy problems, eight foods account for a large percentage of such problems 1. Wheat 2. Dairy (especially cow’s milk) 3. Soy 4. Eggs 5. Tree nuts (cashews, walnuts, almonds, pecans etc.) 6. Peanuts 7. Fish 8. Shellfish. These foods are common causes of allergy problems which can go undiagnosed for years or even decades. Part of the problem is that some of these foods (especially wheat, dairy, and soy) are ubiquitous in the modern food chain. Often, we don’t think of food as a possible cause of medical problems. However, these eight foods are common causes of problems ranging from intestinal symptoms to sinus problems to skin problems. Removing all eight of these foods from one’s diet is difficult and usually not necessary. However, a sequential elimination diet can be helpful in many cases. To do this, remove one item at a time from your diet to see if symptoms improve. This process should always be practiced under the supervision of a board-certified physician with experience with allergy problems. Keep in mind that each type of food should be removed from your diet for at least three to six months as it can take that long for an improvement to be noted. During this process, be careful to look for these foods in places you might not expect such as supplements, toothpaste, and mouthwash. The elimination diet can help identify any culprits in the food chain that may be contributing to your allergy problems. In general, do your best to avoid foods that contain colorings and other additives as these can also be common causes of food allergies.

5. Air purification: We all know it’s not optimal to breathe cigarette smoke and that second-hand smoke should be avoided. While we accept that cigarette smoke is damaging to our bodies, we often don’t consider the health consequences of breathing the air pollution found in so many big cities. In 2007, the prestigious New England Journal of Medicine published an article establishing a direct relationship between the level of air pollution in one’s community and the risk of dying from heart disease. Other studies have confirmed that your life expectancy is related to how much air pollution you breathe. It’s clear that the quality of the air you breathe has a significant effect on health—and that bad air quality is a problem, regardless of what causes the poor air quality. So, what are we to do? Most books that deal with this topic urge us to advocate for stricter air emissions controls in our local communities. That is definitely important in the long term as improving air quality is the ultimate solution to this problem. In the meantime, I encourage you to focus on what you can do to immediately improve air quality for yourself and for your family.  My first recommendation is to place a HEPA air purifier in each bedroom of your house. I prefer the standalone individual room HEPA air purifiers because they’re mobile and relatively inexpensive. However, installing a total house purification system is another option. I frequently hear from people that air purifiers aren’t important because you need to go outside or spend time in buildings that don’t have good air purification systems. Thus, why should people go through the expense of having a bedroom air purifier? My answer to this is that the average person spends about eight hours per day in the bedroom, which is one-third of your life. If you have a high quality air purifier in your bedroom, that means that one-third of the time you’re breathing in better quality air. Secondly, many people who work outside the home also spend much of their workday in an office. If those people also put an air purifier in their office space, then nearly two-thirds of their day could be spent in a room with high quality air. The key is to optimize the amount of time that you spend in rooms with good air quality. What should you look for in an air purifier? First, make sure it does not have an ionizer. Ionizers don’t appear to significantly improve air quality and some of them emit ozone which can precipitate asthma problems. Second, measure the room and make sure that the purifier is strong enough to filter the air in a room of that size. Most companies put the room size specifications on the box to make this process easier. Look for the CADR (clean air density rate) for the machine you’re considering. This measures how much volume of air the machine can filter per minute. In general, look for CADR’s or over 150 for most normal sized rooms. Very large rooms may require higher rates. Third, ensure that the air purifier is a HEPA air purifier. The HEPA specification means that it removes of at least 99.97% of particles from the air that are 0.3 micrometers in size or larger. Fourth, make certain that the machine is from a reputable company that has a proven track record for effectiveness. Finally, please be sure to check the filters regularly and change them per the manufacturer’s recommendations or when they look dirty. The filters can be a bit expensive for some of these machines, so check out the replacement filter prices before you buy the unit. If possible, purchase a HEPA air purifier for your bedroom and/or office space and remember to change the filters when necessary. Also, consider having a HEPA unit in other rooms where you spend more than a few hours per day. While I’m on the subject of indoor air quality, I want to also remind you to be sure to change the filters in your home’s furnace on a regular schedule (typically every 2-3 months depending on how often you run your air system).