EXPERT > Doctor In The House

Allergy Prevention And Control

By Dr. Matthew Lau
Interviewed by Melissa Moniz
Wednesday - July 09, 2008
E-mail this story | Print this page | Comments (0) | Archive

| RSS |

Del.icio.us Share

Dr. Matthew Lau
Chief of Allergy, Kaiser Permanente Hawaii
Interviewed by Melissa Moniz

Where did you receive your schooling and training?

I graduated from Kalani High School, attended the University of Colorado at Boulder for my undergraduate, and then John A. Burns School of Medicine and internal medicine residency at UH. My allergy specialty training was at the University of California, San Francisco. I am Board Certified in Allergy & Immunology and in Internal Medicine. I’ve been with Kaiser Permanente for about 15 years.

What is the most common allergen that people are sensitive to?

Dust mites. They survive by eating human skin flakes, mostly living in carpets and bedding. They are very common to tropical areas.

With allergies, how much of it is attributed to genetics and how much of it is environmental?

The balance or the combination of both the genetic tendency from parents and the environment at a really young age probably contribute to developing allergic diseases. They are both important, but genetics play a very large role. So if you don’t come from an allergic family, then the odds are much less.

Is smoking a cause for allergies and asthma?

Smoking really increases a person’s chances of having asthma and can promote allergic antibody production that leads to allergic diseases. Plus, it also affects lung growth, which is a negative for children developing asthma.

Is it common for people to develop allergies in adulthood?

Most allergies tend to start in childhood and usually very early. Some allergies will improve dramatically and then return later in life, especially asthma. But some of those conditions that affect the nose and lungs that happen later in life have less of an allergic trigger.

Dr. Matthew Lau talks with Melissa Kim about asthma and what goes on in the airway

What about with food allergies?

Food allergies oftentimes get lumped together with non-allergic food reactions. So sometimes there’s some confusion about adults getting allergies in later years, which turns out to be intolerances and not allergies. True allergies tend to start when we are young and usually incorporate a limited number of foods. Food intolerances can be a wide variety of things that don’t really use an allergic mechanism.

What are the differences in symptoms between an allergy and an intolerance?

Food allergies are much more severe. A person can tell the difference between a food allergy and an intolerance in this way: If it’s a food allergy, there tends to be very immediate symptoms within 30 minutes to an hour, with lots of itching involved. With food allergies there can be trouble breathing, or even passing out. For the intolerant types who are non-allergic, it is sometimes fast, but the reaction is usually hours later and there usually isn’t a lot of itching. Symptoms may be more of an upset stomach, nausea, cramping.

What’s the most common food allergy?

There are five most common food allergies, in general: egg, cow’s milk, soy, wheat and peanut. For adults, shellfish, peanuts, and other tree nuts are probably the most common. For children, the most common tend to be egg and milk.

Is there any medication that someone can take to be able to eat food they are allergic to?

For the true food allergies, the standard recommendation is avoidance. Right now, we don’t have any recommended therapy that will allow a person to eat a food that they are allergic to. The good news is that the great majority of children outgrow their food allergies. I think in the future ways to desensitize someone to their food allergies will be looked at, but that’s not available or recommended yet.

Are there ways to prevent allergies?

We’re working on trying to prevent a child from getting an allergic disease in the first place. I conduct a Kaiser Permanente class called “Preventing Allergies In Your Child,” which is free and open to the public. People can call 432-2260 for more information. Pregnant women will benefit the most, especially if the parents have allergies. There are things that can be done in the environment that can reduce their child’s risk. Some examples would be breast-feeding up until age 6 months, avoiding tobacco exposure, and delaying introduction of certain foods. There used to be a recommendation to delay certain foods in a child’s diet such as eggs, milk and peanuts until they reach a certain age. But now the research doesn’t look like delaying those foods actually prevents that much. One other thing we talk about is the use of probiotics. Some studies show that if it’s taken in late pregnancy and during early breastfeeding, it can reduce the chance of eczema.

How do you develop an allergy later on in life (as adults)?

Most adult onset allergies tend to be reactions to medications that we take for other medical conditions as we age. Examples include antibiotic allergies to penicillin or sulfa drugs. These can be mild or serious but frequently involve skin rashes or hives. It is good to be aware that sulfa antibiotic allergies are not related to sulfites in wines that can cause wheezing. Another common medication allergy occurring in adulthood is to nonsteroidal anti-inflammatory medications (NSAIDS) such as aspirin or ibuprofen. In some individuals, NSAIDS can trigger asthma and sinus problems.

Can you discuss the new asthma guidelines?

The 2007 National Heart Lung Blood Institute guidelines talk more about asthma control as an important measure. That’s a short-term assessment of how much a person’s asthma symptoms are bothering them to decide whether their current regimen is adequate. You can take a free asthma control test at http://www.asthmacontrol.com as well as http://www.kp.org. It’s a simple five-question survey that will tell you if your asthma needs to be looked at by a physician. If your score is 20 or higher, that’s good, and if it’s under 20, then you should talk to your physician. The guidelines also stresses that medications that prevent asthma from flaring are important to take on a regular basis.