Allergic and Asthmatic Conditions – Advice from Leading Specialists

 The information below is entirely based on the authoritative medical reference The Washington Manual of Allergy, Asthma, and Immunology, 2nd Edition (2013), edited by Dr. Shirley Joo and Dr. Andrew L. Kau—both prominent experts in allergy and clinical immunology at Washington University School of Medicine in St. Louis, USA. This publication is the collaborative work of numerous physicians, educators, and researchers with extensive clinical and academic experience, combining the latest scientific knowledge with practical approaches to diagnosing, treating, and monitoring allergic and immunologic diseases.

This guide offers answers to key questions that any patient with an allergic condition might ask. The goal is to provide short, science-based, and easy-to-understand explanations that address the everyday needs and concerns of patients.

“The most important step toward a correct diagnosis of allergic diseases is a carefully taken medical history—it is the key to effective treatment.”

Experts Weigh In 

Allergic diseases—including allergic rhinitis, asthma, urticaria (hives), and food or drug allergies—are affecting more and more people worldwide. This rising prevalence makes it essential for patients and their families to have access to reliable and understandable information from leading medical specialists and researchers. Below, we present five expert opinions and key takeaways from the authors of The Washington Manual of Allergy, Asthma, and Immunology, each with its own focus, to give you the most useful, practical, and up-to-date insights into the most important aspects of diagnosing, treating, and monitoring allergic conditions.

1. Why is taking a medical history so important in diagnosing allergic diseases?

“As with most disorders in medicine, the most important component in diagnosing allergic disorders is taking a thorough history. Identify the symptom location, character, and frequency, as well as the alleviating and exacerbating factors. Exacerbating or alleviating factors: Seasonal variation of symptoms, prior response to medications, reactions to specific and nonspecific exposures (pets, smoke, irritant fumes, perfume, food, medications, etc.).”

Explanation: A proper diagnosis of allergic conditions starts with a well-taken history—a complete description of your symptoms, how often they occur, and their specific characteristics, along with what makes them better or worse. Even the best tests can be misleading without a solid medical history, so share every detail with your doctor, including your home environment, diet, contact with animals, seasonal changes, and reactions to medications.

2. What role do heredity and environment play in the development of allergies?

“Allergic diseases have a strong hereditary link. A parental history of allergic rhinitis increases a 6-year old’s odds of allergic rhinitis by 1.84. A parental history of asthma increases a 6-year old’s odds of asthma by 2.72... Environmental exposures exacerbating symptoms may not be obvious to the patient... Typical questions that may help to identify relevant exposures include: location of home (rural, urban, suburban), work exposures, hobbies, water damage, visible mold, pets, age of mattress/bedding, carpeting.”

Explanation: Genetics plays a significant role in the risk of allergic diseases, but environmental factors are also extremely important. If allergies or asthma run in your family, your risk is higher—but that risk is also influenced by lifestyle, home and work environments, the presence of mold, old carpets, pets, and more. When allergies are suspected, consider all these factors.

3. What are the most reliable methods for diagnosing allergies?

“Skin testing is the most rapid and specific method to test for allergic sensitivity. In vitro testing (radioallergosorbent test [RAST] and ImmunoCAP) is designed to screen for the presence of allergen-specific immunoglobulin E (IgE) in the patient’s serum. These methods have lower sensitivity and specificity compared to epicutaneous skin testing but are helpful in instances where skin testing cannot be performed.”

Explanation: Skin tests are the fastest and most accurate way to identify allergic sensitivities. When skin testing isn’t possible for medical reasons, blood tests for IgE (such as RAST) can be used. While they’re less sensitive, they may still be the only available option. Remember that test results should always be interpreted in the context of your symptoms.

4. What are the most up-to-date approaches for treating allergic rhinitis and sinusitis?

“Intranasal steroids are the mainstay of therapy. They are considered superior to all other medication choices for allergic rhinitis because they help prevent both early and late-phase response. Oral antihistamines are also commonly used. Nonsedating second-generation antihistamines include loratadine, desloratadine, fexofenadine, cetirizine, and levocetirizine. Environmental modification: Dust mite proof covers for mattresses and pillows, vacuum with a HEPA filter, wash linens in hot water, indoor humidity <50%, hard surface flooring is preferable.”

Explanation: Intranasal corticosteroids are the most effective medications for allergic rhinitis, often used in combination with second-generation non-drowsy antihistamines. Just as important is reducing allergen exposure at home: use allergy-proof covers, wash bedding in hot water, keep humidity under 50%, and minimize carpets and other soft surfaces.

5. When and why should you see an allergist?

“There are multiple indications for referral to an allergist-immunologist... Rhinitis with prolonged, severe disease and comorbid conditions such as asthma, recurrent sinusitis, nasal polyps. Symptoms interfere with quality of life or ability to function. Current medications are ineffective or associated with adverse reactions. More education is needed. Patient requests consultation.”

Explanation: You should see an allergist if your symptoms are severe or long-lasting, if you have related conditions like asthma or chronic sinusitis, or if your current treatment isn’t working or causes side effects. You may also simply need more information or want a specialist’s opinion.

Questions and Answers

1. What are the most common symptoms of allergic rhinitis, and how can I recognize them? Answer: The most common symptoms include sneezing, a watery runny nose (rhinorrhea), nasal congestion, itching in the nose, throat, or ears, postnasal drip (mucus draining down the back of the throat), and frequent tearing or itchy eyes. In young children, you might notice the habit of rubbing the nose with the palm (“allergic salute”) and dark circles under the eyes (“allergic shiners”).

2. What risk factors increase my chances of developing an allergy? Answer: Risk factors include a family history of atopic diseases (such as allergies, asthma, eczema), high serum IgE levels in early childhood, being a firstborn child, living in homes with high allergen exposure (like dust mites, mold, or pets), and early exposure to cigarette smoke and other irritants.

3. Does a positive skin or blood test always mean I’m allergic to that allergen? Answer: Not necessarily. These tests show “sensitization”—an immune response to an allergen—but that doesn’t always mean you’ll have symptoms. You could test positive and not react at all in real life. That’s why test results must always be interpreted together with your symptoms and medical history.

4. What can I do at home to relieve symptoms besides taking medication? Answer: In addition to medication, many environmental changes can reduce your exposure to allergens: use allergy-proof covers for mattresses and pillows, wash linens in hot water, maintain humidity below 50%, use a vacuum with a HEPA filter, remove carpets, limit contact with pets, and air out rooms when pollen counts are low. For hay fever, keep windows closed during high-pollen seasons and avoid outdoor activities on dry, windy days.

5. What are the potential complications if I don’t treat my allergic rhinitis properly or on time? Answer: If left untreated or poorly managed, allergic rhinitis can lead to chronic sinusitis, middle ear infections, nasal polyps, and medication-induced rhinitis (from overusing nasal sprays). It can also cause sleep problems, chronic fatigue, difficulty concentrating, mood changes, and a significant reduction in quality of life.

Conclusion 

These answers reflect the leading expert opinions and current medical guidelines presented in The Washington Manual of Allergy, Asthma, and Immunology, created by physicians and researchers with years of experience in the field of allergy. Whether it's symptoms, risk factors, diagnosis, home care strategies, or potential complications, every patient deserves clear, evidence-based information. Being informed is the first step toward better self-monitoring, more effective communication with your doctor, and active participation in your own care. For any additional questions or uncertainties, always consult a specialist in allergy or clinical immunology.

Source: The Washington Manual of Allergy, Asthma, and Immunology, Editors: Shirley Joo, MD; Andrew L. Kau, MD, PhD; Washington University School of Medicine, Second Edition, Lippincott Williams & Wilkins, 2013. https://www.amazon.com/Washington-Allergy-Immunology-Subspecialty-Consult/dp/1451113676?utm_source=chatgpt.com