1. Will my asthma turn into emphysema?

No, asthma and emphysema are two separate conditions. Asthma, unlike emphysema, is usually reversible. However, we have recently learned during the last 10 years, that in some cases asthma left untreated can result in permanent lung damage with obstruction that is not reversible. This is one of the reasons why we treat asthma so vigorously - to lessen the chance that permanent lung damage will occur. This type of lung damage is distinct from emphysema but can still produce significant impairment.

2. If I have allergies, will my child also have them?

We know that the predisposition to allergies is genetic. While we are not sure of the exact mechanism of inheritance, we know that children born to allergic parents have an increased risk of developing allergy. The exact risk has not been established but one can consider that approximately one-third to one-half of children born to parents where only one parent is allergic will have allergies, and 50 to 70 percent of children born to parents both of whom have allergies will become allergic.

3. Are there breeds of dogs or cats that are less likely to produce allergy?

No. If you are allergic to cats, you'll more than likely be allergic to all varieties of cats. The same holds true for dogs. The allergen that produces the symptoms is shared amongst all breeds. (There is some evidence to indicate that people might be slightly less allergic to certain breeds of dogs, but usually there is significant allergy no matter what breed is considered.)

4. Can I take allergy shots for poison ivy?

Theoretically, desensitization or allergy shots to poison ivy can be accomplished; however, practically it cannot be done. It has been tried in the past, and the side effects have been too great to warrant widespread use. Thus, at the present time, there is no available desensitization program for poison ivy or poison oak.

5. I catch three to four sinus infections a year - can I do anything about this?

What most people do not understand is that sinus infections (probably more accurately called "upper respiratory tract viral infections") are not abnormal. That is, the average American adult catches about three per year and the average American child as many as nine per year. Viruses cause all sinus infections. At the present time we do not have any adequate preventive measures to keep people from catching these infections. Thus, there is nothing we can do at this point in time to minimize or prevent these types of infections. However, the good news is that research is being done in this area and hopefully in the foreseeable future we may have the means of preventing or diminishing the severity of these afflictions.

6. Why can't I take drops underneath my tongue rather than shots for my allergies?

The studies that have looked at the effectiveness of drops underneath the tongue for the treatment of allergies have shown that this treatment, as presently practiced, is ineffective. There is research being done on oral desensitization which may, in the future, result in the development of effective oral vaccines. At the present time however, drops underneath the tongue are neither appropriate nor effective therapy for allergies.

7. Do allergies cause chronic fatigue syndrome?

Allergies per se do not produce fatigue. If you have strong allergic reactions (i.e., sneezing, itchy eyes, and/or wheezing), you might feel fatigued. However, you do not become fatigued from allergies alone - only from the degree of symptoms they produce. It is worth noting, however, that in one study, people with chronic fatigue syndrome had a higher incidence of allergy than the population as a whole. Whether or not this has any significance is not known.

8. I have had reactions to many antibiotics. Can you test me and tell me which I can and cannot take?

Unfortunately there is no panel of allergy tests for antibiotics that will give us accurate information. We are able to test to some antibiotics, for example penicillin and some of the cephalosporin drugs, under certain circumstances. However, we could not test you on a panel of these drugs and accurately predict which you could or could not take. We usually reserve testing for specific instances when an antibiotic to which the patient has demonstrated an allergy is an absolute requirement, and no other antibiotic will suffice. Part of the difficulty is related to the fact that a single testing produces a result that is only good for the next administration. Thus, for example, you could develop an allergy to an antibiotic after taking it a couple of times and therefore tests, in most instances, do not give a "carte blanche" lifelong guarantee that you will not develop an allergy to a given antibiotic. Thus, they are best used for isolated cases where no substitution can be made and the antibiotic is necessary for the patient's good health.

9. I am 40 years old and have asthma for the first time. How could this happen?

It is a common misconception that asthma is a disease that affects only children. Asthma can have its onset at any time during life, and in fact, a very large percent of asthmatics have their illness begin after age 40.

10. I have asthma, but you said that I dont have allergies. How could this be?

One can have asthma without any allergy whatsoever. Asthma is not actually a disease per se; rather, it is a condition with many causes. For example, it is not like tuberculosis, an infection with a single cause - the tuberculosis organism. It is rather an abnormality of the lung that can be triggered by many different things. These things include weather conditions, irritants such as cigarette smoke, and upper respiratory tract infections. A significant percent of asthmatics also have allergies as a trigger of their illness. This is usually more common in younger asthmatics. Many people who have asthma as adults, especially those whose asthma begins as an adult, have no allergies whatsoever. In addition, almost all asthmatics, even those who have a great deal of allergies, will have their asthma triggered by other things. The universal response of the lung in asthma, regardless of the trigger, is swelling of the lining of the bronchial tubes, a closing down of the tubes because the muscles surrounding them contract, and an excess production of thick, tenacious mucus.

11. Why are my symptoms worse at night?

We are not 100 percent certain as to why respiratory symptoms worsen at night. We do know, however, that both nasal symptoms and lung symptoms are almost always worse at night. Thus, whether you have rhinitis or asthma, we can expect that the symptoms will be worse at night. There are several theories as to why this occurs. One theory is that the worsening is due to our diurnal hormonal cycles. We manufacture certain hormones in larger amounts during the day than at night. It is thought that these hormones, especially cortisol, are protective and diminish respiratory symptoms. Thus when they are at low levels we are more likely to have problems. Also, there is another hormone, epinephrine or adrenaline, that follows the same pattern - lower at night than during the day. Adrenaline is also protective. In addition, our blood histamine level goes up at night. Finally, the cells, known as eosinophils, that produce respiratory symptoms when they enter the lung and nose seem to do so easier at night. This may be because of the lack of protective hormones as well.

In addition, we know that when we lie down our nose stops up. This is a reflex produced by pressure on the skin. When we lie flat on our back, both nostrils will close. When we lie on our left side, the left nostril will close, and when we lie on the right side, the right nostril will close. These are reflexes produced by the pressure of the bed sheet on the skin. It has been called the "crutch reflex" because if you put pressure underneath your arm with a crutch, the nostril on that side will close. A similar mechanism is thought to account for the changes that occur when we lie down.

12. Will moving to a different area help my symptoms?

This is somewhat unpredictable. We do know that sometimes people with respiratory disease, either sinusitis, rhinitis, or asthma, are benefited by a move to a different climate. However, this does not occur with any consistency. It is impossible to predict, in a given patient, which climate might be better. Nonetheless, we do know that being very near the ocean benefits some people and others seem to do better in a dry desert climate. We do not know the reasons for this. Usually the only way that one can tell for sure whether or not a change of climate might be helpful would be to actually visit the place for a reasonable length of time and try and detect whether or not the change is helpful to them. This can be tricky, however, since whether or not one improves might be due to the time of year they visit. Thus, it is quite often difficult for a physician to recommend a move with great confidence. With that said, many patients know that they are better in certain climates. In such instances, when this has occurred on a consistent basis, we can assume that a move might be beneficial.

13. Will my asthma go away or resolve by itself?

We know that childhood asthma can subside spontaneously - usually around puberty or shortly thereafter. This occurs in a significant number of cases. On the other hand, adult asthmatics rarely undergo remissions. In adults with asthma, the disease is almost always lifelong although there have been recorded cases of spontaneous remissions.

14. When I stop my allergy shots, will I maintain the same degree of relief?

We know that allergy shots can produce a prolonged remission in symptoms even after they are stopped. We know that many patients maintain the degree of relief they have achieved lifelong, and it is not uncommon at all for this relief to last years. However relapses can occur and some patients, on occasion, resume injections after having stopped them. Unfortunately we are unable to determine, at the initiation of allergy injection therapy, which patients will respond for sure and which patients will maintain relief once the injections are stopped.

15. How long will it take for the allergen from my cat to be gone from my home once the cat is removed?

We know that the levels of cat allergen drop quickly once the cat is removed from the home, but unfortunately the allergen level can remain in moderate quantity for up to six months. In addition, cat allergen can remain in a mattress (where the cat has laid) for years. We know that many patients get total relief of their allergy symptoms when they remove a pet, such as a cat, from the home, but it is still oftentimes necessary for them to remain on medicine for a few months until the amount of cat allergen in the environment reaches levels insufficient to produce symptoms.

16. My child is allergic to cats and dogs - can we have a gerbil?

Probably not. Allergic people tend to react broadly to mammals. Thus, all hairy or furry pets have the potential to produce allergy symptoms. We normally therefore advise that allergy patients have non-furry or hairy pets, such as fish, in their home.