General Articles
Breathing Easy / by Juliet Porton / February, 2013

North Bay doctors explain what causes asthma and allergies, why an accurate diagnosis is so important and how to find the best treatment options for yourself and your family

Asthma and allergies affect a total of 60 million people in the United States, and those numbers are on the rise. The conditions can affect the health of both young and old, active and sedentary, in every part of the country. With billions of dollars being spent each year on related medications, hospital visits, sick days and decreased productivity, all that wheezing and sneezing is also leaving its mark on the nation’s bottom line. To better understand the two conditions, we’ve asked three North Bay doctors, who regularly treat allergies and asthma, to explain what causes them, why an accurate diagnosis is so important and how to find the best treatment options for yourself and your family.

A confused immune system

Allergies occur when our immune system overreacts to something we’ve eaten, breathed in, injected or touched. For reasons not fully understood, our bodies see that harmless substance, called an allergen, as an illness-causing invader to be fought off, and it will create the antibodies necessary to set off an allergic reaction. Those reactions run the gamut from simple (coughing, runny nose or sneezing to hives) to severe (inflammation of the airways or anaphylaxis, a possibly life-threatening condition).
We can be allergic to a wide variety of substances, and these allergies can develop at any age, seemingly without warning. The most common are indoor and outdoor allergies (sometimes called seasonal or nasal allergies), food allergies, drug allergies, skin allergies, eye allergies and allergies to insect bites or stings.
Asthma, on the other hand, is a chronic disease in which the airways of the lungs become inflamed, limiting the amount of air that can get to your lungs and causing wheezing, coughing and difficulty breathing. Doctors differentiate between two distinct types of asthma: allergic and nonallergic. In allergic asthma, symptoms are most often brought on by inhaled allergens, such as pet dander, mold or tobacco smoke. In patients with nonallergic asthma, common triggers are stress, exercise, changes in weather and viruses.
At North Bay Allergy & Asthma Associates, with offices in Napa and Sonoma, Dr. Larry S. Posner specializes in treating patients with allergies and asthma. A trained pediatrician (allergy is a medical subspecialty, with most allergists having backgrounds in either pediatrics or internal medicine), Posner originally became interested in treating these conditions after seeing the negative effects they often had on children’s school performance and overall health. He now treats patients of all ages.
“I tell people without allergies to imagine how you feel when you have a cold,” he explains. “Your head feels fuzzy, you lack energy and can’t concentrate. That’s what it feels like to have chronic allergies.”
Though the underlying causes of allergies and asthma are still unclear, genetics do seem to play a role. According to Posner, a child has a 35 percent chance of developing asthma or allergies if one parent is affected. Those odds rise to 50 to 60 percent if both parents have one or both of the conditions.
Up to 90 percent of children have allergic triggers for their asthma, a number that drops to 50 percent for adults, which may help explain why some children seem to “outgrow” their asthma as their immune systems develop. “About 40 percent of children will have a ‘remission’ of their asthma symptoms at some point in childhood, and about half of those will have asthma recurrence as adults,” explains Posner. “Kids who don’t have allergies are more likely to experience such a remission.”
It may also be true that asthma is not a single, isolated disease, he continues. “In 10 to 20 years, we may likely find that what we now call asthma is really five to 10 different diseases that had been lumped together,” says Posner.

A good diagnosis

Dr. Annemieke Austin’s family moved to the United States from Germany when she was a girl, in part because her own childhood allergies and asthma were so unmanageable. She now draws from that personal experience as a board-certified family physician and head of the allergy department at Gordon Medical Associates in Santa Rosa.
Austin’s first step in diagnosing allergies or asthma is to conduct a thorough patient history and physical exam during the first visit. Chronic cough, runny nose or sinus infections, or a history of childhood asthma or chronic ear infections, may be indications of allergic issues. Chronic bowel issues, chronic fatigue syndrome, headaches, depression and chronic skin conditions may also be related to allergies. If sensitivities are suspected, Austin conducts either a blood test or a skin test on a patient’s arm, in which proteins from potential allergens are injected under the skin a certain distance apart. (Numbing creams can be used for children or those anxious about the testing.) After 10 minutes, she can measure the size, and therefore the intensity, of any rashes, indicating an immune system reaction.
At Gordon Medical, doctors not only look at those immediate results, but also for any latent, delayed reactions. This means patients come back in after 24 and 48 hours to check on how those reactions have changed or whether new ones have formed. Austin believes this additional follow-up is vital to proper diagnosis. “It’s going back to the basic science we learned in medical school about the different kinds of immune responses,” she says. “I see a lot of people who have chronic sinus or ear infections or asthma, who’ve been told it has nothing to do with allergies, but it may be a delayed allergic response.”
Dr. Shiroko Sokitch, owner of Heart to Heart Medical Center in Santa Rosa and Novato, is a former emergency medical physician and surgeon who’s also trained extensively in Chinese medicine and acupuncture. In her practice, she strives to bring the best of both traditions to patients to improve their overall health. Sokitch believes in asking questions about all aspects of her patients’ lives, including their diets, exercise and sleep habits, and how their relationships and jobs are going. She then performs both traditional Western and Eastern-style medical exams. “In Chinese medicine, practitioners feel the pulse and look at the tongue to find signs of energy imbalances,” explains Sokitch. “The idea is that you’re made of energy, which travels through your body, and when energy is out of balance, health problems occur.”
Recognizing allergies in yourself can be difficult, especially because they can manifest themselves in so many ways. “You can just be chronically tired, or have a lot of headaches or stomachaches, but those could also be signs of an allergy,” she says.
When food allergies are suspected, all three doctors recommend trying an elimination diet, in which likely allergens are removed from the diet for several weeks, then slowly reintroduced, one at a time, so reactions can be noted.
Austin says she’s seen many patients improve their allergies and asthma just by getting off dairy. “Even if you’re not allergic to dairy products, they increase mucous formation and congestion, so allergy season is a good time to stay away from them,” adds Sokitch.
Many people are now trying gluten-free diets to alleviate a wide variety of allergy symptoms. Posner says that true gluten allergies are rare, but if you suspect a sensitivity, the best thing to do is get tested. “Our diets nowadays are too heavily weighted in carbohydrates anyway, so most people do feel better when they limit gluten and eat a more balanced diet,” he says.
Posner offers another good rule of thumb in diagnosing food allergies: True food allergies never cause isolated respiratory symptoms, such as a runny nose or sneezing. “The foods we eat get into our whole bodies, not just one place,” he says, “So unless you have other symptoms also, like gastrointestinal problems or a rash, it probably isn’t a food allergy.”

Finding the right treatment

Today there are more treatment options for allergies and asthma than ever, and more studies are being done on the effectiveness of alternative treatments. Of course, as each person’s needs are different, patients need to consult their own health providers before altering or beginning any course of treatment.
Posner says he’s seen great success in treating allergies in three main ways. First and foremost, he recommends testing to learn specifically what each patient is allergic to and then working to reduce exposure to those triggers. Second, he advocates the use of allergy medications, which have improved over the years to be more effective with fewer side effects. Third is immunotherapy, or allergy shots, in which patients are injected with increasing levels of a particular allergen, initially on a weekly basis then scaling back to monthly for a period of three to five years, letting their bodies develop immunity over time.
While Austin is a proponent of allergy shots and medications in certain situations, particularly when necessary for asthma control, she also believes in the use of sublingual (under the tongue) drops of isolated allergen proteins as a way to desensitize patients with allergies. After performing the latent reaction skin test, her office will create a single dropper bottle of proteins from each allergen, suspended in glycerin. Similar to allergy shots, amounts are slowly increased as tolerance rises (treatment generally spans one to four years).
Austin notes that similar treatments have been used for decades in Europe. “Sublingual treatment also tends to be easier because people are much more compliant, since they can treat themselves at home and don’t have to come in every week,” she says.
It’s important to add that if a patient has severe, uncontrolled asthma, Austin will wait until the asthma is controlled on medication before testing or treatment to avoid triggering a reaction. Even with treatment, patients may still need their inhalers or other medications, but the goal is to rely on them less. Austin also notes that allergies can sometimes be symptoms of other health problems, such as gastrointestinal or thyroid problems, and that treating those underlying issues can be key.
While stressing there’s no “one size fits all” treatment, Sokitch often employs a combination of acupuncture, herbs and nutritional supplements for allergies. “From the Chinese medicine point of view, it almost doesn’t matter what you’re allergic to, because the treatment is always to balance your immune system,” she explains. “Rather than trying to eliminate a particular allergy, the goal is to make your body strong so it can heal itself. It’s a much bigger picture.”
In acupuncture, small needles are inserted into the skin at precise points on the body’s energy pathways. For allergy treatment, it’s believed to strengthen the immune system, increase blood flow and minimize pain by stimulating our innate nervous system healing responses.
One supplement Sokitch recommends for allergies is N-acetyl cysteine, derived from the amino acid L-cysteine. “It’s good at breaking down mucous to open up ear and nasal passages and aids in loosening chest congestion,” she explains. “It’s also known for helping the liver do its job, which is a nice crossover to Eastern medicine, in which the liver is connected to springtime, our main allergy season.” Another supplement she often recommends is quercetin, a naturally occurring plant pigment found in such foods as apples, tomatoes and black and green tea, which works as an anti-oxidant and natural antihistamine. Sokitch also stresses that medication can be an important part of treatment for some people, especially those with asthma.

Separating fact from fiction

There are a lot of questions about allergies and asthma floating around. Are we really seeing a rise in allergies and asthma because of an overuse of cleaning products and hand sanitizers? Are seasonal allergies particularly bad in the North Bay? And can we really prevent allergies by eating local honey, as is sometimes advertised?
According to Posner, researchers have found a correlation between higher bacterial exposure rates in childhood and a lower incidence of allergies and asthma. This “hygiene hypothesis” seems to, at least in part, explain why rates of these conditions are rising in developed nations, with their heavy use of antibiotics and good sanitation, but are remaining relatively stable in less developed countries, where immune systems must work harder to fight germs—though it doesn’t account for the whole picture. New studies being conducted now will hopefully bring more conclusive data.
As to whether the North Bay is a particularly bad place for seasonal allergies, the answer is yes, though some spots are a lot worse. “Anywhere there’s agriculture, like here or in the Central Valley, there are two things at play,” says Sokitch. “First, a lot of chemicals are being sprayed on the land, which I think has a lot to do with why it gets worse and worse every year. Second, there are all those pollens from different plants flying around and we can’t get away.”
Austin also points out that our rural valleys, with their damp morning fog and afternoon heat, are a perfect breeding ground for molds and naturally occurring yeasts. The valleys also trap air pollution, like fireplace smoke, that’s dispersed easily closer to the coast. And unfortunately, honey hasn’t proven itself to be a viable cure for allergies, as it’s often the bee pollen that many are allergic to.

Staying one step ahead

Your best defense against allergies and asthma is to be prepared, both by keeping your immune system strong and by having a treatment plan in place. Sokitch encourages her patients to schedule a “tune-up” appointment to strengthen their immune systems before flu season or allergy season rolls around.
“Seasonal allergies are fairly predictable each year, so we look at treating people by the calendar, not just by how they feel,” says Posner. “We know these viruses are going to go around and these pollens are going to come out. So let’s develop a strategy about how to treat them and stay one step ahead of the game.”
Education is another key component to finding the best treatment for you. Austin and her colleagues host free public lectures on health topics, including allergy treatments, at their offices on select Thursday nights. “People should understand that they don’t have to suffer,” emphasizes Posner. “There are so many effective therapies available that can really turn their lives around.”

Resources and Further Information

North Bay Allergy & Asthma Medical Associates (707) 258-8100 (Napa); (707) 996-0212 (Sonoma)
Gordon Medical Associates (707) 575-5180;

Heart to Heart Medical Center (707) 524-9640 (Santa Rosa); (415) 895-5068 (Novato);

Sonoma County Asthma Coalition:

American Academy of Allergy Asthma and Immunology: