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Allergic to what? Cause of problem not always obvious

STORY AND PHOTOS BY CHARLIE SMITH AND ASSOCIATED PRESS

Feasting at a seafood boil leads to a bad reaction, and your first thought is that you’re allergic to shrimp.
But the real culprit can be a sneakier source: the seasonings.
“I had a gal who was convinced it was shrimp allergy. We had to break down all the spices in Zatarain’s crab boil to find out she was allergic to sage,” said Dr. Sam Sprehe.
The board-certified allergist with Greenwood ENT and Allergy Clinic sees it all when it comes to Delta allergies.
They can be divided into two main categories: things you inhale and things you eat.
Inhalants are divided into seasonals — trees, grasses or weeds that only cause trouble during a certain time of the year — and perennials, which are constant nuisances. Those include mold — which Sprehe said is a huge problem around here — as well as pet danders and dust mites.
Right now, grasses are stopping pollinating, and weeds are just starting, Sprehe said.
“So the summer kind of wanes a little bit,” he said. “Now because of the temperate climate of the Delta area, they overlap quite a bit because there’s not any specific seasons. Up north, you can really tell when summer starts and fall starts.”
When beginning an allergy practice here, Sprehe worked with Mississippi State to better specify sources of allergy problems in Greenwood.
“We pick up everything that’s sweeping up out of north Louisiana, east Texas, Arkansas. Anything that starts to the left and moves right, it’s going to hit us,” he said.
Mississippi State helped identify what species of trees and grasses cause problems here, leading to a more sophisticated panel given to test people who think they might have an allergy. It’s also resulted in giving allergy shots that are more specific to what people are allergic to, Sprehe said.
The first step in treating someone with a possible allergy is to take a long, careful history, Sprehe said.
Next he starts them on a non-drowsy, over-the-counter antihistamine.
“Claritin and Allegra are wonderful, and they used to be prescription drugs,” the physician said. “They don’t sedate anybody, and they’re relatively cheap. You can get a month’s  worth for less than twenty bucks at Walmart.”
A steroid nose spray is also used to stabilize the nasal membranes, so you don’t react so violently to whatever you’re allergic to. The sprays are used immediately after showers because the nose is open from the steam, Sprehe said.
That procedure is all 70 percent ever need, he said.
The rest require allergy shots.
The tests for allergies don’t require pin sticks anymore; doctors simply draw a blood sample.
They don’t take a shotgun approach of testing for every possible allergy.
“I can’t test for you everything at the grocery store. I’ll bankrupt you, and you don’t have enough blood,” Sprehe quipped. “We do things that make sense based on their diet.”
Patients complete a 10-page food diary of what they eat every day, giving doctors clues about what needs to be checked.
Managing allergies is key. Someone who is just allergic to grasses can take a nose spray and allergy pill beginning in May and stopping in September, Sprehe said.
With food, obvious ones can be avoided.
“If you’re allergic to shrimp, well, it’s pretty hard for somebody to slip you a piece of shrimp without you knowing you’ve eaten shrimp,” Sprehe said. “But if it’s corn or if it’s milk, those are tough. Those are hidden in a lot of stuff.”
Seafood allergies are very common in the Delta, Sprehe said.
“And that has to be broken down into crustaceans like the things that turn red when you boil them like crayfish, shrimp, lobster, crab, versus the other things like fish, bass, catfish,” he said.
Sprehe said workers from Heartland Catfish have been forced to retire or quit because they are allergic to touching catfish, even if wearing gloves.
Sprehe said there’s some cross-reactivity: If you’re allergic to shrimp, you might be allergic to related crustaceans such as lobsters or crayfish. But it doesn’t cross family lines to oysters or mussels, he said.
A freshwater bass caught in a pond in Carrollton could cause the same allergies as a sea bass on the coast, but it wouldn’t apply to cod at Long John Silver’s.
Peanut is a common allergy, but Sprehe said there’s no cause for concern with a peanut warehouse opening this summer in Greenwood.
“Yes, there’s going to be a lot of aerosolized material in the air, but we don’t really have any long-term studies anywhere to show that a peanut plant, any more than a cotton seed mill, is going to sensitize a population to an allergy,”  he said.
Sprehe said industries do a great job today of washing their byproducts so they aren’t released into the air.
“It’s not just belched out into the community. It’s not burped out all over town. These people are very responsible,” he said.
But he said someone with a peanut allergy might want to think about not working at the plant.

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