Online Health Chat with David M. Lang, MD

Monday, March 28, 2016


Allergic disorders affect an estimated one in five adults and children (40 to 50 million people) and are the sixth leading cause of chronic illness in the United States, according to the Allergy Report from the American Academy of Allergy, Asthma and Immunology (AAAI).

One of the most common chronic diseases in the world, asthma has become more prevalent and more severe in recent years. Asthma causes the airways of the lungs (bronchial tubes) to narrow, the lining of the airways to swell and the cells that line the airways to produce more mucus. These changes make breathing difficult and cause symptoms such as cough, shortness of breath, wheezing, chest tightness and excess mucus production.

About the Speaker

David M. Lang, MD, is a professor of medicine and chair of the Department of Allergy and Clinical Immunology, co-director of the Asthma Center and director of the Allergy/Immunology fellowship for the Respiratory Institute. He is board-certified by the American Board of Allergy and Immunology, the American Board of Internal Medicine, and the National Board of Medical Examiners.

Previously, he was section chief of allergy/immunology in the Department of Medicine at Thomas Jefferson University in Philadelphia, Pa., division chief of allergy/immunology and co-director of the Allergy and Asthma Center at Hahnemann University. Dr. Lang also teaches evidence-based medicine at the Cleveland Clinic Lerner College of Medicine.

Dr. Lang has carried out a number of research projects. He has directed studies of the epidemiology of urban asthma, anaphylaxis and urticaria/angioedema.

Let’s Chat About Allergy & Asthma

Symptom Specific

grammol: I am a 67-year-old woman with an allergy to cat dander. Twice I had to go to the hospital for treatment due to difficulty breathing and a low oxygen level. As a result, I began seeing an allergist for injections. I have been getting injections for five years now, going every other week. I see a little improvement should I come into contact with a cat, but I expected much better results having received this therapy for so many years. I would like to discontinue. What are your thoughts? I have an EpiPen at home, and I carry loratadine disintegrating tablets with me.

David_Lang,_MD: To receive the optimal benefit of allergen immunotherapy (allergy shots) entails having a lower level of symptoms on contact with the relevant allergen(s) and less reliance on medication. It is not a cure. The decision to continue or suspend this treatment should be made via shared decision-making with your allergist.

sinaihospital: My allergies are acting very badly. Also, my asthma is back again. My coughing is not getting better, my eyes are very red, and my skin is itchy all the time. I’m due to see my allergist on May 6, 2016. Do you have any advice you can give to me please for my allergies and asthma. Thank you, doctor.

David_Lang,_MD: If your symptoms are not well controlled, scheduling an appointment with an allergist is the right next step, but it sounds like you would benefit from being seen sooner than May 6. If I or one of my colleagues can help you, please let us know.

mariearc2015: I have the bronchiolitis and bronchitis pattern of MAI. Is this a form of asthma? Can I do anything to make it better since I am out of breath every day? Thank you.

David_Lang,_MD: This is a separate condition from asthma, but may co-occur with asthma. If you are short of breath, you should contact your physician to determine whether you would be a candidate for a "step up" in therapy. I hope you feel better!

Medications for Itching

lightning#: Because of having sleep apnea, I was using a machine to breathe at night. I became sensitive to the silicone in the mask, causing hives and itching, which spread over most of my upper body. The itching continues and is annoying, to say the least. I have been diagnosed with Ehlers-Danlos syndrome/collagen disorder, and it was suggested that mast cell activation may have occurred. I'm looking for something to calm the itching. Can you suggest something?

David_Lang,_MD: There are three "second generation" antihistamines available over-the-counter: cetirizine, fexofenadine and loratadine. I would suggest that you seek further evaluation and management for the itching and the reaction to your mask.

loveitaly: My skin has always been very sensitive. If a mosquito bites me, it can develop a redness around the area or even spread. I had a severe urticaria three years ago from an insect bite in a garden that spread to the whole body with huge hives and itching. I began taking the tests for allergy about 12 years ago, and I got sick so we stopped the testing. I suffer from Meniere's disease and one of the medications I take on a daily basis is called betahistine. It is a compound medication prepared in the pharmacy for me, and it is not FDA approved, however, it has been used in Canada, Mexico and South America for decades. It is supposed to help with circulation in the inner ear. It is a histamine, however, so I am not supposed to take an antihistamine if I feel allergy symptoms. I try to avoid any situations that could cause my allergy symptoms. Do you have any suggestions for my situation? Thanks for your input.

David_Lang,_MD: The medication you are taking for Meniere's has antihistaminic properties, which should help with regard to your itching skin. The reactions you experience after a mosquito bite are unlikely to reflect a true allergy.

loveitaly: When you answered my previous question regarding the betahistine, they have told me it was a histamine. So, if it has antihistamine properties and I feel symptoms such as watery eyes, sneezing, etc., is it safe to take Claritin or Benadryl, too? I haven't taken anything else for years because I was misinformed. Thanks.

David_Lang,_MD: A commonly prescribed drug for Meniere's in the United States is Antivert. Betahistine is not approved by the FDA, as you noted, so I am not familiar with precautions concerning its use. However, fexofenadine is a second generation antihistamine that does not penetrate the blood-brain barrier. This should be effective and safe for your itching. Fexofenadine is available over-the-counter.

Defining the Diagnosis

rev98: How do I know if I have asthma? When I run, I get very wheezy and cannot breathe. Is this because of asthma or something else?

David_Lang,_MD: Exercise is a common provoking factor for asthma. If these symptoms interfere with your desire to engage in exercise or are occurring at other times, you should seek further evaluation and management with a physician. If these symptoms are due to asthma, the use of an inhaled medication in association with exercise can significantly reduce or eliminate the likelihood of these symptoms occurring, and allow you to exercise with impunity.

runnergrl: What types of tests do you use to diagnose asthma? For example, how can you tell if breathing difficulty if from asthma or a different condition?

David_Lang,_MD: Your breathing difficulty may reflect asthma if you develop chest tightness or wheezing with exercise, exposure to cold air or following a viral upper respiratory infection. A breathing test can be used to confirm or rule out the presence of asthma. A commonly used test is called "spirometry." If desired, an inhalation challenge with a substance called "methacholine" can determine in a definitive fashion whether you have asthma.

Preparation and Prevention

newmom1: I am pregnant and plan on breastfeeding. Is it true that my diet will affect my baby's allergies later in life?

David_Lang,_MD: There is no convincing evidence that your diet will significantly influence the development of allergy in your child. Congratulations on your pregnancy!

runnergrl: Do you recommend using air purifiers in the house or allergen-reducing filters on the furnace? I don't know if they actually work to reduce environmental allergies or if they are just a scam.

David_Lang,_MD: Air filters, particularly HEPA filters, may be effective for your symptoms, but there are other measures specific for allergens (e.g., dust mites, mold spores, cat or dog dander, etc.) that would be associated with greater benefit and reduction of symptoms.

gregk: What can I do to prevent an asthma attack from happening? I take my medicine as prescribed, but still seem to have severe attacks.

David_Lang,_MD: The occurrence of "severe attacks" despite taking regular medication implies that your asthma is not well controlled. This is an indication for you to have further evaluation and management with an asthma specialist. It is possible there are factors that are co-occurring with asthma or environmental exposures accounting for the poor control of your condition. It is also possible that you may need to "step up" your medication regimen.


That is all the time we have for questions today. Thank you, Dr. Lang, for taking time to educate us about allergies and asthma.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at

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