University Health System Blog

Dr. Mary Beth Hogan answers the question: “What are the dangers of allergic reactions if I don’t seek medical treatment?”

There is no danger if an allergic reaction is confined to the skin. These reactions can be treated with antihistamines. However, on rare occasions, a highly sensitive patient may develop symptoms of a systemic reaction after allergen exposure.

Symptoms include itching of throat, nose, palms or skin, hives, flushing, feeling warm, dizzy, sneezing, runny nose, coughing, wheezing or chest tightness, nausea or vomiting and diarrhea. If this reaction is not stopped it can progress to difficulty breathing, a drop in blood pressure or even death.

It is not the presence of hives or extreme swelling of the skin or face that is concerning in these reactions, but the presence of symptoms relatable to difficulty breathing—throat closing off or wheezing—and decreased blood pressure—volume loss from vomiting or diarrhea or a direct drop in blood pressure with loss of consciousness—that can result in a fatality.

Studies have shown that survival after a systemic reaction is directly relatable to how quickly epinephrine can be given. So allergists currently recommend that all patients use their epi-pen and go to an emergency room immediately after developing any symptoms of a systemic reaction.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at the University of Nevada School of Medicine. Dr. Hogan is based out of Reno, Nevada.

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Dr. Dan Spogen answers the question: “I’ve smoked for more than 20 years. Recently I’ve had more difficulty breathing. Do I have COPD?”

COPD, or chronic obstructive pulmonary disease, is a lung disease that makes it hard to breathe. It’s caused by damage to the lungs due to time or environmental factors, such as smoking, which is the primary cause of the disease. It’s often characterized by shortness of breath, the inability to take a deep breath, and a lingering cough that brings up mucus. (More on COPD signs and symptoms.)

While some people eventually get COPD due to advanced age, smokers are the largest segment of society that contract the disease because the damage done to the air sacs in the lungs is accelerated to the point that many smokers start to feel the effects of COPD by age 50. The damage to the lungs due to smoking gets worse over time and cannot be cured, but future damage is stopped immediately if one quits using cigarettes. Exposure to second-hand smoke or smoking illegal substances also affects lung capacity and can lead to COPD.

The disease usually presents itself in one of two ways—inflammation of the airways, which also causes bronchospasm, that take air to the lungs due to the buildup of mucus, or damage to the air sacs in the lungs, making for a less efficient transfer of oxygen to the blood.

Medications, often in the form of an inhaler, are available to treat both conditions. Your family physician or internist can diagnose COPD and recommend an appropriate course of treatment.

Daniel Spogen, M.D. was named chair of the family and community medicine department at the University of Nevada School of Medicine in Reno, Nevada in October 2006. Before joining the medical school’s faculty, Dr. Spogen was in private practice for more than 20 years in northern Nevada. He helped launch fellowship programs in obstetrics and sports medicine at the medical school as well as serves as assistant student clerkship director.

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Dr. Mary Beth Hogan answers the question: “Why is my asthma worse at night?”

This is a frequent frustration for asthma patients who make doctor appointments for sick visits and by the time they arrive at the doctor they are no longer wheezing. It is commonly known that asthma symptoms may actually be worse at night rather than during the day.

There are several proposed reasons which may explain why asthma worsens at night. One such reason is that the body’s ability to control the root cause of asthma—swelling in the breathing tubes, or bronchioles—is less at night than during the day. The breathing tubes are also much tighter at night than they are during the day. In addition, exposure to allergens or other triggers during the day can cause swelling in the breathing tubes multiple hours later after the initial exposure.

Gastroesophageal reflux, or heartburn, is frequently worsened by lying down and reflux is a known trigger of asthma. Sleep apnea is a known trigger for asthma.

The effects of some asthma medications taken at bedtime can wane away overnight. This is particularly true for “rescue” medications such as albuterol which last approximately four to six hours before needing to be redosed.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at the University of Nevada School of Medicine. Dr. Hogan is based out of Reno, Nevada.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers the question: “Can thyroid disease affect your mood?”

Thyroid disease can definitely affect your mood. We often think that thyroid disorders affect only metabolism- weight gain if the thyroid is underactive and weight loss if overactive- but thyroid hormone is definitely active in the brain.

An overactive thyroid or hyperthyroidism may make one edgy or agitated, short-tempered, cause difficulty in sleep, cause problems in “focusing”, or even cause depression. Underactivity of the thyroid or hypothyroidism is more commonly associated with a “foggy” feeling, depression, and also with being “snappy” or short-tempered. Severe hypothyroidism can make one very fatigued.

It is important to remember that once the thyroid function has been returned to the normal range the effect of the disease on mood ends. Any mood issues that persist after the thyroid has been stabilized are not thyroid related and need to be evaluated separately.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Mary Beth Hogan answers the question: “Is it possible to develop a food allergy as an adult?”

It is possible to develop allergies as an adult. In fact, shellfish allergy is one of the most common foods for adults to develop allergy too. Approximately half of a percent of adults nationwide report allergy specifically to shellfish.

Anaphylaxis, a life threatening reaction, can also occur to foods in adults. They can even occur if there was no previous reaction to the food. They can also happen after a prolonged period of avoidance of the food. Symptoms of anaphylaxis are itching, facial swelling, tongue or throat swelling, hives, vomiting, diarrhea or stomach cramping, difficulty breathing, dizziness and fainting.

If your doctor feels that you are at risk for such a reaction, an epipen will be prescribed. At the first sign of these symptoms, use the epipen as directed and seek emergency help immediately. An epipen will not necessarily stop the reaction, but it will slow the reaction down so that you can reach emergency care. In addition, your doctor will teach you how to read labels and avoid hidden or trace amounts of shellfish in your diet.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at the University of Nevada School of Medicine. Dr. Hogan is based out of Reno, Nevada.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Mary Beth Hogan answers the question: “Is food intolerance the same thing as food allergy?”

Many people have abnormal responses to foods. Food intolerance refers to responses that are not caused by an overreaction of the immune system. For example, lactose intolerant people experience abdominal distension and diarrhea after drinking milk or eating dairy products. These symptoms occur because these people do not produce enough of the enzyme lactase in their intestine and cannot digest milk sugars properly.

Naturally occurring toxic chemicals in foods such as mushrooms, beans, cabbage, tomatoes, avocados, bananas, pineapples, cheeses and wines can also cause food intolerance reactions. These responses are not allergic because they do not involve the immune system.

What is food allergy? True food allergy occurs when the body’s immune system overreacts to the ingestion of a food substance that is usually harmless. The part of the food that causes the reaction, for example, the allergen, is generally the protein part of the food. Food allergy is present in only two to three percent of the pediatric population. Symptoms of food allergy can include any of the following—stomach cramps, vomiting, diarrhea, eczema, hives, facial swelling, throat swelling, wheezing and difficulty breathing. Severe reactions are potentially fatal.

Mary Beth Hogan, M.D. is professor of pediatrics and section chief  of pediatric allergy, immunology and pulmonary medicine at the University of Nevada School of Medicine. Dr. Hogan is based out of Reno, Nevada.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Evan Klass answers the question: “Can I use artificial sweetners if I have diabetes?”

Opinions about artificial sweeteners as it relates to diabetes are about as numerous as the stars. There’s no valid scientific evidence to conclude, however, that there’s a health danger to diabetics from using artificial sweeteners. The U.S. Food and Drug Administration allows their use. You might argue that one has more or less of an aftertaste than another but that’s a personal decision.

Sugar alcohols, such as sorbitol and maltitol, may cause intestinal cramps if you eat too much.

The argument that I find most interesting is whether it’s good or bad for people with diabetes to use artificial sweeteners because it allows them to get used to eating sweet things, which may make it harder for them to stick to their diet plan. I take the opposite position—I think it’s a good thing for people with diabetes to enjoy sweets without having to worry about the effects on their blood glucose.

Evan Klass, M.D. is an endocrinologist practicing in Reno, Nevada at University Health System. Dr. Klass completed his fellowship training in endocrinology at George Washington University Medical Center.

Have a health question? University Health System doctors answer select questions from readers like you.