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December 18, 2024
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Q&A: Patients with allergies can stay safe during holidays by being proactive, aware

Fact checked byKristen Dowd
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Key takeaways:

  • Patients should plan ahead to deal with potential triggers.
  • Hidden triggers exist in holiday foods and decorations.
  • Physicians can help in differentiating between the cold, flu and allergies.

The holiday season is a time for celebration, but it is also a challenging time to manage allergies. From scented candles and seasonal plants to holiday foods and winter cocktails, navigating this festive landscape can be difficult.

Healio spoke with Gary Falcetano, PA-C, AE-C, U.S. scientific affairs manager at Thermo Fisher Scientific, about strategies to stay safe from allergies during the holidays.

christmas
Many traditional holiday foods contain common allergens and cooking can pose a risk for cross-contamination. Image: Adobe Stock

Healio: With the holiday season here, what are some of the most common triggers for individuals with allergies?

Falcetano: The holiday season, a time for family, friends, and festive meals, can pose unique challenges for individuals with allergies. Hidden food allergens are a primary concern, as many traditional holiday dishes contain ingredients from the “big nine” allergens: milk, eggs, peanuts, tree nuts, soy, wheat, fish, shellfish and sesame. Desserts often include nuts, eggnog contains dairy and eggs, and savory dishes may feature shellfish or soy. Cross-contamination is another risk, with shared utensils and cooking surfaces easily transferring allergens between dishes.

The holiday season also brings an increase in indoor allergens. Decorations such as ornaments, lights and Christmas trees (both real and artificial) often collect dust or harbor mold spores. Scented candles, a seasonal favorite with fragrances such as pine and cinnamon, can irritate the respiratory system, with their smoke and soot triggering rhinitis or asthma symptoms. Even as outdoor pollen levels drop, indoor plants such as poinsettias, holly and chrysanthemums can release allergens, causing issues for those who are sensitized and allergic.

Healio: How can health care providers (HCPs) help patients identify allergy triggers?
Falcetano: Identifying allergy triggers begins with a thorough patient history. HCPs can ask about exposure to the suspected allergens, the timing of symptoms and whether reactions occurred immediately or after a delay. These details are essential in pinpointing potential allergens.

Gary Falcetano

Once a patient’s history is established, testing can confirm suspected triggers. For potential allergic triggers such as molds, dust mites and pollens that are often associated with real or artificial Christmas trees, blood tests can be utilized to assess for allergic sensitizations. These blood tests can be ordered by any specialist or primary care provider who normally orders laboratory blood testing. Alternatively, skin prick tests, which are usually administered by specialists, can be performed to assess for allergic sensitizations as well.
such as milk, egg, peanuts, tree nuts, wheat and sesame can provide even greater insights. If the diagnosis remains unclear, then patients may be referred to a specialist for an oral food challenge, a supervised test where a patient consumes small, increasing amounts of a suspected allergen under medical observation. It’s used to confirm a diagnosis, assess severity or determine if reintroducing a food is safe.

Healio: Are there any hidden triggers that most people would not suspect that could cause an allergic reaction?

Falcetano: There are several hidden triggers that can cause allergic reactions, some of which might be surprising. These triggers can vary significantly from person to person.

One unexpected trigger is certain food additives, such as carmine red, a dye derived from insect protein. This additive can cause allergic reactions in some individuals, despite being found in a variety of processed foods.

Additionally, cross-contamination is a significant concern, particularly during the holidays. Shared cooking utensils, plates or even small amounts of milk in mashed potatoes can cause a reaction for individuals with specific food allergies.
“Christmas Tree Syndrome,” caused by mold spores, dust and pollen that accumulate on real or artificial Christmas trees. When these trees are brought indoors, handling them or the increased mold exposure can lead to respiratory symptoms or allergic reactions.

Healio: How can clinicians help their patients differentiate between allergy symptoms vs. a cold or influenza?

Falcetano: It is not always easy to tell the difference, especially since colds, flu and allergies all affect the respiratory system and share some overlapping symptoms. And of course, they can co-exist as well, adding to a patient's airway inflammation and symptom burden. But there are key clues that can help.
whereas allergies are an immune system reaction to a trigger, such as pollen or pet dander. Allergy symptoms tend to start as soon as patients are exposed to an allergen and last as long as that exposure continues — sometimes for weeks. Colds and the flu, in contrast to allergies, develop gradually and are typically accompanied by fever, fatigue and prolonged congestion —symptoms not caused by allergies.

Healio: Do some allergies get worse during the holidays?

Falcetano: Yes, some allergies can worsen during the holidays due to increased exposure to new or unexpected triggers. Traveling to unfamiliar environments, such as staying in a relative’s home or visiting new locations, can expose patients to both allergic and nonallergic triggers such as different cleaning products, pollinating plants or local environmental factors.

Healio: Can you elaborate on how holiday travel can cause a heightened risk?

Falcetano: Holiday travel can increase the risk for allergy and asthma flare-ups for several reasons. Travel often involves spending more time indoors in crowded spaces, such as airports, buses and hotels, where allergens such as dust, mold and pet dander can be more concentrated. Additionally, exposure to viral and bacterial pathogens increases the chances of developing an illness that can exacerbate airway inflammation and allergic symptoms.

Air travel can also be problematic, as airplane cabins have low humidity, which can dry out the airways and make the respiratory system more reactive to allergens. Furthermore, changes in routine, such as dietary shifts or exposure to foods with unknown or undisclosed ingredients, can be risky for patients with food allergies.

Healio: What can HCPs do to help patients manage these triggers?

As mentioned above, HCPs can help patients identify their specific triggers through a detailed medical history, allergy testing and discussion about patterns or reactions observed during travel or around certain activities. This can help pinpoint environmental, food or seasonal allergens.

Once triggers are identified, clinicians can develop personalized management plans. For environmental allergies, prescribing appropriate medications and guidance around how to avoid and/or reduce exposure to identified allergens will optimize control of symptoms, especially when traveling. For patients with food allergies, HCPs can provide guidance on reading food labels, avoiding cross-contamination and carrying emergency medications such as epinephrine injectors. They can also consider ordering food allergy component testing, which can provide patients with a deeper understanding of symptoms.

In addition, clinicians may advise practical strategies to minimize exposure, such as using air purifiers during travel, wearing a mask in crowded places and ensuring that accommodations are allergy-friendly. They may also provide advice on preemptively taking medications before traveling to reduce the risk for flare-ups.

By offering tailored advice, medication recommendations and proactive strategies, HCPs can significantly improve their patients’ ability to manage allergy and asthma triggers, ensuring a more comfortable and safer holiday experience.

Healio: Are there specific diagnostic tools available to HCPs for this issue?

Falcetano: Yes, there are several tools available to help clinicians determine whether symptoms are caused by an allergy, and they’ve come a long way since the first skin test was performed in 1872.

For allergies specifically, validated diagnostic tests such as specific IgE blood tests and SPTs are useful for diagnosing allergies. Blood tests measure allergen-specific IgE antibodies, providing a safe way to determine sensitization without the risk for triggering a reaction. They offer the added benefit of being unaffected by factors such as medications or skin conditions. Allergen component blood testing is especially useful for pinpointing specific allergens or proteins, such as those in peanuts or milk, and provides detailed information that may allow for a more precise diagnosis and management plan.

SPTs give immediate feedback by introducing small amounts of allergen to the skin and observing the reaction. Both specific IgE blood testing and SPT need to be interpreted carefully in context with the patient’s history because sensitization doesn’t always mean a clinical allergy.

It’s also important to note what doesn’t work. Unproven methods such as immunoglobulin G (IgG) testing or hair analysis can lead to misdiagnosis, unnecessary dietary restrictions and even harm. IgG, for example, reflects exposure to a food rather than an allergy and may even be linked to tolerance.

Healio: Do you have any other comments?
Falcetano: The holidays are a time to enjoy good food and great company, but for individuals with allergies, they can also present added stress. The key to navigating this season successfully lies in preparation and communication. For patients with allergies, it’s essential to understand triggers, plan ahead and take proactive steps, whether that means asking about food ingredients, ensuring the environment is as allergen-free as possible or avoiding exposure to common irritants.

Collaboration between patients and HCPs can make managing allergies more manageable, whether through identifying triggers, interpreting diagnostic results or finding ways to safely enjoy traditional holiday dishes and traditions.