You can stay away from insects. The trick is persuading them to stay away from you. You can reduce your chances of a disastrous encounter by following the steps in the earlier box.

Given the numbers and agility of our flying and crawling pests, however, you can’t be sure you will never experience a surprise attack. To be on the safe side, doctors recommend that anyone who has a past allergy to venomous insects and who shows a positive skin test receive immunotherapy (also called hyposensitization or desensitization). Immunotherapy is vaccination against bites and stings. Starting with a weak dose, extracts of insect venom are injected regularly, and increased in strength until you can tolerate the amount expected from a bite or sting. Then you receive regular injections to maintain tolerance -weekly during the insect season and every two or three weeks the rest of the year. (Immunotherapy for mosquito bites is fairly successful, but less effective than injections for bee stings.)

Immunotherapy with insect venom is fairly safe, even for children. Nevertheless, it’s reserved for people prone to severe, life-threatening reactions. And since no medical treatment is 100 per cent effective, allergists strongly urge allergic people to carry insect-sting kits (available by prescription) as a backup even if they’re receiving immunotherapy. The kits contain adrenalin and other emergency drugs to stop a reaction. Other doctors go so far as to advise anyone who has suffered even mild symptoms of an allergic reaction to bites or stings to carry the kits. Keep one handy all the time: in your home, in your car and so on.

It’s also wise to wear a medical warning tag or bracelet to alert medical personnel that you are indeed allergic to insects. In the event that you pass out or become incoherent after a sting or bite, precious time will be saved. Your symptoms won’t be confused with those of a heart attack or other illness.

We realize that even with an insect-sting kit tucked away in the picnic basket, anyone who is allergic will still recoil at the sight of a bee or mosquito. But knowing exactly what to do should take some of the anxiety out of venturing into their domain.

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Aspirin. Aspirin is the commonly used name for acetylsalicylic acid (ASA). Although aspirin didn’t show up in the Boston study of allergic skin reactions, aspirin and related compounds are the second most likely drugs to trigger allergy.

Aspirin allergy (which, for some unknown reason, most often affects women) commonly afflicts the skin, resulting in hives. Until a few years ago, many doctors thought that nasal polyps were also a hallmark of aspirin allergy. Now, however, many doctors believe that’s not so.

Aspirin does seem to produce asthma, though: one out of five asthmatics has aspirin to blame. Your airways tighten up. You wheeze heavily. Your nose continues to run like a broken tap. And quite often your skin reddens and you suffer giant, puffy hives. But the lungs and nose don’t have exclusive rights to aspirin allergy. Occasionally, aspirin-sensitive individuals experience intestinal cramps or other abdominal discomfort, diarrhoea and vomiting. A few experience tremors, rapid heartbeat, constipation – even headaches. But runny nose, asthma and hives are the most common reactions, and the pattern is fairly predictable.

Aspirin allergy does not necessarily occur alone. In one study, 75 per cent of people allergic to aspirin were also sensitive to inhalants (such as pollen and dust), 74 per cent were allergic to some sort of food and 43 per cent were allergic to other drugs (Annals of Allergy). As a matter of fact, it’s quite common for allergy to aspirin to be accompanied by allergy to other pain relievers (analgesics). (These dual allergies are called ‘cross-reactions’.)

El02, or tartrazine, often causes serious problems in people who are allergic to aspirin. The two compounds seem to cross-react. By law, drugs that contain tartrazine must list it on the label.

People allergic to aspirin and aspirin compounds may also be allergic to certain foods containing natural salicylates (which have also been linked to hyperactivity). These foods include apricots, berries, cherries, cucumbers, currants, grapes, nectarines, peaches, plums and tomatoes.

Children are not exempt from aspirin allergy. Dr Cecil Collins-Williams and a colleague tell of four children with poorly controlled asthma who began to wheeze within half an hour after taking aspirin. ‘When [aspirin] compounds were removed from their diet, there was a dramatic improvement in their asthma,’ write the doctors (Annals of Allergy).

Aspirin shows up in a variety of over-the-counter remedies for headache pain, menstrual discomfort, sinusitis, backaches, stomach upsets and other aches and pains. Read all the labels of over-the-counter products if you are allergic to aspirin. And quiz your dentist about any treatments you receive; some dentists insert aspirin-containing wicks into tooth sockets during dental repair work.

Vaccines. Flu shots, made from influenza virus cultures on egg, provoke a reaction in anyone who is highly allergic to eggs. Although these vaccines are highly purified, traces of egg occasionally cling to the virus. For this reason, authorities at the national Centers for Disease Control in Atlanta say that people who are highly allergic to eggs shouldn’t receive flu injections.

That applies to people who, when they eat eggs, develop swollen lips or tongue, have dramatic breathing difficulties or collapse in shock.

Insulin. During the first few weeks of insulin therapy, many diabetics experience a slight skin irritation at the site of the injection that usually subsides in a matter of time. Some diabetics, however, experience larger, more troublesome reactions that never let up. The injection site can be itchy, watery or painful to touch. Worse, the person may feel sick or go into anaphylactic shock. Insulin is made from extracts of either beef or pork pancreas, so if a diabetic seems to be allergic to insulin from one animal, doctors may test insulins from the other. If that doesn’t do the trick, some diabetics are able to control the disease by eating a carefully planned diet or by using less powerful drugs that are taken by mouth, or doing both.

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Seven million pounds of formaldehyde are produced each year. Obviously, it’s not all used to preserve lab specimens in school biology classes. The colorless, pungent liquid winds up in a variety of widely used products, from plywood and rugs to permanent-press clothing. Chemically, formaldehyde is fairly unstable – it easily breaks down into a toxic gas that seeps into the air and causes illness. The theory that explains formaldehyde sickness says that the inhaled molecules of the gas combine with a protein in the respiratory tract to form another substance capable of triggering the immune reaction we know as allergy.

Classic symptoms of short-term formaldehyde exposure are burning eyes, headaches, itchy skin or rashes, chest pain, a runny nose or nasal congestion, dry cough, nausea and a sore throat. Diarrhoea and asthma may also be a problem.

‘Since [formaldehyde] is so ubiquitous, common respiratory diseases such as asthma and other phenomena such as allergic dermatitis may be more frequently associated with formaldehyde than is currently realized,’ says Dr Ralph E. Yodaiken of the Centers for Disease Control, in an editorial for one of the most widely read medical journals in the US.

A case of formaldehyde-induced illness that affected hundreds of people occurred at a new administration building at a state college in Pennsylvania. After working in the office for three years, secretaries and administrators alike began to experience the symptoms described above. They would get progressively worse during the day, but feel better at night and on the weekends. When winter came and the heating system was turned on, people felt even worse. A squad of consultants was called in to conduct tests. The cause was narrowed down to formaldehyde gas generated by furniture and by bookshelves made from laminated chipboard and plywood (two common sources of formaldehyde).

As with so many new homes and office buildings, energy-saving measures had cut fresh air to practically nil. So part of the ‘cure’ was to open the windows, flooding the entire building with outside air for two weeks. The offensive desks and bookshelves were also replaced. After being left vacant for a full year, the building was eventually reopened. The staff resumed their work – without symptoms.

That scenario has repeated itself again and again in office buildings from Washington, D.C. to Los Angeles. And evidence now shows that long-term exposure to formaldehyde may cause cancer. Several doctors we spoke to express the hope that if consumers voluntarily avoid formaldehyde-laced products, manufacturers will be reluctant to put them on the market in the first place.

But for now, you’ll have to be your own formaldehyde watchdog. Read labels before you buy. Look carefully: formaldehyde may be disguised as formol, methylene oxide or formalin. Here are some other tips.

• If you’re doing any home building or remodeling, it may be worth your while to spend extra money for solid, genuine wood instead of chipboard and plywood.

• If your house already has lots of plywood and chipboard – in partitions, wardrobes, cupboards and furniture – paint the surfaces with a low-permeability paint.

• Instead of formaldehyde-soaked carpeting, use washable cotton rugs on your floors. (They also cut down on dust and mould.)

• Before buying a house, check to see if it’s foam insulated. If it is, keep shopping – or plan to have the insulation removed.

• Ventilate your house.

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Speaking of children, youngsters tend to have more food allergies than adults. It’s never too early to take steps to prevent those food allergies. Even what women eat during pregnancy can head off eventual sensitivities.

‘If you do the right thing early enough, allergies can be controlled,’ Dr Falliers told us. ‘I have so many examples. I’ve seen some of the worst asthmatics have three or four very healthy children.’

Food allergies may be passed on to the developing foetus by way of the placenta. Expectant mothers should avoid highly allergic foods or foods to which they know they’re allergic.

And of course, doing the ‘right thing’ after childbirth includes breastfeeding, if at all possible.

‘I’ve found time and time again that children who are nursed for at least the first year or fifteen months of life develop substantially fewer allergies,’ says Dr Stigler. ‘Starting with the infant, the only milk I want children to have is breast milk.’

The longer an infant stays away from cow’s milk, the less apt he or she is to become allergic to milk – or anything else, for that matter. As we mentioned withholding cow’s milk from babies’ diets may even prevent nonfood allergies – such as dust and pollen sensitivities – later in their lives.

An editorial in the medical journal, Lancet, points out that there’s something about cow’s milk that encourages sensitivity to environmental allergens of all kinds. Perhaps, suggest the authors, it’s because of milk’s effect on the intestine. In any case, they encourage breast-feeding in no uncertain terms: ‘. . . children born to allergic parents would be better off without the acquaintance of cow’s milk and dairy products in the first six months. We must be sure that simple practical advice about this now reaches the many parents whose children will be genetically predisposed to allergy.’ (Lancet,)

There’s nothing as good as breast milk,’ Dr Falliers told us, adding, ‘I could talk for the next hour about the reasons for breast-feeding – not simply to avoid allergy to cow’s milk, but to provide antibodies that help the white cells resist disease.’

Twenty years ago, I was batting about 50 to 60 per cent in getting mothers to breastfeed,’ said Dr Stigler. ‘Now, I think I have only two mothers in my practice who are not breastfeeding. So, it’s up to 95 per cent or better at this point. It’s not 100 per cent because there’s the uncommon person who doesn’t want to. And there’s the rare person who can’t’

Suppose the nursing mother has allergies herself?

‘If the mother has food allergies, she must avoid allergic food to avoid transmitting her allergies to her baby,’ Dr Stigler told us. Nursing babies may not inherit the same identical allergies. Mum may be allergic to corn and the baby may be allergic to something else. Even if Mum doesn’t have food allergies, though, what she eats can affect her breastfed baby. ‘Wheat comes out in breast milk. Soy comes out in breast milk. Cow’s milk comes out in breast milk,’ says Dr Stigler. ‘For example, the colicky breastfed infant is most often allergic to milk – not the mother’s milk but the cow’s milk the mother is drinking. Take the mother off cow’s milk, and the baby is well in two or three days.’

Either way, nursing mothers, like pregnant women, should avoid foods to which they know they are allergic or to which their baby is likely to become allergic – especially cow’s milk. To compensate for that source of calcium, Dr Stigler asks nursing mothers to continue to take the calcium-containing supplements routinely prescribed during pregnancy, and to eat other dietary sources of calcium.

When the time comes to introduce solid foods into a baby’s diet, don’t blitz the child with several foods at once. Single foods should be added one at a time to check for tolerance before adding subsequent foods. A Rotary Diet, in fact, is an excellent way to head off food allergies in children born to allergy-prone parents.

The best answer is for mothers to breastfeed their babies for a full year,’ Dr Randolph told us. Then hold back on the speed with which they introduce new foods. And when they do add them, rotate. For instance, instead of feeding a mixed cereal three times a day, give oats once every four days, rice once every four days, wheat once every four days and so on. A Rotary Diet should be used from infancy on.’

In other words, food allergies may run in families – but they don’t have to.

Your strategy against food allergies will be all the more successful if you pursue it as a game in which you are pitted against a crafty but not invincible opponent. Using the tactics and ‘inside information’ given here, you can score a victory.

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If you’ve tried the basic elimination diets and still aren’t satisfied that all of your food allergies have been identified, continue to test individual foods in the approximate order (most often to seldom). For instance, to test beef, eliminate beef in all forms for three weeks. Then eat generous portions of beef for three consecutive meals. If allergic symptoms develop, stop eating beef. If allergic symptoms do not develop, you can probably assume that beef is acceptable. Continue to eat beef while you test the next food in the same manner.

If all goes according to plan, elimination diets will leave you with a list of foods responsible for your allergies. Those foods, of course, should be avoided for several months.

Notice we didn’t say ‘avoided forever. Allergies change. After a year or more, you may lose your sensitivity to a food to which you are now allergic. After not eating the food for several months, test it once more. If symptoms reappear, you will have to continue to avoid it indefinitely. If nothing happens, however, you can add that food to your diet at intervals of four days or longer. If you’ve tested every food in your diet and still have symptoms, the next step is to eliminate food additives or pesticides – or both.

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Related Posts:

• INSECT ALLERGIES: IMMUNOTHERAPY
• DRUG ALLERGY: ASPIRIN, VACCINES AND INSULIN AS TROUBLESOME DRUGS
• UNDERSTANDING ALLERGY: FERRETING OUT FORMALDEHYDE
• PREVENTING FOOD ALLERGIES IN CHILDREN