Why Do We Have Allergies 2: What Went Wrong?

We Are Not Alone

If you are looking for a trendy term to impress your friends or co-workers, try microbiome. The microbiome refers to the fascinating world of microorganisms (bacteria, viruses and fungi) that not only fill every nook and cranny of the planet we live on but also every nook and cranny of our own bodies.

By some estimates, we have as many microbes living in our bodies as we do our own cells. (Wouldn’t that be a cool fact to throw out at a dinner party?) For the most part, those microbes living in and on our bodies share a symbiotic relationship with us, meaning they help us and we help them. Supposedly, my dog and I share a symbiotic relationship: I provide him food and shelter and he, well… he hangs around the house looking cute and chewing up my shoes and socks.  (Come to think of it, this may be more indicative of a parasitic relationship.)

Not only do the microorganisms in our body help us digest our food, produce vitamins and help fight off infection, they play an important role in regulating our immune system. From infancy on, these single-celled animals communicate with our immune system and explain the ways of the world to it. It is believed that this early-life education is essential for our immune system to grow up and act appropriately: attacking bad guys – like the measles virus – and not reacting with good things like breakfast or the dander from the sock eating dog.

Of course, the process of this early-life microbial education can involve infection.  And yet, these are usually not life threatening infections, and the end result is a strong, wise and well behaved immune system.What Went Wrong- (1) 2

We No Longer Live in the Garden

Getting back to the question of what went wrong to cause us to have allergies, one of the theories is the hygiene hypothesis which proposes that our immune system is adapted to an environment that – at least for people living in Ahwatukee and most of the westernized world- no longer exists.   At one time in our history, our environment was much more complex and diverse from a microbial point of view with exposure to farm animals and other elements of a farming environment as well as large families with lots of runny-nosed siblings to play with. The hygiene hypothesis was proposed in 1989 when researchers noticed that children who grew up on farms or who came from large families with lots of siblings had fewer allergies.

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The explanation? Progress and myriad changes associated with modern life such as a decrease in natural birth deliveries, antibiotic use, lack of breast-feeding, pasteurization, Lysol in every kitchen and bathroom, and antimicrobial everything (hand wipes, mouth wash, soaps, detergents) – not to mention a noticeable lack of cows, chickens, and pigs in the yard -reduce an infant’s exposure to the wise microbe masters that once kept or immune system from going down the path of the dark side.Untitled design (58)

Just as children who grow up in an overly protective, sterile, and restrictive parental environment may have difficulty coping with challenges later in life, our pampered undirected immune system may react inappropriately.

The unintended consequence of our quest to control everything has been the emergence of allergy and other chronic inflammatory diseases.  Who knew?

Now that we are beginning to understand why we develop allergies, the big question is how to fix it.  Allergy immunotherapy or desensitization is essentially a way of re-educating the immune system to behave more appropriately towards our environment.   It is not a quick fix, but the end result can be life-long immunity to things we are allergic to.  New forms of immunotherapy are in the works that combine conventional immunotherapy with elements of the microbiome to mimic the type of early-life training that has been lost (along with paradise).

Brian Millhollon, MD


Why Do We Have Allergies?

When scientists set out to understand a challenging and complicated problem they frequently construct models to help the process of discovery. Models help us to visualize the big picture, and to see how individual pieces of information fit together. This is true when we try to understand allergy.

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Our immune system is a particularly complex bit of machinery. Its job is to monitor our internal and external environment, and when it detects a problem, eliminate the danger.   It vigilantly looks out for an attack from pathogenic microbes such as bacteria and viruses, injury from various toxic substances, and cancer cells trying to get a foot hold.

When the immune system finds a problem it deals with it through a process called inflammation. Inflammation is what we experience when our immune system is doing its job; or at least believes that it is doing its job.

When we get a fever, snotty nose, and cough with a cold, these symptoms are not caused by the virus but by our immune system fighting the virus. Good thing too, because without that snotty nose the only thing we may feel is the virus eating our brain.


When we get a thorn in our foot, the irritation, itching, redness and swelling in the area is a result of inflammation. Inflammation increases the blood supply to the area and makes the blood vessels leaky so that antibodies, blood clotting chemicals, and white blood cells can rapidly move in. The pain and itching we feel is to alert us to the thorn so that we will stop walking on it and try to get it out.

We would not last long without our immune system doing its job through inflammation, but sometimes our immune system does things that appear to have no point and seem to cause more harm than good.

The reality is, a significant percentage of the chronic medical conditions we suffer from fall under the category of chronic inflammation of unknown cause or, put another way, unknown purpose. What is our immune system thinking?

A variety of devastating autoimmune diseases such as rheumatoid arthritis and lupus certainly fit into the category of chronic inflammation with unknown purpose, but so does some neuro psychiatric and neuro degenerative diseases (such as muscular sclerosis) and of course, allergy.

What But Not Why

In medicine we are pretty good at answering the “what” questions, such as: “What chemical in the skin causes the itching and swelling when you break our in hives?” Or, “What white blood cells cause an asthma attack?”  In fact, I have many big textbooks with pages of explanations and diagrams showing how our immune system reacts with harmless things like breakfast or the family dog to cause allergy misery. TEXT HERE (1)
But to many, myself included, the more pressing question is “why?”.  Why hives?   Why asthma?  Why lupus?  Our sophisticated, highly developed immune system reacts, at times violently, to things that we eat, breathe or touch.  Things that are, to the best of our knowledge, harmless.

A simple answer to these  “why?”questions about the elusive and baffling world of chronic inflammatory disease would be to say that it is a mistake.

A very big mistake.

Millions of dollars spent on medications and doctor visits, time lost from school, work, and play, and even lives lost because of an error?

What Went Wrong and Who is To Blame?

We don’t have clear answers but we do have a large body of emerging data from research that presents some intriguing clues. In the next post (here) I will discuss a few of the current theories and models that are being proposed  that will hopefully help us to unlock the mystery of “why?”.

Brian Millhollon, MD

Pokemon Allergy

It is not every day that a physician from a small town like Ahwatukee gets to discover a new disease.  But this is just such a day and I would like to take this opportunity to announce the first reported case of Pokemon Allergy ©.

The discovery began when a young man came to our allergy clinic complaining of itching and rash of the lower legs.  The rash was not severe but the itching was quite annoying and he found himself scratching his lower legs so much that the thin skin above the shins was raw and bleeding.

My first thought was a contact allergy and so I questioned. “Have you been exposed to any new products?   Sun screens, lotions, soaps, chemicals?”

He had not.

“How about something where you work?”

He worked in an office, sitting most of the day at a desk entering data in a computer and nothing in that environment had changed recently.

“Do you have any new hobbies or participate in sports?”

Like a lot of young adults, his primary hobby (and sport for that matter) was playing computer games.  He was good at it and spent a great deal of his free time indoors on the computer. That environment had not changed either.

That’s when a chance comment about his gaming activities caught my attention.

“I have started playing a new game.  It’s called Pokemon Go.”

“Actually it’s not new.  My brothers and I used to play it all the time as kids. Back then our parents would drive us all over town to buy packs of cards that had pictures of these mythical, cartoon-like characters called Pokemon. The point was to collect all the characters, but some were rare and took a long time and a lot of work (and gas) to collect.

Pokemon Desert Foothills park ahwatukee

Pokemon Hunting Desert Foothills Park Ahwatukee

Now the game is played with a smart phone and the characters are virtually located all over the place –  parks, parking lots,  stores, on the side of the road; even in people’s houses. The most popular place to find them is in community parks.   I would go out to Desert Foothills Park to hunt for Pokemon at 11:00 at night and see hundreds of kids and adults walking around the park, staring at their phones like zombies.”

“Wait. You said walking around in the grass at night for hours.  Did the rash start before or after you started playing Pokemon Go?”

“About the same time.”  He said.  “Could it be related?  How?”

“Well, Bermuda grass causes a lot of allergy problems.

Bermuda Grass flower

Bermuda Grass flower

It is the most common grass grown in Arizona in the summer and likes to release pollen from it’s whirlybird-like pollen stalks during the cooler temperatures at night and early morning.  Although most people who are allergic to the grass will have respiratory symptoms such as sneezing, itchy, watery eyes, nasal congestion and even asthma, high levels of skin exposure  – which could occur when walking in the grass in shorts and sandals – can also cause a contact allergy with itching and rash.  I think this may be it”

It was.

The treatment for Pokemon Allergy?

Although strict Pokemon Go avoidance would no doubt bring about a rapid cure, the substantial health benefits derived from playing the game (spending time out of doors, regular exercise, face-to-face social interaction) in my opinion, make this option less desirable.   Instead, I recommended wearing shoes and long pants and showering after sessions, at least until the winter.

On a recent follow-up visit, the rash had resolved.  He was enjoying his new found life out of his room in front of a computer so much that he started running and hiking for exercise, entered triathlon races, quit his boring job, and enrolled in optometry school.  I never dreamed there would be an app for that.

Brian Millhollon, MD