Dr. David Healy of Glacier Ear, Nose and Throat in Kalispell. (David Reese photo)

How one woman found relief from allergies

By DAVID REESE/Montana Health Journal

Darlene Schottle doesn’t have to shy away from being active in the outdoors any more.

 Thirty years ago was a different story, though.

 Back then, Schottle discovered she had a severe food allergy to celery, and she began immunotherapy — a method of exposing her body gradually to allergens. Testing 30 years ago involved getting scratches on her back and being exposed to numerous allergens. “It was awful — horrifying — to go through that testing," she said.

 For years she battled headaches, difficulty breathing and swelling in her eyes and hands due to her many environmental allergies.

 Over the years, Schottle learned to manage her allergy symptoms by avoiding the allergens that caused her health problems. When she moved to the Flathead Valley in 2004, she started getting symptoms again — some of them severe.

Schottle was on a regimen of antihistamines to control the allergy symptoms, but her primary-care physician advised her that long term antihistamine use was not good for her body; so she went to Glacier Ear, Nose and Throat in Kalispell for allergy testing and subsequently began   immunotherapy.  She found the entire process significantly more comfortable than her initial experience. 

Immunotherapy gradually exposed her body to the allergens that caused her so many problems, and little by little her body began to build up immunity. “I feel so much better,” she said. Schottle received weekly shots over the course of three years while in the Allergy program at Glacier Ear, Nose and Throat. 

Today, immunotherapy is much kinder and gentler than the regimen Schottle received 30 years ago. “It’s light years ahead of what it was,” she said.

 When Schottle once again began to feel some minor allergy symptoms a year ago, she attempted to self-manage the symptoms with antihistamine medications; but decided to schedule updated allergy testing at Glacier Ear, Nose and Throat, where they identified seven new allergies. She began weekly immunotherapy shots and now she’s back enjoying the outdoor activities that she loves, like boating and hiking.

 “They treat what it is you’re allergic to, and they helped educate me on the other things that I need to avoid,” she said. “If you do that, you can have some pretty successful outcomes.”

 She commented that antihistamines made her groggy, and years of allergy suffering caused her to develop severe nasal blockage. Surgery helped to alleviate the nasal blockage. One benefit of immunotherapy has been the positive impact on the quality of her sleep.

She’s glad she took the advice of her physician to undergo immunotherapy under the guidance of Dr. David Healy at Glacier Ear, Nose and Throat. “It has had a really positive impact on my life,” she said. “My body knows how to take care of itself now.”

“It has had a really positive impact on my life. My body knows how to take care of itself now.”

— Darlene Schottle

Healy, an otolaryngologist, and a fellow of the American Academy of Otolaryngic Allergy, said allergies are an overreaction of the body to otherwise nontoxic environmental stimulants. Allergy, he said, is the human body’s immune reaction to an environmental stimulant that should otherwise be benign. Allergens can be food-related or environmental, such as pollen, mold, animal dander or dust. Allergens often impact the nose and lungs. “The allergic response is theorized to combat things that our bodies no longer need to combat, like a parasitic infection,” Healy said.

In other words, human bodies are mistaking everyday allergens like grass or hay for something much worse. Healy postulates that humans are not being exposed to common infections as much as in past decades. He calls this the “hygiene hypothesis.”

 “Our environment is so clean. Our bodies are no longer exposed to the infectious agents they once were," Healy said. By trying to stay extremely clean, humans may be putting their bodies at risk to developing a heightened allergic response.  Babies are coated with antibacterial products and are living in a highly sterilized environment. “They simply don’t have these exposures,” he said.

 Healy said he’s seeing an “epidemic of allergic conditions and the reasons are not fully understood.”
 Accurate evaluation is important for allergy sufferers.

 “If you don’t know what you’re allergic to, you won’t know how to avoid those allergens,” Healy said.

 There are three ways to treat allergies:
 • Avoidance of the allergens;

 • Medicines to treat the symptoms;

 • Immunotherapy — training your body to not have an allergic reaction to common allergens.

 Health trends often follow popular culture, and there seems to be a predominance of people who are allergic to something. Healy has seen patients come to his office looking for help, and they are allergic to something specific though it's not always what they think it is. Through the science of immunotherapy, he's been able to find the exact cause of their allergy.

"It is important for us to stay scientifically grounded in our testing and treatment of allergies," Healy said. "We rely on evidence-based medicine. Patients that complete their immunotherapy regimen are able to live a much better life, and they are free of the allergy that once limited their lifestyle.”

Healy said allergy patients who complete immunotherapy often have great success.

Human bodies are born a blank slate on how they will react to allergens. As human bodies’ immune systems are exposed to the world, the immune system learns to recognize its own body and what it needs to react against.

 Healy said humans are born with their mother’s immune system and then we build up our own immune system based on our environmental exposures. 

 The allergic response is one form of the immune response, and it’s not always a helpful way for the body to react, Healy said.

 Immunotherapy introduces allergens to the body in a methodical fashion that allows a more appropriate immune response which allows the body to grow stronger.

 Immunotherapy is potentially a cure for allergy, he said.  Medicines simply cover up the allergy and minimize the symptoms.

 Our immune systems are constantly changing. As we age they tend to weaken, but that also means that the older human body typically doesn’t react as strongly to allergies, Healy said. However, older adults can develop rhinitis or chronic asthma, even though they didn’t have these conditions as children.
 Through immunotherapy people now have the opportunity to help their bodies grow stronger against common allergens; in effect, possibly preventing immune responses such as asthma, according to Healy, who is a former Navy physician. 

Healy did a fellowship in rhinology at Harvard and is an ear, nose and throat surgeon. Healy finds allergy is often the culprit of underlying medical ailments. 
 “We used to favor surgery as the best option for many patients, but we didn’t always understand the underlying process,” he said. “In order for me to be a good surgeon, I need to understand all the medical aspects I treat. Our understanding of allergy and immunology continues to expand.”

 People often arrive at his clinic with chronic nasal or sinus complaints.  Through a methodical process the clinic is able to narrow down the cause of the patient’s allergy. "The sinus is kind of like a black box," Healy said. "It takes work to get to the bottom of what a person is suffering from."  

WHAT IS ALLERGY?

 The basic understanding of chronic inflammatory conditions is changing, Healy said.

 Chronic sinusitis was once regarded as a chronic bacterial infection, and would be treated with antibiotics. "In most cases it is not," Healy said. "Our understanding now is that it's a chronic inflammatory condition, more like asthma."

 These symptoms are now often treated with anti-inflammatory drugs, rather than antibiotics.

 While Healy takes a scientific approach to immunotherapy, the process is based in human healing.

 "It's wonderful to clarify what people are suffering from," Healy said. "Helping people understand is immensely important, and I enjoy that aspect of my work. Changing their quality of life is meaningful to me as a physician.”

PEANUT FOOD ALLERGY

One Kalispell family has learned how to adapt to their daughter's severe food allergy, and they used immunotherapy to increase their daughter's resistance to histamines.

 Even a handprint of someone who has eaten a peanut butter sandwich can send Jadyn Schussler to the emergency room.  Schussler, 13, has an over-reactive immune disorder that makes her body extremely sensitive to allergens, especially peanut butter. But with the help of immunotherapy at Glacier Ear, Nose and Throat, Jadyn is slowing becoming more immune to everyday allergens. Her mother, Sarah Schussler, remembers when Jadyn was a young girl and Jadyn would aggressively scratch her skin from allergic reactions that caused severe eczema. The young girl would scratch her skin so badly that her parents put socks on her hands so she would not scratch her skin to the point of bleeding. "The fuzzier, the better," Sarah said.

 Her family used light therapy to help reduce the eczema, and for a while they thought they had Jadyn's allergies under control. Her parents had concerns about light therapy, because they had to balance whether Jadyn would get an infection from the open sores on her skin, or if light therapy might lead to skin cancer, Sarah said.

 Then, three years ago, Jadyn ate a peanut butter sandwich, she went into shock and was taken to the Kalispell emergency room.

 After that incident, Jadyn's parents took a more aggressive approach to controlling her allergic reactions, and began immunotherapy at Glacier Ear, Nose and Throat. Jadyn started a four-year immunotherapy regimen two years ago, receiving two shots per session.

 While the immunotherapy regimen does not help with food allergies, Jadyn is able to slowly train her body to not overreact to other allergens that she might be exposed to.

 Jadyn's family had consulted with allergy specialists in Salt Lake City, "but they couldn't help," Sarah said. "Then, here in Kalispell, we found doctors who could help."

 Jadyn's food allergy was so bad that her parents had to change schools when Jadyn was in seventh grade. If Jadyn so much as touched a water fountain that someone with peanut butter on their hands had touched, it could send her body into shock.

 "She couldn't even walk into the school without being scared," her mother, Sarah, said. "She was just this tiny, scared kid."

 The allergic reactions and the histamine response would cause her throat to swell, and put pressure in her chest, Sarah said. Jadyn's parents asked the school to not serve nuts, but they would not change their policy. So the family changed schools. Jadyn’s new school, near Kalispell was more than willing to take her as a student, and the school adopted a policy where other students must eat their peanut butter sandwiches or candy bars in separate lunch rooms.

 Jadyn still has to be careful around places where nuts are served, and her friends are careful not to offer her snacks with nuts. "She's learned a lot," Sarah said. "She knows how to keep herself safe. She's been sick forever, but now that she's older, she's learned to stick up for herself."

 The family has had to make adjustments, and so have the people who are around Jadyn. But they have all adapted. When the family flew to Europe, they asked the airline not to serve peanuts on the flight, and it complied.

 Now, if Jadyn gets a severe allergic reaction, she has an Epi-Pen to fight any severe histamine response.

 Jadyn's parents don't have to worry about their daughter as much they're glad the skin-scratching is over. "She's lucky. She looks beautiful and my little girl just made the cheer team at her high school," her mother said. "It's amazing, because it's something I never would have seen for her."