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Cute little puppy

I had an interesting case yesterday in the office. A patient I evaluated for dog allergy a year ago, who has been on my sublingual allergy drops for a year, though she was relapsing.

I was worried too: it didn’t make sense that the patient, I’ll call Jill, was doing so well on her allergy drops for her dog allergy and then all of a sudden she was having severe trouble breathing.

Jill came into the office to be examined and gave me the scenario: it seemed that when she was at home playing with her dog ‘Cupcake’ she didn’t notice any of her prior allergy symptoms, such as sneezing, itchy eyes or the worst one- difficulty breathing. However, when she was in the car taking Cupcake for rides with her she was experiencing chest tightness – a symptom she used to experience while being around dogs. After examining Jill I felt she needed an asthma inhaler to clear up her lung congestion.

But I was really perplexed – were the allergy drops not working anymore? That would be unusual since for almost a year she was responding so well. Did she develop a new allergy – to pollen or mold? This was a definite possibility and would require additional testing.

The Car Clue

A dog peeping outside the car
The one clue to Jill’s story was that her allergic reaction seemed to occur mainly in the car. Now, she frequently rode with Cupcake in the backseat for the company and so Cupcake seemed to be the culprit; this could make sense since if she was still allergic to the dog being in an enclosed space would clearly intensify the reaction.

But then Jill gave me a key piece of information: she did remember a few times that she developed shortness of breath in the car when Cupcake wasn’t in the car – hmmm? Now I began to wonder if it wasn’t something the car that was triggering the reaction. I asked Jill if it was a new car as new cars have a strong chemical smell. She said no, but she did mention that she did have one of the car air fresheners hanging from her mirror to get the “dog smell” from lingering in the car.

That was the Ah-Ha moment. Air fresheners contain up to 100 different chemicals which can cause irritant and allergic reactions.

The main chemical offender in many air fresheners is phthalates. Phthalates have been known to cause a range of symptoms: headaches, irregular heartbeats, diarrhea, and allergic reactions. The tricky thing is that some companies promote their products as natural or unscented, yet still have been found to contain phthalates. These air fresheners should only be placed in well-ventilated areas – but that’s the catch-22, they are meant to mask foul odors and unfortunately, many cab drivers in New York are using them.

The good news is that my patient Jill ditched the car air freshener and her asthmatic symptoms disappeared. Cupcake is back in everyone’s good graces – as are the allergy drops.

Dean Mitchell, M.D.
Mitchell Medical Group, NYC

About the Author – Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell, M.D. is a Board Certified Allergist and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Clinical Assistant Professor at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma, and Immunology, and the author of Dr. Dean Mitchell’s Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.