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— "Part of the problem with drug allergies is how people define them. A lot of people define drug allergies as anything bad that happens from a drug, so when codeine makes them nauseated, they'll say they're allergic to it, when it's just an expected side effect. When it comes to true allergies, it's defined more narrowly. It's making IGE antibodies to that drug. There are not many that we really understand well or that have been identified that you make IGE antibodies to. Most drug reactions are not true allergies, and we don't really know what causes most of them. It's a very confusing area."

In her own practice, Marquardt treats all types of allergies; like other allergists, the spectrum of severity can be extreme. "I had a patient who had a horrible allergy to bee stings. Bee-sting allergies are tough anyway, because to desensitize people to them, you basically give them shots of bee venom. That's very potent stuff. Even though the desensitization protocol is pretty straightforward, you're basically stinging them with a bee every time you see them! Ultimately, you'll give them a shot with two stings' worth. Well, I saw this woman back in the '80s, and she had tried three times before to be desensitized, and as she would move on, she would have horrible reactions. I had a lot of trepidation about seeing her anyway, but she was sure that if she ever got stung she would die. It wasn't clear to me if I would kill her first or if she would go out and take her chances in the world. I was very, very gingerly moving up on the protocol [increasing the dosage of venom], and she would have reactions, but they weren't that bad. But one time I gave her a shot and within just a minute, she slumped against the wall and said, 'My head is going to explode.' She was very red. She was having anaphylactic shock, and it was very scary. So we gave her some epinephrine, and she got better pretty fast. Then I gave her some antihistamines. I was kind of scared to see her, and I decided that it would be better to give her her own adrenaline, or we might kill her before the bees would!"

Carrying one's own adrenaline to shoot in the case of a reaction -- the "Epi-pen Kit" -- is a common necessity for people with severe allergies. "Pretty much everyone who's had what sounds like anaphylaxis gets an Epi-pen. If you know you're allergic to shrimp or a food or bee stings -- any people with the potential to have anaphylactic shock will get one. There's also exercise-induced anaphylaxis and drug-induced. Mostly things you think you could avoid. It can't hurt to have one. I keep one in my backpack -- not for myself, but for whoever may need it."

Although the progress in new allergy treatments has been slow, Marquardt is confident that there are innovations and breakthroughs yet to come. "We'll have to see. They will come up with a better drug after this one [anti-IGE] comes out. The concept of DNA vaccines is exciting too. They're actually working on that here at UCSD. This involves trying to alter your immune response and skew immune responses away from allergies by vaccinating people with certain types of DNA. It's a new concept being used in a lot of different diseases, but allergy is one that seems to be amenable to it."

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