My brother has never seen an allergist (or even internist) about his cat allergy, but insists that there is NOTHING he can do to alleviate his reaction to cats, and has yet to take antihistimines or decongestants, etc.

We're only talking Thanksgiving and Christmas Day here - and of course kitty cat is quarantined for the visit. -- L.S., Illinois

A couple weeks ago, I answered a similar question. In that newsletter, I gave details of how a cat-owner can prepare for and help an allergic visitor during their stay. You can read my answer here.

But it is important for your brother to realize that much of the responsibility lies on his shoulders. It is also important for you to realize that his compliance with medical recommendations will, to a large degree, depend on how much impact his allergy symptoms have on his quality of life.

It is hard for relatives to see their loved ones suffer. It's natural to want to help. But the first thing we must realize is that we cannot help another unless that person is willing to accept our help.

As far as your brother is concerned, we would not recommend shots for him at our clinic if he has very limited exposure to cats. Here are some of the questions I ask as we evaluate whether shots for cat allergy may help:

• "Do you own a cat?" (Shots may be very beneficial.)

• "Do you have cats in your neighborhood?" (If so, you are tracking cat hair into your house. Shots will likely be beneficial.)

• "Do you frequently visit friends or relatives who own cats?" (If so, you may want to consider taking allergy shots for cat so you can enjoy the visits without being miserable.)

I also point out that no matter how careful we are, all of us will be exposed to cat allergens from time to time. A co-worker spends a few minutes with his cat just before leaving for work, and brings cat dander to the office on his sweater. A stranger hangs her coat, laden with cat hair, over yours on the crowded coat rack at a school or church function. You are sitting on a park bench watching your children play. Suddenly a cat appears from nowhere and begins to caress your foot, purring contentedly. There is no way to avoid some exposure to cats.

Here are some things to consider:

Only the allergy-sufferer himself can determine how severely the allergy affects his lifestyle. Shots may not be the answer for a person who only visits a cat-owner once or twice a year.

If your brother has asthma, or if exposure to cats causes wheezing, coughing, tightness in the chest, difficulty breathing, or swelling, the allergy can be life-threatening. In this case, it is extremely important that your brother be under the care of a physician for the asthma or cat allergy.

If he suffers from chronic allergy symptoms or sinus infections, he may be allergic to other things as well. Allergy testing is recommended. Sinus infections can be dangerous, and should be treated by a physician.

If exposure to cat does not cause these serious or life-threatening symptoms, he must decide whether his symptoms are troublesome enough that he wants medication such as antihistamines or nasal steroids.

If the allergy symptoms only occur when your brother is exposed to cat, and never occur on any other occasions, it seems quite obvious that his allergy is to cat. It may be that your brother's family physician can provide antihistamines or nasal steroids that will help during his occasional visits to cat-owners, without his seeing an allergist.

Over-the-counter antihistamines are also available. Often they cause drowsiness, especially if taken on an occasional basis. This may interfere with his enjoyment of his visit. He should not drive while taking these sedating antihistamines.

One of the non-sedating antihistamines has recently become available without prescription. Your brother could ask his family doctor if an over-the-counter, non-sedating antihistamine would be right for him.

Your brother could have allergy testing, hear his physician's advice, receive prescriptions, and even get the prescriptions filled. But unless he takes the medications, and follows the other advice his doctor gives him, that would not be beneficial for him. Ultimately, he will have to decide whether his symptoms are severe and frequent enough to warrant compliance with a medical regime.

For my response from a different view point on a similar question, see:
Guess who's coming to visit? An allergic guest!

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