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Contact allergies common in Eczema

Approximately one-third of children with Eczema may have one or more hidden contact allergies, possibly contributing to or maintaining the skin symptoms.

Metals were the most common allergens among patch tested children with Eczema, nickel being the most common. Reactions to cobalt chloride and potassium dichromate were also frequent among the children with Eczema. Fragrance, too, is a common sensitizer in children.

Lanolin, and Amerchol L101,  a lanolin derivative that is used as an emollient and emulsifier in ointments and in cosmetic products such as soaps, shampoos, hair conditioners, aftershaves, baby and bath oils, hand sanitizers, lipsticks and creams.[29]Six of the reviewed studies patch tested with Amerchol L101 and all reported relatively high sensitization rates.

Although corticosteroids are not potent allergens,  contact sensitization and ACD from topical corticosteroids is not infrequent. The possibility of a complicating contact allergy to topical treatments should not be ignored in the evaluation of a child with recalcitrant eczema.

Patch testing for contact allergens may be relevant as a screening tool in the management of children with AD and should always be considered in cases of recalcitrant AD or whenever ACD is suggested by the child’s history.

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Allergy shots Effective for older Patients too

Recent years have seen an increase in those suffering from allergies, including baby boomers. And because older people tend to have additional chronic diseases, diagnosis and management of allergic rhinitis (hay fever) can be a challenge. A new study shows immunotherapy (allergy shots) reduced symptoms by 55 percent after three years of therapy, and decreased the amount of medication needed for relief of symptoms by 64 percent.

“Older people who suffer from hay fever may have health challenges that younger people do not,” said allergist Ira Finegold, MD, ACAAI past president. “Hay fever is often ignored in older patients as a less significant health problem because of diseases such as asthma, coronary heart disease, depression and high blood pressure. Also, some baby boomers might not realize they have allergies, and their physicians might not suggest allergy shots. The research indicated that allergy shots were extremely effective for this group.”

Although the guidelines for the diagnosis and treatment of allergic diseases rarely focus on older patients, according to the Polish study, hay fever is more common in patients over 65 years of age.

The study authors state the results of the study indicate an aging immune system doesn’t significantly influence the effectiveness of immunotherapy.

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FDA Clears First Epinephrine Autoinjector for Infants

The US Food and Drug Administration (FDA) has approved the first and only epinephrine autoinjector (EAI) specifically designed for the treatment of life-threatening allergic reactions, including anaphylaxis, in infants and children weighing 16.5 to 33 pounds (7.5 to 15 kg), according to a company statement.

Auvi-Q is a compact epinephrine auto-injector with industry-first features, including a voice prompt system that guides a user with step-by-step instructions through the delivery process, and a needle that automatically retracts following administration. The new 0.1 mg-dose epinephrine auto-injector has a shorter needle length and lower dose of epinephrine than current FDA approved 0.15 mg and 0.3 mg epinephrine auto-injectors.

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Allergy to grains, fruits and vegetables

A survey of 785 adults in the Netherlands, using validated questionnaires found that 6.25% were avoiding wheat due to reported symptoms related to gluten ingestion. The most popular use of a wheat-free diet is to alleviate symptoms related to irritable bowel disorder (IBS); however, it is possible that only one-third of patients with IBS will continue to experience symptomatic relief on long-term wheat avoidance.

Wheat can also cause a true, severe allergic reaction. Jiang et al. reviewed 1 952 cases of anaphylaxis in 907 patients, most of whom were adults. Analysis of the most severe allergic episodes showed that 57% were triggered by wheat.

Individual cases of anaphylaxis to oats have been reported, as has a series of patients with allergy to millet, often consumed as a healthy alternative cereal to wheat.

A retrospective study on 2.7 million patients identified 3.6% had one or more food allergies and intolerances, with fruits and vegetables being the second most common food group identified as trigger foods, with a prevalence of 0.7%.

7% of children attending hospital for reported anaphylaxis had a confirmed allergy to fruits, and data from the European Anaphylaxis Registry also reported that fruits were also responsible for 5% of all causes of anaphylaxis to foods in children and adolescents.

Another study showed that 20% of all food anaphylaxis reactions were caused by fruits and vegetables, often associated with mugwort sensitisation, especially if peaches were the trigger food.

Fruits and vegetables can provoke a severe allergic reaction,  but are often considered as benign, and thus an unlikely cause of allergy by the general public and healthcare professionals alike. The internet is often blamed for misinformation, but it is easy to dismiss symptoms to fruits, vegetables and especially to wheat as intolerance rather than allergy. Accurate assessment to assess whether symptoms to these foods represent a true allergy is essential.

 

 

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Food Allergy vs. Intolerance: Knowing the Difference

Food allergies affect roughly five to eight percent of all children. A food allergy diagnosis can dramatically alter one’s life as it requires constant vigilance during meals and snacks and preparation in case a severe allergic reaction occurs. While many people experience various symptoms after eating certain foods, it is important to understand the differences between food allergy and intolerance.

What is an allergy?

An allergy is a response by the immune system to a food allergen, which causes symptoms that occur immediately (within a few hours) and with every exposure to that allergen.

While any food can potentially cause an allergy; peanuts, tree nuts, eggs, milk, wheat, soy and fish/ shellfish cause more than 90 percent of allergic reactions

What is an intolerance?

An intolerance is a non-immunologic response to a food that mainly causes gastrointestinal symptoms with exposure.

Common food intolerances include lactose (milk), wheat, gluten, fruits and vegetables.

Allergy Symptoms vs. Intolerance Symptoms

So how do you know if your child has an allergy or an intolerance? The good news is, for the most part, signs and symptoms vary between the two. The lists below illustrate the different reactions you might see in your child if they have a food allergy or intolerance.

Allergy Intolerance
Hives Not always reproducible
Swelling More subjective complaints
Difficulty breathing Not always immediate
Difficulty swallowing Bloating
Vomiting Gassiness
Hypotentions (passing out) Heartburn
Anaphylaxis Vomiting
Constipation
Diarrhea

How will a doctor test if my child has an allergy?

The history is the most important part of the evaluation. Allergy testing may be indicated when the history suggests a possible food allergy. If the history does not suggest a food allergy, then testing may not be necessary.

Testing options include:

  • Skin prick testing
  • Serum specific IgE testing
  • Oral food challenge

Some studies show that up to one in three people report having a food allergy. However, only one in 20 actually do. This discrepancy often comes from an incomplete understanding of the differences between food allergy vs. intolerance, or even normal response to some foods. If you have concerns, talk to your Allergist.

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Sinus Infection

Overview

Sinus infection (known as sinusitis) is a major health problem. It afflicts 31 million people in the United States. Americans spend more than $1 billion each year on over-the-counter medications to treat it. Sinus infections are responsible for 16 million doctor visits and $150 million spent on prescription medications. People who have allergies, asthma, structural blockages in the nose or sinuses, or people with weak immune systems are at greater risk.

Sinus infection symptoms

A bad cold is often mistaken for a sinus infection. Many symptoms are the same, including headache or facial pain, runny nose and nasal congestion. Unlike a cold, sinus infection symptoms may be caused by bacterial infections. It often requires treatment with antibiotics (drugs that kill the germs causing the infection).

Sinus infection diagnosis

If you think you have a sinus infection, see your allergist for proper diagnosis. In most cases, sinus infection treatment is easy. By stopping a sinus infection early, you avoid later symptoms and complications.

What is sinusitis?

Sinusitis is an inflammation of the sinuses. It is often caused by bacterial (germ) infection. Sometimes, viruses and fungi (molds) cause it. People with weak immune systems are more likely to develop bacterial or fungal sinus infection. Some people with allergies can have “allergic fungal sinus infection.” Acute sinus infection lasts three to eight weeks. A sinus infection lasting longer than eight weeks is considered chronic.

The sinuses are air-filled cavities. They are located:

  • Within the bony structure of the cheeks
  • Behind the forehead and eyebrows
  • On either side of the bridge of the nose
  • Behind the nose directly in front of the brain

Normal sinuses are lined with a thin layer of mucus that traps dust, germs and other particles in the air. Tiny hair-like projections in the sinuses sweep the mucus (and whatever is trapped in it) towards openings that lead to the back of the throat. From there, it slides down to the stomach. This continual process is a normal body function.

A sinus infection stops the normal flow of mucus from the sinuses to the back of the throat. The tiny hair-like “sweepers” become blocked when infections or allergies cause tiny nasal tissues to swell. The swelling traps mucus in the sinuses.

Some people have bodily defects that contribute to sinus infection. The most common of these defects are:

  • Deformity of the bony partition between the two nasal passages
  • Nasal polyps (benign nasal growths that contain mucus)
  • A narrowing of the sinus openings

People with these defects often suffer from chronic sinus infections.

Symptoms

Common symptoms of sinus infection include:

  • Postnasal drip
  • Discolored nasal discharge (greenish in color)
  • Nasal stuffiness or congestion
  • Tenderness of the face (particularly under the eyes or at the bridge of the nose)
  • Frontal headaches
  • Pain in the teeth
  • Coughing
  • Fever
  • Fatigue
  • Bad breath

Sinus infection (sinusitis) is often confused with rhinitis, a medical term used to describe the symptoms that accompany nasal inflammation and irritation. Rhinitis only involves the nasal passages. It could be caused by a cold or allergies.

Allergies can play an important role in chronic (long-lasting) or seasonal rhinitis episodes. Nasal and sinus passages become swollen, congested, and inflamed in an attempt to flush out offending inhaled particles that trigger allergies. Pollen are seasonal allergens. Molds, dust mites and pet dander can cause symptoms year-round.

Asthma also has been linked to chronic sinus infections. Some people with a chronic nasal inflammation and irritation and/or asthma can develop a type of chronic sinusitis that is not caused by infection. Appropriate treatment of sinus infection often improves asthma symptoms.

How is sinus infection diagnosed?

Diagnosis depends on symptoms and requires an examination of the throat, nose and sinuses. Your allergist will look for:

  • Redness
  • Swelling of the nasal tissues
  • Tenderness of the face
  • Discolored (greenish) nasal discharge
  • Bad Breath

If your sinus infection lasts longer than eight weeks, or if standard antibiotic treatment is not working, a sinus CT scan may help your allergist diagnose the problem. Your allergist may examine your nose or sinus openings. The exam uses a long, thin, flexible tube with a tiny camera and a light at one end that is inserted through the nose. It is not painful. Your allergist may give you a light anesthetic nasal spray to make you more comfortable.

Treatment

Antibiotics

Antibiotics are standard treatments for bacterial sinus infections. Antibiotics are usually taken from 10 to 28 days, depending on the type of antibiotic. Because the sinuses are deep-seated in the bones, and blood supply is limited, longer treatments may be prescribed for people with longer lasting or severe cases.

Antibiotics help eliminate a sinus infection by attacking the bacteria that cause it, but until the drugs take effect, they do not do much to alleviate symptoms. Some over-the-counter medications can help provide relief.

Nasal decongestant sprays

Topical nasal decongestants can be helpful if used for no more than three to four days. These medications shrink swollen nasal passages, facilitating the flow of drainage from the sinuses. Overuse of topical nasal decongestants can result in a dependent condition in which the nasal passages swell shut, called rebound phenomenon.

Nasal decongestants and antihistamines

Over-the-counter combination drugs should be used with caution. Some of these drugs contain drying agents that can thicken mucus. Only use them when prescribed by your allergist.

Topical nasal corticosteroids

These prescription nasal sprays prevent and reverse inflammation and swelling in the nasal passages and sinus openings, addressing the biggest problem associated with sinus infection. Topical nasal corticosteroid sprays are also effective in shrinking and preventing the return of nasal polyps. These sprays at the normal dose are not absorbed into the blood stream and could be used over long periods of time without developing “addiction.”

Nasal saline washes

Nasal rinses can help clear thickened secretions from the nasal passages.

Surgery

If drug therapies have failed, surgery may be recommended as a last resort. It is usually performed by an otolaryngologist. Anatomical defects are the most common target of surgery.

Your surgeon can fix defects in the bone separating the nasal passages, remove nasal polyps, and open up closed passages. Sinus surgery is performed under either local or general anesthesia, and patients often can go home on the same day.

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Flu vaccine is safe for those with severe egg allergy

The flu is responsible for the hospitalization of more than 21,100 children under the age of five annually. Yet according to the American College of Allergy, Asthma and Immunology (ACAAI), up to 2 percent of children may not be receiving the vaccination this year.

The reason? The flu shot has been historically associated with severe side effects in individuals with egg allergy. But ACAAI allergists have found that administration is safe even in children with a history of a severe allergic reaction to eggs.

“The influenza vaccine is grown in chicken eggs, therefore it contains trace amounts of egg allergen,” said allergist James Sublett, chair of the ACAAI Public Relations Committee. “It has been long advised that children and adults with an egg allergy do not receive the vaccination, however, we now know administration is safe. Children and adults should be vaccinated, especially when the flu season is severe, as it is this year.”

A study published in the December 2012 issue of Annals of Allergy, Asthma & Immunology, ACAAI’s scientific journal, showed that flu vaccinations contain such a low amount of egg protein that it won’t cause children to have an allergic reaction.

“The benefits of the flu vaccination far outweigh the risks,” said Dr. Sublett. “The best precaution for children that have experienced anaphylaxis, a life-threatening allergic reaction, after ingesting eggs in the past is to receive the vaccination from an allergist.”

ACAAI also advises the more than 25.7 million Americans with asthma to receive the flu vaccination. Because the flu and asthma are both respiratory conditions, asthmatics may experience more frequent and severe asthma attacks while they have the flu.

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Study shows oral food challenges are safe for diagnosing food allergies

The best way to find out if someone has a food allergy is through an oral food challenge (OFC) where the person is given a very small dose of the food by mouth under the supervision of a board-certified allergist to test for a severe reaction.  A new study shows that OFCs are extremely safe, with very few people having a reaction of any kind.

The majority of those tested were under the age of 18. Researchers found about 2 percent of those being tested had a severe allergic reaction, also known as anaphylaxis, and only about 14 percent had any reaction at all.

“Food challenges improve the quality of life for people with food allergies, even if they are positive,” said allergist Carla Davis, MD, ACAAI member and study senior author. “When an OFC is delayed, sometimes people unnecessarily cut certain foods out of their diet, and this has been shown to lead to increases in health costs to the patient. A delay risks problems with nutrition, especially for children. It’s important to have an accurate diagnosis of food allergy so an allergist can make a clear recommendation as to what foods you need to keep out of your diet. And if no allergy exists, that clears the way to reintroduce foods you may have thought were off-limits.”

Diagnosing food allergy is not always simple, but the need to make a proper diagnosis is very important.

Allergists are specially trained to administer allergy testing and diagnose the results. They can then tailor a plan specific to your allergies.

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Asthma during Pregnancy

One in 10 pregnant women worldwide has asthma. Asthma symptoms worsen in one-third of women, improve in one-third, and remain similar in another third;[7] however, these changes are variable from woman to woman, and pregnancy to pregnancy.

At least 20 to 45% of women have been reported to have an exacerbation of asthma requiring medical intervention during pregnancy, including unscheduled doctor visits, emergency department (ED) presentations, hospitalization, or requirement for oral corticosteroids. Severe exacerbations requiring oral corticosteroids use have been reported in 5 to 11% of women.

A 2011 systematic review and meta-analysis described the increased risks of poor perinatal outcomes associated with maternal asthma, including preterm birth, low birth weight, and preeclampsia.

Asthma in pregnancy guidelines recommend that asthma exacerbations be treated in the same way as nonpregnant women, and emphasize that exposure to asthma medications to appropriately treat exacerbations poses less risk than exposure to exacerbations themselves.

There is ample reassuring data to support the safety for budesonide (ICS) and Albuterol (SABA), and the recommendation that asthma medications be used in pregnancy, as for nonpregnant women. Guidelines also recommend the continued use of ICS medication that has been effective in controlling asthma before pregnancy.

Review of asthma symptoms every 4 weeks is recommended. Guidelines recommend a stepwise approach to treatment adjustment for asthma, and these clinical decisions are made primarily upon symptoms and lung function. However, a novel approach has been suggested, whereby asthma treatment decisions are made according to the level of eosinophilic lung inflammation, which is responsive to ICS treatment. The level of eosinophilic inflammation may be ascertained using FENO (exhaled nitric oxide).

Pregnant women with asthma are at risk of numerous comorbidities, which may impact their asthma, including rhinitis, GERD, cigarette smoking, obesity, and anxiety and depression. These issues need to be addressed.

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