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What is Asthma?

Asthma is a disease that causes narrowing of the airways in your lungs. During an “asthma attack”, you may feel short of breath, wheeze, and cough or have tightness in your chest. In between asthma attacks, the disease is still there – even when you have no symptoms. Many children seem to “outgrow” their asthma, but teenagers and adults may have asthma for the rest of their lives.

What happens during an asthma attack?

If you have asthma, your airways are “twitchy”. They are very irritable and sensitive to certain “triggers” – things you may be allergic or sensitive to, such as pets, house dust, pollen, viral infections, cold air or exercise.

• Bronchoconstriction – you airways and the surrounding muscles tighten. This reduces normal airflow into and out of your lungs, making breathing difficult and leads to wheezing and coughing. The attack may last one or two hours. Inhaling a bronchodilator will usually return your airways to normal.
• Inflammation – sometimes a second reaction occurs after the first attack has resolved, especially if the first attack was caused by something to which you are allergic. The lining of your airways can become inflamed and swollen, and a large amount of mucus is produced, narrowing your airways even more.

How is asthma diagnosed?

The diagnosis is a clinical one using a combination of the patient’s symptoms, physical findings, and response to medications. Often times skin testing and spirometry, a special kind of breathing test that measures your lung volumes are performed.

Asthma management

1. Education: patients should have a good understanding of their disease, be able to identify triggers and appropriately treat chronic and acute symptoms.
2. Environmental controls: elimination of triggers such as pollen, dust, and mold from the home should be attempted. Non-allergic triggers such as cigarette smoke, fumes and strong odors may also exacerbate asthma.
3. Medications: quick relief medications open up the airways in an acute attack while controller medications prevent and treat underlying inflammation.
4. Adjuvant therapy: such as allergy shots or treatment of acid reflux help by reducing triggers and other causes of inflammation.

Allergic conjunctivitis or “Eye Allergy”

Eye allergy occurs when the delicate lining of the eye, or conjunctiva, becomes irritated by an allergen.  Symptoms of eye allergy can include itching, redness, burning, clear watery discharge, and swelling.  While eye allergy is not contagious, it can be confused with a viral or bacterial infection of the eye such as pinkeye.  Eye allergy can occur alone but are usually accompanied by the symptoms of hay fever which are nasal drainage, congestion and sneezing.

Eye Allergy Symptoms:

• Outdoor allergens, such as pollens from grass, trees and weeds.  If you have this type of allergy, you may notice symptoms are worse during certain times of the year such as spring and fall when the pollen load is especially heavy.
• Indoor allergens, such as pet dander, dust mites and mold.
• Irritants, such as cigarette smoke, perfume and diesel exhaust
• Cosmetics or personal hygiene products.

Eye Allergy Management and Treatment:

• Avoid triggers by “environmental controls” – that is, eliminating sources of allergy from your home and life.
• Keep windows closed during high pollen periods; use air conditioning in your home and car.
• Wear glasses or sunglasses when outdoors to keep pollen out of your eyes.
• Shower and change clothes after spending a significant amount of time outdoors.
• Use allergy covers to limit exposure to dust mites, and a dehumidifier to control mold.  Treat any mold infested areas of your home.
• If you are allergic to pet dander, consider removing the pet from the home or at least keeping the pet out of the bedroom.  HEPA filters and thorough cleaning of the home may help with cat dander.

Medications for eye allergy:

• Artificial tears – these lubricate the eyes if dryness if a problem.
• Decongestant eye drops (don’t use eye drops for “red eye” longer than a week, or they can make things worse).
• Oral antihistamines (note that they may dry your eyes and make your symptoms worse).

What is allergic rhinitis?

Allergic rhinitis, also referred to as “hay fever” affects as many as 40 million Americans which is roughly one out of every six individuals.  This disease is more common in the pediatric population.  The average allergic rhinitis patient is symptomatic for five months in a year.

Allergic rhinitis is an inflammatory disease.  This inflammation results in a swollen nasal lining that produces fluid and mucus.  This inflamed tissue is also hyper-reactive to a variety of stimuli.

What are the symptoms of allergic rhinitis?

• sneezing
• itching
• congestion
• mucus production
• complications include sinusitis, triggering of asthma, and development of nasal polyps

How is it treated?

• Environmental controls – the purpose is to decrease exposure to allergens such as dust mites, animal dander, mold and pollen
• Medicine – using medicines help to treat the symptoms of allergic rhinitis and the inflammation that produces these symptoms.  Symptomatic medications include antihistamines, steroids, decongestants and leukotriene inhibitors.  Antihistamines effectively treat sneezing, itching and mucus production.  Decongestants will reduce nasal congestion.  Nasal steroids are preventative/anti-inflammatory medications that must be used every day to be effective.  They do not help eliminate the acute symptoms of allergic rhinitis but will slowly decrease the inflammation that exists in the nasal passages.
• Immunotherapy – allergy injections help the immune system develop tolerance to things which an individual is allergic too.  It is time consuming but is a very effective way of permanently improving allergies.  This treatment is best for people who have multiple allergies, are unresponsive to medications or on too many medicines, or who have interference with normal activities due to allergies.

What is sinusitis?

Sinusitis (infection of the sinuses) is very common.  Some studies suggest that 15-20% of the population are affected by chronic sinusitis at some time in their lives.  There are 4 paranasal sinuses.  These are the maxillary, ethmoid, sphenoid, and frontal sinuses.  Only the ethmoid and maxillary sinuses are present at birth.  The sphenoid sinus develops sometime after age 2 years and the frontal sinuses begin to develop by age 6 years.

What are the symptoms of sinusitis and how do we diagnose it?

Clear or thick nasal drainage and cough are the major symptoms of sinusitis.  Other symptoms include fever, headache, facial pain, earache, nasal congestion, tooth pain, inability to smell, sore throat, foul breath, irritability, eye swelling, cough and worsening of asthma.  The most common factors that predispose an individual to sinusitis are viral upper respiratory tract infections (“colds”, allergic rhinitis, nasal polyps, anatomical abnormalities, and defects of the immune system).

Complications that may arise from sinusitis include worsening of asthma, ear infection, and rarely extension of the infection to the bones of the head and the brain.  Occasionally, an x-ray or CT scan of the sinuses must be obtained to thoroughly examine the anatomy of the sinuses.

How do we treat sinusitis?

Treatment is aimed at killing the bacteria found in the sinuses with antibiotic, promoting adequate drainage of the sinuses and eliminating the inflammation and swelling found in the sinuses.  For patients who suffer from recurrent sinusitis, measure directed at the prevention of recurrent attacks are the most important principles in the management of sinus disease.

– Kill the bacteria: Amoxillcin or a similar antibiotic is the drug of choice for sinusitis.   However, if there is not a response to treatment within a few days or if there is evidence of recurrent or chronic disease, other antibiotics may need to be used.  Antibiotic therapy is continued for 14 days and may need to be extended to 30-45 days on some episodes.

– Drainage of the sinuses: as with any infection, the bacteria and pus must have an opening to drain.  Oral decongestant help shrink swollen tissue and thus can assist with drainage.  Topical decongestants also help shrink swollen nasal tissue, however, they cannot be used form more than three days as a dependence quickly develops with continued use.  Topic nasal steroids will help reduce the inflammation and swelling present in sinusitis and thus will also assist in drainage.  Their ability to decrease inflammation is not seen until several days after starting these agents.  Irrigation of the most can remove secretions and liquefy mucus.  Irrigation can be performed with steam, hot showers, vaporizers, a saline sprays.  Sometimes surgery may be required to correct an anatomical abnormality that may be responsible for inadequate drainage.  Most sinus surgeries can be performed using a limited endoscopic approach with a very high success rate.

– Prevention: preventive measure include treatment of allergic rhinitis with nasal steroids, avoidance of allergens and viruses, and if indicated, immunotherapy.

What is Insect allergy?

Members of the Hymenoptera family of flying insects include honey bees, wasps, hornets, and yellow jackets.  Individuals who have developed an anaphylactic reaction to these insect’s venom are at high risk of developing another anaphylactic reaction when re-stung.   Approximately 50% of individuals allergic to these venoms are at risk of developing a severe reaction when re-stung.

What are the symptoms of Insect allergy?

• breathing difficulties
• cough
• wheeze
• Throat swelling
• Change in the voice
• Nasal congestion
• Tongue and lip swelling
• Hives/angioedema
• Abdominal pain, cramping
• Diarrhea
• Lightheadedness, dizziness
• Loss of consciousness

How do we treat insect allergy?

Obtaining appropriate treatment if anaphylaxis develops after a sting can save your life.  Immediately after being stung, perform the following:

1. Notify someone who can bring you to an emergency room or doctor’s office.
2. Make sure you have injectable epinephrine at hand ready for use
3. Take Benadryl at the recommended dose.
4. Immediately go to an emergency y room or doctor’s office if you develop anaphylaxis
5. Administer your injectable epinephrine if you develop anaphylaxis

Immunotherapy (shots for insect stings) will lower your risk of developing anaphylaxis following a sting. It will bring your risk to that of the general population (about 1-3%), and if you do develop anaphylaxis following a sting, immunotherapy will lessen the severity of the reaction.

A food allergy is when a person has a reaction after eating a food.  Specifically, an allergy antibody binds special cells and causes release of chemicals that cause symptoms of hives, swelling, itching, redness, shortness of breath, nausea, vomiting, diarrhea, dizziness, and even death.  Most reactions occur within minutes to an hour or two after ingestion of the food.  People can also have reactions after touching or inhaling the cooking vapors of certain foods.

The most common foods implicated in food allergy are “the big eight”

• Milk and foods that contain milk, such as ice cream or butter (called dairy foods)
• Eggs
• Wheat
• Soy
• Peanuts
• Tree nuts, such as almonds or cashews
• Fish
• Shellfish, such as shrimp or oysters

Food allergies usually appear in childhood and some, such as milk and egg allergy, are likely to be outgrown.  Others, like peanut and shellfish, persist into adulthood.  People can have an allergy to one or more foods.

Symptoms can differ from person to person. Also, a person can have different symptoms each time he or she has an allergic reaction.

Food allergy management:

Your doctor may perform allergy testing via skin testing or bloodwork.  In some cases, both types of testing are appropriate.  If any of the testing is positive or if the history is consistent with a food allergy it is very important to strictly avoid that specific food.  Ingestion may cause severe symptoms or possibly death even if an earlier reaction was mild.  Sometimes it can be difficult to know what food is causing symptoms.  In these cases keeping a food diary is helpful.  Reading labels is very important since one type of food may have many different names after being processed.  Some patients wear a medical alert bracelet to let others know to what foods they are allergic if they should lose consciousness.

If a food has been accidentally eaten, the best treatment is a medicine called “epinephrine.” All food-allergic patients should carry epinephrine autoinjectors with them at all times.  911 should be called immediately – at the hospital, doctors can give you epinephrine and other medicines to treat your symptoms. Doctors will also watch to make sure your symptoms don’t get worse.  Antihistamines are also used to help with symptoms of itching and hives.

Is there any way to prevent a food allergy?

It’s not clear. If you have a food allergy — or your child does — other family members may have a higher risk of the same allergy.  For pregnant or breastfeeding women it is not safe to avoid a food necessary for basic nutrition, such as milk, prior to talking with your doctor. When your baby is old enough to start eating solids, you will have to decide when to offer the food. Doctors used to think it was better to delay this if a baby was at high risk for allergy. Now, they think it might be better not to wait until the baby is older, and to give the food at the normal time. But there is still no way to know for sure if your baby will have an allergy. Your baby’s doctor can help you decide when and how to offer certain foods.

What are hives?

Hives are raised, red patches of skin that are usually itchy. Hives can be due to an allergy or other causes. In most cases, hives come and go within a few hours but in some people they will show up again and again. Some people who get hives also get a condition called “angioedema.” Angioedema is puffiness or swelling which usually happens in the face, eyelids, ears, mouth, hands, feet, or genitals.

Why did I get hives?

If you just got hives for the first time, you might have a new allergy to something. If your hives are caused by an allergy, you will need to avoid whatever you are allergic to.

• Medicines, such as antibiotics or aspirin
  • Foods, such as eggs, nuts, fish, or shellfish
  • Something they touched, such as a plant, animal saliva, or latex
  • Insect stings

Hives can also be caused by:

• Infections
• Having cold air or water on the skin
• Having something press or vibrate against the skin
• Changes in body temperature (such as when you cool down after a hot shower or a work out)
• Rarely, autoimmune disease or other diseases may cause hives.

See a doctor or call 911 – If you suddenly get hives or get puffy and also have any of these symptoms:

• Trouble breathing
• Tightness in the throat
• Nausea and vomiting
• Cramps or stomach pain
• Passing out

How are hives treated?

Hives usually will go away in a few days or weeks, but they may persist for month’s even years. If you do need treatment, the first step is to figure out if anything triggered the hives. Skin testing and/or lab work looking for causes can be very helpful.

To relieve itching, you can take medicines called antihistamines. These are the same medicines people usually take for allergies. There is also an injectable medicine for people with severe symptoms.

If you have severe hives or your hives will not go away, your doctor might suggest that you take some steroids (Prednisone) for a short period of time.

What is eczema?

Eczema, also referred to as “atopic dermatitis” is a skin condition that makes your skin itchy and flaky. Doctors do not know what causes eczema but most patients with eczema have allergies.

What are the symptoms of eczema?

• In babies, eczema tends to affect the front of the arms and legs, cheeks, or scalp. (The diaper area is not usually affected.)
• In older children and adults, eczema often affects the sides of the neck, the elbow creases, and the backs of the knees. Adults can also get it on their face, wrists, hands, and forearms. The skin can also become thick and dark. It might even forms scars from too much scratching.

Can I reduce my symptoms?

• Use unscented thick moisturizing creams or ointments to keep the skin from getting too dry.
• Avoid becoming too hot or sweaty.
• Avoid stress or worry.
• Avoid sudden temperature changes or being in very dry air.
• Avoid all fragranced products including perfumes, lotions, hand soaps and detergents.
• Avoid wool or synthetic fabrics.

How is eczema treated?

• Moisturizing creams or ointments – These products help keep your skin moist.
• Steroid creams and ointments – They relieve itching and redness.
• Medicines that change the way the immune system works – These medicines are only for people who do not get better with safer treatment options.
• Antihistamine pills – Antihistamines can help relieve itching.
• Light therapy –Doctors do not use light therapy much. During light therapy, your skin is exposed to a special kind of light called ultraviolet light.

Irritated skin can be caused by a variety of factors. These include immune system disorders, medications and infections. When an allergen is responsible for triggering an immune system response, then it is an allergic skin condition.

Atopic Dermatitis (Eczema)

Eczema is the most common skin condition, especially in children. It affects one in five infants but only around one in fifty adults. It is now thought to be due to “leakiness” of the skin barrier, which causes it to dry out and become prone to irritation and inflammation by many environmental factors. Also, some people with eczema have a food sensitivity which can make eczema symptoms worse. In about half of patients with severe atopic dermatitis, the disease is due to inheritance of a faulty gene in their skin called filaggrin. Unlike with urticaria (hives), the itch of eczema is not caused by histamine so anti-histamines do not control the symptoms. Eczema is often linked with asthma, allergic rhinitis (hay fever) or food allergy. This order of progression is called the atopic march.

Allergic Contact Dermatitis

Allergic contact dermatitis occurs when your skin comes in direct contact with an allergen. For instance, if you have a nickel allergy and your skin comes in contact with jewelry made with even a very small amount of nickel, you may develop red, bumpy, scaly, itchy or swollen skin at the point of contact.

Coming in contact with poison ivy, poison oak and poison sumac can also cause allergic contact dermatitis. The red, itchy rash is caused by an oily coating covering these plants. The allergic reaction can come from actually touching them, or by touching clothing, pets or even gardening tools that have come in contact with the oil.

Urticaria (Hives)

Hives are an inflammation of the skin triggered when the immune system releases histamine. This causes small blood vessels to leak, which leads to swelling in the skin. Swelling in deep layers of the skin is called angioedema. There are two kinds of urticaria, acute and chronic. Acute urticaria occurs after eating a particular food or coming in contact with a particular trigger. It can also be triggered by non-allergic causes such as heat or exercise, as well as medications, foods or insect bites. Chronic urticaria is rarely caused by specific triggers and so allergy tests are usually not helpful. Chronic urticaria can last for many months or years. Although they are often uncomfortable and sometimes painful, hives are not contagious.

Angioedema

Angioedema is swelling in the deep layers of the skin. It is often seen together with urticaria (hives). Angioedema many times occurs in soft tissues such as the eyelids, mouth or genitals. Angioedema is called “acute” if the condition lasts only a short time such as minutes to hours. Acute angioedema is commonly caused by an allergic reaction to medications or foods. Chronic recurrent angioedema is when the condition returns over a long period of time. It typically does not have an identifiable cause.
Hereditary angiodema (HAE) is a rare, but serious genetic condition involving swelling in various body parts including the hands, feet, face, intestinal wall and airways. It does not respond to treatment with antihistamines or adrenaline so it is important to go see a specialist.

Skin conditions are one of the most common forms of allergy treated and managed by an allergist / immunologist, a physician with specialized training and expertise to accurately diagnose your condition and provide relief for your symptoms.

Latex is a milky white fluid produced by rubber trees that grow in South America.  Latex can be used to manufacture many items that we use in medicine and everyday life including gloves, balloons, rubber bands, car tires, and condoms.  During recent years, allergic reaction to latex have been reported with increasing frequency, especially in health care professionals and patients.

The most common type of reaction to latex is a contact dermatitis.  In this type of reaction, an individual has itching, redness or scaling of the skin wherever latex has come into contact.  This may occur quickly but usually takes a few hours or days to develop.  The second type of latex is an immediate, potentially life threatening reaction that is mediated by an allergy antibody (IgE) to latex.  In this type of reaction, an individual may have shortness of breath, throat closing, angioedema (swelling), hives, or loss of consciousness when contacting latex.  The greatest danger in this type of reaction occurs when latex contacts mucus membranes or moist areas like the mouth, eyes, nasal passages, respiratory tract because more latex can be absorbed quickly.

How is treated?

• The first step is awareness of the problem.  After discussing with your doctor, a detailed history and examination will be performed.  Skin testing is available and occasionally, laboratory evaluation is helpful.
• Avoidance is the hallmark of treatment.  Substitution of synthetic gloves for latex and synthetic products in place of natural rubber latex products is important.  There is no adequate substitution for latex condoms available.  Natural skin condoms may prevent pregnancy but do not protect against viruses such as HIV.
• Certain fruits such as banana, avocado, kiwi and chestnuts must also be avoided in patients sensitive to latex due to cross-reactivity.
• Patients with immediate life threatening reactions to latex should carry injectable epinephrine and have a medical alert bracelet.