Allergic Eye Conditions (Allergic Conjunctivitis)
Allergic Nasal Conditions (Allergic Rhinitis, Hay Fever)
Allergic Reactions
Allergic Skin Conditions
Anaphylaxis (Life threatening allergic reactions)
Angioedema (Skin swelling)
Asthma
Atopic Dermatitis (Eczema)
Bee Sting Allergy
Chronic Cough
Chronic Sinusitis
Contact Dermatitis
Food Allergy
Hives (Urticaria)
Medication Allergy
Non-allergic Rhinitis
Recurrent Infection and Suspected Immunodeficiency

 

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What Is Allergic Conjunctivitis?

When your eyes are exposed to substances like pollen or mold spores, they may become red, itchy, and watery. These symptoms mean you have allergic conjunctivitis. Allergic conjunctivitis refers to eye inflammation resulting from an allergic reaction to substances like pollen or mold spores.

The inside of your eyelids and the covering of your eyeball have a membrane called the conjunctiva. The conjunctiva is susceptible to irritation from allergens, especially during hay fever season. Allergic conjunctivitus is quite common and affects about one-fifth of the population. It is your body’s reaction to substances it considers potentially harmful.

What Are the Types of Allergic Conjunctivitis?

Allergic conjunctivitis comes in two main types:

Acute Allergic Conjunctivitis

This is a short-term condition that is more common during allergy season. Your eyelids suddenly swell, itch, and burn. You may also have a watery nose.

Chronic Allergic Conjunctivitis

A less common condition called chronic allergic conjunctivitis can occur year-round. It is a response to allergens like food, dust, and animal dander. Burning and itching of the eyes and light sensitivity are common symptoms.

What Causes Allergic Conjunctivitis?

You experience allergic conjunctivitis when your body tries to defend itself against a perceived threat. It does this in reaction to substances that trigger the release of histamine, a potent chemical your body produces to fight off foreign invaders. Some of the substances that cause this reaction are:

• household dust
• pollen from trees and grass
• mold spores
• animal dander
• chemical scents (e.g., household detergents or perfume)

Some people may also experience allergic conjunctivitis in reaction to certain medications or substances dropped into the eyes, such as contact lens solution or medicated eye drops.

Who Is at Risk for Allergic Conjunctivitis?

People who have allergies are more likely to develop allergic conjunctivitis. Allergies affect 10 to 20 percent of the population. They often run in families.

Allergies affect people of all ages, though they are more common in children and young adults. If you have allergies and live in locations with high pollen counts, you are more susceptible to allergic conjunctivitis.

What Are the Symptoms of Allergic Conjunctivitis?

Red, itchy, watery, and burning eyes are common symptoms of allergic conjunctivitis. You may also wake up in the morning with puffy eyes.

How Is Allergic Conjunctivitis Diagnosed?

Your doctor will examine your eyes and review your allergy history. Redness in the white of the eye and small bumps inside your eyelids are visible signs of conjunctivitis. Your doctor may also order one of the following tests:

• An allergy skin test exposes your skin to specific allergens and allows your doctor to examine your body’s reaction, which may include swelling and redness.
• A blood test may be recommended to see if your body is producing proteins (antibodies) to protect itself against specific allergens like mold or dust.
• A scraping of your conjunctival tissue may be taken to examine your white blood cells. Eosinophils are white blood cells that become activated when you have allergies.

How Is Allergic Conjunctivitis Treated?

Home Care

Treating allergic conjunctivitis at home involves a combination of prevention strategies and activities to ease your symptoms. To minimize your exposure to allergens:

• close windows when the pollen count is high
• keep your home dust-free
• use an indoor air purifier
• avoid exposure to harsh chemicals, dyes, and perfumes

To ease your symptoms, avoid rubbing your eyes. Applying a cool compress to your eyes can also help reduce inflammation and itching.

Medications

In more troublesome cases, home care may not be adequate. You will need to see a doctor who might recommend:

• an oral or over-the-counter antihistamine to reduce or block histamine release
• anti-inflammatory and/or anti-inflammation eye drops
• eye drops to shrink congested blood vessels
• steroid eye drops (only in severe cases)

What Is The Long-Term Outlook?

With proper treatment, you can experience relief or at least reduce your symptoms. Recurring exposure to allergens, however, will likely trigger the same symptoms in the future.

How Do I Prevent Allergic Conjuctivitis?

Completely avoiding the environmental factors that cause allergic conjunctivitis can be difficult. The best thing you can do is to limit your exposure to these triggers. For example, if you know that you are allergic to perfume or household dust, you can try to minimize your exposure by using scent-free soaps and detergents, or by installing an air purifier in the home.

Allergic Nasal Conditions (Allergic Rhinitis, Hay Fever)

There are two types of rhinitis: allergic and non-allergic.
Allergic Rhinitis
If you have allergic rhinitis, your immune system mistakenly identifies a typically harmless substance as an intruder. This substance is called an allergen. The immune system responds to the allergen by releasing histamine and chemical mediators that typically cause symptoms in the nose, throat, eyes, ears, skin and roof of the mouth.
Seasonal allergic rhinitis (hay fever) is most often caused by pollen carried in the air during different times of the year in different parts of the country.

Allergic rhinitis can also be triggered by common indoor allergens such as the dried skin flakes, urine and saliva found on pet dander, mold, droppings from dust mites and cockroach particles. This is called perennial allergic rhinitis, as symptoms typically occur year-round.

In addition to allergen triggers, symptoms may also occur from irritants such as smoke and strong odors, or to changes in the temperature and humidity of the air. This happens because allergic rhinitis causes inflammation in the nasal lining, which increases sensitivity to inhalants.

Many people with allergic rhinitis are prone to allergic conjunctivitis (eye allergy). In addition, allergic rhinitis can make symptoms of asthma worse for people who suffer from both conditions.

Nonallergic Rhinitis
At least one out of three people with rhinitis symptoms do not have allergies. Nonallergic rhinitis usually afflicts adults and causes year-round symptoms, especially runny nose and nasal congestion. This condition differs from allergic rhinitis because the immune system is not involved.

Allergic Reactions

Allergies are an overreaction of the body’s natural defense system that helps fight infections (immune system). The immune system normally protects the body from viruses and bacteria by producing antibodies to fight them. In an allergic reaction, the immune system starts fighting substances that are usually harmless (such as dust mites, pollen, or a medicine) as though these substances were trying to attack the body. This overreaction can cause a rash, itchy eyes, a runny nose, trouble breathing, nausea, and diarrhea.

An allergic reaction may not occur the first time you are exposed to an allergy-producing substance (allergen). For example, the first time you are stung by a bee, you may have only pain and redness from the sting. If you are stung again, you may have hives or trouble breathing. This is caused by the response of the immune system.

Most people will have some problem with allergies or allergic reactions at some point in their lives. Allergic reactions can range from mild and annoying to sudden and life-threatening. Most allergic reactions are mild, and home treatment can relieve many of the symptoms. An allergic reaction is more serious when severe allergic reaction (anaphylaxis) occurs, when allergies cause other problems (such as nosebleeds, ear problems, wheezing, or coughing), or when home treatment doesn’t help.

Allergies often occur along with other diseases, such as asthma, ear infections, sinusitis, and sleep apnea. For more information, see the topic Allergic Rhinitis.

There are many types of allergies. Some of the more common ones include:

• Food allergies, which are more common in children than adults. Food allergies are most common in people who have an inherited tendency to develop allergic conditions. These people are more likely to have asthma and other allergies. For more information, see the topic Food Allergies.
• Medicine allergies. Many prescription and nonprescription medicines can cause an allergic reaction. Allergic reactions are common and unpredictable. The seriousness of the allergic reaction caused by a certain medicine will vary.
• Allergies to insect venom. When you are stung by an insect, poisons and other toxins in the insect’s venom enter your skin. It is normal to have some swelling, redness, pain, and itching at the site of a sting. An allergic reaction to the sting occurs when your body’s immune system overreacts to the venom of stinging insects. For more information, see the topic Allergies to Insect Stings
• Allergies to animals, which are more likely to cause breathing problems than skin problems. You may be allergic to your pet’s dead skin (dander), urine, dried saliva, or hair.
• Allergies to natural rubber (latex). Some people develop allergic reactions after repeated contact with latex, especially latex gloves.
• Allergies that develop from exposure to a particular inhaled substance in the workplace. These are called occupational asthma.
• Allergies to cosmetics, such as artificial nails, hair extensions, and henna tattoos.

Seasonal allergies show up at the same time of the year every year and are caused by exposure to pollens from trees, grasses, or weeds. Hay fever is the most common seasonal allergy.

Allergies that occur for more than 9 months out of the year are called perennial allergies.

Year-round symptoms (chronic allergies) are most likely to occur from exposure to animal dander, house dust, or mold.

Check your symptoms to decide if and when you should see a doctor.

Allergic Skin Conditions

An allergy is a physiologic reaction caused when the immune system mistakenly identifies a normally harmless substance as a substance that is damaging to the body.
Typically, the human immune system is utilized to defend itself against harmful substances such as viruses or bacteria, but sometimes it aggressively attacks normally harmless substances that the body is exposed to and considers them “foreign”. These immune/allergic reactions occur in two varieties: delayed, and immediate reactions. Delayed reactions, or allergic contact dermatitis is the most common allergic presentations on the skin, and occurs when various substances get on the skin and a persistent itchy rash develops a day or two later. A poison ivy rash is typical for a delayed allergy, but a similar type of reaction can occur after contact with shampoos, cosmetics, creams, earrings, and many other chemicals. Immediate immune reactions are those in which substances such as mold, dust, pollen, or animal dander cause swelling of the nose or sinuses, asthma, or itchiness of the eyes within minutes of exposure. This is the reaction with typical seasonal allergies.

Delayed Reactions (allergic contact dermatitis) may result in:

• A rash that can be red, itchy, rough, scaly, crusty
• A blistering reaction
• Swelling of the skin
• Redness and swelling in the mouth

Immediate Reactions may result in:

• Rhinitus (nasal stuffiness, sneezing, nasal itching, nasal discharge)
• Allergic conjunctivitis (red, itchy, watery eyes)
• A flare of atopic dermatitis (red, itchy, dry skin)
• Asthma

Cutaneous Allergy – How it is diagnosed

Delayed allergies are evaluated through patch testing. This is a process in which various allergens are applied to the back with tape and left in place for two days at which time they are removed. The patient is brought back another two days later to evaluate for delayed reactions on the skin which present as red, swollen areas.
Immediate-type allergies are evaluated through either making a small scratch or prick in the skin through diluted allergens that are applied to the back. The evaluation/reading of this type of testing is done about 30 minutes later. Also, various blood tests can also be utilized to evaluate for this type of allergy as well.
At the University of Utah, Department of Dermatology, a thorough evaluation can be performed for both delayed, and immediate type allergies.

Anaphylaxis (Life threatening allergic reactions)

Anaphylaxis is a life-threatening type of allergic reaction.

Causes

Anaphylaxis is a severe, whole-body allergic reaction to a chemical that has become an allergen. After being exposed to a substance such as bee sting venom, the person’s immune system becomes sensitized to it.

When the person is exposed to that allergen again, an allergic reaction may occur. Anaphylaxis happens quickly after the exposure, is severe, and involves the whole body.

Tissues in different parts of the body release histamine and other substances. This causes the airways to tighten and leads to other symptoms.

Some drugs (morphine, x-ray dye, aspirin, and others) may cause an anaphylactic-like reaction (anaphylactoid reaction) when people are first exposed to them. These reactions are not the same as the immune system response that occurs with “true” anaphylaxis. However, the symptoms, risk for complications, and treatment are the same for both types of reactions.

Anaphylaxis can occur in response to any allergen. Common causes include:

• Drug allergies
• Food allergies
• Insect bites/stings

Pollens and other inhaled allergens rarely cause anaphylaxis. Some people have an anaphylactic reaction with no known cause.

Anaphylaxis is life-threatening and can occur at any time. Risks include a history of any type of allergic reaction.

Symptoms

Symptoms develop quickly, often within seconds or minutes. They may include the following:

• Abdominal pain
• Abnormal (high-pitched) breathing sounds
• Anxiety
• Chest discomfort or tightness
• Cough
• Diarrhea
• Difficulty breathing
• Difficulty swallowing
• Dizziness or light-headedness
• Hives, itchiness
• Nasal congestion
• Nausea or vomiting
• Palpitations
• Skin redness
• Slurred speech
• Swelling of the face, eyes, or tongue
• Unconsciousness
• Wheezing

Exams and Tests

Signs include:

• Abnormal heart rhythm (arrhythmia)
• Fluid in the lungs (pulmonary edema)
• Hives
• Low blood pressure
• Mental confusion
• Rapid pulse
• Skin that is blue from lack of oxygen or pale from shock
• Swelling (angioedema) in the throat that may be severe enough to block the airway
• Swelling of the eyes or face
• Weakness
• Wheezing

The health care provider will wait to test for the allergen that caused anaphylaxis (if the cause is not obvious) until after treatment.

Treatment

Anaphylaxis is an emergency condition that needs professional medical attention right away. Call 911 immediately.

Check the person’s airway, breathing, and circulation (the ABC’s of Basic Life Support). A warning sign of dangerous throat swelling is a very hoarse or whispered voice, or coarse sounds when the person is breathing in air. If necessary, begin rescue breathing and CPR.

1. Call 911.
2. Calm and reassure the person.
3. If the allergic reaction is from a bee sting, scrape the stinger off the skin with something firm (such as a fingernail or plastic credit card). Do not use tweezers — squeezing the stinger will release more venom.
4. If the person has emergency allergy medicine on hand, help the person take or inject the medication. Avoid oral medication if the person is having difficulty breathing.
5. Take steps to prevent shock. Have the person lie flat, raise the person’s feet about 12 inches, and cover him or her with a coat or blanket. Do NOT place the person in this position if a head, neck, back, or leg injury is suspected, or if it causes discomfort.

DO NOT:

• Do NOT assume that any allergy shots the person has already received will provide complete protection.
• Do NOT place a pillow under the person’s head if he or she is having trouble breathing. This can block the airways.
• Do NOT give the person anything by mouth if the person is having trouble breathing.

Paramedics or other health care providers may place a tube through the nose or mouth into the airways (endotracheal intubation) or perform emergency surgery to place a tube directly into the trachea (tracheostomy or cricothyrotomy).

The person may receive antihistamines, such as diphenhydramine, and corticosteroids, such as prednisone, to further reduce symptoms (after lifesaving measures and epinephrine are given).

Outlook (Prognosis)

Anaphylaxis is a severe disorder that can be life-threatening without prompt treatment. However, symptoms usually get better with the right therapy, so it is important to act right away.

Possible Complications

• Airway blockage
• Cardiac arrest (no effective heartbeat)
• Respiratory arrest (no breathing)
• Shock

When to Contact a Medical Professional

Call 911 if you develop severe symptoms of anaphylaxis. If you are with another person, he or she may take you to the nearest emergency room.

Prevention

• Avoid triggers such as foods and medications that have caused an allergic reaction in the past. Ask detailed questions about ingredients when you are eating away from home. Also carefully examine ingredient labels.
• If you have a child who is allergic to certain foods, introduce one new food at a time in small amounts so you can recognize an allergic reaction.
• People who know that they have had serious allergic reactions should wear a medical ID tag.
• If you have a history of serious allergic reactions, carry emergency medications (such as a chewable form of diphenhydramine and injectable epinephrine or a bee sting kit) according to your health care provider’s instructions.
• Do not use your injectable epinephrine on anyone else. They may have a condition (such as a heart problem) that could be negatively affected by this drug

Angioedema (Skin swelling)

Definitions

Urticaria is a skin rash, also called hives, or nettle rash, which is often accompanied by swelling and itching of the skin.
Angioedema (in the past this was called giant urticaria or angioneurotic edema) is a condition involving swelling in the deeper layers of the skin, caused by a build up of fluid leaking from thin-walled blood vessels. It can accompany hives or occur alone.

Symptoms

Hives are itchy and have a central, raised white wheal surrounded by an area of redness. Hives whiten if pressure is applied to the rash. The rash generally disappears within 24 hours.

Swelling of deeper layers of the skin, angioedema, is often seen with hives. The redness that accompanies hives isn’t seen, but the swelling is very obvious. The swelling generally occurs on the fingers and toes, as well as areas of the head, neck, face, and, in men, the reproductive organs, and is often described as painful or burning.

Classification

Hives and angioedema are described by the length of time that symptoms last. A rash and/or swelling lasting less than six weeks is called acutehives/angioedema. Episodes that last more than six weeks are described as chronic hives/angioedema. The causes and the body’s reactions that lead to development of hives are different in acute and chronic hives/angioedema, and so treatment is also different.

Acute Hives
Acute hives can be divided into two general types, depending on the rate at which hives develop and the length of time the rash lasts. In one type, the rash lasts 1-2 hours; this is usually the type found in physically induced hives (see below). The second type can last as long as 36 hours; this is the type commonly seen in food or drug reactions.

Chronic Hives and Angioedema
Chronic hives and angioedema are diagnosed when hives and swelling are present for more than six weeks. Before the diagnosis is made, it is important to make sure that what seems to be a long-lasting attack of hives is not really a series of short attacks occurring close together.

Chronic Idiopathic Hives and Idiopathic Angioedema

This is a common disorder, and the diagnosis of idiopathic hives and angioedema is made when no cause can be found. The skin symptoms may vary from severe to mild or may intermittently subside, and routine blood tests show no obvious abnormalities. Chronic hives does not appear to be a true allergic reaction, because IgE antibody is not involved, and no contact with an allergen is needed to bring on the symptoms.

Causes 

Allergic Hives

Acute hives caused by an allergic reaction is a common condition in children and adults. When an allergen (for example, a food or insect sting) to which the person is allergic enters the bloodstream, it starts a series of reactions in the body’s immune system. These reactions lead to the release of histamine and other chemicals into the blood and can result in hives and/or other allergic symptoms. Common allergens that can cause acute hives include foods, drugs, and venoms from the stings of insects such as bee, wasp, yellow jacket, hornet, or fire ant, but virtually any allergen has the potential to cause hives.
In general, if an allergen causes hives or swelling, it is usually eaten (food, drug taken by mouth) or injected (drugs, stings). Allergens that are inhaled tend to cause asthma or rhinitis and may contribute to the development of eczema in children.
If an allergen can penetrate the skin, hives will develop at the site of exposure. For example, contact hives may occur following exposure to latex gloves if sufficient latex penetrates through the skin.
Non-specific Causes

Acute hives can result from causes other than true (IgE-mediated) allergies. An example is exposure to certain dyes used in X-ray procedures, which can cause a whole-body reaction called anaphylaxis which includes hives. Acute viral illnesses in children can be associated with hives which last a few weeks and then spontaneously subside. This usually occurs in association with the symptoms of a common cold, sore throat, or bronchitis. If these patients are given an antibiotic, the cause of the hives becomes confused, because a reaction to the antibiotics may be causing the hives. If antibiotics have been taken, the doctor may perform an allergy skin test, or blood tests for IgE antibodies against the antibiotic, because it is important to know whether or not the patient has had an allergic reaction to the antibiotic. Hepatitis B, glandular fever and intestinal parasites may all be associated with the development of hives.

Hives and angioedema can also result from drug treatments. These include codeine and opiate-derived medications, as well as aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). The responses to NSAIDs can be life-threatening because the angioedema can lead to serious swelling of the tongue and/or throat. Drugs used to treat high blood pressure, known as ACE inhibitors, can cause recurrent episodes of angioedema.

If chronic hives do not appear to be associated with any other disease, and are not due to one of the physically induced urticarias described below, they are called idiopathic, that is, of unknown origin. Research suggests that in 35-45% of patients with idiopathic hives the cause may be autoimmunity – that is, the patient’s immune system working against itself. These autoimmune types of hives are not serious and usually respond to treatment with antihistamines.

Physical Hives
Hives and/or angioedema can be caused by environmental factors, such as a change in temperature, or pressure on the skin. Two rare causes of hives are exposure to sunlight, or contact with water.

Cold-dependent Disorders
Cold urticaria is the rapid onset of itching, redness, and swelling of the skin after exposure to cold. The symptoms of cold urticaria may occur for the first time some weeks after a viral infection, and only affect those parts of the body that have been exposed to cold. To test for this, an ice-cube can be placed on the forearm for 4-5 min. A positive reaction leads to a hive in the shape of the ice cube within 10 minutes after the source of cold has been removed.

Cold urticaria can be restricted to certain areas of the body, for example, where there has been a cold injury, or at the sites of allergen immunotherapy (desensitization) injections, or insect bites. Another skin condition which is related to cold is cold-dependent dermatographism where hives form if the skin is scratched and then chilled.

Exercise-induced Disorders
Cholinergic or generalized heat urticaria is the onset of small wheals surrounded by a large area of redness, associated with exercise, hot showers, sweating and anxiety. The rash first appears on the neck and upper chest, giving a flushed appearance. This is accompanied by intense itching. The rash spreads gradually to the face, back, and extremities, and the wheals increase in size. In some people the hives join up and resemble angioedema. Watering eyes, increased saliva production and diarrhea can occur at the same time. Cholinergic urticaria is the only form of hives that can be caused by emotional responses.

Exercise-induced anaphylaxis was first described in a series of people who experienced combinations of itching, skin rash, swelling, wheezing, and low blood pressure as a result of exercise. The hives seen with exercise-induced anaphylaxis are large, in contrast to the small hives seen in cholinergic urticaria. A type of exercise-induced anaphylaxis has been described that is related to food, and occurs only if exercise takes place 5-24 hours after eating a food to which the individual is allergic.

Pressure-induced Hives/Angioedema
Pressure-induced hives/angioedema occurs 4-6 hours after pressure has been applied to the skin. There may be either a rash or swelling, or both, occurring around tight clothing; the hands may swell with activity such as hammering; foot swelling is common after walking; and buttock swelling may occur after sitting for a few hours.

Solar Urticaria

Solar urticaria is a rare disorder in which brief exposure to light causes the development of hives within 1-3 minutes. It starts with itching about 30 seconds after exposure to sunlight, and is followed by swelling and redness of the light-exposed area. The symptoms usually disappear within 1-3 hours.

Aquagenic Urticaria
Individuals develop small wheals after contact with water, regardless of its temperature.

Association with Autoimmune Thyroid Disease
Patients with chronic hives have an increased frequency of Hashimoto’s Disease (thyroiditis), and tests of thyroid function and thyroid antibody levels can be performed to see if this is responsible for the skin symptoms.

Treatment 

Treatment of Acute Hives and Angioedema
Acute episodes of hives and/or swelling can be treated with antihistamines, and 1% menthol in aqueous cream may help control itching. If the allergens causing hives and/or swelling have been identified, either from the description of the attacks, or by blood testing for specific IgE antibodies, allergen avoidance will help to prevent further attacks. If the hives or swelling have resulted from taking medications, the patient’s physician will be able to identify different types of medications for future treatment. Tightly-fitting clothes should be avoided, as wheals often occur in areas of pressure. As the itching associated with hives can be more severe in warm conditions, it may help to keep the home cool, and to ensure that the bedroom is not too hot. Urticaria and angioedema can be symptoms of a systemic reaction called anaphylaxis and may require urgent administration of intramuscular epinephrine (adrenaline).

Treatment of Chronic Hives

Antihistamines are valuable in the treatment of chronic hives and are more effective on the itching than the wheals. If the symptoms continue when the maximum recommended amount of antihistamines has been given, a short course of corticosteroid tablets may be helpful.

Epidemiology: Who Develops Urticaria and Angioedema, and Why?

Urticaria and angioedema are thought to affect 20% of the population at some time during their lifetime. Hives alone or associated with the swelling of angioedema are more common in women, while angioedema alone, in the absence of hives, is more common in men. Less than 10% of hives develop into a chronic problem. Very often an attack of hives occurs without anyone understanding why it has happened, with little or no risk of the symptoms recurring.

Links to Additional Information on Urticaria and Angioedema

American Academy of Allergy, Asthma and Immunology (AAAAI)
www.aaaai.org/public/publicedmat/advocate/2000/summer/ what_is_urticaria.stm
www.aaaai.org/public/publicedmat/tips/allergicskinconditions.stm
www.aaaai.org/public/publicedmat/tips/spanishtips/ condiciones_alergicas_de_la_piel.stm  (in Spanish)

American College of Allergy, Asthma and Immunology (ACAAI)
www.acaai.org/allergist/allergies/Types/skin-allergies/hives/Pages/default.aspx

Australasian Society of Clinical Immunology and Allergy (ASCIA)
www.allergy.org.au/aer/infobulletins/urticaria.htm

Asthma

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.

For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.

Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust treatment as needed.

Asthma symptoms range from minor to severe and vary from person to person. You may have infrequent asthma attacks, have symptoms only at certain times — such as when exercising — or have symptoms all the time.

Asthma signs and symptoms include:

• Shortness of breath
• Chest tightness or pain
• Trouble sleeping caused by shortness of breath, coughing or wheezing
• A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Signs that your asthma is probably worsening include:

• Asthma signs and symptoms that are more frequent and bothersome
• Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
• The need to use a quick-relief inhaler more often

For some people, asthma symptoms flare up in certain situations:

• Exercise-induced asthma, which may be worse when the air is cold and dry
• Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust
• Allergy-induced asthma, triggered by particular allergens, such as pet dander, cockroaches or pollen

When to see a doctor

Seek emergency treatment

Severe asthma attacks can be life-threatening. Work with your doctor ahead of time to determine what to do when your signs and symptoms worsen — and when you need emergency treatment. Signs of an asthma emergency include:

• Rapid worsening of shortness of breath or wheezing
• No improvement even after using a quick-relief inhaler
• Shortness of breath when you are doing minimal physical activity

Contact your doctor

See your doctor:

• If you think you have asthma. If you have frequent coughing or wheezing that lasts more than a few days or any other signs or symptoms of asthma, see your doctor. Treating asthma early may prevent long-term lung damage and help keep the condition from worsening over time.
• To monitor your asthma after diagnosis. If you know you have asthma, work with your doctor to keep it under control. Good long-term control helps you feel better on a daily basis and can prevent a life-threatening asthma attack.
• If your asthma symptoms get worse. Contact your doctor right away if your medication doesn’t seem to ease your symptoms or if you need to use your quick-relief inhaler more often. Don’t try to solve the problem by taking more medication without consulting your doctor. Overusing asthma medication can cause side effects and may make your asthma worse.
• To review your treatment. Asthma often changes over time. Meet with your doctor on a regular basis to discuss your symptoms and make any needed treatment adjustments.

Atopic Dermatitis (Eczema)

This is a common skin disease in children. It is so common that people have given it a few names:

• Eczema (name most people use).
• Dermatitis.
• Atopic (a-top-ic) eczema.
• Atopic dermatitis.

To avoid confusion, we’ll use the medical term atopic dermatitis.
Children often get atopic dermatitis (AD) during their first year of life. If a child gets AD during this time, dry and scaly patches appear on the skin. These patches often appear on the scalp, forehead, and face. These patches are very common on the cheeks.

No matter where it appears, AD is often very itchy. Infants may rub their skin against bedding or carpeting to relieve the itch.

In children of all ages, the itch can be so intense that a child cannot sleep. Scratching can lead to a skin infection.

Because atopic dermatitis can be long lasting, it is important to learn how to take care of the skin. Treatment and good skin care can alleviate much of the discomfort.

Bee Sting Allergy

Stinging Insect Allergy Overview

Most of us develop redness and swelling at the site of an insect bite. Yet people who are allergic to stinging insect venom are at risk for a much more serious reaction. This life-threatening reaction is called anaphylaxis (an-a-fi-LAK-sis).

Understanding differences in symptoms between a normal reaction and an allergic reaction can bring peace of mind. It is also important to have an accurate diagnosis so you can manage your condition and be prepared for an emergency.

An allergic reaction occurs when the immune system overreacts to an allergen. In stinging insect allergy, the allergen is venom from a sting. Most serious reactions are caused by five types of insects:
•    Yellow jackets are black with yellow markings, found in various climates. Their nests are usually located underground, but sometimes found in the walls of buildings, cracks in masonry or in woodpiles.
•    Honeybees have round, fuzzy bodies with dark brown and yellow markings. They can be found in honeycombs in trees, old tires or other partially protected sites.
•    Paper wasps are slender with black, brown, red and yellow markings. They live in a circular comb under eaves, behind shutters or in shrubs and woodpiles.
•    Hornets are black or brown with white, orange or yellow markings. Their nests are gray or brown and are usually found in trees.
•    Fire ants are reddish-brown ants living in large mounds, mostly in warmer climates. They attack with little warning, inserting highly concentrated toxins that cause burning and pain.

Stinging Insect Allergy Symptoms & Diagnosis

Symptoms
Most people develop pain, redness and swelling at the site of an insect sting. This is a normal reaction that takes place in the area of the bite.

A serious allergic reaction occurs when the immune system gets involved and  overreacts to the venom, causing symptoms in more than one part of the body such as:
•    Swelling of the face, throat or tongue
•    Difficulty breathing
•    Dizziness
•    Stomach cramps
•    Nausea or diarrhea
•    Itchiness and hives over large areas of the body

This severe allergic reaction is called anaphylaxis.

Insect stings can cause serious symptoms that are not allergic. A toxic reaction occurs when the insect venom acts like a poison in the body. A toxic reaction can cause symptoms similar to those of an allergic reaction, including nausea, fever, swelling at the site of the sting, fainting, seizures, shock and even death. A toxic reaction can happen after only one sting, but it usually takes many stings from insects.

Serum sickness is an unusual reaction to a foreign substance in the body that can cause symptoms hours or days after the sting. Symptoms include fever, joint pain, other flu-like symptoms and sometimes hives.

Diagnosis
If you think you might be allergic to stinging insects, an accurate diagnosis is essential. An allergist / immunologist has specialized training and skills in determining the cause of your symptoms. Your allergist will conduct a thorough health history followed byallergy testing to determine what, if any, allergens put you at risk for serious reactions to stinging insects.

Stinging Insect Allergy Treatment & Management

Avoiding contact with stinging insects is the key to successfully managing this allergy. These steps can help:
•    Insects are most likely to sting if their homes are disturbed, so have hives and nests around your home destroyed. Because this activity can be dangerous, you should hire a trained exterminator.
•    If you spot stinging insects, remain calm and quiet, and slowly move away.
•    Avoid brightly colored clothing and perfume when outdoors. Many stinging insects are searching for food and could confuse you with a flower.
•    Be careful outdoors when cooking, eating or drinking sweet beverages like soda or juice. Cover food and drinks to keep insects out.
•    Wear closed-toe shoes outdoors and avoid going barefoot to steer clear of stepping on a stinging insect.
•    Avoid loose-fitting garments that can trap insects between material and skin.
If you have an anaphylactic reaction, inject epinephrine immediately and call 911.
After a serious reaction to an insect sting, make an appointment with an allergist / immunologist. With proper testing, your allergist can diagnose your condition and determine the best form of treatment.
Immunotherapy (allergy shots) may be effective long-term treatment for stinging insect allergy. Your allergist will give you shots containing small doses of your allergen, allowing your body to build a natural immunity to the trigger.

Chronic Cough

What is chronic cough?

Chronic cough is a cough that persists. Chronic cough is not a disease in itself, but rather a symptom of an underlying condition. Chronic cough is a common problem and the reason for many doctor visits.

What are causes of chronic cough?

Some common causes of chronic cough include asthma, allergic rhinitis, sinus problems (for example sinus infection), and esophageal reflux of stomach contents. In rare cases, chronic cough may be the result of inhaling foreign objects into the lungs (usually in children). It is important to see a doctor who may order a chest X-ray if a chronic cough is present. The following are common causes of chronic coughing.

• Cigarette smoking is the most common cause of chronic cough.
• Asthma is a disease of the airways, resulting in difficulty breathing orwheezing often characterized by abnormal breathing tests. Some asthma sufferers have chronic cough as their only symptom. They may even have normal lung functions tests. This is often referred to as cough-variant asthma. Asthma symptoms can be aggravated by cold air, exposure to air pollutants, pollen, smoke, or perfumes.
• Gastroesophageal reflux disease (GERD) refers to acid reflux, or backward flow, of stomach acid and other contents into the esophagus. If stomach acid moves backward up the esophagus, reflexes result in spasm of the airways that can cause shortness of breath and coughing. In some instances, acid reflux can be so severe that substances can be inhaled (aspirated) into the lungs and cause similar symptoms as well as damage to lung tissue. In some individuals, no sensation of heartburn is felt and their only symptom may be cough.
• Sinus problems and postnasal drip can also cause chronic cough with mucus. This condition can be difficult to detect. Sometimes CT scan of the sinuses is necessary for diagnosis. Affected individuals often complain of a “tickle in their throat” and frequent throat clearing.
• Infections such as bronchitis or pneumonia can cause acute cough or a chronic cough. These infections can be caused by viruses, bacteria, or fungus. Viral infections do not respond to antibiotics. In patients with asthma, viral upper respiratory infections often result in a prolonged cough even after the infection has cleared.
  • A particular strain of bacterial pneumonia, called Mycoplasma, may cause a chronic cough with fatigue, weakness, shortness of breath, and sputum production. This infection is sometimes referred to as “walking pneumonia,” and commonly affects young and healthy people.
  • Whooping cough (pertussis) is an acute, highly contagious respiratory infection caused by the bacterium Bordetella pertussis.Whooping cough commonly affects infants and young children, but can be prevented by immunization with pertussis vaccine. In adults, whooping cough can be a cause of chronic cough.
• Chronic cough in children is uncommon. Foreign material obstructing the airways of the lungs, asthma, and allergies are evaluated by a pediatrician.
• Certain medications, notably ACE inhibitors (enalapril [Vasotec],captopril [Capoten] etc.) used in treating high blood pressure, can cause chronic cough.
• Less common causes of chronic cough include allergies, tumors,sarcoidosis, congestive heart failure, or other lung diseases such as chronic obstructive disease (COPD) or emphysema.

If chronic cough persists it is important to be evaluated by a doctor. The doctor will consider the possibility of asthma, postnasal drip, esophageal reflux, drug side effects, interstitial lung disease, or other unusual infections.

Chronic Sinusitis

Sinusitis is inflammation of the sinuses. It occurs as the result of an infection from a virus, bacteria, or fungus.

Causes

The sinuses are air-filled spaces in the skull. They are located behind the forehead, nasal bones, cheeks, and eyes. Healthy sinuses contain no bacteria or other germs. Most of the time, mucus is able to drain out and air is able to flow through the sinuses.

When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.

Sinusitis can occur from one of these conditions:

• Small hairs (cilia) in the sinuses fail to properly to move mucus out. This may be due to some medical conditions.
• Colds and allergies may cause too much mucus to be made or block the opening of the sinuses.
• A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.

There are two types of sinusitis:

• Acute sinutitis is when symptoms are present for 4 weeks or less. It is caused by bacteria growing in the sinuses.
• Chronic sinusitis is when swelling and inflammation of the sinuses are present for longer than 3 months. It may be caused by bacteria or a fungus.

The following may increase the risk that an adult or child will develop sinusitis:

• Allergic rhinitis or hay fever
• Cystic fibrosis
• Going to day care
• Diseases that prevent the cilia from working properly
• Changes in altitude (flying or scuba diving)
• Large adenoids
• Smoking
• Weakened immune system from HIV or chemotherapy

Symptoms

The symptoms of acute sinusitis in adults usually follow a cold that does not get better or gets worse after 5 – 7 days. Symptoms include:

• Bad breath or loss of smell
• Cough, often worse at night
• Fatigue and general feeling of being ill
• Fever
• Headache — pressure-like pain, pain behind the eyes, toothache, or tenderness of the face
• Nasal stuffiness and discharge
• Sore throat and postnasal drip

Symptoms of chronic sinusitis are the same as those of acute sinusitis, but tend to be milder and last longer than 12 weeks.

Symptoms of sinusitis in children include:

• Cold or respiratory illness that has been getting better and then begins to get worse
• High fever, along with a darkened nasal discharge, that lasts for at least 3 days
• Nasal discharge, with or without a cough, that has been present for more than 10 days and is not improving

Exams and Tests

The doctor will examine you or your child for sinusitis by:

• Looking in the nose for signs of polyps
• Shining a light against the sinus (transillumination) for signs of inflammation
• Tapping over a sinus area to find infection

Most of the time, regular x-rays of the sinuses do not diagnose sinusitis well.

Viewing the sinuses through a fiberoptic scope (called nasal endoscopy or rhinoscopy) may help diagnose sinusitis. This is often done by doctors who specialize in ear, nose, and throat problems (ENTs).

Imaging tests that may be used to decide on treatment are:

• A CT scan of the sinuses to help diagnose sinusitis or view the bones and tissues of the sinuses more closely
• An MRI of the sinuses if there might be a tumor or fungal infection

If you or your child has sinusitis that does not go away or keeps returning, other tests may include:

• Allergy testing
• Blood tests for HIV or other tests for poor immune function
• Ciliary function test
• Nasal culture
• Nasal cytology
• Sweat chloride tests for cystic fibrosis

Treatment

SELF CARE

Try the following measures to help reduce congestion in your sinuses:

• Apply a warm, moist washcloth to your face several times a day.
• Drink plenty of fluids to thin the mucus.
• Inhale steam 2 – 4 times per day (for example, while sitting in the bathroom with the shower running).
• Spray with nasal saline several times per day.
• Use a humidifier.
• Use a Neti pot to flush the sinuses.

Be careful with use of over-the-counter spray nasal decongestants. They may help at first, but using them for more than 3 – 5 days can make nasal stuffiness worse.

To help ease sinus pain or pressure:

• Avoid flying when you are congested.
• Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.
• Try acetaminophen or ibuprofen.

MEDICATIONS AND OTHER TREATMENTS

Most of the time, antibiotics are not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time it takes for the infection to go away. Antibiotics may be prescribed sooner for:

• Children with nasal discharge, possibly with a cough, that is not getting better after 2 – 3 weeks
• Fever higher than 102.2° Fahrenheit (39° Celsius)
• Headache or pain in the face
• Severe swelling around the eyes

Acute sinusitis should be treated for 10 – 14 days. Chronic sinusitis should be treated for 3 – 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.

At some point, your doctor will consider:

• Other prescription medications
• More testing
• Referral to an ear, nose, and throat (ENT) or allergy specialist

Other treatments for sinusitis include:

• Allergy shots (immunotherapy) to help prevent the disease from returning
• Avoiding allergy triggers
• Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are nasal polyps or allergies

Surgery to enlarge the sinus opening and drain the sinuses may also be needed. You may need to consider this procedure if:

• Your symptoms do not go away after 3 months of treatment.
• You have more than two or three episodes of acute sinusitis each year.

An ENT specialist (also known as an otolaryngologist) can perform this surgery.

Most fungal sinus infections need surgery. Surgery to repair a deviated septum or nasal polyps may prevent the condition from returning.

Outlook (Prognosis)

Most sinus infections can be cured with self-care measures and medical treatment. If you are having repeated attacks, you should be checked for causes such as nasal polyps or other problems, such as allergies.

Possible Complications

Although very rare, complications may include:

• Abscess
• Bone infection (osteomyelitis)
• Meningitis
• Skin infection around the eye (orbital cellulitis)

When to Contact a Medical Professional

Call your doctor if:

• Your symptoms last longer than 10 – 14 days or you have a cold that gets worse after 7 days.
• You have a severe headache that is not relieved by over-the-counter pain medicine.
• You have a fever.
• You still have symptoms after taking all of your antibiotics properly.
• You have any changes in your vision during a sinus infection.

A green or yellow discharge does not mean that you definitely have a sinus infection or need antibiotics.

Prevention

The best way to prevent sinusitis is to avoid colds and flu or treat problems quickly.

• Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection.
• Get an influenza vaccine each year.
• Reduce stress.
• Wash your hands often, particularly after shaking hands with others.

Other tips for preventing sinusitis:

• Avoid smoke and pollutants.
• Drink plenty of fluids to increase moisture in your body.
• Take decongestants during an upper respiratory infection.
• Treat allergies quickly and appropriately.
• Use a humidifier to increase moisture in your nose and sinuses.

Contact Dermatitis

You call it a rash. Your doctor calls it dermatitis. Either way, it happens when your skin gets inflamed after it comes in contact with something.

Contact Dermatitis Causes
Your rash could be caused by an allergy, or by damage to your skin.

If it’s caused by an allergy, your immune system is involved. After your skin touches something, your immune system mistakenly thinks it’s under attack. It springs into action, making antibodies to fight the invader. A chain of events takes place that causes a release of chemicals like histamine. That’s what causes the allergic reaction — in this case, an itchy rash. It’s called allergic contact dermatitis.
Usually, you won’t get a rash the first time your skin is touching something you’re allergic to. But it sensitizes your skin, and you have an allergic reaction the second time your skin touches it. If you get a rash the first time, chances are you were exposed to the allergic trigger before and just didn’t know it.

Allergic Reaction Triggers

• Poison ivy, poison oak, and poison sumac
• Hair dyes or straighteners
• Nickel, a metal found in jewelry and belt buckles
• Leather (chemicals used in tanning leather)
• Latex rubber
• Citrus fruit, especially the peel
• Fragrances in soaps, shampoos, lotions, perfumes, and cosmetics
• Some medications that are applied to the skin

When Skin Damage Causes a Rash
Some rashes look like an allergic reaction but really aren’t because your immune system isn’t involved. Instead, you touched something that directly hurt your skin. The longer that thing stayed on your skin, the worse the reaction. It’s called irritant contact dermatitis.

If you have eczema, you’re more likely to get this kind of a rash.

Telling Rashes Apart
It’s not easy to tell whether your rash was caused by an allergy or by damage to your skin, because many of the symptoms can be the same.

• With an allergy, symptoms are usually right around where you touched the thing you’re allergic to. A rash from skin damage may be more widespread.
• You’ll usually see a rash immediately if something is irritating or damaging your skin. With an allergy, it may be a day or two before the rash shows up.
• In both cases, your skin may blister, or you may get a raised red rash.
• Your skin will itch and maybe burn. Irritant contact dermatitis (skin damage) tends to be more painful than itchy.
• A rash on your hands can be a tell-tale sign of skin damage, because your hands are exposed to so many substances.

When to See Your Doctor

Call your doctor if your rash isn’t better after a couple of days. Usually your doctor can examine you and ask questions to figure out what’s causing the rash.
Depending on how severe your rash is, your doctor may prescribe steroid pills or ointment, and an antihistamine.

Treating a Rash at Home

• Don’t touch the thing that caused the rash.
• If you can wash your skin with mild soap and cool water right after exposure, you may get rid of all or most of the problem substance. That will help reduce symptoms.
• For blisters, try applying cold moist compresses for 30 minutes three times a day.
• Oral antihistamines can help relieve itching.
• Don’t use an antihistamine lotion unless suggested by your doctor, because it sometimes can cause skin irritation or an allergic reaction.
• If the rash covers only a small area, a hydrocortisone cream may be all you need for relief.

Food Allergy

Food allergy symptomsoccur most often in babies and children but can appear at any age. Foods that you have eaten for years without problems can cause allergies.

• Types of food allergies
• Food allergy treatment

An allergy occurs when something causes your body’s natural defenses to overreact. More than 50 million Americans have an allergy of some kind, but food allergies are rare. Up to 4 percent of adults have food allergies.

By using caution and carefully following an allergist’s advice, you can bring food allergy under control. Please contact your allergist with further questions and concerns about food allergy treatment.

Food allergy causes:
The body’s natural defense network is called the immune system. It keeps you healthy by fighting off infections and other dangers to good health. Most people have no problem eating many kinds of foods. An allergic reaction occurs when the immune system attacks a specific food or something in a food by mistake. This battle causes:

• Blood vessels to swell up,
• Smooth muscles to contract, and
• Skin areas to become red, itchy and swollen

Why do I have food allergy?
If both your parents have allergies, you have about a 75 percent chance of being allergic. If one of your parents is allergic, or if one of your relatives from either side has allergies, you have a 30-40 percent chance of having some form of allergy yourself. If neither parent has allergy, the chance is only 10-15 percent.

The amounts of a food or a kind of food you eat, and how often you eat, it may be important to why you become food allergic.
Which foods are most likely to cause allergy?

Almost any food can start an allergy. Peanuts, tree nuts and shellfish often cause severe food allergies.

Someone allergic to a food may also react to related foods. A person allergic to walnuts may also react to pecans. Persons allergic to shrimp may also react to crab and lobster. A person allergic to peanuts may have problems with soy, peas or certain kinds of beans.

Most food allergy patients only react to one or two foods. Someone allergic to pecans may not have to stop eating all nuts. This should be discussed with your allergist.

For additional resources on food allergies, visit the Food Allergy and Anaphylaxis Network.  For the Guidelines for the Diagnosis and Management of Food Allergy in the United States visit the National Institute of Allergy and Infectious Diseases.

Hives (Urticaria)

What are hives (urticaria) and angioedema?

Hives (medically known as urticaria) appear on the skin as wheals that are red, very itchy, smoothly elevated areas of skin often with a blanched center. They appear in varying shapes and sizes, from a few millimeters to several centimeters in diameter anywhere on the body.

It is estimated that 20% of all people will develop urticaria at some point in their lives. Hives is more common in women than in men. One hallmark of hives is its tendency to change size rapidly and to move around, disappearing in one place and reappearing in other places, often in a matter of hours. Hives usually lasts no longer than 24 hours. An outbreak that looks impressive, even alarming, first thing in the morning can be completely gone by noon, only to be back in full force later in the day. Very few, if any other, skin diseases occur and then resolve so rapidly. Therefore, even if you have no evidence of hives to show the doctor when you get to the office for examination, the diagnosis can be established based upon the accurate accounting of your symptoms and signs. Because hives fluctuates so much and so fast, it is helpful to bring along a photograph of what the outbreak looked like at its worst.

Swelling deeper in the skin that may accompany hives is calledangioedema. This swelling of the hands and feet, as well as the lips or eyelids, can be as dramatic as it is brief.

Hives facts

• Hives (medically known as urticaria) are red, itchy, raised areas of skin that appear in varying shapes and sizes, each one characteristically lasts no longer than six to 12 hours.
• Hives is very common, and most often their cause is elusive.
• Hives can change size rapidly and move around, disappearing in one place and reappearing in other places, often in a matter of hours.
• Ordinary hives flare up suddenly.
• Physical hives are produced by direct physical stimulation by environmental forces.
• Treatment of hives is directed at symptom relief while the condition goes away on its own.
• Antihistamines are the most common treatment for hives.
• Hives typically is not associated with long-term or serious complications.

Medication Allergy

Drug Reactions and Drug Allergies

Most of us have had trouble with one drug or another. Some drugs can cause an upset stomach or drowsiness. Some drugs can threaten our lives. Drugs put more than 2 million people into the hospital every year. Drugs cause more than 100,000 deaths every year. The number of serious drug reactions goes up every year.

A drug reaction is a problem caused by a drug that you or your doctor did not expect. Any prescription or non-prescription drug can cause a problem. Reactions can occur between medications. Most drugs cause trouble by working on your body chemistry.

Rarely, your immune system may react to a drug or to a chemical that your body created from that drug. This type of reaction is called a hypersensitivity reaction. Allergic drug reactions are one type of hypersensitivity reaction.

Drug allergy symptoms

Allergic drug reactions may cause:

• Skin rash or hives
• Itchy skin
• Wheezing or other breathing problems
• Swelling of body parts
• Anaphylaxis, a life-threatening allergic reaction

Reactions can occur in any part of your body.
A “pseudoallergic” or “anaphylactoid” drug reaction looks like an allergic drug reaction, but it is not allergic. This type of reaction can happen when you take the drug for the first time. This can occur with aspirin or X-ray dye. This can also happen with other drugs.

Drug allergy treatment
For a mild reaction, you may only have to stop the drug.
For a more serious allergic drug reaction that is not life-threatening, your Allergist may give you:
An antihistamine (to counteract the histamine released into your body during the reaction)
A non-steroidal anti-inflammatory drug or a corticosteroid (to reduce inflammation)

What causes a drug allergy?
Any person can get an allergic drug reaction to any drug. Allergic drug reactions are less common than other types of drug reactions.

For a drug allergy to happen, you must have taken the drug before. You are more likely to get an allergy to a drug that gave you a drug allergy before. You can loose a drug allergy. You might have a reaction that looks like a drug allergy, but is not a true drug allergy.

If you have a family member who had a drug allergy, then you are more likely to have an allergy to any drug. You are not more likely to develop a drug reaction that that drug.

If you never had the drug before, then you cannot develop a drug allergy to that drug. You might expose yourself to that drug without knowing it. You might eat a food that contains an antibiotic. Then you could get a drug allergy to that antibiotic, if you take the antibiotic for an infection.

You are more likely to have a medication allergy if you get the drug through your veins. When you take a drug through your veins, the drug goes immediately into your blood system. The higher the amount of the drug in your blood system, the more likely you will have an allergic drug reaction to it. Less often, you can get a drug allergy from swallowing the drug. The more often you take a drug, the more likely you will have a drug allergy to it.

Diagnosing drug allergies

Drug reactions can be hard to diagnose. They can look like other diseases. Many of the drug reactions are known. Others may not have been identified yet.

It is important to figure out if the reaction you suffered is allergic or not allergic. Your doctor may ask you to see an allergist.
When you visit an allergist, you can help if you take with you the following information:

• When did you take the drug
• When did you stop the drug
• When did you problem begin
• What happened to you
• How long did your problem last
• What other prescription drugs did you take
• What other non-prescription drugs
• What health foods did you take
• What herbs did you take
• What minerals did you take
• What are the exact names
• What treatments did you get for the reaction

You should bring with you:

• Your usual medicines
• Your other drug reactions
• Your medical and surgical problems
• Problems that run in your family

Bring the exact name for all of your drugs. If you can, bring the suspected drug with you. This will help the allergist recommend different drugs, if you need them.

The allergist will give you a physical examination. The allergist will look for problems that are part of the drug reaction. The allergist will look for non-allergic reasons for the reaction.

Skin tests are available for some drugs. Drug challenge tests can be helpful. For a drug challenge, you take the drug and you doctor observes your reaction. If you had a serious reaction, drug challenge can be too dangerous. Drug challenge may be the best type of testing if there is no other drug to save your life. Blood tests for some drugs are available, but they are less helpful.

Other medications
Sometimes you can replace the drug with other medicines. If not, then the allergist may offer you desensitization to the drug.

Desensitization means taking the drug in increasing amounts until you can tolerate the needed dose. This must be done in a doctor’s office or hospital to get the care you need if you have problems. Desensitization can help only if you will take the drug every day. Once you stop the drug, you may need another desensitization.

What is anaphylaxis?
Anaphylaxis is a severe, life-threatening allergic reaction. This serious reaction happens within seconds to minutes after you take the drug. With this type of reaction, you may experience:

• Swelling of your body parts, with or without hives
• Light headedness or dizziness
• Sudden drop in your blood pressure, with or without loss of consciousness
• Shock, with damage to your internal organs

Anaphylaxis requires emergency treatment to prevent death and damage to your internal organs. Treatment includes:

• Drugs (oxygen, adrenalin, antihistamine)
• Intravenous fluid

These treatments help support your blood pressure and your internal organs. Your doctor may give you a form of steroids. If you stop breathing, the doctor may give you artificial breathing.

If you take a drug and find yourself in the middle of this type of reaction, you and those around you must act fast. Immediately call your local emergency telephone number (911 in most places in the United States and Canada). Antihistamines might help. Alone, they will not keep you out of serious trouble.

If you carry self-administered epinephrine (adrenalin), then you should take it immediately. If you do carry adrenalin, be sure you really know how and when to use it in an emergency. If you observe someone go into anaphylaxis, then be sure to put the person on their back and raise that person’s feet. Call your local emergency telephone number immediately!

If you have a drug allergy:

• Make sure all of your doctors know the drug you took and the drug reactions you suffered
• Check with your doctor about related drugs that you must avoid
• Check with your doctor about drugs that you can take, if needed
• Wear an emergency medical alert bracelet or necklace, with the offending drug engraved

For more information on drug allergy, please visit the following site at the National Institutes of Health:

http://www.nlm.nih.gov/medlineplus/ency/article/000819.htm

Non-allergic Rhinitis

When a person has rhinitis the inside of their nose becomes inflamed (swells), causing cold-like symptoms, such as itchiness, blocked nose, runny nose and sneezing. Rhinitis can be caused by an allergy (allergic rhinitis) or something else (non-allergic rhinitis). This article is about non-allergic rhinitis. The symptoms of non-allergic and allergic rhinitis are similar, but the causes are different.

Some individuals with non-allergic rhinitis often find they have a runny nose that does not seem to get better, while others find that symptoms keep recurring. The blood vessels inside the nose expand, causing the lining of the nose to swell. This stimulates the mucus glands in the nose, causing it to become congested and “drippy”. According to The Mayo Clinic, USA, and the National Health Service (NHS), UK, both children and adults are similarly affected by non-allergic rhinitis. Women tend to be more susceptible to nasal congestion during menstruation and pregnancy. The English medical word rhinitis comes from the Greek word rhinos meaning “nose” and the Greek suffix (word ending) itis meaning “inflammation“. 

There are different types of non-allergic rhinitis:

• Infectious rhinitis – also known as viral rhinitis. This is caused by an infection, e.g. the common cold or flu.
• Vasomotor rhinitis – the blood vessels in the nose are too sensitive, leading to inflammation. There is abnormal nerve (neuronal) control of the blood vessels in the nose, resulting in inflammation.
• Atrophic rhinitis – the membranes inside the nose become thinner and harder, causing the nasal passages to widen and become drier. Crusts form inside the nose, some of them foul smelling. The patient can lose his/her sense of smell. This type of rhinitis may be a complication of nose surgery or an infection.
• Other causes – some people may develop non-allergic rhinitis after taking certain medications, such asbeta blockers, aspirin or the overuse of nasal decongestants (rhinitis medicamentosa). Sometimes pregnancy, puberty or an over-active thyroid gland can cause rhinitis (due to a hormonal imbalance). Eating spicy foods can cause rhinitis in some people (this is not allergic rhinitis because it is not caused by an immune system response).

What are the signs and symptoms of non-allergic rhinitis?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. 

The signs and symptoms of infectious rhinitis, vasomotor rhinitis and rhinitis medicamentosa are similar, and they include:

• Sneezing
• A blocked nose
• A runny nose
• Nasal pressure
• Nasal pain
• Postnasal drip – phlegm (mucus) in the throat

The signs and symptoms of atrophic rhinitis include:

• Crusting inside the nose
• Crusts produce a foul smell
• The nose may bleed when the patient tries to remove the crust
• Anosmia – loss of the sense of smell

Individuals with non-allergic rhinitis do not generally have itchy nose, eyes or throat (allergic rhinitis symptoms).

What are the risk factors for non-allergic rhinitis?

A risk factor is something which increases the likelihood of developing a condition or disease. For example,obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. Risk factors for non-allergic rhinitis include:

• Irritants – people who are exposed to tobacco smoke, smog, exhaust fumes, and some other irritants are more likely to develop non-allergic rhinitis. People who work in environments with irritants, such as airplane fuel, jet exhaust, solvents, and some other substances have a higher risk.
• Overuse or prolonged use of nasal sprays and drops – people who use OTC (over-the-counter, no prescription required) decongestant drops or sprays for longer than a few days have a significantly higher risk of developing severe nasal congestion.
• Gender – females tend to be more susceptible to nasal congestion during menstruation and pregnancy.
• Some health conditions – individuals with lupus, cystic fibrosis, some hormonal disorders and asthmaare more likely to develop non-allergic rhinitis, compared to other people.

What are the causes of non-allergic rhinitis?

Viral rhinitis – the lining of the nose and throat become inflamed when a virus attacks the area. Inflammation triggers the production of more mucus, which in turn leads to sneezing and a runny nose. 

Vasomotor rhinitis – blood vessels inside the nose should contract and expand, thus helping to control the flow of mucus. If the blood vessels are oversensitive they can dilate when exposed to several kinds of environmental triggers, leading to congestion and too much mucus. Triggers include chemical irritants, perfumes, paint fumes, smoke, changes in humidity, a drop in temperature, consumption of alcohol, spicy foods and mental stress. 

Atrophic rhinitis – atrophic rhinitis can occur if the turbinate tissue becomes damaged. The turbinate tissue refers to three ridges of bone that are covered by a layer of tissue inside the nose. Surgery is a common cause of turbinate tissue damage – if air flow is obstructed it is sometimes necessary to surgically remove turbinate tissue. Infection can damage turbinate tissue (more common in India, China and Egypt. Very rare in Western Europe and the Americas). 

Turbinate tissue helps keep the inside of the nose moist, it protects against bacteria, helps regulate air pressure of the oxygen we breathe in, and contains nerve endings that give us our sense of smell. If some turbinate tissue is lost, the inside of the nose becomes dry, crusty and much more vulnerable to infection. 

While some people need to lose a significant amount of turbinate tissue for atrophic rhinitis to develop, others need only lose a small amount. 

Rhinitis medicamentosa – caused by over-use of nasal decongestants. In some cases it can be caused by cocaine use. Nasal decongestants reduce the swelling of the blood vessels inside the nose. If the patient uses nasal decongestants for more than five to seven days non-stop the lining inside the nose can start to become inflamed again – even after whatever caused the symptoms, such as a cold, has gone. If the patient carries on using decongestants to try to reduce the swelling, it will probably make the swelling worse (rebound congestion).

How is non-allergic rhinitis diagnosed?

Viral rhinitis – the signs and symptoms of an infection, as may be observed in a cold or flu, help a doctor diagnose viral rhinitis. 

Vasomotor rhinitis – as this type of rhinitis has similar symptoms to allergic rhinitis, diagnosis is not so easy. There is no single test that can diagnose vasomotor rhinitis. Doctors use a system known as diagnosis through exclusion to be able to eventually make a diagnosis. All other potential rhinitis causes may have to be checked, including allergens, such as animal fur or pollen. This will include some allergy tests:

• Skin prick test – drops of diluted foods are placed on the patient’s arm. The skin is then pierced through the drop, thus introducing the food into the system. If there is itching, redness or swelling, the indication is most likely a positive reaction. Experts say that negative results are 95% accurate, while positive results are 55% accurate.
• Blood test – the aim is to measure how much IgE (Immunoglobulin E) antibody there is in the blood. IgE is produced by the immune system in response to a suspected allergen.
• Patch test – a tiny amount of suspected allergen is added to metal discs which are then taped to the patient’s skin. They remain there for up to two days. The health care professional then inspects the skin to see whether there has been a reaction. The test is generally done in hospital.

If the patient is found not have any allergic reactions, the doctor will probably diagnose vasomotor rhinitis. 

Atrophic rhinitis – signs and symptoms, such as nasal crusting, widening of the passages in the nose, a foul smell, and the patient’s loss of his/her sense of smell indicate that the patient has atrophic rhinitis.

CT (computerized tomography) scan

 – the CT scanner uses digital geometry processing to generate a 3-dimensional (3-D) image of the inside of an object. The 3-D image is made after many 2-dimensional (2-D) X-ray images are taken around a single axis of rotation – in other words, many pictures of the same area are taken from many angles and then placed together to produce a 3-D image. Doctors may use a CT scan to confirm diagnosis and check for changes in the nasal cavities.

Rhinitis medicamentosa – the doctor will ask the patient whether they have been using decongestant nasal sprays, and how long for. The patient needs to answer honestly. The doctor is interested in making a diagnosis, and will not judge or criticize the patient. 

Ruling out a sinus problem – the doctor may want to determine whether the patient might have a deviated septum or nasal polyps. Either a nasal endoscopy or CT scan may be ordered.

What are the treatment options for non-allergic rhinitis?

Viral rhinitis – as the infection that caused the rhinitis usually goes away on its own, medical treatment for the rhinitis is not usually required. Nasal decongestants may help reduces swelling and blocked nose – it is important not to overuse as this may eventually make the congestion worse, leading to rhinitis medicamentosa. People taking MAOI (monoamine oxidase inhibitor) antidepressants should not take nasal decongestants. 

Vasomotor rhinitis – an individual who has been diagnosed needs to try to avoid exposure to the environmental triggers that are causing vasomotor rhinitis. Corticosteroid nasal sprays may help reduce inflammation and congestion. If the patient does not respond, the doctor may try:

• Antihistamine nasal sprays – even though these are more commonly prescribed for patients with allergies, they sometimes help patients with vasomotor rhinitis.
• Anticholinergics nasal sprays – this medication helps widen the airways, which helps breathing. They also reduce the production of mucus.
• Sodium cromiglicate – reduces the production of mucus as well as inflammation. In most cases the medication is inhaled.

Atrophic rhinitis – nasal irrigation is most commonly recommended. A saline solution is inserted into the nasal cavities with the use of a syringe. Nasal irrigation is effective in treating crusting and dryness. If there is an infection – often the case if there is a foul smell – the patient will be prescribed an antibiotic. 

The following surgical procedures are sometimes used to treat atrophic rhinitis:

• Young’s operation – the nasal cavity is closed, usually for about nine months, after which it is reopened. This allows it to heal with a much lower risk of infection.
• Nasal narrowing – grafted bone or cartilage, and sometimes Teflon or silicon is used to narrow the affected nasal cavity. If the cavity is narrower crusting is less likely to occur.

Rhinitis medicamentosa – the patient needs to stop using the nasal decongestant spray. Some may find this difficult, especially if they have been using them for a long time. The following may help:

• Do not use the spray on the good nostril (or less congested one). The good nostril will eventually open up – then stop using it on the other nostril.
• There are some types of antihistamine, especially the older ones, that cause drowsiness and help the patient sleep. When taking them be careful not to drive or operate heavy machinery.
• Use a saline solution to naturally lubricate your nose.

Recurrent Infection and Suspected Immunodeficiency

Disease Definition

Primary and secondary immunodeficiency disorders are a diverse group of illnesses resulting from one or more abnormalities of the immune system. The clinical manifestations include increased susceptibility to infection and an increased risk for autoimmune disease and malignancy. Primary immune deficiency (PID) diseases are a group of serious disorders arising from an intrinsic defect in the immune system, generally the result of a genetic disease that can be traced directly to a particular immune pathway. In contrast, secondary immune deficiencies stem from impairment of the immune response through another mechanism, such as an infection, metabolic derangement, malignancy or toxins, with the immune defect being a secondary manifestation. Although the possibility of immunodeficiency should be considered in any individual with recurrent infections, it is also important to consider nonimmune conditions as a cause. Such disorders include circulatory abnormalities leading to stasis or cellular ischemia, as can occur in sickle cell disease, diabetes or heart failure; obstructive lung conditions such as chronic obstructive pulmonary disease, ciliary dyskinesia, and cystic fibrosis; or ureteral stenosis, resulting in defective pathogen clearance; and breaches in the integument and mucosal surfaces, as is seen in erythema multiforme or burns, allowing entry to opportunistic organisms and infection. Each of these is associated with infection by specific pathogens and results in characteristic clinical manifestations.

Secondary immune dysfunctions are far more common in adults than PID. Common causes include malnutrition, HIV/AIDS, malignancy, immune suppressive drugs, and toxin exposure. Malignancy can directly suppress B-cell function, as is seen in chronic lymphocytic leukemia and lymphomas. Malignancy can also directly cause bone marrow failure, resulting in neutropenia and impaired T-cell function.

Metabolic disorders such as diabetes, uremia and liver failure are often associated with severe, life threatening infections due to impairment of the cellular functions of lymphoid and myeloid cells. Protein-losing enteropathies, burns and nephrosis lead to loss of soluble factors, such as immunoglobulin and complement, thereby increasing the risk for sepsis and peritonitis. Autoimmune diseases, especially those associated with immune complexes such as systemic lupus erythematosis (SLE), often result in secondary complement deficiency due to chronic consumption that exceeds hepatic synthesis. Transient activation and depletion of complement can also occur with sepsis, viremia, burns and trauma. In the diagnostic approach to an adult with recurrent infections and suspected immune deficiency, these nonimmune and secondary causes need to be considered.