Allergic Rhinitis

Recurrent or chronic nasal congestion, runny nose, itching of the nose, and sneezing may sound like a minor medical problem; but do you know that this condition is one of the leading causes of decreased work and school productivity, sleep disturbance, and recurrent ear and sinus infections.

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The most common way of dealing with allergic symptoms is with the use of medications. Whether one has pollen-related “hay fever” or animal-triggered allergic rhinitis, there are a large variety of antihistamines, decongestants, cortisone sprays and eye medications that can be helpful. Asthma medications have steadily been improving and good control is usually possible, although some patients need to be on medications on a routine daily basis. Discussions with your doctor will help determine what the best course is for your treatment plan.

For some types of allergic problems, when the above techniques are not successful enough, or when symptoms are more annoying, a course of allergen immunotherapy injections (“allergy shots”) can be very helpful to get symptoms under control, decreasing the amounts of medications needed. This is often an effective and helpful longer-term solution to allergic problems, decreasing symptoms and dependence on medications. This too can be discussed with your physician, concerning the appropriateness in your case and the probabilities of success.

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The most effective way to control allergies is by prevention – avoidance of the substance you are allergic to. This is often difficult. Substances like pollens, molds and dust mites are difficult to avoid but your physician can discuss ways of dealing with this such as keeping windows closed in the summer, showering when coming home after exposure on a high pollen day, avoiding musty areas, using pillow and mattress zippered cases to decrease dust mite contact. Animal avoidance is usually not an option in patients who own an animal, but routine bathing of the animal and limiting the animal to certain areas of the house (away from the bedroom) can be helpful.

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Allergic conjunctivitis

  • Not only are the symptoms of eye allergies annoying with itching and watering of the eyes; but the redness and swelling is noticeable and alarming to others who may be concerned you have “pink eye”. Children are often sent home with these symptoms as the school is concerned about having epidemics of “pink eye”.
  • Several conditions mimic eye allergies and it is crucial to quickly differentiate between them.
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Food Allergies

One of the common presenting complaints of our patients is concern over food allergies. Allergic and adverse reactions are indeed a mixed bag. Classic food allergies to nuts or shellfish are easy to identify since they usually cause immediate itching, hives, throat closing, etc. However, adverse reactions to foods are more difficult to pinpoint. We will conduct testing that has been proven to be scientifically accurate to diagnose food allergy. If needed, elimination diets may be used.

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Drug Allergies

  • Numerous different reactions can occur with medications. These can include immediate reactions with hives or anaphylaxis or delayed reactions that usually cause rash. Some of these reactions only occur in light exposed areas of the skin.

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Stinging Insect Allergies

  • Symptoms of a non-allergic insect sting include redness, swelling and/or itching at the site of the sting.
  • Symptoms of a severe allergic reaction occur in a small number of people with venom allergy and stings may cause a life-threatening or anaphylactic reaction. Symptoms may include two or more of the following: itching and hives, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea. In severe cases, a rapid fall in blood pressure may result in shock and loss of consciousness. Anaphylaxis is a medical emergency and may be fatal. If you have these symptoms after an insect sting, get emergency medical care.
  • An allergist is the best physician to diagnose stinging insect allergy and provide a treatment plan designed to keep you safe and healthy.

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  • To avoid stinging insects, it is important to identify them.
    • Yellow Jackets – nests are made of a paper-maché like material and are usually located underground, but can sometimes be found in the walls of frame buildings, cracks in masonry or woodpiles.
    • Honeybees and bumble bees are non-aggressive and will only sting when provoked. However, Africanized honeybees (AKA “killer bees”) found in the Southwestern United States are more aggressive and may sting in swarms. Domesticated honeybees live in man-made hives, while wild honeybees live in colonies or “honeycombs” in hollow trees or cavities of buildings.
    • Paper wasps – nests are usually made of a paper-like material that forms a circular comb of cells which opens downward. The nests are often located under eaves, behind shutters, or in shrubs or woodpiles.
    • Hornets – usually larger than yellow jackets. Their nests are gray or brown, football-shaped and made of a paper material similar to that of yellow jackets’ nests. Hornets’ nests are usually found high above ground on branches of trees, in shrubbery, on gables or in tree hollows.

What are allergies?

When people say they have “allergies,” they are often referring to the symptoms of runny nose, sneezing and watery eyes that can occur during the warmer months as a result of an allergic reaction to pollens in the air. But allergies are really a more general term referring to a problem with the immune system. The body’s immune system is a mechanism the body has to defend itself against foreign, potentially harmful, invaders such as bacteria and viruses that can cause disease. The body often produces antibodies (proteins called immunoglobulin E or IgE) to those invaders to help protect itself from harm the next time that invader presents itself to that person. If one is allergic (usually determined by the genes you inherited from your parents), it means that you are one of the 20-25% of the population that responds to actually harmless substances such as animals, pollens, dust mites, foods, molds by producing these antibodies to “defend” itself against something that would not cause any symptoms. Thus, being allergic is not a defect in the immune system, it is really the immune system working overboard unnecessarily.

Individuals can be allergic to many things they come in contact with – whether inhaled (pollens, animal dander, dust mites, molds), ingested (foods, medications, chemicals such as food dyes and preservatives), contacted with (latex, chemicals, fabrics, metals), or injected with (insect stings or bites, medications, contrast dyes for medical tests ). When these substances enter the body again, the body (viewing them as potentially harmful) mobilizes its defenses and “sends out” an army of fighters – different chemicals and cells to fight it off, but it is these chemicals (such as histamine) and cells that cause the symptoms of allergies, resulting in itchiness, mucous congestion and areas of swelling. You then take antihistamines and other medications to counteract this, depending on where and what the problem is (congestion in your nose and eyes being allergic rhinitis or conjunctivitis, congestion in your chest being asthma, or a reaction on your skin being hives or eczema).

These allergic problems can start at any time in your life, although it is most common to see eczema and food allergies start in infancy, asthma in toddler years and nasal allergies in early school years. Hives and medication allergies can occur at any age.

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Allergy Testing

Solutions of various allergens (substances that can cause allergic reactions) can be dropped on the skin (usually on the back) and then the skin is lightly scratched or “pricked” and an allergic reaction consisting of itchiness, swelling and redness is observed over a twenty minute period. If this does not result in any reaction, an intradermal test can then be done (typically on the arm) in which a very small amount of the antigen is injected into the top surface of the skin and an allergic reaction is looked for. These skin tests are typically done to pollens, animals, molds, dust mites, stinging insects and foods, but can also be done for latex, local anesthetics, vaccines and a small number of medications, particularly antibiotics.

With the patient having avoided taking (for a few days) any antihistamines or anti-inflammatory drugs (such as aspirin and ibuprofen) which can negate the skin test results, the skin tests are done and the reactions recorded. At times when skin testing is not possible (such as when a patient is taking several medications that could interfere with the skin testing but cannot be stopped, or when the patient has severe extensive eczema so that there is no clear area of skin to place the tests on), alternative blood tests (RAST tests) can be done that can give similar information concerning that patient’s allergies.

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Your doctor will first classify your hives based on how long you have had them. Sometimes hives represent an allergic reaction to something. If you have had hives for more than 6 weeks, we consider this chronic hives. Contrary to popular belief, hives are not always due to an allergic reaction to something. They can come from the immune system. There are treatments for hives and you will work closely with your doctor to find a treatment that works well for you.

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Contact Dermatitis

Contact dermatitis is a delayed type allergic reaction to something coming in contact with the skin that can cause an itchy rash in the area of the skin that was exposed to the offending agent. Patch testing can be used to help identify potential allergens. In this week long testing series, commonly allergenic components of products are placed on the skin and covered by a bandage with repeated readings to see if an area of irritation has developed on the skin.

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Atopic Dermatitis

Atopic dermatitis, or eczema, is a chronic allergic itchy skin condition. There can be multiple triggers of atopic dermatitis including exposure to allergens, dryness, contact dermatitis, immune inflammation. Treatment of atopic dermatitis should be approached in a stepwise fashion depending on the severity. Your doctor will discuss hydrating skincare, avoidance of allergens, and prescription medicines that can be used to calm the rash and decrease itching.

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