February 3, 2017

Eosinophilic esophagitis or “EE,” and also known as “EoE”, is an allergic reaction that causes inflammation and damage to the esophagus, the muscular tube that connects mouth to stomach. EoE is characterized by inflammation and accumulation of a specific type of immune cell, called an eosinophil, in the esophagus.

Eosinophils are a special type of white blood cell. Eosinophils help us fight off certain types of infections, such as parasites or hookworms. However, eosinophils also are involved in other conditions, including allergies, cancer and other problems. The eosinophil is a cell that serves many roles. Some roles are specific and some not specific, which means that there are a number of different processes in the body that can cause eosinophils to be present. An eosinophilic disorder may be present when eosinophils are found in high numbers in the blood or part of the body for a long period of time without a known cause. Generally, this means more than 6 months.

Eosinophilic disorders can occur in different areas of the gastrointestinal (GI) tract. For instance, eosinophilic esophagitis (EoE) means abnormal numbers of eosinophils in the esophagus. Eosinophils are not normally present in the esophagus. Eosinophils are normally found in small numbers in other areas of the GI tract.

The exact prevalence in adults is uncertain, but it is estimated to affect 1 per 10,000 children and approximately 1 per cent of adults in the US.

Causes

Eosinophilic esophagitis is caused by the presence of a large number of eosinophils in the esophagus. The production and accumulation of eosinophils may be caused by many factors such as particular foods or environmental irritants in some affected individuals. Some individuals with this condition have been found to have an unusually high expression of a particular gene called eotaxin-3 and an abnormal eotaxin-3 gene. This gene codes for a protein that is important in controlling the accumulation of eosinophils. Eosinophilic esophagitis can run in families but the mode of genetic transmission has not yet been determined.

Foods reported to be the cause of EE have included milk, eggs, peanuts, shellfish, peas, beef, chicken, fish, rye, corn, soy, potatoes, oats, tomatoes and wheat. Of these, the most common food triggers are milk, egg, wheat, rye and beef.

Environmental allergens, such as pollens, molds, cat, dog and dust mite allergens may also be involved in the development of EE.

Risk Factors

Climate – Living in a cold or dry climate.

Season – May be more likely diagnosed between the spring and fall, probably because levels of pollen and other allergens are higher and people are more prone to be outdoors.

Sex – More common in males than in females.

Family history – If family members have eosinophilic esophagitis, there may be a greater chance of being diagnosed.

Allergies and asthma – If a person has food or other allergies, or asthma, he or she isare more likely to be diagnosed.

Age – Originally thought to be a childhood disease, but now is known to be common in adults as well. However, the symptoms differ somewhat.

Symptoms

Symptoms vary from one person to the next. The symptoms may differ depending on age. Symptoms in young children may include problems with eating, vomiting and poor weight gain. Older children and adults may experience reflux, chest pain and difficulty swallowing. The symptoms can occur days or even weeks after eating a food allergen. However, symptoms may wax and wane, meaning they are not always present. This can be confusing. Common symptoms include =

  • Reflux that does not respond to usual therapy (this includes proton pump inhibitors, a medicine which stops acid production in the stomach)
  • Difficulty swallowing (dysphagia)
  • Food impactions (food gets stuck in the throat)
  • Nausea and vomiting
  • Failure to thrive (poor growth or weight loss)
  • Abdominal or chest pain
  • Poor appetite
  • Malnutrition
  • Difficulty sleeping

Complications

Complications associated with EE include –

  • Choking
  • Food impaction (getting food stuck in the throat) that requires a trip to the emergency room
  • Eating disorders can develop if eating is painful
  • Scarring and narrowing of the esophagus that may require surgery to fix
  • Feeding aversion may develop in toddlers, so that even if their EE is being managed, they may still not want to eat because they associate eating with feeling uncomfortable

Treatment

Medication – Medication to reduce acid production will reduce acid reflux and the scarring that can result. Topical asthma steroid puffers can reduce inflammation in the oesophagus. These are swallowed instead of inhaled, are low dose, poorly absorbed, and extremely unlikely to cause cortisone/steroid tablet like side effects. They help reduce inflammation and the scarring that can result from untreated disease. Montelukast (Singulair) is an asthma tablet that reduces inflammation by blocking the effects of inflammatory chemicals known as leukotrienes released by white cells. Other medicines are also being studied.

Steroids are the most commonly used medication for both the control of the inflammation and the direct suppression of the eosinophils. These medications can be taken orally (in pill form) or topically. Steroids may need to be taken long term, though their long-term use for eosinophilic esophagitis has not been well studied. What is known is that for some patients, continued swallowed use of steroids can result in Candida infections (yeast infections of the mouth and esophagus) as a side effect.

Dilation – Sometimes if the oesophagus is very narrow, an endoscopy and a procedure known as dilation may be required to open up the oesophagus to allow food to pass more easily.

Diet manipulation – Dietary manipulation should be undertaken under the direction of a medical specialist and supervision of a specialist dietitian. Dietary manipulation may assist both adults and children. When undertaking dietary manipulation, the foods are removed for a period of time and then re-introduced one at a time to see which foods result in symptom recurring.

 

Reference –

http://www.hopkinsmedicine.org/healthlibrary/conditions/digestive_disorders/eosinophilic_esophagitis_134,168/

http://www.lohud.com/story/news/health/2015/05/11/eosinophilic-esophagitis-disease-children/27114437/

http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=73247

http://www.espghan.org/fileadmin/user_upload/guidelines_pdf/Guidelines_2404/Management_Guidelines_of_Eosinophilic_Esophagitis.27.pdf

http://www.news-medical.net/news/20150901/Scientists-elucidate-chemical-process-behind-eosinophilic-esophagitis.aspx

https://www.niaid.nih.gov/topics/foodallergy/understanding/Pages/eoe.aspx

http://allergies.about.com/od/foodallergies/a/ee.htm

https://my.clevelandclinic.org/health/diseases_conditions/hic_eosinophilic_esophagitis

http://www.webmd.com/a-to-z-guides/eosinophilic-esophagitis

http://www.cincinnatichildrens.org/health/e/eosinophilic-esophagitis-ee/

http://umm.edu/programs/childrens/services/pulmonology-and-allergy/eosinophilic-esophagitis

http://emedicine.medscape.com/article/1610470-overview

Posted in ALLERGIES
February 3, 2017

Edema is swelling or puffiness of parts of the body caused by fluid retention i.e. excess fluid is trapped in the body’s tissues. Edema happens most often in the feet, ankles, and legs, but can affect other parts of the body, such as the face, hands, and abdomen. It can also involve the entire body.

Normally the body maintains a balance of fluid in tissues by ensuring that the same of amount of water entering the body also leaves it. The circulatory system transports fluid within the body via its network of blood vessels. The fluid, which contains oxygen and nutrients needed by the cells, moves from the walls of the blood vessels into the body’s tissues. After its nutrients are used up, fluid moves back into the blood vessels and returns to the heart. The lymphatic system (a network of channels in the body that carry lymph, a colorless fluid containing white blood cells to fight infection) also absorbs and transports this fluid. In edema, either too much fluid moves from the blood vessels into the tissues, or not enough fluid moves from the tissues back into the blood vessels. This fluid imbalance can cause mild to severe swelling in one or more parts of the body.

There are many types of edema. The most common ones are –

  • Peripheral edema – In the feet (pedal edema), ankles, legs, hands and arms.
  • Cerebral edema – In and around the brain (cerebral edema).
  • Eye edema – In and around the eyes, e.g. macular edema, corneal edema, periorbital edema (puffiness around the eyes. Macular edema is a serious complication of diabetic retinopathy.

Pregnant women and older adults often get edema, but it can happen to anyone. Edema is a symptom, not a disease or disorder. In fact, edema is a normal response to injury. Edema becomes a concern when it persists beyond the inflammatory phase. Widespread, long-term edema can indicate a serious underlying health problem.

Causes

Edema has many possible causes –

  • Blood clots – Clots can cause pooling of fluid and may be accompanied by discoloration and pain. In some instances, clots may cause no pain.
  • Edema can occur as a result of gravity, especially from sitting or standing in one place for too long. Water naturally gets pulled down into your legs and feet.
  • It can happen from a weakening in the valves of the veins in the legs (a condition called venous insufficiency). This problem makes it hard for the veins to push blood back up to the heart, and leads to varicose veins and a buildup of fluid in the legs.
  • Certain diseases — such as congestive heart failure and lung, liver, kidney, and thyroid diseases can cause edema or make it worse.
  • Some drugs, such as medications that you are taking for your blood pressure or to control pain, may cause or worsen edema.
  • An allergic reaction, severe inflammation, burns, trauma, clot(s), or poor nutrition can also cause edema.
  • Too much salt from your diet can make edema worse.
  • Being pregnant can cause edema in the legs as the uterus puts pressure on the blood vessels in the lower trunk of the body.
  • Edema can be a side effect of some medications, including:
    • High blood pressure medications
    • Nonsteroidal anti-inflammatory drugs
    • Steroid drugs
    • Estrogens
    • Certain diabetes medications called thiazolidinediones
  • Menopause – Around the period of the menopause, as well as after, hormone fluctuations can cause fluid retention. Hormone replacement therapy after the menopause can also cause edema.
  • Malnutrition and/or bad diet – Dietitians say low consumption of thiamine (vitamin B1), as well as insufficient vitamins B6 and B5, may contribute toward fluid retention. Low levels of albumin may also play a part – low albumin levels can also be caused by kidney disease.

Symptoms

The fluid build-up may cause swelling in one particular part of the body, after an injury, for example, or may be more general. Generalized edema is usually seen in health disorders such as heart failure or kidney disease. Symptoms include –

  • Swollen and puffy skin
  • Skin discoloration
  • Skin that “pits” when pressed
  • Stiff, tender and painful joints
  • Weight gain or weight loss
  • Raised blood pressure and heart rate

Complications

If left untreated, edema can cause –

  • Increasingly painful swelling
  • Difficulty walking
  • Stiffness
  • Stretched skin, which can become itchy and uncomfortable
  • Increased risk of infection in the swollen area
  • Scarring between layers of tissue
  • Decreased blood circulation
  • Decreased elasticity of arteries, veins, joints and muscles
  • Increased risk of skin ulcers

Treatment

Diuretics – These are drugs that raise the rate of urination, providing a means of forced diuresis. Diuresis is the increased production of urine by the kidney. There are several types of diuretics – they increase the excretion of water from the body in various different ways. Diuretics are not suitable if the patient is pregnant, or has chronic venous insufficiency (weakened valves in the veins of the legs).

Oxygen therapy – Oxygen delivered through the nose may improve poor vision caused by diabetic macular edema.

Antiangiogenesis therapy (controlling blood vessel growth) – The beneficial effects of anti-angiogenesis drugs in the treatment of the glioblastomas (deadly brain tumors) appear to result primarily from the reduction of edema.

Alternative Treatment

Pycnogenol was shown in both pre-clinical and clinical studies to strengthen capillary walls and prevent edema. Research has shown Pycnogenol actually seals the brittle capillaries and stops the outflow of blood into tissue which causes the swellings, edema and microbleedings. Coupled with its anti-inflammatory properties and patent for reducing platelet aggregation, these are the fundamental mechanisms of action behind Pycnogenol for edema.

B vitamins are essential for proper functioning of several metabolic processes in the body and for red blood cell formation. Deficiency of B vitamins, especially vitamins B-1 and B-2, can lead to edema and swelling.

Flavonoids – A new class of largely unstudied vitamins are referred to as flavonoids. They provide the intense flavors in food, such as capsacin in cayenne, and the pigments, such as anthocyanin in blueberries. High doses of flavonoids are demonstrated by controlled studies to effectively reduce edema and aid in many potential causes. The best sources are fresh herbs and spices combined with colored vegetables and fruits.

Thiamine – B1 deficiency is one known cause of fluid retention. The presence of other deficiency side effects suggest positive diagnosis. These include aching and stiff jointed in the swollen areas.

Pantothenic Acid – Vitamin B5 is directly linked to edema. One of the primary functions of this vitamin is the excretion of excess fluids. Deficiency also results in such symptoms as nausea, insomnia, and muscle cramping.

Vitamin B6 is another vitamin linked directly to heart and circulatory health. Failure of the heart and vessel walls to maintain the right amount of pressure results in fluid retention.

Magnesium is needed for nerve conduction and to provide muscular strength. Because it can close some calcium channels on the membranes of neurons, high levels of magnesium can reduce the activity of nerves in the nervous system. Loop diuretics and thiazide diuretics can promote magnesium loss in the kidneys. This is an unfortunate side effect involving another unwanted side effect of diuretics: potassium loss.

Alfalfa – Provides necessary minerals. Has chlorophyll which detoxifies the body.

Calcium – Replenishes minerals lost in the edema correction process.

Cornsilk – Combination of herbs and corn silk that have been known to reduce the formation of sediments in the kidneys and helps to reduce water retention.

Horse Chestnut – Horse Chestnut seed contain Aescin which has helped to effectively reduce post-surgical edema.

Dandelion leaf is itself a diuretic, so it should not be used while taking diuretic medications.

Grape seed extract for antioxidant support. Evidence suggests that using grape seed extract may improve chronic venous insufficiency, which causes swelling when blood pools in the legs.

Acupuncture – Acupuncture may improve fluid balance.

Massage– Therapeutic massage can help lymph nodes drain.

 

Reference –

 

https://www.nlm.nih.gov/medlineplus/edema.html

http://www.medicalnewstoday.com/articles/159111.php

https://my.clevelandclinic.org/health/diseases_conditions/hic_Edema

http://www.cancer.net/navigating-cancer-care/side-effects/fluid-retention-or-edema

http://www.healthline.com/symptom/swollen-ankle

https://umm.edu/health/medical/altmed/condition/edema

http://www.medscape.com/viewarticle/524606

http://www.cvphysiology.com/Microcirculation/M010.htm

http://www.whattoexpect.com/pregnancy/symptoms-and-solutions/edema.aspx

http://www.drugs.com/health-guide/edema.html

http://www.msdmanuals.com/professional/cardiovascular-disorders/symptoms-of-cardiovascular-disorders/edema

http://www.fpnotebook.com/renal/Edema/Edm.htm

http://www.news-medical.net/health/What-is-Edema.aspx

http://www.strokecenter.org/professionals/brain-anatomy/cellular-injury-during-ischemia/edema-formation/

Posted in ALLERGIES
February 3, 2017

Dizziness is a term which is used to describe a variety of sensations. It is defined as feelings of unsteadiness, wooziness, and lightheadedness; and sensations of moving, spinning, floating, swaying, tilting, or whirling (sensations known as vertigo). These sensations occur even when standing still or lying down.

Many people who experience dizziness find it difficult to explain exactly how it makes them feel. For example, some people who feel dizzy, light-headed, giddy or off-balance describe the feeling as if they, or their surroundings, are spinning around. Doctors use the term vertigo (see below) to describe this spinning, revolving form of dizziness. Others describe feeling “wobbly”, as if they were on a merry-go-round or on a boat on choppy water.

Dizziness can range from fleeting faintness to a severe balance disorder that makes normal functioning impossible. Among adults over 60, about 20 percent have had a dizziness episode that affected their usual activities.

Dizziness may feel like:

  • Lightheadedness, as though you might pass out
  • Unsteadiness or a loss of balance
  • A false sense that you or your surroundings are spinning or moving (vertigo)
  • Floating, swimming or heavy-headedness

Dizziness is often temporary and goes away without treatment. As you talk with your doctor about your condition, try to describe your specific symptoms, how the dizziness makes you feel as it is coming on and after it has passed, what triggers it, and how long it lasts. This will help your doctor diagnose the cause and treat it.

Causes

For the body to feel balanced, the brain requires input from the inner ear, eyes, muscles and joints. Since mechanisms for maintaining balance are so complex, finding the exact cause of dizziness is often difficult and requires input from several medical specialties. Dizziness is generally not serious. However, it may be the result from problems associated with the inner ear, brain, or heart. It can also be the result of medications.

A wide range of conditions and diseases can cause dizziness, including –

Inner ear problems – Disorders of the inner ear account for about half of all cases of persistent (ongoing) dizziness. Disorders include Meniere’s disease, benign paroxysmal positional vertigo (BPPV) and vestibular neuritis.

Anxiety disorders – Stress or anxiety may play a role in causing dizziness or, more commonly, may be a contributing factor in dizziness from other causes, such as inner ear disease.

Brain disorders – A common cause of dizziness is migraine, even without the headache that most people associate with a migraine. Very rarely, other causes of dizziness can include stroke or other brain diseases.

Other conditions – Some cases of dizziness are due to underlying medical conditions such as low blood pressure, infection, some heart problems (such as cardiac arrhythmias) and hypoglycaemia (low blood sugar). Drugs that are used to treat conditions such as epilepsy, coronary heart disease and high blood pressure can also cause dizziness in some people.

Unknown causes – Although a cause may not be found in some people, it does not necessarily mean that these people cannot be helped by the appropriate treatment.

Medications are a common source of dizziness. The medicines can include drugs to treat seizure disorders (eg, carbamazepine, phenytoin), drugs to help calm or sleep (sedating drugs/antidepressants), and even drugs used to treat inner ear infections (eg, gentamicin, streptomycin).

Alcohol consumption is another cause of dizziness.

Dizziness caused by aging –

  • Reduced capacity for exercise or activity, weakness, and deconditioning
  • Reduced ability for the blood circulation to compensate for quickly assuming an upright position (orthostatic hypotension)
  • Hardening of the arteries (arteriosclerosis)
  • Neuropathy (a progressive dysfunction of the nerves that is caused by different illnesses, especially diabetes)
  • Menopause
  • Poor eyesight and coordination
  • Dementia

 

Symptoms

Descriptions of dizziness may include:

  • A sensation of movement (including spinning), either of yourself or the external environment
  • Unsteadiness, including finding it difficult to walk in a straight line
  • Light-headedness
  • Feeling faint.

Other symptoms that may accompany dizziness include:

  • Headache
  • Nausea and vomiting
  • Ringing or other sounds in the ears (tinnitus)
  • Difficulty hearing
  • Staggering gait and loss of coordination (ataxia)
  • Unusual eye movements, such as flitting of the eyes (nystagmus)
  • Finding it difficult to see clearly when moving, for example, when reading a sign while walking or driving.

Treatment

Vestibular rehabilitation – The key treatment for almost all of the conditions that can cause dizziness is vestibular rehabilitation. The aim of vestibular rehabilitation is to help the development of vestibular compensation.

Cawthorne-Cooksey Exercise – The aims of the Cawthorne-Cooksey exercises include relaxing the neck and shoulder muscles, training the eyes to move independently of the head, practising good balance in everyday situations, practising the head movements that cause dizziness, improving general co-ordination, and encouraging natural spontaneous movement.

Gaze stabilization exercises – The aim of gaze stabilization exercises is to improve vision and the ability to focus on a stationary object while the head is moving.

Canalith repositioning procedures (CRP) – Canalith repositioning procedures (CRP) are the key treatment for benign paroxysmal positional vertigo (BPPV). Although most people with BPPV will recover within a few weeks or months, CRP can bring about a rapid recovery after just one or two sessions.

Medications – Medications such as meclizine (Antivert) or benzodiazepines (such as diazepam [Valium], lorazepam [Ativan]) are used to control the spinning feeling associated with dizziness, when vertigo is a possible cause.

 

Alternative Treatment

Vitamin B6 – This vitamin is essential for the brain and the nervous system to function normally; getting enough is vital for avoiding dizziness.

Vitamin D – The inner ear is partly responsible for your sense of balance, so any ear problems may cause dizziness. Getting enough vitamin D is vital for your ear health.

Vitamin B12 – This is the usual vitamin deficiency suspect if you’re experiencing dizziness. Vitamin B-12’s primary functions are in the formation of red blood cells and the maintenance of a healthy nervous system.

Antioxidants—Antioxidants mitigate the damaging effects of free radicals on tissues, cell membranes, and DNA. Vitamin C, vitamin E, lipoic acid, and glutathione are among the most important antioxidants. Vitamin C has been shown to have a beneficial effect on patients with Ménière’s disease when given in combination with glutathione.

Ginkgo biloba—Researchers have found that dizziness induced by vestibular receptor impairment can be reduced by Ginkgo biloba extract.

Ginger – Ginger, or Zingiber officinale, is a perennial used in cooking and herbal medicine. It’s a traditional remedy for stomach problems, nausea, fever, coughs and diarrhea. The rhizomes are rich in volatile oil, and have antibacterial, cholesterol-lowering, hypoglycemic and anti-ulcer action.

 

Reference –

https://my.clevelandclinic.org/services/head-neck/diseases-conditions/hic-what-is-dizziness

http://www.dizziness-and-balance.com/disorders/

http://www.aafp.org/afp/2010/0815/p361.pdf

http://vestibular.org/node/2

http://www.brainandspine.org.uk/sites/default/files/documents/dizziness_and_balance_problems.pdf

Posted in ALLERGIES
February 3, 2017

Contact dermatitis is an inflammation of the surface of the skin caused by exposure either to an irritant or an allergen – something that the skin is allergic to – like poison ivy. Dermatitis and eczema are two terms used to describe the same pattern of inflammation. It causes red, itchy skin which may also blister. Contact dermatitis describes inflammation which is caused by contact with something in the environment. It may sometimes be referred to as contact eczema.

The dermatitis is generally confined to the site of contact with the allergen, although severe cases may extend outside the contact area or it may become generalised. Sometimes the allergen is transmitted from the fingers so unexpected sites can be affected eg the eyelids and genitals. Dermatitis is unlikely to be due to a specific allergen if the area of skin most in contact with that allergen is unaffected. The affected skin may be red, swollen and blistered or dry and bumpy.

Some typical examples of allergic contact dermatitis include –

  • An eczema of the wrist underlying a watch strap due to contact allergy to nickel
  • An eczema of the lower leg when ankle strapping has been removed due to contact allergy to rosin in the adhesive plaster
  • Hand dermatitis caused by rubber accelerator chemicals used in the manufacture of rubber gloves
  • Itchy red face due to contact allergy with methylisothiazolinone, a preservative in wash-off hair products and baby wipes.

Types & Causes of Contact Dermatitis

  • Irritant contact dermatitis – Any substance can be an irritant to the skin, especially if the concentration and duration of contact are sufficient. Most irritants are chemical in nature. Irritants such as soaps, detergents, deodorants, lotions, and perfumes often require repeated or prolonged contact to produce inflammation. Stronger irritants such as acids or alkalis are so damaging that they will injure the skin immediately on contact. If daily exposure to mild irritants is continued, normal skin may become hardened or tolerant to this trauma and contact may be continued without further evidence of irritation.
  • Allergic contact dermatitis – Allergic contact dermatitis, on the other hand, requires skin contact with an allergen (i.e. any product, plant or chemical to which you are allergic). The oils of plants like poison ivy or sumac, and metals like gold and nickel are very common allergens. The reaction is typically delayed. A period as long as 5 to 21 days may elapse after your first exposure to the allergen before you see a reaction. However, the reaction time after re-exposure typically occurs within 12 days.

Common irritants include solvents, industrial chemicals, detergents, fumes, tobacco smoke, paints, bleach, woolen fabrics, acidic foods, astringents and other alcohol (excluding cetyl alcohol) containing skin care products, and some soaps and fragrances. Allergens are usually animal or vegetable proteins from foods, pollens, or pets.

Sometimes substances such as proteins in fruit and vegetables can cause an immediate allergic reaction leading to itchy skin swellings known as contact urticaria (hives), which in turn can aggravate your dermatitis.

  • Certain Occupation – Some occupations have more exposure to chemicals or substances that can result in sensitization and cause allergic contact dermatitis. Examples of these include dental workers, health care workers, florists, hairdressers, and machinists.

 

  • Genetic – People with a tendency to asthma, eczema and hay fever develop irritant contact dermatitis more easily than others, and this tendency does run in families.

 

  • Hobbies – Hobbies may be the source of allergic contact dermatitis. Examples include woodworking with exotic tropical woods or processing film using color-developing chemicals that may provoke cutaneous lesions of lichen planus from direct skin exposure.

 

  • Medications (both self-prescribed and physician-prescribed) are important causes of allergic contact dermatitis. The workplace nurse may dispense ineffective and sensitizing topical preparations, such as thimerosal (Merthiolate), which may change a simple abrasion into a severe case of allergic contact dermatitis. Individuals may develop allergy to preservatives in medications and/or to the active ingredients in topical medications, especially neomycin and topical corticosteroids.

Contact dermatitis cannot be caught from nor spread to other people.

Symptoms

Contact dermatitis symptoms can range from mild redness and dryness to severe pain and peeling that can be disabling.

Allergic contact dermatitis symptoms include –

  • Reddening of skin (either in patches or all over the body)
  • Intermittent dry, scaly patches of skin
  • Blisters that ooze
  • Burning or itching that is usually intense without visible skin sores (lesions)
  • Swelling in the eyes, face, and genital areas (severe cases)
  • Hives
  • Sun sensitivity
  • Darkened, “leathery,” and cracked skin

Allergic contact dermatitis can be very difficult to distinguish from other rashes.

Irritant contact dermatitis symptoms include –

  • Mild swelling of skin
  • Stiff, tight feeling skin
  • Dry, cracking skin
  • Blisters
  • Painful ulcers on the skin

Symptoms vary depending on the cause of dermatitis.

 

Complications

  • Chronic itchy, scaly skin – A skin condition called neurodermatitis (lichen simplex chronicus) starts with a patch of itchy skin. As a person scratchs the area, which makes it even itchier. Eventually, he or she may scratch simply out of habit. This condition can cause the affected skin to become discolored, thick and leathery.
  • Infection – If you repeatedly scratch a rash, the affected person may cause it to become wet and oozing. This creates a good place for bacteria or fungi to grow and may cause an infection.

Treatment

Symptomatic Treatment – Emollients or moisturizers help keep the skin moist, and also help skin repair itself. They protect the skin from becoming inflamed again. They are a key part of preventing and treating contact dermatitis. Examples include:

  • Petroleum jelly
  • Vanicream
  • Cetaphil
  • Eucerin

Medications – In cases where the symptoms are severe, corticosteroids applied to the skin or taken orally are used. Contact dermatitis that leads to a bacterial skin infection is treated with antibiotics. Common antihistamines include –

  • Diphenhydramine (Benadryl)
  • Hydroxyzine (Atarax)
  • Cetirizine (Zyrtec)
  • Loratadine (Claritin)
  • Fexofenadine (Allegra)

Phototherapy – Individuals with chronic allergic contact dermatitis that is not controlled well by topical corticosteroids may benefit from psoralen plus ultraviolet-A (PUVA) treatments. Psoralen is a photosensitizer that is ingested prior to light exposure. Narrow-band UVB phototherapy may be as effective.

Lifestyle Changes

For allergic contact dermatitis –

  • Avoid contact with substances that cause the skin rash.
  • Wash any area that comes into contact with allergic substances.
  • Learn to recognize poison oak and poison ivy.

For irritant contact dermatitis –

  • Wear cotton gloves under rubber gloves for all wet work. Use plain petroleum jelly to protect the skin. Reapply the petroleum jelly two or three times a day and after washing your hands.
  • Avoid contact with substances that irritate the skin.
  • Use mild soaps.
  • Use hand creams and lotions frequently.

Alternative Treatment

Fish oil – In one study, people taking fish oil equal to 1.8 g of EPA (one of the omega-3 fatty acids found in fish oil) had significant reduction in symptoms of contact dermatitis after 12 weeks. Researchers think that may be because fish oil helps reduce leukotriene B4, an inflammatory substance that plays a role in dermatitis.

Probiotics may boost the immune system and control allergies, especially in children. In fact, studies show that taking probiotics during pregnancy, or early infancy, can protect against the development of dermatitis.

Vitamin C can act as an antihistamine. In one study, it helped reduce symptoms of dermtits, but more studies are needed.

Flavonoids, antioxidants found in dark berries and some plants, have anti-inflammatory properties, strengthen connective tissue, and may help reduce allergic reactions.

Borage oil, like evening primrose oil, contains the essential fatty acid GLA, which acts as an anti-inflammatory.

Evening primrose oil -In some studies, evening primrose oil helps reduce the itching associated with dermatitis.

Bromelain, an enzyme derived from pineapple, helps reduce inflammation. Bromelain can have a blood-thinning effect.

Hydrotherapy Remedies – Itching may persist when medications wear off in between doses. Symptoms of allergic reactions may be stronger than those associated with irritant contact dermatitis. For additional relief of discomfort, patients can take cool showers or therapeutic baths.

A combination of Licorice root, DHEA and Pregnenolone may be able to substitute for Cortisone if the patient cannot tolerate this medication.

Vitamin A is very important for skin and membranes.

Quercetin is very important for three reasons: it prevents the release of histamine; it inhibits production of leukotrienes; it is an effective treatment for inflammation.

Witch Hazel can reduce inflammation. However, for all areas with eruptions (vesicles), the best kind may be one without alcohol.

St. John’s wort used as a topical cream.

Reference –

https://www.aad.org/public/diseases/eczema/contact-dermatitis

https://www.nlm.nih.gov/medlineplus/ency/article/000869.htm

http://www.mayoclinic.org/diseases-conditions/contact-dermatitis/basics/definition/con-20032048

http://www.nhs.uk/conditions/eczema-(contact-dermatitis)/Pages/Introduction.aspx

http://www.emedicinehealth.com/contact_dermatitis/article_em.htm

http://www.webmd.com/skin-problems-and-treatments/contact-dermatitis

https://my.clevelandclinic.org/health/diseases_conditions/hic_Contact_Dermatitis

http://www.brown.edu/Student_Services/Health_Services/Health_Education/common_college_health_issues/dermatitis.php

http://www.britishskinfoundation.org.uk/SkinInformation/AtoZofSkindisease/ContactDermatitis.aspx

http://www.aafa.org/page/contact-dermatitis.aspx

Posted in ALLERGIES
February 3, 2017

Coughing is normal occasionally, especially if a person suffers from cold, allergies or flu. It has a purpose, as it is body’s way of keeping unwanted stuff from getting into the lungs i.e. it is a reflex action. Coughing helps clear extra mucus from the airways (small tubes in your lungs). This extra mucus could be caused by smoking, a cold, nasal or sinus problems, a lung infection or a lung disease like asthma or COPD.

A chronic cough is more than just an annoyance. Chronic cough is defined as lasting eight weeks or longer in adults, four weeks in children.

While it can sometimes be difficult to pinpoint the problem that’s triggering a chronic cough, the most common causes are tobacco use, postnasal drip, asthma and acid reflux — the backflow of stomach acid that can irritate your throat. Chronic cough typically disappears once the underlying problem is treated.

Chronic coughing is common, so frequent that it rates as one of the most common reasons for seeing a doctor. Although both patients and doctors rightly focus their attention on finding the cough’s cause, the cough itself is responsible for significant problems. In addition to worry about the diagnosis, patients experience frustration and anxiety, especially if diagnosis and treatment stretches out over weeks, which is often the case.

Coughing interrupts sleep, producing fatigue and impairing concentration and work performance. In this age of scary new viruses, social interactions are likely to suffer. And coughing can also have important physical consequences, ranging from urinary incontinence to fainting and broken ribs. Between medical tests, lost productivity at work, remedies that don’t help, and treatments that do, coughing is also expensive.

Causes

Chronic cough is usually caused by these health problems-

  • Smoking – Smoking is the number one cause of chronic cough.
  • Asthma – This is the second most frequent cause of chronic cough. Shortness of breath and wheezing are by-products of asthma. These breathing difficulties can result in a chronic cough. On the other hand, chronic cough may be the only symptom of asthma.
  • Acid reflux – Gastroesophageal reflux disease (GERD) occurs when stomach acid backs up into the esophagus. Symptoms of GERD include heartburn, chest pain, wheezing and shortness of breath. Irritation caused by these symptoms can lead to chronic cough.
  • Sinusitis and post nasal drip – Recurrent sinus infections can cause post-nasal drip, sometimes called ‘a tickle in the back of the throat,’ drainage can trigger chronic cough. The ‘tickle’ occurs when a larger-than-normal amount of mucus runs down the back of the throat.
  • Allergies – Chronic cough can result from inhaling dust, pollen, pet dander, chemical/industrial fumes (over many years), molds, freshly cut grass, and other irritants.
  • Bronchitis – Inflammation of these airway passages can trigger shortness of breath and wheezing and result in chronic cough.
  • Upper respiratory infections – Lengthy bouts of colds, the flu, pneumonia or other infections can lead to the development of chronic cough. Whooping cough (pertussis) occurs more commonly in infants and young children.
  • Chronic obstructive pulmonary disease (COPD) – This is a lung condition that occurs most often in smokers. It is caused by a build-up of mucus in the lungs, which the body tries to clear by coughing. COPD includes the related conditions, emphysema and chronic bronchitis.
  • High blood pressure drugs – ACE inhibitors are a specific category of drugs used to treat high blood pressure. A side effect of these drugs is chronic cough. Some common ACE inhibitors are lisinopril (Prinivil, Zestril), enalapril (Vasotec), peridopril (Aceon), captopril, (Capoten), and ramiparil (Altace).
  • Lung or other airway cancers – Rarely, chronic cough can be a sign of either a lung cancer or cancer in the upper airway.

Symptoms

A chronic cough can occur with other signs and symptoms, which may include –

  • A runny or stuffy nose
  • A feeling of liquid running down the back of your throat
  • Frequent throat clearing and sore throat
  • Hoarseness
  • Wheezing and shortness of breath
  • Heartburn or a sour taste in your mouth
  • In rare cases, coughing up blood
  • Fever (higher than 101°F®)
  • A drenching overnight sweat

Complications

  • Physical exhaustion
  • Insomnia (inability to sleep)
  • Disruption of the daily routine
  • Muscle discomfort
  • Hoarse voice
  • Headache/dizziness
  • A drenching sweat
  • Urinary incontinence (loss of bladder control)
  • Minor bleeding in the eye
  • Hernia
  • Broken ribs

Treatment

Medication

In case of Asthma – drugs such as inhaled bronchodilators and/or steroids are prescribed. These drugs help reduce airway inflammation and wheezing.

Cough medicines – Cough suppressants for a dry cough or expectorants for a wet, productive cough that brings up mucus, are available over the counter and by prescription.

Antihistamines – Can temporarily relieve a runny nose by drying up nasal secretions; they may help if your cough is due to allergies. Non-drowsy antihistamines available over the counter include loratadine (Claritin), fexofenadine (Allegra), and cetirizine (Zyrtec).

Bronchodilators – Increase airflow by opening airways and help make it easier to breathe.

GERD – several non-drug treatments and prescription medications are tried. Non-drug treatments include using pillows to prop up the head when lying down, avoiding foods that cause acid reflux (such as chocolates, colas, red wines) and not eating right before bedtime. Prescription medicines, such as cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac), esomeprazole (Nexium), lansoprazole (Pravacid®), and omeprazole (Prilosec), are prescribed to reduce stomach acids.

Bacterial Pneumonia or bronchitis, antibiotics, such as azithromycin (Azithrocin, Zithromycin), cefuroxime (Ceftin) or cefprozil (Cefzil), are prescribed.

Post-nasal drip, over-the-counter decongestants, such as diphenhydramine or pseudoephedrine, may help relieve post-nasal drip symptoms. Antibiotics may be prescribed if the cause of the chronic cough is sinusitis. Nasal spray, such as ipratopium (Atrovent) can relieve runny nose, sneezing and post-nasal drip. A nasal glucocorticoid, such as fluticasone (Flonase) can also reduce post-nasal drip.

High blood pressure medicines (ACE inhibitor drugs), other high blood pressure drugs can be prescribed instead.

Lifestyle

Avoid allergens -If the chronic cough can be traced back to nasal allergies, try to avoid the substances that cause your symptoms.

Quit smoking – The most common cause of chronic bronchitis, smoking irritates the lungs and can worsen coughs caused by other factors.

Reduce acid reflux – A cough caused by acid reflux can often be treated with lifestyle changes alone. This includes eating smaller, more frequent meals; waiting three to four hours after a meal before lying down; and elevating the head of the bed at night.

Alternative Treatment

Probiotics – These may help overcome underlying conditions. Research suggests that Lactobacillus may help prevent colds and flu, and possibly reduce allergy to pollen. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it is not possible to say whether the vitamins, minerals, or probiotics were responsible for the benefit.

Quercetin – Quercetin is a flavonoid, a plant pigment responsible for the colors found in fruits and vegetables. Studies suggest that quercetin inhibits the production and release of histamine, which causes allergy symptoms, such as a runny nose and watery eyes.

Bromelain – Some studies show that bromelain may help reduce symptoms of sinusitis and relieve swelling and inflammation caused by allergies.

Peppermint – Peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant.

Licorice – Licorice root is a traditional treatment for sore throat and cough, although scientific evidence is lacking. Licorice interacts with a number of medications.

Thyme – Thyme has traditionally been used to treat respiratory illnesses, such as bronchitis, and to treat cough. Two preliminary studies suggest that thyme may help treat acute bronchitis and relieve cough.

Phosphorous – For chest tightness associated with a variety of coughs, particularly a dry, harsh cough with a persistent tickle in the chest and significant chest pain; symptoms tend to worsen in cold air and when the individual is talking; this remedy is most appropriate for individuals who are often worn out and exhausted, suffer from unnecessary anxiety (even fear of death), and require a lot of reassurance.

Vitamins

Reference –

http://www.nationaljewish.org/healthinfo/conditions/cough/

http://www.emedicinehealth.com/coughs/article_em.htm

http://bestpractice.bmj.com/best-practice/monograph/69/diagnosis/differential-diagnosis.html

http://www.pdrhealth.com/diseases/cough

http://www.fpnotebook.com/lung/Sx/ChrncCgh.htm

http://www.aafp.org/afp/2011/1015/p887.html

http://www.everydayhealth.com/symptom-checker/cough

http://www.aaaai.org/conditions-and-treatments/conditions-dictionary/chronic-cough.aspx

http://www.avogel.co.uk/health/immune-system/cough/persistent/

Posted in ALLERGIES
February 3, 2017

Asthma is the common chronic respiratory disease in childhood. Approximately 6.5million, or 9 percent of children under the age of 18, have asthma; that makes it the most common chronic condition in childhood. In fact, asthma is one of the leading reasons kids are hospitalized.

Unlike a cold or other respiratory illness, asthma isn’t contagious; hence a child will not catch it from his or her friends. It is a chronic inflammatory disorder of the airways, known as bronchial tubes, in which many cells and cellular elements play a role. The bronchial tubes are lined on the inside with mucous membranes and encased by smooth, sensitive muscles on the outside. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment.

The inner lining of the bronchial tubes contains special cells, called inflammatory cells, which release chemicals after exposure to irritants. These chemicals cause the bronchial muscle constriction, mucous secretion, swelling of the bronchial tube inner lining, and coughing. Some of these chemicals also tell the body to send more inflammatory cells into the area. The lining of the bronchial tubes of asthmatics contain more of these special cells. In addition, in asthmatics, the inflammatory cells release their chemicals after exposure to things the person is allergic to — for example, after exposure to dogs, or cats, or ragweed.

The result is a wheezing sound that may be more noticeable when a child exhales. Frequent coughing is a common companion of asthma as well as a tight feeling in the chest.

Causes

Asthma results from an interaction between different environmental and genetic factors.

Environmental Factors The environmental influences begin during pregnancy: allergic sensitisation has been described before birth, and several studies have demonstrated reduced lung function in newborn infants of smoking mothers compared to those of nonsmoking mothers. Smoking increases the risk of both asthma and poorer lung function throughout childhood. All children should have the right to an environment free from tobacco smoke products both before and after birth.

Allergens – Allergen exposure may cause acute asthma exacerbations, and even in the absence of an exacerbation, may increase airway inflammation and bronchial hyperresponsiveness. Allergens may be encountered both outdoors and indoors, and house dust mites and animal dander are particularly important perennial indoor allergens. Occupational agents play a minor role during childhood, but several types of allergy may influence the choice of education in relationship to later working life. Kindergartens and schools are the working environment of children, and the need for a healthy indoor environment in such institutions should be emphasised. Special consideration should be given to the increased risk of respiratory infections, especially in kindergartens. In schools, precautions may be taken to reduce allergen exposure for allergic asthmatic children.

Medicine – It is widely accepted that antibiotics play a role in asthma attacks and may contribute to its original cause. Many children are so well protected from germs, bacteria and childhood illnesses that their immune systems don’t develop properly. Instead of acquiring the immune cells specific to certain bacteria and viruses, they retain highly reactive immune cells.

Ampicillin, amoxycilllin cephalosporins, erythromycin, spiramycin and tetracycline, both in prescription form and the antibiotic-treated animal products we ingest, worsen asthma attacks. Acetaminophen, aspirin, ibuprofen and naproxen can trigger or worsen asthma attacks. Other drugs such as betablockers, estrogen, NSAIDs and sulfites can trigger or worsen asthma attacks.

Genetic – Asthma, and one of its major causes, allergy, have strong hereditary traits. During recent years, much effort has been put into genetic family studies in order to identify genetic markers. A large number of markers with possible relationships to asthma and airway inflammation have already been identified, but these vary between populations. There has also been increased focus upon epigenetics: the finding that environmental influences may cause DNA methylation and histone formation, and thus change and inactivate the influence of specific genes, has given insight into how the environment may interact with genes, and has shown that this interaction may even be transferred from mother to child.

Infections – Respiratory virus infections are the major cause of acute bronchiolitis in infancy and of acute asthma attacks among older asthmatic children. From 2 years of age, rhinovirus infections are the most frequent precipitators of acute asthma.

Exercise – Throughout childhood, but increasingly during school age, exercise is an important cause of asthma exacerbations (exercise-induced asthma). It has been reported that 30% of all asthmatic children suffer from restriction of physical activity and it is very important to teach asthmatic children to master exercise, by education, advice related to ‘warming up’ and medical treatment.

Risk Factors

Factors that may increase the child’s likelihood of developing asthma include –

  • Exposure to tobacco smoke
  • Previous allergic reactions, including skin reactions, food allergies or hay fever (allergic rhinitis)
  • A family history of asthma, allergic rhinitis, hives or eczema
  • Living in an urban area with increased exposure to air pollution
  • Low birth weight
  • Obesity
  • A chronic runny or stuffy nose (rhinitis)
  • Severe lower respiratory tract infection, such as pneumonia
  • Inflamed sinuses (sinusitis)
  • Heartburn (gastroesophageal reflux disease, or GERD)
  • Being male
  • Pet dander

Symptoms

Breathing problems are common. They can include –

  • Shortness of breath
  • Feeling out of breath
  • Gasping for air
  • Trouble breathing out (exhaling)
  • Breathing faster than normal
  • When the child is has a hard time breathing, the skin of the chest and neck may suck inward.

Other symptoms of asthma in children include –

  • Coughing that sometimes wakes the child up at night (it may be the only symptom)
  • Dark bags under the eyes
  • Feeling tired
  • Irritability
  • Tightness in the chest
  • A whistling sound made when breathing (wheezing).

Complications

Asthma may cause a number of complications, including –

  • Severe asthma attacks that require emergency treatment or hospital care
  • Permanent narrowing of the airways (bronchial tubes)
  • Missed school days or getting behind in school
  • Poor sleep and fatigue
  • Symptoms that interfere with play, sports or other activities

Treatment

Inhalers – There are different types of inhaler devices, which deliver asthma medication to the airways either in dry powdered form, or as an aerosol form with a propellant.

  • Preventers are used to reduce the inflamed areas of the lungs and to prevent the symptoms of asthma occurring. They contain steroid medication to be inhaled usually once or twice a day, and work as a long term treatment to control asthma.
  • Relievers (bronchodilators) are used to provide immediate relief from the symptoms of asthma when they develop. These inhalers work by opening up the airways to allow more air into the lungs and make breathing easier. They do not help reduce inflammation or prevent symptoms from occurring in the future. Some medicines work as both a preventer and a reliever.

Nebulisers – Nebulisers are sometimes used to treat emergency situations where asthma has become out of control. They used to be used in children experiencing a particularly severe attack of asthma, but research has shown that inhalers used with a spacer are as effective as nebulisers in delivering medicine. Nebulisers continue to be used by ambulance crews, some GPs and in A&E departments, as they allow oxygen to be given at the same time. However, a hospital may use an inhaler with spacer instead as doing so may allow the child to be discharged from hospital sooner.

Steroids – Steroids work by reducing inflammation. In the case of asthma, when a patient uses an inhaler, steroids are taken directly to the lungs, thereby directly treating the area that is affected by the allergy. The steroids then reduce the swelling of the airways which is the underlying problem in asthma. Also, some allergic responses involve a second (late phase) reaction after the initial allergic reaction. Steroids, unlike anti-histamines, can reduce the symptoms of these late phase reactions, by limiting the activity of the cells responsible for releasing further chemicals in the body. In this way steroids not only reduce inflammation, but they can also stop an ongoing allergic reaction.

Anti-leukotrienes – Leukotrienes are chemicals released by the immune system that cause swelling and secretion, and can cause allergy symptoms to persist. Anti-leukotrienes work by reducing inflammation and mucus production, and work in a similar way to steroids, but with fewer side effects.

Lifestyle Changes for Parents –

  • Try to avoid triggers which could makes the child’s asthma symptoms worse (e.g. animal hair) and note down any new ones to discuss with your doctor.
  • Do not smoke around the child or allow the child to stay in smoky surroundings.
  • Exercise can play an important part for the child. Swimming and sport should be encouraged as long as the child’s asthma is under control.
  • Think about any triggers in holiday areas, such as house dust mite or pets. Request a pet-free place to stay if possible, and make sure to give details to any holiday club staff about your child’s condition.

Alternative Treatment

Beta-carotene, the compound that gives fruit and vegetables their orange or red color, reduced asthma attacks in 53% of people in one study. Carotenoids are the basis of vitamin A which is involved in the mucous membranes. Severity of asthma correlates with low vitamin A.

Vitamin B3 and vitamin B12 are commonly low in asthmatics. These nutrients lower antihistamine levels and reduce wheezing.

Folate, or vitamin B9, reduced allergic reactions and inflammation. It lowers wheezing by 40%.

Fish oil – The evidence for using omega-3 fatty acids (found in fish oil) to treat asthma is mixed. At least a few studies have found that fish oil supplements may reduce inflammation and symptoms in children.

Quercetin, a kind of antioxidant called a flavonoid, helps to reduce the release of histamine and other allergic or inflammatory chemicals in the body. Histamine contributes to allergy symptoms, such as a runny nose, watery eyes, and hives.

Coenzyme Q 10 (CoQ10) to act as antioxidants.

Vitamin C is a powerful antioxidant and helps to detoxify the body. Vitamin C reduces wheezing and inflammation.

Magnesium – The idea of using magnesium to treat asthma comes from the fact that people who have asthma often have low levels of magnesium.

Potassium – For healthy immune system.

Coleus forskohlii – Coleus forskohlii, or forskolin, is another herb used in Ayurvedic medicine to treat asthma.

Pycnogenol – French maritime pine bark, called pycnogenol, suggests that it may reduce symptoms and improve lung function in children with asthma

Boswellia (Boswellia serrata) – Boswellia (also known as Salai guggal) is an herb commonly used in Ayurvedic medicine, a traditional Indian system of health care.

Saiboku-to – In three preliminary studies, a traditional Japanese herbal mixture called Saiboku-to has helped reduce symptoms and allowed study participants to reduce doses of corticosteroids.

 

Reference –

http://www.kidshealth.org.nz/asthma

http://acaai.org/asthma/who-has-asthma/children

http://www.childrenshealthfund.org/child-health-care/special-initiatives/childhood-asthma-initiative

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/asthma-and-young-children

http://www.medindia.net/patients/patientinfo/childhood-asthma.htm

http://www.childhoodasthma.org/

http://www.erswhitebook.org/chapters/childhood-asthma/

http://www.nhs.uk/conditions/asthma/Pages/Introduction.aspx

http://publichealth.lacounty.gov/ha/reports/habriefs/v3i6_asthma/asthm.pdf

http://kidshealth.org/parent/medical/lungs/asthma_basics.html

Posted in ALLERGIES
February 3, 2017

Asthma is characterized by inflammation of the air passages resulting in the temporary narrowing of the airways that transport air from the nose and mouth to the lungs. Asthma symptoms can be caused by allergens or irritants that are inhaled into the lungs, resulting in inflamed, clogged and constricted airways. Symptoms include difficulty breathing, wheezing, coughing tightness in the chest. In severe cases, asthma can be deadly.

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial hyper-responsiveness to a variety of stimuli.

The inside walls of an asthmatic’s airways are swollen or inflamed. This swelling or inflammation makes the airways extremely sensitive to irritations and increases your susceptibility to an allergic reaction.

As inflammation causes the airways to become narrower, less air can pass through them, both to and from the lungs. Symptoms of the narrowing include wheezing (a hissing sound while breathing), chest tightness, breathing problems, and coughing. Asthmatics usually experience these symptoms most frequently during the night and the early morning. Asthma is an incurable illness. However, with good treatment and management there is no reason why a person with asthma cannot live a normal and active life.

Asthma is among the most common chronic childhood illnesses, accounting for 10.5 million missed school days a year. It also accounts for 14.2 million lost workdays for adults. Every year, about 14 million Americans see a doctor for asthma. About 1.4 million patients visit a hospital outpatient department for asthma; almost 1.75 million go to a hospital emergency room. The number of people in the U.S. diagnosed with asthma is increasing.

How is an Asthma Attack?

An asthma episode, or an asthma attack, is when symptoms are worse than usual. They can come on suddenly and can be mild, moderate or severe.

  • The muscles around the airways tighten up, narrowing the airway.
  • Less air is able to flow through the airway.
  • Inflammation of the airways increases, further narrowing the airway.
  • More mucus is produced in the airways, undermining the flow of air even more.

Types of Athma

  • Child-Onset Asthma – Asthma that begins during childhood is called child-onset asthma. This type of asthma happens because a child becomes sensitized to common allergens in the environment – most likely due to genetic reasons. The child is atopic – a genetically determined state of hypersensitivity to environmental allergens.
  • Adult-Onset Asthma – This term is used when a person develops asthma after reaching 20 years of age. Adult-onset asthma affects women more than men, and it is also much less common than child-onset asthma. It can also be triggered by some allergic material or an allergy. It is estimated that up to perhaps 50% of adult-onset asthmas are linked to allergies. However, a substantial proportion of adult-onset asthma does not seem to be triggered by exposure to allergen(s); this is called non-allergic adult-onset asthma.
  • Exercise-Induced Asthma – If a person coughs, wheezes or feels out of breath during or after exercise, he or she could be suffering from exercise-induced asthma. Obviously, the level of fitness is also a factor – a person who is unfit and runs fast for ten minutes is going to be out of breath. However, if the coughing, wheezing or panting does not make sense, this could be an indication of exercise-induced asthma.
  • Cough-Induced Asthma – Cough-induced asthma is one of the most difficult asthmas to diagnose. The doctor has to eliminate other possibilities, such as chronic bronchitis, post nasal drip due to hay fever, or sinus disease.
  • Occupational Asthma – This type of asthma is triggered by something in the patient’s place of work. Factors such as chemicals, vapors, gases, smoke, dust, fumes, or other particles can trigger asthma. It can also be caused by a virus (flu), molds, animal products, pollen, humidity and temperature.
  • Nocturnal Asthma – Nocturnal asthma occurs between midnight and 8 AM. It is triggered by allergens in the home such as dust and pet dander or is caused by sinus conditions. Nocturnal or nighttime asthma may occur without any daytime symptoms recognized by the patient.
  • Steroid-Resistant Asthma (Severe Asthma) – While the majority of patients respond to regular inhaled glucocorticoid (steroid) therapy, some are steroid resistant. Airway inflammation and immune activation play an important role in chronic asthma. Current guidelines of asthma therapy have therefore focused on the use of anti-inflammatory therapy, particularly inhaled glucocorticoids (GCs).

Cause

Allergies – Almost all asthma sufferers have allergies. In fact, over 25% of people who have hay fever (allergic rhinitis) also develop asthma. Allergic reactions triggered by antibodies in the blood often lead to the airway inflammation that is associated with asthma. Common sources of indoor allergens include animal proteins (mostly cat and dog allergens), dust mites, cockroaches, and fungi. It is possible that the push towards energy-efficient homes has increased exposure to these causes of asthma.

Environmental Factors – Pollution, sulfur dioxide, nitrogen oxide, ozone, cold temperatures, and high humidity have all been shown to trigger asthma in some individuals. During periods of heavy air pollution, there tend to be increases in asthma symptoms and hospital admissions. Smoggy conditions release the destructive ingredient known as ozone, causing coughing, shortness of breath, and even chest pain. These same conditions emit sulfur dioxide, which also results in asthma attacks by constricting airways.

Pregnancy – Babies born by Caesarean sections have a 20% increase in asthma prevalence compared to babies born by vaginal birth. It is possible that immune system-modifying infections from bacterial exposure during Cesarean sections are responsible for this difference.

Obesity – Overweight adults – those with a body mass index (BMI) between 25 and 30 – are 38% more likely to have asthma compared to adults who are not overweight. Obese adults – those with a BMI of 30 or greater – have twice the risk of asthma. According to some researchers, the risk may be greater for nonallergic asthma than allergic asthma.

Tobacco smoke has been linked to a higher risk of asthma as well as a higher risk of death due to asthma, wheezing, and respiratory infections. In addition, children of mothers who smoke – and other people exposed to second-hand smoke – have a higher risk of asthma prevalence. Adolescent smoking has also been associated with increases in asthma risk.

Stress – People who undergo stress have higher asthma rates. Part of this may be explained by increases in asthma-related behaviors such as smoking that are encouraged by stress. However, recent research has suggested that the immune system is modified by stress as well.

Genetic Factors – Genes linked to asthma also play roles in managing the immune system and inflammation. There have not, however, been consistent results from genetic studies across populations – so further investigations are required to figure out the complex interactions that cause asthma.

Inflammatory Triggers – Inflammatory (allergic) triggers can cause inflammation of the lungs’ airways or tightening of the airways’ muscles. Inflammatory triggers include –

  • Dust mites
  • Animals
  • Cockroaches
  • Moulds
  • Pollens
  • Viral infections
  • Certain air pollutants

Symptom Triggers – Symptom (non-allergic) triggers generally do not cause inflammation, but they can provoke “twitchy” airways, especially if they’re already inflamed. Symptom triggers include-

  • Smoke
  • Exercise
  • Cold air
  • Chemical fumes and other strong-smelling substances like perfumes
  • Certain food additives like sulfites
  • Certain air pollutants
  • Intense emotions

Symptoms

Asthma symptoms can differ for each person, but here are some of the most common:

  • Wheezing – People may notice a whistling sound when you breathe. Sometimes this happens only when you exercise or have a cold.
  • Frequent cough – This may be more common at night. People may or may not cough up mucus.
  • Shortness of breath – This is the feeling that you can’t get enough air into the lungs. It may occur only once in a while, or often.
  • Chest tightness – The chest may feel tight, especially during cold weather or exercise. This can also be the first sign of a flare-up.

Treatment

Conventional Treatment

MedicineLong-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you’ll have an asthma attack. Types of long-term control medications include –

  • Inhaled corticosteroids – These anti-inflammatory drugs include fluticasone (Flonase, Flovent HFA), budesonide (Pulmicort Flexhaler, Rhinocort), flunisolide (Aerospan HFA), ciclesonide (Alvesco, Omnaris, Zetonna), beclomethasone (Qnasl, Qvar), mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta).
  • Leukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms for up to 24 hours.
  • Long-acting beta agonists – These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways.
  • Combination inhalers – These medications — such as fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort) and formoterol-mometasone (Dulera) — contain a long-acting beta agonist along with a corticosteroid.
  • Theophylline – Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps keep the airways open (bronchodilator) by relaxing the muscles around the airways.
  • Short-acting beta agonists – These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex).
  • Ipratropium (Atrovent) – Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe.
  • Oral and intravenous corticosteroids – These medications — which include prednisone and methylprednisolone — relieve airway inflammation caused by severe asthma.

 

Alternative Treatment

Vitamins – Antioxidant vitamins are commonly suggested complementary therapies for asthma. Adults whose diets are naturally high in antioxidants such as vitamin C– and vitamin E–rich foods have the fewest pulmonary problems.

Magnesium – Dietary magnesium intake is strongly correlated with asthma symptoms; the more magnesium, the fewer the symptoms. Intravenous magnesium has proven helpful in treating pediatric status asthmatics.

Selenium – Plasma and erythrocyte levels of selenium and the activity of the selenium-dependent enzyme glutathione reductase are lower in asthmatic adults than in non-asthmatics.

Salt restriction – While bronchial sensitivity to methacholine is increased by high salt intakes, a pediatric case control study found no association between levels of salt intake and asthma or exerciseinduced bronchospasm.

Fatty acids – Omega-3 fatty acids (found in fish oils, canola oil, and flax seed oil) have been touted as important anti-inflammatory food supplements. Omega-3 fatty acids limit leukotriene synthesis by blocking arachidonic acid metabolism.

Zinc – There is little evidence of zinc deficiency causing asthma symptoms, but asthma patients have been shown to have lower plasma zinc than healthy controls.

Ginkgo extract has been shown to reduce inflammation.

Lobelia (Indian tobacco) was used by Native Americans to treat respiratory disorders, including asthma.

Other natural herbs that have been used to treat asthma include mullein, boswellia (Indian frankincense), dried ivy, and butterbur.

Coffee and tea can both be useful in treating asthma symptoms. Caffeine is a natural (mild) bronchodilator. Tea contains minute amounts of theophylline, one of the major prescription drugs for asthma.

Complementary Treatment

Acupuncture – A technique that involves inserting needles into key points of the body. Evidence suggests that acupuncture may signal the brain to release endorphins. These are hormones made by the body.

Biofeedback – A technique that helps people control involuntary physical responses. Results are mixed, with children and teenagers showing the greatest benefit.

 

Chiropractic spinal manipulation – A technique that emphasizes manipulation of the spine in order to help the body heal itself. There is no evidence that this treatment impairs the underlying disease or pulmonary function.

Hypnosis – An artificially induced dream state that leaves the person open to suggestion, hypnosis is a legitimate technique to help people manage various conditions. Hypnosis might give people with asthma or allergies more self-discipline to follow good health practices.

Laser treatment – A technique that uses high intensity light to shrink swollen tissue or unblock sinuses.

Massage, relaxation techniques, art/music therapy, yoga – Stress and anxiety may cause your airways to constrict more if you have asthma or allergies. Various techniques can help you relax, reduce anxiety or control your breathing.

 

 

Reference –

http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/

http://www.nhs.uk/Conditions/Asthma/Pages/Symptoms.aspx

http://www.medicalnewstoday.com/info/asthma/treatment-for-asthma.php

http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/treatment

http://www.nationalasthma.org.au/understanding-asthma/what-is-asthma-#2

http://www.asthma.ca/adults/about/symptomTriggers.php

http://acaai.org/asthma/about

https://www.blf.org.uk/Page/Causes-of-asthma

http://www.healthline.com/health/natural-asthma-treatment-and-alternative-therapies#Overview1

http://www.asthmaaustralia.org.au/Complementary_Therapies.aspx

https://dphhs.mt.gov/Portals/85/publichealth/documents/Asthma/CAMUseandAsthma.pdf

Posted in ALLERGIES
February 3, 2017

Allergy is more than just a runny nose. In the practice of Environmental Medicine, allergy is the number one environmentally caused disease or disorder. Yet many people don’t realize how many different problems can develop because of allergies.

The term allergy was first introduced by Dr. Von Pirquet in 1904 and was defined as “any altered reaction to a substance.” This definition of allergy was generally accepted until 1967, when Dr. Ishizaka isolated immunoglobulin E in a person’s blood and identified this protein as the specific marker to identify allergic reactions. With identification of what was then thought of as the only physiological means of mediating allergy, the term allergy came to be applied only to immunoglobulin E (IgE) mediated reactions.

Ishizaka’s new definition of allergy, however, resulted in the failure of most physicians to recognize that people can and do react to many things which are not IgE mediated. Inhalant allergens such as pollen, dust, molds, and danders (typically IgE mediated) are indeed major causes of classical allergy—allergic rhinitis, asthma, and eczema—and it is helpful to reduce the allergic load coming from them through avoidance or allergy extracts.

However, sensitivities to foods and chemicals are often not IgE mediated and are thus missed in the diagnosis. In our 36 years of experience at The Center for Occupational and Environmental Medicine, we have found that chronic symptoms and disease are very often caused by exposures to allergenic foods and chemicals. Reactions to these substances may be mediated by immunoglobulin G (IgG) or other immunoglobulins, or may occur as a reaction within the gastrointestinal tract itself.

Based on our experience from working with thousands of patients, we at The Center, prefer to use the terms “food and chemical sensitivity” rather than “food and chemical allergy,” knowing that people do react even if the mechanism is not IgE mediated. We have found that common causes of headaches are often (but not always) sensitivity to cane, corn, cola, chocolate, and/or citrus, and common causes of arthritic pain are sensitivity to beef, pork, apple, soy, coffee, and the solanine containing foods—tomato, potato, eggplant and peppers. The mechanism of these reactions is clearly not IgE mediated. To complicate matters further, each person is unique and their triggers for these disorders and other pain syndromes are highly individual.

Most physicians practicing Environmental Medicine are of the opinion that if you could do only one thing with a patient presenting with multiple chronic signs and symptoms, it would be an elimination diet followed by a deliberate challenge testing of the patient’s foods. Most patients are amazed to learn that problem foods are usually those that are eaten frequently or craved. Experience with brittle asthmatics reveals that 50-60 percent get better with food elimination. This again emphasizes the important role of the gut as the gatekeeper of the body and also the importance of good digestion.

Any organ or system of the body can be the target of an “allergic” or sensitivity reaction. Thus, we often see patients presenting with multi-system involvement. Identifying their food, chemical, and inhalant triggers helps resolve such problems as gastro-esophageal reflux, chronic nausea, vomiting, diarrhea, bedwetting, frequency and urgency of urination, chronic persistent cough, asthma, and chronic joint pain. Yet the organ system taking the biggest hit is the nervous system. Allergy or sensitivity involving the nervous system as the target of reactions can cause learning disabilities, psychosis and schizophrenia, depression, lethargy, fatigue, agoraphobia, panic attacks, sleep apnea, restless legs, and other neurological impairments. Why use life-long drug therapy when in many cases identifying contributing allergies or sensitivities can eliminate or greatly reduce such problems?

People may often note that their medical problems are cyclical, occurring at a specific time of the year. What they don’t recognize is that the seasonality of onset is related to pollens—trees in the spring, grass in the summer, and weeds in the fall. It is therefore important to ask not only what problem the patient has, but also when do they get their symptoms? It is equally important to understand that foods cross-react with pollens. One may be more reactive to specific foods when there are concomitant pollens in the air. In addition, in women cyclical signs and symptoms may be related to their menstrual cycle. We call this endocrine allergy, reactions being related to hormone sensitivities. Premenstrual syndrome (PMS) is a manifestation of hormonal sensitivity and responds quickly to the Environmental Medicine approach.

One of the major causes of disease is autoimmunity: the body literally attacks itself because it no longer recognizes self from non-self. Such diseases as lupus, rheumatoid arthritis, Sjogren’s syndrome, multiple sclerosis, and thyroiditis are autoimmune diseases. They are often caused by microorganisms living in the body that cross-react against specific body tissues. Cross-reactivity of the organism Group A beta hemolytic streptococcus with heart and kidney tissue is the cause of rheumatic fever and glomerulonephritis. Allergy or sensitivity to even normally occurring microbial flora may trigger autoimmune diseases in susceptible individuals. Using techniques of hypo-sensitization and neutralization can be beneficial in overcoming cross-reactivity to various organisms and thus helping to control autoimmune diseases.

Hopefully, this article has demonstrated that “allergy” is more than just a runny nose, and that it can be the cause of many of your signs and symptoms. For nearly four decades the Center for Occupational and Environmental Medicine has helped identify the cause of chronic disease and disorders through comprehensive diagnostic evaluation, utilizing allergy and sensitivity testing as needed. We’re very pleased that our success rate in this area has been so helpful in returning patients to good health.

Posted in ALLERGIES