February 3, 2017

Latex is a milky sap produced by rubber trees. The sap is blended with chemicals during manufacturing to give latex its elastic quality. Natural rubber latex is often found in rubber gloves, condoms, balloons, rubber bands, erasers and toys.

A latex allergy is an allergy to products made from natural rubber latex. Some of the other chemicals used in making latex products can cause serious allergies, as well. Also, latex gloves are dusted with powder to make them easier to put on and take off. When this powder combines with the latex protein, it can get into the air when the gloves are used and be inhaled. The allergy-causing particles become attached to the cornstarch powder in gloves, swimming caps and balloons. Moisture from the skin can enhance this process. The particles can become airborne and inhaled when products are used. Sensitized individuals react to these particles. Milk protein is sometimes mixed in with latex in surgical and household gloves and this can be the cause of reactions in milk allergic individuals.

This type of allergic reaction is the same type that occurs in hay fever, allergic asthma and peanut allergy. It can vary in severity from a mild nettle rash on contact, to severe anaphylaxis with respiratory symptoms and collapse. It is potentially fatal but deaths are fortunately very uncommon.

Hundreds of products may contain latex –

  • Medical devices (gloves, blood pressure cuffs, IV tubes and catheters);
  • Dental items (dams and orthodontic rubber bands);
  • Clothing (the elastic waistbands in pants and underwear);
  • Children’s items (toys, bottle nipples, pacifiers and teething toys);
  • Household items (rugs, bathmats and rubber gloves);
  • Personal care items (diaphragms and condoms);
  • Office and school supplies (rubber bands, erasers, rubber cement and paint).

Who is at Risk?

People at greatest risk include –

  • People with allergies who may have cross reactions
  • Children with spina bifida or multiple surgeries
  • Health care workers and housekeeping staff in health facilities
  • People who require frequent medical procedures, such as catheterization
  • Child care providers
  • Food service workers
  • Workers in tire factories and rubber manufacturing
  • Others who must wear latex gloves at work.

Types of Latex Allergies

There are three different kinds of adverse reactions to latex, although they do overlap to a certain degree. These include –

Irritant dermatitis – Characterized by crusty skin lesions. Irritant dermatitis isn’t the same as latex allergy, because it can be caused by a wide range of other factors, including washing with harsh soap or the action of sweat inside rubber gloves. However, irritant dermatitis is often a starting point for the development of latex allergy. Broken skin allows the absorption of latex. Without intervention, people with genetic susceptibility will progress from irritant dermatitis to latex allergy.

Allergic contact dermatitis – This skin problem is caused by a reaction to the chemicals added to latex during processing, not to the latex proteins themselves. Typically, symptoms (including rough skin patches and a weeping rash) tend to develop a few days after exposure. Once again, this is not true latex allergy. However, the absorption of latex through broken skin can increase the risk of latex allergy in susceptible people.

Immediate-type latex allergy – In genetically susceptible people, initial exposure to latex prompts the immune system to create antibodies. On subsequent exposure to latex, the body mounts an immune system response, which includes the release of histamine. This can cause a wide range of sudden reactions including hives, swollen lips and, in severe cases, anaphylaxis. Anaphylaxis, or anaphylactic shock, is an emergency and can be fatal.

How are people exposed to latex?

Respiratory exposure – Cornstarch powder is sometimes added to disposable latex gloves during manufacture to make them easier to put on. Latex proteins leach into the powder and become airborne when the gloves are removed. Inhaling the powder can cause respiratory sensitisation in susceptible people.

Skin exposure – Skin exposure can occur from handling latex products and wearing latex gloves. During glove use, chemicals added during manufacture and latex proteins can leach out of the glove material causing skin sensitisation in susceptible people. Skin exposure can also occur from touching surfaces that are contaminated with powder from powdered latex gloves

Causes

Research has identified a protein substance in natural latex as a major source of the allergy. The protein can be absorbed through the skin or the powder containing the protein can be inhaled. However, chemicals such as zinc diethyldithiocarbamate (which is added to the latex) and starch powder (found in new gloves) have also caused allergic reactions in sensitive people. Actually, it is the protein in the glove material that has been absorbed by the cornstarch that causes the allergic reaction. Powder-free gloves cause fewer allergic problems.

Latex allergy is an occupational health hazard for many people including –

  • Health care workers (operating room workers, dental care workers, special procedure and general medical nurses, emergency response workers).
  • Laboratory technicians.
  • Greenhouse workers.
  • Hair salon workers.
  • Glove manufacturing workers.

Food service workers:

  • Police and/or enforcement.
  • Other workers who use latex gloves for protection.

Cross Reaction – Around half of all people with latex allergy have allergic reactions when People who have a latex allergy may be allergic to some foods, as well. This is called a cross reaction. When this happens, your body Latex responds with the same allergic symptoms that you would have if you were exposed to latex. Cross reactions differ from one person to another. Someone may have a reaction to all the foods noted to cause cross reaction while another may have no reaction at all. Likewise, if you are allergic to any of these foods, you may also be allergic to latex:

  • apples, bananas, kiwi, peaches, plums, figs, grapes, melons, papaya, passion fruit, cherries, nectarines, pears, pineapple and strawberries;
  • carrots, celery, raw potatoes, avocados and tomatoes;
  • chestnuts and hazelnuts;
  • wheat and rye

Symptoms

Latex allergy can be mild or severe, with symptoms such as –

  • Itchy, red, watery eyes
  • Sneezing or runny nose
  • Coughing
  • Rash or hives
  • Chest tightness
  • Shortness of breath

Some people who wear latex gloves get bumps, sores, cracks or red, raised areas on their hands. These symptoms usually appear 12 to 36 hours after contact with latex. Changing to non-latex gloves, using glove liners, and paying more attention to hand care can help relieve these symptoms.

A person who is highly allergic to latex can also have a life-threatening allergic reaction, called anaphylactic shock. Symptoms include –

  • Difficulty breathing
  • Dizziness
  • Confusion
  • Wheezing
  • Nausea
  • Vomiting
  • Rapid or weak pulse
  • Loss of consciousness

Someone having an anaphylactic reaction needs immediate medical attention.

Treatment

Allergic reactions may be treated by removal of the latex product and drug treatment according to the type of symptoms developing. If the symptoms are irritant contact dermatitis, antihistamine and/or corticosteroid medicines may be enough to treat symptoms. Severe reactions should also be treated with epinephrine, intravenous fluids, and other support by hospital or emergency personnel.

If you have a latex allergy, it is important for you to wear a MedicAlert bracelet and carry two emergency epinephrine syringes.

If you’ve had a severe allergic reaction to latex, you may need to carry injectable epinephrine with you at all times. If you go into anaphylactic shock, you may need:

  • An emergency injection of adrenaline (epinephrine)
  • A trip to the emergency room
  • Oxygen
  • Corticosteroids

Alternative Treatment         

Quercetin – A flavonoid and antioxidant found in many plants that may help reduce allergic reactions. Some people may get more benefit from the water-soluble form of quercetin, called quercetin chalcone. Quercetin may impact the way the liver metabolizes certain medications.

Vitamin C – Supports immune system function and enhances the effect of quercetin. Lower the dose if diarrhea develops.

Zinc – Zinc may help protect against gastrointestinal symptoms (stomach cramps, nausea, vomiting, or diarrhea) that sometimes accompany anaphylaxis. Zinc can potentially interfere with some medications, including antibiotics and cisplatin (Platinol-AQ).

Alpinia galangal – One of several plants commonly called galangal and used as a spice in Thai food, Alpinia galanga is a member of the ginger family. Preliminary animal studies suggest it may have antihistamine properties. Take capsules or drink tea.

Chinese skullcap – May have antihistamine properties. Do not use Chinese skullcap if you are pregnant or nursing. Chinese skullcap can potentially interact with a variety of medications.

Licorice – Has been used traditionally to support the immune system and may have antihistamine properties. Licorice should only be used under the direction of a trained physician.

Stinging nettle – May have anti-inflammatory and antihistamine properties. Look for freeze-dried, encapsulated nettles, which are believed to retain most of the antihistamine effects of the plant.

Sweet chestnut tree – Contains quercetin and reduced skin and blood vessels reactions.

Spreading sneezeweed – Contains flavonoids and is used in Traditional Chinese Medicine for its anti-inflammatory and antihistamine effects.

 

Reference –

https://www.health.ny.gov/publications/1454.pdf

http://www.hse.gov.uk/healthservices/latex/allergyguide.pdf

http://www.tdi.texas.gov/pubs/videoresource/fslatexallergy.pdf

http://latexallergyresources.org/definition

http://familydoctor.org/familydoctor/en/diseases-conditions/latex-allergy/symptoms.html

http://www.medicalnewstoday.com/articles/247168.php?page=2

http://acaai.org/news/chinese-herbs-can-complement-proven-allergy-treatments

http://www.allergy.org.au/patients/product-allergy/latex-allergy/73-aer/about

http://www.medicinenet.com/latex_allergy/article.htm

https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0020/83009/latex-allergy.pdf

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

http://www.ccohs.ca/oshanswers/diseases/latex.html

http://www.cdc.gov/niosh/docs/98-113/

Posted in ALLERGIES
February 3, 2017
Posted in ALLERGIES
February 3, 2017

Hypersomnia means “excessive sleep.” Patients with idiopathic hypersomnia sleep a reasonable amount at night (at least six hours) but have difficulty waking up and always feel tired and sleepy. In addition to excessive daytime sleepiness, people with idiopathic hypersomnia may:

  • Sleep enormous amounts every day (10 hours or more)
  • Display “sleep drunkenness,” such as extreme sleep inertia, difficulties waking up with alarm clocks and feeling groggy for long period of times.

Idiopathic hypersomnia (IH) belongs to a class of sleep disorders known as Central Disorders of Hypersomnolence. This group of sleep disorders includes narcolepsy types I and II, idiopathic hypersomnia, Kleine-Levin syndrome, insufficient sleep syndrome, and hypersomnia due to medical, hypersomnia due to medication or substance, and hypersomnia associated with a psychiatric disorder.

IH is a chronic disorder that remits in less than 1 in 6 cases, and that responds poorly to traditional treatments. It often negatively impacts upon the patient’s life to such an extent that working, socializing and even driving eventually become impossible due to an inability to sustain vigilant wakefulness.

Causes

The exact cause of idiopathic hypersomnia is unknown. Researchers suspect that a genetic link may be possible because it appears to run in families, but there is no proof of this. It seems to be a rather uncommon type of sleep disorder. The condition usually develops slowly before the age of 30. In the vast majority of cases, idiopathic hypersomnia is a lifelong condition.

Idiopathic hypersomnia causes people to sleep a long time during the night. People may sleep more than 10 hours a night. Despite such long periods of sleep, people with idiopathic hypersomnia feel very sleepy during the day. No matter how much they nap during the day, they still feel very sleepy. This condition can be very disabling, limiting a person’s ability to maintain employment, relationships, and quality of life.

Symptoms

The most common symptoms shared by sufferers of IH are –

  • Greater than 10 hours sleep per 24 hour period – often as much as 16+ hours per 24 hour period
  • Long, unrefreshing naps that typically last several hours
  • Awakening from sleep feeling unrefreshed, often with significant sleep inertia (commonly known as ‘sleep drunkenness’)
  • An inability to be woken from sleep – even multiple alarm clocks or physical attempts made by family/friends are largely unsuccessful.
  • Cognitive problems caused by the overwhelming desire to sleep (commonly referred to as ‘brain fog’)

As the condition progresses less common symptoms can include –

  • Anxiety and depression – often as a result of the limits this disorder imposes upon what the patient is able to do with their limited time awake
  • Raynaud’s type phenomena – freezing cold hands and feet
  • Loss of impulse control – especially in regard to food
  • Impotence

Those with IH often describe themselves as experiencing two types of sleepiness –

  • A physical exhaustion that ‘normal’ people might experience after missing several nights sleep in a row.
  • A cognitive exhaustion similar to Executive Dysfunction that can make even simple tasks like reading, conversation with friends, or watching a movie beyond their reach.

Treatment

Medication

There are no medicines specifically designed to treat idiopathic hypersomnia, but medications used for narcolepsy can often help. The main medications used are stimulants, such as modafinil, dexamphetamine and methylphenidate, which help to keep people awake during the day. See treating narcolepsy for more information on these medicines. Antidepressants may be prescribed if emotional problems are interfering with the sleep.

The most common treatments prescribed are:

  • Amphetamines (such as Dextroamphetamine® or Adderall®)
  • Methylphenidate (such as Ritalin® or Concerta®)
  • Modafinil (such as Provigil® or Modavigil®)
  • Armodafinil (such as Nuvigil® or Waklert®) (Currently unavailable in Australia)
  • Sodium Oxybate (such as Xyrem®) (Currently unavailable in Australia)
  • Antidepressants

Lifestyle Changes

  • Keep a consistent sleep schedule
  • Avoid caffeine and alcoholic beverages
  • Talk to others about the condition.
  • Don’t over extend oneself.
  • Avoid operating motor vehicles or using dangerous equipment
  • Avoid working at night or social activities that delay the bedtime

Alternative Treatment

Exercise – Regular exercise not only helps people to lose weight and gain strength, it can also help treat sleep disorders naturally. Regular exercise increases feel-good chemicals such as serotonin in the brain, which can help ease feelings of anxiety and encourage restful sleep.

Nutrients that can help manage IH include calcium and magnesium, choline, chromium picolinate, coenzyme Q10, omega-3 fatty acids, B vitamins, vitamin C complex (including bioflavonoids) and vitamins D and E.

St John’s wort is an herbal remedy recommended for IH because of its action as a nervous system treatment. The herb might improve sleep quality and calm the nerves, which can be affected by the disorder as well as the emotional effects of living with the disease.

Ginkgo biloba nourishes the nervous system in two ways: It protects cells with its antioxidant effects and it improves circulation to the brain. Both of these functions might improve the condition of IH. The active constituents in ginkgo leaves are flavonoids and terpenoids. Balch recommends not taking the herb if you have a bleeding disorder or upcoming surgical procedure.

Gotu kola is an ayurvedic herb native to subtropical climates and has long been used in India as a treatment for the support of veins. It works by strengthening connective tissues. When veins are strong, blood flow is improved and the brain receives more oxygen and nutrients, which might be an effective treatment for narcolepsy, according to Balch.

Country mallow is an ayurvedic herb that stimulates the body and might help those suffering from IH stay awake. Be careful using this herb if you have a cardiovascular disorder, as it causes a rise in blood pressure.

Reference –

https://www.patientslikeme.com/conditions/513-idiopathic-hypersomnia

https://stanfordhealthcare.org/medical-conditions/sleep/idiopathic-hypersomnia.html

http://www.talkaboutsleep.com/message-boards/forum/idiopathic-hypersomnia/

http://idiopathichypersomnia.org/

http://www.medmerits.com/index.php/article/idiopathic_hypersomnia/P9

https://www.msdmanuals.com/professional/neurologic-disorders/sleep-and-wakefulness-disorders/idiopathic-hypersomnia

http://www.nodss.org.au/ih.html

http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=228315

http://www.mayoclinic.org/diseases-conditions/hypersomnia/basics/definition/con-20036556

Posted in ALLERGIES
February 3, 2017

Headaches are one of the most common neurological problems presented to GPs and neurologists. They are painful and debilitating for individuals, an important cause of absence from work or school and a substantial burden on society.

A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and sometimes by taking medicines.

Anyone can experience a headache. Nearly 2 out of 3 children will have a headache by age 15. More than 9 in 10 adults will experience a headache sometime in their life. Headache is our most common form of pain and a major reason cited for days missed at work or school as well as visits to the doctor. Without proper treatment, headaches can be severe and interfere with daily activities. Certain types of headache run in families. Episodes of headache may ease or even disappear for a time and recur later in life. It’s possible to have more than one type of headache at the same time.

Symptoms & Types

There are two types of headaches –

Primary headaches – This occur independently and are not caused by another medical condition. It’s uncertain what sets the process of a primary headache in motion. A cascade of events that affect blood vessels and nerves inside and outside the head causes pain signals to be sent to the brain. Brain chemicals called neurotransmitters are involved in creating head pain, as are changes in nerve cell activity (called cortical spreading depression). Migraine, cluster, and tension-type headache are the more familiar types of primary headache.

  • Tension headaches – These are caused by muscle tension in the shoulders, neck, and head. The tension may  come from fatigue, an uncomfortable body position, or emotional stress. Tension headaches typically begin in the  morning or early afternoon and can get worse during the day. They often involve a tight pressure feeling like a band  around the forehead, but pain may spread over the entire head and downward into the neck and shoulders.
  • Cluster headaches – These types of headaches can be very painful. The intensely sharp pain usually involves one side of the head and spreads around the eye. Cluster headaches start suddenly and generally last about an hour. Attacks come in groups hence the name “cluster” occurring several times a day or each week and continuing for 6 to  8 weeks.
  • Migraine headaches – Often marked by intense throbbing head pain… blurred vision with shimmering light specks, dizziness or nausea, sensitivity to light, sound, or odors. Migraines are certainly a different type of headache.

Secondary headaches – These are symptoms of another health disorder that causes pain-sensitive nerve endings to be pressed on or pulled or pushed out of place. They may result from underlying conditions including fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke, tumors, and nerve disorders (particularly trigeminal neuralgia, a chronic pain condition that typically affects a major nerve on one side of the jaw or cheek).

  • Headaches related to high blood pressure – As the blood vessels and circulatory system throughout the body  are affected by high blood pressure, headaches may result. The pain is typified by a throbbing sensation throughout the  head, though the headaches are generally not chronic in nature.
  • Headaches resulting from eye or sinus problems – Sinus congestion or built­up pressure in the eyes due to  glaucoma are examples of the types of physical problems that can occur with your eyes, ears, nose and/or throat that result  in headaches. These headaches will often disappear when the underlying condition is effectively treated.
  • Headaches associated with facial disorders – One such disorder (originally known as temporomandibular joint or TMJ syndrome), now known as myofascial pain dysfunction (MPD), is characterized by a dull aching pain in and  around the ear that is associated with chewing food. The pain may radiate to the side of the scalp causing a headache. Difficulty opening the mouth or a clicking/popping sound in the jaw joint may also be present. Once symptoms are recognized, treatment can be effective.

Causes

Anything that stimulates the pain receptors in a person’s head or neck can cause a headache, including –

  • Stress
  • Muscular tension
  • Dental or jaw problems
  • Infections
  • Diet
  • Eye problems
  • Hormonal influences
  • Medications
  • Disorders of the ear nose or throat
  • Disorders of the nervous system
  • Injury to the head, neck or spine
  • High blood pressure
  • Poor posture – puts unnecessary strain on the muscles of the back and neck
  • Hangover from abuse of alcohol or drugs
  • Temperature – extremes of heat or cold
  • Dehydration – affects blood pressure
  • Noise – especially loud noises
  • Temporal arteritis – inflammation of the artery at the temple, most common in elderly people
  • Arthritis

In rare cases, a headache can be a sign of something more serious, such as:

  • Bleeding in the area between the brain and the thin tissue that covers the brain (subarachnoid hemorrhage)
  • Blood pressure that is very high
  • Brain infection, such as meningitis or encephalitis, or abscess
  • Brain tumor
  • Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus)
  • Buildup of pressure inside the skull that appears to be, but is not a tumor (pseudomotor cerebri)
  • Carbon monoxide poisoning
  • Lack of oxygen during sleep (sleep apnea)
  • Problems with the blood vessels and bleeding in the brain, such as arteriovenous malformation (AVM), brain aneurysm, or stroke

Treatment

Pain reliever — A pain reliever may be recommended first for the treatment of tension type headache. These drugs include –

  • Aspirin
  • Acetaminophen (eg, Tylenol®)
  • Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen (eg, Motrin or Advil), indomethacin, or naproxen (eg, Naprosyn or Aleve).

Pain medicine combinations — Mild pain relievers are also available in combination with caffeine, which enhances the drug’s effect. As an example, Excedrin® contains a combination of acetaminophen-aspirin-caffeine. This combination may be recommended if a pain reliever alone does not relieve the headache. However, this combination is not recommended more than nine days per month due to the potential risk of developing medication-overuse headaches.

Antidepressants — Antidepressant medicines called tricyclics (TCAs) are often used to help prevent frequent tension headaches. Examples of TCAs include amitriptyline (used most commonly), nortriptyline, and protriptyline.

The dose of TCAs used for people with headaches is typically much lower than that used for treating depression. It is believed that these drugs reduce pain perception when used in low doses, although it is not exactly clear how the medicines work.

Other treatments — Tricyclic antidepressants are sometimes used in combination with behavioral therapy to prevent tension-type headaches. The goal of behavioral therapy is to identify and try to avoid behaviors that can trigger a headache. (See ‘Lifestyle changes’ below.)

Alternative treatment

Magnesium – Magnesium plays a vital role in multiple physiologic processes and therefore it is a vital component in a healthy diet. It is absorbed through the gastrointestinal tract (gut), with more absorbed when the internal content is lower. Magnesium also appears to facilitate calcium absorption.

Feverfew (Tanacetum parthenium) – Feverfew (Tanacetum parthenium) is a species in the chrysanthemum family, whose dried leaves have long been used as a headache remedy.

Coenzyme Q10 (CoQ10) – Coenzyme Q10 (CoQ10) is often described as a vitamin, or a vitamin-like substance. CoQ10 is involved in the creation of the important substance in the body known as adenosine triphosphate (ATP). ATP serves as the cell’s major energy source and drives a number of biological processes including muscle contraction and the production of protein. CoQ10 also works as an antioxidant.

Riboflavin – Riboflavin, also known as vitamin B2, is found in small amounts in many foods. It is needed for converting food to energy, and like CoQ10 also works as an antioxidant by mopping up the damaging free radicals.

Butterbur (Petasites hybridus) – Butterbur is a perennial shrub, found throughout Europe as well as parts of Asia and North America. It is usually found in wet, marshy ground, in damp forests, and adjacent to rivers or streams. The common name is attributed to the large leaves being used to wrap butter during warm weather.

Melatonin – There are many reasons melatonin should be beneficial in headache, but no proof exists presently. It has been shown to be useful for insomnia.

Vitamin D3 – Vitamin D deficiency/insufficiency is common and harmful.

Acupuncture – This ancient technique uses hair-thin needles inserted into several areas of the skin at defined points. While the results are mixed, some studies have shown that acupuncture helps reduce the frequency and intensity of chronic headaches.

Biofeedback – Patients might be able to control headaches by becoming more aware of and then changing certain bodily responses, such as muscle tension, heart rate and skin temperature.

Massage – Massage can reduce stress, relieve pain and promote relaxation. Although its value as a headache treatment hasn’t been determined, massage may be particularly helpful if someone has tight muscles in the back of the head, neck and shoulders.

 

Reference –

http://www.mayoclinic.org/symptoms/headache/basics/causes/sym-20050800

http://www.medicalnewstoday.com/articles/73936.php#signs_and_symptoms

http://www.healthline.com/health/tension-headache#Causes2

https://www.wtamu.edu/webres/File/Student%20Life/Medical%20Services/Headaches.pdf

http://www.ihs-classification.org/_downloads/mixed/International-Headache-Classification-III-ICHD-III-2013-Beta.pdf

http://www.sign.ac.uk/pdf/sign107.pdf

https://www.nice.org.uk/guidance/cg150

Posted in ALLERGIES
February 3, 2017

Granuloma annulare is a common skin condition characterized by bumps appearing over the joints and the backs of the hands. Its cause is not known, and most episodes of granuloma annulare clear up after a few years, with or without treatment.

Granuloma annulare (GA) is a relatively common inflammatory skin condition, which can manifest with cutaneous eruptions in a handful of patterns. GA tends to occur in the third to fifth decades of life.

Localized ranuloma annulare most often affects children and young adults. It is slightly more common in girls. The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes or thyroid disease. Generalized granuloma annulare occurs more commonly in older patients.

Causes

The cause is unknown, but granuloma annulare does not damage the general health, and is not infectious or due to allergies. Some types of granuloma annulare have been linked with diabetes, but this is very uncommon in the ordinary type.

There are a number of conditions that are associated with it. The following is a list:

  • Autoimmune disease
  • Cancer
  • Chemotherapy drugs that interfere with the immune system
  • Diabetes
  • Drug reaction – Studies indicates amlodipine as a cause. Amlodipine is used alone or in combination with other medications to treat high blood pressure and chest pain (angina). It is in a class of medications called calcium channel blockers. Allopurinol is another medicine that can rarely cause granuloma annulare. There may be other drugs that induce this skin condition that we may not be aware of yet and possible ones to look into in the future include Zocor, Fosamax, levoxyl and topiramate.
  • Giardia infection
  • Hepatitis B and C infection
  • Herpes Zoster
  • Immunosuppression
  • Leukemia and Lymphoma
  • Thyroid disease including autoimmune thyroiditis
  • Vaccination with tetanus, BCG,
  • Granuloma annulare skin lesions have developed in patients during anti-tumor necrosis factor (TNF) therapy.
  • SSRI antidepressants may be a rare cause

Symptoms

Granuloma annulare usually causes no other symptoms, but the rash may be slightly itchy.

Patients usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands, or feet. Occasionally, they may find a number of rings. Granuloma annulare occurs most frequently over the joints or in areas that experience mild injury. The most common locations for granuloma annulare include –

  • Backs of the hands and tops of the fingers
  • Tops of the feet
  • Around the elbows
  • Around the knees

The lesions of granuloma annulare are usually found in the same areas on both sides of the body (symmetrically).

Rarely, granuloma annulare may appear as a firm nodule under the skin of the arms or legs. In some cases, the rash may spread all over the body. Patients over the age of 40 may often experience more intense itching with widespread granuloma annulare.

The signs and symptoms of granuloma annulare can vary, depending on the variety –

  • Localized – This is the most common type of granuloma annulare. The lesion borders have a circular or semicircular shape, with a diameter up to 2 inches (5 centimeters). It occurs most commonly on the hands, feet, wrists and ankles of young adults, particularly women.
  • Generalized – Up to 15 percent of the people who have granuloma annulare have lesions over a large portion of their bodies — including the trunk, arms and legs. This variety is more likely to be itchy and most often affects adults.
  • Subcutaneous – Occurring predominantly in young children, this type of granuloma annulare produces a firm lump under the skin instead of a rash. The lump is usually less than 1.5 inches (3.8 centimeters) in diameter.

Treatment

  • Corticosteroid creams or ointments – Prescription-strength products may help improve the appearance of the lesions and speed their disappearance.
  • Corticosteroid injections – If the skin lesions are thicker and the symptoms are greater, the doctor may inject corticosteroids directly into the lesions to help them disappear faster.
  • Freezing the lesions – Applying liquid nitrogen to the affected area can help remove the lesions and stimulate the growth of new skin.
  • Light therapy – Exposing the lesions to particular types of light is sometimes helpful. Certain types of laser treatments also work for some people.
  • Oral medications – In severe cases, especially when the lesions are widespread, your doctor might prescribe drugs used to prevent immune system reactions in people who have rheumatoid arthritis or who have received an organ transplant.

Alternative Treatment

Reference –

http://www.medicinenet.com/image-collection/granuloma_annulare_picture/picture.htm

http://www.aafp.org/afp/2006/1115/p1729.pdf

http://www.dermis.net/dermisroot/en/38200/image.htm

http://emedicine.medscape.com/article/1123031-clinical#b4

http://www.siloamhospitals.com/diseases-and-conditions/granuloma-annulare

https://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID=85&ContentID=P00289

http://www.msdmanuals.com/home/skin-disorders/hypersensitivity-and-inflammatory-skin-disorders/granuloma-annulare

Posted in ALLERGIES
1 February 3, 2017

We eat to survive, and most of us enjoy eating. However, recent studies have found that almost 1 in 20 children and almost 1 in 25 adults are allergic to at least one food. Food allergies can range from being merely irritating to life threatening. As a result, it is a must for each and every person to become aware about food allergy.

What is Food Allergy?

Food Allergy is an abnormal response to a particular food, triggered by the body’s immune system. The immune system is responsible for identifying and destroying the invaders like bacteria and viruses of our body that can make us sick. A food allergy results when the immune system mistakenly targets a harmless food protein i.e. allergen as a threat and attacks it. Food allergy involves two aspects of the human immune response. One is the production of immunoglobulin E (IgE) – a type of a protein called antibody that circulates in the blood and the other is the mast cell – a type of cell that occurs in all body tissues but is specifically common in the areas of the body that are typical areas of allergic reactions like nose, lungs, throat, skin and gastrointestinal tract.

The binding of IgE to particular molecular present in a food triggers the immune response. The response may be mild, but at times it can cause severe life threatening reaction called anaphylaxis (explained further).

Allergic reaction occurs when the person who is predisposed to form IgE to certain foods, is exposed to that food. It is a process which includes two steps:

Step 1– The first time an individual is exposed to a food allergen; the immune system considers the food to be harmful and reacts accordingly by producing particular IgE antibodies to that allergen. These antibodies are circulated through the blood stream and gets attached to mast cells and basophils (basophils are found in the blood and also in the tissues that have become inflamed due t allergens)

Step 2– The next time that individual is exposed to the same food allergen; it binds to the IgE antibodies that are attached to the mast cells and basophils. This signals the cells to release massive amounts of chemicals such as Histamine – an organic nitrogenous compound that plays a key role in many allergic reactions, dilating blood vessels and making the vessel walls abnormally permeable. Depending on the tissue in which they are released, histamine will cause you to have various symptoms of food allergy.

Sometimes, a reaction to food is not a food allergy at all but another type of reaction called food intolerance. It is important to know the difference between these two. Some of the symptoms of food allergy and food intolerance are similar, but the differences between the two are very important. Food allergy reactions can be life threatening, so people with this type of allergy should be careful to avoid their food triggers.

Being allergic to food also results in being allergic to a similar protein found in something else. For instance, if an individual is allergic to birch tree pollen, a primary airborne allergen responsible for symptoms in the springtime, the reactions may get triggered by peach, apple, pear, kiwi, plum, coriander, fennel, parsley, celery, cherry and carrot. This type of food allergy is known as cross- reactivity. Cross reactivity occurs when the immune system thinks one protein is closely related to another.

Studies have suggested that eight kinds of food cause 90 percent of food allergies.

  • Milk
  • Eggs
  • Peanuts
  • Wheat
  • Fish
  • Soy
  • Nuts

Symptoms

An allergic reaction of food affects the skin, the respiratory tract, the gastrointestinal tract and in rare or severe cases, it may also affect the cardiovascular system. Its symptoms typically appear within minutes to several hours of eating the allergic food. It is very important to understand, that children may describe these symptoms in a different way.

Mild symptoms may include the following:

  • Tingling or itching in the mouth
  • Hives (reddish, swollen, itchy areas on the skin)
  • Nausea or vomiting
  • Eczema (a persistent dry, itchy rash)
  • Diarrhea
  • Nasal congestion or a runny nose
  • Redness of the skin and around the eyes
  • Slight dry cough
  • Sneezing
  • Stomach pain
  • Uterine contraction
  • Itchy ear

Severe symptoms may include the following:

  • Trouble swallowing
  • Turning blue
  • Chest pain
  • Drop in blood pressure
  • Wheezing or shortness of breath
  • Loss of consciousness
  • Sense of ‘impending down’
  • Obstructive swelling of lips, tongue and throat

Severe symptoms alone or in combination with milder symptoms, may be signs of severe or serious allergic reactions.

  • Anaphylaxis

Anaphylaxis is a medical emergency. It includes a wide range of symptoms that occurs in many combinations. These symptoms are not life threatening, but the most severe restrict breathing and blood circulation. Many different body parts are affected like –

  • Skin – Itching, redness, swelling
  • Nose – sneezing, stuffy nose, runny nose
  • Throat – Itching, tightness, difficulty in swallowing, hoarseness
  • Mouth – Itching, swelling of lips or tongue
  • Heart – Weak pulse, passing out, shock
  • Nervous System – Dizziness or fainting
  • Chest – Shortness of breath, cough, wheeze, chest pain , tightness

Symptoms may begin within several minutes to several hours after exposure to the food. Anaphylaxis caused by an allergic reaction to a certain food is highly unpredictable. The severity of a given attack does not predict the severity of subsequent attacks. The response will vary depending on several factors, such as:

  • Sensitivity to the food
  • How much of the food an individual is exposed to
  • How the food is entered into the body

Any anaphylaxis reaction may result in becoming dangerous and should be evaluated as soon as possible. Food allergy is the leading cause of anaphylaxis. However, medications, insect stings, and latex can also cause an allergic reaction that leads to anaphylaxis.

  • Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis (EoE) is a recently recognized chronic disease that can be associated with food allergies. It is increasingly being diagnosed in children and adults. Symptoms of EoE include nausea, vomiting, and abdominal pain after eating. A person may also have symptoms that resemble acid reflux from the stomach. In older children and adults, it can cause more severe symptoms, such as difficulty swallowing solid food or solid food sticking in the esophagus for more than a few minutes. In infants, this disease may be associated with failure to thrive. If you are diagnosed with EoE, you will probably be tested for allergies. In some situations, avoiding certain food allergens will be an effective treatment for EoE.

 

Types of Food Allergies

There are two categories of food allergies namely:

  • Immunoglobulin E (IgE) mediated– Symptoms result from the body’s immune system making antibodies called Immunoglobulin E (IgE) antibodies. These IgE antibodies react with a certain food.
  • Non-IgE mediated– Other parts of the body’s immune system react to a certain food. This reaction causes symptoms, but does not involve an IgE antibody. Someone can have both IgE mediated and non-IgE mediated food allergies

 

  • Cross Reactivity or Oral Allergy Syndrome

Some people who have allergies to pollens, such as ragweed and grasses, may also be allergic to some foods. Proteins in the pollens are like the proteins in some fruits and vegetables. So, if your child is allergic to ragweed, he or she may have an allergic reaction to melons and bananas. That’s because the protein in ragweed looks like the proteins in melons and bananas. This condition is oral allergy syndrome.

Symptoms of an oral allergy syndrome include an itchy mouth, throat or tongue. Symptoms can be more severe and may include hives, shortness of breath and vomiting. Reactions usually occur only when someone eats raw food. In rare cases, reactions can be life-threatening and need epinephrine.

 

  • Cross Reactivity or Oral Allergy Syndrome

Some people who have allergies to pollens, such as ragweed and grasses, may also be allergic to some foods. Proteins in the pollens are like the proteins in some fruits and vegetables. So, if your child is allergic to ragweed, he or she may have an allergic reaction to melons and bananas. That’s because the protein in ragweed looks like the proteins in melons and bananas. This condition is oral allergy syndrome. Symptoms of an oral allergy syndrome include an itchy mouth, throat or tongue. Symptoms can be more severe and may include hives, shortness of breath and vomiting. Reactions usually occur only when someone eats raw food. In rare cases, reactions can be life-threatening and need epinephrine.

 

  • Allergic Proctocolitis

Allergic proctocolitis is an allergy to formula or breast milk. This condition inflames the lower part of the intestine. It affects infants in their first year of life and usually ends by age 1 year.

The symptoms include blood-streaked, watery and mucus-filled stools. Infants may also develop green stools, diarrhea, vomiting, anemia (low blood count) and fussiness. When properly diagnosed, symptoms resolve once the offending food(s) are removed from the diet.

 

  • Mixed reaction

Some children may have a mixed reaction where they experience both “IgE” symptoms, such as swelling, and “non-IgE” symptoms, such as constipation.

This often happens to children who have a milk allergy.

 

  • Exercise-induced food allergy

Sometimes a food allergy can be triggered after eating a certain food and then exercising vigorously. This can lead to anaphylaxis in severe cases, at times known as food-dependent exercise-induced anaphylaxis.

 

Food and its allergies

 

  • Casein

If a glass of milk causes significant symptoms like swollen lips, hives etc, you may have an allergy to casein – a protein in milk. Most dairy products contain casein, but not all. Since casein is a protein, it is found in dairy products that have higher protein content, such as milk, yogurt, kefir, cheese and ice cream. Dairy products that contain barely any protein, such as butter and cream, only have traces of casein. Casein is in a family of phosphoproteins that make up 80% of the proteins in cow’s milk. In fact, casein is found in all mammalian milk in varying quantities, including human milk, where it constitutes 25-45% of proteins. It is a complete protein that supplies all the essential amino acids – those that can’t be synthesized naturally by the body. It is also associated to gluten.

 

Symptoms of Casein Allergy:

 

  • Swelling of the lips, mouth, tongue, face, or throat
  • Skin reactions such as hives, a rash, or red, itchy skin
  • Nasal congestion, sneezing, runny nose, itchy eyes, coughing, or wheezing
  • Anaphylaxis (in rare cases)
  • Wheat Allergy

Wheat is the major component of our daily diet. It is more common amongst children and is usually outgrown before reaching adulthood. Symptoms of wheat allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis.

An allergic reaction to wheat involves IgE (immunoglobulin) antibodies to at least one of the following proteins found in wheat:

  • Albumin
  • Globulin
  • Gliadin
  • Glutenin (gluten).

The most common allergic reactions involve albumin and globulin. Allergy to gliadin and gluten are less common. Gluten allergy is often confused with Celiac disease.

The most common symptoms of wheat allergy are:

  • Mouth irritation and possible swelling
  • Nausea
  • Throat irritation and possible swelling
  • Urticaria – hives, an itchy rash (possible swelling of the skin)
  • Vomiting
  • Watery and/or itchy eyes
  • Bloated stomach
  • Allergic rhinitis– nasal congestion
  • Anaphylaxis
  • Asthma
  • Atopic dermatitis (eczema)
  • Diarrhea

 

  • Gluten Allergy

 

A gluten allergy – not to be confused with gluten sensitivity or celiac disuse, is caused by an allergic reaction to a gluten protein. It is caused by gliadin, a glycoprotein that along with glutenin – a wheat protein, forms gluten. It is found in wheat and other related grains such as barley, oats, and rye. Gliadin is also one of the major allergens associated with wheat allergies and a trigger for celiac disease, a serious autoimmune disorder of the small intestine.

 

Symptoms

  • Troubled breathing
  • Ulcers in the mouth
  • Asthma
  • Depression
  • Weight Loss
  • Rash
  • Swollen lips
  • Anaphylaxis (in rare cases)

 

  • Soy Allergy

Soy allergy is a common food allergy especially among children. Allergic reactions to soy are typically mild; however, although rare, severe reactions can occur. Soybeans are a member of the legume family, which include plant species that bear seed pods that split upon ripening. Some examples of other legumes include beans, peas, lentils and peanut. People with a soy allergy are not necessarily allergic to other legumes.

Fish Allergy

Salmon, tuna and halibut are the most common kinds of finned fish to which people are allergic. More than half of all people who are allergic to one type of fish also are allergic to other fish, so allergists often advise their fish-allergic patients to avoid all fish.

A fish allergy can cause a very serious reaction, even if a previous reaction was mild. A child who has a fish allergy must completely avoid eating fish. Sometimes an allergist can test for allergies to specific types of fish, but until the culprits are known, it’s best for someone with a fish allergy to avoid all fish.

The pattern of symptoms following ingestion of fish and seafood is similar to that reported for other foods, including, nausea, sickness, diarrhea, abdominal cramps, wheezing, rhinitis, flushing, urticarial rashes and dramatic swelling.

Finned fish and shellfish do not come from related families of foods, so being allergic to one does not necessarily mean that you must avoid both.

 

  • Egg Allergy

Eggs are everywhere, not only are they served for breakfast, but they’re also in all sorts of foods — from muffins to meatloaf. But the question is what if you were allergic to eggs?

Egg allergy develops when the body’s immune system becomes sensitized and overreacts to the proteins available in the egg white and yolks. It is estimated that about 2 percent of children are allergic to eggs, although about 70 percent of these children may outgrow the condition by age 16.

Children who are allergic to eggs can have reactions ranging from a mild rash to anaphylaxis, a life-threatening condition that impairs breathing and can send the body into shock.

 

  • Tree nuts Allergy

Tree nut allergy is the second most common allergy in infants and young children. Approximately 0.4- 0.5% of American children have a tree nut allergy. Tree nuts are a common allergen reported to cause fatal and near-fatal allergic reactions. Tree nuts can cause a severe, potentially fatal allergic reaction. Tree nuts include, but are not limited to, walnut, almond, hazelnut, cashew, pistachio, and Brazil nuts. These are not to be confused or grouped together with peanut, which is a legume, or seeds, such as sunflower or sesame.

 

  • Peanuts Allergy

Peanut allergy is one of the most common food allergies. Peanuts can cause a severe, potentially fatal, allergic reaction (anaphylaxis). Allergy to peanuts appears to be on the rise in children. According to a certain study, the number of children in the U.S. with peanut allergy more than tripled between 1997 and 2008.

Peanut allergies tend to be life long, although studies indicate that approximately 20 percent of children with peanut allergy do eventually outgrow their allergy. Younger siblings of children allergic to peanuts may be at increased risk for allergy to peanuts.

 

  • Other Allergies

 

While the above allergies account 90 percent of all food allergic reactions, a person can be allergic to any food.

The list below is of foods of which allergic reactions have been reported too:

  • Corn
  • Gelatin
  • Meat (beef, chicken, mutton, and pork)
  • Seeds (sesame, sunflower, and poppy being the most common)
  • Spices (caraway, coriander, garlic, mustard, etc.)

Diagnosis

The first step to diagnose a food allergy is by the study of a thorough medical history of the patient. Later, the allergist may conduct the following tests:

  • Skin Prick Test

Food allergy symptoms are caused by the interaction between a food allergen and IgE. The Skin Prick test is one of the tests to diagnose it.

During the test, a drop of solution containing the allergen is placed on the forearm. When the test is of fruits and vegetables, fresh food is used instead of the solution. A small plastic probe or needle is used to prick or scratch the skin and a tiny amount of solution is allowed to enter just below the surface. This type of test is not painful and there is no bleeding. The test results usually appear in 30 minutes.

 

  • Blood Test

Blood test is used to measure the presence of IgE antibodies to specific foods. With the skin test, the results are immediate, but with the blood tests, the results may take several days to arrive. Unlike the skin prick test, the blood test is not affected by antihistamines and can be performed for people with extensive rashes that prevent using skin tests.

 

  • Oral Food Challenge

At times, even after performing skin prick and blood tests, an allergist is unable to arrive at a definitive diagnosis. In this case, you may be asked to undergo an oral food challenge (OFC), a highly accurate diagnostic test for food allergy. OFC has the potential to cause serious reaction; hence, it is performed by experienced allergists.

During this test, the patients are given the suspect food in measured doses, starting with small amount that may not trigger any symptom. Following each dose, the patient is observed for any signs of a reaction. If there is no symptom, the patient will be given increasingly larger doses.

OFC includes the following:

  • Double-Blind, Placebo-Controlled Food Challenge (DBPCFC) – For example, if a patient is being tested for milk allergy, he/she may eat a piece of hamburger that contains milk powder, or a look-alike that has no milk in it. This process ensures that the test results are objective. Neither the patient’s anxiety nor the allergist’s preconceptions can influence the outcome.
  • Single-Blind Food Challenge – In this test, the allergist knows if the patient is receiving the allergen, but the patient don’t.
  • Open Food Challenge – Both the doctor and the patient know whether and not the patient is receiving an allergen. This type of challenge is most often done when a patient’s nervousness is unlikely to affect the results.

 

  • Food Elimination Diet

The elimination diet generally lasts two to four weeks. During this period, the patient will avoid the suspect foods while the doctor monitors the symptoms. If one or more of these foods is causing an allergy, the symptoms should disappear by the end of this period. In some cases, the doctor may add another step, gradually reintroducing a problem food to the diet. If the symptoms return, it is likely that the patient is allergic to that food.

Treatment

Food allergies are often treated from several directions at the same time, such as eliminating allergens, strengthening the patient nutritionally, and modifying the patient’s immune response. The most important part of your treatment YOU will do, not your doctor. Food allergy is a very individual problem, and you know your body better than anyone else does. It may be difficult to take action because of your health, but if you want to get well, YOU must take responsibility for yourself.

  • Medication – The choice of medication depends upon the severity of the reaction. These medications are for controlling the allergy and not for curing it.
    • Antihistamines

Antihistamines are one of the best known allergy medications, and most of them are easily available at a pharmacy without prescription. They work well to relieve symptoms of different types of allergies.

Antihistamines are of different types, including tablets, capsules, liquids, nasal sprays and eye drops. Below are some of the antihistamines available:

  • Astelin, Astepro (azelastine) nasal sprays
  • Atarax, Vistaril (hydroxyzine)
  • Clarinex (desloratadine)
  • Cyproheptadine (generic only)
  • Emadine (emadastine) eye drops
  • Livostin (levocabastine) eye drops
  • Optivar (azelastine) eye drops
  • Palgic (carbinoxamine)
  • Xyzal (levocetirizine)
  • Mast Cell Stabilizers

Mast cell stabilizers are used to block the release of immune system chemicals that contribute to the allergic reactions. These drugs are safe, but usually need to be used for several days to reach full effect.

  • Cromolyn (Nasal spray and eye drop)
  • Lodoxamide
  • Pemirolast
  • Nedocromil
  • Decongestants

Decongestants are used for quick, temporary relief of nasal and sinus congestion. They can cause insomnia, headache, increased blood pressure and irritability. They are not recommended for women who are pregnant or for people with high blood pressure, cardiovascular disease, glaucoma or hyperthyroidism.

For example: pseudoephedrine- Sudafed, Afrinol, others, Cetirizine (Zyrtec-D), Desloratadine (Clarinex-D), Fexofenadine (Allegra-D), Loratadine

 

  • Corticosteroids

The steroids used for the treatment of allergies are corticosteroids, and are almost identical to the natural hormone, cortisol, which is produced by the body’s adrenal glands. But with any medication, it is important to follow the dosage, as prescribed by a health practitioner, as over-use of any medication can be harmful.

For example:

  • Budesonide (Rhinocort Aqua)
  • Fluticasone furoate (Veramyst)
  • Fluticasone propionate (Flonase)
  • Mometasone (Nasonex)
  • Triamcinolone (Nasacort Allergy 24 Hour)
  • Adreneline

The use of adrenaline (epinephrine) as an emergency allergy treatment is well understood by doctors, and it has saved many lives. It is used to treat anaphylactic shock, where the sudden, high levels of histamine and other substances released during an allergic reaction cause the patient to have difficulty breathing, and can also cause loss of consciousness. Research has shown that the sooner adrenaline is given once an anaphylactic reaction has started, the better the health outcome for the patient. This makes rapid treatment of anaphylaxis possible, rather than having to wait for ambulances carrying the medication to arrive.

 

  • Antibiotics

The symptoms of some allergic conditions can increase the likelihood of localized infections. In particular, irritated skin caused by eczema can be vulnerable to infection, as can the nasal sinuses of people who suffer from hay fever or perennial rhinitis. For this reason it is important that infections are diagnosed and treated as soon as possible.

 

  • Anti-leukotrienes

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

  • Anti-IgE drugs

The IgE antibodies are the most common cause of the immune system reacting to an allergen and initiating an allergic response. New anti-IgE drugs are being developed, which aim to take the IgE antibodies out of circulation. A number of studies have been conducted using anti-IgE drugs as an add-on treatment for people with severe allergic asthma. They showed that the anti-IgE medication could allow some people to reduce, and even stop, their inhaled steroid treatments.

 

  • Calcineurin inhibitors

Calcineurin inhibitors are a new treatment, currently available as two creams – Tacrolimus and Pimecrolimus (also known as Protopic and Elidel) – for use on children over the age of two. They work by reducing the sensitivity of the immune system when the skin comes into contact with an allergen.

 

Alternative Treatments

Allergens are often associated with weak adrenal, immune and digestive functions. Alternative treatments help to support and improve these functions and also help in alleviating the symptoms. Following are some:

 

  • Nutritional Treatment

 

Alterations and changes in the nutritional intake help in reducing the allergic symptoms. The diet should contain, a moderately low-fat, high complex carbohydrates. Drinking ½ of body weight in ounces of water daily is must.

Following should be included:

  • Dark green leafy vegetables
  • Nettles, bamboo shoots, cabbage, beet tops, beets, carrots, yams
  • Onions, garlic, ginger, cayenne, horseradish
  • Deep yellow and orange vegetables

 

Following should be eliminated

  • Foods causing allergies
  • Citrus fruit
  • Alcohol, caffeine and dairy products
  • Food coloring (tartrazine)
  • Sugar
  • Wheat

 

  • Supplements, Vitamins and Minerals

 

  • Flaxseed oil
  • Probiotics (e.g., lactobacillus acidophilus and bifidus) -. Probiotics are bowel microflora organisms—microscopic bacteria that normally inhabit the intestines.
  • Multivitamin
  • Bioflavonoids (e.g., quercetin, catechin, hesperidin) – When symptoms are severe, take up to 6 grams. Bioflavonoids are natural antihistamines and strongly anti-allergenic. Bromelain and vitamin C can enhance the action of bioflavonoids.
  • Vitamin A
  • Vitamin C – Bioflavonoids are natural antihistamines and strongly anti-allergenic. Bromelain and vitamin C can enhance the action of bioflavonoids.
  • Vitamin E
  • Zinc

 

  • Herbal Medicine

 

Many plants have therapeutic properties and one only has to remember that digoxin comes from the Foxglove, salicin from the bark of the Willow tree and opiates from the glorious Poppy. Herbal remedies such as the Ma Huang plant (Ephedra sinica) which contains ephedrine has been used to treat asthma for 5000 years but there is very little evidence that herbal medicines in general confer any major benefit. In some cases they may even be hepatotoxic. One recently noted exception is the use of traditional Chinese herbal tea in the treatment of atopic eczema. Ling zhi (Reishi Mushroom) is another eastern herbal preparation with steroid like properties used to treat allergies. Butterbur has been advocated in hay fever.

 

  • Homeopathy
    • Allium cepa – for bland, non-irritating discharge from eyes; copious, watery, acrid discharge from nose; hoarseness; and feeling better in cool air and open room.
    • Euphrasia – for symptoms such as copious, watery, acrid discharge from eyes; non-irritating discharge from nose; dry, hard cough; much sneezing; diarrhea; and feeling worse in open air.
    • Natrum muriaticum – for watery or egg white-like discharges; cold sores; no sense of taste or smell; headaches; and feeling better outside.
    • Nux vomica – for runny nose in daytime, then dry nose at night; violent sneezing; nose feels blocked but there is watery nasal discharge through one nostril; and feeling worse outside.
    • Wyethia – for extreme itching in the nose and throat; throat feels swollen; back of throat is dry and burning; and sensation as if something were in nasal passages.

 

  • Acupuncture

Acupuncture is an ancient Chinese form of treatment that involves inserting tiny needles into specific meridians or areas of the body. It has been found to be particularly useful for pain relief and the practice has grown remarkably in recent years. Claims that the use of acupuncture is useful in treating allergies in general are not based on well-performed clinical trials.

 

 

This article has successfully proved that ‘allergy’ is more than just a runny nose; it can be the reason for lot of problems and symptoms. At our center we have successfully identified the cause of chronic disease and disorders through comprehensive diagnostic evaluation, utilizing allergy and sensitivity testing as needed. We believe in helping the patients return home in good health….

 

Bibliography

Food Allergyhttp://www.medicinenet.com/food_allergy/article.htm

Living with the Allergies: http://www.nhs.uk/Livewell/Allergies/Pages/Allergieshome.aspx

Diseases and Conditions: ]http://www.mayoclinic.org/diseases-conditions/food-allergy/basics/definition/con-20019293

Common Food Allergies: http://www.healthline.com/health/allergies/common-food-allergies#Overview1

Is Non-Celiac Gluten Sensitivity a Real Thing?\ http://www.healthline.com/health-news/is-non-celiac-gluten-sensitivity-a-real-thing-041615

All Food Allergies: http://www.singleswithfoodallergies.com/

Posted in ALLERGIES
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