Patient Education

What is allergic rhinitis?

Asthma is caused by narrow and inflamed airways in the lungs which makes it difficult to breathe. Symptoms of asthma include shortness of breath, cough, wheeze and chest tightness. There are many different triggers of asthma including cigarette smoke, exercise, cold air, irritants, viruses, medications, pollens, cat, dog, mold and stress. Your asthma symptoms can be intermittent or persistent.

Often allergic rhinitis and allergic conjunctivitis go together, and this results in a condition called allergic rhinoconjunctivitis. Frequent symptoms include runny nose, stuffy nose, itchy nose and palate, and sneezing. Often this may lead to symptoms like bloody noses, headache, sinus congestion, postnasal drip and cough.

Allergic rhinitis may be seasonal or perennial (year round). Seasonal allergic rhinitis can mean a predominance of symptoms in any season, but the one we encounter most is springtime allergies, when the grasses and trees start pollinating. The culprits in seasonal allergic rhinitis are usually wind borne pollens, which are light and stay afloat in the breathing zone for miles and miles.

Perennial allergic rhinitis usually refers to allergens in which people are in contact with all year long, such as dust mite and animal danders. The most common animals that affect people with allergies are cat and dog, mostly because these are the most common pets. However, other furry animals such as rabbits, hamsters, rats and mice can also cause allergies. Some of these are household pets, while others may be unwelcome guests.

Allergic rhinoconjunctivitis is generally treated with nasal sprays and oral antihistamines, although avoidance (when possible), and allergy shots may be indicated as well. Allergy shots provide the only way to change the immune system to render an individual “less allergic”. While this is generally not a permanent change, the benefits can persist for many years, even after shots are stopped.

What is asthma?

Asthma is caused by narrow and inflamed airways in the lungs which makes it difficult to breathe. Symptoms of asthma include shortness of breath, cough, wheeze and chest tightness. There are many different triggers of asthma including cigarette smoke, exercise, cold air, irritants, viruses, medications, pollens, cat, dog, mold and stress. Your asthma symptoms can be intermittent or persistent.

To evaluate for asthma your doctor may perform a breathing test called spirometry. If you have possible allergic asthma, your doctor will recommend performing skin testing to enviromental allergens. The skin testing will take about 15-20 minutes and involves placing a small drop of allergen on the surface of the skin: the testing is usually performed on the forearm or back If you have redness and swelling at the test site(s), that allergen(s) may be triggering your asthma.

If you have allergic asthma, your doctor may recommend allergy shots. Once you reach a maintenance dose, you will receive monthly allergy shots for a course of 3-5 years. Allergy shots modify your immune system to produce a decreased sensitivity to the allergens which are triggering your asthma. Allergy shots carry a small risk of anaphylaxis or severe allergic reaction.

If you have symptoms consistent with asthma, your doctor may prescribe asthma medications. Asthma medications help decrease asthma symptoms, improve lung function and prevent asthma attacks. There are 2 types of inhalers. Albuterol is a quick-acting, rescue inhaler and used for symptomatic relief. These rescue inhalers work within 5-15 minutes and may cause you to feel shaky. If your asthma symptoms are more severe, your doctor may prescribe you a long-term controller inhaler. This daily maintenance inhaler will help prevent asthma attacks.

Your doctor will discuss with you about avoiding your asthma triggers. You should get an annual influenza vaccination.

What is food allergy?

Food allergy is a reaction to a certain food(s) which often occurs within minutes to 1-2 hours of ingesting that particular food. Symptoms may include itching, hives, shortness of breath, cough, sweling of the throat and/or abdominal symptoms. If severe and left untreated, food allergy can cause death. Symptoms and severity can differ between individuals and episodes.

The most common food allergens are milk, egg, wheat, soy, fish, shellfish, treenuts and peanuts. Allergy to milk and egg are often “outgrown,” whereas allergy to seafood and peanut tend to be lifelong.

To test for food allergy, your doctor may perfom skin testing and/or blood testing. The skin testing will take about 15-20 minutes and involves placing a small drop of food allergen on the surface of the skin: the testing is usually performed on the forearm or back If you have redness and swelling at the test site you may be allergic to that food.

An oral food challenge may be recommended to confirm or rule out a suspected food allergy in selected patients, determine if a patient has outgrown their food allergy or determine whether food allergens associated with chronic conditions such as atopic dermatitis or allergic eosinophilic esophagitis will cause immediate reactions. A food challenge consists of ingestion of increasing amounts of the suspected food under doctor supervision.

If you have a food allergy, complete avoidance to that food and other foods with cross reactivity is recommended. Your doctor will discuss with you about the importance of reading food labels, certain foods that may contain the specific food, and importance of vigiliance when eating out at restaurants.

You will also be prescribed an Epi-Pen to use in case of severe allergic reaction or anaphylaxis. You should carry the Epi-Pen autoinjector with you at all times.

What is atopic dermatitis (eczema)?

Atopic dermatitis is a rash that is red, scaly, and itchy with possible crusting or blister formation. It is a chronic skin condition that is due to a defective protein in the skin barrier. There will be times when your skin worsens or has a flare-up.

Atopic dermatitis commonly affects children and often improves or even clears by adulthood. There is no cure for atopic dermatitis. It requires daily care to eliminate worsening factors, repair the skin barrier and moisturization of skin. Things that can worsen eczema include excessive bathing, overheating, low humidity and exposure to skin irritants.

To determine whether food allergens are associated with your eczema, your doctor may perfom skin testing and/or blood testing. The skin testing will take about 15-20 minutes and involves placing a small drop of food allergen on the surface of the skin: the testing is usually performed on the forearm or back.

Management of eczema include maintaining skin moisturization—your doctor will recommend thick creams or ointments such as Eucerin, Cetaphil, Vanicream, Vaseline. These creams should be applied at least twice daily after bathing.

It is also helpful to control the itch with possible antihistamines, lukewarm baths and wet dressings to keep the skin moist. Your doctor may prescribe topical steroids. If you have atopic dermatitis, you are at increased risk of skin infections. If you notice any worsening of your eczema, weeping of the skin, drainage or vesicles, notify your doctor. For secondary infections, your doctor may prescribe antibiotics and/or bleach baths. If you continue to have severe symptoms, you may be started on medications that lower your immune system or UV light therapy.

What is allergic contact dermatitis?

Allergic contact dermatitis is a rash that is dry, scaly, red, itchy and can sometimes cause thickening of the skin. In most cases, the rash is delayed and only at the site of contact such as your hands, face or eyelids.

The most common agents that cause allergic contact dermatitis include latex materials, protective equipment, soap and cleansers, resins and acrylics. Other allergens include metals, fragrances, topical antibiotics, preservatives, chemicals used in hair-care products, topical steroids, glues, plastics and rubber. Many people may react to nickel or from contact with poison ivy, oak and sumac.

Workers at highest risk of allergic contact dermatitis include healthcare professionals, chemical industry workers, beauticians and hairdressers, machinists and construction workers.

To evaluate for allergic contact dermatitis, patch testing may be recommended. Patch testing involves the application of test allergens to the skin of your upper back for 2 days. The initial reading of results is done shortly after the allergens are removed whereas the second reading is often done on day 4 or 5.

Treatment for allergic contact dermatitis include avoidance of allergen and using alternative products. If you have a nickel allergy, you should avoid nickel containing jewelry, buttons and zippers. Coating a nickel object with nail polish or using duct tape can be helpful. Treatment for allergic contact dermatitis also includes skin protection with both over-the counter and prescription creams.

What is chronic urticaria (hives) and angioedema?

Chronic urticaria is an episodic rash which lasts for 6 weeks or longer. The rash is red, raised, itchy and may be round and/or variable in size. Angioedema is similar to hives but involves swelling of the deeper tissues and often involves the lips, cheek, face, extremities.

Most of the time, there is no allergic cause for the rash. It is often NOT due to environmental, food or drug allergy. Chronic urticaria is associated with autoimmune disorders such as thyroid disease, rheumatoid arthritis.

Hives are more common in women, often between the ages of 30-50. The average duration of hive is 2-5 years, with most resolving within a year.

If possible, avoid heat, hot showers, tight clothing, alcohol, anti-inflammatory medications such as aspirin, ibuprofen—all of these may worsen hives.

To diagnose chronic urticaria, it is often NOT necessary to perform any allergy testing or to order blood work.

To treat your hives and/or angioedema, your doctor will first recommend anti-histamines. These medications may cause you to feel drowsy.

If your symptoms are not controlled with antihistamines, your doctor may recommend an allergy shot called Omalizumab or medications that suppress your immune system.

What is penicillin allergy?

Penicillin and penicillin-related antibiotics are often more effective, less toxic and more effective than other antibiotics. Allergy to penicillin and penicillin-related antibiotics such as Augmentin is the most commonly reported drug allergy in the US.

If you have a history of allergy to penicillin, most likely you have outgrown that allergy. In fact, more than 85% of people who believe they are penicillin “allergic” are found to be skin test negative which means they are not allergic to penicillin. Approximately 97% of patients with negative skin tests can tolerate penicillin and Augmentin without developing a serious, allergic reaction.

For evaluation of a possible penicillin allergy, your doctor will perform skin testing. It will involve “prick” skin testing and “intradermal” skin testing. “Prick” skin testing involves placing a small drop of penicillin on the surface of the skin and the testing is usually performed on the forearm. If you have redness and swelling at the test site you may be allergic to penicillin. If the “prick” skin testing is negative, your allergist may perform “intradermal” skin testing which in performed by injecting a small amount of penicillin just underneath the surface of the skin, usually along the side of the arm. The “prick” skin testing and “intradermal” skin testing each take about 15-20 minutes.

If your skin testing to both the “prick” and “intradermal” are negative, your doctor may proceed with an oral challenge to amoxicillin. If you do not develop any reactions during the oral challenge, you may no longer have a penicillin allergy.

What is latex allergy?

Latex allergy is caused by proteins in latex from the commercial rubber tree, Hevea brasiliensis.

If you have a latex allergy, there can be cross-reactivity between latex, fruit and pollens. Symptoms can include itchy mouth or throat with banana, kiwi, avocado, chestnut, papaya, potato, tomato.

You can be at increased risk of having a latex allergy if you work in the healthcare community, have had multiple surgeries, or work in occupations in which latex gloves are commonly used.

The most common symptoms of latex allergy include dry, crusted and irritated skin which is called irritant contact dermatitis. Other symptoms include hives, watery, itchy eyes, asthma or anaphylaxis (life-threatening allergic reaction).

To evaluate for possible latex allergy, your doctor will take a detailed clinical history and may obtain blood work.

If you are diagnosed with latex allergy, management strategies include avoidance. Potential sources of latex include gloves, balloons, condoms, adhesives, pacifiers, golf and tennis racquet grips, rubber cement, blood pressure cuffs, orthodontic products.

If you have a latex allergy, you should wear a medical alert bracelet indicating latex allergy, be prescribed and carry an Epi-Pen and carry nonlatex gloves. You should report your allergy prior to any medical, dental, gynecological, or surgical procedure and request a latex-safe environment.

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