Allergy and Asthma Source

From the American Academy of Allergy, Asthma, and Immunology patient tips:
Atopic dermatitis/eczema
Also see: Allergic Contact Dermatitis
A common allergic reaction often affecting the face, elbows and knees is atopic dermatitis, also known as eczema. This red, scaly, itchy rash is usually seen in young infants, but can occur later in life in individuals with personal or family histories of atopy, meaning asthma or allergic rhinitis (”hay fever”). Eczema may at times ooze, or at times may look very dry. A physician will rarely have difficulty diagnosing atopic dermatitis, based on three factors: an 1) itchy, 2) “eczematous” or bubbly rash in an 3) atopic individual. If one of these three features is missing, your physician should consider other causes.

Identifying the cause of the itch is essential in managing symptoms. Common triggers include overheating or sweating, and contact with irritants such as wool, pets or soaps. In older individuals, emotional stress can cause a flare-up. For some patients, usually children, food can also trigger eczema. Secondary staph infections also can cause a flare-up in children. These patients usually have very dry skin and “allergic shiners”-an extra crease, called a Dennie’s line, across their lower eyelids. They are also more susceptible to other skin infections.

Preventing the eczema itch is the primary goal of treatment. The patient must stop scratching and rubbing the rash. Applying cold compresses is helpful, and lubricating the dry skin with cream or ointment, especially during dry seasons, is essential. Patients should remove all “irritants” that aggravate the condition from their environments. If a food is identified as the culprit, it must be eliminated from the diet.

Topical corticosteroid cream medications are most effective in treating the rash once all preventative measures are taken. Rarely, antihistamines or oral corticosteroids are also prescribed, and if a secondary infection has been introduced by scratching, antibiotics are required.

When to see an allergy/asthma specialist
Whenever you have an unusual rash, make sure to contact your allergist, who will work with you to determine its cause-whether allergies, irritants, or another trigger. Most importantly, your physician and other health care providers can offer a support system and assist you in managing your skin condition.

The AAAAI’s How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:

Need to confirm the diagnosis of atopic dermatitis or contact dermatitis in a patient with dermatitis.
Need to identify the origin of contact dermatitis.
Have atopic dermatitis that responds poorly to treatment.
Need to identify the role of mite allergy in patients with atopic dermatitis.
Need to identify the role of food allergy in patients with atopic dermatitis.

Your allergist/immunologist can provide you with more information on allergic skin conditions.

Links:

Key Therapy Points for Patients with Atopic Dermatitis/ Eczema
Allergy and Asthma Consultants of Rockland and Bergen

I found this shocking video on YouTube. It is a tragic example of what happens when a child is misdiagnosed and the family is given a diagnosis of “Multiple Chemical Sensitivity”.   

From the video, I seriously doubt that this child is being treated by a board certified Allergist- Immunologist. Her treatment (sub-lingual drops for food allergy???) is definitely not a scientifically proven therapy.  The insurance company is absolutely right.  ($2500 a month? Who are they kidding?)

  It also does not speak well of Fox News’ fact checking department.  A phone call to any trained allergist would have revealed to them that this child’s treatment is bogus.

Also see Multiple Chemical Sensitivity and Food Allergy pages

June 2007 UPDATE: Thanks to Orac and “Respectful Insolence”, we have an insight into Dr. Patel’s finances and the income she has acquired through her practice($30M, dang! there’s gold in them thar neutralizing enzymes!)

LINKS:
Multiple Chemical Sensitivity Syndrome Has Strong Psychological Component

AAAAI video 

Diagnosis or determining whether someone is suffering from allergies or not, begins with the history. The physician or health care provider is interested in knowing the pattern of the symptoms and their relation to any possible allergen exposures. For example in the case of allergic rhinitis one would ask:

• Do you sneeze or get itchy nose/ eyes during a specific season or all year round?
• Is it worse at night or during the day?
• Indoors or outdoors?
• With exposure to pets or other animals?

Tests are performed when the history points to a possible allergic reaction to a specific allergen. Skin tests and RadioAllergoSorbent blood Tests (RAST) are performed to determine the presence or measure the level of the allergic antibody, IgE, to the allergen.

It should be stressed that a positive allergy test alone does not make the diagnosis of an allergic reaction. The results of the test must be correlated with the patient’s history.

1. Skin tests the most commonly used form of allergy testing. In this test, an extract of the allergen is placed on the skin, then a superficial puncture or scratch is made at the site allowing contact between the deeper layer of the skin and the allergen.If a person is allergic to that particular allergen, an itchy wheal with surrounding redness will form within 15 minutes. If this “scratch” or epicutaneous test is negative, in the case of airborne or medication allergies, the patient may then go on to get small doses of the allergen injected under the skin, called “intradermal” skin testing. The intradermal test is not recommended for food allergens.
2. Blood Test or RAST- measures the levels of the allergic antibody IgE in the blood to specific allergens. This test is not as sensitive as the skin test, but is used if a skin test can not be performed because the patient is taking antihistamines, has a rash covering his body, or if he or she had a severe allergic reaction (anaphylaxis) to the suspected allergen.
3. Challenge Test- In the case of food or medications, even if a person has a negative skin test or blood test, there is still a chance that a person may still have an allergic reaction to the suspected allergen.In this case, challenge tests are performed where the person is given small, increasing doses of the suspected food or medication at regular intervals and under close monitoring to determine if he or she develops any signs or symptoms of an allergic reaction. These tests may be open or blinded where the person and/or the physician may or may not know whether the patient is getting the actual allergen or a placebo to avoid bias.

Otitis media with effusion (OME) refers to fluid in the middle ear space without the symptoms of an acute ear infection like fever or redness of the ear drum. Fluid builds up when the Eustachian tube, which connects the inner ear to the back of the throat and drains secretions, gets blocked by inflammation from respiratory infections, allergies, or environmental irritants like cigarette smoke. It usually affects younger children. Treatment may consist of observation, antibiotics, hearing tests, and ear tube placement depending on how long the ear effusion has been present.

A new study released by the Cochrane Database reviewed the use of antihistamines and decongestants and found no benefit of these medications in the treatment of OME and does not recommend their use.

However, the study did not differentiate between allergic and non-allergic OME patients. Up to 40% of OME have an allergic component and numerous studies have shown improvement in OME patients with allergic rhinitis with use of antihistamines and other allergy medications, avoidance of allergy triggers, and allergen immunotherapy in resolving and preventing recurrent OME episodes.

The bottom line is: One size does not fit all. While antihistamines and decongestants may not work for OME patients without allergies, they are effective in OME patients with allergies particularly in preventing recurrent episodes.

Learn more about allergy symptoms and ask your doctor about allergy testing, .

References:

1. Cochrane Database Syst Rev. 2006 Oct.18;(4):CD003423.
2. Stillwagon PK, Doyle WJ, Fireman P: Effects of an antihistamine/decongestant on nasal and eustachian tube function following intranasal pollen challenge. Ann Allergy 58:422-426, 1987.
3. Chan KH, Swarts JD, Tan L: Middle ear mucosal inflammation: an in vivo model. Laryngoscope 104:970-980, 1994.

Hurst DS: Allergy management of refractory serous otitis media. Otolaryngol Head Neck Surg June, 102(6):664-669, 1990.

 Whether or not a child develops allergies depends on the family history of allergic disease and degree of exposure to potential allergens.  Here are some recommendations from the American Academy of Allergy, Asthma and Immunology  for preventing allergies in children:

 Food Allergies:

1. Delay exposure to allergenic foods. Mothers are advised to breast feed infants  with a strong family history of food allergy for at least 4-6 months. Breast feeding also strengthens the child’s immune system thus reducing infections which can also reduce their risk of developing allergies.Children who are not fed breast milk should receive protein hydrolysate formulas such as Alimentum.  Milk and soy based formulas should be avoided.

2.  Infants should not be fed solid food until 6 months of age.When they are 6-12 months, they can be fed rice, meat, vegetables, and fruit with each food introduced one at a time over a period of several weeks so it can be observed if the child is reacting to the food. After one year, the child may start eating milk, wheat, corn, citrus, and soy. At age 2, egg can be introduced and at age 3 or older, more potentially allergenic foods such as peanut and fish can be included in the diet.

Airborne Allergies and Asthma

1. Practice house dust mite avoidance. Reduction of exposure to house dust mites at a young age has been shown to delay or even prevent development of allergic rhinitis and asthma.  The data regarding cat and dog exposure is not as clear, and it is recommended that you consult with your allergist to get the most recent information and determine what is best for you and your family.

2. Avoid smoking during pregnancy and exposing the child to second-hand smoke.Tobacco smoke exposure has been shown to increase the risk of allergies and asthma in children.

3.  Prevent respiratory infections. Increased frequency of colds and other respiratory infections in children have also been shown to increase risk for allergies and asthma. Reducing exposure to other children who can pass infections to infants will reduce their risk.

Link: Childhood Asthma