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General

    Should immunization be any different for the allergic child?

Smallpox vaccination is no longer recommended. It did cause serious problems in some children with eczema.  Measles, mumps, and rubella vaccines are grown in chicken tissue, and were avoided in egg sensitive individuals.  Now we realize that the amount of egg in these vaccines is to small to produce a reaction and can be given to individuals who are egg-sensitive. Influenza vaccines, and several others are grown on egg protein and should not be given to individuals who are highly sensitive to egg.  Please consult your physician before administration of any of these vaccines.

  Should exercise be avoided if it produces or aggravates wheezing or coughing?

No.  Many people with asthma have some wheezing with exercise.  The amount of difficulty varies with the individual and the duration of exercise.  This "exercise-induced bronchospasm," is generally prevented by the use of medication before anticipated exercise. Conditioning may also play some role.  Specific medicines for this problem should be reviewed with us to avoid unnecessary restriction of physical activity.

  Are there any medications which make allergy problems worse?

"Beta-blocking" agents, such as those used to control high blood pressure, can aggravate asthma, and potentiate allergic reactions.  Please tell us all the medications you are taking so that we can be certain there are no issues.

  Should aspirin be avoided by people with allergies?

Aspirin can cause reactions in some people, including asthmas, hives, and nasal congestion.  Aspirin should be avoided if there is any suspicion that symptoms are aggravated by this medication.  Many aspirin substitutes (e.g., ibuprofen) can cause similar reactions, and should also be avoided in aspirin-sensitive individuals.

  Why do such things as perfumes, strong odors, and aerosol sprays seem to cause

Most people with allergies have unusually sensitive airways.  Factors that may cause only mild irritation in non-allergic people can cause a great deal of aggravation and discomfort in those with allergies, and can actually reproduce their allergic symptoms.  Avoidance of these irritants is the best treatment, but good control of the underlying allergy may improve tolerance.

  Do people outgrow their allergies?

The allergic diseases, especially in children, tend to eventually become more easily controlled, or even seem to be "outgrown" or dormant.  This may take years, however, so that allergy treatment may be necessary for prolonged periods.  Asthma may occur in childhood, resolve, then recur as an older adult.

  Are Allergies inherited?

The allergic tendency is inherited but the mechanism is not as yet well-defined.  The stronger the family history of allergy, the more likely it will be that other family members will be allergic.

Allergic Disease

  Will a humidifier help?

Humidification of the air, especially in the winter, will sometimes help the allergic patient.  However, some patients are made worse by humidification if excessive, particularly those who are mold or mite sensitive.  Ideal humidity for respiration is 25-50% .

  Will a fan help my allergy?

Fans potentially make respiratory allergies worse.  Anything which circulates air and allergy particles without filtering tends to make allergy sufferers have more trouble.  This same principle applies to riding around in open cars in pollen season, walking in fields or wood on dry, windy days, etc.

Specific Allergens

  Urticaria (hives)

Urticaria (hives) are itchy welts which can occur anywhere on the skin.  Acute hives can be due to an allergic reaction to any of a variety of agents (foods, infections, drugs, insect stings, allergy injections, etc.).  They may also be of non-allergic origin.

Hives can also become a more chronic problem and often are not due to allergy.  An exact cause may remain undetermined in spite of extensive investigations.  Even then, it is usually possible to control symptoms with medications.

  Eczema

There are allergic inflammatory cells which are permanent residents in the skin, and this  leads to the chronic dry itchy red skin seen in eczema.  Routine treatment to minimize further inflammation is necessary to control the symptoms.

Swimming and  bathing are useful to reduce the bacterial burden found in eczematous skin.  However this does tend to dry out the skin.  Therefore bathing should be followed immediately by lubrication.  Creams or ointment are preferable to lotions.  Children's faces may be irritated by wiping with a damp cloth after meals.  To avoid this, vaseline can be applied to the child's face before meals.  The food can then be easily removed after meals without using soap and water.

Overheating and sweating can cause itching.  Clothing should be selected which will not cause overheating.  For the same reason, nylon leotards and sneakers or rubber packs should not be worn for long intervals.  Wool is very irritating and should not be worn next to the skin.  Cotton or soft corduroy are good materials to select.

Skin testing may reveal food and other sensitivities which contribute to the inflammation underlying eczema.  Topical steroid creams or ointments, and some non steroidal anti-inflammatory agents (elidel, protopic) used on the skin help control the eczema by decreasing inflammation and controlling infection.

There is no question that much effort and continuing care are required to help the patient with eczema, but the results can be gratifying and long-lasting.

  Stinging Insects

The venom of yellow jackets, hornets, honeybees, and wasps is a very potent allergen and can cause serious allergic reactions in sensitized individuals.  Individuals who have had an allergic reaction to a sting should be evaluated by an allergist for consideration of allergy testing and immunotherapy.   Immunotherapy for stinging insects is highly successful in preventing serious allergic reaction on subsequent stings.

  Pets in the Home

Indoor warm blooded pets are frequent allergens.  Efforts to reduce dander levels while the pet remains in the home are uniformly unsuccessful.  Many products are marketed with claims they will help a patients allergies; but the only proven effective means to reduce allergen levels below those which trigger allergic inflammatory responses is to remove the animal from the home environment.  Preventing the animal from entering the bedroom area, use of HEPA filters, removing carpeting, and "mite control" measures may be of some limited benefit.

  Molds

Molds are fungi.  They produce seeds, or spores, which are even smaller than pollen and are found in the air in large numbers at certain times of the year.  For most individuals outdoor molds are the primary source of mold problems.

Outdoors they are abundant in soil, grass, dead leaves, haystacks, barns, and stables.  Indoors, they are prevalent in areas with moisture.  They are responsible for the familiar musty smell noticeable in such places. Areas of visible mold or areas with flooding are the most problematic.

It is quite difficult to eliminate molds from the home environment. Special attention to ventilation and drainage may help decrease indoor molds.

  Dust Mites

Dust mites are a major part of household dust in most homes in our climate.  They live on human dander and are therefore found largely in areas where dander accumulates.  This includes bedding (mattresses, pillows, blankets, and carpets in bedrooms).  It is very important therefore to cover mattresses, and pillows with dust proof, air tight encasings. These covers should be cleaned with a damp sponge with each bedding change.  All bedding should be laundered in hot (rather than warm or cold) water to remove dust mites.    Comforters or quilts that are not easily laundered are therefore not recommended.
   
Carpets are a notorious source of dust mite allergen.  Vacuum cleaning does little to remove mite allergen from carpets.  Ideally, therefore, bedroom flooring should be a hard polished surface with only washable throw rugs on the floors.

  House Dust

Ordinary house dust represents one of the most troublesome materials to which allergic patients are exposed.  House dust is made up of many tiny organic and inorganic particles.  These organic particles may include house dust mites, animal and human danders, pollens, and molds.  Therefore, house dust control is an important part of the overall treatment of many allergic people.  Since a person spends more time breathing the air of his bedroom than of any other room–in fact one-half of his time in childhood-the focus centers largely in the bedroom.

Allergy Shots

  How effective are allergy injections?

The amount of relief depends in part upon the disease being treated, the age of the patient, and the allergen involved.  Most patients do derive significant relief from their symptoms and some become completely free of symptoms.  Unfortunately, a few patients derive no benefit and other means of therapy must be found.

  Are there any side effects of allergy immunotherapy?

Since the shots contain materials to which the patients is allergic, it is possible to produce allergic symptoms with the injections.  Many patients experience short term itching or swelling at the injection site.   Taking an antihistamine on the day of the injection can minimize this reaction.  Rarely hives, trouble breathing, or a generalized allergic reaction may occur.  A reaction is more common if the injection is given in a setting of active asthma symptoms.  Always report any breathing difficulties before receiving allergy immunotherapy.
A 30 minute observation period following an allergy injection is necessary so that in the unlikely event of a reaction it can be treated promptly.

  How long must the shots be continued?

This varies with the allergy being treated and the response of the patient.  In general, patients require injections at regular intervals for three to five years.  This will vary with the allergies being treated, and the response of the patient.

  Must the injections be given regularly?

Since development of tolerance is a slow process, and since very low doses of the allergenic substances must be used at the start, the injections should be given at the prescribed intervals.  If injections are given irregularly, control of symptoms may be reduced or delayed, and risk of allergic reactions to the injections is increased.

  How often must injections be given?

In general, allergy shots are given at intervals which can be as often as twice a week, to as little as once a month.  Most schedules require injections once or twice a week at the start, until the desired maintenance dose is achieved, then extending to monthly for the duration of therapy.

  What is the allergy shot?

Allergy injections contain small amounts of the substances (allergens) to which the particular patients is allergic.  Allergy injections may be prescribed for stinging insects, pollens, mites, molds and animal danders.  Food allergy cannot be treated with allergy immunotherapy.

  Does it "cure" the allergy?

No, but a tolerance is induced which can be long lasting, even after the injections are discontinued.

  What is allergy immunotherapy?

A series of injections to the allergens to which the patient is allergic, a tolerance to these allergens is gradually build up so that exposure to the allergen can occur without developing the same degree of allergic symptoms.

Skin Testing

  How accurate is skin testing?

In general, skin test results correlate very well with clinical sensitivity.  As is true in all of medicine, however, there are some patients who do not follow the rule, and correlation with the clinical history is, therefore, a very important part of allergy evaluation.

  How is skin testing done?

In this office, two methods are generally used. A majority of tests are done by "prick" method.  Drops of the skin test material are applied in rows across the back as tiny pricks are made through each drop, pressing the allergen into the skin.  Results are usually read in 10 to 20 minutes.  Also, some "intradermal" tests may be done.  These involve a small injection into the superficial layers of the skin of the arm.  "Patch" tests are used to identify materials causing skin reactions on contact.  Small amounts of these materials or gauze patches are taped on the skin and left for 48 to 72 hours before being read.

  What is Skin Testing?

Skin testing is performed to detect the presence of allergic antibody to an allergen by introducing the allergen to the allergy cells in the area of the back or arm.  If allergic antibody is present, a small wheal and flare (hive) will occur at the skin test site.

General Info. for Allergy Patients

  Medications containing antihistamines

Medications containing antihistamines can suppress skin tests reactions.  Antihistamines are present in many cold remedies, allergy medicines, and motion sickness pills. Most antihistamines must be stopped seven days prior to skin testing.  Some antidepressants also have antihistamine activity and may interfere with skin tests.  If you cannot go without these medications, or question whether or not your particular medication should be stopped, check with your doctor or have them call our office.

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