Patient Education

INSECT BITES OR STING ALLERGIES

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Insect stings usually produce only local irritation and discomfort. However, for an unlucky few, about 1% of us injected with insect venom during a sting can have more serious consequences. Reactions can range from a large local reaction to death due to an allergy to the venom.

Some people have symptoms of an allergic reaction to insect bites and insect stings from mosquito’s, horse flies, or deer flies. Usually they do not need any testing or treatment except antihistamines. It is vary rare that someone has a severe allergic reaction with insect bites. However, we do see large local reactions to mosquito bites.

The more severe reactions are due to insect stings. There are five insects in this part of the country that can cause severe reactions including life threatening anaphylaxis. The most common is yellow jacket, and two other insects called hornets. These three belong to the same family. The honey bee belongs to a different family, and usually, when a patient is stung by a honey bee, it leaves a stinger. Wasp is the fifth insect, and there are some cross reactions between the wasp, the yellow jacket and the hornet venoms. The most common reaction with these insects is a local reaction, and we do not recommend any medical treatment. One percent of these patients ultimately may develop severe allergic reactions, but the incidence is no different than the general population.

The second most common reaction is a large, local reaction. Usually the swelling gets worse a few hours later. This is treated with antihistamines and occasionally oral steroids if the swelling is vary large. In general, they do not need allergy testing nor desensitization. About 10% of these patients ultimately may develop systemic reaction if they get stung again.

The third reaction, which is not common but is life threatening, is a systemic reaction with hives, itching all over the body, swelling of the throat, wheezing and hypotension. Adults are at a higher risk than children for fatal reactions. Children with skin reactions only (hives) are not at high risk and do not need testing or treatment; however, adults that have a systemic reaction and children that have systemic symptoms involving respiratory, gastrointestinal or cardiovascular system must be tested and need desensitization. Both children and adults in this category need to carry an epinephrine kit and know how and when to use it.

Management

  • Seek immediate medical treatment if you experience itching, hives, dizziness, wheezing, nausea, stomach cramps, or diarrhea.
  • All patients who have generalized reactions should keep an EpiPen or an AnaKit to use in case of severe reactions and seek immediate medical treatment.
  • All patients who have had a generalized (systemic) reaction, should have skin testing with insect venom.
  • Desensitization with insect venom is recommended to those who reacted to skin testing. Studies shown that 95% of patients treated with insect venom injections gained protection. When these patients were re-stung after several months of therapy, only 5% experienced a significant reaction.
Prevention
As with other types of allergic disease, prevention is the key to staying healthy. Certain precautions can be taken to reduce the risk of an insect sting during the summer months:
  • Wear long-sleeved shirts and full-length pants with socks and shoes when outdoors.
  • Remove known stinging insect nests from areas around your home. This is best done by a professional exterminator.
  • Avoid areas that attract such insects, such as brightly-colored flowers.
  • DO NOT wear perfume or cologne.
  • DO NOT wear pastel or brightly colored clothing. Wear muted greens, white and khaki.
  • Keep lids on garbage cans closed.
  • DO NOT drink from opened soda or juice cans where you cannot see what is inside.
  • Check your car for insects before you get in. Then, drive with your car windows and sunroofs closed.

ASTHMA

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Asthma is a chronic inflammatory disorder of the airways in which susceptible individuals experience recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. The inflammation causes hyperactivity/hyper responsiveness of the airway to a variety of stimuli (triggers). The response to these stimuli is airflow obstruction, which is at least partially reversible, either spontaneously or with treatment. In addition, there is a further increase in inflammation and bronchial hyper responsiveness.

Asthma is the most common chronic disease of childhood and is increasing in prevalence. It is potentially fatal, and is the 3rd leading cause of preventable hospitalizations in the U.S. It remains under diagnosed and undertreated, possibly because signs and symptoms vary widely from patient to patient, as well as within each patient over time. Typical symptoms of asthma include wheezing, cough, chest congestion, chest tightness, and shortness of breath. Symptoms may be worse at night, or during or just after exercise.

Asthma is diagnosed by taking a detailed history, physical examination and lung function testing. Asthma can then be classified as mild intermittent, mild persistent, moderate persistent, or severe. Allergy testing may be performed to help identify triggers or if there is a positive family history of allergies.

Levels of asthma severity (before or without treatment) Mild Intermittent: symptoms occur < 2 times a week and are brief (few hours or days). Nighttime symptoms < 2 times a month. Mild Persistent: symptoms > 2 times a week but < 1 time a day and may affect activity. Nighttime symptoms > 2 time a month. Moderate Persistent: daily symptoms which affect activity. Nighttime symptoms > 1 time a week. Severe Persistent: continual symptoms, limited physical activity, and frequent exacerbations. Nighttime symptoms occur frequently.

HEADACHE

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Headache is one of the top health complaints of Americans
We’re bombarded with advertisements – and we pay many millions of dollars – for pain relievers. Headache is also one of the most common reasons people see physicians, and it’s not a new problem. Primitive healers may have bored in the skulls of their suffering patients to release trapped spirits thought to be causing the pain. Fortunately, modern medicine offers less drastic treatment for headache sufferers. Some types of headaches have an allergic basis. In these cases, careful evaluation may pinpoint the allergen, or allergy-causing substance, causing your headache.

Everybody gets headaches. How do you know when you should see a doctor about them?
Because each of us is different in how we handle pain, you must decide yourself. However, here are some conditions which may call for a consultation with a physician:

  • The recent onset of frequent, moderate to severe headaches, associated with other symptoms such as nausea or vomiting.
  • Frequent headaches which occur on a daily or weekly basis.
  • Headaches which make it impossible for you to think, do your work, go to school, or enjoy life.
  • Headaches which respond only to a great deal of over-the-counter medication such as aspirin and Tylenol-type products.
  • Headaches with fever that last more than a day or two.
How are headaches diagnosed? Your doctor will ask you: To describe how severe the pain is
  • Where it is strongest?
  • How you obtain relief?
  • If other symptoms accompany your headaches?

A physical examination will reveal the causes of some headaches. If necessary, your doctor will order laboratory tests, X-rays, and brain-wave tests. Often these tests are ordered after consultation with a neurologist, a physician who specializes in nerve and brain problems. Most people who come to an allergist for evaluation and treatment of their headaches have been seen by other physicians. If you have not had such a preliminary evaluation, it may be worthwhile to visit your primary care physician first to rule out other causes of your headaches. One hint that allergies may play a role in your headaches is if you have other allergies such as hay fever.

What kinds of headaches have been shown to be caused by allergies?

Two types of headaches clearly can be caused by allergies – sinus headaches and migraines. Another unusual headache called cluster headache is possibly related to allergic disease.

What are the symptoms of sinus headache?

The four groups of sinus cavities in the head are hollow air spaces, with openings into the nose for the exchange of air and mucus. They’re located inside each cheek-bone, behind the eyes, behind the bridge of the nose and in the forehead. Secretions from the sinus cavities normally drain into the nose. Sinus headaches and pain occur when the sinuses are swollen and their openings into the nasal passages are obstructed, stopping normal drainage and causing pressure to build up. Often the pain is localized over the affected sinus. For example, if the maxillary sinus in the cheeks is obstructed, your cheeks may be tender to the touch and pain may radiate to your jaw and teeth. Sinus pain can be dull to intense, often begins in the morning and becomes less intense after you move from a lying-down to an upright position. Antihistamines/decongestants help relieve the pain. If the area over a sinus becomes tender and you have a fever, the obstructed sinus may be infected. More intensive treatment, including antibiotics, is then required.

What about migraines?

Migraine headaches vary from mild to very intense and disabling. Migraines tend to be throbbing, usually one-sided headaches, which often are aggravated by sunlight and are frequently accompanied by nausea. There are two general types of migraine: classic and common (plus many variations). Classic migraine attacks tend to be severe and of long duration. They are preceded by aura, a sensation that signals the start of a headache. The aura may be funny smell, partial vision loss, or a strange sound. Common migraine is more prevalent than classic migraine. Attacks are generally milder and shorter. There is no aura. However, because the attacks may occur more frequently, common migraine also can be quite disabling.

What is the role of allergies in these types of headaches?

Sinus headaches develop because of swollen sinus membranes. Allergic reactions to airborne pollens, dust, animal danders, molds, as well as foods can lead to sinus obstruction. Treatment of the underlying allergic cause of sinus pain will result in long-term relief. Medications used to treat allergies include antihistamines, decongestants, intranasal steroids and cromolyn. In some cases, immunotherapy or “allergy shots”, may be recommended. When possible, of course, avoid the allergen if your allergy is caused by an avoidable substance – such as food or an animal. A large number of recent scientific studies have described the importance of food allergies in migraine attacks. Some migraine sufferers will benefit from a careful evaluation of food allergies as a cause of their headaches. Some migraines are provoked by food additives or naturally occurring food chemicals such as monosodium glutamate (often added to Chinese food and packed foods), tyramine (found in many cheeses), phenylethylamine (found in chocolate) or alcohol. The artificial sweetener aspartame and the preservative metabisulfite also may cause migraines. Often, only a few foods trigger migraines and, by limiting or avoiding their use, you can experience complete or marked relief without medication. If you have more questions, your allergist will be happy to answer them.

IMMUNE SYSTEM REACTION

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Most of you are familiar with allergy problems; however, very few understand the term “Immunology.” The immune system protects us from the outside environment so we can all lead a healthy life. The immune system consists of many different types of cells, and these cells make antibodies and mediators. The combination of these mediators and antibodies work to keep us healthy. If they do not function, people develop a group of diseases called immunodeficiency diseases. A common example that we all know now is AIDS, which is caused by the HIV virus that attacks the immune cells.

Allergic Diseases as a group develop when part of the immune system reacts excessively and produces an immunoglobulin called IgE antibody. This IgE antibody system is supposed to fight the parasitic infections; however, it reacts to the normal environmental antigens (dust mite, animal dander, pollen, mold spores, insect venom, and food). These diseases include asthma, allergic rhinitis, conjunctivitis, eczema, insect sting allergy, and some forms of hives.

If the immune system reacts to self antigens, people develop a group of diseases called auto-immune diseases. For the immune cells to react they have to recognize which is self and non-self. In most of us, immune cells can perform this function very effectively; however, in some patients who have a genetic tendency they recognize the self antigens as foreign and react to them. There is a constant reaction which goes on between the self antigens and antibodies which create inflammation. Some examples of these diseases are lupus, rheumatoid arthritis, polymyositis, etc...

Immune cells also do surveillance in the body and if they recognize any foreign cell or a tumor cell they will kill these cells. People who do not have enough of these cells are more prone for malignant diseases or cancers. As you can see, the immune system is the key to keeping us healthy. Most of these diseases do have a genetic tendency; however, environmental factors lead to the diseases. Most of the people who have asthma have a genetic tendency; however, they must be exposed to an allergen or a virus to develop an asthma attack.

Even though as allergists and immunologists we do not deal with all these diseases, we have a clear knowledge of how the immune system works and how to diagnose these diseases.

CHRONIC COUGH

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More than 12 million pediatric doctor visits are due to coughs every year. Most coughs last a few days due to common colds. It is frustrating if a cough is present for weeks and result in several sleepless nights for both children and parents.

Protective

Coughing is an important protective mechanism of the lungs. Coughing helps guard against aspiration and assists in the removal of secretions from the airways. Chronic cough results when cough receptors are constantly triggered by various stimuli. Cough receptors are located in the nose, sinuses, ear canals, pharynx, larynx, trachea, and bronchi. They are also found in the diaphragm and pericardium.

Variety of Causes Chronic cough can be caused by a variety of conditions such as:
  • Cough variant asthma – Chronic cough may be the sole manifestation of asthma. It is the most common cause of chronic cough in children. Cough occurs day and night precipitated by excessive cold air, common cold or flu.
  • Viral or bacterial pneumonia can produce chronic cough.
  • Sinusitis, which presents a post-nasal drip, yellow or greenish mucous, facial pain, foul odor of breath, and sore throat, can be a cause for chronic cough.
  • CIGARETTE SMOKING – There is a direct association between chronic cough and cigarette smoking. In general, the rate of cough increases with the number of cigarettes smoked. Also, there is a clear association of chronic cough and passive smoking. Children who have parents that smoke have more respiratory disease. Even if you smoke only in one room, the smoke spreads all through the house. If you smoke outside of the house, the irritant is carried on the clothing, hair, and skin.
  • Habit cough, also known as psychogenic cough. This type of cough is characterized by a single dry repetitive honking cough. Habit cough typically occurs only during the day and disappears during sleep. It may be precipitated by anxiety.
  • Other causes, like cyctic fibrosis, congenital malformations, foreign body and aspiration, can cause chronic cough in children.
  • Gastro-Esophageal Reflux.
  • Vocal Cord dysfunction.
  • Medications: ACE inhibitors for high blood pressure (i.e.: Capoten, Vasotec, Prinivil, etc.) may cause chronic cough

Nose, Sinuses and Ears

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We all take for granted that breathing through the nose is normal for everyone. However, there are several million people who do not have the luxury of breathing through their nose. When we breathe through the nose, the air circulates through the sinuses and while passing through the sinuses the air is humidified, filtered, and brought to body temperature. The sinuses also give resonance to our voice.

Anyone with nasal obstruction, either functional or mechanical, has rhinitis. A major symptom of rhinitis in adults can be sinus headaches. These headaches are usually caused by sinus pressure and will not be shown on x-rays or CAT scans. If rhinitis persists the sinus problem can lead to fluid collection in the sinuses and ultimately turn into a sinus infection. Most people who have sinus problems do in fact have nasal obstruction, either partial or complete. Unless the nasal symptoms are cleared, the sinus problems will persist.

The most common complications of rhinitis in children include recurrent fluid collection in the ears and middle-ear infections. In this group of children, hearing loss may be significant which, in turn, can lead to learning problems in early childhood.

Patients who have chronic rhinitis also have constant post-nasal drip and frequent sore throats. Children may have an upset stomach in the morning hours because of the swallowing of mucous and increased gastric acidity.

Nasal obstruction also causes tear-duct obstruction and teary eyes. In extreme cases of nasal obstruction, people experience a loss of smell and taste. Chronic mouth breathing may cause orthodontic problems. The well-known cause of allergic shiners is due to nasal obstruction and venous congestion in the lower eyelids. A crease across the nose can be caused by constant rubbing of the nose.

Cold symptoms that last more than 10 – 14 days, often with green or yellow nasal discharge, may be due to a sinus infection.

Chronic sinusitis can cause a flare-up of asthma and bronchitis. Keeping the upper airways clear is very important in asthmatics.

There are several causes for this nasal blockage and some of the most common are described as follows:
  • Allergic Rhinitis – this is the most common cause of nasal blockage, more common in children and young adults. Allergies are less common in older people.
  • Non-Allergic Rhinitis with Eosinophils – These people have similar symptoms as people with allergies, however, the symptoms are present all year long. They respond well to the usage of steroid nasal sprays.
  • Vasomotor (non-allergic) Rhinitis – Patients with vasomotor rhinitis basically have very sensitive nasal linings and any irritants like smoke, dust, perfumes, hair sprays, cold air, temperature changes, and barometric pressure changes can aggravate symptoms. They have chronic nasal congestion and constant postnasal drip. Most of these people ultimately end up with chronic sinus problems
  • Nasal Polyps – Nasal polyps are growths of extra tissue in the nose and allergies can aggravate them. Nasal polyps never become cancerous. These patients should be on cortisone nasal sprays to prevent recurrence.
  • Mechanical Blocking - such as nasal septal deviation, enlarged adenoids or any foreign bodies.
  • Rhinitis Medicamentosa – caused by excessive use of decongestant nasal sprays. This condition is most common in patients with vasomotor rhinitis.
  • Rhinitis due to infection – Rhinitis, secondary to the common cold, usually lasts 10 to 14 days and gets better.
  • Antihypertensive medications and oral contraceptives sometimes cause nasal stuffiness.

ALL PATIENTS WHO HAVE CHRONIC RHINITIS SHOULD BE EVALUATED FOR ANY OF THE ABOVE CONDITIONS. BY TREATING THE NASAL SYMPTOMS AGGRESSIVELY, WE CAN PREVENT CHRONIC SINUS PROBLEMS.

Treatment of Allergies

Once we find out what a person if allergic to, avoidance is the best measure. Based on the targeted organs, we either treat the nasal symptoms, eye symptoms, or asthma problems. Allergy injections reduce the specific IgE antibody levels, and build up IgG antibody levels.

The most common treatment for nasal symptoms are nasal sprays. There are two major classes of nasal sprays. The first class is “relief” medications which helps within a few minutes. The most common is the non-prescription, over-the-counter decongestant sprays. Long-term use of this is not recommended as it can be habit forming. The other type of relief nasal sprays are antihistamine nasal sprays, i.e.: Astelin, and anticholinergic nasal sprays such i.e.: Atrovent.

The second major class of nasal sprays are “control” medications for nasal symptoms. Most common in this group are the nasal steroids. They do not have any systemic side effects as we use them in minute amounts. The most common side effects are nose bleeds, dryness, and irritation. These nasal sprays must be taken on a regular basis in order to work. There is also a control nasal spray, cromolyn sodium, which is very safe to use; but this nasal spray must be taken at least three to four times a day on a regular basis.

The relief-type medications (antihistamines, decongestants, or a combination) can be taken on an as-needed basis, mostly by mouth.

In the long run, avoiding exposure to allergens, taking medications on a regular basis, and getting allergy injections will prevent nasal symptoms. If nasal symptoms are not well controlled, complications of chronic sinusitis, chronic ear infections, postnasal drip, chronic mouth breathing, and in some instances, lacrimal-duct obstruction and venous congestion in the lower eyelids (dark circles under the eyes), can occur.

Asthma, Allergies, and Eczema

Asthma, allergies, and eczema usually runs in the family. If you have all three of these diseases, we will sometimes refer to you as an “atopic individual”. However, all three diseases are different. Approximately one-third of the people who have allergies also have asthma problems, and about one-third of those also have eczema problems.

If you check your family history for two or three generations, some family members may have just had allergies, some of them may have had both allergies and asthma, and some may have had all three. Allergic tendencies run in families. Once a person has a tendency, he must be exposed to potential allergens for a period of time. The greater the exposure, the greater the chance of developing allergies. Once a person has been exposed to a potential allergen long enough, his or her immune system produces a specific IgE antibody to that allergen.

Normally, we all make antibodies which belong to the classes of immunoglobulin A, G, and M, which we need for protection from infections. However, the IgE response is an abnormal response which actually causes the allergic reactions. The IgE antibodies are very specific to each antigen. For example, if you are allergic to cats, you make an IgE antibody very specific to cat proteins. Once these IgE antibodies are made, they affix to the surface of a mast cell. The mast cells are located in the nasal linings, conjunctivae, lungs, GI tract, and skin. These mast cells are loaded with histamine and other inflammatory chemicals. Once there is re-exposure to the antigen, all these chemicals are released and together create an inflammation.

Inflammation in the nose is called rhinitis, inflammation in the eyes is called conjunctivitis, and if there is a tendency for asthma, inflammation in the airways within the lungs causes asthma. If a sensitive person is exposed to a food allergen, he or she can develop hives and angioedema with swelling of the lips and throat, wheezing, or anaphylaxis.

When we do skin testing, we put the antigen on the surface of the skin, and if the person has an IgE antibody to that antigen, a small local reaction, redness and swelling at the site of the skin test occurs.

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Asthma Allergy Centers was established in 1980 as a solo allergy practice with one location. Over the years, we have grown to 14 locations and 6 providers. The concept of multiple locations...

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Patient Education

Insect stings usually produce only local irritation and discomfort. However, for an unlucky few, about 1% of us injected with insect venom during a sting can have more serious consequences.

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Patient Information

Your initial appointment will take about 90 minutes. Please inform us as soon as possible if you are not able to keep your appointment time.

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