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Allergic rhinitis is caused by substances that we breathe called allergens. Allergens are usually harmless substances that can cause problems only in some people. These problems are caused because the immune system of people with allergic rhinitis mistakenly identifies these substances as intruders and generates a reaction against them. During this reaction, the immune system cells release substances such as histamine and leukotrienes that cause the symptoms of allergic rhinitis; these and other substances also cause inflammation in the nasal lining. This inflammation makes the nose very sensitive to irritants such as smoke and strong odors or to changes in the temperature and humidity of the air.
Causes of Allergic Rhinitis
When allergic rhinitis is caused by common outdoor allergens, such as airborne tree, grass and weed pollens or mold, it is called seasonal allergic rhinitis, or "hay fever".
Allergic rhinitis is also triggered by common indoor allergens, such as animal dander (dried skin flakes and saliva), indoor mold, droppings from dust mites and cockroach particles. This is called perennial allergic rhinitis.
Symptoms of Allergic Rhinitis
Stuffy nose (congestion)
Itching in the nose, roof of the mouth, throat, eyes and ears
Diagnosis of Allergic Rhinitis
If you have symptoms of allergic rhinitis, an allergist/immunologist can help determine which specific allergens are triggering your illness. We will take a thorough health history followed by a physical exam. Tests will be recommended to determine if you have allergies. Skin tests are the most common method for determining your allergic rhinitis triggers.
Allergic Rhinitis Treatment
Once your allergic rhinitis triggers are determined, we will work with you to develop a plan to avoid the allergens that trigger your symptoms. You might be prescribed medication to decrease your allergic rhinitis symptoms. Allergen immunotherapy, also known as "allergy shots," may be considered if your symptoms persist.
Nonallergic Rhinitis produces many symptoms similar to allergic rhinitis. Some people have both allergic and nonallergic rhinitis. In nonallergic rhinitis, unlike allergic rhinitis, there is no family history or seasonal pattern, and allergy tests are negative. The immune system is not involved. Such patients are often more susceptible to sinus infections. The most common triggers include weather changes, cigarette smoke, dust exposure, alcohol (wine and beer) and odors (malls, new fabric, pollution, perfumes and detergents). Nonallergic rhinitis can not be cured, but allergists are equipped to recommend appropriate avoidance measures and medications.
As allergic rhinitis is an allergic nose condition, allergic conjunctivitis is an allergic eye condition. The underlying factors and causes of allergic conjuctivitis are the same as for allergic rhinitis. The symptoms of allergic conjunctivitis include redness, itching, tearing or swelling. The diagnosis and treatment for allergic conjunctivitis is the same as for allergic rhinitis, including the benefit of allergy shots (allergen immunotherapy) in some patients.
ALLERGIC SKIN CONDITIONS
Red, bumpy scaly and/or itchy skin can signify an allergic skin condition. These skin problems are often caused by an immune system reaction, signifying an allergy. Allergic skin conditions can take several forms and are due to various causes.
Hives and Angioedema
Hives or urticaria are red, itchy, swollen areas of the skin that can range in size and appear anywhere on the body. Angioedema, a swelling of the deeper layers of the skin, sometimes occurs with hives. Hives are the result of a chemical called histamine–responsible for many of the symptoms of allergic reactions–in the upper layers of the skin. Angioedema results from the actions of these chemicals in the deeper layers of the skin. These chemicals are usually stored in our bodies' mast cells, which are cells heavily involved in allergic reactions. There are several identifiable triggers that release histamine and other chemicals from the mast cells, causing hives.
Most episodes last less than a few weeks and are termed acute. When hives are present for greater than four weeks they are referred to as chronic. Understanding the process of histamine and other mediator regulation in hives is integral in diagnosis and treatment.
When some substances come into contact with skin, they may cause a rash called contact dermatitis. This is a delayed-type hypersensitivity reaction based on sensitized cells in the skin. Inflammation occurs when the skin comes in contact with certain agents including cosmetics, jewelry, ointments creams or rubber. In addition to an in-depth history and physical exam, patients may be candidates for patch testing. Patch testing involves applying small test panels to the back, and reading them 48, 72 and/or 96 hours later. Patch tests are different from allergy skin tests.
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. Identifying the cause of the itch is essential in managing symptoms. Preventing the eczema itch is the primary goal of treatment.
When to See an Allergist
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 allergist can offer a support system and assist you in managing your skin conditions.
Food allergy is a condition caused by a specific immune (IgE mediated) reaction to a food substance resulting in histamine release. Adverse reactions to foods may also occur due to non IgE immune mediated or nonimmune mediated mechanisms. This includes adverse sensitivities or intolerances. An example is lactose intolerance, in which an individual lacks the proper enzymes to break down milk proteins for proper digestion, and can have uncomfortable abdominal symptoms after consuming milk. There may also be non-allergic reactions to food additives or preservatives.
Representing an important subset of all adverse reactions to foods, food allergy is often misunderstood. Food allergens—those parts of foods that cause allergic reactions—are usually proteins. The most common food allergens are the proteins in cow's milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts. The most common allergic skin condition to food is hives. Hives are red, itchy swollen areas to the skin. Atopic dermatitis is a skin condition characterized by itchy, scaly red skin and can be triggered in some instances by food allergies. Gastrointestinal symptoms of food allergy include vomiting, diarrhea, abdominal cramping, nausea and sometimes itching and swelling of the mouth and throat.
An allergist/immunologist is the best qualified professional to diagnosis food allergies. Diagnosis includes a carefully organized and detailed assessment of the problem. Following this in-depth history, there will be a physical exam. Testing may include allergy puncture skin test or a blood test called RAST. Treatment modalities will then be reviewed.
Medicines are given to help people, but all medicines can have side effects. Side effects (referred to as adverse reactions) to drugs are common. Not all adverse reactions are a true "drug allergy" though they are often referred to as a "drug allergy." A drug allergy is a specific unpredictable immune reaction to a medicine. A true drug allergy is relatively uncommon, accounting for about 5-10% of adverse drug reactions.
It is important to recognize allergic drug reactions because they can be life threatening, causing a reaction called anaphylaxis. An allergist is able to classify a drug reaction, including whether or not it is a true allergy. The most common drugs that cause allergies are antibiotics, anti-seizure drugs, some anesthetic agents, insulin and rarely, vaccines. Some diagnostic tests for drug allergies exist, including some blood tests and skin testing to antibiotics such as penicillins and cephalosporins. There is also a test available for local anesthetics, insulin and some vaccines. Following a detailed history and physical exam, and possible testing, an allergist can then recommend treatment options.
STINGING INSECT ALLERGIES
Some people are allergic to insect stings. This means that their immune system overreacts to the venom injected by a stinging insect. This triggers the release of histamine and other chemicals that cause allergic symptoms.
For a small number of people with severe venom allergy, stings may be life-threatening. Severe allergic reactions to insect stings can involve many body organs and may develop rapidly. This reaction is called anaphylaxis. Symptoms of anaphylaxis may include itching and hives over large areas of the body, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea. In severe cases, a rapid fall in blood pressure may result in shock and loss of consciousness. Anaphylaxis is a medical emergency, and may be fatal.
Most sting reactions are caused by five types of insects: yellow jackets, honeybees, wasps, hornets and fire ants. Anyone who has had a serious adverse reaction to an insect sting should be evaluated by an allergist/ immunologist, who will take a thorough history, perform an examination and recommend testing to determine whether you have an allergy, and which type of stinging insect caused the reaction. Skin or blood (RAST) testing for insect allergy is used to detect the presence of significant amounts of IgE antibody.
Your allergist/immunologist will help you determine the best form of treatment. People who have severe allergies to insect venom and positive allergy tests are candidates for receiving insect venom immunotherapy. Venom immunotherapy (allergy shots) is a highly effective vaccination program that actually prevents future allergic sting reactions. During immunotherapy, you will be administered gradually stronger doses of venom extract, initially every week. As maintenance doses are reached the interval is expanded to one month or more.
If you have questions about venom immunotherapy or other treatments for stinging insect allergy, be sure to ask your allergist/immunologist. Patients who receive appropriate treatment such as immunotherapy and who practice careful avoidance measures can participate in regular outdoor activities.
Allergy to proteins in natural rubber latex became a significant concern by the late 1980's. Latex allergy appears to have originated from an increased use of latex gloves over the past decade due to infection precaution policies that have been instituted at health care facilities and changes in processes used to manufacture latex products.
What is Latex?
Latex is a milky fluid produced by rubber trees (Hevea brasiliensis). Products made from blends of natural rubber latex and other compounds are very common. In those with latex allergy, allergic reactions are most often triggered by dipped latex products. Products that commonly cause reactions can include gloves, balloons, and condoms. In rare instances, people who are allergic to latex may also react to rubber bands, erasers, rubber parts of toys, various rubber components in medical devices, rubber elastic in clothes, or feeding nipples and pacifiers. Products molded from hard, crepe rubber, such as soles of shoes, are unlikely to cause reactions. Almost all latex paints are not a problem.
Types of Allergic Reactions
There are two types of allergic reactions to latex. The first is delayed-type contact dermatitis, a poison ivy-like rash that appears 12-36 hours after contact with latex products. This most commonly appears on the hands of people who wear latex gloves, but it may occur on other parts of the body following contact with rubber products. Immediate, or IgE antibody-mediated allergic reactions, are potentially the most serious form of allergic reactions to latex.
Cross Reactions Between Latex and Foods
Latex-sensitive patients may also be allergic to some foods, especially bananas, avocados, kiwi fruit, and European chestnuts. This is because these foods contain some of the same allergens as latex.
Evaluation and treatment
The first step in treating latex allergy is awareness of the problem. Visit your allergist/immunologist if you think you may have symptoms of latex allergy. After taking a detailed history and examining you, your doctor or nurse practitioner will decide whether additional diagnostic tests for latex allergy are needed.
This information is provided with permission from the American Academy of Allergy, Asthma and Immunology (AAAAI).