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Showing posts with label allergy. Show all posts
Showing posts with label allergy. Show all posts

The Top Choices For Over the Counter Allergy Medicine

By Roger Calfsman


If you are trying to fix on an over the counter allergy medicine, of course first and most important you should study the different allergy relief medicine options that you have to make a choice from. This way you’ll have a place to start, and have a better concept of which over the counter allergy medicine products are going to work best on you.

Before deciding on an honest to goodness over the counter allergy medicine to try, you need to learn about the different types that are available.


Antihistamines


These are typically the 1st that doctors prescribe to their patients who are suffering from allergies. Antihistamine drugs work by blocking histamine from interacting with the nasal tissues, so that as a result the indications of allergies are prevented before they even start.


There are many alternative kinds of antihistamines that are available today, but it may take a little bit of random test before you can find one that basically works for you.


Decongestants


There also are the decongestants, which work much differently. These medicines work by helping to reduce the swelling in your head and nose, which are both evidence of allergies, and as a result this alleviates the pressure and improves airflow through your sinuses.


Topical Corticosteroids


Though not commended half as frequently, this is another option, one that your doctor may suggest if you’re dealing with allergies. These work by helping to manipulate the itching, swelling and inflammation caused by allergies.


Remember, choosing the right over the counter allergy medicine is vital if you’d like to effectively deal with your allergies and get back to living as standard a life as you most likely can. If you have just started experiencing allergies as of recently or otherwise aren’t sure which over the counter allergy medicine is going to be ideal for you, talk to your physician and they’ll be able to work with you on this.


You should not stop taking any medicine abruptly, and always hear your doctor. They have dealt with many cases of allergies during the past, and so they’re going to understand which treatment will work best for you, and be in a position to tell you whether or not you are making correct improvement. If they realize that your allergies are just staying the same or worsening, they will likely need to modify you to a different allergy medication or even try a mixture of 2 or more to get the best results. – 29627




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Twitter Updates from the Severe Asthma Workshop at the 2008 Annual Meeting of American College of Allergy, Asthma & Immunology (ACAAI)

Twitter is a microblogging service where people answer the question “What are you doing?” via 140-character messages from their cellphone, laptop or desktop. The service can also be used to collect notes and ideas or to report from a medical conference. I have already explored the same communication channel while attending the NEJM Horizons Conference in October and the reports were generally met with approval by both the meeting participants and bloggers from around the world. This experience encouraged me to make the first attempt at using Twitter to post updates from the 2008 Annual Meeting of American College of Allergy, Asthma & Immunology (ACAAI). I attended the meeting to present our project AllergyCases.org to the program directors and fellows and to discuss 2 posters.


In order to make the Twitter postings (or “tweets”) easily searchable, I included the hash tag “#ACAAI” with each tweet from the meeting. You can search Twitter for “#ACAAI” to find tagged updates from any participants who used Twitter to report from the ACAAI meeting.


The short updates from the workshop about treating severe asthma were posted in real time on Twitter at an interval of every 3-5 minutes. After the workshop, I used my cell phone and the mobile Twitter interface to discuss the asthma updates with several fellows during and after the ACAAI meeting.


The oldest post is at the bottom, the newest at the top:


#ACAAI Severe Asthma: AAF pts have more ER visits and hospitalizations for multiple reasons: poverty, obesity, no PCP, cockroach exposure… 7:04 PM Nov 8th from web


#ACAAI Severe Asthma: Theophylline pendulum may be swinging back — useful again? 6:57 PM Nov 8th from web


#ACAAI Severe Asthma: No response to oral steroids? Consider GERD. 6:51 PM Nov 8th from web


#ACAAI Severe Asthma: Maximal dose of oral steroids beyond which there is no effect? 60 mg po qd. 6:51 PM Nov 8th from web


#ACAAI Severe Asthma: Older papers – methylprednisolone may “get into the lungs” better than prednisone – consider different steroid… 6:48 PM Nov 8th from web


#ACAAI Severe Asthma: Macrolides may be considered if nothing else helps. May have steroid-sparing effect. 6:47 PM Nov 8th from web


#ACAAI Severe Asthma: Clarithromycine tx for months is used in “infectious asthma” – studies ongoing. 6:45 PM Nov 8th from web


#ACAAI Severe Asthma: Monitor LFTs in Zileuton therapy. 6:44 PM Nov 8th from web


#ACAAI Severe Asthma: Zileuton is not the same as Singulair or Accolate. Works in a different way. 6:43 PM Nov 8th from web


#ACAAI Severe Asthma: Strategies for “SABA abuser” (Albuterol 18 x day), no response to ICS+LABA+LTRA? Consider zileuton and Xolair. 6:42 PM Nov 8th from web


#ACAAI Severe Asthma: FEV1 cutoff below which you don’t use Xolair for fear they won’t tolerate anaphylaxis? Some use 50-70% similar to SCIT 6:38 PM Nov 8th from web


#ACAAI Severe Asthma: Pts on Xolair tx – nasal polyps can get better. Nasal polyps are a heterogeneous disease like asthma. 6:32 PM Nov 8th from web


#ACAAI Severe Asthma: When do you give up on using Xolair? How long do you try? 4-6 months. 6:30 PM Nov 8th from web


#ACAAI Severe Asthma: There is no way to predict which patient will benefit from Xolair. 6:29 PM Nov 8th from web


#ACAAI Severe Asthma: Several attendees share experience with using Xolair in pts with IgE higher than 700. 6:28 PM Nov 8th from web


#ACAAI Severe Asthma: How do you monitor Xolair tx in pts with very high IgE? Monitor PFTs. Checking IgE levels is useless in these patients 6:26 PM Nov 8th from web


#ACAAI Severe Asthma: Xolair and IgE of 4k? Classic wisdom: Xolair will not bind enough IgE to be effective. Some pts still respond however 6:25 PM Nov 8th from web


#ACAAI Severe Asthma: Xolair use in pts with very high IgE (4-5 k)? Anecdotal evidence: it may help. Use the highest dose calculated for 700 6:23 PM Nov 8th from web


#ACAAI Severe Asthma: Treat GERD, if no response for a month, try doubling the dose. Don’t give up if no response at the lower dose. 6:19 PM Nov 8th from web


#ACAAI Severe Asthma: GERD – Beta agonists and theophylline relax GE sphincter which may exacerbate GERD and make asthma worse. 6:18 PM Nov 8th from web


#ACAAI Severe Asthma: Obesity – Losing weight (diet or surgery) changes metacholine sensitivity. Losing wt improves asthma in obese pts. 6:15 PM Nov 8th from web


#ACAAI Severe Asthma: What is behind the connection between obesity and asthma? Can diet play a role? 6:12 PM Nov 8th from web


#ACAAI Severe Asthma: Workshop shifts to Q&A brought by the participants. 6:11 PM Nov 8th from web


#ACAAI Severe Asthma: With genetics, we may be able to tailor-make the therapy to individual patients rather than blindly follow guidelines. 6:10 PM Nov 8th from web


#ACAAI Severe Asthma: Vit D deficiency could be a risk factor of asthma but there is not enough data to make a final conclusion. 6:07 PM Nov 8th from web


#ACAAI Severe Asthma: Ciclesonide is the new ICS. Activated by esterase in target tissues. Less suppression of HPA than other ICS – FP/BUD 6:05 PM Nov 8th from web


#ACAAI Severe Asthma: Xolair decreases hospitalizations in pts on moderate dose ICS. 6:04 PM Nov 8th from web


#ACAAI Severe Asthma: Omega-3 FA, fish oil may be beneficial in children. 6:02 PM Nov 8th from web


#ACAAI Severe Asthma: Lactose is added or removed from DPIs, check contents of each inhaler. 6:00 PM Nov 8th from web


#ACAAI Severe Asthma: Consider lactose sensitivity in pts who don’t respond to Advair or Symbicort. Check contents of each inhaler. 5:59 PM Nov 8th from web


#ACAAI Severe Asthma: Consider GERD if asthmatic pts don’t respond to medications. 5:58 PM Nov 8th from web


#ACAAI Severe Asthma: Asthma in 30% pts of pts with chronic asthma. 5:57 PM Nov 8th from web


#ACAAI Severe Asthma: Sinusitis in 75% of pts with moderate asthma. 5:57 PM Nov 8th from web


#ACAAI Severe Asthma: Link between sinusitis and asthma. 5:56 PM Nov 8th from web


#ACAAI Severe Asthma: Treat co-morbid conditions – rhinitis, sinusitis, GERD – “One airway disease” 5:55 PM Nov 8th from web


#ACAAI Severe Asthma: Some pts may have airway irritation from the delivery system, e.g. dry powder inhalants. Listen to pts… 5:53 PM Nov 8th from web


#ACAAI Severe Asthma: A subpopulation of patients may benefit from erythromycin or other ABx. 5:52 PM Nov 8th from web


#ACAAI Severe Asthma: Is asthma an infectious disease? 5:50 PM Nov 8th from web


#ACAAI “Some asthmatics don’t respond to ICS, so why try them at all?” but this is not what the guidelines say with their stepwise approach. 5:49 PM Nov 8th from web


#ACAAI Since 1976: Asthma is a heterogeneous disease, but this is not reflected in the guidelines. 5:47 PM Nov 8th from web


#ACAAI Attending the workshop Treating the severe asthmatic patient. 5:45 PM Nov 8th from web


#ACAAI As far as I know, this will be the first ACAAI meeting reflected on Twitter.


#ACAAI The #ACAAI tag means you will be able to find the tagged posts on Twitter Search http://search.twitter.com/


#ACAAI Going to the annual ACAAI meeting. I have 2 posters and 1 website presentation. Will be updating Twitter with the tag #ACAAI





Video: Twitter in Plain English by CommonCraft.

References:
Twitter Dispatches from the New England Journal of Medicine’s Horizons Conference. The Efficient MD.
I will be attending NEJM Horizons Conference to push the boundaries of traditional medical publishing, suggestions welcomed
Allergists Can Use Twitter Microblogging Service to Send Patient Reminders
Using Twitter to Microblog a CME Meeting
A Doctor’s Opinion: Why I Started Microblogging on Twitter


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Cream of Tartar Allergy?

Is it possible to be allergic to cream of tartar? I think this might be the cause of my allergies in recent years. A couple years ago I broke out with an all-over itchy allergic reaction after making a souffle for dinner, which called for cream of tartar. The allergy lasted a long time, and I weened myself off allergy meds so I wouldn’t be dependent on them. Yesterday, I made a caramel sauce for a quickie stroopwafel. The sauce wasn’t thick enough, so I added cream of tartar to thicken it. Today, I started itching. Another issue with the cream of tartar is that I used it in a copper core sauce pan. The whole pan is not made of copper, just the heating core, but I came across many warning not to use cream of tartar in copper cookware because it is used as a cleaner of copper. Ugh! I hope I don’t have copper in my system. Anyone need some thick caramel sauce? Let me know if you’ve heard of this allergy.


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Chicago Allergy and Health Blog


Runny noses and persistent post-nasal drips are the result of the body’s response to a simple component of a food or pollen molecule – a phenolic.  Substance intolerance shows up in many forms besides the common allergic symptoms of swelling, itching, and run-amuck mucous. For instance, it is not uncommon for practitioners to have patients report that “chocolates give them headaches”, “tomatoes cause joint pain”, their “tongue swells up”, or they “develop blisters when they eat nuts”, and they get “severe diarrhea from oranges”. Other allergic reactions to phenolics can include nausea, fatigue, depression, irritability, insomnia, trouble concentrating, muscle ache, abdominal pain, bloating, gas, diarrhea, constipation, and a host of other unexplained and difficult-to-treat symptoms and disease complexes.  To this amazingly diverse list of afflictions, you can add autism, mental retardation, hyperactivity, dyslexia, insomnia, bedwetting, respiratory allergies, headaches, abdominal pains; and asthma in children, as well as in adults; migraine, colitis, hypertension, menstrual disorders, dermatological problems including eczema, and arrhythmias.


Don’t confuse what we’re talking about with “cure-all.” What is given here is a very brief introduction to a discipline of diagnosis and treatment that most allergy sufferers and even most allergists are unaware of. Which are the Real Allergens? It is time to rethink allergies. Maybe the more universal cause of allergies is a set of chemical compounds, more simple than proteins, called phenolics or aromatics. Unfortunately, many researchers holding to the concept of proteins as allergens have largely ignored the work done on phenolics.


Some studies over the past decade suggest that more attention should be focused on aromatic organic chemical compounds found in most foods, pollens, and other organic materials. Since many of these aromatic chemicals are related to phenol, they are called phenolics as a class of physiological substances. Most perfumes, many cooking odors, and many other chemical smells are phenolic compounds, as is everything from the purple color of a grape (malvin) to the spicy taste and smell of cinnamon (cinnamic aldehyde). There are thousands of different phenolic compounds that a person could be allergic or hypersensitive to and not even know it, which is why it is so difficult to address using conventional methods.


Unfortunately, the vast majority of treatment techniques for asthma and allergies do not even consider phenolic sensitivity as a possible factor. Could this be why many forms of allergy treatment do not work? A substantial step forward in understanding allergies is taken by considering the part phenolic compounds have in the plant and animal kingdoms and in human body chemistry. This is especially true of food allergies. Many clinicians dismiss phenolics outright while others are searching for new ways to look at the chemical arena of allergies. Attempting to address allergies without addressing phenolic sensitivity is ridiculous.  How a person develops this condition is complicated. Just know that to test and treat allergy symptoms appropriately this information can not be ignored, but often times it is!


Science is pointing to the fact that phenolics are the cause of a substantial number – if not most allergic responses. Fortunately, there is new technology that can accurately test and treat for phenolic sensitivity. And, given the complexity of the topic I consider it nothing short of a revolutionary breakthrough!

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Peanuts, Peanut Products Cause Most Severe Food Allergy Reactions In Children

Main Category: Allergy
Article Date: 09 Jul 2013 – 1:00 PDT Current ratings for:
Peanuts, Peanut Products Cause Most Severe Food Allergy Reactions In Children
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Raise your hand if you like peanut butter. Most of us raise our hands, but some are forced to keep theirs down. They’re allergic.


Food allergies affect nearly 10 percent of children younger than 4-years-old, and the peanut allergy causes the most severe reactions. Exposure to even trace quantities of peanuts can lead to a fatal reaction called anaphylaxis, causing breathing problems and heart arrhythmias that can lead to sudden death.


Only 20 percent of kids grow out of it, so if it’s not you, chances are someone around you deals with a peanut allergy. There are more people with peanut allergies than ever before[1]. Rather than make jokes about those missing the joy of PB&J, let’s see what we can do to help.


Paranoid over Peanuts. Thanks to George Washington Carver (who found 300 new uses for the legume) we now have peanuts everywhere, and some sufferers aren’t sure how close in contact they can get.


Thirty kids, ranging from 4 to 15, with documented peanut allergies were challenged by casual exposure to peanut butter. Their previous reactions stemmed from being kissed by someone who ate peanut butter, being near PB&J sandwiches, even being exposed to peanut breath.


In the study, dishes were prepared with a scoop of peanut butter and placed alongside tuna and mint extract to hide the peanut odor. Other dishes replaced the peanut butter with soy butter as a placebo test. The dishes were covered with gauze and held to the kids’ noses for 10 minutes. For an hour, they were watched for reactions.


No one exposed to the peanut butter had a reaction. One person reported an itch on the roof of the mouth, but it was provoked by the placebo test and resolved spontaneously. Based on this, researchers found it unlikely that the smell of peanuts triggers an allergic reaction.


Another large study of 4,685 peanut-allergic individuals found only 1 percent reported reactions to airborne peanut dust, 91 percent reported ingestion was the culprit. This should be somewhat reassuring that the smell of peanuts is likely not harmful.


Butter Clean Up. A pinch of nuts on the tongue is enough to cause a reaction. The common peanut, Arachis hypogaea, has eight different protein allergens named after its scientific name, from Ara h1 to Ara h8. Some people are allergic to one, and some to all eight, so wiping up the peanut butter becomes important. A study showed liquid and bar soap cleans Ara h1 just fine, but antibacterial hand-sanitizer left traces on 6 of 12 hands[2]. Most household cleaning agents were sufficient in cleaning tables.


Symptoms alert. Reactions typically occur within 20 minutes of exposure and can range from itchy skin (most common) to GI complaints (least common). Asthma reactions (coughing, wheezing) or anaphylaxis are the most serious. Ingesting nuts is the most common cause, and rarely does skin contact cause a problem.


A third of people will have a second reaction from the exposure 1-8 hours after the first reaction has resolved. Allergic people should wear MedicAlert bracelets and have injectable epinephrine (e.g., EpiPen) readily available.


If you’re peanut allergy free, do what you can to help those less fortunate avoid the risks and just enjoy the jelly.


Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Learn more at unmc.edu.


Written by Michael Huckabee, Ph.D., professor and director of the University of Nebraska Medical Center physician assistant program


Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our allergy section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:


MLA


Huckabee, Michael. “Peanuts, Peanut Products Cause Most Severe Food Allergy Reactions In Children.” Medical News Today. MediLexicon, Intl., 9 Jul. 2013. Web.
24 Jul. 2013. APA


Please note: If no author information is provided, the source is cited instead.



posted by S Z Berg on 10 Jul 2013 at 7:56 am


Peanuts, Peanut Products Cause Most Severe Food Allergy Reactions In Children misinforms the public. Peanuts and peanut products do not cause the most severe food allergy reactions in children. Severity depends upon how allergic a child is. Anaphylactic reactions are not limited to peanuts.


S.Z. Berg
Award-winning Journalist
Blogger, The Huffington Post
Credits: New York Times, Washington Post, TheStreet.com,
Consumer Reports, Consumers Digest, The Scientist, Marie Claire, and others
Member, American Society of Journalists and Authors


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Peanut Allergy Forces Emergency Landing (Video)

As a parent of a 13 year old anaphylactic to peanuts this is my worst fear!  And we fly a lot.  You can’t trust what the crew says at all.

Peanut Allergy Forces Emergency Landing (Video)




Finally I can introduce my peanut allergic child to Thai food!  This is completely peanut and tree nut free!  I can’t wait to make this!

Allergy-Friendly Pad Thai | Allergic Living




Interesting article about a possible connection with food allergies to autism.  Will read more about this later.

Disordered Mast Cells, and the Clues to Food Allergy | Allergic Living




http://www.huffingtonpost.com/sue-scheff/be-aware-the-dangers-of-f_b_3689585.html

This is terrifying to think about.  My daughter could turn her back for one instant and someone could sneak something into her food or drink and next thing you know she’ll be in anaphylactic shock.  We need to bring more awareness to this life-threatening food allergy so that teens are aware that their “prank” could result in a trip to the emergency room ~~ or worse.





This story hits so close to home because my own is 13 years old and is also anaphylactic to peanuts and tree nuts.  This could have easily been my precious daughter.  My heart goes out to this family.

CARMICHAEL, Calif. – It was supposed to be the last day of a family vacation at a popular summer camp, but it ended in tragedy for one Sacramento-area family when a loved one had a fatal allergic reaction.


Relatives says 13-year-old Natalie Giorgi died from a severe allergic reaction to peanut butter while she was attending Camp Sacramento off Highway 50 in El Dorado County.

Now, the family says it really wants to get the message out about how dangerous and deadly food allergies can be.

Giorgi was very careful about what she ate and always made sure her food did not have nuts, according to family and friends.

But she had unknowingly eaten a Rice Krispies-type snack made with peanut butter.

On Friday night, the final night of camp, there was entertainment and refreshments. A dessert tray was put out in a dark area of the camp.

Giorgi reached for a treat and took a bite out of it. She knew something wasn’t right, spit it out and told her mother, who also tasted the treat.

They later realized it contained peanut butter. Natalie felt fine for about 20 minutes, but then began vomiting, had trouble breathing and went into cardiac arrest.

3 epinephrine pens were used but they could not help save the girl, according a family friend.

Giorgi was taken to the hospital by ambulance where she was pronounced dead.

Family and friends are coming to terms with Giorgi’s sudden death.

“She took every care. She knew the situation, that’s (connected to) the allergy she had. And they were really on it all the time,” said Pastor Michael Kiernan of Our Lady of the Assumption Church in Carmichael.

A special vigil was held at the church for Giorgi Sunday evening.

Some say they’ll remember her smile and laughter. Others will remember how much she loved to draw and how much she loved her friends.

Her family said Giorgi wanted to become a neonatologist, to care for premature babies like her and her twin sister.

Meanwhile, family members extended their gratitude to the paramedics, firefighters and everyone who tried to help save Natalie.

They offered the following written statement:

“While our hearts are breaking over the tragic loss of our beautiful daughter Natalie, it is our hope that others can learn from this and realize that nut and food allergies are life threatening. Caution and care for those inflicted should always be supported and taken.”

An allergist said food allergies and nut allergies have tripled in the past decade. He says more people need to understand the dangers of food allergies and that they can sometimes be fatal.

By Suzanne Phan, sphan@news10.net









What is a Stay-at-home Mom’s Work Worth? [infographic] | Education Insights



Drs. Oz and Roizen: What you can do about food allergies






Syndicated columnsBy Syndicated columns 
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on June 09, 2013 at 6:00 AM, updated June 09, 2013 at 6:04 AM


















































Email













Food allergies are skyrocketing in North America and around the world. Rates in children and teens have gone up 50 percent in the past 15 years, to 1 in 20, one new report says. And today’s numbers could be even higher: A recent survey of 38,000 parents found that 1 in 13 kids have had mild to life-threatening reactions to everyday foods like milk, eggs, nuts, wheat and shellfish. And 30 percent of food-allergic kids have reactions to more than one food.

Scientists are racing to pin down the causes of this puzzling outbreak. Leading the list are the usual suspects: emulsifiers and additives used in processed foods, such as peanut butters that are made with more than just peanuts, lunch meats, margarine, mayonnaise, sauces, candy and bakery products. Interesting fact: Emulsifiers seem to make a protein (like peanuts) appear foreign, so the immune system attacks it. In China, where peanuts are boiled and peanut butter is made only with peanuts, the allergy is rare; when the nuts are fried or cooked in non-peanut oils and emulsifiers are added for quick spreading, the allergy pops up.

But another possible trigger is our too-clean environment; it makes our immune system overeager for work, so it turns on us and creates autoimmune diseases and allergies.

Here are five smart ways to prevent and deal with food allergies.

No. 1. Keep up with the latest info about allergy-causing foods. You can ban eggs, nuts, shellfish, wheat and soy from your home, but these foods are lurking in restaurant foods. Watch out for emulsifiers in mass-produced salad dressings and sauces, and for sulfites in seemingly safe packaged foods like trail mix or dried fruit. Get the inside info by connecting with groups like Food Allergy Research & Education at www.foodallergy.org. You can sign up for email alerts.

No. 2: Turn off “allergy genes.” 
Cutting-edge thinking says something in the environment is switching genes on and off in ways that set the stage for allergies. Early evidence points to tobacco smoke, polluted air and fast food. The gene changes may even be passed down through several generations. Meanwhile, pregnant moms can help fortify their newborns against allergies by eating a healthy diet, and after birth, by breastfeeding their baby as long as possible.

No. 3: Take kids with food reactions to an allergist. 
Fewer than 25 percent of kids who end up in hospital emergency rooms are told to see an allergist, but that should be your next move. This specialist can determine which foods likely caused the allergic response and make sure you’re equipped with emergency medication that stops life-threatening reactions.

No. 4: Outfit kids (and yourself) with TWO EpiPens.
 Experts suggest that kids with food allergies carry two EpiPens, self-injectable epinephrine that stops severe reactions. One in eight kids who go to the ER with a bad reaction need a second shot, yet many leave the ER without a prescription. Talk with your doctor about getting the doses you need, and about when to replace EpiPens. Not all states allow or require schools to stock these life-saving devices — though more are considering this smart move. So make sure your kid’s classroom and school nurse have a supply of several pens (check their expiration dates).

No. 5: Talk with your pediatrician about introducing allergenic foods. Until recently, conventional wisdom said delaying “trouble foods,” such as peanuts, protected babies from developing allergies. But in 2013, an American Academy of Allergy, Asthma & Immunology committee suggested that early exposure actually might train a young immune system to react properly. Some experts even suspect that lowered exposure to common food allergens like peanuts and wheat could help explain the rise in food allergies.

WARNING: 
This advice is not for babies and young children who have already reacted negatively to a food, have a related allergic condition like eczema or atopic dermatitis or a sibling with a food allergy. Remember to talk this over with your doc before trying.





















Q. I’ve read differing views on whether it would be safe for a nut-allergic person to eat baked goods with coconut or coconut oil. What’s your view on coconut?

Dr. Scott Sicherer: Despite its name, coconut is not actually a nut, but a fruit. Regardless, the Food and Drug Administration considers it a tree nut, which is why it’s included in U.S. labeling laws.

It is difficult to assess the risk of coconut allergy among those with tree-nut allergies because allergic individuals may become wary of coconut and avoid it. Still, coconut allergy appears rare, and uncommon even among those with tree-nut allergies.

In a national registry of 5,149 people with peanut or tree-nut allergies, only four self-reported an allergy to coconut. And a more recent study of 40 children with positive tests or known allergy to peanuts or tree nuts showed no increased risks for having positive tests or allergy to coconut.

Your allergist would consider your personal allergy history in deciding whether to add coconut to your diet or to perform any testing. However, be aware that tests are often positive to coconut in people who could actually tolerate it, so a physician-supervised feeding test may be necessary for a conclusive answer.

When it comes to coconut oil, there is almost no medical literature on allergic reactions to it, which may reflect the likelihood that the processed forms of coconut oil contain little or no protein, although this has not been studied. Still, for those with verified coconut allergy, avoidance of coconut oil should be considered because it may have residual protein.

Finally, it’s important to note that people with peanut or tree-nut allergies who choose to eat coconut must be diligent to avoid cross-contact with avoided tree nuts or peanut.

Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Together with Dr. Hemant Sharma, he writes “The Food Allergy Experts” column in the American Edition ofAllergic Living magazine. Questions submitted below will be considered for answer in the magazine.








Thoughts and Ideas from Deanie Humphrys-Dunne: Interview with Award-Winning Children’s Author, Ca…: Th “This morning I have the tremendous honor of interviewing award-winning children’s author, Carla Burke.” “…


Thoughts and Ideas from Deanie Humphrys-Dunne: Interview with Award-Winning Children’s Author, Ca…:”This morning I have the tremendous honor of interviewing award-winning children’s author, Carla Burke.” “…

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Food Allergy In Cats - Symptoms, Treatments And Diagnosis

Not only humans’ Even animals are affected by food allergy. It mainly affects cars and is rated among the main causes of atopy, flea bite allergies. Cats usually develop allergies from constantly fed kind of foods.

Often cats are sensitive to a certain type of food ingredient. So, an antibody in their intestinal tracts responds, leading to food allergy. Among all other type of allergies, with a 10% ratio allergies caused by food are more prone to cats.







Food allergies affect male, neutered cats and also female ones. It is also a misconception connecting specific breed of cats to allergies caused by food. This condition can initially create symptoms for cats from four months young to eleven years old. But majority of food allergy cases occur between 3- 6 years in cats. These cats are also in connection with inhalant allergies.

The main difference between food intolerance and food allergy should be learned to correctly manage allergy in cats. Allergy caused by food are taken as true allergies revealing symptoms like itching and skin problems associated with feline and canine allergies. Incase diarrhea or vomiting happens without creating allergic responses, it means that it’s only intolerance of food. Cat food intolerance is similar to a human having a stomach ache or diarrhea as a result of consuming spicy food or eating food that is fried. By utilizing foods food intolerance and allergies can be prevented. This doesn’t offend the agents.


Many studies reveal that few ingredients of food are the main causes of allergies when compared to the rest. The main common causes in cats are dairy products, fish and beef. Many pet owners would have observed that the following ones are the main ingredients found in foods that are consumed by the cat. Even though few proteins are more antigenic, it still comes in similar forms. So, this reaction depends mostly on the quantity of exposure.


The symptoms of this allergy in cats are most likely the same to most kinds of allergies. But the major ones are excessive scratching, hair loss, military dermatitis and itchy skin. For pet owners it is difficult to distinguish cars that suffer from atopy or food allergy by physical signs. But, they must suspect food allergy if these symptoms begin to take place during winter or through out the year and the cats fail to respond to antihistamine or steroid treatment.


When you figure out the symptoms of different allergies in cats it is very simple to diagnose the allergy. Symptoms of food allergy are similar to that of bacterial, notoedric mange, hypersensitivity to intestinal parasites, seborrhea and yeast infections.


It is necessary to carry out food trials. Elimination and provocative testing diets could be done. One should feed the cat with foods that has carbohydrates, proteins for 11 – 12 weeks without any treats. A typical instance is potato and venison or potato and duck. These foods are commercially available in the market or could be homemade. Young and growing cats have special nutritional needs. Diets made at home containing a carbohydrate and a protein eliminating multivitamins and fatty acids could be fed for 12 weeks. Food trials for kitten are carried out by giving a commercially balanced diet. After few weeks, feed the cat with previous food that they once have consumed. In case the symptoms are shown then it’s surely food allergy. Others perform blood testing which is not accurate when compared to trials (food).


Feed the cats with commercial diets from hill or Purina or homemade diets which makes treatment of allergy simple and easy.


Abhishek has got some great Allergy Relief Secrets up his sleeves! Download his FREE 54 Pages Ebook, “How To Win Your War Against Allergies!” from his website http://www.Health-Whiz.com/552/index.htm. Only limited Free Copies available.
Article Source: http://EzineArticles.com/1656420


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Relief From Ragweed Allergy Symptoms Offered By Once-A-Day Pill

Main Category: Allergy
Article Date: 10 May 2013 – 0:00 PDT Current ratings for:
Relief From Ragweed Allergy Symptoms Offered By Once-A-Day Pill
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An international team of researchers, led by physician-scientists at Johns Hopkins, reports that a once-daily tablet containing a high dose of a key ragweed pollen protein effectively blocks the runny noses, sneezes, nasal congestion and itchy eyes experienced by ragweed allergy sufferers.


Tests showed that treatment with the pill, which contains the protein Ambrosia artemisiifolia major allergen 1, and is placed under the tongue to be absorbed, also reduced the need for anti-allergy drugs to get relief. More than 80 million Americans are allergic to ragweed.


The study is believed to be the first and largest, multicenter, double-blind, randomized controlled trial of its kind to investigate the use of sublingual immunotherapy against ragweed allergy. Begun in April 2010, it was funded by the drug’s manufacturer, Merck of Whitehouse Station, N.J.


Results of the trial, published in the Journal of Allergy and Clinical Immunology, showed that overall symptoms and need for such allergy medications as antihistamines and nasal steroids fell by 27 percent in people who took a pill containing 12 units of the allergen. During peak ragweed season, the roughly two-week period between August and October when pollen counts are highest, symptoms and medication use dropped 24 percent.


Researchers say that if the pill wins approval from the U.S. Food and Drug Administration, it could serve as a more convenient, less painful option than weekly or monthly allergy shots. The pill also presents fewer potential side effects than allergen injections.


“Our results show this oral tablet for ragweed allergy is highly effective and well-tolerated, and offers considerable relief from what many allergy sufferers consider the most agonizing part of the year,” says allergist and lead study investigator Peter Creticos, M.D.


Some 784 men and women from the United States, Canada, Hungary, Russia and the Ukraine volunteered to take part in the year-long study, in which participants were randomly assigned to take either a high-, medium-, or low-dose tablet, or placebo. Neither researchers nor study participants were aware of which dose of the pill or placebo they were taking. Patients kept track of their symptoms and medication use through detailed and daily diaries, which were later scored by researchers for analysis.


“Physicians treating ragweed allergy sufferers may soon have an alternative to the current approach to managing ragweed allergy, which usually involves weekly or monthly visits to the doctor’s office for allergy shots and carries the risk of swelling and pain at the injection site, plus risk of anaphylactic shock,” says Creticos, an associate professor at the Johns Hopkins University School of Medicine.


Creticos says that no adverse events occurred during the study. The only side effects observed were mild throat irritation, itchy tongue and swollen lips.


Creticos says his team has also begun studies of other non-injectible forms of immunotherapy, including ragweed allergy drops, and treatment applications where the allergen is lightly pricked or inserted into the middle layers of the skin.


Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our allergy section for the latest news on this subject. Other researchers involved in the study are Jennifer Maloney, M.D., Amarjot Kaur, Ph.D., Nancy Lui, Ph.D., and Hendrik Nolte, M.D., Ph.D., at Merck; David Bernstein, M.D., at the Bernstein Clinical Research Center and University of Cincinnati College of Medicine, in Ohio; Thomas Casale, M.D., at Creighton University in Omaha, Neb.; Robert Fisher, M.D., at Allergy Research and Care in Milwaukee, Wis.; Kevin Murphy at Boys Town National Research Hospital in Omaha, Neb.; and Kristof Nekam, M.D., at Hospital of the Hospitaller, Brothers of St. John of God, in Budapest, Hungary. During the conduct of the study, Creticos was a paid member of a Merck scientific advisory board.
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Allergy Treatment PA Options: Allergies And It"s Cure

By Brix R. Langley


Many people who suffer from allergy related health problems each year reach a point where they feel they should investigate their allergy treatment PA medical options in an effort to ease or cure their illness. These allergies generally occur as their immune system reacts to a foreign substance. For most of the world’s population, this response does not produce an exaggerated response, it only protects them from dangerous viruses and bacteria that could make them sick or get an infection. For some individuals, however, their immune system identifies harmless allergens as a threat and attacks them, causing uncomfortable or serious symptoms like rashes, itchy eyes and skin, restricted airways, irritated bowels, among others. The list below describes a few of the most common auto immune responses.

Hay fever, which is also called allergic rhinitis, can cause various cold type symptoms, such as a runny nose, itchy eyes, sneezing, congestion, or sinus pressure, which can seriously hamper daily activities and overall quality of life. However, it is not caused by a virus, unlike a cold is, but rather by outdoor and inside allergens like pollen, dust mites, and pet dander.


Eczema, which is also known as a topic dermatitis, is an allergic reaction that causes a person’s skin to break out in itchy red rashes behind their knees, elbows, arms, and legs. What it is exactly that causes eczema is undetermined at this point, but the running theory is that it might be a combination of inherited traits such as sensitive skin and immune system malfunctions. This condition tends to flare up and then disappear, and is sometimes accompanied by other auto immune conditions like asthma and hay fever.


Food allergies affect a large percentage of kids and adults, and result from an auto immune reaction that occurs when a person eats even a small amount of an allergy-causing food. This immune system response could cause digestive problems, hives, constricted breathing, and even anaphylactic shock.


Insect allergies are caused by the immune systems over sensitive response to bug venom. These reactions can include coughing fits, asthma attacks, itching, swelling in the area of skin around the bite, chest tightening, and in very serious cases, anaphylactic shock.


Sometimes a person has an abnormal reaction to a medication they take, which is aptly referred to as a drug allergy. This reaction can be caused from an assortment of over-the-counter and prescription drugs, and may include fever, hives, or rashes. Strangely, an individual can have suddenly had a reaction to a drug that has not produced a reaction in the past. This is not to be confused with an adverse drug reaction, which is not triggered by the immune system, but can have similar symptoms.


Allergies cannot be cured, but they can be managed and relieved by a number of sinusitis treatment pa and allergy treatment pa options that are available. These treatments include a few non-invasive surgery options, allergy drops, shots, and assorted alternative treatment techniques.










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Allergy and Asthma - Practical Diagnosis and Management.pdf (8,623 KB)



Allergy and Asthma – Practical Diagnosis and Management.pdf (8,623 KB)  


Contents
Authors . . .  . . . . . . . . . . . . xvii
Preface . . .  . . . . . . . . . . . . xxii
1. Introduction to the Immune System .. 1
Massoud Mahmoudi, DO, PhD
The Immune System 1 Cells of the Immune System 7
Innate Immunity 1 Mast cells 7 Natural Killer Cells 1 Basophils 8
Complement System 2 Eosinophils 8
Adaptive Immunity 2 Defective Immune System 8
Humoral Immunity 2 Hypersensitivity Diseases 8
Cell-Mediated Immunity 2 Type I: Immediate Hypersensitivity or Anaphylactic 8
Interaction of Antigen and Antibody 4 Type II: Antibody-Mediated Hypersensitivity 8
B Cells: Responsible for the Production of Antibodies 4 Type III: Immune Complex–Mediated Hypersensitivity 10
Autoimmunity 4 Type IV: Cell-Mediated Hypersensitivity 11
T Cell–Antigen Interaction 6 Evidence-Based Medicine 11
T Helper Cell Regulation 6 Bibliography 11
2. The History and Physical Examination of the Allergic Patient . . . . . . . . . 12
Mary Alice Murphy, MD, MPH
The Physical Examination 12 The Physical Examination of the Allergic Patient 14
The Medical History 12 Vital Signs 14
Chief Complaint 12 General Appearance 15
Review of Systems 12 Skin 15
Medications 13 Face 15
Drug Allergies 13 HEENT: Head, Eyes, Ears, Nose, and Throat 15
Current Medications 13 Neck 15
Past Medications 13 Chest 16
Hospitalizations 13 Cardiovascular 16
The Clinic or Large Health Maintenance Additional Examination (as Indicated
Organization Settings 13 by the Patient Complaint) 16
Occupational History 13 Procedures 16
Social History 13 Skin Testing 16
Environmental Exposures 14 Spirometry and Peak Flow Meters 16
Personal Habits 14 Pulse Oximetry 16
Dietary (Food) History 14 Nitrous Oxide Measurement 17
Geographic History 14 Endoscopy 17
Family History 14 Evidence-Based Medicine 17
Previous Allergy Diagnosis and Conclusion 17
Treatments 14 Bibliography 17
3. Prevalence of Allergic Diseases in Children, Adults, and the Elderly . .. . 18
Massoud Mahmoudi, DO, PhD
Allergic Rhinitis 18 Occupational Allergy 20
Respiratory Allergy-Allergic Asthma 18 Evidence-Based Medicine 20
Food Allergy 19 Bibliography 20
Atopic Dermatitis 20


4. Allergic Diseases of the Eye . . . . . . . . . . . . . . . . 21
Eric Kavosh, MD and Leonard Bielory, MD
The Ocular Surface 21 Contact Dermatitis of the Eyelids 27
Clinical Examination 21 Blepharoconjunctivitis 27
Immunopathophysiology of Ocular Allergy 22 Ocular Allergy Treatment 27
Acute Allergic Conjunctivitis 24 Vasomotor Conjunctivitis or Perennial Chronic
Vernal Keratoconjunctivitis 25 Conjunctivitis 30
Atopic Keratoconjunctivitis 25 Conclusion 30
Giant Papillary Conjunctivitis 26 Evidence-Based Medicine 30
Dry-eye Syndrome (Tear Film Dysfunction) 26 Bibliography 31
5. Prevalence of Pollens in the United States and Elsewhere . . . . . 32
Jennifer Yoo, MD and Massoud Mahmoudi, DO, PhD
Tree Pollen 32 Africa 33
Grass Pollen 32 Asia 33
Weed Pollen 32 Europe 36
Methods of Pollen Collection 33 Evidence-Based Medicine 36
Worldwide Prevalence of Pollens 33 Bibliography 37
North America 33
6. Allergic Rhinitis: Diagnosis and Treatment . . . . . . . . . . . 38
Dennis K. Ledford, MD
Pathophysiology and Specific IgE 38 Rhinitis Associated with Systemic Diseases
Epidemiology 40 or Anatomic Defects 46
Classification of Allergic Rhinitis 41 Treatment of Allergic Rhinitis 48
Differential Diagnosis of Allergic Rhinitis 41 Allergen Avoidance 48
Allergic Rhinitis 41 Allergen Immunotherapy 48
Perennial Nonallergic Rhinitis 43 Pharmacotherapy 51
Nonallergic Rhinitis with Eosinophilia 45 Future Therapeutic Options for Allergic Rhinitis 52
Rhinitis Induced by Drugs or Hormones Conclusion 53
(Rhinitis Medicamentosa) 46 Evidence-Based Medicine 53
Atrophic Rhinitis 46 Bibliography 53
7. The Effect of Rhinitis on Sleep, Quality of Life, Daytime Somnolence, and Fatigue . . . . . . . 55
Carah Santos, MS and Timothy J. Craig, DO
Evidence for Sleep Impairment in Allergic Rhinitis 55 Effects of therapy 60
Mechanisms of Sleep Impairment 56 The Role of Intranasal Corticosteroids 60
Nasal Congestion 56 Conclusion 60
Immune Response Mediators 58 Evidence-Based Medicine 60
Sleep Impairment and Quality of Life 58 Bibliography 61
The Effects of Sleep Impairment 58
Measuring Sleep Impairment and Impact
on Quality of Life 59
8. Sinusitis . . . . . . . . . . . . 62
Kevin C. Welch, MD and Andrew N. Goldberg, MD, MSCE, FACS
General Considerations 62 Bacteriology 66
Classification of Rhinosinusitis 62 Acute Bacterial Rhinosinusitis 67
Anatomy 62 Chronic Rhinosinusitis 67
The Septum and Turbinates 62 Diagnosis 68
The Ostiomeatal Complex 63 History and Physical Examination 68
The Paranasal Sinuses 63 Diagnostic Imaging 69
Pathophysiology 65 Culture 69
Acute Bacterial Rhinosinusitis 65 Treatment 69
Chronic Rhinosinusitis 66 Medical Therapy 69
Antibiotic Therapy 69 Fungal Rhinosinusitis 72
Surgical Therapy 71 Allergic Fungal Sinusitis 72
Complications 71 Invasive Fungal Sinusitis 72
Orbital Complications 71 Evidence-Based Medicine 72
Intracranial Complications 72 Conclusion 73
Bibliography 73
9. Allergic Diseases of the Ear . . . . . . . . . . .. . . . . . 74
Doris Lin, MD and Steven W. Cheung, MD
General Considerations 74 Otitis Media with Effusion 76
Allergic Diseases of the External Ear 74 Food Allergy in Otitis Media with Effusion 76
Chronic Otitis Externa 74 Allergic Diseases of the Inner Ear 77
Contact Sensitivity 74 Ménière’s Disease 77
Dermatophytid Reaction 74 Evidence-Based Medicine 77
Allergic Diseases of the Middle Ear 74 Bibliography 77
Eustachian Tube Dysfunction 75
10. Cough and Allergic Diseases . . . . . . . . .. . . . . . . . 78
Eric M. Chen, MD, FACP, FAAAAI, FACAAI
Definition and Physiology 78 Asthma and Cough 80
Causes of Cough 78 Cough Variant Asthma 81
Upper Airway Cough Syndrome Nonasthmatic Eosinophilic Bronchitis 81
(Postnasal Drip Cough) 78 Gastroesophageal Reflux Disease and Cough 81
Allergic Rhinitis and Cough 78 Symptomatic Treatment of Cough 81
Nonallergic Rhinitis and Cough 79 Conclusion 83
Infectious Rhinitis and Cough 80 Evidence-Based Medicine 83
Angiotensin-Converting Enzyme Inhibitor Cough 80 Bibliography 83
11. Urticaria and Angioedema . . . . . . . . . . .. . . . . . . . . . 84
Bettina Wedi, MD, PhD and Alexander Kapp, MD, PhD
Classification of Urticaria 84 Special Types of Urticaria 91
Spontaneous Urticaria 84 Cholinergic Urticaria 91
Acute Urticaria 84 Aquagenic Urticaria 91
Chronic Urticaria 85 Contact Urticaria 91
Physical Urticaria 88 Angioedema Without Urticaria 92
Dermographic Urticaria 88 Classification of Angioedema Without Urticaria 92
Delayed Pressure Urticaria 89 Non–C1 INH Deficient Angioedema Without Urticaria 92
Cold Urticaria 89 Hereditary Angioedema 93
Localized Heat Urticaria 90 Acquired C1 INH Deficiency Angioedema 93
Solar Urticaria 90 Evidence-Based Medicine 94
Vibratory Urticaria (Angioedema) 91 Bibliography 94
12. Atopic Dermatitis . . . . . . . . . . . . . . . . .  . . . . . . . . 95
Satoshi Yoshida, MD, PhD, FACP, FAAAAI, FACAAI
Pathogenesis of Atopic Dermatitis 95 Avoidance of Allergens 100
Immunohistology of atopic Dermatitis 95 Avoidance of Exacerbation Factors 101
Cutaneous Infections: Role for Superantigens 96 Probiotics 101
The Diagnosis of Atopic Dermatitis 97 Topical Corticosteroids 101
Differential Diagnosis 98 Topical Calcineurin Inhibitors 103
Complications 98 Specialized Therapy 104
The Treatment of Atopic Dermatitis 98 Future Perspective 105
Skin Hydration and Moisturizers 99 Evidence-Based Medicine 105
Avoidance of Irritancy 99 Diagnosis 105
Treatment for Pruritus and Deterrent Management (Indirect Outcome) 105
to Skin Scratching 100 Bibliography 105
13. Allergic Contact Dermatitis . . . . . . . . . . . . . . . . . . . . 107
Bettina Wedi, MD, PhD
Definition, Classification, Epidemiology 107 Patch Test Procedure 109
Recognizing Those at Risk 107 Repeat Open Application Test 112
Pathogenesis 107 Angry Back or Excited Skin Syndrome 112
Immunology 107 Pitfalls 112
Histology 108 Management 113
Clinical Symptoms 108 Evidence-Based Medicine 113
Diagnosis 109 Bibliography 114
14. Pediatric Asthma . . . . . . . . . . . . . . .. . . 115
Sixto F. Guiang, MD
Epidemiology of Pediatric Asthma 115 Goals of Treatment 119
Asthma in the Preschool––Age Child 116 Definition of Good Control 119
Natural History of Childhood Asthma 117 Managing Bronchial Asthma in Children 119
Will My Child Outgrow Peak Flow Monitoring 121
the Asthma? 117 Immunotherapy as a Treatment Option 121
Diagnosis of Asthma in the Older Child When does Referral to an Asthma Specialist
or Adolescent 117 Become Desirable? 121
Assessing Severity of the Disease Before Evidence-Based Medicine 122
Initiation of Therapy 118 Bibliography 123
15. Adult Asthma . . . . . . . . . . . . . . . . .  . . . . . . . . 124
Eric C. Chenworth, DO and Daniel E. Maddox, MD
Definition 124 Asthma Exacerbations 130
Epidemiology 124 Maintaining Asthma Control 131
Pathogenesis 124 Special Considerations in the Management
Asthma Diagnosis 125 of Adult Asthma 132
Diagnostic Studies 126 Pregnancy and Asthma 132
Asthma Management 129 Heart Disease and Asthma 132
Classification of Severity 129 Chronic Obstructive Pulmonary Disease and Asthma 132
Management 129 Evidence-Based Medicine 132
Exercise-Induced Asthma 130 Bibliography 133
16. Exercise-Induced Asthma . . . . . . . .  . . . . . . . . . . . . . 134
Laura H. Fisher, MD and Timothy J. Craig, DO
Clinical Characteristics 134 Scuba 142
Diagnosis 135 Hiking 143
Pathophysiology 137 Scuba Diving and EIA: Evidence-Based Medicine 143
Treatment 139 Conclusion 143
Special Considerations 141 Bibliography 143
Olympics 142
17. Occupational Asthma . . . . . . . . . . . . . . . . . . . . . . . . . 145
Jonathan A. Bernstein, MD
Definition 145 Immunologic Assessment 151
Historical Perspective: Incidence and Prevalence 145 Physiologic Assessment 152
Pathogenesis 146 Clinical Assessment of Occupational Asthma 153
Mechanisms of Occupational Asthma 146 Treatment 154
Genetics of Occupational Asthma 146 Prevention and Immunosurveillance 154
Diagnosis of Occupational Asthma 147 Evidence-Based Medicine 155
History 147 Bibliography 155
Differential Diagnosis 148
viii / CONTENTS
18. Asthma and Pregnancy . . . . . . . . . .  . . . . . . . . . . 156
Peg Strub, MD
Adverse Pregnancy Outcomes for Patients Education 158
with Asthma 156 Smoking 158
Physiology 156 Triggers 158
Maternal Respiratory Physiology 156 Treatment Plans 158
Maternal Cardiovascular Physiology 156 Medications 158
Maternal Gastroesophageal Reflux 156 Treatment Guidelines 161
Fetal Physiology 157 Exacerbations 164
Asthma Treatment During Pregnancy 157 Mechanical Ventilation 164
Assessment of Asthma 157 Conclusion 164
Assessment of the Fetus 157 Evidence-Based Medicine 164
Reassurance 158 Bibliography 167
19. Pseudoasthma: When Cough, Wheezing, and Dyspnea Are Not Asthma . . . . . . . . . . . . . . . 168
Miles Weinberger, MD and Mutasim Abu-Hasan, MD
What is Asthma? 168 Partial Airway Obstruction 172
When isn’t it Asthma? 168 Vocal Cord Dysfunction Syndrome 173
Cough that is not Asthma 168 Dyspnea that is not Asthma 173
Other Inflammatory Airway Diseases 168 Hyperventilation 173
Cystic Fibrosis 168 Exertional Dyspnea 173
Tracheomalacia and Bronchomalacia 170 Conclusion 174
Habit Cough Syndrome 171 Evidence-Based Medicine 175
Other Rare Causes of Chronic Cough 171 Bibliography 176
Wheezing that is not Asthma 172
20. Hypersensitivity Pneumonitis . . . . . . .. . . . . . . . . . 177
Joshua Gibbs, DO and Timothy J. Craig, DO
Epidemiology 177 Pulmonary Function Testing 185
Prevalence 177 Bronchoscopy 185
Incidence 177 Histologic Analysis 185
Immunopathogenesis 181 Video-Assisted Thorascopic Surgery 186
Overview 181 Environmental History 186
Acute Phase of Hypersensitivity Pneumonitis 181 Environmental Sampling 186
Subacute Phase of Hypersensitivity Pneumonitis 181 Challenge Methods 187
Chronic Phase of Hypersensitivity Pneumonitis 182 Diagnostic Criteria 187
Clinical Presentation 182 Treatment 187
Acute Presentation 182 Avoidance of Antigen 187
Radiography and Pulmonary Function Testing 183 Environmental Remediation 187
Subacute Presentation 183 Corticosteroids 188
Radiography and Pulmonary Function Testing 183 Prognosis 188
Chronic Presentation 183 Evidence-Based Medicine 188
Diagnosis 183 Conclusion 189
Laboratory Findings 184 Bibliography 189
Radiographic Evaluation 184
21. Allergic Bronchopulmonary Aspergillosis .. . . . . . . 190
Satoshi Yoshida, MD, PhD, FACP, FCCP, FAAAAI, FACAAI
Pathogenesis 190 Treatment 193
Diagnosis 190 Evidence-Based Medicine 194
Staging 191 Diagnosis 194
Radiology 192 Management 194
Laboratory Findings 192 Bibiliography 194
22. Serum Sickness and Immune Complex Disease . . . . . . . . 195
Michael R. Nelson, MD, PhD
Discovery 195 Laboratory 199
Definition 195 Differential Diagnosis 200
Epidemiology 195 Natural History 201
Pathophysiology 196 Management 201
Immune Complexes 196 Monitoring 201
End-Organ Damage Mediated by Therapeutic Options 201
Immune Complexes 197 Prevention 203
Human Disease 197 Future Directions and Evidence-Based Medicine 203
Triggers 197 Conclusion 203
Symptoms and Signs 198 Bibliography 204
Diagnosis 199
Clinical 199
23. Complement Systems and Allergy Diseases . . . . . . . . 206
Marianne Frieri, MD, PhD
The Complement System 206 Autoimmune Urticaria 212
Pathways and Physiologic Activities 206 Complement Therapeutics in Clinical Practice 212
Biologic Properties of Complement Fragments Evidence-Based Medicine 213
Related to Allergic Diseases 206 Bibliography 214
Cellular Receptors and Regulators 208
Clinical Associations 208
Immunomodulation of Autoimmunity
with Intravenous Immune Globulin
and Mechanisms of Immunomodulation 210
24. Food Allergy . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . 215
Oscar L. Frick, MD, PhD
Mucosal Immunity and Tolerance 215 Prick Skin Tests 218
Pathogenesis 215 In Vitro Tests 219
Allergens 215 Basophil-Degranulation Tests 219
Cross-Reacting Food Allergens 216 Atopy Patch Tests 219
Clinical Manifestations 216 Food Elimination Diets 219
Skin 216 Management and Treatment 220
Gastrointestinal Tract 216 Elimination Diet 220
Respiratory 218 Pharmaceuticals 220
Genitourinary 218 New Experimental Approaches 220
Central Nervous System 218 Hypoallergenic Foods 220
Diagnosis 218 Evidence-Based Medicine 220
Oral Food Challenges 218 Bibliography 220
25. Insect Allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Donald F. German, MD, FAAAAI, FACAAI
Stinging insects, Classification, Immunotherapy 226
and Characteristics 222 Reactions to Immunotherapy 227
Venoms 223 Duration of Immunotherapy 227
Insect Sting Reactions, Classification 224 Biting Insect Hypersensitivity 227
Normal Reaction 224 Insect Bite Reactions 228
Toxic Reaction 224 Antigens 228
Local Reactions 224 Immune Response to Insect Bites 228
Systemic Reactions 224 Diagnosis 229
Unusual Reactions 224 Treatment 229
Natural History of Sensitivity 224 The Future 229
Diagnosis 225 Evidence-Based Medicine 229
Treatment of Insect Sting Reactions 225 Bibliography 230
26. Latex Allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Donald F. German, MD, FAAAAI, FACAAI
History 231 Diagnosis 232
Epidemiology 231 Management 234
Natural Rubber Latex Products, The Future 234
Production, and Allergens 231 Evidence-Based Medicine 234
Pathogenesis 232 Bibliography 235
27. Drug Allergy . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 236
Schuman Tam, MD, FACP, FAAAAI
Classification 236 Evidence-Based Medicine 243
Type A Drug Reaction 236 Absence of Cross-Reactivity Between Sulfonamide
Type B Drug Reaction 236 Antibiotics and Sulfonamide Nonantibiotics 243
Immunologic Drug Reaction (Drug Allergy) 236 The Risk of a Course of Penicillin Resensitizing the Patient
Immunologic Drug Reaction Based on Gell and with a Positive History but Negative Skin Test Response
Coombs Classification 236 is Low 244
Diagnosis of Drug Reaction/Allergy 238 Recent Advances 245
Clinical Assessment 238 The Role of T Cells in Drug Reaction 245
Diagnostic Investigation 238 Noncovalent Interactions of Drugs with Immune Receptors
Graded Drug Challenge (Test Dosing) 240 May Mediate Drug-Induced Hypersensitivity Reactions 245
Management 240 Diagnostic Testing for T-Cell-Mediated (Type IV)
General Considerations 240 Drug Reaction 245
Desensitization 240 Bibliography 245
Special Considerations 240
28. Smoke, Pollution, and Allergies . . . . . . . . . . . . . . . . . 247
Haig Tcheurekdjian, MD and Massoud Mahmoudi, DO, PhD
Characteristics of Pollutants 247 Diesel Exhaust 250
Indoor Versus Outdoor Pollution 247 Nitrogen Dioxide 250
Actions of Pollution 247 Ozone 251
Characteristics of Individuals 248 Particulate Matter 251
Respiratory Tract Development 248 Sulfur Oxides 252
Immune System Development 249 Conclusion 252
Specific Pollutants 249 Evidence-Based Medicine 252
Tobacco Smoke 249 Bibliography 253
29. Sick Building Syndrome . . . . . . . . . . . . . . . . . . . . . 254
Massoud Mahmoudi, DO, PhD
Is Sick Building Syndrome an Allergic Condition? 254 Characteristics of a Healthy Building Environment 255
Etiology of Sick Building Syndrome 254 How to Prevent Sick Building Syndrome 256
Stachybotrys Chartarum and Human Diseases 254 Management of Sick Building Syndrome 256
Where are the Molds Found? 254 Evidence-Based Medicine 257
Identification of Molds in the Building 254 Bibliography 257
Symptoms 255
30. Allergy in the Elderly . . . . . . . . . . . . . . . . .. . . . . . . 258
Marianne Frieri, MD, PhD
Chronic Rhinitis and Sinusitis 258 Evidence-Based Medicine 261
Asthma in the Elderly 258 Bibliography 261
Other Allergic Conditions 258
Acquired Angioedema, Anaphylaxis,
Food and Drug Allergy 258
CONTENTS / xi
31. Diagnostic Testing in Allergic Diseases . . .  . . . . . . . . . . 262
Paul Cheng, MD, PhD, FAAAAI
Percutaneous Allergy Testing 262 In Vitro Measurement of Allergen-Specific Immunoglobulin E 264
Prick/Puncture Method 262 Allergy Testing with no Proven Value 265
Intradermal Testing 263 Evidence-Based Medicine: Newer Trends in Allergy Testing 265
Diagnostic Value of Percutaneous Allergy Testing 264 Bibliography 265
32. Primary Immunodeficiencies . . . . . . . . . . . . . . . . . . . . . 266
Pedro C. Avila, MD
When to Suspect Immunodeficiency and How Other forms of Combined Cellular and
to Work It Up 266 Humoral Deficiencies 283
Antibody Deficiencies 267 Bare Lymphocyte Syndromes Class I and II 283
X-Linked Agammaglobulinemia 267 Omenn Syndrome 283
Transient Hypogammaglobulinemia of Infancy 270 Wiskott-Aldrich Syndrome 283
Common Variable Immunodeficiency 270 Ataxia Telangiectasia 284
Hyper IgM Syndrome 271 X-Linked Lymphoproliferative Disease or
Other Forms of Hyper-IgM Syndrome Duncan Syndrome 284
(Autosomal Recessive Forms) 272 Phagocyte Deficiencies 284
Selective IgA Deficiency 272 Neutropenic Syndromes 284
Other Antibody Deficiencies 273 Congenital Neutropenia or Kostmann Syndrome 284
Immunoglobulin Replacement Therapy 273 Chédiak-Higashi Syndrome 285
Complement Deficiencies 275 Chronic Granulomatous Disease 285
Laboratory Evaluation of the Other Enzyme Deficiencies 286
Complement System 276 Glucose-6-Phosphatase Dehydrogenase Deficiency 286
Treatment of Complement Deficiencies 277 Myeloperoxidase Deficiency 287
Cellular Immunodeficiencies 277 Hyper-IgE Syndrome or Job Syndrome 287
DiGeorge Syndrome 277 Leukocyte Adhesion Deficiency Type 1 287
Chronic Mucocutaneous Candidiasis 278 Leukocyte Adhesion Deficiency Type 2 288
Immunodysregulation, Polyendocrinopathy, Deficiency in the IL12/IFN-γ Pathway 288
Enteropathy, X-Linked Syndrome 278 Evidence-Based Medicine 288
Autoimmune Lymphoproliferative Syndrome 278 Prenatal Diagnosis 288
Other Cellular Deficiencies 279 Gene Therapy for Immunodeficiencies 288
Combined Cellular and Humoral Bibliography 288
Immunodeficiencies 280 Web-Based Resources 289
Severe Combined Immunodeficiencies 280
33. HIV Infection . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 290
Mitchell H. Katz, MD and Andrew R. Zolopa, MD
Pathophysiology of HIV 290 Hypersensitivity Reactions 297
Immunologic consequences of HIV Infection 290 Immune Reconstitution Inflammatory Syndrome 297
Treatment of HIV Infection 291 Evidence-Based Medicine 298
Antiretroviral Treatment 291 Resources 298
Prophylaxis of Opportunistic Infections 296 Bibliography 298
Treatment of HIV Manifestations 297
34. Complementary and Alternative Medicine in the Treatment
of Allergic and Asthmatic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Jennifer Heimall, MD and Leonard Bielory, MD
What is Complementary and Alternative Medicine? 299 How Modalities have been Studied to Date 300
Definitions and Descriptions of Commonly Identifying Patients most Likely to Use CAM 300
Used Modalities 299 Epidemiology of CAM Use 300
Herbal Therapies 299 Why Patients May Use CAM 301
Homeopathy 299 Identifying Populations Likely to Use CAM 301
Acupuncture 299 Screening for CAM Use by Patients 302
Ayurveda 300
Behavior Modification Techniques 300
Modalities Commonly Used in the Treatment Nontraditional Immunotherapy 304
of Asthma 302 Behavioral Techniques and Behavior Modification 304
Herbals 302 Ethical and Legal Issues Raised by Patient’s Use of CAM 304
Acupuncture 302 Side Effects of CAM 304
Homeopathy 302 Significant Interactions with Western Therapies 307
Behavioral Techniques and Behavior Risks Associated with Lack of Western
Modification 303 Therapeutic Involvement 307
Modalities Commonly Used in the Treatment of Liability Risks for Physicians 308
Allergic Rhinoconjunctivitis 303 Conclusion 308
Herbals 303 Evidence-Based Medicine 308
Acupuncture 303 CAM in the Prevention of Allergic and Asthmatic Disease 308
Homeopathy 304 Bibliography 309
35. Nutrition, Diet, and Allergic Diseases  . . . . . . . . . . . . . . . . . 310
Avraham Giannini, MD
Controlling One’s Destiny 310 Evidence-Based Medicine 313
Historical Perspective 310 Conclusion 313
Dietary Guidelines 311 Bibliography 313
Supplements with an Eye on Allergy 311
36. Prevention and Control Measures in the Management of Allergic Diseases . . . . . . . . . . . . . 315
Shuba Rajashri Iyengar, MD, MPH and Massoud Mahmoudi, DO, PhD
Indoor Allergens 315 Outdoor Allergens 318
Dust Mite 315 Background 318
Control Strategies 315 Control Strategies 319
Animal Dander 316 Evidence-Based Home intervention Methods 319
Cockroach 317 Bibliography 319
Control Strategies 318
37. Antihistamines and Mast Cell Stabilizers . . . . . . . . . . . . . . . . . . . . . . 321
Giselle S. Mosnaim, MD, MS and Timothy J. Craig, DO
Mechanism of Allergic Disease 321 Mast Cell Stabilizers 327
Antihistamine Mechanism of Action 321 Intranasal Chromomes/Mast Cell Stabilizers 327
Antihistamines 321 Intraocular Mast Cell Stabilizers 327
Oral First-Generation Antihistamines 321 Conclusion 327
Oral Second-Generation Antihistamines 322 Evidence-Based Medicine 327
Topical Nasal Antihistamines 326 Bibliography 327
Topical Skin Antihistamines 326
Ocular Antihistamines and Antihistamine/Mast
Cell Stabilizer Combination Products 326
38. Bronchodilators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Jennifer S. Kim, MD and Rachel E. Story, MD, MPH
Pharmacology of Bronchodilators 329 Devices for Aerosolized Administration
β-Agonists 329 of β-Agonists 331
β-Adrenoreceptors 329 Metered-Dose Inhalers 331
Mechanism of Action and Cellular Effects 329 Nebulizers 331
Structure and Development Dry Powder Inhalers 331
of β-Adrenergic Agents 329 Clinical Use of Bronchodilators for Acute
Short-Acting Nonselective β-Agonists 329 Severe Asthma 332
Short-Acting Selective β2-Agonists 330 Selective Short-Acting β-Agonists 332
Long-Acting Selective β2-Agonists 330 Second-Line Agents for Acute Severe Asthma 332
Enantiomers 330 Long-Acting β2-Agonists 332
Xanthines 330 Long-Term Control Medication Use in Asthma 332
Magnesium Sulfate 330 Short-Acting β-Agonists 332
Routes of Administration for β-Agonists 331 Long-Acting β-Agonists 332
Methylxanthines 333 Evidence-Based Medicine 333
Exercised-Induced Bronchospasm 333 Bibliography 334
Adverse Effects and Safety of β-Agonists 333
Adverse Effects of β-Agonists 333
Safety of β-Agonists 333
39. Glucocorticoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Joseph D. Spahn, MD
Chemistry 335 Available Inhaled Glucocorticoids 343
Mechanisms of Action 335 Dose/Frequency of Use 343
Systemic Glucocorticoid Therapy 335 Adverse Effects of Inhaled GC Therapy 345
Pharmacokinetics 335 Intranasal Glucocorticoids for the Treatment
Efficacy of Oral Glucocorticoid Therapy of Allergic Rhinitis 346
in Asthma 338 Antiinflammatory Effects 346
Adverse Effects of Chronically Administered Clinical Efficacy 346
Systemic Glucocorticoids 340 Adverse Effects of Nasal Glucocorticoid Therapy 346
Inhaled Glucocorticoid Therapy 342 Conclusion 347
Efficacy of Inhaled Glucocorticoid Therapy 342 Evidence-Based Medicine 347
Inhaled Glucocorticoids as First-Line Therapy 343 Bibliography 348
40. Anti–Immunoglobulin E Therapy . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . 349
Kari C. Nadeau, MD, PhD
Background 349 Other Indications 353
Immunoglobulin E and Inflammation 349 Food Allergy 353
Measurement of IgE for Diagnostic Purposes 350 Allergic Rhinitis 353
Anti-IgE Therapy 350 Atopic Dermatitis 354
Anti-IgE Therapy in Asthma 350 Immunotherapy 354
Studies Using Anti-IgE in Asthma 350 Evidence-Based Medicine 354
Route of Administration 351 Randomized Controlled Study Using Anti-IgE
Efficacy 351 in Rush Immunotherapy 354
Pediatric Trials 352 Use of Anti-IgE Therapy Reduces Leukotrienes in
Studies Using Anti-IgE Therapy in Pediatric Children with Allergic Rhinitis 354
Subjects with Asthma 352 Future Directions 355
Cost-Effectiveness Studies 352 Conclusion 355
Omalizumab Indicated for Treatment of Asthma 353 Bibliography 355
Recommended Dosing 353
Indicated Patient Population 353
41. Allergy Immunotherapy . . . . . . . . . . . . . . . . .. . . . . . . 356
Jeffrey R. Stokes, MD and Thomas B. Casale, MD
Indications 356 Immunotherapy in General Practice 359
Mechanism 356 Efficacy and Outcomes 359
Contraindications 356 Evidence-Based Medicine 360
Dosing 357 Conclusion 360
Safety 358 Bibliography 360
Treatment of Anaphylaxis 359
42. Anaphylaxis and Its Management . . . . . . . . . . . . . . . . 362
Sharon E. Leonard, MD and Lawrence Schwartz, MD, PhD
Definition 362 Latex 364
Pathophysiology 362 Miscellaneous 365
Cells 362 Epidemiology 365
Mediators 363 Overall Incidence 365
Etiology 363 Foods 365
Foods 363 Drugs 365
Drugs 364 Insects 365
Insects 364 Latex 365
Diagnosis and Differential Diagnosis 365 Treatment 367
Signs and Symptoms 365 Acute 367
Time Course 366 Prevention 370
Laboratory Diagnosis 366 Evidence-Based Medicine and Future Directions 370
Differential Diagnosis 367 Bibliography 371
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373


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