In our office we routinely perform skin testing to identify contributing factors involving Hayfever, Asthma, Eczema and numerous other Allergy sensitivities. We also perform Bee Venom testing, identifying patients at risk for severe reactions. We will successfully provide immunotherapy for these and other allergies, such as Pollen, Dust, Dander, Mold and Bee sensitivities. Drug allergies can also be diagnosed by a thorough history. When indicated, skin testing can be done to penicillin along with desensitization if necessary. We treat local anesthetic allergies as well. Chronic coughs are a common concern and can sometimes indicate Asthma. We provide pulmonary (lung) function testing to identify the difference. The advantage an allergist has over a pulmonologist is the ability to identify and treat possible underlying factors in your environment such as Dust or Animal Dander. The following is a partial list describing some common allergies:

Allergic rhinitis is also known as hay fever. It is very common, affecting about 1 in 5 adults in the USA. Typical signs for having nasal allergies are frequent sneezing, runny nose or stuffiness. People often complain of an irritating cough or a drip in the back of their throat. Some feel popping of their ears, itching of the ears, nose, or mouth. If the congestion gets severe, patients may have headaches. Fatigue and lack of restful sleep at night due to allergies is a major reason why people seek treatment for their allergies. These people may also experience irritability and poor school or work performance.
What are nasal allergies caused by?
Allergies result when our immune system overreacts to substances in our environment. Common triggers for seasonal allergy problems are pollen (from tree, grass, weeds) or mold spores. Indoor allergies are often caused by pet dander, dust mite or mold. Some people may experience year-round symptoms that worsen during peak pollen seasons.
Can nasal allergies lead to any further problems?
People with nasal allergies get sinus and ear infections more easily. Some patients with long-standing allergies can develop nasal polyps or they may develop asthma.
How are allergies diagnosed?
A detailed history of the particular problem is the first step, particularly asking for timing of symptoms compared with exposure to allergens. A physical exam can identify sign of allergy such as nasal congestion, post-nasal drip, polyps, etc. Skin tests can be done on children and adults and can identify the particular allergen causing the nasal allergies. Skin testing is quick and it is extremely reliable.
How can nasal allergies be treated?
There are many ways of treating allergies and each person’s treatment plan must be customized based on the frequency, severity and duration of their symptoms. The first step is to eliminate or reduce allergen exposure.
Avoidance Measures
Dust mite covers for mattress and pillow
Vacuum cleaner with HEPA filter
Air purifiers with HEPA filters
Keep car and house windows closed and use air-conditioning in the summer, if possible.
Do not hang clothing outdoors to dry because pollen may cling to towels and sheets.
Avoid strenuous activity during times of high pollen counts (highest between 5 and 10 am usually), check pollen counts at www.aaaai.org/naib
Allergic Rhinitis Treatments:

• Antihistamines work by blocking the effects of histamine, a chemical that causes many allergy symptoms. They relieve the itching and sneezing, but are not very strong for congestion. Examples include Claritin, Zyrtec and Allegra. Older antihistamines such as Benadryl can make you drowsy, but work just as well.
• There are also antihistamine nasal sprays, which are slightly better than oral antihistamines in treating nasal congestion (Astelin, Astepro or Patanase). Antihistamines also can be used in eye drops for allergic eye problems (Optivar, Patanol)
• Decongestants reduce swelling in the nasal passages, opening up the airways. Oral decongestants may increase blood pressure. Nasal decongestants (like Afrin) are very efficient but should not be used for more than 3-5 days. If used beyond that short time frame, they can lead to worse congestion over time.
• Steroid nasal sprays work by reducing the swelling in the nasal passages while also treating the itchiness, dripping and sneezing (Flonase, Nasonex, and Rhinocort).
• Leukotriene modifiers like Accolate, Singulair, and Zyflo can help control nasal allergy symptoms.

Sinusitis

Sinuses are empty cavities within your cheek bones, around your eyes and behind your nose. Their main job is to warm, moisten and filter air in your nasal cavity.
If your stuffy nose and cough last longer than one or two weeks, you may have more than a cold. Sinusitis (pronounced sine-you-SITE-iss) is a swelling of one or more of your nasal sinuses and nasal passages. It is often called a sinus infection.
You may experience pressure around your nose, eyes or forehead, a stuffy nose, thick, discolored nasal drainage, bad-tasting post-nasal drip, cough, head congestion, ear fullness or a headache. Symptoms may also include a toothache, tiredness and, occasionally, a fever.
By learning more about sinusitis, you will have a better understanding of your symptoms.
An allergist/immunologist, often referred to as an allergist, can make an accurate diagnosis and develop a treatment plan that works for you.
Types and Causes of Sinusitis
Acute sinusitis refers to sinusitis symptoms that last less than four weeks. Most acute sinusitis starts as a regular cold from the common cold viruses and then becomes a bacterial infection. Chronic sinusitis is when symptoms last three months or longer. The cause of chronic sinusitis is believed to be a combination of swelling and infection. Recurrent sinusitis occurs when three or more acute episodes happen in a year.
Allergies or "hay fever" put you at risk for developing sinusitis because allergies can cause swelling of the sinuses and nasal mucous linings. This swelling prevents the sinus cavities from draining, and increases your chances of developing secondary bacterial sinusitis.
If you test positive for allergies, your allergist can prescribe appropriate medications to control your allergies, possibly reducing your risk of developing an infection. In rare cases, immune problems that harm your ability to fight common infections may present with chronic or recurrent sinusitis.
Problems with the structure of your nose-such as narrow drainage passages, tumors or a shifted nasal septum (the bone and cartilage that separate the right from the left nostrils)-can also cause sinusitis. Surgery is sometimes needed to correct these problems. Many patients with recurring or chronic sinusitis have more than one factor that puts them at risk of infection. So, an accurate diagnosis is essential.
Diagnosis
To diagnose sinusitis, an allergist will take a detailed history and perform a physical examination. He or she may also order tests. These tests can include allergy testing, sinus CT scans (which take exact images of the sinus cavities) or a sample of your nasal secretions or lining.
Your physician may also perform an endoscopic examination. This involves inserting a narrow, flexible endoscope (a device with a light attached) into the nasal cavity through the nostrils after local anesthesia. This allows your physician to view the area where your sinuses drain into your nose in an easy, painless manner.
Treatment
Sinus infections generally require a mix of therapies. Your physician may prescribe a medication to reduce blockage or control allergies, which helps keep the sinus passages open. This medicine may be a decongestant, a mucus-thinning medicine or a steroid nasal spray. If bacterial sinusitis is present, your physician may prescribe an antibiotic. For people with allergies, long-term treatment to control and reduce allergic symptoms can also help in preventing sinusitis.
Several non-drug treatments can also be helpful. These include breathing in hot, moist air and washing the nasal cavities with salt water. If you need surgery to fix the structure of your nose, your allergist may refer you to an otorhinolaryngologist, or an ear-nose-throat physician (ENT).
Sinusitis Versus Rhinitis
Symptoms of sinusitis and rhinitis are very similar. Rhinitis is a swelling of the mucous membranes of the nose while sinusitis includes swelling of the sinuses in addition to the nasal passages. For this reason, sinusitis is often called rhinosinusitis.
Rhinitis may be allergic or non-allergic. Allergic rhinitis is caused by allergens in the air, which are usually harmless but can cause problems in allergic people. Symptoms of allergic rhinitis often are a runny nose, sneezing, nasal congestion and itchy eyes, nose, throat and ears. People with non-allergic rhinitis usually just have a stuffy nose. It may be caused by irritants such as smoke, changes in barometric pressure or temperature or overuse of over-the-counter decongestant nasal sprays.
Your allergist can perform simple tests to determine if your symptoms are from sinusitis or rhinitis. The American Academy of Allergy, Asthma & Immunology's brochure on Rhinitis offers also more helpful advice on allergic and non-allergic rhinitis.
Healthy Tips

• Sinusitis is a swelling of the nose and sinuses.
• Acute sinusitis occurs when symptoms last less than four weeks.
• Chronic sinusitis occurs when symptoms last more than three months.
• People with allergies are at greater risk of getting sinus infections.
• Treatment for sinusitis is available. See an allergist for help managing your symptoms.

Asthma

Asthma is a chronic disease that affects about 20 million Americans. Its primary cause is inflamed airways in the lungs. This inflammation makes the airways smaller, which makes it more difficult for air to move in and out of the lungs. Asthma is the most common serious disease among children. Nine million children in the United States have asthma.
Signs that you might have asthma include:

• Coughing
• Wheezing
• Shortness of breath
• Chest tightness

• Pregnancy: Uncontrolled asthma can harm the health of a mother and her baby.
• Work situations: Fumes, gases or dust that are inhaled at work can trigger asthma.
• Age: Older people with asthma face unique health challenges.
• Exercise: Some people may have asthma symptoms when they exercise.
• Medications: Medications like aspirin and ibuprofen, or beta-blockers (used to treat heart disease, high blood pressure, migraine headaches or glaucoma), may cause an asthma attack in some adults.

Triggers and managemnt:
If you have asthma, you can minimize your symptoms and improve your quality of life by avoiding your asthma triggers and working with your allergist/immunologist, often referred to as an allergist, to develop a treatment plan.
Triggers
People with asthma have recurrent episodes of airflow limitation, often from inflamed airways that become narrowed, making it more difficult to move air in and out of their lungs. This can cause wheezing, cough, chest tightness and shortness of breath.
It is important to understand what triggers your symptoms and what makes them go away. Common asthma triggers include:

• Many people with asthma have allergies, which can trigger asthma symptoms. Common allergens include house dust mites, animal dander (dead skin flakes), molds, pollen, cockroach droppings or foods. Your allergist can identify what you are allergic to and recommend ways to avoid exposure to your triggers.
• Tobacco smoke, which is an irritant that often aggravates asthma. No one should smoke around you in your home or your car. Your asthma may also be irritated by strong odors or fumes, weather changes or air pollution.
• Viral and bacterial infections such as the common cold and sinusitis.
• Strenuous exercise or exposure to cold, dry air.
• Acid reflux, even if you do not experience heartburn. This diagnosis can be hard to make and treatment is different from most asthma medications, so talk to your allergist.
• Some medications can cause or worsen asthma. These include aspirin or other non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen; and beta-blockers (used to treat heart disease, high blood pressure, migraine headaches or glaucoma).
• Even eating certain foods can trigger wheezing in some people. If any foods seem to trigger an asthma attack, avoid eating them and talk to your allergist.
• Emotional anxiety may also increase your asthma symptoms and trigger an attack. Proper rest, diet and exercise are important for your overall health and can help in managing asthma.

• Environmental control measures to avoid your asthma triggers
• Medication
• An asthma action plan
• A partnership between you, your family, your allergist and other healthcare providers

• Your asthma symptoms can be triggered by allergens, tobacco smoke, colds or sinus infections, exercise, reflux disease, medications, weather changes or emotions and occasionally, foods.
• Each person has their own triggers and avoidance of these triggers can help improve your asthma.
• Quick-relief medications provide temporary relief of asthma symptoms, while long-term controller medications are taken on a regular basis to control airway inflammation or prevent frequent asthma symptoms.
• Work with your allergist to ensure that your asthma is well-controlled and interferes with your daily life as little as possible.

Food allergies

Some people think that food allergies can cause all kinds of diseases from sneezing, rash to behavior problems, headaches and seizures. The typical food allergy however presents with nausea, vomiting, hives, lip/mouth swelling, diarrhea, possibly faintness within minutes of exposure to the culprit food. For typical food allergies the culprit food in most cases is in the following groups:

• Tree nuts
• Peanut
• Shellfish
• Fish
• Egg
• Milk
• Soy
• Wheat

• After taking a good history and examination, the allergist usually performs skin testing for the foods in question. A small amount of extract gets introduced by scratching into the skin. After 15 minutes the test can be interpreted by an allergist.
• A blood test for allergies can also be performed and can be helpful to follow the level of allergy to food over the years. It can aid in monitoring if a child outgrows a food allergy.
• Oral allergy syndrome can be diagnosed by testing for the pollen allergy and testing with fresh fruits or vegetables in question.
• For the slower food allergies like eczema or the intestinal disorders, testing can be difficult. Some allergists do patch testing for foods, but there is not standardized test. It is mainly performed at Academic centers. A trial of food avoidance with step-by-step reintroduction can be helpful in diagnosis as well.

Everyone reacts to medications differently. One person may develop a rash while taking a certain medication, while another person on the same drug may have no adverse reaction. Does that mean the person with the rash has an allergy to that drug?
All medications have the potential to cause side effects, but only about 5% to 10% of adverse reactions to drugs are allergic.
Whether allergic or not, reactions to medications can range from mild to life-threatening.
It is important to take all medications exactly as your physician prescribes. If you have side effects that concern you, or you suspect a drug allergy has occurred, call your physician. If your symptoms are severe, seek medical help immediately.
Allergic Reactions
Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to a particular medication, your immune system identifies that drug as an invader or allergen. Your immune system reacts by producing antibodies called Immunoglobulin E (IgE) to the drug. These antibodies travel to cells that release chemicals, triggering an allergic reaction. This reaction causes symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin.
Most allergic reactions occur within hours to two weeks after taking the medication and most people react to medications to which they have been exposed in the past. This process is called "sensitization." However, rashes may develop up to six weeks after starting certain types of medications.
One of the most severe allergic reactions is anaphylaxis (pronounced an-a-fi-LAK-sis). Symptoms of anaphylaxis include hives, facial or throat swelling, wheezing, light-headedness, vomiting and shock.
Most anaphylactic reactions occur within one hour of taking a medication or receiving an injection of the medication, but sometimes the reaction may start several hours later. Anaphylaxis can result in death, so it is important to seek immediate medical attention if you experience these symptoms.
Antibiotics are the most common culprit of anaphylaxis, but more recently, chemotherapy drugs and monoclonal antibodies have also been shown to induce anaphylaxis.
Rarely, blisters develop as a result of a drug rash. Blisters may be a sign of a serious complication called Steven-Johnson Syndrome where the surfaces of your eye, lips, mouth and genital region may be eroded.
Toxic epidermal necrolysis (TEN), where the upper surface of your skin detaches like in a patient who has suffered burns, is another type of severe cutaneous adverse reaction. You should seek medical help immediately if you experience any of these. Certain medications for epilepsy (seizures) and gout are often associated with these severe skin reactions.
A number of factors influence your chances of having an adverse reaction to a medication. These include: body size, genetics, body chemistry or the presence of an underlying disease. Also, having an allergy to one drug predisposes one to have an allergy to another unrelated drug. Contrary to popular myth, a family history of a reaction to a specific drug does not increase your chance of reacting to the same drug.
Non-Allergic Reactions
Symptoms of non-allergic drug reactions vary depending on the type of medication. People being treated with chemotherapy often suffer from vomiting and hair loss. Other people experience flushing, itching or a drop in blood pressure from intravenous dyes used in x-rays or CT scans. Certain antibiotics irritate the intestines, which can cause stomach cramps and diarrhea. If you take ACE (angiotension converting enzyme) inhibitors for high blood pressure, you may develop a cough or facial and tongue swelling.
Some people are sensitive to aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs). If you have aspirin or NSAID sensitivity, certain medications may cause a stuffy nose, itchy or swollen eyes, cough, wheezing or hives. In rare instances, severe reactions can result in shock. This is more common in adults with asthma and in people with nasal polyps (benign growths).
Taking Precautions
It is important to tell your physician about any adverse reaction you experience while taking a medication. Be sure to keep a list of any drugs you are currently taking and make special note if you have had past reactions to specific medications. Share this list with your physician and discuss whether you should be avoiding any particular drugs or if you should be wearing a special bracelet that alerts people to your allergy.
When to See an Allergist/Immunologist
If you have a history of reactions to different medications, or if you have a serious reaction to a drug, an allergist/immunologist, often referred to as an allergist, has specialized training to diagnose the problem and help you develop a plan to protect you in the future.
Healthy Tips

• Allergic drug reactions account for 5% to 10% of all adverse drug reactions. Any drug has the potential to cause an allergic reaction.
• Symptoms of adverse drug reactions include cough, nausea, vomiting, diarrhea, high blood pressure and facial swelling.
• Skin reactions (i.e. rashes, itching) are the most common form of allergic drug reaction.
• Non-steroidal anti-inflammatory drugs, antibiotics, chemotherapy drugs, monoclonal antibodies, anti-seizure drugs and ACE inhibitors cause most allergic drug reactions.
• If you have a serious adverse reaction, it is important to contact your physician immediately.

Hives

If you have red, bumpy, scaly, itchy or swollen skin, is it because of a skin allergy?
There are several types of allergic skin conditions. They are often itchy and red and may appear scaly, bumpy or swollen. An allergist/immunologist, often referred to as an allergist, is the most qualified physician to treat allergic diseases. An allergist can determine which condition you have and develop a treatment plan to help you feel better.
While skin allergies are unpleasant and troublesome, there are things you can do to treat them.
Hives and Angioedema
Hives (or urticaria) are red, itchy, raised areas of the skin that can range in size and appear anywhere on your body. Most common are acute cases, where food or drug allergies are triggers. These hives usually go away within a few days. In cases of chronic hives, people may suffer for months to years.
Angioedema is a swelling of the deeper layers of the skin that sometimes occurs with hives. Angioedema is usually not red or itchy. The areas often involved are the eyelids, lips, tongue, hands and feet.
Food or drug reactions are a common cause of acute hives and/or angioedema. Viral or bacterial infection can also trigger hives in both adults and children. Physical urticaria are hives resulting from a non-allergic source: rubbing of the skin, cold, heat, physical exertion or exercise, pressure and direct exposure to sunlight.
If the cause of your hives can be identified, you should avoid that trigger. With acute hives, some drugs or foods may take days to leave the body, so your allergist may prescribe antihistamines to relieve your symptoms until that happens.
Contact Dermatitis
When certain substances come into contact with your skin, they may cause a rash called contact dermatitis. Irritant contact dermatitis is often more painful than itchy, and is caused by a substance damaging the part of your skin it comes into contact with. The longer your skin is in contact with the substance, or the stronger the substance is, the more severe your reaction will be. These reactions appear most often on the hands and are frequently work-related.
Allergic contact dermatitis is best known by the itchy, red, blistered reaction experienced after you touch poison ivy. This allergic reaction is caused by a chemical in the plant called urushiol. You can have a reaction from touching other items the plant has come into contact with. However, once your skin has been washed, you cannot get another reaction from touching the rash or blisters. Allergic contact dermatitis reactions can happen 24 to 48 hours after contact. Once a reaction starts, it takes 14 to 28 days to go away, even with treatment.
Nickel, perfumes, dyes, rubber (latex) products and cosmetics also frequently cause allergic contact dermatitis. Some ingredients in medications applied to the skin can cause a reaction, most commonly neomycin, an ingredient in antibiotic creams. For irritant contact dermatitis, you should avoid the substance causing the reaction. You should also avoid spilling chemicals on your skin. Gloves can sometimes be helpful. Since these reactions are non-allergic, avoiding the substance will relieve your symptoms and prevent lasting damage to your skin.
Treatment for allergic contact dermatitis depends on how severe the symptoms are. Cold soaks and compresses can offer relief for the acute, early, itchy blistered stage of your rash. You may also be prescribed topical corticosteroid creams. To prevent the reaction from returning, avoid contact with the offending substance. If you and your allergist cannot determine the substance that caused the reaction, your allergist may conduct a series of patch tests to help identify it.

Eczema

A common allergic reaction often affecting the face, elbows and knees is atopic dermatitis or eczema. This red, scaly, itchy rash is more common in young infants and those who have a personal or family history of allergy.
Common triggers include aeroallergens like cat dander or house dust, overheating or sweating, and contact with irritants like wool or soaps. In older individuals, emotional stress can cause a flare-up. For some patients, usually children, certain foods can also trigger eczema. Skin staph infections can cause a flare-up in children as well. Eczema patients usually have very dry skin and “allergic shiners” (an extra crease, called a Dennie’s line, across their lower eyelids). They are also more at risk for other skin infections.
Preventing the eczema itch is the main goal of treatment. Do not scratch or rub your rash. Applying cold compresses and creams or ointments is helpful. Also remove all irritants that aggravate your condition from your environment. If a food is identified as the cause, it must be eliminated from your diet.
Topical corticosteroid cream medications and topical calcineurin inhibitors are most effective in treating the rash. Antihistamines are often recommended to help relieve the itchiness. In severe cases, oral corticosteroids are also prescribed. If a skin staph infection is suspected to be a trigger for your eczema flare-up, antibiotics are often recommended.
Healthy Tips

• If you have red, bumpy, scaly, itchy or swollen skin, you may have a skin allergy.
• Hives (or urticaria) are red, itchy, raised areas of the skin that can range in size and appear anywhere on your body. Angioedema is a swelling of the deeper layers of the skin that often occurs with hives.
• When certain substances come into contact with your skin, they may cause a rash called contact dermatitis.
• The red, scaly, itchy rash often affecting the face, elbows and knees is called atopic dermatitis or eczema.
• If you have eczema, avoid scratching or rubbing your rash to prevent an infection.
• An allergist can help figure out which allergic skin condition you have and take steps to treat it.

Allergic skin diseases

If you have red, bumpy, scaly, itchy or swollen skin, is it because of a skin allergy?
There are several types of allergic skin conditions. They are often itchy and red and may appear scaly, bumpy or swollen. An allergist/immunologist, often referred to as an allergist, is the most qualified physician to treat allergic diseases. An allergist can determine which condition you have and develop a treatment plan to help you feel better.
While skin allergies are unpleasant and troublesome, there are things you can do to treat them.
Hives and Angioedema
Hives (or urticaria) are red, itchy, raised areas of the skin that can range in size and appear anywhere on your body. Most common are acute cases, where food or drug allergies are triggers. These hives usually go away within a few days. In cases of chronic hives, people may suffer for months to years.
Angioedema is a swelling of the deeper layers of the skin that sometimes occurs with hives. Angioedema is usually not red or itchy. The areas often involved are the eyelids, lips, tongue, hands and feet.
Food or drug reactions are a common cause of acute hives and/or angioedema. Viral or bacterial infection can also trigger hives in both adults and children. Physical urticaria are hives resulting from a non-allergic source: rubbing of the skin, cold, heat, physical exertion or exercise, pressure and direct exposure to sunlight.
If the cause of your hives can be identified, you should avoid that trigger. With acute hives, some drugs or foods may take days to leave the body, so your allergist may prescribe antihistamines to relieve your symptoms until that happens.
Contact Dermatitis
When certain substances come into contact with your skin, they may cause a rash called contact dermatitis. Irritant contact dermatitis is often more painful than itchy, and is caused by a substance damaging the part of your skin it comes into contact with. The longer your skin is in contact with the substance, or the stronger the substance is, the more severe your reaction will be. These reactions appear most often on the hands and are frequently work-related.
Allergic contact dermatitis is best known by the itchy, red, blistered reaction experienced after you touch poison ivy. This allergic reaction is caused by a chemical in the plant called urushiol. You can have a reaction from touching other items the plant has come into contact with. However, once your skin has been washed, you cannot get another reaction from touching the rash or blisters. Allergic contact dermatitis reactions can happen 24 to 48 hours after contact. Once a reaction starts, it takes 14 to 28 days to go away, even with treatment.
Nickel, perfumes, dyes, rubber (latex) products and cosmetics also frequently cause allergic contact dermatitis. Some ingredients in medications applied to the skin can cause a reaction, most commonly neomycin, an ingredient in antibiotic creams. For irritant contact dermatitis, you should avoid the substance causing the reaction. You should also avoid spilling chemicals on your skin. Gloves can sometimes be helpful. Since these reactions are non-allergic, avoiding the substance will relieve your symptoms and prevent lasting damage to your skin.
Treatment for allergic contact dermatitis depends on how severe the symptoms are. Cold soaks and compresses can offer relief for the acute, early, itchy blistered stage of your rash. You may also be prescribed topical corticosteroid creams. To prevent the reaction from returning, avoid contact with the offending substance. If you and your allergist cannot determine the substance that caused the reaction, your allergist may conduct a series of patch tests to help identify it.
Eczema
A common allergic reaction often affecting the face, elbows and knees is atopic dermatitis or eczema. This red, scaly, itchy rash is more common in young infants and those who have a personal or family history of allergy.
Common triggers include aeroallergens like cat dander or house dust, overheating or sweating, and contact with irritants like wool or soaps. In older individuals, emotional stress can cause a flare-up. For some patients, usually children, certain foods can also trigger eczema. Skin staph infections can cause a flare-up in children as well. Eczema patients usually have very dry skin and “allergic shiners” (an extra crease, called a Dennie’s line, across their lower eyelids). They are also more at risk for other skin infections.
Preventing the eczema itch is the main goal of treatment. Do not scratch or rub your rash. Applying cold compresses and creams or ointments is helpful. Also remove all irritants that aggravate your condition from your environment. If a food is identified as the cause, it must be eliminated from your diet.
Topical corticosteroid cream medications and topical calcineurin inhibitors are most effective in treating the rash. Antihistamines are often recommended to help relieve the itchiness. In severe cases, oral corticosteroids are also prescribed. If a skin staph infection is suspected to be a trigger for your eczema flare-up, antibiotics are often recommended.
Healthy Tips

• If you have red, bumpy, scaly, itchy or swollen skin, you may have a skin allergy.
• Hives (or urticaria) are red, itchy, raised areas of the skin that can range in size and appear anywhere on your body. Angioedema is a swelling of the deeper layers of the skin that often occurs with hives.
• When certain substances come into contact with your skin, they may cause a rash called contact dermatitis.
• The red, scaly, itchy rash often affecting the face, elbows and knees is called atopic dermatitis or eczema.
• If you have eczema, avoid scratching or rubbing your rash to prevent an infection.
• An allergist can help figure out which allergic skin condition you have and take steps to treat it.

Allergic eye diseases

Conjunctivitis is an inflammation of the conjunctiva. This is the mucous membrane covering the white of the eyes and the inner side of the eyelids. If something irritates this clear membrane, your eyes may water, itch, hurt, or become red or swollen.
In some people, conjunctivitis is due to an allergy. In these instances, the condition is called either allergic conjunctivitis or ocular allergy. It can occur alone, or it may be associated with nasal allergy symptoms. Unlike conditions such as pink eye, allergic conjunctivitis is not contagious.
A recent study reported by Leonard Bielory, MD, FAAAAI, states that ocular allergies may be more common than nasal allergies in some areas, especially in the southern United States. And, while most people treat nasal allergy symptoms, they often ignore their itchy, red, watery eyes.
CAUSES AND TRIGGERS
If you have an allergy, your immune system identifies something as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction. This reaction usually causes symptoms in the nose, lungs, throat, sinuses, intestinal tract or the eyes.
The most common allergen is pollen, which is seasonal. People with seasonal allergic conjunctivitis, or rhinoconjuntivitis will experience symptoms at certain times during the year - usually from early spring, into summer, and even into autumn (fall). Those with perennial allergic conjunctivitis are susceptible at any time of year. These irritations may be triggered by perfumes, cosmetics, skin medicines, or environmental allergens such as air pollution or second-hand smoke.
SYMPTOMS
Most people suffering from allergic conjunctivitis have problems in both eyes. Symptoms may appear quickly, soon after the eyes have come into contact with the allergen. The most common symptom occurs when the eyes become irritated, the capillaries (small blood vessels) widen and the eyes become pink or red. Some people experience pain in one or both eyes. Other symptoms include swollen eyelids, a burning sensation, sore or tender eyes.
TREATMENT
According to Dr. Bielory, about 50% of conjunctivitis cases seen by primary care physicians are actually allergic in nature. There are many different treatment options, depending upon the severity of the symptoms.
As with any allergy, the first approach for successful management of seasonal or perennial forms of eye allergy should be prevention or avoidance of the allergens that trigger your symptoms. The AAAAI Outdoor Allergens brochure offers tips on avoiding triggers.
However, avoidance of airborne allergens isn’t always possible. That is when medications may be helpful.
Over-the-counter (OTC) eye drops and oral medications are commonly used for short-term relief of some eye allergy symptoms. However, they may not relieve all symptoms, and prolonged use of some OTC eye drops may actually make your symptoms worse.
Prescription eye drops and oral medications can also treat eye allergies. Prescription eye drops provide both short- and long-term targeted relief of eye allergy symptoms, and they can be used to manage eye allergy symptoms in conjunction with an oral antihistamine that might be taken to manage nasal allergy symptoms.
Dr. Bielory recommends that any medication placed in the eye should be kept in the refrigerator.
An allergist/immunologist can determine which treatment for allergic conjunctivitis is best for you. An allergist can also test for other allergies, as ocular allergy rarely occurs alone.
(from AAAAI.org)

Latex allergies

Natural rubber latex is a milky fluid found in rubber trees. The problem is not with the rubber itself, but a contaminating protein in the rubber. Natural rubber latex is used to make some gloves, condoms, balloons, rubber bands, erasers and toys. Latex can also be found in bottle nipples and pacifiers. It may be surprising, but latex paints do not contain any natural rubber latex protein.
Latex allergy was unusual until the late 1980s when more healthcare workers began using powdered latex gloves to control infections. In the 1990s, manufacturers found ways to make gloves with synthetic latex and/or powder-free, so the number of new cases has decreased.
Reactions to Latex
Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. If you have an allergy, your immune system identifies something that is typically harmless as an invader or allergen. With latex allergy, it overreacts by producing antibodies called Immunoglobulin E (IgE) that can react with proteins found in the natural rubber latex. These antibodies travel to cells that release chemicals, causing an allergic reaction. This reaction usually appears in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin.
People with this allergy have symptoms such as urticaria or hives, itching or flushing, swelling, sneezing, runny nose, cough, wheeze, shortness of breath, chest tightness, nausea, dizziness or lightheadedness. Any combination of these symptoms can be a sign of anaphylaxis (pronounced an-a-fi-LAK-sis), a life-threatening reaction that needs immediate medical attention.
Certain other chemicals used to make latex gloves can cause a delayed onset rash which only forms where the material touches the skin. This is called contact dermatitis. Red, itchy bumps or blisters usually appear within 12 to 48 hours. These symptoms are irritating, but not life-threatening.
Latex can also become airborne and cause respiratory symptoms. For example, latex proteins can attach to the cornstarch powder used in latex gloves. As powdered latex gloves are used, the starch particles and latex allergens become airborne, where they can be inhaled or come into contact with your nose or eyes and cause symptoms. High concentrations of this allergenic powder have been measured in intensive care units and operating rooms. Using non-powdered latex gloves, or synthetic (vinyl, nitrile) gloves reduces the risk of these reactions. The capacity of latex products-especially gloves-to cause allergic reactions varies enormously by brand and by production lot.
Treating Latex Allergy
The first step in treating latex allergy is being aware of the problem. An allergist/immunologist, often referred to as an allergist, has the knowledge and experience to diagnose the problem and develop a treatment plan.
Your allergist may prescribe an antihistamine to take for mild latex allergy symptoms. Your allergist may also prescribe epinephrine, or adrenalin, to keep with you in case you have a severe reaction to latex. Your physician can help decide whether you should wear a bracelet that alerts people about your allergy.
If your allergy is severe, it is important to tell your family, employer, school personnel and healthcare providers about your allergy. If you need surgery, ask that everything be latex-free.
If you have trouble breathing when you are around latex, stay away from areas where powdered gloves are used and avoid all direct contact with latex.
If you need to wear gloves, try substituting vinyl or nitrile gloves for latex. Synthetic latex gloves do not contain natural latex and are another option. These work in nearly all situations, including surgery, but they may be more expensive. If you tend to get a skin rash reaction to latex, latex gloves made without additional chemicals may be a good choice.
Latex condoms may cause serious allergic reactions in some people. If either partner has a latex allergy, synthetic rubber condoms are the best choice, although natural skin condoms may be used.
Who is Most at Risk?
Healthcare and rubber industry workers are at more risk for developing serious allergic reactions to latex. Also at increased risk are people who have had multiple medical procedures or surgeries. This is because the greatest danger of a severe reaction happens when latex comes in contact with moist areas of the body, such as during surgery.
If you have a latex allergy, you also have a greater risk of being allergic to certain foods including bananas, avocadoes, kiwi fruit and European chestnuts. These foods and latex share certain proteins which cause a reaction in people with this allergy.
Healthy Tips

• People who react to latex typically develop a skin rash. This is irritating, but not life-threatening.
• There is no cure for latex allergy. People with severe reactions must avoid latex.
• If you have trouble breathing when you are around latex, or if you get a combination of symptoms, get immediate medical attention. These symptoms include hives, itching or flushing, swelling, sneezing, runny nose, cough, wheeze, shortness of breath, chest tightness, nausea, dizziness or lightheadedness.
• An allergist is the best physician to determine if you are allergic to latex.
• The 1990 Americans with Disabilities Act (ADA) covers people with severe allergies to substances such as latex. Talk with your employer about your options.

Insect allergies

When most people are stung by an insect, the site develops redness, swelling and itching. However, some people are actually allergic to insect stings. This means that their immune systems overreact to the venom.
If you are insect-allergic, after the first sting, your body produces antibodies called Immunoglobulin E (IgE). If stung again by the same kind of insect, the venom interacts with this specific IgE antibody, triggering the release of substances that cause an allergic reaction.
Symptoms of a Severe Reaction
For a small number of people with venom allergy, stings may be life-threatening. This reaction is called anaphylaxis (pronounced an-a-fi-LAK-sis). Symptoms may include two or more of the following: itching and hives, 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. If you have these symptoms after an insect sting, get emergency medical treatment. After this treatment, you should also ask for a referral to an allergist/immunologist, often referred to as an allergist, to learn how to stay safe in the future.
Identifying Stinging Insects
To avoid stinging insects, it is important to identify them.
Yellow jackets' nests are made of a paper-maché material and are usually located underground, but can sometimes be found in the walls of frame buildings, cracks in masonry or woodpiles.
Honeybees and bumble bees are non-aggressive and will only sting when provoked. However, Africanized honeybees (AKA "killer bees") found in the Southwestern United States are more aggressive and may sting in swarms. Domesticated honeybees live in man-made hives, while wild honeybees live in colonies or "honeycombs" in hollow trees or cavities of buildings.
Paper wasps' nests are usually made of a paper-like material that forms a circular comb of cells which opens downward. The nests are often located under eaves, behind shutters, or in shrubs or woodpiles.
Hornets are usually larger than yellow jackets. Their nests are gray or brown, football-shaped and made of a paper material similar to that of yellow jackets' nests. Hornets' nests are usually found high above ground on branches of trees, in shrubbery, on gables or in tree hollows.
Fire ants build nests of dirt in the ground that may be quite tall (18 inches) in the right kinds of soil.
Preventing Stings
Stay away! These insects are most likely to sting if their homes are disturbed, so it is important to have nests around your home destroyed.
If flying stinging insects are close by, remain calm and move slowly away. Avoid brightly colored clothing and perfume when outdoors. Because the smell of food attracts insects, be careful outdoors when cooking, eating or drinking sweet drinks like soda or juice. Beware of insects inside straws or canned drinks. Keep food covered until eaten. Wear closed-toe shoes outdoors and avoid going barefoot. Also, avoid loose-fitting garments that can trap insects between material and skin.
Treating Stings
If the insect left its stinger in your skin, remove the stinger within 30 seconds to avoid receiving more venom. A quick scrape of your fingernail removes the stinger and sac. Avoid squeezing the sac-this forces more venom through the stinger and into your skin. For all stinging insects, try to remain calm, and brush these insects from the skin. Then immediately leave the area.
The following steps can help in treating local reactions to insect stings:

• Raise the affected limb and apply a cold compress to reduce swelling and pain
• Gently clean area with soap and water to prevent secondary infections; do not break blisters
• Use topical steroid ointments or oral antihistamines to relieve itching
• See your physician if swelling progresses or if the sting site seems infected

• Symptoms of a non-allergic insect sting include redness, swelling and/or itching at the site of the sting.
• Symptoms of an allergic reaction may include itching and hives, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea.
• An allergist is the best physician to diagnose stinging insect allergy and provide a treatment plan designed to keep you safe and healthy.
• If you have a serious reaction, get emergency medical treatment and then follow-up with your allergist.

Allergy shots

Immunotherapy is as close to a cure of allergies as we can get currently. It is a form of treatment aiming at decreasing sensitivity to allergens. Allergens, such as pollen, mold, animal dander or dust mite, are substances that causes allergy problems like sneezing, itching, cough, stuffiness. During immunotherapy, patients are injected with increasing amounts of allergen over several months. Our body reacts by developing a tolerance to the allergens. Therefore allergy symptoms decrease. In several studies, immunotherapy was shown to reduce allergy symptoms, prevent new allergies or worsening of allergies in adults and children. It is particularly helpful for nasal and eye allergies, asthma and stinging insect allergy.
Currently there is no established immunotherapy for food allergies, avoidance is currently the standard of care.
There are two phases of immunotherapy:

• Build-up phase: during this 6-9 month period the amount of allergen get increased slowly and injections are typically every week (or twice per week if desired).
• Maintenance phase: When the effective dose of allergen is reached, we call it maintenance dose and keep it stable without further increases. At this point the interval between the shots gets increased slowly to finally once per month. Overall immunotherapy should be continued for 3-5 years or longer. Patients sometimes notice improvement of their allergy symptoms as early as 3 months into immunotherapy, but it may take as long as 12 month or the maintenance dose to notice an improvement. If no improvement is noticed after one 1 year on maintenance therapy, treatment alternatives should be considered.

Pet allergies

There is no such thing as a hypoallergenic dog or cat. Even President Barack Obama would not be able to find a hypoallergenic dog, as I told WebMD recently. There are dogs who may shed less or have less hair or are smaller, but every dog or cat has the allergen in their blood.
If someone has a pet allergy, it is best not to have that pet in the house. Other options are to at least keep the bedroom a pet-free zone, use air purifiers, or get allergy shots for pets.
We all know how hard it is to say goodbye to a loved family pet, but it may be necessary if someone’s allergies get to a certain degree. If a person develops asthma and maybe requires ER visits or hospitalization, it is time to think about getting rid of the pet.
I often advise my “allergic” families to try pet sitting first before they acquire a pet to try out if there will be any problems.

Indoor allergies
Millions of people suffer from allergy symptoms caused by indoor allergens, such as house dust mite droppings, animal dander, cockroach droppings and molds. The symptoms are the result of a chain reaction that starts in the genes and is expressed in the immune system.
Your immune system controls how your body defends itself. For instance, if you have an allergy to dust mites, your immune system identifies dust mites as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction. This reaction usually causes symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin.
With the help of an allergist/immunologist, often referred to as an allergist, you can learn what indoor allergens cause your symptoms and make environmental changes to avoid them.
Controlling Dust Mites
Dust mite allergens-the most common trigger of allergy and asthma symptoms-are found throughout the house, but thrive in bedding and soft furnishings. Because so much time is spent in the bedroom, it is essential to reduce mite levels there.
Encase mattresses, box springs and pillows in special allergen-proof fabric covers or airtight, zippered plastic covers. Bedding should be washed weekly in hot water (130° F) and dried in a hot dryer. Cover comforters and pillows that can't be regularly washed with allergen-proof covers.
Keep humidity low by using a dehumidifier or air conditioning. Wall-to-wall carpeting should be removed as much as possible. Instead, throw rugs may be used if they are regularly washed or dry cleaned.
People with allergies should use a vacuum with a HEPA (high-efficiency particulate) filter or a double-layered bag, and wear a dust mask-or ask someone else to vacuum.
Controlling Pet Allergens
People are not allergic to an animal's hair, but to an allergen found in the saliva, dander (dead skin flakes) or urine of an animal with fur. Usually, symptoms occur within minutes.
For some people, symptoms build and become most severe eight to 12 hours after contact with the animal. People with severe allergies can experience reactions in public places if dander has been transported on pet owners' clothing.
There are no "hypoallergenic" breeds of cats or dogs. The same is true for any animal with fur, so it's best to remove the pet from the home and avoid contact if you're highly allergic. Keeping an animal outdoors is only a partial solution, since homes with pets in the yard still have higher concentrations of animal allergens. Before getting a pet, ask your allergist to determine if you are allergic to animals.
If you cannot avoid exposure, try to minimize contact and keep the pet out of the bedroom and other rooms where you spend a great deal of time. While dander and saliva are the source of cat and dog allergens, urine is the source of allergens from rabbits, hamsters, mice and guinea pigs; ask a non-allergic family member to clean the animal's cage.
As with dust mites, vacuum carpets often or replace carpet with a hardwood floor, tile or linoleum. Some studies have found that using a HEPA air cleaner may reduce animal allergen exposure.
Controlling Cockroaches
An allergen in cockroach droppings is a main trigger of asthma symptoms, especially for children living in densely populated, urban neighborhoods.
Block all areas where roaches could enter the home, including crevices, wall cracks and windows. Cockroaches need water to survive, so fix and seal all leaky faucets and pipes. Have an exterminator go through the house when your family and pets are gone to eliminate any remaining roaches.
Keep food in lidded containers and put pet food dishes away after your pets are done eating. Vacuum and sweep the floor after meals, and take out garbage and recyclables. Use lidded garbage containers in the kitchen. Wash dishes immediately after use and clean under stoves, refrigerators or toasters where crumbs can accumulate. Wipe off the stove and other kitchen surfaces and cupboards regularly.
Controlling Indoor Molds
Indoor molds and mildew need dampness, such as found in basements, bathrooms or anywhere with leaks. Clean up mold growth on hard surfaces with water, detergent and, if necessary, 5% bleach (do not mix with other cleaners). Then dry the area completely. If mold covers an area more than 10 square feet, consider hiring an indoor environmental professional. For clothing, washing with soap and water is best. If moldy items cannot be cleaned and dried, throw them away.
Promptly repair and seal leaking roofs or pipes. Using dehumidifiers in damp basements may be helpful, but empty the water and clean units regularly to prevent mildew from forming. All rooms, especially basements, bathrooms and kitchens, require ventilation and cleaning to deter mold and mildew growth. Avoid carpeting on concrete or damp floors, and storing items in damp areas.
See your allergist for more suggestions.
Healthy Tips

• Your allergist can help you identify things in your home, workplace or school that may be making your asthma or allergies worse.
• Keep your home clean and dry to help make it "allergen-free."
• Focus on sites where allergens accumulate-bedding, carpet and upholstered furniture.
• Weekly vacuuming can help. Use a vacuum with a HEPA filter or double bags.
• Keep humidity low by using an air conditioner or dehumidifier.
• Fix leaks to avoid mold, and clean or remove moldy materials promptly.
• Avoid pests by keeping food in sealed containers and using covered garbage cans.

Alternative therapies

Risks of herbal medicine for the allergy patient
By Clifford W. Bassett, MD, FAAAAI
According to recent data, approximately three-quarters of the world’s population have used herbal supplements. Most individuals use these herbal medicines to enhance their health, as well as to actively treat medical or health symptoms. Allergy and cold complaints are among of the main reasons that individuals utilize non-traditional therapy.
The National Center for Complementary and Alternative Medicine at the National Institutes of Health (NIH) found over one-third of U.S. adults use alternative treatment for health, as reported in a 2002 study. While prescription drugs in the U.S. undergo rigorous evaluation by the FDA for safety and efficacy, the Dietary Supplement Health and Education Act classifies vitamins and herbs as dietary supplements rather than food or drugs. Supplements are therefore not subject to the same regulations and screening as prescription medications. The FDA can remove any supplement that is deemed unsafe or that makes false claims from the market. In 1992 the NIH inaugurated the National Center for Complementary and Alternative Therapy, and has been charged with investigating such therapies (http://nccam.nih.gov).
Side Effects and Risks with Herbal Medicines

• "Natural" doesn’t always mean safe. Like prescription drugs, herbs can cause unwanted side effects, as well as interact with other medications.
• Molds as well as other contaminants have been found in herbal preparations. There have been recent reports of heavy metals being found in some Asian herbal products.
• Herbal remedies made from plants can cause “allergic” type reactions, such as a skin rash, as well as inducing symptoms of asthma. Ingredients may be omitted or incorrect. Aspirin and steroidal substances have been found in these preparations without being notated on the label.
• Taking large quantities of herbs can produce unwanted symptoms and can be dangerous. Many herbs have drug-like effects on the body.
• According to a study in the Journal of the American Medical Association (JAMA), roughly 15 million adults are at risk for possible adverse interactions between prescription medicines and herbs. Even herbs that are considered safe can have side effects under certain conditions. For instance, some herbs can act adversely with anesthesia, causing problems.
• The safety of herbal supplementation in pregnancy or lactation is unknown. It is advised that you consult with your doctor or pharmacist before taking any supplements. Dietary supplements may also interact with prescription and over-the-counter medications.
• Lack of product standardization in the industry is not uncommon.

• Herbal teas may contain leaves and/or pollens in which a seasonal allergic patient may have sensitivity towards.
• Alternative herbal supplements that have been advocated in the therapy of allergic diseases: Butterbur, Bromelain, Quercetin, Stinging nettle, and Vitamin C.
• Caution should be used with Echinacea for those who have sensitivity to ragweed since they are in the same family. The use of chamomile may cause similar allergic-type symptoms, especially in ragweed pollen sensitive persons.
• Echinacea can cause a worsening of seasonal allergies. If you have a sunflower seed and/or melon sensitivity, you may also react to Echinacea. You might use this supplement to fight off a cold and wind up with a worsening allergy-type reaction.
• Be vigilant for any reactions after taking herbal supplements, such as nasal, sinus and respiratory symptoms, particularly if you have asthma.
• Ginkgo biloba, aloe, stinging nettle, evening primrose have been purported for the use in the treatment of asthma and allergic diseases: These herbs can induce gastrointestinal distress. Bee pollen and royal jelly may cause interactions with drug associated effects with diabetes medications.