Download allergy clinic - dr. abr desai ent clinic, mumbai

People who have allergies can live healthy and active lives.
THEY CAN BE HELPED!!
What is an Allergy?
An allergy is the body's immune system response to specific elements in
the environment. Children with allergies react to certain substances in
their everyday environment, which usually don't cause reactions in other
children.
IF BOTH PARENTS HAVE ALLERGIES, THEIR (BIOLOGICAL) CHILD HAS A 75 PERCENT
CHANCE OF HAVING ALLERGIES. IF ONE PARENT IS ALLERGIC, OR IF RELATIVES ON
ONE SIDE OF THE FAMILY HAVE ALLERGIES, THEN THE CHILD HAS ABOUT A 50
PERCENT CHANCE OF DEVELOPING ALLERGIES.
Allergies are incredibly common. Allergies are of many types: If your allergies bother you only at
certain times of year, like in the spring when the trees begin to bloom, you have "hay fever," or
seasonal nasal allergies. If your allergies seem to be with you all year long, you have perennial
nasal allergies.
You can also have food and drug allergies, latex allergies, insect allergies, skin allergies and
eye allergies.
THE MAIN PROBLEM IS THAT NASAL ALLERGIES AND ASTHMA OFTEN
GO HAND IN HAND!!
Causes of Nasal Allergies
An allergy is a sensitivity to a substance called an allergen. Nasal allergies are most commonly
caused by one or more of four kinds of allergens: pollen, house-dust mites, mold, and animals.
Because pollen is a problem only during certain times of the year, it usually causes seasonal
nasal allergies. House-dust mites, mold, and animals may be around all year long, and so
usually cause perennial nasal allergies. Other substances, called irritants, can bother the nose
and make allergy symptoms worse.
Pollen
It's the wind-blown pollen that causes nasal allergies. The amount of pollen in the air varies from
season to season.
House-Dust Mites
House-dust mites are tiny bugs too small to see. They can live in mattresses, blankets, stuffed
toys, and carpets. The droppings of these mites are a common indoor cause of nasal allergies.
Mold
Mold loves dark, damp areas. It tends to grow in bathrooms, basements, refrigerators, and in
the soil of houseplants. Their spores can cause a nasal allergic reaction as well as polyps.
Animals
Pets such as cats, dogs, birds, horses, and rabbits are common causes of nasal allergies.
Irritants Make Allergies Worse
Although irritants don't cause nasal allergies, they can bother the nose and make allergy
symptoms worse. Cigarette smoke, perfume, aerosol sprays, smoke from wood stoves or
fireplaces, car exhaust, and strong odors are examples of irritants.
Allergy Testing
What is allergy testing?
If you have a stuffy nose, trouble breathing (especially in the summer), or hives after eating
certain foods, you may have an allergy. Allergy tests can help you and your doctor find out if
these problems are caused by an allergy and which things you are allergic to. That way you can
stay away from the things that trigger your allergic reaction.
What kinds of allergy tests are available?
There are several types of specific allergy tests. There are skin and blood tests for allergies.
Immediate-type hypersensitivity (IgE) skin tests are typically used to test for airborne allergens,
foods, insect stings, and penicillin. Immediate-type hypersensitivity also can be evaluated
through serum IgE antibody testing called radioallergosorbent testing (RAST).
Delayed-type hypersensitivity skin tests (patch-type skin tests) are commonly used in patients
with suspected contact dermatitis. Some common allergens for patch testing are rubber,
medications, fragrances, vehicles or preservatives, hair dyes, metals, and resins.
About 15 minutes after the application of to skin, the test site is examined for a wheal and flare
reaction. A positive skin test reaction (typically, a wheal 3 mm greater in diameter than the
negative control reaction, accompanied by surrounding erythema) reflects the presence of mast
cellbound IgE specific to the tested allergen.
Skin tests are used most of the time. There are three main kinds of skin tests. The first kind is
called a "scratch" or a "prick" test. Positive-control skin tests (histamine) and negative-control
skin tests (diluent) are essential for correct interpretation of skin test reactions. A tiny drop of
testing allergen fluid is placed on your skin. Then, the skin is pricked through the drop. After 15
minutes, the test site is checked for redness and swelling. There's a "prick" sensation when the
testing is applied, but it doesn't hurt a lot. Usually, about 240 prick tests are needed for a full
exam.
Intra-dermal Tests: In the second kind of skin test, the testing fluid is injected into your skin
(like a shot). This test is used to check for allergy to medicines (most often penicillin) and beesting allergy.
The third kind of skin test is called a patch test. A small patch of material soaked in testing fluid
is taped on your skin. After 2 or 3 days, your doctor will take off the patch and look for redness
and swelling in your skin. Patch tests are used to evaluate rashes caused by allergy to things that
might rub against your skin.
Some commonly used medicines, like pain killers and antihistamines, can interfere with
skin tests. If you take these medicines, you have to stop taking them for at least 4 days
before skin tests can be done.
Why should I be tested for allergies?
It is not always necessary to have allergy tests. In some cases, it can be easier to skip the
tests and go straight to taking allergy medicines. There are a number of safe and
effective medicines that work well for most allergies. If these medicines do not work
for you, or if you have severe allergy reactions, allergy testing may be helpful.
Allergy tests can help you find out what you are allergic to. Once you know what
you are allergic to, you can try to stay away from it.
Having established a correct allergy diagnosis, the physician is better equipped to select
appropriate therapeutic interventions for that patient, such as allergen avoidance,
medications, and, sometimes, immunotherapy. For example, a patient with a specific
pollen allergy may be instructed to increase medication use during the pollen season.
Patients with an animal allergy may be instructed to use allergy or asthma medication
before exposure. After specific testing, avoidance measures can be targeted to allergens
to which the patient is known to be allergic.
Is allergy testing safe?
A retrospective study involving 18,311 patients found six mild systemic reactions over a
five-year period.
Is allergy testing accurate?
The sensitivity and specificity of percutaneous testing were 94 and 80 percent for upper
respiratory symptoms, respectively; 84 and 87 percent for lower respiratory symptoms;
A negative result for percutaneous testing indicated that a true allergy was unlikely.
The performance of percutaneous tests in the diagnosis of food allergy: The sensitivity
of percutaneous tests was 90 percent, with specificity 65 percent, depending on the food
extract used for testing. Negative reactions to suggested food allergens on percutaneous
tests make a diagnosis of true food allergy unlikely in most cases
Assays for Specific IgE Antibodies
In general, RAST and other laboratory methods for IgE testing are highly specific
but somewhat less sensitive than percutaneous tests. Results of laboratory testing
for food-specific IgE are generally poor, even less helpful than those for
percutaneous skin testing.
RAST or other laboratory testing is typically considered when skin testing is
inconvenient or difficult to perform. Most primary care physicians do not have
immediate access to a clinical skin testing laboratory, so RAST may be easier to obtain.
Some patients cannot undergo skin testing because of skin disease that would obscure
wheal and flare results (e.g., extensive atopic dermatitis) or because they cannot stop
taking medications that suppress the skin test response. In cases of life-threatening
allergy (e.g., anaphylaxis), laboratory testing is sometimes used as a proxy result,
keeping in mind its limited sensitivity.
Allergic Rhinitis
The most common allergy-mediated clinical problem where specific testing may be needed is
chronic rhinitis. Many physicians make a presumptive diagnosis of allergic rhinitis based on the
medical history.
Asthma:
Allergic asthma often shares the same allergic triggers as allergic rhinitis. It is important
to consider allergy and asthma as the manifestations of a hypersensitive “UNITED
AIRWAYS.”
The second National Heart, Lung, and Blood Institute (NHLBI) guideline on allergic
rhinitis & asthma management recommends that all allergic rhinitis & asthma patients
who require daily or weekly therapy be evaluated for allergens as possible contributing
factors.10 They also note that, in selected patients with asthma at any level of severity,
specific allergy testing may be indicated as a basis for allergen avoidance or
immunotherapy.
Part of this material is derived from: Copyright © 2002 by the American Academy of Family
Physicians. Permission is granted to print and photocopy this material for educational uses.
Treatment:
Initial Management of these patients is MEDICAL, & may include use of antihistamines,
decongestants, or intranasal steroids. This is a reasonable and effective approach in many
patients.
Allergen immunotherapy may be especially beneficial when avoidance and medications no
longer control the patient's symptoms.
In patients with significantly discomforting or disabling symptoms that
are NOT CONTROLLED with standard measures, surgery may also
rarely be prescribed as an option.
Where nasal obstruction is a predominant symptom, surgery remains
the method of choice for airway correction.
Surgery may involve any or all of the following:
Septoplasty
Reduction of the turbinate size to reduce the sensitivity
Ablation of the vidian nerve (the nerve responsible for a hyper-reactive
nose)
Re-establishment of blocked pathways for the sinuses to aerate (allow
sufficient oxygen to enter).
Immunotherapy
Allergen immunotherapy is a useful option in refractory cases of allergic rhinitis not
amenable to the usual control measures. Specific allergy testing can identify patients
likely to benefit from immunotherapy and provide guidance about which allergens to
include in the therapy regimen. Allergen immunotherapy may be especially beneficial
when avoidance and medications no longer control the patient's symptoms.
74 % of patients required less than 3 periodic topical and systemic steroid courses
per year over a 3 year period.
Tips For Controlling Allergens
Constant exposure to allergens means constant allergy symptoms. That's why
controlling or avoiding the allergens that cause your symptoms is an important
part of your treatment. The more you do to keep all allergens away from your nose,
the better you'll feel.
Pollen
Pollen is in the air whenever trees, grasses, or weeds are blooming, so it's hard to
avoid. But there are some things you can do to limit your exposure to pollen: After
spending time outdoors, change your clothes, and wash your hair before bed. Stay
indoors on windy days.
Mold
If you're allergic to mold, pay special
attention to areas where water tends to
collect. Here are some tips for avoiding
mold: Clean the bathroom shower or tub
regularly with bleach, and check the
shower curtain for mold growth.
Get leaky faucets or leaks in the roof
fixed right away.
While bathing or showering, leave a
window open or run a fan so moisture
can escape.
If your house is damp, use a
dehumidifier.
House-Dust Mites
House-dust mites are almost impossible to get rid of. But you can keep them under control. Try
some of these tips: Enclose your mattress, box spring, and pillows in allergy-proof casings.
Wash sheets, blankets, and mattress pads every 1 to 2 weeks in hot water Wash bedding in hot
water (at least 130°F) to kill house-dust mites. Warm or cold water won't kill them.
Remove stuffed animals and things that collect dust, such as wall hangings, knickknacks, and
books–especially in the bedroom.
Have as little carpeting as possible.
Each week, have your home dusted with a damp cloth and vacuumed.
If someone else can't dust and vacuum for you, take your medication before doing these
tasks. Wearing a filter mask may help.
Animals
The dander, saliva, and urine of animals are all allergens. Cats produce more of these allergens
than most other pets. Animal fur may also contain dust, mold, and pollen. The best way to avoid
animal allergens is not to have a pet. If you already have a pet and can't bear to part with it, try
to reduce your exposure as much as possible.
Use shades or vertical blinds instead of horizontal blinds, which collect dust. Replace drapes
with curtains that can be washed regularly.
Enclose mattresses, box springs, and pillows in allergy-proof casings. Use washable
blankets and quilts. Avoid feather pillows, down comforters, and wool blankets.
EXPOSE BEDDING TO SUNLIGHT!
Install a fan to keep the bathroom well ventilated.
Don't let wet clothing sit and grow mold. And don't hang clothes outside to dry where they can
collect airborne pollen. Dry clothing immediately in a clothes dryer that's vented to the outside.
Check stored food for spoilage and mold growth. Clean up spills right away.
Avoid dust-catching clutter. Have enclosed places to keep books, toys, and clothes. Keep
closet doors closed.
Use washable throw rugs wherever possible, or have bare floors.
Put filters over forced-air heating vents. Change the filters regularly.
Keep your car clean. Vacuum the seats and carpets regularly. If you have air conditioning, use
it instead of opening the windows.
Keep rain gutters clean. Remove leaves and debris that can grow mold.
Seal all the spaces between your cupboards and beds and the wall.
Do not use carpets.
Look for fungus on the walls and have the walls painted regularly.