During an Asthma attack, the following happen:
- The muscle surrounding the airway tightens.
- The lining of the airways become swollen.
- The mucus glands along the airways increase mucus production.
Symptoms of an attack.
- Wheezing - as air passes through the narrowed airways.
- Coughing - as the lungs try to dislodge the mucus.
- Difficulty in breathing - because the airways smaller and filled with mucus.
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Asthma Tirggers. Common cause of asthma attacks.
ALLERGIES
Food, pollens, animals, feathers, inects body parts and feces, sulfites (food preservative), dust
DUST
Cloth, upholstered furniture, bedding, carpets, draperies, brooms, dirty air filters on furnaces and air conditioners, pets.
EMOTIONS
Fear, anger, frustration, laughing too hard, crying, coughing, stress
EXERCISE
Wheezing may begin after overexertion, exercising in cold weather.
HOUSEHOLD PRODUCTS
Vapors from cleaning supplies, paints, solvents, sprays from furniture polish, starch, cleaners, room deodrizers.
INFECTIONS
Colds, other viruses: Bronchitis, Tonsillitis, Sinusitis.
EMPLOYMENT
Dust, vapors, or fumes from wood products, flour, cereals, coffee, tea, grains, metals, soldering fumes, welding fumes, cotton, flax, hemp, mold.
AIR POLLUTION
Changes in the weather, traffic jams, smog, parking jams, smoke filled rooms.
SMOKE
From cigarettes, cigars, pipes, second hand smoke.
WEATHER
Exercising in cold air, changes in the seasons.
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Diagnoses of Asthma.
The usual starting point is a visit to your doctor for a physical exam. This appointment will probably include:
A review of your family's health history
A discussion of your own personal medical history
A physical exam, during which your doctor will listen to your breathing.
Laboratory tests that measure lung function.
Tests for allergies.
Once you and your doctor know what kind of asthma you have, and what your asthma triggers are, you can work together to develop a treatment plan that meets your needs. This plan may include medication, lifestyle changes, and avoidance of triggers.
There are two kinds of medicines that are prescribed to treat asthma:
Maintenance medications such as anti-inflammatory drugs help to prevent and reduce inflammation and swelling of the airways. They are an important part of long-term management of asthma symptoms. Long-acting bronchodilators are also available for the long-term control of daytime symptoms, nocturnal asthma, and exercise-induced bronchospasm (EIB).
Quick-relief, or "rescue" medications such as short-acting bronchodilators help provide rapid relief to relax muscles around the airways.
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Management of Asthma.
You can take an active role in controlling your asthma symptoms by working with your doctor, taking your medication regularly, and making the lifestyle changes that can reduce your risks. Follow these guidelines for more successful asthma management:
- Eat right, exercise, and get enough rest.
- Know your personal asthma triggers and learn how to avoid them.
- Watch for warning signs of asthma episodes and take steps promptly.
- Stay calm when symptoms occur, and don't hesitate to seek help
If your medication does not seem to relieve your symptoms, seek medical care immediately. Make sure that your family, friends, and coworkers are aware that you have asthma, and show them how they can assist you if urgent help is needed. Be sure to keep emergency information and telephone numbers handy.
AVOIDING ASTHMA TRIGGERS
Although it's not reasonable to think you can completely eliminate asthma triggers, removing as many as possible from your home and work surroundings can help you enjoy a healthier life with fewer asthma episodes.
In your home
While it may be impossible to remove every trigger from your home, there are many things you can do to give yourself "breathing room":
- Air conditioning. Many airborne triggers can be captured in the filter of an air conditioning unit. If air conditioning every room is not an option for you, a single unit in your bedroom would probably be the best alternative. Be sure filters are changed regularly.
- Heating. If your home or apartment has forced-air heating, put a filter or a piece of cheesecloth over each vent to help trap airborne particles. Again, change these filters regularly.
- Dust control. Heavy drapes, upholstered furniture, thick rugs, and decorative items are major dust collectors. Try to choose furnishings that can be cleaned easily: vinyl or leather couches, washable lampshades, mini-blinds, and wood or vinyl flooring. Put your favorite decorations in glass-fronted cases or shadow boxes.
- Bedding. Choose pillows with Dacron, foam, or other synthetic fillings. Cover your mattress and box spring with allergen-proof covers, and use washable cotton or synthetic bedding. Wash bedding at least once a week in 130°F water, which is the "HOT" button on most washers. Avoid dust ruffles, which, as their name implies, tend to collect dust and dust mites.
- Prevent mold. Keep bathrooms clean and dry; use a fan or dehumidifier. Check foods regularly for spoilage. Dry freshly laundered clothes promptly. Remove houseplants, since moist potting soil is a haven for mold.
- Pets. Unfortunately, animal dander and saliva are potent allergens. Therefore, at least make your bedroom a "pet-free zone."
- Pest control. Pests, particularly dust mites and cockroaches, can represent significant asthma triggers.
- Strong odors. Cigarette smoke and strong odors from perfumes, air fresheners, household cleaners, and other sources can be severely irritating. Limit smoking to the outdoors or to specific rooms, and avoid use of strong-smelling cleaners or cosmetics.
In your workplace
Help your coworkers and supervisors understand your asthma; they will be more willing to help control the triggers in your workplace. It may be possible to relocate your work area, or make other changes in your work environment.
- Minimize your exposure to smoke, heavy scents, and fumes.
- Air conditioners or air filtration systems can be helpful, if they are maintained regularly.
- Avoid potted plants, which can harbor mold.
- Take steps to manage tension and stress that can contribute to asthma episodes.
Foods and medications
- Many processed foods and drinks contain chemicals (sulfites) that are added as preservatives, but can trigger an asthma episode. The most common are dried fruits, fruit juices, vegetables, and wines.
- Cheese and other dairy products, citrus fruits, tomatoes, seafood, and corn are also foods that may initiate an asthma episode.
- Some medications, even the ones you buy over the counter, may also be asthma triggers. Aspirin and aspirinlike products may cause symptoms in people who have chronic sinus problems or nasal polyps. Beta-adrenergic blocking agents (used to treat migraine, rapid heart rate, congestive heart failure, tremor, and glaucoma) are also know to cause asthma episodes.
- Consult your doctor before you take any drug other than the ones already prescribed for you asthma. Ask about specific foods or drugs you should avoid. And be sure to notify your doctor if you experience any unusual reactions to foods or drugs.
HOW TO USE YOUR INHALER
Metered-dose inhalers
A metered-dose inhaler (MDI) uses an aerosol canister to deliver asthma medication to your lungs. Newer, non-CFC-containing MDIs have been introduced and are available.
To enhance the ability of an MDI to effectively deliver medication to your lungs, a spacer is often used. This short tube, attached to the end of the MDI mouthpiece, holds the medication until you inhale. Spacers help minimize the coordination problems associated with the use of MDIs.
It may take a little practice to get used to using an inhaler. By following these steps, you will soon be comfortable - and will be confident that you are getting the most exact dose of medicine possible.
- Shake well: Before each dose, shake the inhaler gently but thoroughly.
- Remove cap: A flexible strap will keep the cap attached to the inhaler, even when the mouthpiece is exposed. If the cap becomes lost, be sure to inspect the mouthpiece for dust, lint, or other foreign objects before using the inhaler
- Breathe out: Stand up, or sit up straight. Breath out through your mouth. Place the mouthpiece of the inhaler in your mouth and close your lips around it tightly. (Be sure that your tongue does not block the opening of the mouthpiece.)
- Breathe in: Take a slow, deep breath through your mouth, while you press down firmly on the top of the metal canister with your finger.
- Hold your breath: Try to continue inhaling after the puff of medicine is delivered. Then try to hold your breath while you count to 10. Remove the mouthpiece and release your finger from the canister before breathing out.
- Wait 30 seconds: Most inhaled medications require 2 doses or "puffs." Wait about 30 seconds after your first inhalation before you take the next one. Be sure to shake the inhaler between doses.
- Replace cap: Make sure the cap is firmly reattached to keep the mouthpiece clean.
- Clean inhaler: Remove the metal medication canister and clean the plastic inhaler and cap at least once a day. Rinse them with warm, running water, and dry both pieces thoroughly. Replace the medication canister with a gentle twist.
- Discard canister: Always discard the canister immediately after taking the number of doses specified in the product information included with your inhaler.
Inhalation powder delivery system
Inhalation powder delivery systems represent an important alternative to traditional MDIs. This new type of device is breath-activated, using your inspiratory breath (inhalation) to deliver medication to your lungs. This minimizes coordination problems many patients encounter when using traditional MDIs.
Breath-activated delivery technology is available in a variety of devices, each with its own specific instructions for use.
PEAK FLOW MONITORING
Peak expiratory flow (PEF) is a measurement of your ability to push air out of your lungs. You can use a simple device, called a peak flow meter, to monitor your own "lung power"
An important asthma management tool
By keeping a regular record of your peak flow results, you can help your doctor make important decisions about your medication and other elements of your treatment plan. Peak flow monitoring is important because it:
- Helps you decide when to seek emergency treatment
- Allows you to detect the early stages of bronchoconstriction, so you can take steps to remedy the problem.
- Gives you an accurate picture of how your condition changes over a 24 hour period; this enables your doctor to determine when medication should be taken.
- Helps you see the difference between bronchoconstriction and other causes of breathing difficulty, such as hyperventilation.
- Allows you to identify the allergens and other irritants and triggers that cause your asthma symptoms.
- Helps you communicate more effectively with your doctor so he or she can provide proper guidance
- Shows whether your asthma symptoms have stabilized, improved, or worsened.
Using a peak flow meter
Even young children can learn how to use a peak flow meter. Follow these easy steps:
- Place the indicator at the base of the numbered scale.
- Sit up straight, or stand up.
- Take a deep breath.
- Close your lips around the mouthpiece (but keep your tongue clear of the opening).
- Blow out as hard and as fast as you can.
- Write down the number that shows on the scale.
- Repeat these steps 2 more times.
- Write down the highest of the 3 numbers in your peak flow diary.
- Clean the peak flow meter after each use to keep it working accurately.
Every person will have a different "ideal" peak flow number. Your personal ideal number is the highest number that you can reach during a 2 week period when you're well and are not experiencing any asthma symptoms. Here's how to find yours:
- Take peak flow readings when you wake up and before you go to sleep.
- Take additional readings before and after you take your inhaled medication.
- Keep track of the results so you can discuss them with your doctor.
The 3-zone system
Red zone: Below 50% of your ideal number. This signals a medical alert. Immediately take your short-acting bronchodilator, and then contact your doctor.
Yellow zone: 50% to 80% of your ideal number. The signal for caution. You may be experiencing asthma symptoms that require an increase or change in medication. follow your asthma management plan, or call your doctor to find out how to get your asthma back under control.
Green zone: 80% to 100% of your ideal number. This signals all clear. Continue to take your medications as prescribed.
NOTE: Peak flows can vary widely from individual to individual and can also vary among different peak flow meters. If you have questions regarding your peak flow, consult your doctor.
Keeping track of your results
A daily peak flow diary is an important part of your total asthma management plan, because the information it provides helps you and your doctor. Once you have determined your personal ideal reading and the "zones" that apply, you'll have a valuable tool for staying in control of your health.
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Occupational Asthma.
Occupational asthma is generally defined as a respiratory disorder directly related to inhaling fumes, gases, or dust while "on the job."
Asthma may develop for the first time in a previously healthy worker, or pre-existing asthma may be aggravated by exposures within the work place. Symptoms of asthma include wheezing, chest tightness and cough. Other associated symptoms may include runny nose, nasal congestion and eye irritation. The cause may be allergic or non-allergic in nature. Of particular importance is the fact that the disease may persist for a lengthy period in some workers, even if they are no longer exposed to the irritants that caused it. many workers with persistent asthma symptoms have been incorrectly diagnosed as having bronchitis.
It is important to remember that persons living in residential areas near these factories may also be exposed to these fumes and may suffer symptoms as well.
In many cases, a previous family history of allergies will make a person more likely to suffer from occupational asthma. However, many individuals who have no such history will still develop this disease if exposed to conditions that trigger it. Workers who smoke are at greater risk for developing asthma following some occupational exposures. The length of occupational exposure that triggers asthma varies and can range from months to years before symptoms occur.
Prevalence
Occupational asthma has become the most prevalent work-related lung disease in developed countries. However, the exact proportion of newly diagnosed cases of asthma in adults due to occupational exposure is unknown. Researchers estimate that 15% of all male cases of asthma in Japan result from exposure to industrial vapors, dust, gases, or fumes, and 5 - 15% of asthma cases in the U.S. may have job-related origins.
The incidence of occupational asthma varies within individual industries. For example, in the detergent industry, inhalation of a particular enzyme used to produce washing powders has lead to the development of respiratory symptoms in approximately 25% of exposed employees. In the printing profession, 20 - 50% of employees experience respiratory symptoms due to gum acacia, which is used in color printing to separate printed sheets and prevent smearing. Isocyanates are chemicals that are widely used in many industries, including spray painting, insulation installation, and in manufacturing plastics, rubber and foam. These chemicals can lead to asthma in 10% of exposed workers.
The Causes
Occupational asthma may be caused by one of three mechanisms, including direct irritants, allergic triggers or pharmacological factors. Irritants that provoke cases of occupational asthma include exposure to hydrochloric acid, sulfur dioxide or ammonia found in the petroleum or chemical industries. These asthmatic episodes will frequently occur immediately after exposure occurs to the irritant substance, and allergic sensitization is not involved. Workers who already have asthma or some other respiratory disorder are particularly affected by this type of exposure.
Allergic factors play a role in many cases of occupational asthma. This type of asthma frequently requires long term exposure to a work related substance before allergic sensitization occurs. Examples of this allergic-type of occupational asthma include exposure to the enzymes of the bacteria Bacillus subtilis in the washing powder industry, and exposure to castor beans, green coffee beans and papain in the food processing industry. Other allergic forms of occupational asthma can occur in workers in the plastic, rubber or resin industries following exposure to small chemical molecules in the air. Furthermore, veterinarians, fishermen and animal handlers in laboratories can develop allergic reactions to animal proteins. Health care workers can develop asthma from aerosolized proteins from latex gloves or from the mixing of powdered medications.
Pharmacological factors include the inhalation of dust or liquid. These substances do not lead to allergic sensitization, but instead directly lead to the release of naturally occurring substances such as histamine within the lung, which then in turn lead to asthma.
Prevention
Once the cause is identified, exposure levels should be reduced (a worker could be moved to another job within the plant, for example).
Employers might consider prescreening potential employees with lung function tests and then continue to test for symptoms after certain periods on the job once the worker has been hired.
Work areas should be closely monitored so that exposure to asthma-causing substances is kept at the lowest possible levels.
Under an allergist's care, pre-treatment with specific medications to counteract the effects of these substance may be helpful in some cases.
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Food and Asthma.
We all enjoy a variety of foods in a variety of settings as part of a healthful lifestyle.
There are numerous natural components, compounds, or other agents in the foods that we eat. For years, it has been suspected that foods or food ingredients may cause or exacerate symptoms in those with asthma. After many years of scientific and clinical investigation, there are very few confirmed food triggers to asthma.
Of the 10 million Americans (3 - 4%) with asthma, food triggered asthma is unusual, occurring only among 6 - 8 % of asthmatic children, and less than 2% of asthmatic adults. Patients are more likely to experience fatal food-induced anaphylaxis than asthma triggered by food.
What are major triggers of asthma
There are many factors that can trigger an asthma attack.
Do Foods Trigger Asthma?
Food triggered asthma is unusual. Although food allergies may trigger asthma in a small number of people, not all individuals with food allergies have asthma. Substantial scientific investigation has found that the following foods and food additives can trigger asthma.
- Diagnosed food allergens such as:
- milk
- eggs
- peanuts
- tree nuts
- soy
- wheat
- fish
- shellfish
- Sulfites and sulfiting agents: sulfur diooxide, sodium bisulfite, potassium bisulfite, sodium metabisulfite, potassium metabisulfite, and sodium sulfite.
Where are Sulfites Found?
Sulfites or sulfiting agents, both occuring naturally or used in food processing, have been found to trigger asthma. If sulfites are used in food preparation or processing as a preservative agent, you will find them listed on the food label. Common food sources of sulfites include:
- Dried fruits or vegetables
- Potatoes (some packaged and prepared)
- Wine, beer
- Bottle lemon or lime juice
- Shrimp (fresh, frozen, or prepared)
- Pickled foods, such as pickles, relishes, peppers, or sauerkraut (some)
Do the food ingredients trigger asthma
Other food ingredients have been previously suspected to trigger asthma. However, scientific evaluation has not been able to conclusively link these food components to asthma. They include tartrazine (and other food dyes or colorings); benzoates (food and drug preservative); BHA and BHT (food preservatives); Monosodium glutamate (MSG, flavor enhancer); aspartame (NutraSweet®, intense sweetener); and nitrate and nitrite (food preservatives).
What can you do to prevent asthma triggerd by foods
The best way to avoid food-induced or aggravated asthma is by avoiding or eliminating the food or food ingredient from your diet or the enviroment. Rember that these substances can be both released into the air or consumed when eating or drinking.
Reading ingredient labels on food packages and knowing where food triggers are found in foods are your best protections against an asthma attack.
By working with your physician on a care plan and proper use of medications, you will be prepared to act in case of an asthma attack.
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Exercise and Asthma.
Up to 85% of asthmatics have symptoms of wheezing during or following exercise. In addition, many non-asthmatic patients with allergies or a family history of allergy experience bronchospasm or constricted airways caused by exercise. Other symptoms |
| include an accelerated heart rate, coughing and chest tightness occurring five to ten minutes after exercise.
Exposure to cold air and low humidity tends to worsen symptoms since both are thought to increase heat loss from the airways. Nasal blockage worsens exercise-related asthma because the inspired air is not humidified and warmed in the nose. Air pollutants (such as sulfur dioxide), high pollen counts, and viral respiratory tract infections also increase the severity of wheezing following exercise.
Activities That Cause Wheezing
(In order of severity)
- Free running (most likely to induce asthma)
- Treadmill running
- Bicycling
- Swimming (least likely to produce symptoms)
Testing
- A patient history is taken.
- A Breathing test is done while the patient is a rest to see if the patient has undiagnosed asthma. This test may be repeated after exercise.
- Specialized tests may be performed, which can include cycling, running or treadmill tests.
Treatment
- Careful selection of exercise activities such as walking, light jogging, leisure biking, and hiking may aid those who cannot tolerate strenuous outdoor running sports.
(However, it is important to remember that the majority of patients with asthma or exercise-induced bronchospasm should get pre-treatment with proper drugs to allow them to participate in any activity they choose.)
Swimming is often considered the sport of choice for asthmatics and those with a tendency toward bronchospasm because of its many positive factors: a warm, humid atmosphere, year-round availability, and the way the horizontal position may help mobilize mucus from the bottom of the lungs. Swimming also tones upper body muscles.
Other activities recommended for those with asthma include sports that involve using short bursts of energy, such as baseball, football, wrestling, short distance track and field events, golfing, gymnastics, and surfboarding.
Cold weather events (such as skiing and ice hockey) or long-distance, non-stop activities (like basketball, field hockey or soccer) are more likely to aggravate airways. However, many asthmatics have found that with proper training and medical care, they are able to excel as runners or even basketball players.
- Drugs administered prior to exercise, such as albuterol, metaproterenol, terbutaline, cromolyn sodium, nedocromil, and theophylline are all helpful treatment options in controlling and prevention exercise-induced bronchospasm. However, it is very important for everyone with exercise-induced asthma to have a breathing test at rest to assure that they do not have undiagnosed chronic asthma.
- Athletes should restrict exercising when they have viral infections, when pollen and air pollution levels are high, or when temperatures are extremely low.
- Warm-up exercises before competition are important and have been shown to alleviate chest tightness.
- Pursed (narrowed) lip breathing may also help reduce airway obstruction.
Conclusion
For years, the inability to participate in athletic programs and/or recreational sports had been a handicap for asthmatic children and adults alike. It was thought that asthmatics could not and should not take part in team sports and vigorous activities. Today, with proper detection and treatment, those affected by exercise-induced asthma and bronchospasm. can become capable of exercise that is beneficial to both their physical health as well as their emotional well-being. |
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Pregnancy and Asthma.
Increasing evidence indicates that uncontrolled asthma is a possible threat to maternal and fetal survival and fetal growth. The goals of asthma therapy during pregnancy are the same as in non-pregnant patients - to prevent hospitalization, emergency room visits, work loss, and chronic disability. Managing asthma in both situations also is similar. Allergens and irritants should be avoided, including exposure to pets and to the harmful effects from cigarette smoke. Medications should be chosen as safe for both the mother and the fetus. many anti-asthmatic medications are considered safe during pregnancy, but the pregnant asthmatic should be monitored by a subspecialist so as to optimize asthma control using the safest medications.
SOME COMMON QUESTIONS REGARDING ASTHMA AND PREGNANCY |
1. What is the outcome of a pregnancy complicated by asthma?
Recent studies indicate that maternal asthma which is adequately controlled during pregnancy does not increase the risk of maternal or infant complications. The recent studies also indicate that there is a direct relationship between lower birthweight and less controlled asthma. If the mother requires cortisone (steroids) orally or by inhalation, the pregnancy and its outcome does not appear to be adversely affected as long as the asthma is controlled.
2. Why would uncontrolled asthma affect the fetus?
Uncontrolled asthma causes a decrease in the oxygen content in the mother's blood. Since the fetus gets its oxygen from the mother's blood, decreased oxygen in her blood may lead to decreased oxygen in the fetal blood. This can lead to impaired fetal growth and survival. The fetus requires a constant supply of oxygen for normal growth and development. In some cases, women with asthma have had increased rates of prematurity and smaller babies.
3. Are asthma medications harmful to the fetus?
Asthma medications do not appear to be associated with increased congenital malformations. Theoretically, however, some of the asthma medications may contribute to an increased risk to the fetus. Observations in hundreds of pregnancies in women with asthma have demonstrated that most anti-asthmatic medications are appropriate for use in pregnancy. The risks of uncontrolled asthma appear to be greater than the risks of necessary asthma medications. However, any oral medication should be avoided unless necessary for the control of symptoms. In general, aerosol and sprays are preferred therapy.
4. What effect does pregnancy have on asthma?
Pregnancy may effect the severity of asthma. Asthma, in one large study, has been shown to worsen in 35% of women, improve in 28% and remain the same in 33%.
5. During what part of pregnancy will asthma change?
Asthma has a tendency to worsen during pregnancy in the late second and early third trimesters, however women may experience less asthma during the last four weeks of pregnancy. The majority of women with controlled asthma experience little difficulty with asthma during labor and delivery. Troublesome asthma during labor and delivery is extremely rare in women whose asthma has been adequately controlled during pregnancy.
6. Why does asthma improve for some women during pregnancy?
The exact reason is unknown. Increased levels of cortisone in the body during pregnancy may be an important cause of why the improvement can occur.
7. Why does asthma worsen for some women during pregnancy?
Some women may have gastroesophageal reflux causing belching, heartburn, etc. This reflux, sinus infections and increased stress may aggravate asthma. Often, a viral respiratory infection causes an exacerbation of asthma.
8. Can I receive allergy shots during pregnancy?
Allergy shots do not have an adverse effect on pregnancy, so they can be continued. However, they shouldn't be started during pregnancy, and the dose should be carefully monitored because of the risk of an allergic (anaphylactic) reaction to the shots. Such a reaction, though rare, could be harmful to the fetus.
9. Can Lamaze be used by asthmatics?
Yes, most women are able to perform the Lamaze breathing techniques without difficulty.
10. Can I breast-feed if I have asthma?
Breast feeding should not be discouraged. The transfer of drugs into breast milk has not been evaluated precisely, but there appears to be no evidence that anti-asthmatic drugs (theophylline, beta agonists, cromolyn sodium, steroids) and have fever drugs (antihistamines and decongestants) will adversely affect the nursing infant.
Controlled asthma during pregnancy appears to be essential to the good health of the mother and fetus. Pregnant women should be monitored regularly so that worsening of asthma can be countered by an appropriate change in the management program. When episodes of severe asthma are avoided, nearly all women with asthma have normal pregnancies.
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Allergy Testing.
Percutaneous (prick) testing, intradermal testing and RAST testing are the methods used to determine what allergens people are allergic to.
Percutaneous or prick testing is when the suspecting allergens are placed on the patients back and the skin is lightly scratched. After 15 minutes, the skin is checked for a local reaction. The severity of the allergy is determined by the size of the reaction.
Intradermal testing is generally performed if all or certain parts of the Percutaneous test is negative. This process involves injecting a small amount of allergens under the first layer of the skin. As with Percutaneous testing, the skin is checked after 15 minutes.
RAST or radioallergosorbent testing is performed at a laboratory. With this process, a blood sample is sent to a laboratory and checked to see if the patient is making any allergen-specific antibodies. This type of testing is performed when a person has a skin condition or on medication which interferes with skin testing.
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Immune System.
Inside our bodies, we have cells that protect us from being sick. The first cell is the B-Cell. The B-Cells make specific immunoglobulins which help keep us from getting sick. Their job is to kill fungi, bacteria and viruses. The three main immunoglobulins are: IgM, IgG and IgA. The IgMs help first by protecting our blood. IgGs travel in our blood to get to the germs. IgAs protect places where we have mucus, saliva and tears such as our mouth, lungs, intestines and nose. The nice thing about the immunoglobulins is they sometimes help each other out and attack the germs.
The second type of cell is the T-cell. The T-cells are located in our blood and other parts of our body. There are three types of T-cells: Killer T-cells, Helper T-cells and Suppressor T-cells. Killer T-cells kill infected cells. Helper T-cells tells the B-Cell to make more immunoglobulins and tell the Killer T-cells to kill germs. The Suppressor T-cell tells the B-Cells when to stop making the immunoglobulins.
The third type of cell is the Phagocyte. The phagocytes job is to eat germs and to call for other phagocytes to help.
The last cell is the Complement. The complement has 18 different parts. They all work together to protect our body from infection. The complement system works with the immunoglobulins and the phagocytes to kill the germs faster.
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Immunotherapy.
Immunotherapy is the process of injecting the known allergens over a period of time in a gradual dose to a maximal tolerated level. It is a treatment used to prevent allergic symptoms. Successful immunotherapy is dependent upon both an accurate determination of a patient's entire allergen sensitivities, and the correct formulation, handling and mixing of the patient's individually specific allergen extract.
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Allergic Rhinitis.
Known to most people as hay fever, allergic rhinitis is a very common medical problem affecting more than 15 percent of the population, both adults and children.
Allergic rhinitis takes two different forms: Seasonal and perennial. Symptoms of seasonal allergic rhinitis occur in spring, summer and/or early fall and are usually caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores. Other people experience symptoms year-round, a condition called "perennial allergic rhinitis." It's generally caused by sensitivity to house dust, house dust mites, animal danders and/or mold spores. Underlying or hidden food allergies are considered a possible cause of perennial nasal symptoms.
Some people may experience both types of rhinities, with perennial symptoms worsening during specific pollen seasons. As will be discussed later, there are also other causes for rhinitis.
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Rhinitis.
Known to most people as hay fever, allergic rhinitis is a very common medical problem affecting more than 15 percent of the population, both adults and children.
Allergic rhinitis takes two different forms: Seasonal and perennial. Symptoms of seasonal allergic rhinitis occur in spring, summer and/or early fall and are usually caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores. Other people experience symptoms year-round, a condition called "perennial allergic rhinitis." It's generally caused by sensitivity to house dust, house dust mites, animal danders and/or mold spores. Underlying or hidden food allergies are considered a possible cause of perennial nasal symptoms.
Some people may experience both types of rhinities, with perennial symptoms worsening during specific pollen seasons. As will be discussed later, there are also other causes for rhinitis.
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Sinusitis.
What is sinusitis?
You're coughing and sneezing and tired and achy. You think that you might be getting a cold. Later, when the medicines you've been taking to relieve the symptoms of the common cold are not working and you've now got a terrible headache, you finally drag yourself to the doctor. After listening to your history of symptoms, examining your face and forehead, and perhaps doing a sinus X-ray, the doctor says you have sinusitis.
Sinusitis simply means your sinuses are infected or inflamed, but this gives little indication of the misery and pain this condition can cause. Health care experts usually divide sinusitis cases into
Acute, which lasts for 3 weeks or less
Chronic, which usually lasts for 3 to 8 weeks but can continue for months or even years
Recurrent, which is several acute attacks within a year
Health care experts estimate that 37 million Americans are affected by sinusitis every year. Health care workers report 33 million cases of chronic sinusitis to the U.S. Centers for Disease Control and Prevention annually. Americans spend millions of dollars each year for medications that promise relief from their sinus symptoms.
What are sinuses?
Sinuses are hollow air spaces in the human body. When people say, "I'm having a sinus attack," they usually are referring to symptoms in one or more of four pairs of cavities, or sinuses, known as paranasal sinuses. These cavities, located within the skull or bones of the head surrounding the nose, include the:
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Frontal sinuses over the eyes in the brow area |
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Maxillary sinuses inside each cheekbone |
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Ethmoid sinuses just behind the bridge of the nose and between the eyes |
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Sphenoid sinuses behind the ethmoids in the upper region of the nose and behind the eyes |
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Each sinus has an opening into the nose for the free exchange of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining. Therefore, anything that causes a swelling in the nose-an infection, an allergic reaction, or an immune reaction-also can affect the sinuses. Air trapped within a blocked sinus, along with pus or other secretions, may cause pressure on the sinus wall. The result is the sometimes intense pain of a sinus attack. Similarly, when air is prevented from entering a paranasal sinus by a swollen membrane at the opening, a vacuum can be created that also causes pain.
What are the symptoms of sinusitis?
The location of your sinus pain depends on which sinus is affected.
Headache when you wake up in the morning is typical of a sinus problem.
Pain when your forehead over the frontal sinuses is touched may indicate that your frontal sinuses are inflammed.
Infection in the maxillary sinuses can cause your upper jaw and teeth to ache and your cheeks to become tender to the touch.
Since the ethmoid sinuses are near the tear ducts in the corner of the eyes, inflammation of these cavities often causes swelling of the eyelids and tissues around your eyes, and pain between your eyes. Ethmoid inflammation also can cause tenderness when the sides of your nose are touched, a loss of smell, and a stuffy nose.
Although the sphenoid sinuses are less frequently affected, infection in this area can cause earaches, neck pain, and deep aching at the top of your head.
Most people with sinusitis, however, have pain or tenderness in several locations, and their symptoms usually do not clearly indicate which sinuses are inflamed.
Other symptoms of sinusitis can include
Fever
Weakness
Tiredness
A cough that may be more severe at night
Runny nose (rhinitis) or nasal congestion
In addition, the drainage of mucus from the sphenoids or other sinuses down the back of your throat (postnasal drip) can cause you to have a sore throat. Mucus drainage also can irritate the membranes lining your larynx (upper windpipe). Not everyone with these symptoms, however, has sinusitis.
On rare occasions, acute sinusitis can result in brain infection and other serious complications.
What are some causes of acute sinusitis?
Most cases of acute sinusitis start with a common cold, which is caused by a virus. These viral colds do not cause symptoms of sinusitis, but they do inflame the sinuses. Both the cold and the sinus inflammation usually go away without treatment in 2 weeks. The inflammation, however, might explain why having a cold increases your likelihood of developing acute sinusitis. For example, your nose reacts to an invasion by viruses that cause infections such as the common cold or flu by producing mucus and sending white blood cells to the lining of the nose, which congest and swell the nasal passages.
When this swelling involves the adjacent mucous membranes of your sinuses, air and mucus are trapped behind the narrowed openings of the sinuses. When your sinus openings become too narrow, mucus cannot drain properly. This increase in mucus sets up prime conditions for bacteria to multiply.
Most healthy people harbor bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae, in their upper respiratory tracts with no problems until the body's defenses are weakened or drainage from the sinuses is blocked by a cold or other viral infection. Thus, bacteria that may have been living harmlessly in your nose or throat can multiply and invade your sinuses, causing an acute sinus infection.
Sometimes, fungal infections can cause acute sinusitis. Although fungi are abundant in the environment, they usually are harmless to healthy people, indicating that the human body has a natural resistance to them. Fungi, such as Aspergillus, can cause serious illness in people whose immune systems are not functioning properly. Some people with fungal sinusitis have an allergic-type reaction to the fungi.
Chronic inflammation of the nasal passages also can lead to sinusitis. If you have allergic rhinitis or hay fever, you can develop episodes of acute sinusitis. Vasomotor rhinitis, caused by humidity, cold air, alcohol, perfumes, and other environmental conditions, also may be complicated by sinus infections.
Acute sinusitis is much more common in some people than in the general population. For example, sinusitis occurs more often in people who have reduced immune function (such as those with immune deficiency diseases or HIV infection) and with abnormality of mucus secretion or mucus movement (such as those with cystic fibrosis).
What causes chronic sinusitis?
If you have asthma, an allergic disease, you may have frequent episodes of chronic sinusitis.
If you are allergic to airborne allergens, such as dust, mold, and pollen, which trigger allergic rhinitis, you may develop chronic sinusitis. In addition, people who are allergic to fungi can develop a condition called "allergic fungal sinusitis."
If you are subject to getting chronic sinusitis, damp weather, especially in northern temperate climates, or pollutants in the air and in buildings also can affect you.
Like acute sinusitis, you might develop chronic sinusitis if you have an immune deficiency disease or an abnormality in the way mucus moves through and from your respiratory system (e.g., immune deficiency, HIV infection, and cystic fibrosis). In addition, if you have severe asthma, nasal polyps (small growths in the nose), or a severe asthmatic response to aspirin and aspirin-like medicines such as ibuprofen, you might have chronic sinusitis often.
How is sinusitis diagnosed?
Because your nose can get stuffy when you have a condition like the common cold, you may confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold.
Your doctor can diagnose sinusitis by listening to your symptoms, doing a physical examination, and taking X-rays, and if necessary, an MRI or CT scan (magnetic resonance imaging and computed tomography).
How is sinusitis treated?
After diagnosing sinusitis and identifying a possible cause, a doctor can suggest treatments that will reduce your inflammation and relieve your symptoms.
Acute sinusitis
If you have acute sinusitis, your doctor may recommend
Decongestants to reduce congestion
Antibiotics to control a bacterial infection, if present
Pain relievers to reduce any pain
You should, however, use over-the-counter or prescription decongestant nose drops and sprays for only few days. If you use these medicines for longer periods, they can lead to even more congestion and swelling of your nasal passages.
If bacteria cause your sinusitis, antibiotics used along with a nasal or oral decongestant will usually help. Your doctor can prescribe an antibiotic that fights the type of bacteria most commonly associated with sinusitis.
Many cases of acute sinusitis will end without antibiotics. If you have allergic disease along with infectious sinusitis, however, you may need medicine to relieve your allergy symptoms. If you already have asthma then get sinusitis, you may experience worsening of your asthma and should be in close touch with your doctor.
In addition, your doctor may prescribe a steroid nasal spray, along with other treatments, to reduce your sinus congestion, swelling, and inflammation.
Chronic sinusitis
Doctors often find it difficult to treat chronic sinusitis successfully, realizing that symptoms persist even after taking antibiotics for a long period. In general, however, treating chronic sinusitis, such as with antibiotics and decongestants, is similar to treating acute sinusitis.
Some people with severe asthma have dramatic improvement of their symptoms when their chronic sinusitis is treated with antibiotics.
Doctors commonly prescribe steroid nasal sprays to reduce inflammation in chronic sinusitis. Although doctors occasionally prescribe them to treat people with chronic sinusitis over a long period, they don't fully understand the long-term safety of these medications, especially in children. Therefore, doctors will consider whether the benefits outweigh any risks of using steroid nasal sprays.
If you have severe chronic sinusitis, your doctor may prescribe oral steroids, such as prednisone. Because oral steroids are powerful medicines and can have significant side effects, you should take them only when other medicines have not worked.
Although home remedies cannot cure sinus infection, they might give you some comfort.
Inhaling steam from a vaporizer or a hot cup of water can soothe inflamed sinus cavities.
Saline nasal spray, which you can buy in a drug store, can give relief.
Gentle heat applied over the inflamed area is comforting.
When medical treatment fails, surgery may be the only alternative for treating chronic sinusitis. Research studies suggest that the vast majority of people who undergo surgery have fewer symptoms and better quality of life.
In children, problems often are eliminated by removal of adenoids obstructing nasal-sinus passages.
Adults who have had allergic and infectious conditions over the years sometimes develop nasal polyps that interfere with proper drainage. Removal of these polyps and/or repair of a deviated septum to ensure an open airway often provides considerable relief from sinus symptoms.
The most common surgery done today is functional endoscopic sinus surgery, in which the natural openings from the sinuses are enlarged to allow drainage. This type of surgery is less invasive than conventional sinus surgery, and serious complications are rare.
How can I prevent sinusitis?
Although you cannot prevent all sinus disorders-any more than you can avoid all colds or bacterial infections-you can do certain things to reduce the number and severity of the attacks and possibly prevent acute sinusitis from becoming chronic.
You may get some relief from your symptoms with a humidifier, particularly if room air in your home is heated by a dry forced-air system.
Air conditioners help to provide an even temperature.
Electrostatic filters attached to heating and air conditioning equipment are helpful in removing allergens from the air.
If you are prone to getting sinus disorders, especially if you have allergies, you should avoid cigarette smoke and other air pollutants. If your allergies inflame your nasal passages, you are more likely to have a strong reaction to all irritants.
If you suspect that your sinus inflammation may be related to dust, mold, pollen, or food-or any of the hundreds of allergens that can trigger an upper respiratory reaction-you should consult your doctor. Your doctor can use various tests to determine whether you have an allergy and its cause. This will help you and your doctor take appropriate steps to reduce or limit your allergy symptoms.
Drinking alcohol also causes nasal and sinus membranes to swell.
If you are prone to sinusitis, it may be uncomfortable for you to swim in pools treated with chlorine, since it irritates the lining of the nose and sinuses.
Divers often get sinus congestion and infection when water is forced into the sinuses from the nasal passages.
You may find that air travel poses a problem if you are suffering from acute or chronic sinusitis. As air pressure in a plane is reduced, pressure can build up in your head blocking your sinuses or eustachian tubes in your ears. Therefore, you might feel discomfort in your sinus or middle ear during the plane's ascent or descent. Some doctors recommend using decongestant nose drops or inhalers before your flight to avoid this problem.
What research is going on?
Scientific studies have shown a close relationship between having allergic rhinitis and chronic sinusitis. In fact, some studies state that up to 80 percent of adults with chronic sinusitis also had allergic rhinitis. There is also an association between asthma and sinusitis. Some researchers think that as many as 75 percent of people with asthma also get sinusitis. The National Institute of Allergy and Infectious Diseases (NIAID) conducts and supports research on allergic diseases as well as bacteria and fungus that can cause sinusitis. This research is focused on developing better treatments and ways to prevent these diseases.
Scientists supported by NIAID and other institutions are investigating whether chronic sinusitis has genetic causes. They have found that the alterations in genes which cause cystic fibrosis may also contribute to chronic sinusitis. This research focus will give scientists new insights into the cause of the disease in some people and points to new strategies for diagnosis and treatment.
Another NIAID-supported research study is trying to determine whether fungi may play a role in causing many cases of chronic sinusitis. This research also will help scientists develop better medicines to treat chronic sinusitis.
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Stinging Insects.
Each year millions of Americans are stung by bees, wasps, hornets, yellow jackets, and fire ants. These insects, members of the Hymenoptera family, inject venom into their victims when they sting. For a small percentage of people allergic to these venom's, such stings may be life-threatening. The usual reaction to a sting lasts only a few hours. Redness and swelling may develop at the site of the sting. Localized pain and itching is also common. These symptoms resolve rapidly. Occasionally such reactions are larger and more symptomatic, a condition termed a large local reaction. This type of reaction may persist for several days but is not an allergic reaction.
Allergic reactions to insect stings can involve many organ systems of the body, in addition to the skin, and develop rapidly after the insect strikes. Symptoms may include nausea, dizziness, stomach cramps, and diarrhea as well as the more common symptoms of allergy: itching and hives over large areas of the body, wheezing, and difficulty in breathing. In severe cases, a sharp fall in blood pressure may result in shock and loss of consciousness. The medical term for such a serious reaction is anaphylaxis. Anaphylactic reactions may be fatal if prompt emergency medical treatment is not obtained.
PREVENTION
There are several ways to prevent and treat such reactions in persons allergic to one or more insects of the Hymenoptera family. Common sense prevents many stings. Hymen-optera-sensitive patients should take measures to avoid being stung. Calm, quiet behavior without sudden movement or waving of the arms when in the presence of these insects often prevents trouble. Other precautions include:
Prevention at home
The smell of food attracts most of these insects. Be careful when cooking, eating, or even feeding pets outdoors. Keep food covered until eaten. Insects are attracted to trash containers and fruit trees with fallen fruit. Keep trash areas clean and trash covered. Use insecticide sprays to keep insects away.
Gardeners should take additional precautions. Accidentally disturbing a hive will irritate the insects, inciting them to swarm. Watch for nests in trees, vines, shrubs, wood piles, under the eaves of the home, and in other protected places. Use hedge clippers, power mowers, and tractors with caution.
Personal Methods of Prevention
Sweet odors attract insects. Persons allergic to these insects should avoid the use of perfume, scented hair spray and other hair applications, scented suntan lotion, and other cosmetics. Because bees gather nectar from clover and other ground plants, don't go barefoot; wear closed-toe shoes outdoors. Avoid loose-fitting garments that can trap insects between material and skin. Bright colors, flowery prints, and black clothing also attract stinging insects more than do light and muted colors like white, tan, khaki, and green. Hymenoptera sensitive persons should keep an insecticide aerosol in the glove compartment of their car in the event that a stinging insect becomes trapped inside while the care is in motion.
Insect allergic persons should not participate in outdoor activities alone. These activities include hiking, boating, swimming, and golfing. When a sting occurs the insect-allergic patient may require assistance in receiving prompt emergency treatment.
Immediate Removal of the Stinger
Removal of the stinger from the skin immediately after the sting may prevent some of the harmful effects of the venom. Among Hymenoptera species, only the honey bee leaves her stinger (with venom sac attached) in the skin of its victim. Since it takes several minutes for the venom sac to inject all of the venom, instantaneous removal of the stinger and sac will limit the amount of venom received. A quick scrape of the fingernail removes the stinger and sac. Avoid squeezing the sac since this forces more venom through the stinger and into the skin.
Hornets, wasps, yellow jackets, and fire ants don't leave their stingers. They should be brushed from the victim's skin promptly with deliberate movements to prevent additional stings. The victim should quietly and immediately leave the area.
Nests, Colonies, and Hives
Since all Hymenoptera insects will sting if their home is disturbed, it's important to destroy hives and nests around your home. The insect-allergic person should not perform or watch this potentially dangerous activity. A trained exterminator or another person skilled in hive removal should be employed.
To kill insects, use a commercially available stinging-insect aerosol in the evening when most of the insects have returned to the nest. Use appropriate precautions. Wear a hat, long-sleeved shirt, and thick work gloves. Tuck pant legs into socks or boots.
Burning or flooding of nests should be avoided. This will not usually kill all of the insects and will irritate the survivors. Inspect the home and yard weekly, especially in spring and summer, to detect new hives or nests.
Wasps build open-comb nests or mud structures under eaves, in carports, behind shutters, in shrubs and in woodpiles. Yellow jackets usually nest underground in abandoned burrows or tunnels of small rodents, between cracks of rock walls, or between the walls of frame buildings.
Hornets build gray football-shaped hives usually in shrubs or trees, often high up or far out on a branch. Honey bees may be found in commercial hives but may also swarm onto twigs or branches. Their hives may be found in the hollow trunks of trees, suspended from branches, or even between the outside walls of buildings. Ants usually build their colonies in the ground, particularly in areas less frequently disturbed by man.
TREATMENT
Any person who has had a serious adverse reaction to an insect sting should be evaluated by an allergist. The allergist may recommend testing and, if appropriate, treatment and avoidance measures.
Approximately two million Americans are severely allergic to the venom of stinging insects. Severe allergy occurs when the victim's immune system produces too much of a special type of antibody, called IgE, against the injected venom. Why only some people produce excessive amounts of IgE antibody remains unknown.
The production of this antibody follows an initial sting, but there usually is no severe allergic reaction to that encounter. When the person is restung by another insect of the same or similar species of bee, hornet, or ant, the venom enters the body where it combines with the IgE antibody already present in response to the earlier sting. The combination of venom antigen and IgE antibody triggers internal reactions resulting in severe allergic symptoms. Skin or blood (RAST) testing for insect allergy is used to detect the presence of significant amounts of these IgE antibodies in the patient.
Persons severely allergic to the venom of stinging insects can now be treated with venom immunotherapy. For many years these people could only be immunized with extracts prepared by grinding up the entire bodies of insects to which they were sensitive. These whole body extracts were presumed to contain the venom of the specific insect. Further research determined that these preparations did not contain enough pure insect venom to be consistently effective for immunization.
A better way to collect pure venom is now available. Armed with these preparations, allergists use immunotherapy to administer gradually stronger doses of venom stimulating the patient's immune system to become more and more resistant to future insect stings. Once the patient is receiving the highest dose of venom, protection against future severe reactions will be present.
Insect venom's are available for the treatment of allergies to honey bee, yellow jacket, hornet and wasp. Whole body extracts are still used for fire ant hypersensitivity since pure ant venoms are not yet available.
Additional Treatment Measures
Depending on the severity of your allergy, your allergist may instruct you in the use of an epinephrine kit. This self-treatment kit is used in cases of severe allergic reactions. The pre-filled syringe in the kit is filled with epinephrine. This medication aborts or reduces the allergic reaction.
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Atopic Dermatitis.
Atopic dermatitis is one of the most common skin problems today. A form of eczema - a condition which causes skin to become red, swollen and painful - this disorder causes chronic itching eruptions, or breakouts. Though there is no cure, about 50% of children outgrow the disorder and treatment plans are available that make the ailment manageable while symptoms persist.
SYMPTOMS
Atopic dermatitis usually begins during infancy or early childhood. Symptoms include itchy, red patches on the skin that may crust, scale or ooze. These can develop as early as between the ages of two to twelve months and generally will appear on the face, torso, and outside of the arms and legs.
When the child reaches two to four years of age, the rash may affect the elbow and knee creases, neck, wrists, ankles and feet. Clusters of red or flesh colored bumps or scaly patches will appear in these areas. Skin may also become drier, thicker and more noticeably creased.
Once the patient reaches adolescence, the rash may become more predominant on the sides of the neck, hands, feet and face. Accentuated creasing of the skin is also more common at this stage.
Bacterial infections frequently occur with this disorder during all of its stages. These infections produce redness and itching and may cause crusting, oozing and ulcers to develop on the skin.
TREATMENT
The main goal of treatment is to eliminate the itching which provokes the other symptoms and causes the most discomfort. (Itching makes the sufferer scratch the irritated skin, causing outbreaks to occur and bacterial infections to develop.)
Itching is minimized by keeping the skin moist. This can be accomplished by applying emollients, or moisturizers, both after bathing and one to two other times during the day. Tepid rather than hot water is recommended for bathing as hot water may induce itching.
Avoid taking showers, since this washes the oils off the skin. This promotes dryness and therefore aggravates the itching and other problems seen in such patients.
Soft cotton fabrics are advised for clothing. Wools, polyesters and other scratchy materials should be avoided. Mild soaps and detergents should be used for washing and fabric softeners should be avoided as they can be irritating to the skin.
Oral antihistamines may be taken as part of this regimen, as well.
An allergist can help a patient develop a systematic treatment program to keep skin moist and alleviate itching. If a flare-up occurs or a secondary infection develops, medications such as cortisone cream can be prescribed to treat them. So, even though there is no cure for atopic dermatitis, there's no reason why a patient should suffer from its symptoms.
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Contact Dermatitis.
Contact dermatitis is an allergic reaction affecting areas of the skin which become red, itchy and inflamed after contact with certain substances. Blisters also may form on the skin. Later these areas will ooze, thicken and crack. Contact dermatitis differs from "dishpan hands" because "dishpan hands" is an irritant reaction not an allergic reaction. The most common cause of contact dermatitis is poison ivy. Other cause's are: Other plants, cosmetics, medications, metals, and chemicals.
WHAT IS POISON IVY
Poison ivy belongs to the plant family Anacardiasea. Other members of this family include poison oak and sumac.
WHAT HAPPENS WHEN THE SKIN COMES
IN CONTACT WITH POISON IVY?
An oil resin, called urushiol (u-ru-she-ol), found in the plant's sap, causes the reaction. The response is usually not immediate and can occur 24 to 48 hours after contact has been made.
First, the skin becomes red followed by the development of bumps and blisters. Itching and swelling also may be present. After several days, the blisters break, releasing watery liquid. The blisters then begin to heal. Neither the liquid from the blister nor scratching the area will spread the rash.
WHO IS AFFECTED
At least seven of every 10 persons could develop dermatitis if exposed to large amounts of poison ivy, oak or sumac. If contact is made through an accidental brief incident, five out of 10 persons would experience a reaction. Adults are affected more often than very young children. Heredity has not yet been shown to play a role in predicting which family members are more likely to suffer reactions than others.
TREATMENT
Clean skin and clothing with soap and water to remove the urushiol resin. This will help to prevent the development of a rash. Also wash other objects that have been in contact with the resin. This will prevent re-exposure.
Excessive scratching could cause a bacterial infection. Poison ivy allergy will not leave scars, unless such a bacterial infection is involved.
Wet, cold compresses can soothe and relieve inflammation after the blisters have broken. Calamine lotion may relieve itching and acts as a drying agent.
In severe cases, corticosteroids (cortisone) may be recommended by a physician (either topically - directly on the skin - when a small area is involved, or by mouth if a larger area is affected).
Immunotherapy (allergy injections administered over time to increase tolerance) has not been proven effective as treatment.
Avoidance is the best medicine.
WHAT METALS CAUSE CONTACT DERMATITIS
Nickel, chrome and mercury are the most common causes of contact dermatitis.
Nickel can be found in costume jewelry, belt buckles, and wristwatches as well as zippers, snaps and hooks on clothing. Since most commercial metals like chrome contain nickel, it is likely that contact with objects that are chrome-plated also will cause skin reactions in persons sensitive to nickel.
Contact lens solutions containing mercury also can cause problems for some sensitive individuals. Persons sensitive to mercury should check the product label before using. Many contact lens solutions are available which do not contain mercury.
Once again, avoidance is the preferred treatment. Surgical stainless steel and 14 karat gold are recommended alternatives to nickel. These contain lower levels of nickel (18 karat gold contains little, if any nickel).
REACTIONS TO COSMETICS
Cosmetics, ranging from hair dyes to toe nail polish, can cause contact dermatitis or irritating reactions. Permanent hair dyes containing paraphenylenediamine are the most frequent offenders. Dyes used in clothing also can be irritating. Other products often cited include perfume, eye shadow, nail polish, lipstick and sun-screen preparations.
Hypoallergenic products are available for most cosmetic items. These products do not contain the perfume and dye which can cause allergic symptoms. These can be purchased at most stores. A list of manufacturers of hypoallergenic cosmetics is available from the American Academy of Allergy and Immunology. Those individuals with persistent symptoms, should consult their allergist.
REACTIONS TO MEDICATIONS
The most common cause of medication contact dermatitis is neomycin. This is found in antibiotic creams. Penicillin, sulfa medications and local anesthetics (novocaine, paraben) are other possible causes. Health care workers, including physicians and dentists, are at risk because of their constant exposure to these medications.
Your allergist can recommend the appropriate medication, lotion or cream to combat allergic contact dermatitis caused by adverse reactions to medications. In an effort to prevent further allergic reactions, a physician may prescribe a medication alternative when needed. 
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