Tag: allergies

Medication Challenge

A medication challenge is performed when it is believed that a patient is allergic to a certain medication and is the cause of an allergy or skin related problem. The test is always performed by the direct supervision of our board-certified allergist/immunologist. A very small amount of the allergen is inhaled or ingested orally while the patient is monitored closely for any reactions. The dose is usually increased with toleration over a period of several hours. Examples of medication challenges are Tylenol, Advil, Penicillin, and local anesthesia. This is helpful in determining if a patient is truly allergic to a specific medication or just has intolerance to it.

 

food allergies East Lansing

Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis, also known as EoE, is an allergic condition that causes swelling in the esophagus. This swelling can lead to difficulty swallowing, pain in the abdomen, heartburn, and vomiting. In children, other signs that EoE may be present include poor growth, weight loss, poor appetite, and even refusal to eat. EoE is caused by ingesting proteins in certain foods that trigger an allergic response and inflammation, specifically in the esophagus and other parts of the gastrointestinal tract. The involvement of the gastrointestinal system as well as the allergic component means that treating EoE should be a collaborative effort between a gastroenterologist and an allergist or immunologist. The gastroenterologist will usually perform an EGD, or endoscopy, to biopsy esophageal tissue for the presence of abnormally elevated eosinophil levels. An elevation of this type of white cell in the esophagus is the cause of the inflammation and is the diagnostic factor that needs to be confirmed in cases of eosinophilic esophagitis. Once the diagnosis is made, an allergist or immunologist is usually consulted to help identify specific trigger foods using a variety of available testing methods. While skin prick testing for foods is often used, our practice also uses food patch test placement which is more effective in identifying delayed food reactions that skin testing may overlook.

This condition may result in eliminating a variety of foods from the EoE patient’s diet. To ensure nutritional needs of the patient are being satisfied with the dietary changes required, our physician may choose to refer EoE patients to a registered dietitian or nutritionist for consultation and treatment.

bee sting allergies

Stinging Insect Allergies

Many Americans are allergic to insect stings. With many different types of stinging insects and variations in reactions it can be confusing to determine if you have a true allergy and to what type of insect. A true allergic reaction is one that results in anaphylaxis, with the possibility of the following symptoms;

  • Hives, itching, and swelling in areas other than the sting site
  • Tightness in the chest and/or difficulty breathing
  • Hoarseness of voice or swelling of tongue
  • Dizziness
  • Sudden drop in blood pressure
  • Unconsciousness or cardiac arrest
  • Nausea, abdominal cramps, or diarrhea

A normal reaction to an insect sting usually results in swelling, pain, itching and redness at the sting site. A large local reaction can occur and involves swelling beyond the sting site and may require the use of an antihistamine or steroid to reduce the swelling.

There are five common types of stinging insects. Those include yellow jacket, honey bees and bumble bees, wasps, hornets, and fire ants.

For more information on prevention and at home care of stings check out this website.

Treatments for Stinging Insect Allergies

food allergies east lansing

Food Allergies

When a person has a food allergy, it simply means that their body is overreacting to a protein found in that food. Depending on the severity of the allergy, coming into contact with just a small amount of that food can cause reactions. Many young children are diagnosed with food allergies, but they can occur at any age and can grow out of them. There are eight common foods that cause the majority of allergic reactions; cow’s milk, peanuts, tree nuts, eggs, fish, shellfish, soy, and wheat.

Many people who think they have an allergy to foods may just have intolerance. The symptoms between an allergy and intolerance are similar, but the difference between the two is very important. When a person has an allergy to a food, it triggers an immune response that can be life-threatening; they must be very careful to avoid this food trigger.

Some food allergies can be linked to a condition called oral allergy syndrome. The food allergen may have close proteins to other environmental triggers. For example, a person that has an allergy to ragweed may also develop a reaction to bananas or melons.

Common Food Allergies

Egg Allergy

Eggs are one of the most allergenic of all foods, with just a small amount of this food symptoms can occur within minutes, including life-threatening anaphylaxis. This type of reaction can also been seen with exposure to egg or egg products by routes other than the mouth. Reactions can also occur in children during their first exposure to eating eggs.

The proteins ovalbumin, ovomucoid, and ovotransferrin are identified as major allergens in egg white, but many forms are unnamed or of lesser importance. Certain components of egg may be individually used for specific actions in food preparations, therefore some products may contain egg proteins that may not be able to recognize when reading the label.

The following is a list that may indicate the manifestation of egg protein;

Albumin Binder Coagulant Egg White Egg Yolk or Egg Yellow Emulsifier Globulin Lecithin
Livetin Lysozyme Ovalbumin Ovamucin Ovamucoid Ovovitellin Powdered Egg Vitellin
Whole Egg Baked Goods Baking mixes Bouillon Breakfast Cereal Cake flour Candy Cookies
Cream Fillings Ice cream and sherbet Cocoa Drinks Marshmallow Mayonnaise Meringues Muffins Processed Meat Products
Pudding Salad dressing Soup Tartar sauce

 

In addition to foods that contain egg protein, many everyday items contain them as well. Cosmetics, shampoos, and pharmaceuticals can contain these proteins. Reading the label of every product that is used topically or consumed orally is the safest practice to avoid contact with egg proteins.

Allergy to Milk Products

Patients that are very sensitive to milk can have symptoms with a very small amount of milk protein, which could include minor contamination or inhalation of milk powder. Milk can be found in a wide variety of processed foods. Milk contamination of a product is possible if the same equipment is used to manufacture various products.

The following is a list of products and items that contain milk protein

Batter-fried foods Breakfast cereal Cakes Chocolates Cookies Instant  mashed potatoes Margarine Muffins
Soup mixes Soy Vegetarian cheese Caramels Casein Whey Lactalbumin Lactose
Yogurt Rennet

 

Allergy to Tree Nuts

Tree nuts consist of almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, and walnuts. Tree nuts are cross reactive, meaning if you are allergic to one type of tree nut there is a good chance you are allergic to another type, therefore you should avoid all tree nuts.

Peanut Allergy

Peanuts are considered to be one of the most allergenic foods as well as one of the most common. Peanuts are added to a wide variety of processed foods and very commonly used in oriental cooking. Peanuts may be de-flavored, re-flavored, and pressed into other shapes, such as almonds and walnuts, but still contain the allergenicity of peanuts.

The following is a list of foods that contain peanut protein or oil;

Baked goods Baking mix Battered foods Biscuits Breakfast cereal Candy Soy Sunflower Oil Egg rolls Ice cream
Margarine Marzipan Milk Formula Pastry Peanut butter Maize Satay sauce Soups
Thai dishes Vegetable oil Oriental flavoring sauce Peanut butter emulsifier Vegetable burger patties Sweet lupine seed flower (used to make spaghetti-like pasta) Sesame Oil

 

Patients with peanut allergy need to be very cautious of the foods they eat by reading food labels carefully, as well as products being used on the body. Studies are ongoing about the safety of eating tree nuts if allergic to peanuts. An allergy to peanuts warrants avoidance of all type of nuts to decrease the possibility of a life-threatening reaction.

Allergy to Wheat Products

Wheat is the most common allergy among all cereals. Wheat contains the highest amount of gluten compared to all other grains. Those who have wheat sensitivity should avoid all other types of flours, as they may still contain a small amount of wheat flour or a derivative. Even gluten-free bread can contain a small portion of gluten. Spelt has been advertised to be a wheat substitute, but is part of the wheat family, therefore containing wheat protein.

Below is a list of foods that contain wheat protein;

All-purpose flour Bleached flour Bulgur (cracked wheat) Cornstarch Couscous Durum wheat Enriched flour
Farina Gelatinized starch Gluten Graham flour Hard Durum flour High gluten flour High protein flour
Hydrolyzed vegetable protein Kamut Millers bran MSG Protein Semolina spelt starch Unbleached flour Vegetable gum Vegetable starch
Wheat bran Wheat gluten Wheat Starch White flour Whole wheat Whole wheat flour Alcoholic beverages (made from grain)
Gravy Hot dogs Ice cream Ice cream cones Lunch meats Licorice Macaroni
Ale Beer Wine Bourbon Whiskey Baked goods Baking mixes Barley Bread Battered food
Bouillon cubes Breakfast cereals Candy Milk shakes Processed Meats Sausage Semolina snack foods
Spaghetti Soup Soy sauce

Patients with wheat allergy need to be very cautious of the foods they eat by reading food labels carefully, as well as products being used on the body.

Shellfish Allergy

Shellfish and crustaceans are commonly cross reactive, meaning if you are allergic one, you should avoid all of them. Crayfish, crab, lobster, and shrimp are the common crustacean allergens. Shellfish allergens include clams, mussels, oysters, and scallops. Any person with a shellfish allergy should procedure cautiously when eating fish, because they may be processed together.

Soy Allergy

Soy is used frequently in many food items and because of this it is often a hidden allergen. As with other food allergens, a small amount of soy can cause life-threatening anaphylactic reactions in patients with a severe allergy. Soybeans may be consumed as whole beans, flour, or oil. Soy is also used as a texturizer, emulsifier, and protein filler.

The following is a list of foods and products that contain soy protein;

Adhesive blankets Body lotions and creams Dog food Enamel paints Fabric finishes Fertilizers Flooring Soaps
Gum Arabic bulking agent Carob emulsifier Guar gum Hydrolyzed vegetable protein (HVP) Lecithin Miso MSG Protein Protein extender
Soy flour Soy nuts Soy panthenol Soy protein Soy protein isolate Soy sauce Soybean Soybean oil
Stabilizer starch Textured vegetable protein (TVP) Tofu Vegetable broth Vegetable gum Vegetable starch Baby foods Bakery goods
Black pudding bread Breakfast cereals Some burger patties Butter substitutes Cakes Candy Canned meat or fish Canned soup
Canned tuna Artificial cheese Chinese food Cream centered chocolates Cookies Crackers Gravy powders Hamburger patties
Hot dogs Hydrolyzed vegetable protein Ice cream Infant formula Liquid meat replacer Sausage Worcestershire Sweet and Sour sauce
Teriyaki Bouillon cubes Soy Milk

 

Soy is so widely used that it is very hard to eliminate from a person’s diet, but patients with a soy allergy need to be very cautious of the foods they eat by reading food labels carefully, as well as products being used on the body.

How Food Allergies Are Treated

 

Medications That Contain Antihistamines

Please review this list of medications that contain antihistamines:

Actifed (Triprolidine) PBZ (Tripelenamine)
Allegra (Fexofenadine) Periactin (Cyproheptadine)
Antivert or Bonine (Meclizine) Phenergan (Promethazine)
Astelin (dispensed as a nose spray) Polyhistine (Phenyltoloxamine)
Atarax (Hydroxyzine) Seldane (Terfenadine)
Benadryl (Diphenhydramine) Semprex (Acrivastine)
Bromfed (Brompheneramine) Tavist (Clemastine)
Chlortrimeton (Chlorpheniramine) Unisom (Doxylamine)
Claritin (Loratidine) Zyrtec (Cetirizine)
Dramamine (Dimenhydrinate)  

Combination decongestant and antihistamine medications include:

Allegra D Rynatan
Claritin D Semprex D
Naldecon Seldane D
Pannaz (Chlorpheniramine,Phenyl- propanolamine, Methscopolamine Nitrate) Tavist D
Polyhistine D Trinalin Repetabs

*** Most over the counter cold, cough, headache medications

Environmental Allergy Treatment Options

Allergy Skin Testing

Prick Method: The skin is pricked with a blunt needle that has been immersed with a variety of environmental allergen extract.

Intradermal Method: This method consists of injecting a small amount of allergen extract into the superficial layer of the skin.

On a case by case basis, our board-certified allergist will determine if lab work is a more suitable testing option to identify environmental allergies.

There are several treatment options that are available for those who suffer from environmental allergens. Our board-certified allergist/immunologist will collaborate with you to determine the most effective and convenient treatment for you.

Allergy Medications

Antihistamines: Antihistamines are the most widely used medication to help treat and prevent symptoms caused by allergens. These medications help to block histamine from being used during a period of allergic reactions, therefore decreasing your symptoms. Examples of these medications are Benadryl, Allegra, Claritin, and Zyrtec.

Nasal Spray: Nasal sprays are also a common medication used to treat symptoms caused by allergens. There are two common types that your allergist may prescribe for you depending on your symptoms; an antihistamine or steroid based nasal spray. Nasal sprays work by decreasing inflammation and blocking histamine during a response to an allergen. Examples of anthistamine nasal sprays are Astelin, Patanase and Astepro. Examples of steroid based nasal sprays are Rhinocort, Omnaris, Flonase, Veramyst, Nasacort AQ, and Flunisolide.

Oral corticosteroids: Oral steroids are used in situations when allergic reactions worsen and do not responding to your usual medication regimen, exacerbation of asthma, or in certain skin conditions. Steroids help to decrease inflammation in your body by decreasing your immune systems reaction to foreign a stimulus.  

Eye Drops: Eye drops are used for those who suffer from allergic conjunctivitis (allergies of the eyes). Eye drops come in two types; antihistamine and steroid based. Eye drops work by decreasing inflammation and blocking histamine during a response to an allergen. Examples of an antihistamine eye drop are Zaditor, Visine-A, Patanol, and Pataday. Examples of steroid eye drops are Alrex and Lotemax.

Immunotherapy injections (IT): also known as allergy shots, is a long-term treatment option for those that suffer from environmental allergies and asthma. IT can help to decrease your sensitivity to allergens, lessening your symptoms and triggers that exacerbate allergies and asthma.

A small amount of allergen serum is injected subcutaneously into the skin and increases with tolerance to a therapeutic level. There are two phases with IT; building phase and maintenance phase. The building phase consists of weekly injections of serum that increase in strength each week and generally last 6 months depending on compliance. During the building phase you may start to notice a decrease in your allergy symptoms, but it can take as long as 12 months on maintenance dose to notice improvement. The maintenance phase occurs once a therapeutic level has been reached. The strength depends on your sensitivity and tolerance to the serum. During this phase injections are given every 2-4 weeks, which will be established by your allergist. Maintenance phase is usually continued for 3-5 years depending on the success of the treatment. The decision to discontinue IT will be made with your allergist.

seasonal allergies east lansing

Environmental Allergies

An allergy is an abnormal immune response to a non-harmful trigger called an allergen. Studies have shown that up to 50 million people in the US suffer from some form of allergies. When exposed to allergens, a person who is allergic to that allergen can have varying symptoms. More common symptoms may include sneezing, watery, itchy, red eyes; a runny nose; post-nasal drainage; a scratchy throat or cough.

There are two factors that determine if a person will have allergies: their genetic background, and their exposure to allergens. Allergies run in families. If one parent has allergies, there is roughly a 25 percent chance that their child will develop allergies. If both parents have allergies, the probability increases to 50 percent chance that each child will have allergies.

Anything that enters the body has the potential of producing an allergic response. The most common allergens are pollens, from grasses, trees, and weeds, mold spores, dust mites, cockroaches, insect venom, animal dander, and foods. Tobacco smoke, perfume, hair spray and components of air pollution are typically not allergens, but exposure can aggravate allergy symptoms.

Those who suffer from allergies are more likely to experience chronic sinus infections, chronic cough, ear infections, asthma and bronchitis, eczema, sleep disorders, and migraine headaches.

20 percent of the US population of children is affected by allergies. It is the most common chronic disease in children and can range in severity from irritating to life-threatening. Common symptoms for children affected by allergies are nasal congestion, chronic mouth breathing, ear infections, chronic cough, wheezing, runny nose, and itchy eyes.

Although many patients are genetically predisposed to allergies, no two people have the same symptoms or the same allergens, even if genetically related. Exposure to any allergen can create an allergy. The most common environmental allergens are house dust, cockroaches, dust mites, cats, dogs, molds, trees, grasses, weeds, and ragweed.

Each spring, summer, and fall, tiny particles are released from trees, weeds, and grasses known as pollen. Pollen is circulated through the air to fertilize other plants, but also enters the throat and noses of humans, triggering a seasonal allergic reaction, which people know as hay fever. Airborne pollen is one of the most annoying and common allergens, and its cause’s roughly 35 million people to suffer from upper respiratory allergy symptoms each year. All of these allergens can be treated by different types of medications and immunotherapy injections, as well as a specific plan of care created by your board-certified allergist.

Tree Pollen

There are more than 50,000 species of trees in the world, with 600-700 native to North America, with roughly 65 of these species being known to cause allergies. Some people are aware of their seasonal sensitivity, but may not know what the specific cause is (i.e. tree pollen, grass pollen, or molds). Allergy testing is important to identify specific types of allergens that are triggering your symptoms.

Occasionally those with allergic reactions to tree pollens may also cross react to certain raw fruits such as apples, plums, and pears, which results in itchiness of the mouth and throat. This phenomenon is known as oral allergy syndrome. These foods may be less allergenic when cooked.

Tree pollen generally shows little cross reaction between species. A person must develop an allergy to each type of tree pollen in order for symptoms to occur. For example, if you are sensitive to pine trees, it does not mean that you will be sensitive to oak trees. There are two exceptions, the family of trees that contain oak, beeches, and birches and the family that belongs to cedars and junipers. If a person is allergic to one of these trees, there is an increased chance you will have symptoms from one or more members of the same family.

Tree pollen counts tend to be higher on days when it is warm, dry, and windy. Pollen counts tend to be highest in the early morning, late afternoon, and early evening from April through June.

To help decrease your symptoms during tree pollen season, the following are some allergen avoidance tips:

  • Minimize outdoor activity during the morning hours of 5:00-10:00 a.m. when pollen levels are highest
  • Keep car windows closed while driving
  • Avoid lawn mowing and leaf raking which stir up pollens
  • Keep windows closed at home to prevent airborne pollens from coming indoors.

Grass Pollen

Grass pollinates from May through July. When these pollens are inhaled by those who suffer from seasonal allergic rhinitis, the body experiences an over-reaction of the immune system, causing sneezing, congestion, runny nose, watery eyes, and itching of the eyes, nose, and throat. Those that suffer from asthma may experience chest congestion, cough, and difficulty in breathing.

Some of the most common allergy-causing grass pollens in Michigan include Timothy, Bermuda, Orchard, and sweet vernal. Grass that is found in a manicured lawn or golf course typically does not produce much pollen. These allergy inducing grasses are typically found growing in medians, empty lots, and the side of the road. Grass pollens are light and can travel for miles through the air.

As with other pollen producing plants, rain and temperatures play a roll in the amount of pollen produced each year. Dry, windy days are perfect conditions for high pollen counts. Pollen is released during early to mid-morning hours. Our board-certified allergist/immunologist can provide testing to show which grasses you are allergic to and offer appropriate treatment options.

To help decrease your symptoms during grass pollen season, the following are some allergen avoidance tips:

  • Keep the grass short, but have someone else do the mowing. If avoiding yard work is unavoidable, wear a mask when you mow
  • Don’t hang clothes outside to dry, pollen sticks to fabric
  • Stay indoors in the early morning hours of 5:00 am-10:00 am, when pollen counts are highest
  • Save outdoor activities for later afternoon or after a heavy rain
  • Remove clothing worn outside immediately when done and shower right afterwards
  • Keep your home and car windows closed to prevent airborne pollens from coming inside
  • When riding in the car, use the recycled air button on your air conditioner

Ragweed Allergy

Middle of August through the first frost is when ragweed is in season. Pollen that is released from ragweed is airborne and can travel up to 400 miles. Each ragweed plant produces up to one billion pollen grains each season. Shorter days and longer nights are common in mid-August, which help stimulate pollination of ragweed.

After exposure to ragweed, people with allergies will often experience runny nose, sneezing, and swollen, itchy, watery eyes. The American Academy of Allergy, Asthma and Immunology (AAAAI) state that 80% of people with seasonal allergies experience sleep problems, causing fatigue, poor concentration, and low performance at school and work. To discover if you are allergic to ragweed or find a plan of care that works for you, your board-certified allergist/immunologist can help.

The following tips can help allergy suffers reduce their exposure to ragweed:

  • Check local pollen counts (http://www.pollen.com/state.asp?id=mi)
  • Keep windows closed at night to keep pollen from coming into your home.
  • Use air conditioning, which is clean, cool, dry air
  • Minimize outdoor activities during peak pollen times, between 10:00 a.m.-4:00 p.m.
  • Keep car windows up when driving
  • Take a shower after spending time outside. Pollen can collect on your hair, skin, and clothing
  • Don’t hang sheets or clothing out to dry. Pollen and mold can be trapped in fabrics
  • Try and stay indoors when humidity is reported to be high, as well as windy days when dust and pollen are being driven about.

Cat Allergy

Patients that are allergic to cats are actually allergic to their dander, saliva, or urine. Nevertheless, typical symptoms are not a direct result of coming into contact with these agents. What usually occurs is when the cat grooms itself by licking itself; it deposits saliva on the fur and skin of the animal. The saliva dries and leaves behind an antigen that causes the allergy to cats. These allergens are very light-weight and are easily transported through the air. Once airborne, the antigen can spread to clothes, furniture, carpeting, and other household items. According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), there are no hypoallergenic breeds of animals. The allergen is not dependent on the amount of shedding, or the length of hair. Your board-certified allergist/immunologist can help you come up with a plan of care to treat your symptoms.

Dog Allergy

Patients that are allergic to dogs are actually allergic to their dander, saliva, or urine. Nevertheless, typical symptoms are not a direct result of coming into contact with these agents. What usually occurs is when the dog grooms itself by licking; it deposits saliva on the fur and skin of the animal. The saliva dries and leaves behind an antigen that causes the allergy to dogs. These allergens are very light-weight and are easily transported through the air. Once airborne, the antigen can spread to clothes, furniture, carpeting, and other household items. According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), there are no hypoallergenic breeds of animals. The allergen is not dependent on the amount of shedding, or the length of hair. Allergies to dogs are easier to manage than to cats, primarily because dogs are bathed more frequently than cats. Your board-certified allergist or immunologist can help you come up with a plan of care to treat your symptoms.

Dust Mites

Dust mites are too small to be seen with the naked eye. Most people that are allergic to dust mites are actually allergic to their fecal matter. Mites excrete partially digested food and digestive enzymes as feces, which releases allergens very quickly. Dust mite feces are very similar to pollen in three major ways; the size, amount of allergen carried, and rate of proteins released. Dust mites live in humid places that tend to store water, such as carpets, sofas, mattresses, and clothing. As the humidity decreases, the mites will migrate farther from the surface to try and find moisture, such as moving deeper into your mattress. It can take months for mites to die, even in dry conditions, and their allergen levels to fall. Dust mites are prevalent all year round. Your board-certified allergist can providing testing and tips for avoidance of dust mites.

Cockroach Allergy

Cockroaches, especially German cockroaches are a very common pest in crowded cities worldwide. Studies have shown that exposure to cockroaches are a big risk factor for developing allergies and asthma, especially in the inner-city. Cockroaches are a major trigger for asthma symptoms, especially in children. Avoidance can occur by placing baits and traps, extermination, and cleanliness.

Mold Allergy

Mold can be found outdoors as well as indoors. Mold is essential for the environment and helps in the decaying of other organisms that have died. Mold thrives on darkness, dampness, and drafts, as well as humidity and a lack of ventilation. This is important to remember when attempting to eliminate your exposure to mold.  Mold is found year round and can fluctuate in levels depending on its condition. The best way to diagnose a mold allergy is to perform a skin test. Exposure to mold spores can be caused by a variety of things, both indoor and outdoor.  The most common outdoor exposures are a shaded yard with little sunlight, dense vegetation, and standing water. Inside the home factors such as carpet in the bathroom, water leaks or flooding into the home, and vegetation (Christmas tree or plants) sitting in water. A person affected by mold can help avoid it by keeping humidity between 30-50% with the use of a dehumidifier.

Environmental Allergy Treatment Options