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Allergy and Asthma Articles




Magician’s asthma.
A 35-year-old male engineer with a 6-month history of rhinoconjunctivitis and asthma, the latter requiring daily medication for control. Further history revealed that he also worked as a professional magician and that he had obtained a rabbit to pull out of a hat 2 months before the onset of symptoms. Skin test results were negative except for rabbit extract. The rabbit was removed from the act, and the patient became free of symptoms off medication.

This journal article has been summarized. The article information is as follows:

Magician’s asthma. Miller JD. J Allergy Clin Immunol. 2009 Aug; 124(2):386; author reply 386-7. Epub 2009 May 27. [J Allergy Clin Immunol. 2009

Anaphylaxis after a cat bite.
A 42-year-old woman with systemic rash and dyspnea following the index finger of her right hand being bitten by her cat. Dyspnea, systemic rash and headache occurred after 30 minutes. Five years after first obtaining the cat, she noticed nasal symptoms and experienced wheal with itching at the bitten part of her skin. She experienced cough and dyspnea once a month. Specific IgE testing was positive for cat dander, dog dander and other common allergens. Prick test of the cat saliva was markedly positive. The major cat allergen Fel d1 is mainly originated from a sebaceous gland of skin and also present in saliva.

This journal article has been summarized. The article information is as follows:

Anaphylaxis after a cat bite.
Maeda Y, Akiyama K.
Allergol Int 2012 Jul 25

Allergy to Car Seats
This is a case report of a female patient showing a delayed allergic reaction to epoxy resin. The allergic contact dermatitis occurred after sitting in her new car equipped with artificial leather seats.

This journal article has been summarized. The article information is as follows:

Hautarzt. Wurpts G, Merk HF. Allergy to car seat. 2010 Nov;61(11):933-4.
Klinik für Dermatologie und Allergologie, Universitätsklinikum Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen. gwurpts@ukaachen.de

Allergen Levels in Your Vehicles
In a 2002 study, dust mite allergen (Der 1) densities in some automobiles were sufficiently high to be risk factors for sensitization and allergic reactions. Most automobile seats had levels of dog and cat allergen that were well above the threshold levels considered to be risk factors for both sensitization and symptoms, regardless of the presence of a pet in the home.

This journal article has been summarized. The article information is as follows:

Relationship among house-dust mites, Der 1, Fel d 1, and Can f 1 on clothing and automobile seats with respect to densities in houses. Ann Allergy Asthma Immunol. 2002 Apr;88(4):410-5.

Co-factor-enhanced food allergy
Alcohol, exercise or non-steroidal anti-inflamatory drugs (NSAID) are frequently mentioned as amplifiers of food allergic reactions but only individual cases or small series have been previously published. A descriptive study including 74 cases of suspected co-factor enhanced food allergy, assessed by skin-prick tests, specific IgE and oral challenges, reports that anaphylaxis accounted for 85.1% of reactions. In 99% of cases culprit food allergens were plant-derived, mainly vegetables and cereals. NSAID were involved in 58%, exercise in 52.7% and alcohol in 12.2%. Lipid transfer protein was the most frequently involved allergen. The study concludes that co-factor enhanced food allergy should be considered when assessing food, alcohol, exercise and NSAID allergic reactions.
This journal article has been summarized. The article information is as follows:

Co-factor-enhanced food allergy.
Cardona V, Luengo O, Garriga T, Labrador-Horrillo M, Sala-Cunill A, Izquierdo A, Soto L, Guilarte M.
Allergy 2012 Jul 30

Unusual Reactions and Cow’s Milk Allergy in Neonates.
A 4-week-old girl presented with acute swelling of hands and feet preceded by a red facial rash. In the days before formula feeding was gradually introduced. This proved to be a rare but severe generalized allergic reaction to cow milk.

This journal article has been summarized. The article information is as follows:

A neonate with acute swelling of hands and feet. [Dutch]
de Boer FA, Rake JP.
Ned Tijdschr Geneeskd 2012;156(11):A2782

Atopic Dermatitis and Urticaria with Allergy to Horses Early in Infancy
This article is in reference to a 4-month-old infant with chronic eczema and recurrent urticaria initially diagnosed as “allergy to cow’s milk resistant to Néocate”. History revealed the presence of horses in the infant’s environment. The allergy workup confirmed early onset IgE-dependant allergy to horse dander (prick-test strongly positive and the presence of specific serum IgE), which led to consider the mechanism of sensitization: via air-borne or garment-bearing particles, or probably by both means.

This journal article has been summarized. The article information is as follows:

Dermatite atopique et urticaire avec allergie précoce au cheval chez un nourrisson : ne pas oublier d’interroger les parents ! / Atopic dermatitis and urticaria with allergic to horses early in an infant: do not forget to question the parents!
M. Pétrus, G. Dutau, F. Tranchard
Revue Française d’Allergologie 2011;51(7):636-639

Wheat Allergy in Children: Outgrowing the Allergy?
The objective of this study was to evaluate the manifestations of wheat allergy and to follow the patients to evaluate whether outgrowing allergy occurs, and when. Eight previously diagnosed wheat allergic patients were re-evaluated together with 13 other new cases. Severe anaphylaxis was seen after wheat ingestion in more than 90% of the patients. Oral tolerance to wheat developed in three patients (37.5%) out of 8 known previous cases who had been followed for eight years, the mean age of oral tolerance to wheat was 68+/-6.36 (range; 36 months to 108 months). Clinical reactions in our wheat-allergic patients were more severe than those reported before. These patients were at risk for developing chronic allergic symptoms such as asthma. Oral tolerance to wheat was occurring in a minority of these patients.

This journal article has been summarized. The article information is as follows:

Follow-up of the wheat allergy in children; consequences and outgrowing the allergy.
Mansouri M, Pourpak Z, Mozafari H, Abdollah GF, Shokouhi SR.
Iran J Allergy Asthma Immunol 2012 Jun;11(2):157-163

Diagnostic Approach to Drug Allergies
The approach to drug hypersensitivity always comprises a clinical and a diagnostic workup. About 15% of drug side effects are due to hypersensitivity reactions. All types of immunological reactions can be induced by drugs, but type I and type IV reactions are seen most often. The initial judgment of the skin symptoms is therefore one of the key factors besides a stringent history of drug intake for a further diagnostic workup. The goal of a diagnostic workup is not only to identify the culprit drug, but also to defer the patient from similar drugs in order to prevent a second episode. In the case of missing alternatives and unidentified drug sensitivity, reexposure to the previous drug must be discussed; however, in severe cutaneous reactions this should generally be avoided.

This journal article has been summarized. The article information is as follows:

Diagnostic approach to drug allergy.
Harr T.
Chem Immunol Allergy 2012;9747-60

Contact allergy to dimethacrylate.
A 55-year-old woman with a 10-year history of persistent pruritus and burning sensation of the gums every time she wore her dentures. Initially she developed swelling and redness of the face soon after the dentures were placed on the gums. These symptoms abated after a barrier liner was applied between her gums and the dentures. However, the burning sensation and pruritus of the gums progressively worsened and she started to develop blisters on the gums. The skin allergen patch test was 3+ positive with erythema, edema, papules, ulceration, and pruritus for the denture component dimethacrylate. The diagnosis was supported by the patient’s medical history, notably positive patch test, and complete amelioration of the symptoms upon cessation of dimethacrylate denture usage.

This journal article has been summarized. The article information is as follows:

Contact allergy to dimethacrylate.
Vaswani R, Kim SJ, Sanchez A, Vaswani S.
Cutis 2012 Jan;89(1):10-12

Fish and shellfish allergy in children: Review of a persistent food allergy.
This review discusses interesting and new findings in the area of fish and shellfish allergy. New allergens and important potential cross-reacting allergens have been identified within the fish family and between shellfish, arachnids, and insects. The diagnostic approach may require prick to-prick tests using crude extracts of both raw and cooked forms of seafood for screening seafood sensitization before a food challenge or where food challenge is not feasible. Allergen-specific immunotherapy can be important; mutated less allergenic seafood proteins have been developed for this purpose. The persistence of allergy because of seafood proteins’ resistance after rigorous treatment like cooking and extreme pH is well documented. Additionally, IgE antibodies from individuals with persistent allergy may be directed against different epitopes than those in patients with transient allergy. For a topic as important as this one, new areas of technological developments will likely have a significant impact, to provide more accurate methods of diagnosing useful information to patients about the likely course of their seafood allergy over the course of their childhood and beyond.

This journal article has been summarized. The article information is as follows:

Fish and shellfish allergy in children: Review of a persistent food allergy.
Tsabouri S, Triga M, Makris M, Kalogeromitros D, Church MK, Priftis KN.
Pediatr Allergy Immunol 2012 May 3

Patch testing is a useful investigation in children with eczema.
The aim of this analysis was to investigate the results of patch testing of selected children with eczema of various types (mostly atopic dermatitis) and to assess potential allergens that might elicit allergic contact dermatitis. A retrospective evaluation of the patch test results in 110 children aged between 2 and 18 years, found 1 or more positive allergic reactions of current or past relevance in 48/110 children (44%; 29 females and 19 males). There were 94 allergy-positive patch test reactions in 110 patients: 81 had a reaction of current or past relevance, 12 had a reaction of unknown relevance, and 1 had reaction that was a cross-reaction. The commonest allergens with present or past relevance were medicaments, plant allergens, house dust mite, nickel, Amerchol(R) L101 (a lanolin derivative), and 2-bromo-2-nitropropane-1,3-diol. However, finding a positive allergen was not associated with a better clinical outcome. Patch testing can identify relevant allergens in 44% of children with eczema. Patch testing can be performed in children as young as 2 years with the proper preparation.

This journal article has been summarized. The article information is as follows:

Patch testing is a useful investigation in children with eczema.
Moustafa M, Holden CR, Athavale P, Cork MJ, Messenger AG, Gawkrodger DJ.
Contact Dermatitis 2011 Oct;65(4):208-212

Allergic Contact Dermatitis From a Mobile Phone
Allergic contact dermatitis was caused by chromium in a mobile phone.

Allergic contact dermatitis caused by chromium in a mobile phone.
Tan S, Nixon R.
Contact Dermatitis 2011 Oct;65(4):246-247

patch testing East Lansing

Chemical and/or Metal Patch Testing

Like the food patch test, testing can be performed to check allergies to certain chemicals or metals. A patch is simply placed on your back for 72 hours after the specific allergens have been added. The test is then read by our board-certified allergist/immunologist to interpret the results. This testing option is used for patients who experience speculated reactions from coming into contact with certain metals or chemicals.

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.


Common Variable Immunodeficiency CVID

Common Variable Immunodeficiency (CVID)

Common Variable Immunodeficiency (CVID), also known as hypogammaglobulinemia, is an antibody deficiency that leaves the immune system unable to defend against bacteria and viruses, resulting in recurrent and often severe infections. The immune system is composed of white blood cells. White blood cells are made in the bone marrow and travel through the bloodstream and lymph nodes. They are a first line of defense and protect against “foreign” invaders such as germs and bacteria. Patients diagnosed with CVID are missing different forms of white blood cells which decreases immune function. The resulting effects may include a pattern of repeated infections, severe infections and/or infections that are unusually hard to cure. These infections may attack any body

The exact cause and genetic inheritance pattern of CVID is unknown in most cases.  CVID symptoms vary from person to person. CVID can be associated with autoimmune disorders that affect other blood cells causing low numbers of white cells or platelets, anemia, arthritis and other conditions.

CVID can be diagnosed anytime from childhood through adulthood. As with other antibody deficiencies, the most common types of recurrent infections involve the ears, sinuses, nose, bronchi and lungs. These include:
• Pneumonia
• Sinusitis
• Ear infections
• Gastrointestinal infections

CVID may be suspected in patients with a history of recurrent infections involving the lungs, bronchi, ears or sinuses. An accurate diagnosis can be made through screening tests that measure immunoglobulin levels or the number of B cells in the blood.

CVID is treated with immunoglobulin replacement therapy (IRT).  IRT treatments must be given regularly and are life-long. Our allergist/immunologist will make the appropriate referral to a specialty pharmacy that will provide CVID patients with the IRT drug prescribed, as well as instruction on proper administration. Acuite infections that result from CVID are treated with antibiotics, though patients may need treatment for a longer duration than an individual without CVID.

To learn more about immunodeficiencies visit the Immune Deficiency Foundation website. Specific detail on immunoglobulins is outlined below.


Antibodies, also known as immunoglobulins (Ig) are a form of protein. The body produces antibodies when antigens are present. Parasites, bacteria, cancer cells, and viruses are examples of antigens. When the immune system accidentally attacks and destroys healthy body tissue, antibodies are produced. The four types of antibodies, IgA, IgG, IgM, and IgE, all have specific functions to combat antigens in the body. These antibodies are measured with a simple blood test.


IgA antibodies protect the surfaces of the body susceptible to foreign substances. They are located in areas such as in the nose, eyes, ears, digestive tracts, tears, saliva and blood. IgA antibodies are also present in breast milk, where they are passed along to babies to help strengthen their immune system.


All body fluids contain the IgG antibody. They are vital in fighting both bacterial and viral infections. IgG antibodies are the only antibodies that may pass through the placenta in pregnant women to protect the fetus.


IgM antibodies are the largest antibody, accounting for 5 percent to 10 percent of antibodies. They are found in the lymph fluid and blood. IgM antibodies are the first line of defense when an infection is detected. They help stimulate the immune system to combat foreign substances.


IgE antibodies trigger the body to respond against foreign matter like pollen, mold spores, pet dander, and other allergens. They are present in the lungs, skin and mucous membranes. IgE levels are typically high in patients with conditions such as allergies and asthma.

eczema east lansing

Common Skin Allergy Conditions

Irritation of the skin can be caused by many different factors. Allergens, heat, cold, medications, immune system disorders, and infections can all trigger problems with the skin. While our physician treats many skin conditions, our focus is concentrated on immunological triggers. The main skin conditions we treat are dermatitis (also known as eczema), urticaria (also known as hives), and angioedema (swelling of the deep layers of the skin).


Dermatitis is an umbrella term for irritation or inflammation of the skin. The term “dermatitis” is often used interchangeably with “eczema”. When the irritation or inflammation is caused by direct contact with an allergen, it is called allergic contact dermatitis. Examples of allergic contact dermatitis include poison ivy, poison oak, sensitivity to metals, or sensitivity to chemicals. People can develop this form of dermatitis by direct contact with allergenic substances, or by touching a secondary item. For example, if a pet has run through a patch of poison ivy, a person can develop an allergic response by petting that animal. It is important to be cautious of contact with unknown plants and to become familiar with what potentially problematic plants to avoid.

Similarly, a person with a nickel sensitivity can develop allergic contact dermatitis while wearing jewelry with even a small amount of nickel. Many chemicals, metals, and household substances can cause irritation, inflammation, and itching of the skin. There are countless substances that can act as an irritant to sensitive skin, so it is important to identify your triggers and avoid the known irritants. Our board-certified allergist can assist you with identification of such irritants and develop a plan to avoid contact with know triggers.

Atopic Dermatitis (Eczema)

Atopic dermatitis, or eczema, is an allergic disease that tends to have a hereditary component and seems to run in families whose members also have asthma. Itching will usually precede the development of a rash. When a rash does develop, it may appear as patches of dry, hardened skin. The most common areas affected in adults include the hands, neck, face, and legs. In children, presentation usually involves creases of the knees and elbows. There is a strong link between the development of eczema and food allergies, especially in young children. The food groups most commonly implicated include wheat, peanuts, eggs, milk, soy, fish, and seafood. Latex and peanut allergy are also more common in patient’s with atopic dermatitis. Urticaria and acute anaphylaxis to foods have been found to be more prevalent in patients with atopic dermatitis.


Urticaria, or hives, is a condition that affects approximately 20% of people at some point in their lives. Hives can be either an acute or chronic condition. Symptoms of hives include:

Swelling or raised red or white bumps or welts that:

  • Can cover large areas and migrate from one spot to another
  • Itch
  • Range in size
  • Appear anywhere on the body

Acute hives are hives that last less than 6 weeks. Acute hives are the form that develop with ingestion af allergenic foods or contact with irritant substances. The most common causes of acute hives are peanuts, tree nuts, shellfish, eggs, food additives, medications, aspirin, sulfa antibiotics, penicillin, blood transfusions, insect stings, and infections.  Examples of infections that are commonly linked to the development of acute episodes of hives are the common cold, urinary tract infections, infectious mononucleosis, strep throat, and many viral infections. In most cases of acute hives, the symptoms will resolve once the trigger substance is removed or avoided.

In contrast, chronic hives last or reoccur for more than 6 weeks. Chronic hives need to be evaluated by an allergist to investigate and identify the root cause. In some case, the cause of chronic hives cannot be identified even after testing and detailed evaluation. When the cause cannot be determined, the condition is called ideopathic urticaria. Approximately 50% of cases of idiopathic urticaria are caused by immune system disorders. The remaining cases are caused by thyroid disease, hormonal disorders, rarely cancer, and other physical causes. Examples of physical causes that can trigger reoccurring episodes of hives are:

  • Rubbing or scratching (dermographism). This form of hives  is the most common cause of chronic hives. The lesions typically appear within a few minutes in the area being scratched or rubbed. This form of hives often disappears with a half hour or less.
  • Constant pressure (pressure urticaria). Hives can also appear as red swelling caused by constrictive clothing such as belts and socks.
  • Change in temperature. Hives may be caused by heat or cold. Hives called cold urticaria are caused by exposure to low temperature followed by re-warming. This can be severe and life threatening if there is a general body cooling, for example after a plunge into a swimming pool. Hives called cholinergic urticaria are due to an increase in body temperature with sweating, exercise, hot showers, and/or anxiety.
  • Sun exposure (solar urticaria). Hives may occur within a few minutes after exposure to the sun.

It is important to note that while hives, acute or chronic, may be unpleasant, they are by no means contagious.


Angioedema is swelling in the deep layers of the skin, often seen with urticaria (hives). Angioedema most often occurs in soft tissues such as the eyelids, mouth or genitals. Angioedema also has acute and chronic forms. Acute cases last hours to days and are often triggered by medications or foods. Chronic cases reoccur over a long period of time and often have no identifiable cause. Another form of this disease is hereditary angiodema (HAE), which  is a rare, but serious, genetic condition involving swelling in various body parts including the hands, feet, face, intestinal wall and airways.

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.

Treatment Options for Insect Stings

The best treatment for prevention of insect stings is to avoid contact with all stinging insects. Outdoors, avoidance of bright colors and sweet smells will also help to reduce the attraction of stinging insects. For those with severe reactions to stinging insects should always carry injectable epinephrine to be given in emergency situations. Epinephrine is an emergency medication that requires emergency care even after administration of the medication.

Testing is also available to determine exactly which stinging insects you are allergic too. Stinging insect testing consists of both intradermal and prick testing methods. Intradermal testing consists of injecting small amounts of venom under the skin and monitoring for a reaction.

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

Immunotherapy injections (IT) are also available for those with an allergy to stinging insects. It is the same procedure as IT for environmental allergens, but replaced with small amounts of the insects venom that is increased with tolerance to a therapeutic level.

Your board-certified allergist or immunologist can help you determine the best treatment and testing options for you.

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

Treatment Options for Asthma

Asthma can be managed well with the right regimen of medications and treatment prescribed by your board-certified allergist or immunologist.

  • Corticosteroids are an effective medication that can be administered in a pill or inhaler form, depending of the severity of asthma. Examples include Qvar, Pulmicort flexhaler, Symbicort, Advair diskus, Flovent, Asminex, Dulera, and Alvesco.
  • Bronchodilators are known as rescue inhalers, which are used to open up the bronchial tubes allowing more air to flow through. Examples include ProAir.
  • Anti-leukotriene’s help to combat leukotrienes that are responsible for airway inflammation that occurs in the body. Singulair is a popular anti-leukotriene used to treat asthma.
  • Xolair is a treatment option only for patients with high IgE levels and moderate to severe asthma. Xolair comes in the form of an infection, similar to allergy injections, that bind to IgE and inactivates them, reducing asthma symptoms. Xolair helps to decrease asthma attacks in patients who still have asthma symptoms even with the use of inhaled steroids.
  • Immunotherapy injections (IT), also known as allergy shots, can be a very helpful treatment for asthma depending on the cause and triggers to your asthma. IT can help to decrease your sensitivity to environmental allergens which will help to decrease triggers for your asthma and asthma attacks.
asthma treatments East Lansing


Asthma is a chronic lung disease that affects millions of Americans. Asthma is closely linked to allergies, and is considered a risk factor in developing asthma. Asthma is characterized by coughing, chest tightness, shortness of breath and wheezing. Those with asthma have sensitive airways, known as bronchial tubes, which can be triggered by allergens, exercise, reflux disease, illness, pollution, strong odors, or weather changes. Asthma is currently the leading chronic illness among children in the US, although it can affect people of all ages and races; however those of African American decent are more likely to be hospitalized or have more severe cases of asthma than Caucasians.

Asthma can be properly diagnosed by your board-certified allergist/immunologist by performing a pulmonary function test (PFT). The most common form of PFT is spirometry, which specifically measures the amount (volume) and the speed (flow) of air that can be inhaled and exhaled, which can help assess the extent of your asthma.

Treatment Options for Asthma