Does Your Child Have Allergies?… Are You Sure?

Allergies can cause a wide variety of symptoms, many of which you might not expect.

Viruses, bacteria, allergens — there’s any number of small organisms that can make children feel bad. Often the hardest part of treatment is determining the true cause of your child’s illness. For instance, is the latest ear infections the result of a “bug” going around day care or is grass pollen triggering an allergy?

Compounding the situation, allergies manifest themselves in many different ways. Of course, everyone knows that allergies can cause sniffles, watery eyes and sneezing. But here’s a list of other common, though often undiagnosed allergy symptoms in kids:

• Asthma
• Frequent ear infections
• Sinus headaches
• Nasal polyps
• Conjunctivitis (eye irritation)
• Skin rashes and eczema
• Mental problems such as confusion, slow thinking, depression and forgetfulness
• Respiratory effects including endless colds, chronic cough, recurrent bronchitis
• ADHD (Attention Deficit / Hyperactive Disorder)

That’s right,  allergies can even trigger ADHD. So, what do you do? The first step is a full allergy evaluation by a qualified medical provider. An allergy test alone — even a skin test, the gold standard — is not enough; it can show that your child is sensitive to an allergen but not determine if that is causing symptoms. Your provider should conduct a full health history. The results, in conjunction with your answers to when and where your child exhibits symptoms, can help determine if his or her maladies are allergies or something else.

One key to remember is that if your child’s ailments come and go regularly, or if they stay around constantly, there’s a good chance allergies are to blame. If they’re “one and done,” it may be just the cold going around. When in doubt, ask your provider for a full allergy evaluation. To find an AllerVision-affiliated doctor who is qualified to do this, click here.

Top 7 Reasons Nearly Every Doctor Should Test for Allergies

The allergy skin test is painless, quick and accurate.

Family practitioners, internists, pediatricians, dermatologists, ENTs, neurologists, pulmonologists, ophthalmologists and nearly all other types of physicians and health care providers come in contact with patients who suffer from allergies virtually every day. That’s because allergies cause symptoms in every organ system. In fact, they cause many more symptoms than the average person realizes, including rashes (dermatitis), sinus infections, migraine headaches, dizziness, conjunctivitis, respiratory problems, fatigue, muscle and joint pain, and the list goes on. So here are our top seven reasons your healthcare provider should offer allergy testing — and treatment — in his or her office.

1) Since nearly every type of doctor comes in contact with patients suffering from allergies, it’s important that they are trained and have the tools to properly diagnose those patients’ allergies, suggest appropriate treatment, and know when to refer to an allergy specialist.

2) Allergies affect A LOT of people. The World Allergy Organization estimates that “30-40% of the world’s population is now affected by one or more allergic conditions.” And those numbers are growing; allergies have reached epidemic status.

3) There aren’t enough allergists to go around. Allergists make up a very small percentage of doctors. Even if there were enough, people often don’t know that their illness/ailment/discomfort is caused by allergies. Their primary care doctors should be able to make that diagnosis and offer first line definitive treatment as they do with most other chronic conditions (like hypertension and diabetes).

4) It’s impossible to be sure exactly what’s causing the allergic symptoms without a proper test. Pollens ride on the wind and cause discomfort for people up to hundreds of miles away from their source. Pet hair gets stuck in furniture and carpeting, causing allergic reactions even if the animal has been away for months. Dust mites float through the air and hide in bedsheets. Cockroaches leave hidden “presents” that trigger allergies. Which of these items cause your symptoms? The only way to find out is to test. AllerVision provides doctors with a program that allows them to test for reactions to a wide range of regional allergens and a variety of foods.

5) The allergy skin test is painless, easy to administer in the doctor’s office, and produces results in just 15 minutes. This convenient test, which is the diagnostic gold standard, helps doctors quickly determine the problem and the select the right course of treatment immediately.

6) Allergies can lead to asthma attacks. Asthma is a serious chronic airway disease that causes coughing, wheezing, and difficulty breathing. It often interferes with quality of life, preventing sufferers from participating in sports and outdoor activities. Severe asthma attacks in a patient without adequate disease control can be fatal.

7) Allergies can cause anaphylaxis, an extreme, life-threatening reaction. Anaphylaxis is usually associated with insect stings and food allergies but other allergens can cause it as well. Simply put, knowing what you’re allergic to can save your life.

Healthcare providers who don’t offer allergy testing should consider taking the time to learn and add the service to their practice. For more information, click here.

If you think that you may suffer from allergies, get an allergy test and evaluation. (Hint: if you’re feeling bad and don’t know why, it could be allergies.) AllerVision can help you find a local doctor who performs the test, or we can contact your provider to help him or her launch an allergy testing and treatment program. Click here to learn more.

Drug Allergy: The Most Dangerous Reactions You Can’t Miss! Part 2

In Part 1 of this series I discussed the immediate hypersensitivity reactions that occur from a few minutes to a couple of hours after a patient takes a medication. Today, I am covering drug reactions that can occur up to two weeks after a medication is given. These reactions are tricky and dangerous for the clinician. A patient you may have seen for a sore throat and a cough two weeks ago now calls you up and tells you he has sores in his mouth and his eyes are red. What should you do? If it’s a Friday afternoon, don’t tell him you will  see him first thing Monday morning — it might be too late!

The drug reaction I’m describing is well known as the Stevens-Johnson Syndrome. Stevens and Johnson described this reaction back in 1922 in two children who developed extensive skin necrosis, fever, conjunctivitis and stomatitis. The syndrome that bears their name is a potentially life-threatening disease with a sudden onset of erythema and bulbous lesions on the skin; there is epidermal detachment involving less than 10% of the skin, which is accompanied by involvement of two mucosal areas. This syndrome is usually mentioned in the same breath as Toxic Epidermal Necrolysis, which has the same presentation, except here there is 10-30% skin involvement. I have seen just two cases of this in my career — when I was a resident in Internal Medicine. It was very frightening; the patients looked like burn victims. I was also horrified to hear that the son of a medical colleague developed this after a course of antibiotics and has been struggling to recover since.

Most cases of Stevens-Johnson syndrome are linked to specific medications: anticonvulsants such as phenytoin, antibiotics such as sulfonamides and tetracyclines, and widely used non-steroidal anti-inflammatory drugs. Why are some individuals more prone to this syndrome? The answer is probably genetic predisposition — individuals with the HLA types B*1502, B*5701, B*5801, Bw44 and DQB1*0601. Of course, as clinicians we will never know in advance that a patient has these HLA types. However, I would be very cautious in a patient that has told you they seem to get reactions to many different medications. These are not hypochondriacs, there is sufficient medical literature to document individuals with multiple drug reactions. It is only recently that we’ve begun understanding the connection to a person’s genetic-immune make-up.

So, if you get the call or see a patient in the office who is developing a severe desquamating rash along with red eyes and sores in their mouth send them immediately to the hospital. In fact, it’s important that it be a tertiary care hospital that can place this patient in an ICU isolation room. An infection on top of this reaction can be lethal for the patient that is now immune compromised—similar to a burn victim.

I would also suggest that the patient see a good dermatologist and an immunologist who is familiar with drug reactions. The recent medical literature supports using IV gamma globulin to ameliorate the intensity of the disease, and it also helps boost the patient’s immune system.

Today, in our busy practices, most doctors prescribe lots of medications and see just the occasional adverse reactions. It’s important to have your antenna on high alert if you hear a story like the one we just described.

– Dr. Dean Mitchell

Exploring the Allergy Roots of Eczema Leads to New Treatment Options

Eczema is a chronic condition that is often associated with allergies. The sharp provider can offer patients several treatment options.

The cold winter months may offer respite for patients with pure pollen allergy, but they are no friend to patients suffering with eczema. Eczema, also known as Atopic Dermatitis, is the classic allergic skin rash. It’s known as “the itch that rashes,” meaning that it is typical for a patient to experience the symptom of itching first and clinical rash next. Atopic dermatitis patients usually have elevated total IgE, which explains why they frequently have comorbid conditions of allergic rhinitis and asthma. The simple treatment for the eczema patient’s symptoms is a prescription for a topical cortisone cream. Cortisone may give the patient temporary relief, but a more comprehensive plan is needed to provide the fundamental disease control that they deserve.

We sometimes forget that the skin is the largest organ in the body.  It covers our entire outer surface. In order to adequately protect that organ, we must provide an emollient that can serve as a barrier to the harsh environment. The good news is these are easy to acquire and they aren’t very expensive. My professor of allergy and dermatology at Columbia Presbyterian Medical Center extolled the benefits of baby oil. Yes, good old fashioned baby oil just after a shower, when the skin pores are wide open, can provide a nice general coating for the skin. In areas of severe dryness or broken skin resulting from the eczema, plain Vaseline or Aquaphor lotion is helpful. Vaseline may be sticky and messy but it’s effective. When we had patients on the dermatology ward with severe rashes, the nurses coated them with Vaseline — it was very soothing and therapeutic.

Cortisone creams are an important element in the treatment regimen, but they should be targeted to the affected areas. It is very important to show the patient how to apply the cream; they must see how to massage it in coin size amounts to the local areas of redness. If they just lightly smear tons of cream over the body, absorption — and therefore effectiveness — is limited. I usually find that a mid-potency steroid cream, such as Mometasone is effective. However, you should use only low potency hydrocortisone (1 or 2.5%) on the face due to the risk of atrophy with the mid-potency preparations. The other important ointment in the treatment spectrum is Muciprin, which contains an antibacterial agent that helps reduce the growth of Staph.aureus on the affected skin areas. Muciprin should be applied to broken skin areas that are oozing with fluid.

The above steps are familiar to most doctors. Now, comes the expert territory. Even dermatologists are a bit lax when pursuing the underlying cause of eczema. Numerous studies show that atopic dermatitis is worse in children with food or environmental allergies — especially to dust mites. It’s important to take a thorough history on these patients and perform an allergy test to see if an allergen exacerbates the condition. Dr. Hugh Sampson, when he was at Johns Hopkins, demonstrated that 50% of children with eczema had food allergies. The studies further showed that eliminating these foods from the children’s diet caused improvement of the eczema. This was ground-breaking information in the late 1990s — now it’s recognized as a standard of care. The AllerVision allergy skin test panel of standard foods is a good place to start your evaluation. AllerVision also offers an additional food panel that allows you to test for 40 individual foods; it’s an excellent way to augment your program.

Exciting new areas of research into eczema treatment indicate that enhancing immunity may provide significant benefit to the patient. The latest studies from Harvard suggest that supplementing with Vitamin D3 can help control patients’ eczema and decrease reliance on topical corticosteroids. As a result, I have recommended supplementation with Vitamin D3 in the ranges of 1,000- 3,000 units daily for all of my eczema patients. I prefer the liquid Vitamin D3 over pills, as the pills can be difficult to swallow. Following your patients’ D3 level along the course of eczema treatment can provide interesting information regarding management.

Finally, it’s worth noting that studies substantiate the value of sublingual allergy immunotherapy (allergy drops) for patients with mild to moderate atopic dermatitis. Specifically data has shown that dust mite allergy, which is associated with aggravating atopic dermatitis, can be treated effectively with sublingual allergy immunotherapy. The same has not been demonstrated with subcutaneous injection immunotherapy.

Once you determine — though medical history and allergy testing — the root of the eczema, you can determine which of these treatments can take the itch out of your patient’s lives.

– Dr. Dean Mitchell