Asthma affects 10-15% of the world population. It is a chronic inflammatory disease. Usually starts in childhood but it can occur in any period of life. There are several factors present in its pathogenesis: genetics, environment, pollution, house dust mites, molds, pollens, household pets, cockroaches, aspirin, exercices, weather changes, viral upper respiratory infections (colds), stress, cold air, airborn irritants, emotions and ocasionally foods. About 74% of asthmatics are allergic. In 85% of the time asthma is associated with rhinitis (united airways disease). With environmental control, medicines and sometimes with immunotherapy (“allergy shots”) asthmatics usually do very well. Normal life is frequenty achieved. Innovative and combination treatments are promising in asthma.

Rhinitis affects 30% of the world population. Mainly in well developed and hygienic societies. It is a risk factor for asthma. It can be associated with atopic dermatitis usually called eczema. It is allergic in about 2/3 of the time and it has the following precipitating factors: genetics, environment, pollution, house dust mites, molds, pollens, household pets, cockroaches, aspirin, weather changes, viral upper respiratory infections (colds), stress, cold air, airborn irritants, emotions and ocasionally foods. It can be seasonal or perennial. Hypothyroidism and female hormones may cause nasal congestion. Modern treatment with environmental control, medicines and immunotherapy (“allergy shots”) helps bringing the quality of life rhinitics deserve. Treatment of rhinitis improves the control of the associated asthma. Some women report worsening of rhinitis during menstrual periods. Nasal polyps (inflammatory growths in the mucosa) can explain the loss or diminished sense of smell.

Sinusitis is frequently associated with rhinitis. It can be precipitated by viral upper respiratory tract infections (colds). It can afterwards complicate with bacterial infections and even with fungal infections (Ex: aspergillus). CT scan of the sinuses and an allergy evaluation are often required. Endoscopic functional surgery may occasionally be indicated. Nasal polyps and intolerance to aspirin and anti-inflammatory drugs may be present. Otitis media can also be associated. Anti-pneumococal immunization can be given. Quite frequently sinusitis cause severe teeth aches, especially in the maxillary areas.

Conjunctivitis can be associated with rhinitis. It is usually called allergic rhinoconjunctivitis. There is a naso-ocular reflex. Allergy work-up is often asked by the eye specialist. Modern treatment includes eyedrops, oral medicines, topical nasal steroids and occasionally immunotherapy (“allergy shots”). Dry eyes need to be treated with artificial tears.

Urticaria and angioedema can be acute and chronic. They can be associated (40% of the cases) or not. There is a hereditary form caused by an enzyme inhibitor deficiency or dysfunction. Many times the cause is not found (idiopathic). Stress and intolerance to aspirin and anti-inflammatory drugs may be present. . Mast cells may be increased (urticaria pigmentosa and systemic mastocytosis) with serum tryptase elevation. There are also physical urticarias triggered by cold, heat, trauma, pressure, water, vibration, solar light and exercises. Food and drug allergies may be the answer for urticaria and angioedema in selected cases. There are good treatments for the control of these conditions. Alcoholic beverages can agravate urticaria and angioedema.

Anaphylaxis is the most severe emergency in Allergy. It is potentially fatal and requires prompt and agressive treatment. Epinephrin IM in the antero-lateral aspect of the tigh is the first drug to be given followed by anti-histamines and steroids. Good vital signs and proper breathing are fundamental. When laryngeal edema and arterial hypotension are present the patient should be vigorously treated and watched, many times in hospital settings. The most common causes include foods, drugs, anesthesia, insect stings, latex, exercises and other physical allergies. In about 15-30% of the time a cause is not found (idiopathic). It seems that vitamin D (solar light exposure) may confer protection against anaphylaxis. Self-injecting epinephrine (EpiPen) and an allergy evaluation should always be provided to these patients. Mite contaminated flour may be associated with the “pancake anaphylaxis”. Idiopathic anaphylaxis can adequately be controlled and prevented with oral corticosteroids.

Atopic dermatitis is commonly called eczema and it is frequently associated with rhinitis and asthma. Food allergy may be present. It is more prevalent in children than in adults. It has a genetic predisposition and children may outgrow it as they get older. Stress may be present and aggravate it. Treatment of the dry skin and control of the skin infections (Staphilocococus) are fundamental. Topical steroids and immunomodulators are often used. Herpes may complicate the picture in some instances. It is being evaluated the potential benefits of oral probiotics in atopic dermatitis.

Contact dermatitis may be allergic or irritative. Patch testing (reading in 3-4 days) is very helpful for the precise diagnosis. There is no cure for allergic contact dermatitis, only avoidance of the triggering substances. Fancy jewels, rubber, cosmetics and creams are the most common causes of allergic contact dermatitis. Detergents may play a role in irritative contact dermatitis.

Food allergy is more prevalent in childhood and children may outgrow it as time goes by. The most frequent food allergens are: milk, eggs, peanuts, wheat, soy, nuts, shellfish and fish. It may be present in atopic dermatitis. There may be cross reactions between fruits and pollens and between latex and foods like papaya, kiwi, figs, bananas, avocato, pineapple, nuts, etc.). Some patients may mistaken food intolerance for food allergy. There are good allergy skin tests and Lab diagnostic tools for the diagnosis of food allergic conditions. The food allergen and the cross reactive foods should be strictly avoided and a prescription for self injecting epinephrine (EpiPen) should always be provided. New promising research projects with oral and sublingual immunotherapy in food allergy are now in the pipeline.

Many medicines can cause allergic reactions involving the skin, the respiratory tract, the GI and the cardiovascular systems. Drug allergy may cause anaphylaxis and therefore it is potentially fatal. Self injecting epinephrin (EpiPen) is often provided. Good medical history and allergy tests may be applied. Aspirin, anti-inflammatory drugs, penicillins, sulphas, cancer drugs, contrast radiologic agents, muscle relaxants in general anesthesia are common culprits. Avoidance, medic alert, and in some cases drug desensitization are indicated. Allergists can help patients with drug hypersensitivity on how to choose alternative safe choices.

Insects of the Himenoptera class (bees, wasps, hornets, yellow jackets and fire ants) are the main causes of insect allergies. They can cause anaphylaxis and death. Mosquitos can cause non-fatal allergic skin reactions. There are allergy diagnostic tests for their venoms (skin and blood tests). Allergic reactions might be local or systemic (requiring epinephrin IM). EpiPen is therefore provided for these anaphylactic cases. The affected individuals should avoid perfumes, wearing clothes with bright colors, be around food residues and soft drinks when camping outdoors. Pants and shirts with long sleeves are always advised. Immunotherapy (“allergy shots”) is very effective in the treatment of systemic reactions associated with insect allergies. Beekeepers at work can develop anaphylaxis or acquire protective resistance against bee stings.

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