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Atopy is a term that refers to the genetic tendency to develop the “classical” allergic diseases, namely, allergic rhinitis, asthma and atopic dermatitis. Atopy is typically associated with a genetically determined capacity to mount IgE responses to common allergens, especially inhaled allergens and food allergens

Atopic dermatitis is a chronic or recurrent atopic inflammatory skin disease that usually begins in the first few years of life. It is often the initial clinical manifestation of an atopic predisposition, with many children later developing asthma and/or allergic rhinitis (hay fever). Red, bumpy, scaly, itchy or swollen skin – any of these signs may mean you have a skin allergy. The most common allergic skin conditions are: Eczema Hives and angioedema Allergic contact dermatitis Symptoms of a skin allergy include: A strange rash Red, scaly or itchy skin A swelling of the deeper layers of the skin, such as the eyelids, mouth or genitals Dry, flaking skin Inflamed or blistered skin Skin allergies are painful and unpleasant, but there are things you can do to treat and prevent an allergic skin reaction. Some people are allergic to latex, a substance often found in rubber gloves and balloons. Signs of latex allergy may resemble those of contact dermatitis. But sometimes latex allergy causes a serious reaction called anaphylaxis. This life-threatening condition requires immediate medical treatment. If you think you are having this kind of reaction, call your local medical emergency number immediately.

Asthma is a chronic disease that affects about 340 million people all over the world. Its primary cause is inflamed airways in the lungs. This inflammation makes the airways smaller, which makes it more difficult for air to move in and out of the lungs. Asthma is the most common serious disease among children. Nine million children in the United States have asthma. Signs that you might have asthma include:   Coughing   Wheezing   Shortness of breath   Chest tightness Many people have “allergic asthma,” which means that allergens – like dust mites, mold, animal dander, pollen and cockroaches – make their symptoms worse. Other things that can affect adult asthma include:   Pregnancy: Uncontrolled asthma can harm the health of a mother and her baby.   Work situations: Fumes, gases or dust that are inhaled at work can trigger asthma.   Age: Older people with asthma face unique health challenges.   Exercise: Some people may have asthma symptoms when they exercise.   Medications: Medications like aspirin and ibuprofen, or beta-blockers (used to treat heart disease, high blood pressure, migraine headaches or glaucoma), may cause an asthma attack in some adults. Childhood Asthma Children with recurrent cough, wheezing, chest tightness or shortness of breath may have one or more forms of asthma. Left untreated, asthmatic children often have less stamina than other children, or avoid physical activities to prevent coughing or wheezing. Sometimes they will complain that their “chest hurts” or that they can not “catch their breath.” Colds may “go straight to their chest.” They may cough when sick, particularly at night. Asthma has multiple causes, and it is not uncommon for two or more different causes to be present in one child. Asthma is not just “wheezing.” Coughing, recurrent bronchitis and shortness of breath, especially when exercising, are also ways that asthma appears. Diagnosis Diagnosing the precise cause of asthma is sometimes difficult because two or more causes may be present in one child. Unfortunately, there is not a single test that provides all the answers. An allergist/immunologist, often referred to as an allergist, has specialized training and experience to determine if your child has asthma, what is causing it and develop a treatment plan. Your child’s allergist will want to learn how often episodes of wheezing/coughing/other symptoms occur, and how bad they are. It is important to understand what triggers your child’s symptoms, and what (including medications) makes them go away. An understanding of your family history and environment (smoking, pets, etc) is useful, so your physician may ask. Infants may need extra attention during the diagnostic process because asthma symptoms can be caused by many things in this age group, some of which need very different therapies. When an infant has asthma symptoms, it is sometimes called “reactive airway disease.” The two most common triggers of asthma in children are colds and allergens. After infancy, allergies become particularly important, and therefore asthmatic children should have an allergy evaluation to help diagnose and manage their asthma. Avoiding the allergens to which your child is allergic may help improve his or her asthma. If your child is older than 5 years, he or she may be asked to perform pulmonary function testing to learn how air flows in his or her lungs. Other tests that your physician may discuss with you include measures of inflammation, a chest x-ray and tests for some of the less common causes of asthma-like symptoms. Management The most important part of managing asthma is for you and your child to be very knowledgeable about how and when asthma causes problems, how some of the triggers can be avoided and how to use medications. The causes of asthma and best treatment for it in your child may be quite different than for another child. Your allergist will help you develop an asthma management plan, and it is wise to share it with other caregivers. This plan outlines what medications to take, and when and how to increase the doses or add more medication if needed. It also includes advice about when to call your physician. An asthma management plan puts you in control for detection and early treatment of symptoms. Inhaled medications come as metered dose inhalers (sometimes called pumps), nebulizer solutions (delivered as a mist by a machine) and dry powder inhalers. It is important to learn how to use the type of medications prescribed for your child, or they might not work well. Another brochure in this series, Inhaled Asthma Medications, offers helpful information. Asthma medications include inhaled rescue medications (quick relievers) to treat symptoms and long-term controller medicines (inhaled as well as oral) to control inflammation that commonly causes the asthma. If your child’s asthma is more than a rare minor problem, a controller medication will probably be prescribed. Our knowledge about asthma and its therapy is constantly changing. An ongoing relationship with your child’s physician is key to determining what will work best for your child, now and throughout childhood. Answers to Commonly Asked Questions   Will my child outgrow his/her asthma? Many babies who wheeze with viral respiratory illnesses will stop wheezing as they grow older. If your child has atopic dermatitis (eczema), allergies or if there is smoking in the home or a strong family history of allergies or asthma, there is a greater chance that asthma symptoms will persist. Can asthma be cured? Not yet. However, for most children and adults, asthma can be controlled throughout life with appropriate diagnosis, education and treatment. Should my child exercise? Once a child’s asthma is controlled, (usually with the help of proper medications) exercise should become part of his or her daily activities. Children with asthma certainly can and do excel in athletics. Many Olympic athletes have asthma. How can symptoms be controlled at school? You, your family, physician and school personnel can work together to prevent and/or control asthma. Share your child’s asthma management plan with the school nurse and any coaches who oversee your child. With

Angioedema is a swelling of the deeper layers of the skin and often occurs with hives. Angioedema itself is not red or itchy and most often occurs in the body’s soft tissue, such as the eyelids, mouth or genitals. Angioedema is called “acute” if the condition lasts only a short time (minutes to days) and does not recur. This is commonly caused by an allergic reaction to medications or foods. Chronic recurrent angioedema occurs when the condition returns over a long period of time. Chronic recurrent angioedema most often does not have an identifiable cause.

Anaphylaxis (an-a-fi-LAK-sis) is a serious allergic reaction that happens to some people who have allergies to food, insect stings, drugs or latex. Anaphylaxis happens very quickly and affects your entire body. Signs usually start within 5 to 30 minutes of coming into contact with the thing to which you are allergic. But it may take more than an hour for you to notice anaphylactic symptoms. Warning signs may include:   A red rash, with welts, that is usually itchy   Swollen throat or swollen areas of the body   Wheezing   Passing out   Chest tightness   Trouble breathing   A hoarse voice   Trouble swallowing   Vomiting   Diarrhea   Stomach cramping   A pale or red color to the face and body Anaphylaxis requires immediate medical treatment. Who is at risk? Anyone, especially those allergic to foods such as peanut, tree nut, seafood, fin fish, milk, or egg, or to insect stings or bites, natural rubber latex, or medications. When can it happen? Within minutes, anytime the allergic person comes in contact with his or her trigger. How do we know? Several symptoms occur at the same time, such as: itching, hives, flushing, difficulty breathing, vomiting, diarrhea, dizziness, confusion, or shock. Where can it happen? Anywhere; for example, home, restaurant, school, child care or sports facility, summer camp, car, bus, airplane. What should we do? Self-inject epinephrine (Adrenaclick, EpiPen or Twinject), call 911 or your local emergency medical services number, and notify the individual’s family (in that order)! Act quickly. Anaphylaxis can be mild, or it can be fatal. Why is follow-up needed? Anaphylaxis can occur repeatedly. The trigger needs to be confirmed, and long-term preventive strategies need to be implemented.

Allergic conjunctivitis is the most common allergy affecting the eyes. The conjunctivae—the thin membranes covering the eyelids and the exposed surface of the eyes—is an active tissue of the immune system that responds to allergies caused by airborne particles, or allergens. Allergic conjunctivitis can appear in two forms: seasonal and perennial. The seasonal version is much more common, and is related to exposure to specific airborne allergens, such as grass, tree and weed pollens and molds. The perennial form persists throughout the year and is usually triggered by dust mites, animal dander and feathers. EYE ALLERGY: CAUSES AND TREATMENT Conjunctivitis is an inflammation of the conjunctiva. This is the mucous membrane covering the white of the eyes and the inner side of the eyelids. If something irritates this clear membrane, your eyes may water, itch, hurt, or become red or swollen. In some people, conjunctivitis is due to an allergy. In these instances, the condition is called either allergic conjunctivitis or ocular allergy. It can occur alone, or it may be associated with nasal allergy symptoms. Unlike conditions such as pink eye, allergic conjunctivitis is not contagious. A recent study reported by Leonard Bielory, MD, FAAAAI, states that ocular allergies may be more common than nasal allergies in some areas, especially in the southern United States. And, while most people treat nasal allergy symptoms, they often ignore their itchy, red, watery eyes. CAUSES AND TRIGGERS If you have an allergy, your immune system identifies something as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction. This reaction usually causes symptoms in the nose, lungs, throat, sinuses, intestinal tract or the eyes. The most common allergen is pollen, which is seasonal. People with seasonal allergic conjunctivitis, or rhinoconjuntivitis will experience symptoms at certain times during the year – usually from early spring, into summer, and even into autumn (fall). Those with perennial allergic conjunctivitis are susceptible at any time of year. These irritations may be triggered by perfumes, cosmetics, skin medicines, or environmental allergens such as air pollution or second-hand smoke. SYMPTOMS Most people suffering from allergic conjunctivitis have problems in both eyes. Symptoms may appear quickly, soon after the eyes have come into contact with the allergen. The most common symptom occurs when the eyes become irritated, the capillaries (small blood vessels) widen and the eyes become pink or red. Some people experience pain in one or both eyes. Other symptoms include swollen eyelids, a burning sensation, sore or tender eyes. TREATMENT According to Dr. Bielory, about 50% of conjunctivitis cases seen by primary care physicians are actually allergic in nature. There are many different treatment options, depending upon the severity of the symptoms. As with any allergy, the first approach for successful management of seasonal or perennial forms of eye allergy should be prevention or avoidance of the allergens that trigger your symptoms. The AAAAI Outdoor Allergens brochure offers tips on avoiding triggers. However, avoidance of airborne allergens isn’t always possible. That is when medications may be helpful. Over-the-counter (OTC) eye drops and oral medications are commonly used for short-term relief of some eye allergy symptoms. However, they may not relieve all symptoms, and prolonged use of some OTC eye drops may actually make your symptoms worse. Prescription eye drops and oral medications can also treat eye allergies. Prescription eye drops provide both short- and long-term targeted relief of eye allergy symptoms, and they can be used to manage eye allergy symptoms in conjunction with an oral antihistamine that might be taken to manage nasal allergy symptoms. Any medication placed in the eye should be kept in the refrigerator.

Rhinitis is an inflammation of the mucous membranes of the nose. Symptoms include:   Sneezing   Itchy nose, roof of the mouth, throat, eyes and ears   Runny nose   Congestion   Watery eyes Seasonal Allergic Rhinitis (or hay fever) is caused by allergens like mold and pollen. Some people have symptoms of rhinitis no matter what the season. This is called perennial allergic rhinitis. It can be caused by allergens such as animal dander, indoor mold, dust mites and cockroaches. Sinusitis is a painful, long-lasting inflammation of the sinuses. Sinuses are the hollow cavities around the cheek bones found around the eyes and behind the nose. Symptoms of sinusitis include:   Congestion   Green or gray nasal discharge   Postnasal drip   Pressure in the face   Headache   Fever   A cough that won’t go away Sinusitis is common in the winter. It may last for months or years if it is not properly treated. Colds are the most common cause of acute sinusitis, but people with allergies are much more likely to develop sinusitis than people who do not have allergies.

Many patients experience adverse reactions to medications. Only a small percent of these reactions, however, are true allergic reactions. An allergic reaction means the patient’s immune system is programmed to recognize a certain medication and produce a specific reaction whenever it encounters that drug. The most potentially severe allergic reaction to a drug is anaphylaxis. This happens when the patient, unknowingly, has a large amount of an allergy protein (called IgE antibody) in his or her body specific for a drug, such as penicillin. Common Medications Can Have Major Side Effects It is essential to know exactly what medications you are taking, how to take them and what the potential side effects can be. This advice is especially true for older adults with allergies or asthma. Asthma Medications There are times when a medication can be very beneficial for one ailment, but has the potential to cause concern for another condition. Such is the case with inhaled corticosteroids (ICS), one of the most effective classes of medications used to treat asthma. On one hand, ICS are the most effective class of drugs in the treatment of asthma. On the other hand, corticosteroids can contribute to the development of osteoporosis, a condition leading to brittle bones, especially in older women. In most cases, physicians believe the benefits of ICS far outweigh the potential downsides. First, uncontrolled asthma puts you at a high risk for complications requiring hospitalization. Also, if your asthma is uncontrolled, chances are you aren’t sleeping well and exercising is difficult. Reduced levels of activity can also cause osteoporosis. An allergist/immunologist, often referred to as an allergist, has extensive training in the management of asthma and in minimizing the side effects of medications such as inhaled corticosteroids. Your physician can weigh the risks of osteoporosis with the risks of asthma, and may prescribe medications to counteract osteoporosis or order bone density testing. Your physician may also suggest things you can do to reduce your risk of osteoporosis. Regular exercise and dietary supplementation with healthcare practitioner prescribed calcium and vitamin D are good ways to reduce the risk. Allergy Medications Allergies such as allergic rhinitis (hay fever), allergic conjunctivitis and urticaria (hives) are common problems and often require the use of antihistamines. This medication is divided into two classes: first generation antihistamines and second generation antihistamines. First generation antihistamines, while very effective at controlling symptoms, are often associated with symptoms in older adults such as anxiety, confusion, sedation, blurred vision, reduced mental alertness, urinary retention and constipation. These side effects are even more common in people being treated with certain antidepressant medications. The second generation antihistamines tend to cause fewer side effects. Triggering Asthma Beta-blockers are drugs typically used to treat problems such as high blood pressure, heart disease and migraine headache. They may also be used in an eye drop form for treating glaucoma. Beta-blockers are classified in one of two groups: non-specific and specific. Non-specific beta-blockers, such as propranlol, are known to trigger asthma symptoms. Yet beta-blockers can be very important preventative care medications. Your physician may conduct a trial using a “specific” beta-blocker. Remember that even beta-blockers in eye drops can make asthma worse, so be sure to tell your ophthalmologist if you have asthma. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) include some common over-the-counter pain relievers, such as ibuprofen and naproxen. Approximately 10% to 20% of people with asthma may notice that one or more of these drugs trigger their asthma. These asthma attacks may be severe and even fatal, so patients with known aspirin sensitivity must be very careful to avoid these drugs. Pain relief medications that usually don’t cause increased asthma in aspirin-sensitive patients include low-to-moderate dose acetaminophen, propoxyphene and prescribed narcotics (such as codeine). ACE inhibitors, which may be used for hypertension or heart disease, include lisinopril and enalapril. Although they usually don’t cause asthma, approximately 10% of patients who receive one of these drugs develop a cough. This cough may be confused with asthma in some patients and possibly trigger increased wheezing in others. The bottom line in avoiding medication-induced asthma is to talk with your physician about what medications are best for you.

For most people, an insect sting means a little pain and discomfort. But some people may have trouble breathing or itch and have hives all over their body after being stung. These people are allergic to insect stings. This means that their immune system overreacts to the insect’s venom. Most allergic insect sting reactions are caused by five kinds of insects:   Yellow jackets   Honeybees   Paper wasps   Hornets   Fire ants For people who are very allergic to an insect’s venom, a sting may cause a dangerous allergic reaction called anaphylaxis (an-a-fi-LAK-sis). Signs of anaphylaxis include:   Itching and hives over a large part of the body   Swollen throat or tongue   Trouble breathing   Dizziness   Stomach cramps   Nausea or upset stomach   Diarrhea If you are allergic to insect stings, you can reduce your risk of having an allergic reaction by staying indoors during insect season and always carrying autoinjectable epinephrine. You can also talk to your allergist/immunologist about receiving immunotherapy, which can protect you the next time you are stung by an insect.

People with food allergies have an allergic reaction when they come in contact with certain foods. This happens because their immune system overreacts to the proteins in that food. Eight kinds of food cause most food allergies:      Cow’s milk     Eggs     Peanuts     Wheat     Soy     Fish     Shellfish     Tree nuts  Signs of a food allergy include:     A rash, or red, itchy skin     Stuffy or itchy nose, sneezing, or itchy and teary eyes     Vomiting, stomach cramps or diarrhea     Angioedema or swelling  Some people with food allergies can have a serious reaction called anaphylaxis. Signs of this kind of reaction include:     Hoarseness, throat tightness or a lump in the throat     Wheezing, chest tightness or trouble breathing     Tingling in the hands or feet, lips or scalp