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Seasonal allergic rhinitis, often referred to as “hay fever,” affects more than 35 million people in the United States. These seasonal allergies are caused by substances called allergens. Airborne pollens and mold spores are outdoor allergens that commonly trigger symptoms during the spring and fall. During these times, seasonal allergic rhinitis sufferers experience increased symptoms—sneezing, congestion, a runny nose, and itchiness in the nose, roof of the mouth, throat, eyes and ears—depending on where they live in the country and the exact allergen to which they are allergic. These allergic reactions are most commonly caused by pollen and mold spores in the air, which start a chain reaction in your immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, the immune system identifies pollen 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. Pollen Pollen are tiny cells needed to fertilize plants. Pollen from plants with colorful flowers, like roses, usually do not cause allergies. These plants rely on insects to transport the pollen for fertilization. On the other hand, many plants have flowers which produce light, dry pollen that are easily spread by wind. These culprits cause allergy symptoms. Each plant has a period of pollination that does not vary much from year to year. However, the weather can affect the amount of pollen in the air at any time. The pollinating season starts later in the spring the further north one goes. Generally, the entire pollen season lasts from February or March through October. In warmer places, pollination can be year-round. Seasonal allergic rhinitis is often caused by tree pollen in the early spring. During the late spring and early summer, grasses often cause symptoms. Late summer and fall hay fever is caused by weeds. Molds Molds are tiny fungi related to mushrooms but without stems, roots or leaves. Their spores float in the air like pollen. Outdoor mold spores begin to increase as temperatures rise in the spring and reach their peak in July in warmer states and October in the colder states. They can be found year-round in the South and on the West Coast. Molds can be found almost anywhere, including soil, plants and rotting wood. Pollen and Mold Levels Pollen and mold counts measure the amount of allergens present in the air. The National Allergy BureauTM (NABTM) is the nation’s only pollen and mold counting network certified by the American Academy of Allergy, Asthma & Immunology (AAAAI). As a free service to the public, the NAB compiles pollen and mold levels from certified stations across the nation. You can find these levels on the NAB page of the AAAAI’s Web site at www.aaaai.org/nab. Effects of Weather and Location The relationship between pollen and mold levels and your symptoms can be complex. Your symptoms may be affected by recent contact with other allergens, the amount of pollen exposure and your sensitivity to pollen and mold. Allergy symptoms are often less prominent on rainy, cloudy or windless days because pollen does not move around during these conditions. Pollen tends to travel more with hot, dry and windy weather, which can increase your allergy symptoms. Some people think that moving to another area of the country may help to lessen their symptoms. However, many pollen (especially grasses) and molds are common to most plant zones in the United States, so moving to escape your allergies is not recommended. Also, because your allergy problem begins in your genes, you are likely to find new allergens to react to in new environments. Treatment Finding the right treatment is the best method for managing your allergies. If your seasonal allergy symptoms are making you miserable, an allergist/immunologist, often referred to as an allergist, can help. Your allergist has the background and experience to test which pollen or molds are causing your symptoms and prescribe a treatment plan to help you feel better. This plan may include avoiding outdoor exposure, along with medications. If your symptoms continue or if you have them for many months of the year, your allergist may recommend allergy shots, or immunotherapy. This involves receiving regular injections, which help your immune system become more and more resistant to the specific allergen and lessen your symptoms as well as the need for medications. There are also simple steps you can take to limit your exposure to the pollen or molds that cause your symptoms. Keep your windows closed at night and if possible, use air conditioning, which cleans, cools and dries the air. Try to stay indoors when the pollen or mold levels are reported to be high. Wear a pollen mask if long periods of exposure are unavoidable. Don’t mow lawns or rake leaves because it stirs up pollen and molds. Also avoid hanging sheets or clothes outside to dry. Consider taking a vacation during the height of the pollen season to a more pollen-free area, such as the beach or sea. When traveling by car, keep your windows closed. Most important, be sure to take any medications prescribed by your allergist regularly, in the recommended dosage. Healthy Tips Seasonal allergic rhinitis or “hay fever,” causes sneezing, stuffiness, a runny nose and itchiness in your nose, the roof of your mouth, throat, eyes or ears. Pollen and mold in the air commonly cause these symptoms. Treatment from an allergist is the best method for coping with your allergies. This could include medications, limiting exposure or even allergy shots. Monitor pollen and mold levels from the National Allergy Bureau at www.aaaai.org/nab. 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Osteoporosis is a disease in which bones become fragile. With decreased strength, bones have an increased tendency to break or fracture. Since asthma is an inflammatory disease of the lung, continuous use of anti-inflammatory medications is important for most patients with asthma. Cortisone-like medications, called glucocorticosteroids, are the most potent anti-inflammatory medications to treat asthma. There are two types of glucocorticosteroids: oral or systemic, and inhaled or topical. Long-term use of oral glucocorticosteroids, such as the pill prednisone, has been associated with adverse effects, including osteoporosis. As people age, there is often a significant increase in the number of medications they take for medical problems. It is essential that older patients have an awareness of what medications they are taking, how they to take them and what the potential side effects can be. This 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 a particular class of asthma medications: inhaled corticosteroids (ICS). On the one hand, corticosteroids are known to contribute to the development of osteoporosis (a condition leading to brittle bones), which is a common problem for older patients, especially women. On the other hand, ICS are the most effective class of drugs in the treatment of asthma. Physicians worry that ICS may lead to osteoporosis because oral and injected steroids are well-known to contribute to this process. You may ask, “Why should I take ICS at all for my asthma if it may put me at risk for side-effects?” The reason why ICS are so important for the management of asthma is that this is the most effective class of medication to control asthma. 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. Your physician will weigh the risks of osteoporosis with the risks of asthma, and may prescribe medications to counteract osteoporosis or order bone density testing. Your physician will 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. 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. Allergy Medications Allergies such as allergic rhinitis (hay fever), allergic conjunctivitis and urticaria (hives) are common problems for older adults and often require the use of H1 antihistamines. Antihistamines are 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 if you are being treated with certain antidepressant medications. The second generation antihistamines do not cross the blood-brain barrier as readily and, therefore, cause fewer side effects. If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine. Physician and allergist prescribed antihistamines currently in use are generally from the second or third generation drugs that have an extremely favorable safety profile for users. Drugs that can Trigger Asthma Beta-blockers These drugs may be used for problems such as high blood pressure, heart disease and migraine headache. They may also be used in an eye drop form for treating the eye disease glaucoma. They are classified in one of two groups: non-specific and specific. Non-specific beta-blockers, such as propanalol, are the most important ones to avoid. Ideally, a person with asthma would avoid all beta blockers, but these types of drugs may be quite important for certain patients’ health and may not substantially worsen their asthma. Your physician may conduct a trial using a “specific” beta-blocker. Remember that even beta-blockers in eye drops may make asthma worse, so be sure to tell your ophthalmologist that you have asthma. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) This group of medications 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. Medications that usually don’t cause increased asthma in aspirin-sensitive patients include acetaminophen (low to moderate dose), propoxyphene and prescribed narcotics such as codeine. ACE Inhibitors These drugs, which may be used for hypertension or heart disease, include lisinopril and enalopril. 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. In addition, any cough can be associated with reflux (acid coming up from the stomach into the esophagus) which can cause more coughing and worsen asthma. The bottom line in avoiding medication-induced asthma is to talk with your physician about what medications are best for you. It is important not to let your treatments become asthma triggers. Healthy Tips Older patients should always know what medications they are taking, how they to take them and what the potential side effects can be. Inhaled corticosteroids (ICS) are the most effective class of drugs in the treatment of asthma, but are known to contribute to the development of osteoporosis. An allergist has extensive training in the management of asthma and in minimizing the side-effects of medications such as ICS. If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine. Some drugs, such as

Occupational asthma is generally defined as a respiratory disorder directly related to inhaling fumes, gases, dust or other potentially harmful substances while “on the job.” With occupational asthma, symptoms of asthma may develop for the first time in a previously healthy worker, or pre-existing asthma may be aggravated by exposures within the work place. Occupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while “on the job.” Often, your symptoms are worse during the days or nights you work, improve when you have time off and start again when you go back to work. You may have been healthy and this is the first time you’ve had asthma symptoms, or you may have had asthma as a child and it has returned. If you already have asthma, it may be worsened by being exposed to certain substances at work. People with a family history of allergies are more likely to develop occupational asthma, particularly to some substances such as flour, animals and latex. But even if you don’t have a history, you can still develop this disease if you’re exposed to conditions that induce it. Also, if you smoke, you’re at a greater risk for developing asthma. Prevalence Occupational asthma has become the most common work-related lung disease in developed countries. However, the exact number of newly diagnosed cases of asthma in adults due to occupational exposure is unknown. Up to 15% of asthma cases in the United States may be job-related. The rate of occupational asthma varies within individual industries. For example, in the detergent industry, inhaling a particular enzyme used to make washing powders has led to the development of symptoms in some exposed employees. About 5% of people working with laboratory animals or with powdered natural rubber latex gloves have developed occupational asthma. Isocyanates are chemicals that are widely used in many industries, including spray painting, insulation installation and in manufacturing plastics, rubber and foam. These chemicals can cause asthma in up to 10% of exposed workers. Causes Irritants in high doses that induce occupational asthma include hydrochloric acid, sulfur dioxide or ammonia, which is found in the petroleum or chemical industries. If you are exposed to any of these substances at high concentrations, you may begin wheezing and experiencing other asthma symptoms immediately after exposure. Workers who already have asthma or some other respiratory disorder may also experience an increase in their symptoms during exposure to these irritants. Allergies play a role in many cases of occupational asthma. This type of asthma generally develops only after months or years of exposure to a work-related substance. Your body’s immune system needs time to develop allergic antibodies or other immune responses to a particular substance. For example, workers in the washing powder industry may develop an allergy to the enzymes of the bacteria Bacillus subtilis, while bakers may develop an allergy and occupational asthma symptoms from exposure to various flours or baking enzymes. Veterinarians, fishermen and animal handlers in laboratories can develop allergic reactions to animal proteins. Healthcare workers can develop asthma from breathing in powdered proteins from latex gloves or from mixing powdered medications. Occupational asthma can also occur in workers after repeated exposure to small chemical molecules in the air, such as with paint hardeners or in the plastic and resin industries. The length of time you are exposed to a substance before it triggers your asthma varies. It can be months or years before symptoms occur. On the other hand, exposure to a high concentration of irritants can cause asthma within 24 hours. Finally, inhaling some substances in aerosol form can directly lead to the buildup of naturally occurring chemicals in your body, such as histamine or acetylcholine within your lungs, which leads to asthma. For example, insecticides, used in agricultural work, can cause a buildup of acetylcholine, which causes your airway muscles to contract and tighten. Diagnosis and Treatment Many people with persistent asthma symptoms caused by substances at work are incorrectly diagnosed as having bronchitis. If occupational asthma is not correctly diagnosed early, and you aren’t protected or removed from the exposure, it can cause permanent changes to your lungs. An allergist/immunologist, often referred to as an allergist, is the best qualified physician to determine if your symptoms are allergy or asthma-related. Your allergist can properly diagnose the problem and develop a treatment plan to help you feel better and live better. Once the cause of your symptoms is identified, you and your employer can work together to assure that you avoid exposure to the substance that triggers your asthma symptoms and to high concentrations of irritants. Also, you may need to avoid or reduce your exposure to irritants that can trigger symptoms in most asthmatics, such as smoke or cold air. In some cases, pre-treatment with specific medications to protect against asthma worsened at work may be helpful. In other situations, particularly if you are very allergic to a substance in your workplace, avoiding the substance completely may be necessary. Healthy Tips Occupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while at work. You may find that your symptoms are worse during the days or nights you work, improve when you have time off and start again when you go back to work. If occupational asthma is not correctly diagnosed early, and you aren’t protected or removed from the exposure, it can cause permanent changes to your lungs. Once the cause of your symptoms is identified, talk to your employer and avoid exposure to that substance.

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. Everyone reacts to medications differently. One person may develop a rash while taking a certain medication, while another person on the same drug may have no adverse reaction. Does that mean the person with the rash has an allergy to that drug? All medications have the potential to cause side effects, but only about 5% to 10% of adverse reactions to drugs are allergic. Whether allergic or not, reactions to medications can range from mild to life-threatening. It is important to take all medications exactly as your physician prescribes. If you have side effects that concern you, or you suspect a drug allergy has occurred, call your physician. If your symptoms are severe, seek medical help immediately. Allergic Reactions Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to a particular medication, your immune system identifies that drug as an invader or allergen. Your immune system reacts by producing antibodies called Immunoglobulin E (IgE) to the drug. These antibodies travel to cells that release chemicals, triggering an allergic reaction. This reaction causes symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin. Most allergic reactions occur within hours to two weeks after taking the medication and most people react to medications to which they have been exposed in the past. This process is called “sensitization.” However, rashes may develop up to six weeks after starting certain types of medications. One of the most severe allergic reactions is anaphylaxis (pronounced an-a-fi-LAK-sis). Symptoms of anaphylaxis include hives, facial or throat swelling, wheezing, light-headedness, vomiting and shock. Most anaphylactic reactions occur within one hour of taking a medication or receiving an injection of the medication, but sometimes the reaction may start several hours later. Anaphylaxis can result in death, so it is important to seek immediate medical attention if you experience these symptoms. Antibiotics are the most common culprit of anaphylaxis, but more recently, chemotherapy drugs and monoclonal antibodies have also been shown to induce anaphylaxis. Rarely, blisters develop as a result of a drug rash. Blisters may be a sign of a serious complication called Steven-Johnson Syndrome where the surfaces of your eye, lips, mouth and genital region may be eroded. Toxic epidermal necrolysis (TEN), where the upper surface of your skin detaches like in a patient who has suffered burns, is another type of severe cutaneous adverse reaction. You should seek medical help immediately if you experience any of these. Certain medications for epilepsy (seizures) and gout are often associated with these severe skin reactions. A number of factors influence your chances of having an adverse reaction to a medication. These include: body size, genetics, body chemistry or the presence of an underlying disease. Also, having an allergy to one drug predisposes one to have an allergy to another unrelated drug. Contrary to popular myth, a family history of a reaction to a specific drug does not increase your chance of reacting to the same drug. Non-Allergic Reactions Symptoms of non-allergic drug reactions vary depending on the type of medication. People being treated with chemotherapy often suffer from vomiting and hair loss. Other people experience flushing, itching or a drop in blood pressure from intravenous dyes used in x-rays or CT scans. Certain antibiotics irritate the intestines, which can cause stomach cramps and diarrhea. If you take ACE (angiotension converting enzyme) inhibitors for high blood pressure, you may develop a cough or facial and tongue swelling. Some people are sensitive to aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs). If you have aspirin or NSAID sensitivity, certain medications may cause a stuffy nose, itchy or swollen eyes, cough, wheezing or hives. In rare instances, severe reactions can result in shock. This is more common in adults with asthma and in people with nasal polyps (benign growths). Taking Precautions It is important to tell your physician about any adverse reaction you experience while taking a medication. Be sure to keep a list of any drugs you are currently taking and make special note if you have had past reactions to specific medications. Share this list with your physician and discuss whether you should be avoiding any particular drugs or if you should be wearing a special bracelet that alerts people to your allergy. When to See an Allergist/Immunologist If you have a history of reactions to different medications, or if you have a serious reaction to a drug, an allergist/immunologist, often referred to as an allergist, has specialized training to diagnose the problem and help you develop a plan to protect you in the future. Healthy Tips Allergic drug reactions account for 5% to 10% of all adverse drug reactions. Any drug has the potential to cause an allergic reaction. Symptoms of adverse drug reactions include cough, nausea, vomiting, diarrhea, high blood pressure and facial swelling. Skin reactions (i.e. rashes, itching) are the most common form of allergic drug reaction. Non-steroidal anti-inflammatory drugs, antibiotics, chemotherapy drugs, monoclonal antibodies, anti-seizure drugs and ACE inhibitors cause most allergic drug reactions. If you have a serious adverse reaction, it is important to contact your physician immediately.

Latex allergy occurs when the body’s immune system reacts to proteins found in natural rubber latex. Exposure to latex often results in contact dermatitis symptoms. However, in some individuals, latex allergy can trigger a life-threatening reaction called anaphylaxis. If you suspect you have an allergy to latex, visit an allergist/immunologist to discuss the best prevention and treatment methods. Natural rubber latex is a processed plant product used in the production of sterile gloves, balloons and condoms. It is derived almost exclusively from the sap of the tree Hevea brasiliensis found in Africa and Southeast Asia. Certain fruits and vegetables (such as bananas, chestnuts, kiwi, avocado and tomato) can cause allergic symptoms in some latex-sensitive individuals. Synthetic products, including latex house paints, have not been shown to pose any hazard to latex-sensitive individuals. Natural rubber latex is a milky fluid found in rubber trees. The problem is not with the rubber itself, but a contaminating protein in the rubber. Natural rubber latex is used to make some gloves, condoms, balloons, rubber bands, erasers and toys. Latex can also be found in bottle nipples and pacifiers. It may be surprising, but latex paints do not contain any natural rubber latex protein. Latex allergy was unusual until the late 1980s when more healthcare workers began using powdered latex gloves to control infections. In the 1990s, manufacturers found ways to make gloves with synthetic latex and/or powder-free, so the number of new cases has decreased. Reactions to Latex Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. If you have an allergy, your immune system identifies something that is typically harmless as an invader or allergen. With latex allergy, it overreacts by producing antibodies called Immunoglobulin E (IgE) that can react with proteins found in the natural rubber latex. These antibodies travel to cells that release chemicals, causing an allergic reaction. This reaction usually appears in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin. People with this allergy have symptoms such as urticaria or hives, itching or flushing, swelling, sneezing, runny nose, cough, wheeze, shortness of breath, chest tightness, nausea, dizziness or lightheadedness. Any combination of these symptoms can be a sign of anaphylaxis (pronounced an-a-fi-LAK-sis), a life-threatening reaction that needs immediate medical attention. Certain other chemicals used to make latex gloves can cause a delayed onset rash which only forms where the material touches the skin. This is called contact dermatitis. Red, itchy bumps or blisters usually appear within 12 to 48 hours. These symptoms are irritating, but not life-threatening. Latex can also become airborne and cause respiratory symptoms. For example, latex proteins can attach to the cornstarch powder used in latex gloves. As powdered latex gloves are used, the starch particles and latex allergens become airborne, where they can be inhaled or come into contact with your nose or eyes and cause symptoms. High concentrations of this allergenic powder have been measured in intensive care units and operating rooms. Using non-powdered latex gloves, or synthetic (vinyl, nitrile) gloves reduces the risk of these reactions. The capacity of latex products-especially gloves-to cause allergic reactions varies enormously by brand and by production lot. Treating Latex Allergy The first step in treating latex allergy is being aware of the problem. An allergist/immunologist, often referred to as an allergist, has the knowledge and experience to diagnose the problem and develop a treatment plan. Your allergist may prescribe an antihistamine to take for mild latex allergy symptoms. Your allergist may also prescribe epinephrine, or adrenalin, to keep with you in case you have a severe reaction to latex. Your physician can help decide whether you should wear a bracelet that alerts people about your allergy. If your allergy is severe, it is important to tell your family, employer, school personnel and healthcare providers about your allergy. If you need surgery, ask that everything be latex-free. If you have trouble breathing when you are around latex, stay away from areas where powdered gloves are used and avoid all direct contact with latex. If you need to wear gloves, try substituting vinyl or nitrile gloves for latex. Synthetic latex gloves do not contain natural latex and are another option. These work in nearly all situations, including surgery, but they may be more expensive. If you tend to get a skin rash reaction to latex, latex gloves made without additional chemicals may be a good choice. Latex condoms may cause serious allergic reactions in some people. If either partner has a latex allergy, synthetic rubber condoms are the best choice, although natural skin condoms may be used. Who is Most at Risk? Healthcare and rubber industry workers are at more risk for developing serious allergic reactions to latex. Also at increased risk are people who have had multiple medical procedures or surgeries. This is because the greatest danger of a severe reaction happens when latex comes in contact with moist areas of the body, such as during surgery. If you have a latex allergy, you also have a greater risk of being allergic to certain foods including bananas, avocadoes, kiwi fruit and European chestnuts. These foods and latex share certain proteins which cause a reaction in people with this allergy. Healthy Tips People who react to latex typically develop a skin rash. This is irritating, but not life-threatening. There is no cure for latex allergy. People with severe reactions must avoid latex. If you have trouble breathing when you are around latex, or if you get a combination of symptoms, get immediate medical attention. These symptoms include hives, itching or flushing, swelling, sneezing, runny nose, cough, wheeze, shortness of breath, chest tightness, nausea, dizziness or lightheadedness. An allergist is the best physician to determine if you are allergic to latex. The good newspaper has to Because you need to Other methods to learn about term papers would be to ask other students about their experiences https://www.affordable-papers.net/ writing themand

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. Insect sting allergy can be severe, leading to a systemic reaction called anaphylaxis. In addition, after being stung, some individuals experience other symptoms. They include: Anaphyalaxis For a small number of people with severe venom allergy, stings may be life-threatening. Severe allergic reactions to insect stings can involve many body organs and may develop rapidly. This reaction is called anaphylaxis. Symptoms of anaphylaxis may include itching and hives over large areas of the body, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea. In severe cases, a rapid fall in blood pressure may result in shock and loss of consciousness. Anaphylaxis is a medical emergency, and may be fatal. Toxic reaction A toxic reaction can cause symptoms similar to those of an allergic reaction, including nausea, fever, swelling at the site of the sting, fainting, seizures, shock, and even death. A toxic reaction occurs when the insect venom acts like a poison in the body and may result after only one sting, but it usually takes many stings from insects that are not normally considered poisonous. Serum sickness Serum sickness is an unusual reaction to a foreign substance in the body that can cause symptoms hours or days after the sting. Symptoms include fever, joint pain, other flulike symptoms, and sometimes hives.

Infection occurs when a disease-causing germ such as a bacteria, virus or fungus invades the body. To become infected, you must catch the germ (exposure) and have the ability to become infected (susceptibility). Susceptibility is more complicated than exposure. We are all susceptible to infection by thousands of different germs. The purpose of the immune system is to prevent infection by recognizing germs and eliminating or disabling them before they can cause infection.  People with immunodeficiency get the same kinds of infections that other people get—ear infections, sinusitis and pneumonia. The difference is that their infections occur more frequently, are often more severe, and have a greater risk of complications.  We live in a sea of germs, and everyone gets an infection at least once in a while. However, while most people can recover on their own from most infections, some people experience recurring infections that require antibiotic treatment.   Exposure and susceptibility to infections   Infection occurs when a disease-causing germ, such as a bacteria, virus or fungus, invades the body. To become infected, you must catch the germ (exposure) and have the ability to become infected (susceptibility). People with a lot of contact with others, such as elementary school teachers or salespersons, are more likely to be exposed to increased numbers of germs.  Susceptibility is more complicated than exposure. We are all susceptible to infection by thousands of different germs. The purpose of the immune system is to prevent infection by recognizing germs and eliminating or disabling them before they can cause infection. Remarkably, the immune system has the unique ability to learn the “face” of a germ and remember it forever. Some germ families have faces that are so similar that when your immune system learns the face of one member of the family, it protects you from infection by any member of that family. Other germ families are so different that the immune system must learn each face individually. Once your immune system has learned the face of a particular germ and successfully battled it, you are much less susceptible to infection caused by that germ.  The first line of defense against infection is located where the body has contact with the rest of the world—the skin—as well as the membranes that line the respiratory system and digestive systems. Clearly, a cut on the hand is more likely to get infected than unbroken skin. Similarly, irritation, swelling and injury to the mucus membranes lining the nose, sinuses and lungs provide a fertile ground for disease-causing germs. If you have year-round allergies to dust mites, pollen and mold, you may have some injury to your mucus membranes, which can, in turn, increase your susceptibility to infection. Once a germ has entered the body, your immune system springs into action.  Common infections  The most common infections are viral respiratory tract infections—colds. Typically, cold symptoms last five to 10 days. If a child gets 12 colds a year, each lasting less than 10 days and usually improving without needing treatment with antibiotics, there is not usually a cause for concern. It may seem, however, that the child is sick half the time—because he or she is! These viral infections are a result of the close contact that young children have with other infected children and the fact that their immune systems are relatively immature. Once a child’s immune system learns the faces of many of the germs that cause such colds, the child will get infected less frequently.  Another infection, strep throat, is also a “social disease” that children and adults catch because they are in close contact with infected individuals. Although we don’t completely understand why some people get strep throat frequently, we know that recurrent strep throat is rarely an indicator of a weak immune system.  Many people confuse allergic rhinitis, or “hay fever,” which causes stuffiness, nasal itch and a runny nose that lasts for weeks, with a cold or sinus infection. Your allergist/immunologist can help you differentiate allergies from infection, or know when both are present at the same time. Once the possibility of allergy is eliminated, your allergist will consider if your infections are a simply a result of high exposure to other people with infections, or if these infections are warning signals of an immune system problem called immunodeficiency . There are many forms of immunodeficiency and while some are very severe and life-threatening, many are milder but still important enough to cause recurrent or severe infections. Signs of Immunodeficiency  People with immunodeficiency get the same kinds of infections that other people get—ear infections, sinusitis and pneumonia. The difference is that their infections occur more frequently, are often more severe, and have a greater risk of complications. Furthermore, the infections usually do not go away without using antibiotics and often recur within one to two weeks after antibiotic treatment is completed. These patients frequently need many courses of antibiotics each year to stay healthy. Patients with some forms of immunodeficiency are more likely than other people to develop infections inside certain areas of the body, such as the bones, joints, liver, heart or brain.  In most cases, the frequency of infection is the most important issue, but sometimes a single infection with an unusual germ is enough to trigger the need for the doctor to perform a thorough immunologic evaluation of the patient.  So, how many infections are too many? Allergist/immunologists often use the frequency of the use of antibiotics to mark the frequency of significant infections. Older children and adults with healthy immune systems seldom require antibiotic treatment. However, for the reasons mentioned above, many younger children receive several courses of antibiotic therapy each year. Therefore, the number of ear infections that may be “normal” in a child under 5 years of age is clearly abnormal in older children and adults. General guidelines for determining if a patient may be experiencing too many infections are: The need for more than four courses of antibiotic treatment per year in children or more

Millions of people suffer from seasonal allergy symptoms such as congestion, an itchy, runny nose and itchy, watery eyes. However, many also suffer from perennial allergies, which result in symptoms throughout the year. Perennial allergies are triggered by indoor allergens, including house dust mite droppings, animal dander, cockroach droppings and indoor molds. Learn more about managing your allergy symptoms caused by indoor allergens by reading the resources listed below. Millions suffer allergy symptoms caused by indoor allergens such as dust mite droppings, animal dander, cockroach droppings and molds. While it is impossible to avoid these allergens, there are ways you can minimize exposure to them. Controlling Dust Mites Who could guess that a microscopic-sized allergen could cause major problems? • Dust mite allergens are found throughout the house, but thrive in bedding and soft furnishings. • Because so much time is spent in the bedroom, it is essential to reduce mite levels there. Encase mattresses, box springs and pillows in special allergen-proof fabric covers or airtight, zippered plastic covers. Bedding should be washed weekly in hot water (130° F) and dried in a hot dryer. • Keep humidity low by using a dehumidifier or air conditioning. • Wall-to-wall carpeting should be removed as much as possible. Throw rugs may be used if they are regularly cleaned. • People with allergies should use a vacuum with a HEPA (highefficiency particulate) filter or a double-layered bag, and wear a dust mask-or ask someone else to vacuum. Controlling Pet Allergens Contrary to popular opinion, people are not allergic to an animal’s hair, but to an allergen found in the saliva, dander (dead skin flakes) or urine of an animal with fur. • All dogs and cats carry these proteins, so no breed is allergy-free. • If you cannot avoid exposure, try to minimize contact and keep the pet out of the bedroom and other rooms where you spend a great deal of time. • As with dust mites, vacuum carpets often or replace carpet with a hardwood floor, tile or linoleum Controlling Cockroaches An allergen in cockroach droppings is a main trigger of asthma symptoms. • Block all areas where roaches could enter your home, including crevices, wall cracks and windows. Cockroaches need water to survive, so fix and seal all leaky faucets and pipes. Have an exterminator go through the house to eliminate any remaining roaches. • Keep food covered and put pet food dishes away after pets are done eating. Vacuum and sweep the floor after meals, and take out garbage and recyclables. Use lidded garbage containers in the kitchen. Wash dishes after use and clean under stoves, refrigerators or toasters where crumbs can accumulate. Wipe off the stove and other kitchen surfaces and cupboards regularly. Controlling Indoor Molds • Indoor molds and mildew need dampness, such as found in basements, bathrooms or anywhere with leaks. Remove mold on hard surfaces with water, detergent and 5% bleach (do not mix with other cleaners). For clothing, wash with soap and water. • Repair and seal leaking roofs or pipes. Use a dehumidifier in damp basements, but empty the water and clean units regularly to prevent mildew from forming. Don’t carpet concrete or damp floors, and avoid storing items in damp areas.

Hypereosinophilic syndrome (HES) is a rare disorder in which an individual’s blood contains very high numbers of eosinophils, a type of white blood cell that play an important role in the immune system.  Most people have less than 500/microliter of eosinophils in their blood. HES patients usually have more than 1500 eosinophils/microliter in the blood over a long period (more than 6 months) – without an identifiable cause. These eosinophils infiltrate the tissues, causing inflammation and eventually organ dysfunction. The most commonly involved organs in HES include the skin, lungs, heart and the nervous system.  Symptoms  HES can happen at any age, although it is more common in adults. There is great variability in the symptoms of HES. Skin rashes are common and include urticaria (hives), angioedema (swelling) or other types of bumpy rash. The heart may be involved, with or without symptoms. Neurologic symptoms may include changes in behavior, confusion, loss of balance, dizziness, memory loss, or abnormal sensations of pain or numbness. Other less common symptoms include cough, shortness of breath, fatigue, fever and itching. Mouth ulcers, visual symptoms and enlargement of the liver and/or spleen may occur. HES patients are at risk for clots in their blood vessels and may have “mini” or major strokes. Disease Types  HES includes a collection of syndromes. The myeloproliferative type of HES is associated with an acquired genetic problem (FIP1L1-PDGFRA)that causes eosinophils and other blood cells to grow in a manner similar to leukemia. Genetic testing is performed to identify patients with this HES variant as they may respond favorably to treatment with certain cancer drugs such as imatinib mesylate. Diagnosis  There is no specific diagnostic test for HES. The first step is to investigate for other conditions that can cause eosinophilia.These conditions include parasitic infection, allergic disease, cancers, autoimmune diseases and drug reactions.  Testing is individualized according to symptoms and may include stool evaluation to detect parasitic infection, allergy testing to diagnose environmental or food allergies, biopsies of the skin or other organs or blood tests to screen for autoimmunity and radiologic imaging of affected organs. An allergist/immunologist has specialized training to to effectively diagnose the problem, and if HES is present to work collaboratively with other specialists such as a Hematologist or Cardiologist in the treatment and monitoring of HES patients. When diagnosed with HES, it is important to determine the extent of organ damage. A chest x-ray and echocardiogram are routinely performed to evaluate the heart and lungs. Other tests often performed in HES patients include liver and kidney function, serum vitamin B12 levels, erythrocyte sedimentation rate (ESR) and serum tryptase levels.  Treatment  The goal of HES treatment is to reduce eosinophil levels in the blood and tissues, thereby preventing tissue damage–especially in the heart. Standard HES treatment has included glucocorticosteroid medications such as prednisone, and chemotherapeutic agents such as hydroxyurea, chlorambucil, and vincristine. Side effects occur frequently with these medications that are usually required for long-term use.  Interferon-alpha has also been used as a treatment. This medication must be administered by frequent injections and causes potent side effects such as fatigue and influenza-like symptoms.  Research is uncovering new treatment therapies for HES. One new approach for controlling malignant cell growth is the use of tyrosine kinase inhibitors such as Gleevac. Other tyrosine kinase inhibitors currently under study include Dasatinab and Nilotinib. Monoclonal antibody therapy has also shown promise for treatment of HES. A 2008 clinical trial showed that once monthly intravenous anti-IL-5 (Mepolizumab) allowed for lower doses of oral steroids in HES patients that were studied for 9 months.  Prognosis  The prognosis of HES depends upon the extent of any organ damage. In very severe cases, HES may be fatal, but there is hope. Survival rates have improved greatly. In 1975, only 12% of HES patients survived three years. Today, more than 80% of HES patients survive five years or more.

Urticaria, also called hives, are red, itchy, swollen areas of the skin that can range in size and appear anywhere on the body. The blotches can migrate on body, appearing in different areas throughout the course of the reaction. Usually, the cause of urticaria is readily identifiable—often a viral infection, or allergic reaction to drugs, food or latex. These hives usually go away spontaneously or by avoiding the allergic trigger. However, in some cases, medical intervention is needed to increase comfort or prevent recurrence. Treatment with oral antihistamines is frequently successful, but in severe cases, steroids may be needed. Some people have chronic urticaria that occurs almost daily for months or, in some cases, years. For these individuals, scratching, pressure or stress may aggravate hives. An allergist/immunologist can diagnosis the problem and prescribe treatments for this bothersome condition.