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The novel H1N1 flu virus (sometimes called “swine flu”) created headlines around the world. As with the regular, seasonal flu, people with allergies and asthma should take prevention measures to avoid getting sick.  The vaccine for the seasonal flu/ H1N1 is among the best prevention tool available to prevent complications from the flu. However, Individuals with egg allergy may be at risk for an allergic reaction to H1N1 and seasonal influenza vaccines due to the egg content in the vaccine preparations. Before getting vaccinated, consult with your health care provider.  The novel H1N1 flu virus (sometimes called “swine flu”) is creating headlines around the world. With each passing day, medical experts and the public are learning more about this virus – how it behaves and how to treat it.  As with the regular, seasonal flu, people with allergies and asthma should take prevention measures to avoid getting sick.  EFFECT OF ASTHMA A recent report from the Centers for Disease Control and Prevention (CDC) found that the majority of pediatric deaths from H1N1 occurred in children with an underlying medical condition–in some cases asthma.  Children and adults with respiratory conditions such as asthma are more likely to experience serious health problems if they contract the flu. The American Academy of Allergy, Asthma & Immunology (AAAAI) urges all patients with asthma to get the flu/H1N1 vaccine.    IS IT AN ALLERGY OR IS IT THE FLU?  Novel H1N1 and the seasonal flu are not the same, but have similar symptoms. Some allergy symptoms may also be confused for flu symptoms. For parents of children with asthma or allergies, telling the difference between allergic disease symptoms and the seasonal flu or H1N1 may be a bit difficult.  “Itchy eyes, a scratchy nose or sneezing are symptoms of allergies,” explains Thomas B. Casale, MD, FAAAAI. “But if your child suffers from asthma and develops a fever or nausea and vomiting, consult your physician.”  Here’s how to tell if you are suffering from allergies or something more severe  Allergy symptoms Runny nose Sneezing Stuffiness Itchy, watery eyes Itchiness in the nose, mouth or throat  Flu symptoms  Runny nose Coughing Sore throat Tiredness Lack of appetite Fever Nausea or vomiting Diarrhea  FOOD ALLERGIES AND VACCINES  Vaccinations for both the seasonal flu and H1N1 are among the best prevention tools available to prevent complications from the flu. But what if you are allergic to a substance in the vaccines?  “Individuals with egg allergy may be at risk for an allergic reaction to H1N1 and seasonal influenza vaccines due to the egg content in the vaccine preparations,” reports Dr. Casale. “Before getting vaccinated, review the information posted on www.aaaai.org and consult with your health care provider. In most cases, vaccination can be tolerated if done according to these recommendations.”  IF YOU DO GET SICK The Centers for Disease Control and Prevention recommends that people with flu-like symptoms stay home for at least 24 hours after they are free of fever.  If you experience severe symptoms, including difficulty breathing, chest pain/pressure, dizziness or persistent vomiting, seek emergency medical care.

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

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.

Exercise-Induced Bronchoconstriction (EIB) is a narrowing of the airways causing difficulty moving air out of the lungs. Chronic asthma is an inflammatory disorder. Most patients with chronic asthma will have a flare when they exercise. Other individuals appear to have a flare of asthma only when they exercise and do not otherwise have chronic asthma. Symptoms include coughing, wheezing, tight chest, and prolonged and unexpected shortness of breath after about 6 to 8 minutes of exercise. These symptoms are often even worse in cold, dry air. Warm and humid air may lessen the symptoms. Unfortunately pollens and molds are present at the times of the year when the air is warm and humid and these substances in the air may also trigger attacks of asthma. Exercise-Induced Bronchoconstriction (or EIB) causes symptoms of coughing, wheezing, chest tightness to breathing, or shortness of breath. Children with EIB may experience breathing difficulty 5-20 minutes after exertion begins. EIB may occur more easily on cold, dry days than on warm, humid days. If your child’s asthma is triggered by exercise, the symptoms can take subtle forms. They may complain of not being able to run as fast as their peers, and consequently express a dislike for sports. In school-age children, inferior performance in physical education classes or a reluctance to participate in athletics may also lead to problems with fellow students and teachers and low self-esteem. Without proper diagnosis, EIB may cause children to avoid physical activity altogether, but this does not have to be the case. Although the type and duration of recommended activity varies with each individual, some activities are better for those with EIB. Almost all people with EIB should be able to exercise to their full ability with appropriate diagnosis and treatment. Sports that are less likely to trigger EIB: Swimming Walking Leisure biking Hiking Free downhill skiing Team sports that require short bursts of energy , including: Baseball Football Wrestling Golfing Gymnastics Short-distance track and field events Sports that require continuous activity or are cold weather activities are more likely to trigger EIB: Soccer Basketball Field hockey Long-distance running Cross-country skiing Hockey Make sure your child’s physical education teacher and/or coach has specific written instructions that include: The nature of EIB, Which medications are used to prevent EIB and how to use them, Other techniques to prevent EIB (e.g., warm-up period), Warning signs of an asthma episode

Eosinophilic esophagitis (EE) is an allergic condition characterized by inflammation of the esophagus (the tube that connects the throat with the stomach). People with this disease have a large number of eosinophils, a type of white blood cell, in their esophagus. The majority of individuals with eosinophilic esophagitis have family histories of allergies and symptoms of one or more allergic disorders such as asthma, nasal allergies, atopic dermatitis or food allergy. Diagnosis Other diseases, including acid reflux, can cause eosinophils in the esophagus. Therefore, it is useful to exclude acid reflux as the cause with a trial of acid suppressive medications. Currently, the only way to diagnose eosinophilic esophagitis is with an endoscopy and biopsy of the esophagus. This is typically coordinated between a gastroenterologist and a pathologist. After the diagnosis of eosinophilic esophagitis has been made, an allergist/immunologist, often referred to as an allergist, is the most qualified physician to determine the role of allergies in the condition. An allergist can provide you, your family and your gastroenterologist with a comprehensive evaluation of the allergic components of eosinophilic esophagitis. Eosinophilic Esophagitis and Allergies Allergies 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 tree nuts, the immune system identifies tree nuts 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. Food allergy is a major, yet complex, cause of eosinophilic esophagitis in children, and a probable factor in adult eosinophilic esophagitis. Environmental allergies such as dust mites, animals, pollens and molds may also play a role. Testing Allergy skin tests are useful in determining which allergens are triggering your symptoms. With this painless test, a small amount of allergen is put on your skin by making a small scratch or prick on the surface of the skin through a drop of the allergen extract. If a raised bump or small hive develops within 20 minutes, it indicates a possible allergy. If this does not develop, the test is negative. In certain cases, such as severe eczema, an allergy skin test cannot be done and your allergist may recommend a blood test. Another method for testing for food allergies is a challenge. This is done by feeding the food to find if it causes a reaction. Food patch testing is in another type of allergy test that may be used in the evaluation of EE. This test is used to determine whether an individual has delayed reactions to a food. The patch test is done by placing a small amount of fresh food in an aluminum chamber. The food stays in contact with the skin for 48 hours, is removed and the allergist reads the results at 72 hours. Areas of the skin in contact with the food that have become inflamed indicate a delayed reaction to the food. Treatment Elimination Diet Information about specific food allergies obtained from prick, blood and patch testing can be used to determine if specific food groups should be eliminated from your diet. For many people, this is the only treatment that is required to control eosinophilic esophagitis. In some instances, all sources of protein must be removed from the diet. This approach is generally reserved for individuals with multiple food allergies, or who fail to respond to other forms of therapy Medications No medications are currently FDA approved for the treatment of eosinophilic esophagitis. New forms of therapy are under investigation and may provide significant relief in the future. In the meantime, swallowed steroid from an asthma inhaler or nebulizer is being used effectively, under the care of a physician.

A common allergic reaction often affecting the face, elbows and knees is atopic dermatitis, also known as eczema. This red, scaly, itchy rash is usually seen in young infants, but can occur later in life in individuals with personal or family histories of atopy, meaning asthma or allergic rhinitis (“hay fever”). Eczema may at times ooze, or at times may look very dry. A physician will rarely have difficulty diagnosing atopic dermatitis, based on three factors: an 1) itchy, 2) “eczematous” or bubbly rash in an 3) atopic individual. If one of these three features is missing, your physician should consider other causes. Eczema, or atopic dermatitis, is a common allergic reaction often affecting the face, elbows and knees. This red, scaly, itchy rash is usually seen in young infants, but can occur later in life in individuals with personal or family histories of other allergic conditions – such as asthma or hay fever. In infants, eczema usually appears as tiny bumps on the cheeks. Older children and adults often experience rashes on the knees or elbows (often in the folds of the joints), on the backs of hands or on the scalp. Itching is the hallmark symptom and can sometimes be very intense. Eczema can appear very dry, with flaking skin, or can have lesions that ooze – often a sign of a bacterial infection caused by scratching. Identifying the cause of the itch is essential in relieving the dermatitis. Common triggers include allergens, overheating or sweating, emotional stress, eating certain foods and contact with irritants such as wool, pets, soaps or other agents.

Contact Dermatitis refers to a broad range of reactions resulting from the direct contact of an exogenous agent (allergen or irritant) with the surface of the skin. 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 the local Medical Emergency number immediately.

Asthma is the most common serious chronic disease of childhood, affecting nearly 5 million children in the United States. Characterized by coughing, chest tightness, shortness of breath and wheezing, asthma is the cause of almost 3 million physician visits and 200,000 hospitalizations each year. In infants and children, asthma may appear as cough, rapid or noisy breathing in and out, or chest congestion, without the other symptoms seen in adults. Asthma is a chronic disease that affects about 340 million people worldwide. 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. If you think you have asthma, you should talk to an allergist/immunologist – a doctor with special training to manage allergies and asthma.

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.