What are the key differences between food allergies and intolerances. How can you identify and manage these conditions. What are the most common triggers and symptoms to watch out for.

Understanding Food Allergies: When Your Immune System Overreacts

Food allergies are immune system responses that occur when the body mistakenly identifies certain food proteins as harmful invaders. This triggers the production of antibodies to fight against these perceived threats. The most common food allergens include shellfish, nuts, fish, eggs, peanuts, and milk.

How prevalent are food allergies? Approximately 1% of adults and 7% of children are affected by food allergies, though some children may outgrow their allergies over time. The severity of allergic reactions can vary greatly, from mild discomfort to life-threatening anaphylaxis.

Common Symptoms of Food Allergies

• Hives or skin rash
• Swelling of the lips, tongue, or throat
• Difficulty breathing or wheezing
• Nausea and vomiting
• Abdominal pain or cramping
• Dizziness or fainting

Can food allergies be life-threatening? In severe cases, a food allergy can lead to anaphylaxis, a potentially fatal reaction characterized by a sudden drop in blood pressure, loss of consciousness, and multiple body system failures. Immediate medical attention is crucial in such situations.

Food Intolerances: When Your Digestive System Struggles

Unlike food allergies, food intolerances are digestive system responses rather than immune system reactions. They occur when something in food irritates a person’s digestive system or when the body is unable to properly break down certain food components. Lactose intolerance, which affects about 10% of Americans, is the most common food intolerance.

Recognizing Food Intolerance Symptoms

• Nausea
• Stomach pain
• Gas, cramps, or bloating
• Vomiting
• Heartburn
• Diarrhea
• Headaches
• Irritability or nervousness

Are food intolerances more common than allergies? Yes, food intolerances are significantly more prevalent than food allergies. In fact, most people have experienced an unpleasant reaction to something they’ve eaten at some point in their lives.

Key Differences: Allergies vs. Intolerances

Understanding the distinctions between food allergies and intolerances is crucial for proper diagnosis and management. Here are some key differences:

1. Immune System Involvement: Allergies involve the immune system, while intolerances do not.
2. Reaction Severity: Allergic reactions can be life-threatening, whereas intolerances are generally less severe.
3. Amount of Food Required: Even small amounts of an allergen can trigger a reaction, while intolerances often require larger portions or frequent consumption.
4. Consistency of Reactions: Allergic reactions occur every time the food is consumed, while intolerance symptoms may vary.

Is it possible to have both a food allergy and intolerance? Yes, some individuals may experience both food allergies and intolerances, making it essential to work closely with healthcare providers for accurate diagnosis and management.

Unraveling the Causes of Food Allergies and Intolerances

Food allergies and intolerances have distinct underlying causes, though both can significantly impact an individual’s quality of life. Understanding these causes is crucial for effective management and prevention strategies.

The Genesis of Food Allergies

Food allergies arise from an abnormal immune response to specific food proteins. When does this process begin? The first exposure to an allergen typically doesn’t cause symptoms. Instead, it prompts the immune system to create specific antibodies (immunoglobulin E or IgE) against the perceived threat. Subsequent exposures trigger the release of these antibodies and other chemicals, including histamine, leading to allergic reactions.

Is there a genetic component to food allergies? Research suggests a hereditary factor may be involved in the development of food allergies. Individuals with family members who have allergies are more likely to develop food allergies themselves, indicating a genetic predisposition.

The Root of Food Intolerances

Food intolerances can stem from various factors, often related to the body’s ability to digest or process certain foods. Common causes include:

• Enzyme deficiencies (e.g., lactase deficiency in lactose intolerance)
• Sensitivity to food additives (e.g., sulfites, MSG, or artificial colors)
• Irritable bowel syndrome (IBS)
• Celiac disease (an autoimmune reaction to gluten)

Can stress or anxiety contribute to food intolerances? While stress and anxiety don’t directly cause food intolerances, they can exacerbate digestive symptoms and make existing intolerances more noticeable or problematic.

Diagnosing Food Allergies and Intolerances: A Complex Puzzle

Accurately diagnosing food allergies and intolerances can be challenging due to the overlap in symptoms and the complexity of individual reactions. However, proper diagnosis is crucial for effective management and prevention of potentially serious health consequences.

Diagnostic Approaches for Food Allergies

1. Skin Prick Tests: Small amounts of suspected allergens are placed on the skin to observe for reactions.
2. Blood Tests: Measure the presence of allergen-specific IgE antibodies in the blood.
3. Oral Food Challenges: Conducted under medical supervision, these tests involve consuming small amounts of suspected allergens to observe reactions.
4. Elimination Diets: Systematically removing and reintroducing suspected allergens from the diet.

Are home allergy test kits reliable? While home allergy test kits are available, they are not as accurate or comprehensive as tests performed by healthcare professionals. It’s always best to consult with an allergist for proper diagnosis and management.

Identifying Food Intolerances

Diagnosing food intolerances often involves a combination of methods:

• Food Diary: Keeping a detailed record of food intake and symptoms to identify patterns.
• Elimination Diet: Similar to allergy testing, but focused on identifying intolerances.
• Breath Tests: Used to diagnose specific intolerances like lactose or fructose malabsorption.
• Genetic Testing: In some cases, genetic tests can identify predispositions to certain intolerances.

How long does it take to diagnose a food intolerance? The diagnosis process for food intolerances can take several weeks to months, as it often requires careful tracking of symptoms and systematic elimination and reintroduction of foods.

Managing Food Allergies: Strategies for Safety and Prevention

Living with food allergies requires vigilance and careful planning to avoid potentially dangerous reactions. Here are some key strategies for managing food allergies effectively:

Strict Avoidance of Allergens

The primary approach to managing food allergies is complete avoidance of the offending foods. This involves:

• Carefully reading food labels
• Being cautious when dining out
• Communicating allergies clearly to others
• Preparing meals at home to control ingredients

Is it safe for individuals with food allergies to eat at restaurants? While dining out can be challenging for those with food allergies, many restaurants are increasingly accommodating. It’s crucial to communicate allergies clearly to staff and ask about ingredient information and cross-contamination risks.

Emergency Preparedness

For individuals with severe food allergies, being prepared for accidental exposure is critical:

1. Carrying an epinephrine auto-injector (e.g., EpiPen) at all times
2. Wearing medical alert jewelry
3. Educating family, friends, and colleagues about allergy symptoms and emergency procedures
4. Having an action plan in place for allergic reactions

How often should epinephrine auto-injectors be replaced? Epinephrine auto-injectors typically have an expiration date of 12-18 months. It’s important to check the expiration date regularly and replace the device before it expires to ensure its effectiveness in an emergency.

Navigating Food Intolerances: Tips for Symptom Management

While food intolerances are generally less severe than allergies, they can still significantly impact quality of life. Managing food intolerances often involves a combination of dietary adjustments and lifestyle changes:

Identifying Trigger Foods

Keeping a detailed food diary can help pinpoint specific foods or ingredients that cause symptoms. This information is invaluable for developing a personalized management plan.

Gradual Reintroduction and Threshold Testing

Unlike allergies, many food intolerances are dose-dependent. Slowly reintroducing small amounts of problematic foods can help determine individual tolerance thresholds.

Enzyme Supplements

For certain intolerances, such as lactose intolerance, enzyme supplements can aid digestion and reduce symptoms when consuming trigger foods.

Alternative Food Choices

Exploring alternative foods and ingredients can help maintain a balanced diet while avoiding problematic items. For example, individuals with lactose intolerance might try lactose-free dairy products or non-dairy alternatives.

Can probiotics help with food intolerances? Some studies suggest that certain probiotic strains may help alleviate symptoms of food intolerances, particularly in cases of lactose intolerance. However, more research is needed to fully understand the potential benefits.

Prevention Strategies: Reducing the Risk of Developing Food Allergies

While it’s not always possible to prevent food allergies, emerging research suggests some strategies that may help reduce the risk, especially in infants and young children:

Early Introduction of Allergenic Foods

Recent studies indicate that introducing common allergenic foods (such as peanuts, eggs, and milk) to infants at an early age may help prevent the development of allergies. This approach represents a significant shift from previous recommendations to delay the introduction of these foods.

Breastfeeding

Exclusive breastfeeding for the first 4-6 months of life may help reduce the risk of food allergies in some infants. However, the evidence is mixed, and more research is needed to fully understand the relationship between breastfeeding and allergy prevention.

Maintaining a Diverse Diet During Pregnancy

Some studies suggest that a varied diet during pregnancy, including common allergenic foods (unless the mother has known allergies), may help reduce the risk of food allergies in the child.

Promoting a Healthy Gut Microbiome

Emerging research points to the importance of a diverse and healthy gut microbiome in preventing allergies. Strategies to support gut health include consuming a fiber-rich diet, avoiding unnecessary antibiotic use, and potentially using probiotics.

Is there a genetic test to predict food allergies? While genetic factors play a role in allergy development, there is currently no reliable genetic test to predict specific food allergies. However, having a family history of allergies does increase the risk, making awareness and early intervention strategies important.

The Future of Food Allergy and Intolerance Management

As our understanding of food allergies and intolerances continues to evolve, new approaches to diagnosis, treatment, and prevention are emerging. Here are some promising areas of research and development:

Immunotherapy for Food Allergies

Oral immunotherapy and other desensitization techniques are showing promise in helping individuals with food allergies build tolerance to allergens. While not yet widely available, these treatments could significantly improve quality of life for many allergy sufferers.

Advanced Diagnostic Tools

Researchers are working on more precise diagnostic methods, including component-resolved diagnostics, which can identify specific protein components within foods that trigger allergic reactions. This could lead to more targeted and effective management strategies.

Personalized Nutrition Approaches

Advances in understanding how individual genetic, environmental, and lifestyle factors influence food reactions may lead to more personalized approaches to managing both allergies and intolerances.

Gut Microbiome Interventions

As the role of the gut microbiome in allergy and intolerance development becomes clearer, targeted interventions to modulate gut bacteria may offer new prevention and treatment options.

Will there ever be a cure for food allergies? While a definitive cure for food allergies remains elusive, ongoing research into immunotherapy and other novel treatments offers hope for more effective management and potential long-term remission of allergies in the future.

In conclusion, understanding the differences between food allergies and intolerances is crucial for proper diagnosis and management. While both conditions can significantly impact quality of life, they require distinct approaches to treatment and prevention. As research continues to advance, new strategies for managing these conditions are emerging, offering hope for improved outcomes and quality of life for affected individuals. Always consult with healthcare professionals for personalized advice and treatment plans tailored to your specific needs and circumstances.

Food Allergy vs. Food Intolerance: Symptoms, Causes & Prevention

Overview

What is a food allergy?

A food allergy is an immune system response. It is caused when the body mistakes an ingredient in food — usually a protein — as harmful and creates a defense system (antibodies) to fight it. An allergic reaction occurs when the antibodies are battling an “invading” food protein. The most common food allergies are shellfish, nuts, fish, eggs, peanuts, and milk.

What is food intolerance?

Food intolerance is a digestive system response rather than an immune system response. It occurs when something in food irritates a person’s digestive system or when a person is unable to properly digest, or break down, the food. Intolerance to lactose, which is found in milk and other dairy products, is the most common food intolerance.

How common are food allergies and intolerances?

Food allergies affect about 1 percent of adults and 7 percent of children, although some children outgrow their allergies. Food intolerances are much more common. In fact, nearly everyone at one time has had an unpleasant reaction to something they ate. Some people have specific food intolerances. Lactose intolerance, the most common specific food intolerance, affects about 10 percent of Americans.

How can you tell the difference between an allergy and intolerance to food?

Food allergies can be triggered by even a small amount of the food and occur every time the food is consumed. People with food allergies are generally advised to avoid the offending foods completely. On the other hand, food intolerances often are dose related; people with food intolerance may not have symptoms unless they eat a large portion of the food or eat the food frequently. For example, a person with lactose intolerance may be able to drink milk in coffee or a single glass of milk, but becomes sick if he or she drinks several glasses of milk. Food allergies and intolerances also are different from food poisoning, which generally results from spoiled or tainted food and affects more than one person eating the food. Your health care provider can help determine if you have an allergy or intolerance, and establish a plan to help control symptoms.

Symptoms and Causes

What are the symptoms of a food allergy?

Symptoms of a food allergy can range from mild to severe, and the amount of food necessary to trigger a reaction varies from person to person. Symptoms of a food allergy may include:

Anaphylaxis is a very serious and potentially fatal allergic reaction that involves a sudden drop in blood pressure, loss of consciousness and body system failure.

What are the symptoms of food intolerance?

Symptoms of food intolerance include:

What causes food allergies and intolerances?

Food allergies arise from sensitivity to chemical compounds (proteins) in food, even compounds that are found naturally in food. Food allergies are more common in people whose family members have allergies, suggesting a genetic — or hereditary — factor may be involved with the development of food allergies.

Food allergies develop after you are exposed to a food protein that your body thinks is harmful. The first time you eat the food containing the protein, your immune system responds by creating specific disease-fighting antibodies (called immunoglobulin E or IgE). When you eat the food again, it triggers the release of IgE antibodies and other chemicals, including histamine, in an effort to expel the protein “invader” from your body. Histamine is a powerful chemical that can affect the respiratory system, gastrointestinal tract, skin or cardiovascular system.

The allergy symptoms you have depend on where in the body the histamine is released. If it is released in the ears, nose and throat, you may have an itchy nose and mouth, or trouble breathing or swallowing. If histamine is released in the skin, you may develop hives or a rash. If histamine is released in the gastrointestinal tract, you likely will develop stomach pains, cramps or diarrhea. Many people experience a combination of symptoms as the food is eaten and digested.

There are many factors that may contribute to food intolerance. In some cases — as with lactose intolerance — the person lacks the chemicals, called enzymes, necessary to properly digest certain proteins found in food. Also common are intolerances to some chemical ingredients added to food to provide color, enhance taste and protect against the growth of bacteria. These ingredients include various dyes and monosodium glutamate (MSG), a flavor enhancer.

Substances called sulfites, which may occur naturally — as in red wines — or may be added to prevent the growth of mold, also are a source of intolerance for some people. The Food and Drug Administration has banned the use of spray-on sulfates to preserve fruits and vegetables, but sulfates are still found naturally in some foods. Salicylates are a group of plant chemicals found naturally in many fruits, vegetables, nuts, coffee, juices, beer and wine. Aspirin also is a compound of the salicylate family. Foods containing salicylates may trigger symptoms in people who are sensitive to aspirin. Of course, any food consumed in excessive quantities can cause digestive symptoms.

Diagnosis and Tests

How are food intolerances diagnosed?

Most food intolerances are found through trial and error to determine which food or foods cause symptoms. You may be asked to keep a food diary to record what you eat and when you get symptoms, and then look for common factors. For example, after charting what he eats every day for a month, a man finds that he had symptoms only on the days he ate cheese. This points the finger at cheese as a possible cause of his discomfort.

Another way to identify problem foods is an elimination diet. You begin by completely eliminating any suspect foods from your diet until you are symptom-free. You then begin to reintroduce the foods, one at a time. This can help you pinpoint which foods cause symptoms. Seek the advice of your health care provider or a registered dietitian before beginning an elimination diet to be sure your diet provides adequate nutrition.

Management and Treatment

How are food intolerances treated?

Treatment is based on avoiding or reducing your intake of problem foods and treating symptoms when you do eat a problem food; for example, taking an antacid medication for heartburn or stomachache.

Prevention

Can food intolerances be prevented?

Taking a few simple steps can help you prevent the symptoms associated with a food intolerance.

• Learn which foods in which amounts cause you to have symptoms, and limit your intake to amounts you can handle.
• When you dine out, ask your server about how your meal will be prepared. Some meals may contain foods you cannot tolerate, and that may not be evident from the description on the menu.
• Learn to read food labels and check the ingredients for problem foods. Don’t forget to check condiments and seasonings. They may contain MSG or another additive that can lead to symptoms.

Food Allergies in Children | Johns Hopkins Medicine

What is food allergy?

A food allergy is an abnormal response of the body to a certain food. It is
important to know that this is different than a food intolerance, which
does not affect the immune system, although some of the same symptoms may
be present.

What causes food allergy?

Before having a food allergy reaction, a sensitive child must have been
exposed to the food at least once before, or could also be sensitized
through breast milk. It is the second time your child eats the food that
the allergic symptoms happen. At that time, when IgE antibodies react with
the food, histamines are released, which can cause your child to experience
hives, asthma, itching in the mouth, trouble breathing, stomach pains,
vomiting, and/or diarrhea.

What is the difference between food allergy and food intolerance?

Food allergy causes an immune system response, causing symptoms in your
child that range from uncomfortable to life-threatening. Food intolerance
does not affect the immune system, although some symptoms may be the same
as in food allergy.

What foods most often cause food allergy?

Approximately 90 percent of all food allergies are caused by the following
eight foods:

• Milk

• Eggs

• Wheat

• Soy

• Tree nuts

• Peanuts

• Fish

• Shellfish

Eggs, milk, and peanuts are the most common causes of food allergies in
children, with wheat, soy, and tree nuts also included. Peanuts, tree nuts,
fish, and shellfish commonly cause the most severe reactions. Nearly 5
percent of children under the age of five years have food allergies. From
1997 to 2007, the prevalence of reported food allergy increased 18 percent
among children under age 18 years. Although most children “outgrow” their
allergies, allergy to peanuts, tree nuts, fish, and shellfish may be
lifelong.

What are the symptoms of food allergy?

Allergic symptoms may begin within minutes to an hour after ingesting the
food. The following are the most common symptoms of food allergy. However,
each child may experience symptoms differently. Symptoms may include:

• Vomiting

• Diarrhea

• Cramps

• Hives

• Swelling

• Eczema

• Itching or swelling of the lips, tongue, or mouth

• Itching or tightness in the throat

• Difficulty breathing

• Wheezing

• Lowered blood pressure

According to the National Institute of Allergy and Infectious Disease, it
does not take much of the food to cause a severe reaction in highly
allergic people. In fact, as little as 1/44,000 of a peanut kernel can
cause an allergic reaction for severely allergic individuals.

The symptoms of food allergy may resemble other problems or medical
conditions. Always consult your child’s doctor for a diagnosis.

Treatment for food allergy

There is no medication to prevent food allergy. The goal of treatment is to
avoid the foods that cause the symptoms. After seeing your child’s doctor
and finding foods to which your child is allergic, it is very important to
avoid these foods and other similar foods in that food group. If you are
breastfeeding your child, it is important to avoid foods in your diet to
which your child is allergic. Small amounts of the food allergen may be
transmitted to your child through your breast milk and cause a reaction.

It is also important to give vitamins and minerals to your child if he or
she is unable to eat certain foods. Discuss this with your child’s doctor.

For children who have had a severe food reaction, your child’s health care
provider may prescribe an emergency kit that contains epinephrine, which
helps stop the symptoms of severe reactions. Consult your child’s doctor
for further information.

Some children, under the direction of his or her health care provider, may
be given certain foods again after three to six months to see if he or she
has outgrown the allergy. Many allergies may be short-term in children and
the food may be tolerated after the age of 3 or 4.

Milk and soy allergy

Allergies to milk and soy are usually seen in infants and young children.
Often, these symptoms are unlike the symptoms of other allergies, but,
rather, may include the following:

Often, your child’s doctor will change your baby’s formula to a soy formula
or breast milk if it is thought he or she is allergic to milk. If your
child has problems with soy formula, your child’s health care provider
might change him or her to an easily digested hypoallergenic formula.

The symptoms of a milk or soy allergy may resemble other problems or
medical conditions. Always consult your child’s doctor for a diagnosis.

Prevention of food allergies

The development of food allergies cannot be prevented, but can often be
delayed in infants by following these recommendations:

• If possible, breastfeed your infant for the first six months.

• Do not give solid foods until your child is 6 months of age or
  older.

• Avoid cow’s milk, wheat, eggs, peanuts, and fish during your
  child’s first year of life.

Dining out with food allergies

If your child has one or more food allergies, dining out can be a
challenge. However, it is possible to have a healthy and satisfying
dining-out experience; it just takes some preparation and persistence on
your part.

The American Dietetics Association offers these tips for dealing with food
allergies when your family is eating away from home:

• Know what ingredients are in the foods at the restaurant where you
  plan to eat. When possible, obtain a menu from the restaurant ahead
  of time and review the menu items.

• Let your server know from the beginning about your child’s food
  allergy. He or she should know how each dish is prepared and what
  ingredients are used. Ask about preparation and ingredients before
  you order. If your server does not know this information or seems
  unsure of it, ask to speak to the manager or the chef.

• Avoid buffet-style or family-style service, as there may be
  cross-contamination of foods from using the same utensils for
  different dishes.

• Avoid fried foods, as the same oil may be used to fry several
  different foods.

Another strategy for dining out with food allergies is to give your server
or the manager a food allergy card. A food allergy card contains
information about the specific items your child is allergic to, along with
additional information, such as a reminder to make sure all utensils and
equipment used to prepare your meal is thoroughly cleaned prior to use. You
can easily print these cards yourself using a computer and printer. If your
child is eating out with friends and you are not going to be present, give
your child a food allergy card (or make sure the adult in charge has one)
to give to the server.

Alternately, there are several types of allergy cards available on the
internet that can be customized with your child’s personal information. One
example is the Food Allergy Buddy Dining Card, promoted by the National
Restaurant Association.

The Food Allergy Initiative, in conjunction with the National Restaurant
Association and the Food Allergy and Anaphylaxis Network, has developed the
Food Allergy Training Program for Restaurants and Food Services. This
training program was developed to help restaurants and other food service
outlets to ensure their customers, including those with food allergies,
will receive a safe meal prepared to customer specifications.

Allergic and non-allergic rhinitis frequently asked questions

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Allergies, including allergic rhinitis, affect an estimated 40 to 50 million people in the United States.

Some allergies may interfere with day-to-day activities or lessen the q​​uality of life.

Your allergist-immunologist, with his or her specialized training and expertise in managing allergies and asthma, can develop a treatment plan for your individual condition. The goal will be to enable you to lead a life that is as normal and symptom-free as possible.

What is rhinitis?

Rhinitis is a term describing the symptoms produced by nasal irritation or inflammation.

Symptoms of rhinitis include runny nose, itching, sneezing and stuffy nose due to blockage or congestion. These symptoms are the nose’s natural response to inflammation and irritation.

Arbitrarily, rhinitis lasting less than six weeks is called acute rhinitis, and persistent symptoms are called chronic rhinitis. Acute rhinitis is usually caused by infections or chemical irritation. Chronic rhinitis may be caused by allergy or a variety of other factors.

The nose normally produces mucus, which traps substances like dust, pollen, pollution, and germs such as bacteria and viruses. Mucus flows from the front of the nose and drains down the back of the throat.

When mucus production is excessive, it can flow from the front, as a runny nose, or become noticeable from the back, as post-nasal drip. Nasal mucus, normally a thin, clear liquid, can become thick or colored, perhaps due to dryness, infection or pollution.

When post-nasal drip is excessive, thick, or contains irritating substances, cough is the natural response for clearing the throat.

Itching and sneezing are also natural responses to irritation caused by allergic reactions, chemical exposures including cigarette smoke, or temperature changes, infections and other factors.

The nasal tissues congest and decongest periodically. In most people, nasal congestion switches back and forth from side to side of the nose in a cycle several hours long.

Some people, especially those with narrow nasal passages, notice this nasal cycle more than others. Strenuous exercise or changes in head position can affect nasal congestion. Severe congestion can result in facial pressure and pain, as well as dark circles under the eyes.

What is sinusitis?​

Sinusitis is inflammation or infection of any of the four groups of sinus cavities in the skull, which open into the nasal passages. Sinusitis is not the same as rhinitis, although the two may be associated and their symptoms may be similar.

The terms “sinus trouble” or “sinus congestion” are sometimes wrongly used to mean congestion of the nasal passage itself. Most cases of nasal congestion, though, are not associated with sinusitis.

What is allergic rhinitis?

Known to most people as hay fever, allergic rhinitis is a very common medical problem affecting more than 15 percent of the population, both adults and children.

Allergic rhinitis takes two different forms seasonal and perennial. Symptoms of seasonal allergic rhinitis occur in spring, summer and/or early fall and are usually caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores.

Other people experience symptoms year-round, a condition called “perennial allergic rhinitis.” It’s generally caused by sensitivity to house dust, house dust mites, animal dander and/or mold spores. Underlying or hidden food allergies are considered a possible cause of perennial nasal symptoms.

Some people may experience both types of rhinitis, with perennial symptoms worsening during specific pollen seasons. As will be discussed later, there are also other causes for rhinitis.

What causes the sneezing, itchy eyes and other symptoms?​​​​

When a sensitive person inhales an allergen (allergy-causing substance) like ragweed pollen, the body’s immune system reacts abnormally with the allergen. The allergen binds to allergic antibodies (immunoglobulin E) that are attached to cells that produce histamine and other chemicals.

The pollen “triggers” these cells in the nasal membranes, causing them to release histamine and the other chemicals. Histamine dilates the small blood vessels of the nose and fluids leak out into the surrounding tissues, causing runny noses, watery eyes, itching, swelling and other allergy symptoms.

Antibodies circulate in the blood stream, but localize in the tissues of the nose and in the skin. This makes it possible to show the presence of these antibodies by skin testing, or less commonly, by a special blood test. A positive skin test mirrors the type of reaction going on in the nose.

No hay, no fever so why “Hay Fever?”​

“Hay fever” is a turn-of-the-century term which has come to describe the symptoms of allergic rhinitis, especially when it occurs in the late summer. However, the symptoms are not caused by hay (ragweed is one of the main culprits) and are not accompanied by fever. So physicians prefer the term “allergic rhinitis” because it’s more accurate.

Similarly, springtime symptoms are sometimes called “rose fever,” but it’s just coincidental that roses are in full-bloom during the grass-pollinating season. Roses and other sweet-smelling, showy flowers rely on bees, not the wind, for pollination, so not much of their pollen gets into the air to cause allergies.

Is there any escape?​​​

A common question from allergic rhinitis sufferers is: Can I move someplace where my allergies will go away?

Some allergens are tough to escape. Ragweed which affects 75 percent of allergic rhinitis sufferers blankets most of the United States. Less ragweed is found in a band along the West Coast, the southern-most tip of Florida and northern Maine, but it is still present. Even Alaska and Hawaii have a little ragweed.

Allergist-immunologists seldom recommend moving to another locale as a cure for allergies. A move may be of questionable value because a person may escape one allergy to ragweed, for example only to develop sensitivity to grasses or other allergens in the new location.

Since moving can have a disrupting effect on a family financially and emotionally, relocation should be undertaken only after consultation with an allergist-immunologist.

Is allergic rhinitis ever the cause of other problems?

Some known complications include ear infections, sinusitis, recurrent sore throats, cough, headache, fatigue, irritability, altered sleep patterns and poor school performance.

Occasionally, children may develop altered facial growth and orthodontic problems. Allergy treatment can eliminate or alleviate most of these problems.

Are all cases of rhinitis caused by allergies?​

Rhinitis may result from many causes other than allergic reaction. Not all rhinitis symptoms are the result of allergies. Listed below are the three most common Rhinitis types and their characteristics.

Allergic. Common name: Hay fever. Allergic sensitivity: Yes. Causes may include dust, foods, animals, pollens and molds. Duration of symptoms are perennial and/or seasonal.

Infectious. Common name: Colds or flu. Allergic sensitivity: No. Causes may include viruses and bacteria. Duration of symptoms are 3-7 days.

Non-allergic. Common name: Irritant. Allergic sensitivity: No. Causes may include Smoke, air pollution, exhaust fumes, aerosol sprays, fragrance, paint fumes, etc. Duration of symptoms are Perennial and/or following exposure.

The most common condition causing rhinitis is the common cold, an example of infectious rhinitis. Most infections are relatively short-lived, lasting from three to seven days. Colds can be caused by any one of more than 200 viruses.

Children, particularly young children in school or day care centers, may have from eight to 12 colds each year. Fortunately, the frequency of colds lessens after immunity has been produced from exposure to many viruses.

Colds usually begin with a sensation of congestion, rapidly followed by runny nose and sneezing. Over the next few days, congestion becomes more prominent, the nasal mucus may become colored, and there may be a slight fever and cough.

Cold symptoms resolve within a couple of weeks, although a cough may sometimes persist. Cold symptoms that last longer may be due to other causes, such as chronic rhinitis or sinusitis.

What are other causes of rhinitis?

Not all symptoms in the nasal passage are caused by allergy or infection. Similar symptoms can be caused by mechanical blockage, use of certain medications, irritants, temperature changes or other physical factors. Rhinitis can also be a feature of other diseases and medical conditions.

Drug-induced nasal congestion can be caused by birth control pills and other female hormone preparations, certain blood pressure medications and prolonged use of decongestant nasal sprays.

Decongestant nasal sprays work quickly and effectively, but they alter how the nasal passages normally work. After a few weeks of use, nasal tissues swell after the medication wears off. The only thing that seems to relieve the obstruction is more of the medicine, and the medication’s effect lasts shorter lengths of time. Permanent damage to the nasal tissues may result. Consultation with a physician to “get off” the medication is often necessary.

Cocaine also alters how the nasal passages normally work, causing a condition identical to, or even more severe than that produced by decongestant nasal sprays. If you use cocaine, it is important to tell your physician so that appropriate therapy can be prescribed.

Irritant rhinitis, or “vasomotor rhinitis” describes a group of poorly understood causes of rhinitis, with symptoms not caused by infection or allergy. Many people have recurrent or chronic nasal congestion, excess mucus production, itching, and other nasal symptoms similar to those of allergic rhinitis, but the disorder is not caused by allergy.

What triggers vasomotor rhinitis?​

Irritants that can trigger vasomotor rhinitis include cigarette smoke, strong odors and fumes including perfume, hair spray, other cosmetics, laundry detergents, cleaning solutions, pool chlorine, car exhaust and other air pollution. Other irritants are spices used in cooking, alcoholic beverages (particularly beer and wine), aspirin, and certain blood pressure medications. Some people are very sensitive to abrupt changes in weather or temperature.

Skiers often develop a runny nose, but in some people any cold exposure may cause a runny nose. Others start sneezing when leaving a cold, air conditioned room. These agents are not allergens, do not induce formation of allergic antibodies and do not produce positive skin test reactions. Occasionally, one or two positive skin tests may be observed, but they do not match with the history and are not relevant or significant.

The cause of vasomotor rhinitis is not well understood. In a sufficiently high concentration, many odors will cause nasal irritation in almost anyone. Some people are unusually sensitive to irritation and will have significant nasal symptoms even when exposed to low concentrations of irritants. Thus, vasomotor rhinitis seems to be an exaggeration of the normal nasal response to irritation, occurring at levels of exposure which don’t bother most people. It occurs more often in smokers and older individuals.

As is the case with allergic rhinitis, vasomotor rhinitis often can’t be cured. Fortunately, symptoms can be kept under control by avoiding or reducing exposure to substances that cause symptoms and by taking medication when needed. Patients with vasomotor rhinitis should not smoke or permit smoking in their homes.

Dryness of the nasal tissues can be a normal effect of aging, or a characteristic of a nasal condition associated with a foul smelling nasal discharge. Rhinitis can also be a feature of endocrine disease, like hypothyroidism, or can occur during pregnancy. Rhinitis can be made worse or even improved during pregnancy. Alcoholic beverages can cause the blood vessels in the nose to enlarge temporarily and produce significant nasal congestion.

How do you know what kind of rhinitis you have?

Consult your physician. Sometimes several conditions can coexist in the same person. In a single individual, allergic rhinitis could be complicated by vasomotor rhinitis, septal deviation (curvature of the bone separating the two sides of the nose) or nasal polyps. Use of spray decongestants for chronic sinusitis, septal deviation or vasomotor rhinitis may cause rhinitis medicamentosa.

Any of these conditions will be made worse by catching a cold. Nasal symptoms caused by more than one problem can be difficult to treat, often requiring the cooperation of an allergist-immunologist and an otolaryngologist (ear, nose and throat specialist).

How is allergic rhinitis diagnosed?

Your allergist-immunologist may begin by taking a detailed history, looking for clues in your lifestyle that will help pinpoint the cause of your symptoms. You’ll be asked about your work and home environments, your eating habits, your family’s medical history, the frequency and severity of your symptoms, and miscellaneous matters, such as if you have pets.

Then, you may require some tests. Your allergist-immunologist may employ skin testing, in which small amounts of suspected allergen are introduced into the skin. Skin-testing is the easiest, most sensitive and generally least expensive way of making the diagnosis. Another advantage is that results are available immediately. In rare cases, it also may be necessary to do a special blood test for allergens, using the RAST or other methods.

How is rhinitis treated?

When no specific cure is available, options are ignoring your symptoms, avoiding or decreasing exposure to irritants or allergens to the extent practical, and taking medications for symptom relief.

Once allergic rhinitis is diagnosed, treatment options include avoidance, medication and immunotherapy (allergy shots).

Avoidance – A single ragweed plant may release one million pollen grains in just one day. The pollen from ragweed, grasses and trees is so small and buoyant that the wind may carry it miles from its source. Mold spores, which grow outdoors in fields and on dead leaves, also are everywhere and may outnumber pollen grains in the air even when the pollen season is at its worst.

While it’s difficult to escape pollen and molds, here are some ways to lessen exposure.

• Keep windows closed and use air-conditioning in the summer, if possible. A HEPA (High Energy Particulate Air) filter or an electrostatic precipitator may help clean pollen and mold from the indoor air. Automobile air conditioners help, too.
• Don’t hang clothing outdoors to dry. Pollen may cling to towels and sheets.
• The outdoor air is most heavily saturated with pollen and mold between 5 and 10 a.m., so early morning is a good time to limit outdoor activities.
• Wear a dust mask when mowing the lawn, raking leaves or gardening, and take appropriate medication beforehand.

Medication – When avoidance measures don’t control symptoms, medication may be the answer. Antihistamines and decongestants are the most commonly used medications for allergic rhinitis. Newer medications, such as cromolyn, inhibit the release of chemicals that cause allergic reactions.

Nasal corticosteroid sprays reduce the inflammation from the allergic trigger. Medications help to alleviate nasal congestion, runny nose, sneezing and itching. They are available in many forms, including tablets, nasal sprays, eye drops and liquids. Some medications may cause side effects, so its best to consult your allergist-immunologist if there’s a problem.

Immunotherapy – Allergen immunotherapy, known as “allergy shots,” may be recommended for persons who don’t respond well to treatment with medications, experience side-effects from medications or have allergen exposure which is unavoidable. Immunotherapy does not cure allergies but can be very effective in controlling allergic symptoms. Allergy injections are usually given at variable intervals over a period of three to five years.

An immunotherapy treatment program consists of injections of a diluted allergy extract, administered frequently in increasing doses until a maintenance dose is reached. Then, the injection schedule is changed so that the same dose is given with longer intervals between injections.

Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure, and sometimes can actually make skin test reactions disappear. As resistance develops, symptoms should improve, but the improvement from immunotherapy will take several months to occur. Immunotherapy does not help the symptoms produced by non-allergic rhinitis.

There are many ways of treating allergies, and each person’s treatment must be individualized based on the frequency, severity and duration of symptoms and on the degree of allergic sensitivity. If you have more questions, your allergist-immunologist will be happy to answer them.

A​bout antihistamines​​​​​

Antihistamines are the most inexpensive and commonly used treatment for rhinitis. These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes place. Although other chemicals are involved, histamine is primarily responsible for causing the symptoms.

Antihistamines do not cure, but help relieve: nasal allergy symptoms, such as sneezing, itching and discharge; eye symptoms, such as itching, burning, tearing, and clear discharge; skin conditions, such as hives, eczema, itching and some rashes; and other allergic conditions as determined by your physician.

There are dozens of different antihistamines and wide variations in how patients respond to them. Some are available over-the-counter and others require a prescription.

Generally, they work well and produce only minor side effects. The body tends to build up resistance to some antihistamines over time. This tendency varies from individual to individual. If you find that an antihistamine loses its “strength,” notify your physician who may then recommend an antihistamine of a different class or strength.

Persons with nasal dryness or thick nasal mucus should avoid taking antihistamines without consulting a physician. Contact your physician for advice if an antihistamine causes drowsiness or other side effects.

Proper use. Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 24 hours. The short-acting antihistamines are often most helpful taken 30 minutes before anticipated allergic exposure (picnic during ragweed season). Timed-release antihistamines are better suited to chronic (long-term) use for those who need daily medications.

Proper use of these drugs is just as important as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for many later to reduce established symptoms. Many times a patient will say that he “took one, and it didn’t work.” If he or she had taken the antihistamine regularly for three to four days, and built up blood levels, it might have been effective.

Side effects. The most common side effect is sedation or drowsiness. For this reason, it is important that you do not drive a car or work with dangerous machinery the first time you take an antihistamine. You should take the antihistamine for the first time at home, several hours before bedtime.

When you are sure that the medicine will not cause sedation, you then can take it any time as prescribed during the day. In persons who experience drowsiness, the sedation effect usually lessens over time. Some of the newer antihistamines have no drowsiness side effects.

Another frequently encountered side effect is excessive dryness of the mouth, nose, and eyes. Less common side effects include restlessness, nervousness, over excitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances, decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea, increased or decreased urination, high or low blood pressure, nightmares (especially in children), sore throat, unusual bleeding or bruising, chest tightness or palpitations. Consult your allergist-immunologist should these reactions occur.

Alcohol and tranquilizers increase the sedation side effects of antihistamines.

Important precautions:

• Never take anyone else’s medication.
• Do not use more than one antihistamine at a time, unless prescribed.
• Keep these medications out of the reach of children.
• Know the effect of the medication on you before working with heavy machinery or driving.
• Follow your physician’s instructions.
• There have not been enough studies to determine absolute safety of antihistamines in pregnancy. Again, consult your allergist-immunologist or obstetrician if antihistamines must be taken.

While an​tihistamines have been taken safely by millions of people in the last 50 years, don’t take antihistamines before telling your allergist-immunologist if you are allergic to or intolerant of any medicine; are pregnant or intend to become pregnant while using this medication; are breast feeding; have glaucoma or enlarged prostate; have any medical illness.

What other medications are effective in treating rhinitis?

Decongestants help relieve the stuffiness and pressure caused by allergic, swollen nasal tissue. They do not contain antihistamines, so do not cause antihistamine side effects. They do not relieve the other symptoms of allergic rhinitis, such as runny nose, post-nasal drip and sneezing.

Decongestants are available as prescription and non-prescription medications and are often seen in combination with antihistamines or other medications. It is not uncommon for patients using decongestants to experience insomnia if taking the medication in the afternoon or evening. If this occurs, a dose reduction may be needed.

At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications for the management of emotional or behavioral problems should discuss this with their physicians before using decongestants. Pregnant patients should also check with their physician before starting decongestants.

Non-prescription decongestant nasal sprays work within minutes and last for hours, but should not be used for more than a few days at a time without a physician’s order.

Oral decongestants are found in many over-the-counter and prescription medications, and may be the treatment of choice for nasal congestion. They don’t cause rhinitis medicamentosa, but need to be avoided by some patients with high blood pressure. If you have high blood pressure, you should check with your physician before using them.

Non-prescription saline nasal sprays will help counteract symptoms of dry nasal passages or thick nasal mucus. Unlike decongestant nose sprays, a saline nose spray can be used as often as needed. Sometimes, your physician may recommend washing (douching) of the nasal passage.

Corticosteroids counteract the inflammation caused by the body’s release of allergy-causing substances, as well as that caused by other non-allergic factors. Thus, they generally work for many causes of rhinitis symptoms and are sometimes useful for chronic sinusitis.

Corticosteroids are sometimes injected or taken orally, but usually on a short-term basis for extremely severe symptoms. Physicians warn that injected or oral steroids may produce severe side effects when used for long periods or used repeatedly and, for this reason, they should be used with extreme caution.

In rhinitis, a corticosteroid is much safer when used by spraying it into the nose. Side effects are less common, but may include nasal ulceration, nasal fungal infection, or bleeding.

Cromolyn is a medication that blocks the body’s release of allergy-causing substances. It does not work in all patients. The full dosage is four times daily, and improvement may take several weeks to occur.

Atropine and the related drug ipratropium bromide are sometimes used to relieve the runny nose of rhinitis; in fact, most antihistamines have a slight atropine-like effect. Atropine can be taken orally and as a nasal spray. It is a component of some antihistamine decongestant preparations.

Antibiotics are for the treatment of bacterial infections. They do not affect the course of uncomplicated common colds, and are of no benefit for non-infectious rhinitis, including allergic rhinitis. In chronic sinusitis, antibiotics may help only temporarily, and surgery may be needed.

Eye allergy preparations are used when the eyes are affected by the same allergens that trigger rhinitis, causing redness, watery eyes and itching. Eye preparations are available as prescription and non-prescription medications. Check with your physician or pharmacist about these medications.

Nasal surgery will usually cure or improve symptoms caused by mechanical blockage or chronic sinusitis not responsive to prolonged antibiotics and nasal steroid sprays. Stopping the use of offending medications will cure rhinitis medicamentosa, providing that there is no underlying disorder.

Check with your physician or pharmacist if you are unsure about a specific drug or formula.

Advice from your allergist: rhinitis​​

Allergies, including allergic rhinitis, affect an estimated 40 to 50 million people in the United States. Some allergies may interfere with day-to-day activities or lessen the quality of life.

The allergist-immunologist, with his or her specialized training and expertise in managing allergies and asthma, can develop a treatment plan for your individual condition. The goal will be to enable you to lead a life that is as normal and symptom-free as possible.

Antiemetic Histamine h2 Receptor Blockers – StatPearls

Continuing Education Activity

First-generation antihistamines have several indications that primarily include nausea and vomiting secondary to motion sickness and vertigo, but secondarily are useful for allergic rhinitis, insomnia, allergic reactions, parkinsonism, and antitussive. This activity reviews the indications, contraindications, activity, adverse events, and other key elements of antiemetic use of h2 receptor blockers in the clinical setting as relates to the essential points needed by members of an interprofessional team managing the care of patients who can benefit therapeutically from these agents.

Objectives:

• Summarize the mechanism of action of h2 receptor blockers.

• Identify the approved indications for h2 receptor blockers.

• Review the adverse events, toxicity, and contraindications of h2 receptor antagonists.

• Outline interprofessional team strategies for improving care coordination and communication to advance appropriate clinical outcomes with h2 receptor antagonist therapy to treat nausea and vomiting and drive the optimal outcomes.

Access free multiple choice questions on this topic.

Indications

First-generation antihistamines have several indications that primarily include nausea and vomiting secondary to motion sickness and vertigo, but are useful secondarily for allergic rhinitis, insomnia, allergic reactions, parkinsonism, and antitussive.

Diphenhydramine

Nasal allergies, allergic dermatosis, anaphylaxis in combination with epinephrine, insomnia, prevention of motion sickness, antiemetic, management of parkinsonian symptoms including extrapyramidal symptoms

Off-label: Oral mucositis

Meclizine

Motion sickness and vertigo

Promethazine

Allergic conditions, antitussive, motion sickness, surgical analgesic/hypnotic, sedation

Off-label: Nausea and vomiting associated with pregnancy

Doxylamine Succinate

Nausea and vomiting of pregnancy

During pregnancy, up to 10% of patients will require pharmacotherapy to treat their nausea and vomiting. The American College of Obstetricians and Gynecologists have recommended a combination of oral vitamin B6 and doxylamine succinate as a first-line treatment after conservative measures have failed, including the BRAT diet. Doxylamine succinate is an antihistamine and has a similar mechanism of action as other antihistamines. This combination has been studied in over 6000 patients and controls and shows no evidence of teratogenicity, and randomized controlled clinical trials showed a 70% reduction in nausea and vomiting. Doxylamine succinate is the only FDA Pregnancy Category A medication approved for nausea and vomiting of pregnancy. For breakthrough nausea and vomiting, diphenhydramine and promethazine can be additional therapeutic agents. Analysis of over 200,000 females, antihistamines have shown no congenital disabilities and no serious maternal or fetal outcomes.[1]

It should be noted antihistamines such as diphenhydramine and dimenhydrinate carry a similar efficacy in reducing postoperative nausea and vomiting as dexamethasone and droperidol.[2] However, antihistamines are typically not a first-line treatment. In Eskander’s randomized controlled clinical trial, one group used only intravenous opioids, and the other group used intravenous opioids in addition to intravenous promethazine for nausea and vomiting.[3] The study showed patients received a discharge from the PACU an average of 19.2 minutes earlier in the opioid and promethazine group. Each patient got discharged when their Aldrete score was 9 or higher. Based on this study, promethazine may warrant further study to include in PACU medications.[3] However, sedation and extrapyramidal side effects can limit promethazine’s use for nausea and vomiting.

Gan had a randomized controlled clinical trial that tested two groups’ responses to antiemetics after undergoing gynecological laparoscopic surgery. One group took promethazine only, and the second group received a combination of granisetron and promethazine. The clinical trials tested for the total response rate, the incidence of nausea, vomiting, use of rescue antiemetics, nausea severity, activity level, and patient satisfaction. The overall response rate was higher in the combination group, and maximum nausea was lower in the combination group. Gan’s study showed the combination of both granisetron and promethazine are more effective in postoperative nausea and vomiting and post-discharge nausea and vomiting.[4]

Mechanism of Action

h2 receptors in central nervous system areas include the area postrema and vomiting center in the vestibular nucleus. Also, many of the antihistamines have anticholinergic properties that block muscarinic receptors at the same sites. Antihistamines must cross the blood-brain barrier to affect the central nervous system.[5][6]

Administration

Dosing for Nausea and Vomiting

• Diphenhydramine: 25 to 50 mg orally (PO) every 6 hours, as needed

• Dimenhydrinate: 50 to 100 mg PO every 6 hours, as needed

• Meclizine (mainly used for motion sickness and vertigo): 25 every 6 hours, as needed

• Promethazine: PO, intramuscular (IM), rectal, or intravenous (IV): 12.5 to 25 mg every 6 hours, as needed

Adverse Effects

These agents can exhibit many anticholinergic effects, including central nervous system (CNS) depression, fatigue, paradoxical vomiting, blurred vision, xerostomia, worsening of narrow-angle glaucoma.

Warnings/Precautions

According to Beers criteria, all first-generation antihistamine histamines carry a higher risk for severe adverse events to the elderly with diphenhydramine and hydroxyzine, posing an even higher risk for adverse events, including CNS depression. They block CYP2D6, which diminishes the effects of codeine, tramadol, and tamoxifen in the geriatric population.[7]

Neuroleptic malignant syndrome has increased risk of occurring when combined with phenothiazines and antipsychotic drugs. Hyperpyrexia, muscle rigidity, altered mental status, tachycardia, irregular pulse, irregular blood pressure, and cardiac dysrhythmias are typical manifestations of the disease.[8]

Promethazine (FDA Boxed Warning): Injection can cause tissue injury, including but not limited to tissue necrosis, gangrene, abscesses, venous thrombosis, and amputation. The preferred route of injection is intramuscular and never subcutaneous. Discontinue injections if there is any burning or pain out of fear of perivascular extravasation or arterial injection. Using injectable promethazine is not advised.[9]

Children younger than two years of age are at increased risk of respiratory depression while taking promethazine.[10]

Contraindications

Hypersensitivity to the medications or other phenothiazines is a contraindication. Patients with lower respiratory tract symptoms, including asthma, should cautiously use antihistamines, especially for children under the age of 2.

Pregnancy/Breastfeeding Considerations

Ten percent to 15% of females have taken antihistamines during pregnancy for the treatment of allergic reactions and nausea. Diphenhydramine, loratadine have been safely used during pregnancy.[11] However, antihistamine usage during breastfeeding is contraindicated because they may inhibit lactation due to decreased maternal serum prolactin concentrations. When antihistamines are needed, second-generation antihistamines are preferable in the breastfeeding population.[12]

Monitoring

The therapeutic index of first-generation antihistamines depends on several factors including the disease (allergic rhinitis, vomiting, nausea, urticaria, motion sickness, vertigo, parkinsonian, insomnia), formulation (by mouth, intranasal, intravenous, intramuscular), and the population (pediatric, adult, elderly). All antihistamines can cause anticholinergic effects; however, diphenhydramine causes the most anticholinergic and cardiac toxicity effects. Anticholinergic effects include cutaneous vasodilation, hydroceles, hidrotic hyperthermia, noninteractive eye injuries, delirium, hallucinations, urinary retention. Cardiac toxicity effects include tachycardia and prolonged QTc.[13] Special monitoring of patients with epilepsy, chronic alcohol abuse, or pre-existing heart because the conditions may decrease the safety profile of antihistamines, especially with a narrow therapeutic index medication such as diphenhydramine.[14]

Toxicity

Initial treatment should be with stabilization of the airway, monitoring breathing, and circulation. The patient should receive supplemental oxygen, continuous pulse oximetry, intravenous access, and an ECG. In patients with prolonged QRS intervals or arrhythmias, sodium bicarbonate is an option.[15] Benzodiazepines can be useful to address agitation and seizures. Hypothermia treatment includes evaporative cooling. If no altered mental status is present and ingestion of anticholinergic agents is likely, activated charcoal is an option.[16] If the airway access is threatened, consider intubation instead. Supportive care is usually adequate; however, in patients with peripheral and central anticholinergic toxicity, administration of anticholinesterase inhibitor, physostigmine may be warranted. Consultation with a medical toxicologist or regional poison center is a recommended process before administration. Caution is necessary for patients with cardiac abnormalities, reactive airway disease, or gastrointestinal obstruction. Atropine should be available at bedside in case of an overdose of physostigmine.

Enhancing Healthcare Team Outcomes

Antihistamine toxicity usually manifests itself as anticholinergic poisoning and requires an interprofessional team of nurses, physicians, laboratory technologists, pharmacists to narrow down the differential diagnosis. Without proper management, a patient can receive incorrect treatment and could cause cardiac arrest. A patient with delirium, seizures, or tachycardia has a wide range of diagnoses when initially admitted. When a diagnosis of anticholinergic toxicity is suspected, a healthcare provider should perform a screening test. Finger-stick glucose, acetaminophen concentrations, salicylate concentrations, ECG, and a pregnancy test for women of childbearing age are necessary. Monitoring the patient for any cardiac arrhythmias or altered mental status will further dictate treatment. Clinicians should use benzodiazepines for agitation, but physostigmine may be more effective (Level IV and Level V).[17][18] A toxicologist consult is in order if physostigmine is needed. The patient should be placed on a cardiac monitor, have resuscitation equipment and atropine available at the bedside when administering physostigmine. Pharmacists should review the patient’s medication record both before and after the toxicity, and consult with the clinicians regarding a plan to move forward. Nursing will monitor treatment and report any concerns to the treating clinicians. If there is any question of the etiology of the poisoning, please call the United States Poison Control network at 1-800-222-1222.

Following patient stabilization, the patient will need a thorough history to assess for any underlying psychiatric problems, medication nonadherence, exposure, or medical issues, causing an increased concentration of the offending medication. All these interprofessional strategies can result in safer use of antihistamines, and help patients who encounter toxicity from these medications. [Level V]

References

1.

Madjunkova S, Maltepe C, Koren G. The delayed-release combination of doxylamine and pyridoxine (Diclegis®/Diclectin ®) for the treatment of nausea and vomiting of pregnancy. Paediatr Drugs. 2014 Jun;16(3):199-211. [PMC free article: PMC4030125] [PubMed: 24574047]

2.

Kranke P, Morin AM, Roewer N, Eberhart LH. Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand. 2002 Mar;46(3):238-44. [PubMed: 11939912]

3.

Eskander JP, Rapoport Y, Cornett E, Gennuso S, Franklin M, Kaye AD, Fox CJ. Does promethazine shorten the length of stay in the post anesthesia care unit? J Perioper Pract. 2018 Jul-Aug;28(7-8):194-198. [PubMed: 29737920]

4.

Gan TJ, Candiotti KA, Klein SM, Rodriguez Y, Nielsen KC, White WD, Habib AS. Double-blind comparison of granisetron, promethazine, or a combination of both for the prevention of postoperative nausea and vomiting in females undergoing outpatient laparoscopies. Can J Anaesth. 2009 Nov;56(11):829-36. [PubMed: 19730966]

5.

Miller AD, Leslie RA. The area postrema and vomiting. Front Neuroendocrinol. 1994 Dec;15(4):301-20. [PubMed: 7895890]

6.

Bhargava KP, Dixit KS, Palit G. Nature of histamine receptors in the emetic chemoreceptor trigger zone. Br J Pharmacol. 1976 Jun;57(2):211-3. [PMC free article: PMC1667111] [PubMed: 938795]

7.

Glare P, Miller J, Nikolova T, Tickoo R. Treating nausea and vomiting in palliative care: a review. Clin Interv Aging. 2011;6:243-59. [PMC free article: PMC3180521] [PubMed: 21966219]

8.

Duggal HS. Neuroleptic malignant syndrome precipitated by promethazine and lorazepam. Aust N Z J Psychiatry. 2001 Apr;35(2):250-1. [PubMed: 11284912]

9.

Onifer DJ, Butler FK, Gross KR, Otten EJ, Patton R, Russell RJ, Stockinger Z, Burrell E. Replacement of Promethazine With Ondansetron for Treatment of Opioid- and Trauma-Related Nausea and Vomiting in Tactical Combat Casualty Care. J Spec Oper Med. 2015 Summer;15(2):17-24. [PubMed: 26125161]

10.

Starke PR, Weaver J, Chowdhury BA. Boxed warning added to promethazine labeling for pediatric use. N Engl J Med. 2005 Jun 23;352(25):2653. [PubMed: 15972879]

11.

Li Q, Mitchell AA, Werler MM, Yau WP, Hernández-Díaz S. Assessment of antihistamine use in early pregnancy and birth defects. J Allergy Clin Immunol Pract. 2013 Nov-Dec;1(6):666-74.e1. [PMC free article: PMC4140658] [PubMed: 24565715]

12.

Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014 Mar;70(3):417.e1-10; quiz 427. [PubMed: 24528912]

13.

Estelle F, Simons R. h2-receptor antagonists: safety issues. Ann Allergy Asthma Immunol. 1999 Nov;83(5):481-8. [PubMed: 10582735]

14.

Radovanovic D, Meier PJ, Guirguis M, Lorent JP, Kupferschmidt H. Dose-dependent toxicity of diphenhydramine overdose. Hum Exp Toxicol. 2000 Sep;19(9):489-95. [PubMed: 11204550]

15.

Sharma AN, Hexdall AH, Chang EK, Nelson LS, Hoffman RS. Diphenhydramine-induced wide complex dysrhythmia responds to treatment with sodium bicarbonate. Am J Emerg Med. 2003 May;21(3):212-5. [PubMed: 12811715]

16.

Guay DR, Meatherall RC, Macaulay PA, Yeung C. Activated charcoal adsorption of diphenhydramine. Int J Clin Pharmacol Ther Toxicol. 1984 Aug;22(8):395-400. [PubMed: 6490221]

17.

Burns MJ, Linden CH, Graudins A, Brown RM, Fletcher KE. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med. 2000 Apr;35(4):374-81. [PubMed: 10736125]

18.

Beaver KM, Gavin TJ. Treatment of acute anticholinergic poisoning with physostigmine. Am J Emerg Med. 1998 Sep;16(5):505-7. [PubMed: 9725967]

Zithromax Side Effects | Allergies & Diarrhea from Azithromycin

Most people tolerate Zithromax, or Z-Pak, well. The prescription antibiotic is a common substitute for patients with a penicillin allergy because its active ingredient, azithromycin, can fight a slightly wider spectrum of bacteria. However, as much as 18 percent of people who took the drug during clinical trials reported some minor side effects.

Nausea was the most common side effect reported during clinical trials. About 3 percent to 18 percent of patients reported the adverse reaction.

Meanwhile, 4 percent to 12 percent of patients reported diarrhea, and between 2 percent and 7 percent of patients reported abdominal pain or vomiting. All other common side effects identified during clinical trials were reported by less than 1 percent of patients.

Z-Pak side effects may include:

• Abdominal pain
• 
  Blood in feces
• 
  Constipation
• 
  Diarrhea
• 
  Dizziness
• 
  Fatigue
• 
  Flatulence
• 
  Headache
• 
  Indigestion
• 
  Insomnia
• 
  Loss of sense of taste or smell
• 
  Nausea
• 
  Rash and itching
• 
  Tinnitus
• 
  Upset stomach
• 
  Vaginal inflammation
• 
  Vomiting

Clinical studies and post-marketing reports have also suggested several rare but serious Zithromax side effects. These include severe and potentially life-threatening conditions such as allergic and skin reactions, liver damage, heart problems and Clostridium difficile-associated diarrhea.

The drug can also cause worsening or new onset of myasthenia gravis, a disease that causes muscle weakness. Infants who take the medication may develop an intestinal condition known as infantile hypertrophic pyloric stenosis, which happens when the opening between the stomach and small intestine thickens. Zithromax has also been linked to an increased risk of cancer relapse in people who have beaten cancer of the blood or lymph nodes when it is used as a long-term treatment.

COVID-19 Alert

Medical providers are experimenting with azithromycin plus hydroxychloroquine to treat COVID-19.

Learn More

Allergic and Skin Reactions

People have suffered serious and sometimes deadly allergic reactions to azithromycin. Reported reactions include angioedema, which causes swelling under the skin, and anaphylaxis, which is a full-body reaction that can be fatal.

Since the U.S. Food and Drug Administration approved azithromycin in 1991, studies and adverse event reports have also associated the drug with several skin reactions including: Acute Generalized Exanthematous Pustulosis (AGEP), a sudden skin eruption that appears approximately five days after treatment starts; Stevens-Johnson syndrome, a serious disorder that causes blistering and peeling of skin and mucous membranes; and toxic epidermal necrolysis, a potentially deadly reaction that can lead to cell death in organs or blistering and skin peeling that can lead to sepsis.

“Allergic reactions can happen in people taking azithromycin the active ingredient in Zithromax, even after only 1 dose,” according to the Zithromax prescribing information.

“Allergic reactions can happen in people taking azithromycin the active ingredient in Zithromax, even after only 1 dose.”

Some people who used Z-Pak reported a condition called drug reaction with eosinophilia and systemic symptoms (DRESS). This is a rare but potentially fatal condition, and genetic factors play a significant role in who may develop it.

The condition causes an influx of infection-fighting white blood cells called eosinophils which cause severe inflammation. DRESS may start as a rash that can spread all over the body. It can cause injury to the liver, kidneys, lungs, heart or pancreas.

The drug’s label warns that some patients’ allergic symptoms initially went away with treatment but came back when treatment was stopped. This happened even without further exposure to azithromycin. The patients needed long-term observation and treatment.

Cancer Relapse

In 2018, the FDA warned long-term use of azithromycin can cause cancer relapse in patients who have had cancer of the blood or lymph nodes and have undergone a donor stem cell transplant. The agency based its warning on results from a clinical trial that found about one-third of patients who had taken long-term azithromycin to prevent a lung condition called bronchiolitis obliterans syndrome experienced a relapse in their cancer.

Researchers stopped the trial after about a year because of an “unexpected increase in the rate of both relapses and death.” A total of 95 patients who had been treated with the antibiotic died. The two-year survival rate for azithromycin-treated patients was 56 percent compared to 70 percent in patients who took a placebo.

Cancer patients who undergo donor stem cell transplants are at risk for a serious lung condition called bronchiolitis obliterans syndrome. Doctors sometimes prescribe azithromycin to prevent the condition. But the FDA did not approve the drug for this use.

“Health care professionals should not prescribe long-term azithromycin for prophylaxis of bronchiolitis obliterans syndrome to patients who undergo donor stem cell transplants because of the increased potential for cancer relapse and death.”

Pfizer Inc. sent out a warning letter to doctors telling them to stop the practice. The FDA warned patients who have had a stem cell transplant not to stop taking the drug without a doctor’s direct supervision.

“Health care professionals should not prescribe long-term azithromycin for prophylaxis of bronchiolitis obliterans syndrome to patients who undergo donor stem cell transplants because of the increased potential for cancer relapse and death,” the agency said.

Heart Problems

Zithromax has also been associated with heart problems, including prolonged QT interval, which throws off the electrical cycle of the heart. A prolonged QT interval can lead to dangerous irregular heart rhythms that can sometimes cause sudden cardiac death.

In May 2012, a study in The New England Journal of Medicine reported a small increase in cardiovascular death in patients treated with azithromycin compared with patients treated with amoxicillin, ciprofloxacin or no drug.

“As compared with amoxicillin, there were 47 additional cardiovascular deaths per 1 million courses of azithromycin therapy.”

Adverse event reports to the FDA associating azithromycin with irregular heartbeats prompted the study. Researchers concluded certain patients were more likely to die while taking azithromycin than while using other antibiotics or none at all.

“As compared with amoxicillin, there were 47 additional cardiovascular deaths per 1 million courses of azithromycin therapy,” the researchers wrote.

Z-Pak users at high risk for cardiovascular death include those:

• With existing or a history of QT interval prolongation
• With low blood levels of potassium or magnesium
• With a slower than normal heart rate
• Who take certain drugs to treat arrhythmias

The risk of death while on azithromycin increased proportionally with the patients’ cardiovascular risk score. The study found 245 additional deaths per million five-day courses in patients with the highest risk scores versus with just nine additional deaths in patients with the lowest risk scores as compared to amoxicillin.

The increased death rate did not continue once patients finished their five-day Z-Pak courses. The increased risk stemmed from the drug and lasted as long as the drug levels were high in the blood.

The FDA issued a public statement in March 2013 that detailed the study and warned the medication may have previously unknown side effects relating to risk of developing abnormal heart rhythms that may be fatal. The agency said patients who are most at risk are those with known risk factors such as existing heart problems.

A study sponsored by the Danish Medical Research Council found no evidence of increased risk of death for young and middle-aged adults without heart problems who took Zithromax compared with those who took a different antibiotic such as penicillin. Researchers concluded that any increased risk of cardiovascular death associated with azithromycin is restricted to high-risk patients with a history of heart disease or problems.

The drug’s label also includes a warning about a potentially fatal condition called torsades de pointes (TdP). The condition involves rapid heartbeats that start in the ventricles.

Researchers reported cases of TdP during postmarketing surveillance of patients taking Zithromax. Once this serious heart condition develops, few patients will survive it without prompt treatment.

Clostridium difficile-Associated Diarrhea (CDAD)

Clostridium difficile-associated Diarrhea (CDAD) is a side effect reported with nearly all antibiotics, including Zithromax. It can range in severity from mild diarrhea to fatal inflammation of the colon called colitis. CDAD typically develops within a few days after taking an antibiotic, however reports have shown that some patients have experienced the side effect over two months after taking an antibiotic.

Antibiotics alter the normal gut flora, or the good and bad bacteria that live in the digestive tract and colon. This can kill off so-called “good bacteria” and lead to an overgrowth of Clostridium difficile, or C. difficile.

C. difficile is an antibiotic-resistant bacterium. Quick treatment is crucial to managing the infection.

Azithromycin and other macrolide antibiotics are considered to have a moderate risk of causing or contributing to C. difficile infections. Medical professionals have suggested substituting tetracyclines for macrolides when treating some conditions in older patients who are at greater risk of C. difficile infection.

Liver Damage

The National Institutes of Health says azithromycin’s popularity has made it “one of the more common causes of drug-induced liver injury.”

It has been linked in rare cases to hepatotoxicity, which refers to chemical- or medication-driven liver damage. Liver damage associated with the antibiotic has sometimes resulted in death.

Conditions of liver impairment and/or injury reported in patients include:

• Abnormal liver function
• 
  Hepatitis
• 
  Cholestatic jaundice
• 
  Hepatic necrosis
• 
  Liver failure

A 2014 study in the journal Clinical Gastroenterology and Hepatology found azithromycin-induced liver injury can happen within one to three weeks after a person starts taking the drug. The researchers said the damage tended to happen at the cellular level.

“Although most patients recover fully, severe cutaneous (skin-related) reactions, chronic injury, and serious complications leading to death or liver transplantation can occur,” the authors wrote.

Other research suggests Z-Pak treatment may be riskier for people who have previously experienced a liver condition.

A study published in 2015 in the journal Gastroenterology looked at 899 patients with drug-induced liver injury. Ten percent of the patients had a pre-existing liver disease.

The researchers found azithromycin was associated with 6.7 percent of liver injuries among those with pre-existing liver conditions compared with 1.5 percent of cases among those who had no pre-existing condition.

Esophagitis | Cedars-Sinai

Not what you’re looking for?

What is esophagitis?

Esophagitis is when the lining of your esophagus becomes irritated
and inflamed. The esophagus is the tube that connects the back of your throat to
your stomach. Food and liquid go down the tube when you swallow. The lining of the
esophagus is sensitive. Because of this, many things can cause irritation.

What causes esophagitis?

Causes of esophagitis can include:

• Stomach acid often leaking up into your esophagus
  (gastroesophageal reflux disease, or GERD)
• Chronic vomiting
• Medicines, such as aspirin or other anti-inflammatory
  medicines
• Medical procedures, such as radiation therapy
• Infections that weaken your immune system
• Allergies, often to foods

Who is at risk for esophagitis?

You may be at risk for esophagitis if you:

• Are pregnant
• Smoke
• Are obese
• Are an older adult
• Use certain medicines, such as NSAID pain relievers
  (nonsteroidal anti-inflammatory medicines), nitrates, beta blockers, certain
  antibiotics, or potassium
• Have a spinal cord injury
• Have had radiation therapy for chest tumors
• Swallow medicine with too little water or get a pill stuck
  in your throat
• Have scleroderma, an autoimmune disease
• Have many allergies, especially to certain foods

What are the symptoms of esophagitis?

Symptoms can occur a bit differently in each person. They can
include:

• Sore throat
• Feeling that something is stuck in your throat
• Sores in your mouth
• Nausea or vomiting
• Trouble swallowing
• Pain when swallowing
• Heartburn

The symptoms of esophagitis may look like other health conditions.
See your healthcare provider for a diagnosis.

How is esophagitis diagnosed?

You may see a healthcare provider called a gastroenterologist.
This is a doctor who specializes in the digestive system. They will ask about your
symptoms and health history and will also give you a physical exam. You may also
have tests. These include:

• Upper GI series. This test takes
  X-ray images of your esophagus and stomach as you swallow a barium fluid. The
  test shows any problem areas.
• Endoscopy. Your healthcare
  provider uses a tiny camera on a thin, flexible tube to look inside your
  esophagus for signs of irritation.
• Esophageal pH test for stomach
  acid.
  Your provider will put sensors or thin wires into your esophagus
  either while you’re awake or with an endoscopy. These sensors or wires are left
  in place to gather information over 1 to 3 days. This can show if stomach acid
  backs up in the esophagus.

How is esophagitis treated?

Treatment depends on the cause. It will also depend on how severe
the condition is. Treatments include:

• Taking medicines. Acid-blocking
  medicine causes your stomach to make less acid. Other medicines can sometimes
  help make the valve between the esophagus and stomach stronger. This valve is
  called the lower esophageal sphincter (LES). It keeps stomach acid in your
  stomach. Other medicines may include infection-fighting medicines (such as
  antibiotics). You may take steroids to reduce swelling (inflammation) in
  certain kinds of esophagitis.
• Not taking certain medicines.
  Don’t take aspirin or ibuprofen and similar NSAIDs unless your healthcare
  provider tells you to.
• Not eating certain foods. If
  food allergies cause your condition, you will need to not eat those foods.
• Dilation. This is stretching of
  the esophagus. It is done during an endoscopy.
• Surgery or endoscopic treatment.
  Your healthcare provider may advise this treatment if you have bleeding or
  narrowing of the esophagus. It also might be advised to control the spread of
  precancerous cells.

Your healthcare provider may advise these lifestyle changes if
your condition is caused by GERD:

• Raise the head of your bed. This will help prevent reflux
  when you sleep.
• Change your eating habits. You may need to switch to a bland
  diet for a while. This means not having spicy foods, citrus, chocolate, fatty
  foods, or caffeine.
• Stop smoking.
• Don’t drink alcohol or limit how much you drink.
• Keep a healthy weight.
• Be more active.

Talk with your healthcare provider about the risks, benefits, and
possible side effects of all treatments.

What are possible complications of esophagitis?

Esophagitis can affect your quality of life. If left untreated, it
may also develop into a condition called Barrett’s esophagus. This may increase your
risk for esophageal cancer.

Other problems that can happen include:

• Trouble swallowing or eating
• Bleeding
• Narrowing of the esophagus

What can I do to prevent esophagitis?

Esophagitis can come back. You will need to follow your healthcare
provider’s advice about lifestyle changes and medicine use.

When should I call my healthcare
provider?

Call the healthcare provider if you have:

• Symptoms that don’t get better, or get worse
• New symptoms

Key points about esophagitis

• Esophagitis is when the lining of your esophagus becomes
  irritated and inflamed.
• Causes of esophagitis can include GERD, vomiting, and
  medicines. You may be at risk for esophagitis if you are pregnant, smoke, or are
  obese.
• Symptoms can include sore throat and a feeling that
  something is stuck in your throat.
• Treatments can include lifestyle changes, medicines,
  dilation, and surgery.
• If left untreated, the condition may also develop into a
  condition called Barrett’s esophagus. This may increase your risk for esophageal
  cancer.
• Esophagitis can come back. You will need to follow your
  healthcare provider’s advice about lifestyle changes and medicine use.

Next steps

Tips to help you get the most from a visit to your healthcare
provider:

• Know the reason for your visit and what you want to
  happen.
• Before your visit, write down questions you want
  answered.
• Bring someone with you to help you ask questions and
  remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any
  new medicines, treatments, or tests. Also write down any new instructions your
  provider gives you.
• Know why a new medicine or treatment is prescribed and how
  it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the
  results could mean.
• Know what to expect if you do not take the medicine or have
  the test or procedure.
• If you have a follow-up appointment, write down the date,
  time, and purpose for that visit.
• Know how you can contact your provider if you have
  questions.

Medical Reviewer: Jen Lehrer MD

Medical Reviewer: Rita Sather RN

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Not what you’re looking for?

Tick Bites | Michigan Medicine

Overview

Ticks are small spiderlike animals (arachnids) that bite to fasten themselves onto the skin and feed on blood. Ticks live in the fur and feathers of many birds and animals. Tick bites occur most often during early spring to late summer and in areas where there are many wild animals and birds.

Most ticks don’t carry diseases, and most tick bites don’t cause serious health problems. But it is important to remove a tick as soon as you find it. Removing the tick’s body helps you avoid diseases the tick may pass on during feeding. Removing the tick’s head helps prevent an infection in the skin where it bit you. See Home Treatment for the best way to remove a tick.

Usually, removing the tick, washing the site of the bite, and watching for signs of illness are all that is needed.

Some people may have an allergic reaction to a tick bite. This reaction may be mild, with a few annoying symptoms. In rare cases, a severe allergic reaction (anaphylaxis) may occur.

Many of the diseases ticks carry cause flu-like symptoms, such as fever, headache, nausea, vomiting, and muscle aches. Symptoms may begin from 1 day to 3 weeks after the tick bite. Sometimes a rash or sore appears along with the flu-like symptoms. Ticks are found worldwide and can carry many diseases, such as:

Tick paralysis is a rare problem that may occur after a tick bite. In some parts of the world, tick bites may cause other tick-borne diseases, such as South African tick-bite fever.

Check Your Symptoms

Do you have a concern about a tick bite?

How old are you?

Less than 12 years

Less than 12 years

12 years or older

12 years or older

Are you male or female?

Why do we ask this question?

• If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
• If your symptoms aren’t related to those organs, you can choose the gender you identify with.
• If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Could you be having a severe allergic reaction?

This is more likely if you have had a bad reaction to something in the past.

Yes

Possible severe allergic reaction (anaphylaxis)

No

Possible severe allergic reaction (anaphylaxis)

Do you think you may have a fever?

Are there red streaks leading away from the area or pus draining from it?

Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?

“Hardware” includes things like artificial joints, plates or screws, catheters, and medicine pumps.

Yes

Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area

No

Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area

Do you have a new rash or sore after being bitten by a tick?

The rash could be anywhere on the body. It may or may not be near the bite.

Does the rash cover a lot of your body?

Yes

Rash over much of body

Have you developed any flu-like symptoms after a tick bite, such as fever, muscle or joint pain, headache, nausea and vomiting, or a general feeling of illness?

This could happen within minutes of the bite or up to 3 weeks later.

Yes

Flu-like symptoms after bite

No

Flu-like symptoms after bite

Have you had symptoms for more than a week after a tick bite?

Yes

Symptoms for more than 1 week after tick bite

No

Symptoms for more than 1 week after tick bite

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

• Your age. Babies and older adults tend to get sicker quicker.
• Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
• Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
• Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
• Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

• Try home treatment to relieve the symptoms.
• Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of a severe allergic reaction (anaphylaxis) may include:

• The sudden appearance of raised, red areas (hives) all over the body.
• Rapid swelling of the throat, mouth, or tongue.
• Trouble breathing.
• Passing out (losing consciousness). Or you may feel very lightheaded or suddenly feel weak, confused, or restless.

A severe reaction can be life-threatening. If you have had a bad allergic reaction to a substance before and are exposed to it again, treat any symptoms as an emergency. Even if the symptoms are mild at first, they may quickly become very severe.

Symptoms of infection may include:

• Increased pain, swelling, warmth, or redness in or around the area.
• Red streaks leading from the area.
• Pus draining from the area.
• A fever.

You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.

• For a dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
  • You haven’t had a tetanus shot in the past 5 years.
  • You don’t know when your last shot was.
• For a clean wound, you may need a shot if:
  • You have not had a tetanus shot in the past 10 years.
  • You don’t know when your last shot was.

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in adults are:

• Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
• Long-term alcohol and drug problems.
• Steroid medicines, which may be used to treat a variety of conditions.
• Chemotherapy and radiation therapy for cancer.
• Other medicines used to treat autoimmune disease.
• Medicines taken after organ transplant.
• Not having a spleen.

Tick paralysis is a rare reaction to the venom that some ticks release when they bite. Symptoms usually start 4 to 7 days after a tick attaches to your body and may include:

• Tingling, numbness, or loss of feeling or movement that starts in your hands or feet.
• Trouble swallowing or talking.
• Double vision.
• Loss of movement in your face.

Removing the tick stops the release of the venom and reverses the problem.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

• Call your doctor now to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care in the next hour.
• You do not need to call an ambulance unless:
  • You cannot travel safely either by driving yourself or by having someone else drive you.
  • You are in an area where heavy traffic or other problems may slow you down.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

• Make an appointment to see your doctor in the next 1 to 2 weeks.
• If appropriate, try home treatment while you are waiting for the appointment.
• If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

• Call your doctor today to discuss the symptoms and arrange for care.
• If you cannot reach your doctor or you don’t have one, seek care today.
• If it is evening, watch the symptoms and seek care in the morning.
• If the symptoms get worse, seek care sooner.

Home Treatment

Most ticks don’t carry diseases, and most tick bites don’t cause serious health problems. The sooner ticks are removed, the less likely they are to spread disease.

Some ticks are so small that it is hard to see them. This makes it hard to tell whether you have removed the tick’s head. If you do not see any obvious parts of the tick’s head in the bite site, assume you have removed the entire tick, but watch for signs of a skin infection.

• Use fine-tipped tweezers to remove a tick. If you don’t have tweezers, put on gloves or cover your hands with tissue paper, then use your fingers. Do not handle the tick with bare hands. If part of the tick stays in the skin, leave it alone. It will likely come out on its own in a few days.
• Do not try to smother a tick that is attached to your skin with petroleum jelly, nail polish, gasoline, or rubbing alcohol. This may increase your risk of infection.
• Do not try to burn the tick while it is attached to your skin.
• Wash the area of the tick bite with a lot of warm, clean water.
• Apply a thin layer of petroleum jelly, such as Vaseline, lightly to the wound. It will keep the bite from sticking to the bandage.
• After you remove the tick, wash your hands really well with soap and water.

When you return home from areas where ticks might live, carefully examine your skin and scalp for ticks. Check your clothing, outdoor gear, and pets, too. Remove any ticks you find. Then put your clothing in a clothes dryer on high heat for 1 hour to kill any ticks that might remain.

Home treatment to help relieve pain and itching

• Apply an ice pack to your bite for 15 to 20 minutes once an hour for the first 6 hours. When you are not using ice, keep a cool, wet cloth on the bite for up to 6 hours.
• Try a nonprescription medicine for the relief of itching, redness, and swelling. Be sure to follow the nonprescription medicine precautions.
  • An antihistamine medicine, such as a nondrowsy one like loratadine (Claritin) or one that might make you sleepy like diphenhydramine (Benadryl), may help relieve itching, redness, and swelling. Don’t give antihistamines to your child unless you’ve checked with the doctor first.
  • A spray of local anesthetic containing benzocaine, such as Solarcaine, may help relieve pain. If your skin reacts to the spray, stop using it.
  • Calamine lotion applied to the skin may help relieve itching.
• After the first 6 hours, if there is no swelling, try putting a warm washcloth on the bite for comfort.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

Prevention

To prevent tick bites:

• Apply an insect repellent safely. Use insect repellents according to the directions on the label, particularly when applying repellent to children.
  • Use a lower-concentration repellent on children.
  • Do not put repellent on small children’s hands, since they often put their hands in their mouths.
  • Wash the insect repellent off with soap and water after returning indoors.
• Use products that contain 0.5% permethrin on your clothing and outdoor gear, such as your tent. You can also buy clothing already treated with permethrin.
• Cover as much of your skin as possible when working or playing in grassy or wooded areas. Wear a hat, a long-sleeved shirt, and long pants with the legs tucked into your socks. Keep in mind that it is easier to spot ticks on light-colored clothes. If you think you may have a tick on your clothing, put your clothing in a clothes dryer for 10 to 15 minutes to kill the tick.
• Wear gloves when you handle animals or work in the woods.
• Take steps to control ticks on your property if you live in an area where Lyme disease is prevalent. Clearing leaves, brush, tall grasses, woodpiles, and stone fences from around your house and the edges of your yard or garden may help reduce the tick population and the rodent population that the ticks depend on. Remove plants that attract deer, and use barriers to keep deer—and the deer ticks they may carry—out of your yard. Treating yards with chemicals that kill ticks (ascaricides) is sometimes effective but exposes you and your pets to chemicals that may not be safe. You may choose to treat your lawn for ticks with nonchemical or environmentally safe methods instead. Call your local landscaping nursery or county extension office for more information.
• Stay away from tick-infested areas.

For information on how to specifically prevent Lyme disease, see the topic Lyme Disease.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• When were you bitten? How many times were you bitten? If you saved the tick, bring it with you to your doctor’s appointment. If not, be prepared to describe the tick.
• What are your main symptoms?
• When did your symptoms begin? How have your symptoms developed, progressed, or changed since the bite?
• What home treatment have you tried? Did it help?
• Have you traveled in the wilderness or in another country recently?
• Do you have any health risks?

Credits

Current as of:
February 26, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP – Emergency Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
H. Michael O’Connor MD – Emergency Medicine
Martin J. Gabica MD – Family Medicine

Current as of: February 26, 2020

Author:
Healthwise Staff

Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & E. Gregory Thompson MD – Internal Medicine & H. Michael O’Connor MD – Emergency Medicine & Martin J. Gabica MD – Family Medicine

Attention, allergy

Attention, allergy

World Allergy Day has been celebrated by the World Health Organization since 2000 due to a sharp increase in allergy manifestations around the world. Russian doctors believe that various manifestations of allergic reactions occur in at least every third resident of the country.

In the early 20th century, allergy was a relatively rare condition.Today it belongs to the most common diseases. The term “allergy” (from the Greek alios – another and ergon – action) to denote increased sensitivity in contact with various substances was proposed in 1906 by the Austrian pediatrician Clemence Perquet.

Allergy is manifested by severe irritation of the mucous membranes, skin rashes, general malaise, etc. The most famous allergens are plant pollen, spores of microscopic fungi, house dust mites, animal dander, medicines, food products, latex and nickel, and products.Any tissues and organs can be involved in the process. The skin, the gastrointestinal tract, the respiratory tract are more often affected by the development of allergies.

There are several types of allergies, each with its own characteristics of the course, exacerbation, treatment. These are, first of all, bronchial asthma, allergic rhinitis, food allergies, urticaria and atopic dermatitis, allergic conjunctivitis, hay fever, bronchial asthma, Quincke’s edema, urticaria, anaphylactic shock, perennial allergic rhinitis.

With an exacerbation of allergies, general malaise, poor health, headache, chills, nausea, sometimes vomiting, shortness of breath, dizziness are noted. Itching of the skin, a burning sensation in the mouth and nose, a feeling of numbness, nasal congestion, continuous sneezing appears. The most severe manifestation of allergies is anaphylactic shock, which develops most often in response to drugs or insect bites. Everyone should know about its symptoms. Signs of anaphylactic shock include loss of consciousness, convulsions, shortness of breath, rash all over the body, involuntary urination and defecation, vomiting.If urgent help is not provided, a person may die due to cardiac and respiratory arrest. Therefore, when going outdoors, do not use perfume, hairspray or other aromatic products that attract bees or wasps. Do not leave food and drinks open. Do not make sudden movements and do not try to swat the insect if it has settled on the skin. Best of all, flick it away.

The best way to prevent the occurrence of an allergic reaction is to avoid contact with the allergen and immediately use an antiallergic drug if such contact is unavoidable.If you yourself or your family members suffer from allergies, be sure to keep one of the antihistamine drugs at home. Such a drug will quickly stop the allergic reaction, preventing it from developing into an attack that threatens with serious consequences. The choice of such a drug should be carried out under the mandatory supervision of the attending physician.

Adults with allergies should pay special attention to the environment of their children, keeping in mind that the child may have hereditary allergies.The pronounced aroma of flowers and perfumes, tobacco smoke, pet hair – all this can trigger the mechanism of an allergic reaction in the child’s body. There are a number of rules, the observance of which will make life easier for all allergy sufferers.

Pollinosis, i.e. allergy to pollen, most often manifests itself in the form of rhinitis, conjunctivitis and pollen bronchial asthma. Of course, it is impossible to avoid any possible contact with plant pollen, however, its safety can be reduced: during the pollination period, keep the car windows closed; avoid going on picnics and hiking; relax by the sea, where there is much less pollen; Avoid outdoor walks, outdoor sports, and outdoor activities in the middle of the day when temperatures are at their highest.

And dust allergy is a year-round phenomenon that does not depend on the weather and season. According to some reports, the number of citizens suffering from it is 85% of the total number of all allergy sufferers combined. Any house dust is a complex set of allergens, the main of which is house dust mite. The bedroom must be cleaned very often, and the room must be constantly ventilated. It is important to regularly vacuum the floor, carpets, curtains and all surfaces of the mattress, in addition, it is necessary to dry the mattress in the sun from time to time.Bed linen, blankets and stuffed animals should be washed periodically at a temperature of at least 60 ° C. Wool blankets, feather pillows and duvets should be replaced with synthetic fabrics. Ideally, it is advisable to remove paintings, carpets, wool and fur from the bedroom and not use heavy fabrics for curtains and curtains. There are special insecticidal sprays, which periodically – 4-5 times a year – need to be treated carpets and mattresses. The substances in the spray kill the ticks.After processing, it is necessary to thoroughly vacuum the surface of the carpet or mattress, because dead mites cause allergies in the same way as live ones. Mold is a type of microscopic fungus. Ventilate areas where mold can develop often, especially bathrooms, kitchens, basements, and attics. Fight dampness, eliminate all sorts of leaks. Clean and disinfect ventilation and air conditioners. Do not store moldy food (moldy orange releases up to 15 billion spores into the air!).Pay attention to the flower pots for any white or orange bloom (mold). People with food allergies should avoid foods that cause an allergic reaction. But, unfortunately, we do not always know which ingredients are contained in a particular dish. Many people are allergic to soy, which is found in many baked goods and pastries. Peanuts and peanut butter are also found in a great many ready-to-eat foods on store shelves.

We all well understand that it is, alas, impossible to completely exclude contact, for example, with household dust. In such cases, antiallergic drugs come to the rescue. The effect of such drugs boils down to the fact that the drug literally replaces those receptors in the body that the allergen was supposed to occupy. Such a mechanism of action is capable of suppressing an allergic reaction, but it is not yet possible to completely save the patient from the disease even with drugs of the fifth generation, which act quickly and for a long time.Therefore, antiallergic drugs have to be taken constantly throughout the patient’s life. Topical creams and ointments can relieve itching or burning, but their effect on an allergic reaction is considered minimal. Thus, we have to admit that it is currently impossible to achieve a complete cure for allergies. The only consolation is the fact that the right treatment can reduce allergic manifestations to a minimum.

Remember! It is impossible to cure allergies, but it is quite possible to peacefully coexist with this disease, taking medications and getting rid of the allergen!

Food allergy in animals

Food allergy in animals

October 29, 2021

Food allergy in animals

There are hardly fewer allergy sufferers among our four-legged friends than among humans.Food allergy in animals can manifest itself at any time – it is not necessary to change the diet or diet in order to develop hypersensitivity to a particular food component.

Symptoms

The following symptoms may indicate that an animal has developed a food allergy:

1. itching and redness of the skin;

2. seborrhea;

3. bacterial skin infections;

4. diarrhea, nausea, vomiting (observed in about 50% of sick animals).

In domestic cats, itching most often occurs in the head area. The animal is often licked, which provokes alopecia (partial baldness of skin areas).

It is important not to confuse food allergies in animals with food intolerances. In the second case, immunity does not take any part in the reaction to the causative agent, and intolerance does not affect the condition of the skin. Its main symptoms are flatulence, nausea, and soft stools.

Most often, a negative reaction of immunity is caused by:

1. chicken, pork;

2. cereals;

3. flavor enhancers;

4. flavors, preservatives and other additives.

At the same time, the high class of feed does not guarantee the protection of the animal from food allergies.Moreover, pet food manufacturers often do not include in their composition by-products (eg wheat, corn), which can also provoke the pet’s immune system.

Diagnostics and treatment

A reliable method for detecting food allergies in an animal is a diagnostic diet. The four-legged one switches to a diet consisting of foods that he has never eaten before or has rarely eaten. Only a specialist can formulate the correct nutritional diet.

After 4-12 weeks on a new diet, subject to the weakening or disappearance of allergy symptoms, a so-called provocation is performed.The diet of the caudate is changed back to the “old” one, and if the symptoms return, the diagnosis is finally confirmed.

The easiest way to treat an animal’s food allergy is to remove the allergenic ingredient from its diet. It is calculated by the elimination method; the search may take several months. A simpler alternative is to leave the pet on the diet that the doctor prescribed during the diagnosis.

Veterinary clinic “Doctor Aibolit”

Symptoms of food allergies are similar to those of a number of other diseases in pets, so only an experienced doctor with all the necessary equipment can make an accurate diagnosis.

Veterinary clinic “Doctor Aibolit” offers a full range of diagnostic and therapeutic services for your pets. Our doctors will help you choose a balanced diet for the animal, carry out the necessary examinations and help maintain the health of the four-legged animal so that it is always active and cheerful.

Our three branches operate in the city. You can make an appointment at any of them by calling the phones listed at the bottom of the page.We are ready to answer all your questions by e-mail [email protected].

90,000 Potential complications

Unfortunately, there are no absolutely safe medical procedures. When conducting PET-CT studies, complications may arise, which, in most cases, are associated with the introduction of X-ray contrast agents. We will already know about the possibility of such complications at the stage of the initial consultation with the patient.In general, the procedure is well tolerated by patients.

The radioactive substances used in PET studies and obtained with all quality control measures are well tolerated. Due to the fact that biological compounds are present in RFP in negligible amounts, they do not have side effects, do not cause allergic reactions and do not have pharmacological effects (allergies, nausea or vomiting, fever are unknown). The level of radiation (the amount of radiation exposure) received during PET is negligible, and, in general, is significantly lower than with X-ray examination, therefore nuclear diagnostics is used even in pediatrics.Delayed complications have not been noted in world practice.

Rarely enough, but complications occur after an intravenous injection of a radiopaque contrast agent: damage to the skin and blood vessels, the occurrence of an abscess at the injection site, hemorrhage, hematomas, difficulty in movement, pain, inflammation of the nerve. For the most part, such complications go away on their own, they are easily treated. An allergic reaction may occur due to an iodine-containing X-ray contrast agent or an anesthetic and sedative drug (urticaria, rash, or other skin irritation).Rare allergic reactions requiring hospital treatment include anaphylactic shock, cardiogenic shock, status asthmaticus, and Quincke’s edema. It is extremely rare that there may be impaired renal function, the development of renal failure; hyperfunction of the thyroid gland, thyrotoxic crisis; conditions, the treatment of which in most cases is carried out by means of infusion, but may require surgical intervention.

When taking a contrast agent orally (inside), nausea, vomiting, and diarrhea may occur.

Wheat allergy or intolerance | Symptoms and treatment

What is wheat allergy?

Wheat allergy is an allergic reaction to foods containing wheat. An allergic reaction can be caused by eating wheat and, in some cases, inhaling wheat flour. Unlike grass allergies, it is not wheat pollen that causes an allergic reaction, but its proteins.

Wheat allergy is a fairly common allergy among young children, most of whom will outgrow it.However, in adults, wheat allergies tend to be persistent.

Wheat is also found in some non-food products that can cause allergic reactions. Examples are Play-Doh, used by children, some cosmetics and bath products.

Wheat and celiac disease allergy

Wheat allergy and celiac disease are completely different things.However, since celiac disease is caused by the body’s response to gluten, a protein found in wheat, the two can be confused.

Celiac disease is not an allergy; it is an autoimmune disease in which the body attacks gluten with antibodies and damages the intestinal lining. Also, unlike wheat allergies, celiac disease is always persistent. Treatment consists of adhering to a strict gluten-free diet.

Many gluten-free foods are also suitable for people with wheat allergies, but not all.Conversely, some foods do not contain wheat, but they are not suitable for people with celiac disease because gluten is also present in other grains, namely barley and rye.

Causes of wheat allergy and risk factors

If you are allergic to wheat, exposure to wheat protein will prepare your immune system for an allergic reaction. A person can develop allergies to any of the four classes of wheat proteins: albumin, globulin, gliadin, and gluten.

Some people with wheat allergies only develop symptoms if they exercise for several hours after consuming wheat. Exercise-induced changes in the body either trigger an allergic reaction or impair the immune system’s response to wheat protein. This condition, called exercise-induced wheat-induced anaphylaxis (WDEIA), usually results in life-threatening anaphylaxis.

Another variant is associated with so-called baker’s asthma, a serious obstructive respiratory disease that affects 4% to 25% of bakeries worldwide.Wheat flour is the main grain used in baked goods, and wheat flour allergy is the main cause of baker’s asthma.

Certain factors may lead to a greater risk of developing wheat allergy:

• Family history. A person is at increased risk of wheat or other food allergies if their parents have food allergies or other allergies such as asthma.
• Age. Wheat allergy is most common in infants and toddlers with immature immune and digestive systems.But adults can also develop wheat allergies.

Wheat allergy symptoms

The main symptoms of wheat allergy are on the skin and in the respiratory tract, often immediately after a meal. However, it can also cause stomach upset, which can occur over time.

How do you know if you are allergic to wheat?

There are a wide variety of signs and symptoms of wheat allergy, including:

• Swelling, itching, or irritation of the mouth or throat.

• Hives, itchy rash or swelling of the skin.

• Nasal congestion

• Headache

• Shortness of breath

• Convulsions, nausea or vomiting.

• Diarrhea

• Anaphylaxis

In some people, wheat allergy can cause a life-threatening reaction known as anaphylaxis, a condition that causes chest pain or tightness, swelling or tightness in the throat, severe difficulty breathing, trouble swallowing, pale skin to a blue tone and dizziness or fainting.

If anyone shows signs of anaphylaxis, call the emergency number. Anaphylaxis requires immediate medical attention and can be fatal.

If you suspect that you or your child is allergic to wheat, make an appointment with your doctor.

Wheat allergy and wheat intolerance or sensitivity

Some people do not have an allergic reaction to wheat, but they have problems digesting it, which can cause painful and unpleasant symptoms.

For many people, bloating, stomach cramps, diarrhea and nausea usually develop very slowly after eating foods made from wheat such as bread. Unlike wheat allergy, there are no diagnostic tests for wheat intolerance or sensitivity.

If wheat allergy has been ruled out by the test, but you continue to notice symptoms after consuming wheat, you can try the elimination diet. This is when you completely eliminate wheat from your diet for four weeks and then gradually reintroduce it to see if symptoms recur.When reintroducing wheat, it might be a good idea to start with a very pure form of wheat, such as breakfast cereals, as opposed to bread, which has many different ingredients.

If symptoms return, this confirms your wheat sensitivity. You can also determine which foods are particularly bad for your gut by reintroducing them separately. Some people, for example, only have problems with pasta, while others cannot eat bread.

If you have a wheat intolerance or sensitivity, the best way to relieve symptoms is to adopt a wheat-free or partially wheat-free diet if you have identified some foods that are not causing the problem.

Diagnosis and treatment of wheat allergy

As with other allergies, wheat allergy symptoms should be recorded in a food and symptom diary. The next step includes a specific antibody test and a skin prick. If the symptoms are similar to those of celiac disease, in other words, if symptoms such as stomach cramps, diarrhea, or nausea occur after eating wheat, it is important to rule out celiac disease before proceeding.

To avoid misdiagnosis, you should not go on a wheat or gluten free diet until your condition has been diagnosed.

How to check for wheat allergy

Wheat allergy can be diagnosed with a skin injection or blood test.

In a skin prick, a small amount of a liquid containing wheat protein is injected into the back or forearm, which is injected with a small sterile probe to allow the liquid to penetrate the skin.If a raised, reddish spot forms within 15 to 20 minutes, it could indicate an allergy.

In a blood test, a blood sample is sent to a laboratory to be tested for the presence of immunoglobulin E antibodies to wheat protein.

Wheat allergy in adults and children

Wheat allergy is quite common in young children. About 0.3% of children under the age of five in Europe are allergic to wheat. About two-thirds of children outgrow wheat allergy by age 16, but adults can develop it as well, often as a result of cross-sensitivity to grass pollen.

How to cope with wheat allergy or intolerance

The main treatment for wheat allergy is dietary change. After an allergy specialist diagnoses a wheat allergy, you should eliminate wheat and related grains from your diet.

Keep in mind that wheat is hidden in many processed foods that you might not even know existed. For example, rye bread can also contain wheat. Gluten-free foods are not the same as wheat-free foods because they may contain gluten-free wheat starch, which is not suitable for people with wheat allergies.It is important to always read the label before purchasing a product.

In addition to large amounts of bread and baked goods, breakfast cereals, pasta, couscous, flour, spelled and semolina, wheat proteins are also often present in crackers, hydrolyzed vegetable protein (HVP) and other flavorings, soy sauce, processed meats, such like hot dogs, certain dairy products, modified food starch, gelatinized starch, and vegetable gum.

To ensure a balanced diet and become familiar with cooking and baking alternatives, it is recommended that you seek nutritional advice and advice on dealing with wheat allergies.

How long do wheat allergy symptoms last?

There are no rules as to how long an allergy will last. In most cases, when a young child develops a wheat allergy, it goes away at some stage.But this is not always the case. In general, the later a person develops a wheat allergy, the more likely it is to be a permanent illness.

90,000 Opiates / opioids (“narcotic analgesics”) to relieve a migraine attack

What is it

Opiates and opioids are substances obtained from plant extracts or artificially synthesized. They belong to the group of narcotic pain relievers.Opiates and short-acting opioids are used to relieve severe migraine attacks.
The drugs used by people with migraine may include opiates or opioids such as codeine, hydrocodone, meperidine, tramadol, oxycodone [1, 6].
It is important to understand the main thing: All short-acting narcotic analgesics can cause physical and psychological dependence . These drugs are only suitable for very rare, occasional use.If they are used regularly, drug dependence and tolerance develop: the body gets used to it and more and more doses are required for the onset of the effect [2].

Don’t be fooled! No one can resist the development of drug dependence on short-acting narcotic analgesics. Opiate- / opioid-containing pain relievers can only be taken with a doctor’s prescription, which clearly states the amount of the drug and the time it is taken! Attempting to increase the dose on your own will not lead to good results [3].

How they are used

Narcotic analgesics are used in doses recommended by a doctor, at a time when the headache increases from moderate to intense. A delay in taking the drug can lead to insufficient effect, when the headache only diminishes, but does not completely go away and will soon return, forcing another dose to be taken. And this already increases the risk of developing dependence and tolerance [5].

Side effects

All narcotic analgesics can cause nausea and itching.This is not an allergy, but a side effect. Also, all narcotic analgesics cause drowsiness. They cannot be combined with alcohol and other sedative medications. Taking narcotic analgesics, you need to drive a car with care, work with mechanisms, at height, be especially careful in case of other potential danger [6].

In addition, overuse of narcotic analgesics leads to aggravation of the migraine course . Attacks become more frequent, up to daily.To avoid the development of drug dependence, tolerance and chronic headache, it is necessary to strictly limit the use of narcotic analgesics to ten doses per month . In addition, there is more and more evidence that taking even small doses of narcotic analgesics reduces the effectiveness of other drugs for relieving a migraine attack, which can subsequently make it difficult to interrupt migraine attacks [4].

Thus, narcotic analgesics are a class of drugs that may be suitable for the treatment of migraine headaches, but only with rare, occasional use.Long-term, chronic abuse of these drugs leads to the development of drug dependence, tolerance and chronic headache [6].

Literature:

1. Ekusheva E.V., Filatova E.G., Golubev V.L. “Zaldiar in the treatment of migraine attacks.” // RMJ. – 2011.
2. Bigal M.E., Lipton R.B. “Excessive opioid use and the development of chronic migraine.” // Pain. -2009. – v.142. – p. 179-182
3. Biondi D.M. “Opioid resistance in chronic daily headache: a synthesis of ideas from the bench and bedside.” // Curr Pain Headache Rep. – 2003. – v.7. – p.67-75.
4. Ho T.W., Rodgers A ,, Bigal M.E. “Impact of recent prior opioid use on rizatriptan efficacy. A post hoc pooled analysis “. // Headache. – 2009. – v.49. – p. 395-403
5. Piekos K., Spierings E.L. “Management of daily headache unresponsive to preventive treatment: daily triptans versus daily opioids.” // Rev Neurol Dis. – 2009. – v.6. – E121-30.
6. Rothrock J.F. “Opiate and opioid (” narcotic “) therapy for acute migraine headache.” // Headache. – 2008. – v.48. – p. 1283

Migraine – treatment, symptoms, causes, diagnosis

Migraine is a disorder characterized by intense headache preceded or accompanied by sensory disturbances such as flashes of light in the eyes, blind spots, tingling sensations in the hands and feet, nausea, sometimes vomiting, and increased sensitivity to light and sound. The excruciating migraine headache can last from a few hours to several days.

Migraine facts

Here are some key points specific to migraines:

• Migraine headaches are caused by dilatation of blood vessels and the release of chemicals from the nerve fibers that surround those blood vessels.
• Migraine headaches can lead to feelings of nausea, diarrhea and vomiting.
• Approximately 12% of Americans have migraine-related headaches.
• Migraine usually affects people between the ages of 15 and 55.
• Some people with migraines can clearly identify the triggers or factors that cause headaches, such as allergies, light and stress.
• Some people experience migraine attacks with a subjective disorder called an aura.
• The aura may act as a prodrome that precedes the onset of a migraine attack.
• Lifestyle changes may help reduce the frequency of migraine attacks.
• Conventional analgesics may relieve or reduce pain.

Characteristics of migraine

Migraine headaches are caused by a combination of dilated blood vessels and the release of chemicals from the nerve fibers that surround those blood vessels.

During a headache attack, an artery that is located on the outside of the skull under the skin in the temple area (temporal artery) expands. This triggers the release of chemicals that cause inflammation, pain, and further expansion of the artery.

Migraine through the stimulation of the sympathetic nervous system leads to a feeling of nausea, diarrhea and vomiting. This stimulation also delays the emptying of stomach contents into the small intestine (affects the absorption of food), decreases blood circulation (which leads to cold hands and feet), and increases sensitivity to light and sound.

According to research, approximately 12% of Americans suffer from migraines. Women suffer from migraines more often than men.

This is a vascular headache that usually develops in people between the ages of 15 and 55.About three quarters of all migraine sufferers have a family history of migraine.

Reasons

Some people who have migraines can clearly identify the triggers or factors that cause headaches, but many patients cannot. Potential migraine triggers include:

• Allergies and allergic reactions
• Bright lights, loud noise, some odors or perfumes
• Physical or emotional stress
• Changes in sleep patterns or irregular sleep
• Smoking or exposure to smoke
• Skipping meals or fasting
• Alcohol
• Menstrual fluctuations, birth control pills, hormone fluctuations during the onset of menopause
• Foods containing tyramine (red wine, mature cheese, smoked fish, chicken liver, figs, and some beans), monosodium glutamate or foods with nitrates (such as bacon, sausages and salami)
• Other foods such as chocolate, nuts, peanut butter, avocados, bananas, citrus fruits, onions, dairy products, and fermented or pickled foods.

Triggers do not always cause migraines, and avoiding triggers may not always prevent migraine attacks.

Symptoms

Symptoms of migraine may appear before the onset of the headache, immediately before the headache, during the headache, and after the headache. While not all types of migraines are the same, typical symptoms include:

• Moderate to severe pain, usually on one side of the head
• Headache, throbbing
• Increased pain intensity during physical activity
• Disability due to pain to perform normal activities
• Nausea
• Vomiting
• Increased sensitivity to light and sound.

Migraine with aura – Many people experience migraine attacks with an aura that develops just before or during a headache, but not everyone has an aura.

The aura is manifested by disturbances of perception such as:

• Unpleasant thoughts or experiences
• Sensation of perceiving strange lights, sparkling or flashing
• Stripes in the field of view
• Blind spots
• Tingling sensation with needles in hands or feet
• Stiffness in the shoulders, neck or limbs
• Sensation of unpleasant odors.

When a migraine with aura affects vision, the patient may see things that do not exist, for example, the transparent structure of objects, not see parts of the object in front of him, or even feel as if part of their visual fields appears, disappears and then comes back again.

When patients describe visual impairments, the most common description of visual impairment is similar to the sensations that arise after photographing with a device with a very bright flash, which was done in a dark room

For many migraine sufferers, the aura acts as a warning, signaling that a headache is coming soon.

In adults, the aura usually develops before the headache, but in children, the aura can be present before and during the headache at the same time.

Patients with migraine may also have a premonition called a prodrome, which can occur for several hours or a whole day before the headache. These forebodings can include feelings of euphoria, rush of energy, sugar cravings, thirst, drowsiness, irritability, or depression.

Diagnostics

The diagnosis of migraine is based primarily on medical history and the presence of characteristic symptoms.The International Headache Society recommends Criteria 5, 4, 3, 2, 1 for the diagnosis of migraine without aura. These criteria are as follows:

• 5 or more headache attacks
• duration of an attack from 4 hours to 3 days
• The presence of at least 2 seizures with unilateral localization, of a pulsating nature, moderate to severe pain, aggravated by exertion and prevented in the absence of normal physical activity
• At least 1 additional symptom such as nausea, vomiting, sensitivity to light, sensitivity to sound.

Instrumental examination methods such as electroencephalography (EEG), computed tomography (CT), magnetic resonance imaging (MRI) and lumbar puncture are used to exclude conditions such as:

• Brain hemorrhage
• Subdural hematoma
• Stroke
• Dilated blood vessels in the brain
• Increase or decrease in cerebrospinal fluid
• Inflammation of the membranes of the brain and spinal cord
• Inflammation of the sinuses
• Postictal headache (after stroke or seizure)
• Brain tumors

Treatment and prevention

Several lifestyle changes can help reduce the frequency of migraines, and these include:

• Adequate Sleep
• Stress Reduction
• Drinking enough water
• Avoid certain foods
• Regular exercise.

Migraine treatment (abortive therapies) and prevention (prophylactic therapy) focus on avoiding triggers and controlling symptoms.

Medicines

OTC drugs such as naproxen, ibuprofen, acetaminophen (paracetamol) and other analgesics such as Excedrin (caffeinated aspirin) are often the first abortive therapies to relieve or reduce headaches.

Antiemetics can also be used to treat symptoms such as nausea and vomiting.

Serotonin agonists such as sumatriptan may also be prescribed for severe migraine attacks that do not respond to over-the-counter analgesics. In addition, some selective serotonin reuptake inhibitors (SSRIs) – antidepressants such as tricyclic antidepressants – are prescribed to reduce migraine symptoms, although they are not recommended for migraine in all countries.

Another class of abortive drugs is called ergotamines, and they are usually effective when given immediately after the first signs of a migraine headache.

Other drugs are also used to treat migraines, such as a combination of barbiturates, paracetamol or aspirin and caffeine (Fioricet or Fiorinal) and a combination of acetaminophen, dichlororalphenazone, and isomeptene (Amidrine, Duadrin and Midrin). If vomiting interferes with the ability to swallow, then antiemetics are prescribed.

Preventive treatments

Prevention of migraine begins with avoiding the triggers that lead to the development of a migraine attack.The main goals of preventive therapies are to reduce the frequency, pain and duration of migraine attacks and to increase the effectiveness of abortive therapies.

There are several categories of preventive migraine therapy, ranging from diet and exercise changes to certain medications. Some of them include:

• Prescription of beta-blockers, anticonvulsants and antidepressants
• Prescription of botulinum toxin (Botox)
• Prescribing herbs and vitamins such as butterbur, cannabis, coenzyme Q10, pyrethrum, magnesium citrate, riboflavin, B12, melatonin
• Surgical treatment in which the muscle that wrinkles the eyebrow and nerve is dissected zygomaticotemporal
• Stimulator implantation in the spinal cord
• Hyperbaric oxygenation
• Vision correction
• Exercise therapy, sleep normalization
• Visualization and self-hypnosis
• Manual therapy and acupuncture
• Special diets such as a gluten-free diet.

But it must be borne in mind that patients taking too many drugs may experience abusal headaches.

90,000 What is allergy?

For hundreds of years, the human body’s immune system has worked harmoniously, protecting us from “enemies” – infectious, parasitic diseases. But, at the beginning of the twentieth century, civilization has stepped far forward, technological progress has led to the fact that we now breathe air filled with automobile and industrial emissions, we build our houses from synthetic materials, we surround ourselves with the same furniture, dishes, household appliances, detergents , medicines.Even the products on our table are often of dubious quality – grown using chemicals, or processed with them in order to increase the shelf life. Our immunity cannot cope with new foreign substances that have appeared and accepts, recognizes harmless substances as potentially dangerous. An allergy appears – this is an acute reaction of the body’s immune system to usually harmless substances.

Today, such a phenomenon as allergies occurs quite often. Young children are especially susceptible to allergic reactions, it is often found even in infants.Many mothers observe scaly spots, small blistering rash, crusts on the skin and reddened cheeks in their babies, the so-called “diathesis” among the people. The substances that cause allergies are called allergens. The most common allergens are pollen of plants (flowers, trees, cereals, weeds), poplar fluff, seeds, house and book dust, dust mites, animal hair, bird feathers, insect bites, fungal spores, medicines; chemical cleaning agents; products – dairy, eggs, wheat, citrus fruits, seafood and many others.Depending on the cause of the allergy and its main symptoms, several forms of the disease are distinguished: food allergy, drug disease, bronchial asthma, hay fever, atopic dermatitis. An allergic reaction can occur in different parts of the body, and symptoms can last from a few minutes to several days. For example: allergic rhinitis, cough, reddened, watery eyes; hay fever, asthma; atopic dermatitis, eczema, urticaria; joint pain and inflammation; diarrhea, vomiting, indigestion.In early childhood, an allergic disease begins more often with increased sensitivity to food allergens, when eating formula milk, cow’s milk, semolina, citrus fruits, chicken eggs. The child grows up and as he grows up, food allergies appear to foods with dyes and preservatives (ice cream, cakes, cakes, marmalade, jam, carbonated drinks), to nuts, chocolate, exotic fruits, and then to household, chemical, pollen allergens, and medicines.

If the allergen is not detected in a timely manner, the treatment is absent or self-medication, the uncontrolled use of drugs, the child may experience dangerous complications – anaphylactic shock (severe allergic reaction), collapse (acute vascular insufficiency), shortness of breath or wheezing, confusion, rapid pulse, cold sweat, clammy skin, stomach cramps, dizziness, nausea, cramps.In such cases, immediately contact your doctor (pediatrician, allergist) or call an ambulance.

It is impossible to “completely” recover from allergies, because this is a special type of immune system reaction that you inherit. In some cases, adults experience childhood allergies. But if the allergy manifests itself already in adulthood, it is very difficult to get rid of it. Allergic rhinitis (called rhinitis by experts) or hay fever affects 1 in 10 people and is often hereditary.People with other allergic conditions, such as bronchial asthma or eczema, also often suffer from allergic rhinitis. Such allergies are more common in women than in men. With an allergic rhinitis, the following symptoms may appear: itching in the eyes, throat, nose and palate, sneezing, as well as stuffy nose, watery eyes, mucous discharge from the nose, conjunctivitis (redness and pain in the eyes). In severe cases, an allergic rhinitis can cause an asthma attack (in people with asthma) and / or eczema.

How can I help my child with allergies? First of all, consult with your doctor and strictly follow his recommendations, and also try to avoid food, drugs and other substances – potential allergens to which your baby has ever had an allergic reaction. Your relatives and close people should know about an allergic disease. Always inform all doctors (including dentists, beauticians, etc.) about any child’s allergic reactions, especially to medications.This applies to both prescription drugs and over-the-counter drugs. Before taking any medicine, carefully read the packaging and instructions. For mild allergic rhinitis, use decongestant drops and sprays to relieve symptoms. If allergy is caused by a drug, stop using it immediately and consult your doctor. Take antihistamines (allergy medications) as prescribed by your doctor. If you are allergic yourself, remember to avoid driving and operating machinery when taking sedative antihistamines, as they can cause drowsiness.For allergic skin reactions, use an antipruritic cream or lotion to relieve the irritation.

Preventive measures for allergies – these should be started even before the baby is born. To prevent the appearance of allergies in a baby, it is necessary to pay attention to the health and nutrition of a woman during pregnancy and during breastfeeding, to the living conditions and environment of the child, heredity. At this time, it is possible to revise your lifestyle, nutrition (exclude potentially dangerous products), eliminate contacts with occupational hazards, for the sake of the child’s health, get rid of bad habits or addictions.It is important to strengthen the immune system, try not to get sick with colds, and take medications only on the recommendation of a doctor, not self-medicate. Children born to an allergic or smoking mother are at risk of developing allergies. Also, early refusal of breastfeeding or its complete absence can provoke an allergic reaction to artificial mixtures, because the baby does not receive the protective substances he needs from the mother’s milk.If it is not possible to feed the baby with breast milk, you should carefully choose and use only hypoallergenic mixtures, introduce complementary foods with caution. Your doctor can help you formulate a special diet for children with food allergies.

Try to identify substances that cause allergies in your baby and always avoid them. Keep your home clean and free of dust, lint, and feathers. When you are sweeping or vacuuming, knocking out dust from furniture, changing bedding and any other contact with dusty objects, cover your nose (use a gauze bandage or mask), and most importantly, perform these actions in the absence of your baby.Children’s bedding and clothes should be made of natural, non-allergenic materials, replace the feather pillow and duvet with synthetic winterizer, and use special baby powders for washing children’s clothes. Free your child’s room from carpets, curtains, pillows, stuffed animals, bookshelves that can accumulate dust. Timely carry out antifungal treatment of the apartment, especially the kitchen, toilet and bathroom.

Before you have a pet, check if your child is allergic to pets, otherwise it is better to forget about “our smaller brothers”.Try to get rid of bad habits – never smoke in the room where the child is, do not use aerosol cosmetics and household chemicals. Limit walks in the park or forest when trees and grasses are in bloom. During this period, it is better not to ventilate living rooms, but to carry out daily wet cleaning without ventilation.

If you or your child are allergic to medications, you should definitely have a special card with you, which says which medications you are allergic to.In this case, you will be insured against the introduction of an allergen, even if you cannot remember the name of the drug. The baby should be vaccinated only during the period when the baby is healthy and the immune system is ready for it. Do not forget that your home medicine cabinet must contain drugs for allergies, and your family members, close people, friends should know about the child’s illness and emergency first aid measures in the development of severe acute conditions – an attack of bronchial asthma or anaphylactic shock.

Lead a healthy lifestyle, watch your diet, temper your child, try to get rid of bad habits – this is the best prevention.

Healthcare Institution “15th City Children’s Polyclinic”

otolaryngologist Lisovskaya D.