Tips for surviving a severe allergy season

Spring has sprung and so has allergy season. In many areas of the United States, spring allergies begin in February and last until the early summer. Tree pollination begins earliest in the year followed by grass pollination later in the spring and summer and ragweed in the late summer and fall. Mild winter temperatures can cause plants to pollinate early. A rainy spring can also promote rapid plant growth and lead to an increase in mold, causing symptoms to last well into the fall.

“It’s already started,” says Dr. Keyvan Ravakhah, internal medicine specialist and department of medicine chairman at St. Vincent Charity Medical Center. “All we need is a nice sunny, warm, breezy day and the pollen counts are going to jump up.”

Trees are starting to pollinate and will continue to do so into June. Grasses typically begin pollinating in May, he said, adding that May and June are when spring allergies are typically at their worst.

“People with spring allergies typically feel pretty badly in May because there’s an overlap of tree pollen, grass pollen and mold,” Ravakhah said.

According to the Asthma and Allergy Foundation of America (AAFA), allergies are increasing. They affect as many as 30 percent of adults and 40 percent of children – that’s more than 50 million people – in the United States.

The most common culprit for fall allergies is ragweed, a plant that grows wild almost everywhere, but especially in the Midwest. Ragweed pollen, which causes hay fever, usually hits peak levels in mid-September, but temperature changes and rain can lead to a prolonged season. An excessive amount of ragweed pollen causes prolonged runny noses, itchy throats, nasal congestion, sneezing, headaches and eye irritation for those with ragweed allergies.

Cleveland.com spoke with Dr. Keyvan Ravakhah, internal medicine specialist and department of medicine chairman at St. Vincent Charity Medical Center, about advice for surviving a particularly brutal allergy season.

“I’ve had many patients coming in thinking they have a cold or some sort of sinus infection, but in most cases they are suffering from allergies,” said Ravakhah. 

Here’s everything you need to know to survive another allergy season.

Determining the correct diagnosis: cold and allergies?

Ravakhah explains that both illnesses cause similar symptoms such as a runny nose, congestion, sore throat and sneezing, but there are differences. Colds are viral infections that cause fever, aches, pains and cough. Allergies, or allergic rhinitis, is a condition where the airways in the nose become irritated to certain particles in the air as you breath. As a result, the sinuses and airways become inflamed (red and swollen) and produce a lot of mucus. This leads to runny nose, congestion, watery eyes, itchy throat and sinus headaches. These symptoms overlap with the symptoms of a cold so it can be difficult to determine the cause of your suffering.

Sneezing, itchy eyes (both eyes) and rashes are associated with allergies. Viral infections of the upper airways (nose, back of the throat, sinuses) present symptoms similar to allergies. However, as mentioned above, allergies have a “trigger”, and do not present with features other than that affecting the nose, sinuses, eyes and throat. Also, allergies would not cause things like fevers, chills, joint pain, tummy pain or vomiting to occur. Allergies do not usually cause a cough (unless it is after lying down – which is called a post nasal drip). Allergies tend to respond to nasal sprays and antihistamines while an infection may not.

“If you have a fever, have aches and pains, swollen glands or have a cough with phlegm, you should see a doctor,” said Ravakhah.

An allergist can confirm a hay fever allergy with a skin test in which a small amount of the allergen is applied to the skin to see if it causes a rash or other reaction.

Know your triggers and avoid them.

There are a number of things that can trigger allergies. Well known types of pollen to cause allergic rhinitis are birch, maple, oak, sycamore, hickory and walnut. Ragweed and golden rod pollen dominate in the fall. Other common triggers include freshly cut grass, dust or animal fur and dander.

If you are allergic to pollen, try to avoid the outdoors when pollen activity is high. Use Google or a weather app on your mobile device to view daily pollen activity. If you live close to trees and grass, keep doors and windows closed during the day. When driving, keep the windows up. If possible, use an air conditioner to keep pollen out of your indoor environment. Be sure the air conditioner is set to recycle indoor air, and use a filter that traps allergens. If pollen counts are very high, wear a mask when outdoors.

“I wear a mask outdoors and shower at night to wash off pollen,” said Ravakhah. “I also try to avoid freshly cut grass and after mowing the lawn I remove my clothing that has been exposed to pollen in the garage before entering the house. “

Taking a shower after an outdoor exposure can remove the pollen that is stuck to your face and skin. Pets can be another trigger for allergy symptoms. In addition to the animal dander itself, animals can carry pollen on their fur so they may need to be washed or brushed before entering the home.

Pay attention to what makes your nose itch and to which activities and seasons bring about allergy symptoms. This will help determine the most effective way to get relief from symptoms.

Choosing the right treatment.

Allergy sufferers should take care of themselves by resting, staying hydrated and taking antihistamines or other over-the-counter allergy medication. Nasal sprays can also help, but take a few days to work. They work by reducing the inflammation and the mucus in the nose. Antihistamines are pills that also help with the inflammation and mucus. However, drowsiness is a common side effect so they aren’t for everyone. There are other decongestant pills which may work short-term. These help by stopping the blood vessels from becoming enlarged which also reduces inflammation.

In severe cases of ragweed allergy, an allergist can prescribe shots that help the body build up a resistance to the allergen, or medication that must be started several weeks before ragweed season starts.

“A lot of patients come in and ask for antibiotics, but antibiotics are used to treat infections caused by bacteria. They are not used to treat allergies or infections caused by viruses,” said Ravakhah. “Same goes for vitamins. Vitamins are good for a lot of things, unfortunately this is not one of them.”

Consider home and herbal remedies.

Try flushing your nose with water frequently or as needed with a Neti pot. A Neti pot is a small pot filled with warm water and salt, used to rinse nostrils. It flushes out allergens, or particles that cause allergy symptoms. Camphor rubs are another option. Camphor used to be made by distilling the bark and wood of the camphor tree. Today, camphor is chemically manufactured from turpentine oil. It is used in products such as Vicks VapoRub. Camphor products can be rubbed on the skin (topical application) or inhaled.

Some herbal remedies can interact with other medications and should be taken with caution. Further caution should be taken if pregnant or nursing. If you are interested in these medications, speak with your primary care physician.

Click here to read the article from Cleveland.com.

Can Allergies Cause Swollen Lymph Nodes? It’s Possible, but Not Super Common

Swollen lymph nodes are usually a telltale sign that your body is fighting off an infection, whether it’s from bacteria or a virus. This can stem from strep throat, an ear infection, mononucleosis, or even an infected tooth.

You might experience swollen lymph nodes—small, bean-shaped glands throughout your entire body—on your neck, in your armpits, under your chin, or around your groin, according to the Mayo Clinic.

But is it possible that your swollen lymph nodes are caused by something else, like allergies? If you’re a seasonal allergy sufferer, you may be wondering if allergens like pollen and grass could be behind your sudden swelling, especially in your throat area. Here’s what you need to know.

What are lymph nodes, again?

Lymph nodes are part of your lymphatic system, a network that routes lymph fluid throughout your body, according to the American Cancer Society (ACS). Your lymph system is a crucial part of your immune system.

The job of your lymph system is to collect fluid, waste material, viruses, and bacteria that are in your tissues and send them to your lymph nodes. These nodes are small structures that work as filters for harmful substances, the ACS explains. They help fight infection by attacking and destroying germs (thanks to unique white blood cells called lymphocytes) that are carried to them by lymph fluid.

You have hundreds of lymph nodes located all around your body—some are deep in your body, like between your lungs or around your bowel, and others are closer to your skin.

After lymph fluid flows around your body, it dumps filtered fluid, salts, and proteins back into your bloodstream.

Photo credit: Doucefleur – Getty Images

Why do lymph nodes swell?

When a lymph node is trying to filter out pathogens, it can swell or enlarge while it goes to work, the ACS explains. Usually, only one area of lymph nodes swells at once, and the most common areas for lymph nodes to swell are in the neck, groin, and armpits. There’s actually a medical term for this: lymphadenopathy.

Story continues

Swollen lymph nodes are a signal that something is off, but it’s usually paired with other symptoms that will help you and your doctor figure out what, exactly, is going on in your body.

Can allergies cause swollen lymph nodes?

Possibly. “Anything that activates the immune system can cause swollen lymph nodes,” says Purvi Parikh, M.D., an allergist and immunologist with the Allergy & Asthma Network.

Susan Besser, M.D., a primary care physician at Baltimore’s Mercy Medical Center, agrees. “An upper respiratory infection, a cold, allergies—all can cause lymph nodes to swell as the body responds to the immunologic ‘crisis,’” she explains. These are most often felt on either side of the neck, under the jaw around the throat, or behind the ears.

Children are more likely to experience swollen lymph nodes due to allergies, but “it can happen” in adult allergy sufferers, notes Catherine Monteleone, M.D., an allergist and immunologist at Rutgers Robert Wood Johnson University Hospital.

That said, it’s not a typical symptom and it is unlikely that seasonal allergies would cause someone to have swollen lymph nodes, Dr. Parikh says. The only time that would happen is if your allergies are “very severe,” she notes.

It is more common, though, to develop swollen lymph nodes as part of a secondary infection from your allergies, like a sinus infection, says Omid Mehdizadeh, M. D., an otolaryngologist and laryngologist at Providence Saint John’s Health Center in Santa Monica, Calif.

How to treat swollen lymph nodes from allergies

Swollen lymph nodes are a sign that something is off in your body. To reduce the swelling, you need to treat the underlying cause, Dr. Parikh says. Here are a few things you can do:

• Take an allergy medication. If you suspect that severe allergies are behind your swollen lymph nodes, taking a fast-acting allergy medication like an antihistamine may help. “If the allergy symptoms are controlled, the lymph node swelling should go down,” Dr. Besser says.

• Apply a warm compress to the area. It’s unlikely to make the swelling go down, but it may help you feel a little better, Dr. Besser says.

• Gargle with warm salt water. Dr. Monteleone recommends this soothing home remedy if you have swollen lymph nodes in your throat.

❗When to call your doctor if you have swollen lymph nodes

If your swollen lymph nodes come and go and don’t get “significantly large,” then you’re probably OK to wait and see if allergy medication helps, Dr. Besser says.

But, if the swelling persists for several days, doesn’t seem to be getting better, and is even getting worse, it’s a good idea to talk to your doctor. Ditto if you develop a fever (note: allergies do not cause a fever) or if you are seriously uncomfortable around your lymph nodes. “That could be a sign of infection,” Dr. Mehdizadeh says.

Go here to join Prevention Premium (our best value, all-access plan), subscribe to the magazine, or get digital-only access.

FOLLOW PREVENTION ON INSTAGRAM

You Might Also Like

Hayfever (seasonal rhinitis) | HealthEngine Blog

What is hayfever or seasonal rhinitis?

Allergic rhinitis is an allergic disease which affects many people worldwide. Rhinitis means ‘inflammation of the nose’, whilst the term allergic describes ‘a normal but exaggerated response to a substance’. It may be perennial, which means symptoms are present throughout the year, or seasonal, with symptoms peaking during the months of spring and summer when pollen levels are at their highest.

Seasonal rhinitis, also known as hayfever, is characterised by irritation and congestion or watering of the nose, itchy eyes, ears and throat, and sneezing. It occurs due to an exaggerated response to an environmental trigger which results in inflammation of the lining of the nose (see picture below).In the case of seasonal rhinitis, pollen is the most common trigger, hence symptoms are usually experienced during the spring and summer months when the pollen season is at its peak.

Statistics of hayfever

The prevalence of seasonal rhinitis varies worldwide. Many people do not seek treatment hence the exact figures for allergic rhinitis are often under-reported, however it is universally acknowledged that it is an extremely common condition. The 2004-05 National Health Survey stated that 3.2 million Australians (approximately 16.1% of the population) self-reported experiencing symptoms of hay-fever and allergic rhinitis. The prevalence was found to be highest amongst those aged 25-34 and was slightly higher among females (1.7 million) than males (1.5 million).

Number of people with allergic rhinitis (by age)

Percentage of the population with allergic rhinitis (by state)

State	NSW	Vic	Qld	SA	WA	Tas	ACT	Aust
% Population	13. 8	18.2	14.1	20.9	18.8	14.7	21.6	16.1

Risk factors for hayfever

Atopy describes a syndrome of over-active immune responses, in which individuals are more likely to develop allergy-related diseases including allergic rhinitis, asthma, and eczema. These individuals have higher levels of IgE antibody in their blood which is responsible for the inflammatory response seen in allergies. Predisposing factors to atopy include:

• Genetics: Atopy is inherited as an autosomal dominant condition.
• Maternal and neonatal factors: Such as smoking in pregnancy and early childhood, low birth weight, birth during the pollen season (though this is still being debated), early introduction of formula and food.

There is much research underway into other factors which may predispose to atopy in childhood, including early exposure to allergens in the environment, and maternal and early childhood diet. Exposure to allergens is the second component of allergic rhinitis. Seasonal rhinitis (hay fever) is caused by grass pollens, tree pollens, and mould spores.

Progression of hayfever

Some people are predisposed to have an exaggerated response to a substance that is usually tolerated by the body. When these substances promote an allergic reaction they are known as allergens. In susceptible individuals, allergens initiate an immune response which is controlled by immune cells in the body (such as mast cells). The allergen binds to a protein called IgE on the surface of mast cells, causing them to release potent inflammatory agents such as histamine.

In the case of allergic rhinitis, the early response to allergens results in a runny nose, itching, and sneezing. The late response is similar, however the nose is usually more congested. Seasonal allergic rhinitis sufferers experience this at certain times of the year, when the allergens causing their disease (usually pollens) are at their highest concentrations. Symptoms often become worse as the pollen season progresses as more immune cells gather in the lining of the nose.

Nasal polyps occur in some people with seasonal rhinitis; they are smooth, round, soft structures attached to the lining of the nose. They can cause obstruction of the nose, and loss of smell. Occasionally they need to be surgically removed due to extreme discomfort. Over time, people with seasonal rhinitis may experience a reduced sense of smell, headaches, and recurrent infections. Other potential complications include infections of the middle ear and sinuses.

Symptoms of hayfever

When diagnosing seasonal allergic rhinitis the doctor asks a number of questions relating to the onset, duration and character of the symptoms. This can help identify substances that trigger the allergic response and confirm a diagnosis of rhinitis. The presence of risk factors, including a history of asthma or other allergic diseases would also support this diagnosis. The onset of symptoms of seasonal rhinitis usually corresponds with the pollen season.

Symptoms:

• Nose: sneezing, nasal congestion, watery or runny nose, reduced sense of smell, itchy nose.
• Throat: dry, sore, itchy throat.
• Eyes: irritated, itchy, watery eyes, conjunctivitis.

Clinical examination of hayfever

Initial observation may reveal a dull, nasal voice resulting from blockage of the nose. The eyes may be red and watery, and dark circles may be evident below the eyes due to congestion of the nasal veins. A horizontal crease may be noticeable on the outside of the nose, particularly in children, as a result of frequent wiping. The nose is examined using a nasal speculum or an otoscope with an attachment for the nose. This allows the inside of the nose to be viewed directly.

In people with allergic rhinitis the lining of the nose is usually pale and swollen, however there may be areas of redness, which may be due to infection or ‘rhinitis medicamentosa‘ (inflammation of the nose caused by intrasnasal medications). Secretions are usually thin, watery and colourless. Thicker mucous which is yellow or green may indicate an infection. The nasal septum which separates the two sides of the nose should also be examined to look for any deviation or perforation.

The doctor will also look for evidence of any masses, such as nasal polyps, which may restrict the flow of air through the nose and cause breathing difficulties. The ears and throat should be examined to look for signs of inflammation or infection such as redness or pus. The GP may press gently on your forehead and cheeks. If this is painful there may be an infection of the underlying sinuses.

Examination of the neck should also be performed to feel for enlarged lymph nodes which may indicate an infection or tumour. It is also important to listen to the lungs as there is a strong relationship between allergic rhinitis and asthma.

How is hayfever diagnosed?

Skin prick tests are used to confirm if a patient is allergic to a substance. Small quantities of various allergens are injected under the skin of the forearm to see if they evoke an allergic response. A positive test will show a ‘wheal and flare’ response which includes redness, swelling and itching.

Radio Allergo Sorbent Testing (RAST testing) is similar to a skin prick test, however it is more expensive so it is only used if the skin prick test is not suitable (eg. where there is a high risk of anaphylaxis) or unavailable. Various allergens are exposed to a blood sample taken from a patient and the levels of IgE produced are measured.

Prognosis of hayfever

Seasonal allergic rhinitis is a benign condition and can be well-managed with appropriate treatment. Nevertheless, it can be a frustrating disease to live with. Atopic patients are also more likely to develop a serious allergy to other substances (eg. peanuts and other food allergies) and thus may be at risk of anaphylactic reactions which are associated with significant mortality.

There is also a strong relationship between allergic rhinitis and asthma; patients with allergic rhinitis are three times more likely to develop asthma and effective treatment of allergic rhinitis has beneficial effects on asthma.

Treatment of hayfever

The management of seasonal rhinitis involves the avoidance of triggers such as pollen, in conjunction with pharmacological treatments.

Allergen avoidance

Total avoidance is impossible in the case of pollen allergens. Exposure may be minimised, however, by closing the bedroom window at night, wearing sunglasses, and avoiding walks in the countryside, especially during the afternoon throughout the pollen season.

Corticosteroids

eg. Budesonide (Rhinocort), Mometasone furoate (Nasonex)

Corticosteroids in the form of a nasal spray are the first-line treatment for hayfever. Steroids reduce the inflammatory response caused by the allergic reaction, thereby helping to reduce the nasal symptoms such as itching and either congestion or watering of the nose.

Intranasal corticosteroids are cheaper than antihistamines and provide better relief of nasal symptoms, however the two can be used together for optimal symptom control. The side effects of this treatment are minimal as the dose is small and acts locally on the lining of the nose.

Oral corticosteroids such as prednisolone may be required if the nasal spray does not help and these are associated with significant side effects with long-term use.

Antihistamines

eg. Cetirizine hydrochloride (Zyrtec), Fexofenadine hydrochloride (Telfast)

These drugs work by blocking the effects of histamine which is one of the main substances driving allergic reactions. Histamine is responsible for the itchy eyes, nose and throat, sneezing and runny nose experienced in seasonal rhinitis. Antihistamines block this effect, relieving the symptoms.

Older anti-histamines may cause unwanted effects such as drowsiness, fatigue and decreased concentration, and may also cause constipation, impotence and difficulty urinating. Newer antihistamines have less side-effects are provide effective relief of hayfever symptoms, particularly when used with intranasal corticosteroids.

Decongestants

eg. Phenylephrine hydrochloride (Sudafed)

Decongestants may be taken orally or as a nasal spray to reduce the secretions and swelling of the lining of the nose by constricting the blood vessels in the nose. Decongestants can cause ‘rhinitis medicamentosa’ (worsening of symptoms when the medication is stopped) hence they should only be used for a limited period of time to open the nasal passages to allow the administration of other therapy, such as corticosteroids.

Oral decongestants are not suitable for everyone, such as those with high blood pressure or heart disease, and they may cause side-effects such as anxiety, restlessness and insomnia.

Anti-inflammatories

eg. Sodium cromoglycate (Rynacrom)

These drugs also block the inflammatory pathways that cause the symptoms of hayfever, however they have not been found to be more effective than corticosteroids or antihistamines.

Eye drops

eg. Ketotifen fumarate (Zaditen), Hydrocortisone acetate (Hycor)

Eye drops containing anti-histamine or steroids may be used to control symptoms such as itchy or watery eyes.

Allergen desensitisation

This involves exposing the patient to small doses of allergens in an attempt to desensitize them and prevent an allergic response. This procedure must be performed by qualified practitioners with immediate access to resuscitation equipment as it may be associated with severe reactions including anaphylaxis. Most of the drugs used in the treatment of seasonal rhinitis are available over the counter from the pharmacy, however some may require a prescription from your GP.

Kindly reviewed by Associate Professor Frank Thien MD FRACP FCCP; Consultant Respiratory and Allergy Physician; Department of Medicine; Alfred and Box Hill Hospitals; Monash University Central and Eastern Clinical School; Editorial Advisory Board Member of the Virtual Allergy Centre and Virtual Respiratory Centre.

Spring allergies

	For more information on spring allergies, including why people get allergies, how allergies affect you and how to prevent them, as well as some useful animations and videos, see Spring Allergies.
	For more information on identifying Allergic Rhinitis sufferers and the current guidelines for classification and management of allergic rhinitis, please see Why is hayfever (Allergic Rhinitis) such a problem in Australia?

References

1. Australian Bureau of Statistics. National Health Survey 2004-05: Summary of Results. Australia; 2006
2. Kumar P, Clark M. Clinical Medicine. Sixth Ed. Elsevier Saunders, 2005. pp220, 895-8.
3. Cookson WOCM, Hopkins JM. Dominant inheritance of atopic immunoglobulin I responsiveness. Lancet 1988; 1: 86-8.
4. Bellussi L, et al. Natural history of allergic rhinitis: a review. Clinical and Applied Immunology Reviews 2001: 207-16.
5. Pawankar R. Allergic rhinitis and asthma: the link, the new ARIA classification and global approaches to treatment. Current Opinion in Allergy and Clinical Immunology 2004; 4(1): 1-4.
6. Basger B, et al. Optimising the management of allergic rhinitis: an Australian perspective. MJA 2005; 182 (1): 28-33.
7. Puy R. Diagnosing and treating allergic rhinitis. Medicine Today 2003; 4(10): 14-21.

Swollen Glands: Causes, Symptoms and Treatment

Do you have a sore throat, headache, and fatigue? It is possible that you could have swollen lymph nodes, also called “swollen glands.” Typically, if your glands are swollen, it is an indication that your body is fighting an infection or some other type of illness.

Purpose of Lymph Nodes

Helping your body battle infections and other diseases, lymph nodes are bean-shaped, small masses of tissue components of a large lymphatic system. When lymphatic fluid moves through your body, lymphocytes (immune cells) within the lymph glands trap viruses, bacteria and other possibly harmful substances and destroy them. This helps keep these pathogens from spreading any further.

Locations

No doubt, you are already aware of the lymph nodes found in your neck. However, you actually have hundreds of lymph nodes located throughout your entire body. Your tonsils are also classified as lymph tissues. Sometimes, they can become swollen and inflamed to fight illnesses like tonsillitis. This condition is most common in children, but adults can also contract it. Other areas of the body where you might feel swollen lymph nodes include:

• Behind your ears
• Under your jaw
• The lower part of the back of your head
• Your armpits
• Your groin area

Symptoms and Signs

Under normal circumstances, you should not be able to feel your glands. Normally, they are approximately one half inch in diameter. However, when you or your child fights off an illness, these glands may swell to double or triple their regular size. At this point, they can be felt very easily. Additional signs and symptoms of swollen glands include:

• Pain or tenderness when pressure is applied
• Sore throat, fever and or sores in the mouth
• Warm, red and swollen skin over the gland
• Glands that feel “lumpy”

Causes and Concerns

Soft, tender and moveable swollen glands are typically signs of an inflammation or infection. Lymph nodes that are painless, feel hard to the touch, and resist movement need further examination by a head and neck specialist, as they could be warning signs of more serious conditions. The most common causes of swollen glands include:

• Bacterial infections including strep throat
• Infected teeth or mouth sores
• Viral infections including mononucleosis, also known as “mono”
• Skin infections
• Ear infections
• Sexually transmitted diseases, also known as STDs
• Cancers like Hodgkin’s disease, non-Hodgkin’s lymphoma, leukemia and breast cancer
• Immunodeficiency conditions such as rheumatoid arthritis (RA), lupus and HIV infections
• Possible side effects from vaccines or other types of medications

Solutions and Options

After the illness has been treated and you feel better overall, your lymph nodes should shrink back to normal. Treatment of your swollen glands tends to be cause-dependent. The following home remedies can prove to be helpful in reducing the pain and discomfort you are experiencing:

• Non-prescription pain relievers: Tylenol (acetaminophen), and anti-inflammatory medications like Advil (ibuprofen), reduce the swelling and inflammation. However, do not ever administer aspirin to a child, as there is a significant risk for Reye’s syndrome.
• Warm, wet compresses: Apply to the affected areas for soothing effect.
• Rest: Make sure to get lots of rest, as this helps your body recover from illness.

When to see a Doctor

There are some symptoms and indications that your swollen glands require treatment from a healthcare professional. 

Additional treatment may be required if swollen glands are accompanied by:

• A high fever (more than 104 degrees F)
• Breathing difficulties
• Problems swallowing
• Night sweats
• Unexplained loss of weight
• Reddened skin over top of the swollen lymph nodes
• Large swollen nodes that are very tender, hard to the touch and do not reduce in size

Summary

The majority of cases of swollen glands are no cause for great concern. They usually go away with basic treatment at home. However, the more serious symptoms mentioned above should never be ignored. If you are experiencing persistent or problematic swollen glands, contact our office for an appointment. One of our competent head and neck specialists can offer you a solution and treatment.

Additional Reading:

http://www.emedicinehealth.com/swollen_lymph_glands/page8_em.htm

http://www.webmd.com/pain-management/swollen-glands

Hayfever: self-care – MyDr.com.au

General Information

Hayfever (allergic rhinitis) can be seasonal, such as during spring, or happen all year round (perennial). It is important to prevent and treat hayfever because it can affect your sleep, work or learning.

Hayfever is mostly associated with triggers or allergens, such as pollens, grasses, pet hair and dust mites. Seasonal hayfever can appear when there are higher pollen levels, such as in the morning or evening, or in hot and humid weather. Hayfever can also be occupation based, from using certain chemicals at work that trigger symptoms.

If you or family members suffer from allergies, asthma or eczema you may be more prone to hayfever. Adolescents are more likely to have hayfever but it tends to improve with age.

Symptoms can be like those of a cold and they include an itchy nose, roof of the mouth or eyes, sneezing, a blocked or runny nose, a sore or tickly throat and red, watery eyes. Talk to your pharmacist or doctor if you are not sure.

Symptoms can also become worse even though allergen levels are the same; this is why most people will complain of worsening symptoms throughout hayfever season.

See Your Pharmacist or Medical Professional

• if you have shortness of breath, coughing or wheezing, this could be asthma
• if you have swollen glands, a fever and/or a persistent headache, you may have an infection
• if you have yellow discharge coming from your eyes or nose, or a bloody nose
• if only one side of your nose or one eye is affected
• if you have persistent nasal obstruction
• if your ears or sinuses (around your cheekbones) are painful
• if you are pregnant or breastfeeding; some hayfever medicines may not be suitable
• if you have other medical conditions, such as asthma, or take other medicines
• if you have allergies to any medicines
• if hayfever medicines do not seem to work after five days

Treatment Tips

• continuous exposure to triggers can make hayfever worse
• identifying triggers and avoiding them is important in treating hayfever
• try to stay indoors when pollen counts are high and avoid grassy areas; wearing wrap-around sunglasses can help keep pollen out of your eyes
• keep windows closed and re-circulate air in the car
• reduce exposure to dust and pet hair by removing or shampooing carpets, removing soft toys from bedrooms, washing bed linen in hot water and limiting contact with pets
• have a shower after pollen exposure
• start treatment early and take it regularly, especially if you know you will be exposed to triggers
• if you have eye and nasal symptoms, controlling nasal symptoms often improves the eye symptoms
• sodium chloride nasal irrigation (e. g. Flo or Fess) may help clear nasal passages by washing out allergens and sticky mucus, and reducing congestion and irritation.

Treatment Options

• there are two main types of medicines to treat hayfever:
  • medicines that treat or prevent an allergic reaction, such as corticosteroid nasal sprays and antihistamines
  • medicines that relieve the symptoms rather than treat the allergic reaction, such as decongestants
• it is better to treat or prevent the allergic reaction, so the treatment choice depends on what your main symptoms are, when they happen and how severe they are
• some medicines need to be taken before you have symptoms and need to be used regularly to be effective
• there are also many tablet and syrup products available that combine an antihistamine with a decongestant, and sometimes a pain reliever as well
• these options are not included here, but your pharmacist can tell you if one may be suitable

Nasal corticosteroid sprays

[PHARMACY ONLY]
e. g. beclometasone (Beconase Allergy & Hayfever 12 hour), budesonide (Rhinocort Hayfever), fluticasone (Flixonase Allergy & Hayfever 24 hour), mometasone (Nasonex Allergy Aqueous Nasal Spray, Azonaire Hayfever and Allergy Prevention & Relief Nasal Spray, Sensease Nasal Allergy Relief Nasal Spray)

• nasal corticosteroid sprays work by suppressing the body’s response to allergens or triggers
• use the spray every day throughout the hayfever season to prevent hayfever
• you can begin the spray a few weeks before the hayfever season starts
• these sprays begin to work within a few days but may take a few weeks to reach their full effect
• you might also need to use a nasal decongestant or an antihistamine to start with
• these sprays are particularly effective for more severe or persistent hayfever, particularly for nasal symptoms
• they are not appropriate if you have a sinus infection
• nasal corticosteroids are considered safe, but some minor side effects include irritation, unpleasant taste, headache, coughing and nasal dryness

Nasal decongestant sprays

[GENERAL SALE]

e. g. phenylephrine (Nyal Decongestant Nasal Spray)

[PHARMACY ONLY]
e.g. oxymetazoline (Dimetapp 12 Hour Nasal Spray, Drixine, Logicin Rapid Relief Nasal Spray, Vicks Sinex Nasal Spray), xylometazoline (FLO Rapid Relief Nasal Spray, Otrivin), tramazoline (Spray-Tish, Spray-Tish Menthol),

• these decongestants unblock your nose and make breathing easier
• nasal drops, rather than sprays, are recommended for young children
• use only for up to five days, otherwise their effect is lost and a blocked nose from rebound congestion is likely

Oral antihistamines (tablets and syrups)

• when you have an allergic reaction your body releases histamine, which leads to hayfever. Antihistamines block this reaction. There are two types:
  • newer, less sedating antihistamines, which do not typically cause drowsiness
  • older sedating antihistamines that cause drowsiness
• antihistamines are good for treating hayfever symptoms as they occur, especially if you have a lot of different symptoms. You can also take them in advance if you know you are going to be exposed to allergens or triggers

Newer less-sedating antihistamines

[GENERAL SALE]
cetirizine (Zyrtec packs of 5), fexofenadine (Fexotabs, Pharmacy Action Fexorelief, Telfast), loratadine (Allereze – pack size up to 10, Claratyne – packs up to 10, Lorano)

[PHARMACY ONLY]
e.g. cetirizine (Alzene, APOHealth Cetirizine Hayfever & Allergy Relief, Zilarex, Zyrtec – larger packs), desloratadine (Aerius), loratadine (Allereze – packs 30 or 50, Claratyne – pack above 10 tablets), fexofenadine (Fexo, Fexotabs – larger packs, Pharmacy Action Fexorelief – larger packs, Tefodine, Telfast – larger pack size or stronger dose, Xergic)

• cetirizine and loratadine are available as syrups for children; check correct doses for different age groups
• newer antihistamines may rarely cause drowsiness; do not drive or operate machinery if you are affected.

Older sedating antihistamines

[PHARMACIST ONLY]
e.g. chlorpheniramine (Demazin 6 Hour Relief Tablets), dexchlorpheniramine (Polaramine), promethazine (Phenergan, Sandoz Fenezal, Allersoothe)

• these medicines are not available without a prescription for children under two years old
• these medicines can cause drowsiness, sometimes the next day; it is important you do not drive or operate machinery
• do not drink alcohol with medicines that make you drowsy
• sedating antihistamines are not suitable for everyone; check with your pharmacist.
• if you have other medical conditions, such as glaucoma, epilepsy or prostate problems, or you take antidepressants, check with your pharmacist before taking these medicines

Anti-allergy nasal sprays and eye drops

[PHARMACY ONLY]
e.g. azelastine (Azep Nasal Spray, Eyezep Eye Drops), ketotifen (Zaditen Eye Drops), levocabastine (Livostin Eye Drops, Livostin Nasal Spray, Zyrtec Levocabastine Eye Drops, Zyrtec Levocabastine Nasal Spray), lodoxamide (Lomide Eye Drops 0. 1%), pheniramine + naphazoline (Naphcon-A Eye Drops,  Visine Allergy with Antihistamine Eye Drops), naphazoline + antazoline (Albalon-A)

• anti-allergy drops and sprays can relieve symptoms such as itching, sneezing and watery eyes
• azelastine works quickly
• some eye drops combine an antihistamine with a decongestant (e.g. naphazoline) which reduces redness; these are for short term use only (no more than five days)
• you may need to remove contact lenses before using; check instructions
• throw drops away one month after opening; mark the opening date on the bottle
• some eye drops cause temporary stinging

Preventative eye drops/nasal sprays

[PHARMACY ONLY]
e.g. cromoglycate (Opticrom Eye Drops, Rynacrom Metered Dose Nasal Spray)

• cromoglycate should be used to prevent symptoms of hayfever
• start treatment before hayfever season starts, as it may take a few weeks to work
• may cause temporary stinging
• throw away eye drops one month after opening

More Information

Availability of medicines

• GENERAL SALE available through pharmacies and possibly other retail outlets.
• PHARMACY ONLY available for sale through pharmacies only.
• PHARMACIST ONLY may only be sold by a pharmacist.

Search myDr for Consumer Medicine Information

1. Australian Medicines Handbook. 2019. Rhinitis.

The lymphatic system 4: allergies, anaphylaxis and anaphylactic shock

Allergies are becoming more common; this article, the fourth in a six-part series about the lymphatic system, explores the reasons for this and discusses what happens during allergic responses including anaphylaxis

Abstract

This article, the fourth in a six-part series on the lymphatic system, discusses the nature of allergy, exploring common allergens and the body’s response to them in atopic people, including anaphylaxis. It questions why allergies are becoming increasingly common, particularly in developed countries, exploring a number of theories.

Citation: Knight J, Nigam Y (2021) The lymphatic system 4: allergies, anaphylaxis and anaphylactic shock. Nursing Times [online]; 117: 1, 54-58.

Authors: John Knight is associate professor in biomedical science; Yamni Nigam is professor in biomedical science; both at the College of Human and Health Sciences, Swansea University.

• This article has been double-blind peer reviewed
• Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)
• Click here to see other articles in this series

Introduction

This article is the fourth in a six-part series about the lymphatic system. This series has previously examined the system’s components, its role in tissue drainage, and the trapping of foreign and potentially pathogenic material. The most recent article highlighted the nature of both non-specific immunity, which is active against a broad range of infectious agents, and specific immunity, which targets single pathogens and usually retains a memory of the encounter to allow a swift response on subsequent re-exposure. A finely tuned immune response is essential to health and survival; however, in some people, immune reactions can be elicited against harmless materials in the environment, leading to allergy. This article explores the nature of allergy and examines how, in some people, allergic responses can become much more serious and potentially lead to life-threatening anaphylaxis and anaphylactic shock.

Allergens and allergy

An allergen can be broadly defined as anything that can trigger an allergic response (Woodfolk et al, 2015). In theory, any foreign (environmental) material can act as an allergen, although some substances are more likely to trigger allergic responses than others: most allergens are proteinaceous in nature (Goodman and Breiteneder, 2019). Common environmental allergens include:

• The various types of tree and flower pollen that cause hayfever;
• House dust, which usually includes the highly allergenic faecal pellets of house dust mites that are responsible for perinneal rhinitis;
• Shellfish and peanut or other nut proteins, which can trigger anaphylactic responses.

Some people seem particularly prone to developing allergies and are referred to as atopic individuals. This susceptibility to allergy is likely to be due to a combination of genetic and environmental factors (Justiz Vaillant et al, 2020).

IgE-mediated allergy

The majority of allergic responses are associated with the production of high concentrations of a specific allergic antibody – immunoglobulin E (IgE) – that is raised against the allergen. This is called an IgE-mediated allergic response and could be triggered by various allergens, including pollen grains, shellfish proteins, insect venom, antibiotics, peanuts (ground nuts) or tree nut proteins. The following description of an IGE-mediated allergic response (illustrated in Fig 1) uses a pollen grain as an example.

To develop an allergy, an initial exposure to the allergen is required; in this example it could be initial exposure to high levels of pollen on a trip to the countryside. Pollen grains are microscopic and easily carried in the air for long distances before being inhaled into the upper respiratory tract through the nose. Many species of plants and trees produce pollen with highly allergenic proteins that can irritate and breach the epithelial mucosal barriers in the respiratory tract (Hosoki et al, 2015). On exposure to pollen allergens (as with most foreign materials), the immune system’s B-lymphocytes mature into plasma cells and generate specific antibodies against the pollen and, in the case of atopic individuals, copious amounts of the allergic antibody IgE. This specific IgE circulates in the blood and binds to tissue-resident mast cells, which are found throughout the body and possess IgE receptors. The mast cells, which are packed with granules of histamine, are now sensitised against that particular type of pollen and the individual will respond quickly to any subsequent re-exposure.

The secondary exposure to the allergen might occur when the pollen count rises. At this point, inhaled pollen grains can quickly react with the specific surface IgE antibodies now coating the mast cells. This causes the mast cells to degranulate, releasing histamine and other inflammatory mediators into the local tissues. Histamine quickly initiates local vasodilation, leading to redness and irritation at the contact site. This triggers the sneezing, runny nose and streaming eyes that are characteristic of hayfever.

Regardless of the allergen, the basic principles of sensitisation and the onset of symptoms following secondary exposure are the same. Allergic (IgE-mediated) responses that have these characteristics are referred to as type 1 or immediate-hypersensitivity reactions (Basu and Banik, 2018).

House dust mite allergy

Allergy to house dust mites’ faecal pellets is extremely common, affecting up to 130 million people worldwide (Calderón et al, 2014). House dust mites are found throughout homes, particularly in soft furnishings and bedding, including mattresses and pillows. These small arthropods feed primarily on shed skin cells and other particulate materials and produce large quantities of faecal pellets, which can be inhaled into the respiratory tract. These pellets contain a highly allergenic proteinaceous epitope called Der P1, which has an enzymatic activity and can cleave its way through the tight junctions between the ciliated epithelial cells lining the bronchial tree (Zhang, 2018). When house dust mite allergens enter these subepithelial tissues, they can trigger the production of the allergic antibody IgE in the way described above and in Fig 1.

In the case of house dust mite allergy, the most common feature of the allergic response initiated by secondary exposure is perennial rhinitis, which is characterised by continually streaming eyes and nose. The release of inflammatory mediators (particularly histamine) from degranulating mast cells leads to rapid vasodilation in the ocular and nasal mucosa, causing red eyes and a congested nose. Histamine also binds to receptors on the mucus-producing goblet cells in the upper respiratory tract. This increases mucus production, which contributes to congestion and the continually streaming nose (Fig 2). It is usually easy to recognise perennial rhinitis in a patient because of the red, itchy eyes and so-called ‘allergy salute’ as they are continually wiping their streaming nose.

Sometimes other effects are associated with house dust mite allergy. This can include dermatitis if the faecal pellets are ground into the skin, for example, when the patient rolls over in bed or changes position on the sofa. This can initiate histamine release from the large population of mast cells resident in the skin, leading to a prominent and often itchy skin rash called urticaria. Another major problem associated with house dust mite allergy is that inhaled faecal pellets can provoke asthma attacks in susceptible patients (Gautier and Charpin, 2017). People with a house dust mite allergy can often reduce their symptoms effectively with antihistamines; the frequency of episodes can also be reduced by switching to hypoallergenic bedding and pillows (Portnoy et al, 2013).

Anaphylaxis and anaphylactic shock

Most allergic responses are localised to the tissue with which the allergen has made contact; for example, hayfever primarily affects the nose, nasal cavity and eyes, where airborne pollen makes contact. However, some allergens can elicit more widespread and potent effects, known as an anaphylactic response. Common allergens associated with anaphylaxis include peanut and tree nut proteins, antibiotics, shellfish proteins and insect venoms, such as bee and wasp stings.

Anaphylactic responses are, by definition, severe and life-threatening in nature. They are associated with widespread mast cell degranulation and the release of copious amounts of histamine and other inflammatory mediators, which can elicit systemic effects (Reber et al, 2017). The release of large amounts of histamine can induce widespread vasodilation, which results in a rapid drop in blood pressure. Significant hypotension is a key clinical feature of anaphylactic shock and can lead to weakness, collapse and loss of consciousness (Castells, 2017). Histamine can also have dramatic effects on the airway binding to histamine receptors in the smooth-muscle layers of the bronchial tree, inducing bronchoconstriction and stimulating increased mucus production from goblet cells in the respiratory mucosa (Thangam et al, 2018).

During many severe anaphylactic episodes, a lipid mediator called platelet-activating factor (PAF) is released from platelets and a variety of leukocytes (white blood cells), including basophils, neutrophils and monocytes; PAF acts synergistically with histamine to significantly increase vascular permeability (Nakamura and Murata, 2018). This can lead to rapid accumulation of a watery (serous) exudate in soft tissues such as the lips, mouth and tongue, commonly in response to the ingestion of allergens, such as shellfish, tree nut or – more commonly – peanut proteins. In some cases, the swelling can be so severe that the airway becomes completely occluded, necessitating emergency intubation (Bernstein et al, 2017). Other potent mediators of inflammation – including prostaglandin D2 and the slow-reacting substance of anaphylaxis (SRS-A) – exacerbate bronchoconstriction and airway occlusion, resulting in the characteristic wheezing often associated with anaphylactic episodes. SRS-A is estimated to be up to 1,000 times more potent than histamine in inducing bronchoconstriction (Reber et al, 2017).

Anaphylactic shock is a medical emergency and requires rapid assessment and treatment to ensure the best chance of survival. The standard treatment is adrenaline. If a patient has previously had an anaphylactic episode, they may have been given an auto-injection device such as an EpiPen. Two devices are usually provided in case more than one dose of adrenaline is required. These devices are designed to auto-inject a fixed dose of adrenaline (usually 0.3mg) into the anterolateral aspect of the thigh and can be injected through clothing if necessary (EpiPen, 2020). Because adrenaline is a natural fight-or-flight hormone it dilates the airway, allowing the patient to breathe more easily, while simultaneously inducing peripheral vasoconstriction and increasing the heart rate to help restore blood pressure (Knight et al, 2020). Most patients begin to feel better quickly following the dose of adrenaline; however, sometimes other medications are also used, including antihistamines and asthma inhalers, such as salbutamol (a beta-agonist that mimics adrenaline to promote bronchodilation). For severe anaphylactic episodes, novel drugs that block the biosynthesis of the more potent inflammatory mediators are available, such as SRS-A (Haeggström, 2018).

Anaphylaxis and peanut allergy

Peanut allergy appears to be particularly common in children: up to 2% are affected in the UK and, worryingly, many of them experience severe anaphylactic responses when exposed to peanut products (Allergy UK, 2020). Peanuts are not, strictly speaking, nuts, but are legumes more closely related to lentils and peas. They are unusual in that they have multiple allergenic proteinaceous epitopes associated with them: currently 16 have been identified, which are denoted as Ara h2 to Ara h26 (Palladino and Breiteneder, 2018). Peanut allergies have become progressively more common over the last few decades, although the reasons for this are still poorly understood.

Certainly exposure to peanut products has increased over the years. It has also been demonstrated that peanut allergens can appear in breast milk within minutes of being consumed by the mother (Bernard et al, 2014). Initially it was thought that avoiding peanut products during pregnancy and while breastfeeding would reduce the incidence of peanut allergy in children, but this does not appear to be the case. The current advice in the UK is that peanuts and peanut products should be consumed during pregnancy and when breastfeeding and eaten in early childhood (from the age of six months) to allow tolerance to peanut proteins to naturally develop (Allergy UK, 2020; NHS, 2017).

In China, where peanut consumption is much higher than the UK, the incidence of peanut allergy is much lower. It has been hypothesised that this may be due to the way peanuts are consumed in the UK: grinding peanuts into pastes to make peanut butter and roasting them to make peanut oil (also referred to as groundnut oil) may expose more of the allergenic epitopes or denature and change the configuration of the peanut proteins, potentially making them more allergenic (Iqbal et al, 2016).

Non-IgE-mediated anaphylaxis

Most episodes of allergy and anaphylaxis are reliant on IgE sensitisation of mast cells. Rarely, however, anaphylaxis can be initiated without the involvement of IgE or any other antibodies. One of the most frequently encountered examples of this is following the use of contrast mediums involved in coronary and cerebral angiography. To visualise blood vessels to look for occlusion or blood vessel malformation or defects, radiopaque dyes, such as gadolinium (Omniscan), are injected and circulate throughout the body. In around 1 in 10,000 patients, gadolinium-based contrast mediums can trigger severe anaphylactic responses (Rosado et al, 2020). The exact mechanism causing these responses is not fully understood, but it is thought that the contrast medium directly irritates and initiates the release of histamine and other inflammatory mediators from tissue-resident mast cells (Kun and Jakubowski, 2012). Although such reactions are relatively rare, it important that health professionals who work with gadolinium-based contrast mediums are trained and equipped to deal with anaphylactic reactions when they arise.

Some individuals can experience prominent skin reactions when exposed to sudden changes in ambient temperature, for example, when leaving a hot, centrally heated house to go outside on a freezing winter morning. These so-called heat or cold urticarial reactions typically cause a prickling sensation and prominent skin rash. However, more rarely, such responses may develop into more severe reactions that resemble anaphylaxis, resulting in significantly reduced blood pressure and wheezing. As with reactions to contrast mediums, these types of response are thought to be initiated by direct stimulation of the tissue-resident mast cells, which degranulate in response to the sudden changes in temperature experienced at the skin’s surface (Simmons, 2010).

Non-allergic histamine reactions

Histamine is synthesised in basophils and mast cells from the amino acid L-histidine. Both cell types produce an enzyme called L-histidine decarboxylase, which rapidly converts L-histidine into histamine that is then stockpiled in the cells in the form of granules. Dark-fleshed species of fish, such as anchovies and tuna, have high concentrations of L-histidine in their muscle tissues. Many groups of bacteria synthesise the enzyme L-histidine decarboxylase and, if freshly caught fish are not stored correctly, these bacteria can colonise and grow on the flesh of the fish and rapidly convert the L-histidine into biologically active histamine. When this spoilt fish is eaten, large amounts of preformed histamine are consumed and can elicit symptoms very similar to anaphylactic shock; this is known as Scombroid poisoning. Histamine is a powerful vasodilator and can also act with other mediators to increase vascular permeability, resulting in redness and severe swelling of the lips and oral tissues, as well as gastrointestinal symptoms, including vomiting and diarrhoea. Scombroid poisoning is usually self-limiting and can be treated effectively with antihistamines (Stratta and Badino, 2012).

“Allergies are more prevalent in developed western countries, where widespread use of potent cleaning products reduces pools of infection”

Why are allergies becoming more common?

Some people appear to be highly susceptible to developing allergies compared with the general population. The exact reason for this increased susceptibility to allergic responses in atopic individuals is poorly understood; however, many factors are thought to be involved, including the inheritance of certain genes and the environment people are exposed to while growing up.

The hygiene hypothesis

In the 1980s it was noted that allergies were more prevalent in developed western countries, where smaller family sizes and the widespread use of potent cleaning products were likely to reduce the available pools of infection in the domestic environment. A key study in the UK noted that babies born into families with many siblings were less likely to develop allergies such as hayfever later in life. It was speculated that an increased number of siblings was likely to increase an infant’s exposure to micro-organisms during early childhood, which appeared to be associated with a reduced risk of developing allergies (Strachan, 1989). The study coined the term ‘hygiene hypothesis’ and this proposed phenomenon was then examined further by multiple studies. Although the hygiene hypothesis appears to explain many of the features of atopy and allergy, it is apparent that many other factors are involved.

Antibody class switching

The previous article in this series (Nigam and Knight, 2020) examined the role played by different leukocytes in the immune infection, these cells produce chemical signals called cytokines that facilitate normal antibody production to resolve the infection. Helper T-cells exist as two major populations of cells: Th2 cells and Th3 cells. We appear to be born with a large population of Th3 cells and subsequently acquire greater populations of Th2 cells when we suffer repeated infections in early childhood (Fig 3). People with a balanced population of Th2 and Th3 cells appear less likely to be atopic and show reduced susceptibility to allergic disease (Fig 3a).

When a person with a balanced population of Th2 and Th3 cells encounters a pathogen such as a bacterium, their B-lymphocytes generate immunoglobulin G (IgG), which is known as plasma antibody. IgG circulates in the blood and binds to the pathogen, marking it out for destruction (opsonisation) by the immune system’s phagocytic cells. It has been suggested that the initial low populations of Th2 cells in neonates may help explain the increased susceptibility to infection in early infancy, as their immune system is less able to mount an effective antibody-mediated immune response (Zaghouani et al, 2009).

Fig 3b shows that atopic people raised in hyper-clean environments usually have a much larger population of Th3 cells, which generate the cytokines interleukin 4 (IL4) and interleukin 13 (IL13). IL4 and IL13 are both elevated in atopic individuals, with IL4 stimulating B-lymphocytes to synthesise large amounts of IgE instead of the usual IgG; as described above, this results in the IgE circulating throughout the body in the blood and sensitising mast cells following the initial exposure to the allergen. This phenomenon is referred to as antibody class switching and is a key feature of allergy (Junttila, 2018).

Gut microbiota

It has been noted that many regions of the world with low incidences of allergic disease also have endemic worm infestations, which have been largely eliminated in most developed countries. It is now known that having certain resident worm parasites in the gastrointestinal tract can lead to the production of anti-inflammatory cytokines – such as interleukin 10 (IL10) – that downregulate the immune system, making allergic responses less likely (Scudellari, 2017).

The healthy human gut is usually colonised by a diverse variety of micro-organisms in early infancy, including multiple species of bacteria, viruses and fungi, which collectively form the gut microbiota (Knight et al, 2019). However, it has been suggested that the use of antibiotics, smaller family sizes, reducing sharing of toys and food and increased use of surface-cleaning products have led to an impoverished gut microbiota, with a less diverse population of microbes.

It is known that the gut microbiota produces a multitude of chemical signals that can modulate the immune system: the gut microbiota has even been referred to as a virtual endocrine organ (Valdes et al, 2018). However, a lack of exposure to a diverse spectrum of micro-organisms in early life is thought to contribute to atopy and increase the subsequent risk of allergies.

Key points

• Some people are more prone to allergies, and common allergens include pollen, dust, shellfish and nuts
• In most allergic responses, the body produces high concentrations of an allergic antibody called immunoglobulin E
• Histamine is released, causing local vasodilation and sometimes life-threatening anaphylaxis that requires emergency treatment
• Allergies are becoming more common, which may be due to decreased exposure to micro-organisms during early childhood

References

Allergy UK (2020) Peanut Allergy. Allergy UK.

Basu S, Banik BK (2018) Hypersensitivity: an overview. Immunology: Current Research; 2: 1, 1-2.

Bernard H et al (2014) Peanut allergens are rapidly transferred in human breast milk and can prevent sensitization in mice. Allergy; 69: 7, 888-897.

Bernstein JA et al (2017) Angioedema in the emergency department: a practical guide to differential diagnosis and management. International Journal of Emergency Medicine; 10: 1, 15.

Calderón M et al (2014) Respiratory allergy caused by house dust mites: what do we really know? Journal of Allergy and Clinical Immunology; 136: 10, 1016-1028.

Castells M (2017) Diagnosis and management of anaphylaxis in precision medicine. Journal of Allergy and Clinical Immunology; 140: 2, 321-333.

EpiPen (2020) Why Prescribe EpiPen®? EpiPen

Gautier C, Charpin D (2017) Environmental triggers and avoidance in the management of asthma. Journal of Asthma and Allergy; 10, 47-56.

Goodman RE, Breiteneder H (2019) The WHO/IUIS allergen nomenclature. Allergy; 74: 3, 429-431.

Haeggström JZ (2018) Leukotriene biosynthetic enzymes as therapeutic targets. Journal of Clinical Investigation; 128: 7, 2680-2690.

Hosoki K et al (2015) Innate responses to pollen allergens. Current Opinion in Allergy and Clinical Immunology; 15: 1, 79-88.

Iqbal A et al (2016) Allergens of Arachis hypogaea and the effect of processing on their detection by ELISA. Food & Nutrition Research; 60, 10.28945.

Junttila IS (2018) Tuning the cytokine responses: an update on Interleukin (IL)-4 and IL-13 receptor Complexes. Frontiers in Immunology; 9: 888.

Justiz Vaillant AA et al (2020) Atopy. In: StatPearls. StatPearls Publishing.

Knight et al (2020) Understanding Anatomy and Physiology in Nursing. SAGE Publishing.

Knight J et al (2019) Gastrointestinal tract 6: the effects of gut microbiota on human health. Nursing Times; 115: 11, 46-50.

Kun T, Jakubowski L (2012) Influence of MRI contrast media on histamine release from mast cells. Polish Journal of Radiology; 77: 3, 19-24.

Nakamura T, Murata T (2018) Regulation of vascular permeability in anaphylaxis. British Journal of Pharmacology; 175: 13, 2538-2542.

NHS (2017) Some babies should be given peanuts early say new US guidelines. NHS. 6 January.

Nigam Y, Knight J (2020) The lymphatic system 3: its role in the immune system. Nursing Times; 116: 12, 45-49.

Palladino C, Breiteneder H (2018) Peanut allergens. Molecular Immunology; 100, 58-70.

Portnoy J et al (2013) Environmental assessment and exposure control of dust mites: a practice parameter. Annals of Allergy, Asthma & Immunology; 111: 6, 465-507.

Reber LL et al (2017) The pathophysiology of anaphylaxis. Journal of Allergy and Clinical Immunology; 140: 2, 335-348.

Rosado A et al (2020) Anaphylaxis induced by magnetic resonance imaging (MRI) contrast media. Current Treatment Options in Allergy; 7, 32-42.

Scudellari M (2017) News feature: cleaning up the hygiene hypothesis. Proceedings of the National Academy of Sciences of the United States of America; 114: 7, 1433-1436.

Simmons FE (2010) Anaphylaxis. Journal of Allergy and Clinical Immunology; 125: 2, S161-S181.

Strachan DP (1989) Hayfever, hygiene, and household size. BMJ; 299: 6710, 1259-1260.

Stratta P, Badino G (2012) Scombroid poisoning. Canadian Medical Association Journal; 184: 6, 674.

Thangam EB et al (2018) The role of histamine and histamine receptors in mast cell-mediated allergy and inflammation: the hunt for new therapeutic targets. Frontiers in Immunology; 9, 1873.

Valdes AM et al (2018) Role of the gut microbiota in nutrition and health. BMJ; 13: 361.

Woodfolk JA et al (2015) Allergens, sources, particles, and molecules: why do we make IgE responses? Allergology International: Official Journal of the Japanese Society of Allergology; 64: 4, 295-303.

Zaghouani H et al (2009) Neonatal immunity: faulty T-helpers and the shortcomings of dendritic cells. Trends in Immunology; 30: 12, 585-591.

Zhang J (2018) Allergen delivery inhibitors: characterisation of potent and selective inhibitors of Der p 1 and their attenuation of airway responses to house dust mite allergens. International Journal of Molecular Sciences; 19: 10, 3166.

Allergies & Your Immune System

More than 50 million people experience allergies. There are various types of allergies which are triggered by the body’s immune system responding to a substance. The immune system is vital for health and survival, protecting the body from infection. Allergic reactions occur when the immune system overreacts to a harmless substance – pollen, food, pet dander etc. Though this response cannot be medically treated, there are useful ways allergies can be effectively managed!

Understanding the Immune System

The immune system comprises a critical and vast network of tissues, cells, and organs that protect the body from infection. This complex network is responsible for preventing bacteria, fungi, germs, and viruses from invading the body and causing disease or infection. This happens by identifying and attacking infectious microorganisms. Key components of the immune system include: 

• Lymphoid Organs: includes adenoids (glands in the back of nasal passages), appendix, blood vessels, bone marrow, lymph nodes, lymphatic vessels, spleen, thymus, and tonsils.
• Lymphocytes: the lymphoid organs also release lymphocytes, a type of white blood cell. These cells identify, remember, and destroy invading microorganisms. 

The immune system works by identifying a particular substance as harmful and activating its response system. Lymphocytes make and release antibodies which are proteins that lock onto the substance, neutralizing it which prevents harm. These antibodies stay in the body so when a person comes into contact with the same substance, it destroys it.  

Types of Allergies & Symptoms

There are countless allergens, external substances that a person is allergic to, that people come into contact with in three primary ways: 

• Inhale: substances that are inhaled through the mouth and nose are the most prevalent type of allergens. Pollen is the most common allergen that people experience. Other sources of inhaled allergens include pet dander, mold, and fungi. This type of allergy is commonly referred to as hay fever. 

• Ingest: ingested allergens specifically refer to food allergies. The most common food allergens are: eggs, milk, peanuts, tree nuts, wheat, soy, fish, and shellfish. 
• Contact: contact allergens describe allergens that are touched which triggers the allergic response. Common contact allergens include soap, detergent, and poison ivy. These are typically easily identifiable because symptoms are clearly visible (rashes, eczema, bumps, redness etc. ). 

When a person comes into contact (through inhaling, consuming, or touching) an allergen, the body mistakenly identifies the substance as toxic. This overreaction triggers the release of antibodies which attack the substance and releases chemicals (like histamine) into the bloodstream. This response by the immune system then produces the symptoms associated with allergies: 

• Itchy, watery eyes 
• Runny nose, sneezing, nasal congestion 
• Skin irritation, rash, dryness 
• Inflammation of tongue
• Dizziness 
• Nausea, vomiting, stomach pain, diarrhea

Symptoms can range from mild to life threatening. The most severe symptom is anaphylaxis which is when the airways become restricted caused by inflammation. This prevents airflow and makes breathing difficult, requiring immediate medical attention. 

Managing Allergies

If you experience symptoms, it is important to be evaluated by a doctor. There are a few ways that allergies are diagnosed: skin tests, blood tests, and elimination diets. Once you are aware of the substance(s) you are allergic to, you are able to eliminate or reduce contact and better manage symptoms.  

Symptoms are most commonly managed by different types of over the counter medications: 

• Antihistamines: taken orally, antihistamines are used to alleviate the most common symptoms of allergies (Claritin, Zyrtec, Allegra, etc.) 
• Decongestants: specifically relieve nasal congestion and can be taken either orally or via nasal spray. 
• Nasal Spray: alleviates nasal congestion. 

In addition to nonprescription medications, people often incorporate natural remedies including:  

• Rinsing nasal pathways to remove mucus and allergens in your nasal passages
• Using a humidifier to drain accumulated mucus
• Herbal tea mixtures to treat irritation in the throat

In addition to managing symptoms, it is important to eliminate or reduce contact with allergens. A few tips include: 

• Be aware of the pollen count by checking the forecast and avoid being outdoors when pollen is high
• Keep the air indoors clean by regularly vacuuming and using a purifier 
• Always thoroughly read ingredient labels

If allergies are getting in the way of your best life, contact us! We provide comprehensive allergy services and allergy testing. We look forward to helping you manage your allergies. 

90,000 History of allergies. Favorites

Ksenia Skrypniko the most interesting facts from the history of allergies and allergy tests

The oldest description of allergies that has survived to this day is dated 2540 BC. According to ancient chronicles, it was in this year that the Egyptian pharaoh Menes died of allergic shock caused by a wasp sting.

Symptoms of allergies were described in detail by Hippocrates: he paid attention to skin rashes and digestive disorders after eating a particular food. Avicenna in her writings mentions a strange “spring runny nose” during the flowering of herbs. An Italian physician of French origin, Leonardo Botallo, in 1565 described the “pink fever” that some people suffered during the blooming period of roses. Instead of enjoying the wonderful smell, the unfortunate ones suffered from terrible coughs and runny nose.

Hay fever was first reported by the English physician John Bostock, who spoke at a meeting of the London Society of Medicine and Surgical in 1819 on “recurrent eye and chest disease.”The scientist described the symptoms of the disease of a certain patient with the initials JB (he was John Bostock himself): from the age of eight, every year at the beginning of summer, he suffered from a severe runny nose, watery eyes, and shortness of breath. The doctor thought that the disease was somehow caused by hay and gave the mysterious disease the name “hay fever.”

Histamine – the very substance that causes watery eyes, runny nose, shortness of breath and other allergic symptoms – was identified by Henry Dale in 1910. The scientist was studying ergot, a parasitic fungus of cereals.Together with chemist George Barger, he managed to isolate histamine from ergot, which was first named β-imidazolyl-ethylamine. The study of the role of this substance in the development of allergies has made possible the emergence of antihistamines.

The mystery of hay fever in 1859 was discovered by Charles Blackley, a British researcher who also suffered from this form of allergy. Once, having smelled a bouquet of field herbs, he sneezed violently several times. Then he suggested that his reaction was associated with the pollen of grasses blooming in early summer.Humans breathed in the airborne pollen, which caused some to sneeze, runny nose and watery eyes. In those years, hay fever was believed to be a disease of only educated people in highly skilled jobs. Charles Blackley was of the same flattering opinion. However, at the beginning of the 20th century, it became finally clear that the disease affects representatives of any strata of society.

The phenomenon of anaphylaxis was discovered by the French physiologist Charles Robert Richet. In 1901, Richet, together with Prince Albert of Monaco, took part in a scientific expedition to the Mediterranean Sea.The researcher studied the poisonous properties of the tentacles of a Portuguese ship – a marine inhabitant whose burns are dangerous to humans. A few years earlier, Richet conducted an experiment on dogs, injecting them with conger eel blood serum. With each injection, the animals felt worse and worse. Now the physiologist repeated his experiments using the poison of a Portuguese boat. In an attempt to determine the lethal dose for dogs, he injected them with various concentrations of poison. If the dog tolerated the first injection well, the scientist gave a second injection, containing much less poison.And unexpectedly this led to the imminent death of the animal. Richet showed that a similar reaction can be associated with other substances. In recognition of his work on anaphylaxis, Charles Richet was awarded the Nobel Prize in Physiology or Medicine in 1913.

The word “allergy” was coined in 1906 by the Austrian pediatrician Clemens Peter Freiherr von Pirquet, denoting an unusual reaction of the body to the introduction of antidiphtheria serum. Pirke and his colleague Dr. Bela Sik were very surprised when some of the patients who received the serum had swollen lymph nodes, swollen joints, skin rashes and fever.The term proposed by Pirke combined two Greek words: allos (“other”, “changed”) and ergos (“work”).

Intralymphatic Immunotherapy and Vaccination in Mice

Intralymphatic immunization and immunotherapy have not been shown to be suitable for stimulating both antibody and T cell responses. As shown in this video article, the intralymphatic vaccination procedure is a quick and easy way to stimulate a strong immune response in mice. A trained surgeon can complete the procedure within 3-4 minutes.The session can also be split between two surgeons, where anesthesia and suturing are usually done and the second surgeon makes an incision and injection. The effectiveness of the procedure is more dependent than another method of immunizing the operator, especially if the surgeon is not well trained. However, an experienced operator can reproduce the experimental results also quantitatively monitored by means of an immune response assay. A modification of the method is to inject the vaccine into the spleen ^1,2. The preparation is the same as in the intralymphatic injection, but the size of the incision is usually larger and two stitches are made to close it. The main advantages of such intrasplenic immunization are that the spleen is easier to find and enter than the lymph node, large injection volumes and more frequent injections can be applied, and while any damage to the lymph node caused by needle insertion or injection will involve one of the most important directions of the lymph node. damage to the spleen will involve relatively less organ and be more localized.

The order of intralymphatic immunization in mice can be repeated (eg vaccine boost injection) after a recovery time of 3-4 weeks before a second injection into the same lymph node is done. If more frequent injections are planned, both left and right inguinal lymph nodes should be used. At least two lymph node injections can be made, but further research is needed to more accurately determine this potential limitation.Further injections can be difficult to scar both in the lymph nodes and in the skin, as well as the potential for granuloma formation caused by adjuvants. On the other hand, immunization will cause short-term inflammation of the lymph nodes, and an increase in the size of the lymph node will facilitate localization and subsequent injections. Indeed, the localization of the lymph node is one of the main limitations of the method. While young mice (less than 5 weeks old) may have very small lymph nodes, older and especially older male mice may have so much subcutaneous fat that localization is difficult.Optimal conditions are obtained with female mice 6-12 weeks old. In fact, one of the most important steps in the procedure is the insertion into the lymph node itself. Injection in the adjacent area of ​​the node will be equivalent to subcutaneous injection with weaker triggering of immune responses than after direct intralymphatic injection. The reason is that instead of the hard capsule that surrounds the node, it is impermeable to large molecules. For the antigen to enter the lymph node, it must drain with the lymph.This journey, as a rule, begins in the initial lymphatic vessels in the skin, continues in large channels in the deeper layer of the skin, which drain the lymph to the collection vessels in the subcutaneous tissue, from where the lymph is brought into peristalsis to the next drainage of the lymph nodes ^23.24. The further downstream the antigen is deposited along this path, the less it will get access to afferent lymph.

The intra-lymphatic immunization method is of particular interest for the administration of antigens that are weakly immunogenic when administered using conventional methods such as intramuscular or subcutaneous injection.Intralymphatic vaccination was performed with mRNA, plasmid DNA, peptides, proteins, viruses and bacteria ^22,25-27. While peptides and proteins do not have in-build excipients, mRNA plasmids of viruses and bacteria DNA exert an internal adjuvant EFFEc, providing danger signals (viral and bacterial replication) or by stimulating Toll-like receptors (TLR ,), which can perceive pathogenic linked molecular models (PAMPs), such as single-stranded RNA (TLR7 and TLR8), double-stranded RNA (TLR3), non-methylated cytosine and guanine oligonucleotide clusters (TLR9), bacterial flaggelin (TLR5) (lipopolysaccharide TLR2 and 4), as well as other viral and bacterial molecules ^28. Thus, especially peptide- and protein-based vaccines will benefit from immune potentiation by injecting the vaccine directly into the lymph node. Indeed, it has been shown that B and T cell responses are increased after intralymphatic peptides and proteins are vaccinated in mice ^1,8,9. In addition, genetic vaccines, especially mRNA-based vaccines, are very unstable and for this reason they will certainly profit from a route of administration that allowed short transit times in extracellular tissues.Indeed, intra-lymphatic vaccination with antigen-anRNA encoding elicited potent prophylactic and therapeutic immunity in ^{+4 mouse tumor models.} Likewise, intra-lymphatic administration of excipients such as CpG included a decrease in toxicity due to the lower dose required, and an increase in the adjuvant effect was observed due to a direct and undiluted effect on cells of the immune system ^13. In addition, the performance of other excipients or delivery systems such as antigen polymeric nano- and microparticles, as well as liposomes can be improved by the introduction of intra-lymphatic ^11. Another major advantage over conventional intralymphatic vaccination routes is that much lower doses are usually required. For proteins and to stimulate antibody responses, the dose can be reduced 100-1000 times ^9, while the DNA dose to stimulate cytotoxic CD8 T cell responses can be reduced from approx. 10,000-fold ^2.

Unlike subunits of antigens or dead vaccines, live virdr. and bacterial vaccines are generally not expected to benefit from intralymphatic administration.The reason for this is in part which live microbes usually sediment into the lymph nodes without adjuvant aid. In addition, infectious microorganisms can cope with the effects of dilution of antigen in peripheral tissues by replication. Consequently, the dose of antigen reaching the secondary lymphatic system will usually be sufficient to generate immunity. However, where existing live vaccines produce inadequate immunity, intralymphatic administration can provide the correction needed to make the vaccine effective.It has recently been shown that immunity after vaccination is currently only available with tuberculosis vaccine M. Bovis BCG can be significantly improved by direct injection of BCG in the inguinal lymph nodes of mice ^12. Intralymphatic Administration has also reduced the inoculated amount of BCG by 100-1000 times compared to subcutaneous admitting. This represents a safety advantage of intralymphatic vaccination, especially in immune-compromised individuals.

Intralymphatic immunization and immunotherapy in humans is still used today for cancer patients and allergy sufferers. The method in humans is non-invasive, but the best results and quality control are obtained with ultrasound to administer injections, which may limit use in hospitals or larger nursing units. In cancer studies, prime-pressurization of plasmid and peptide DNA vaccination for the treatment of metastatic melanoma, immunogenicity and evidence of disease control have been identified in a specific patient population of 90,021 29. In addition, intralymphatic autologous dendritic cell vaccination has been performed in cancer patients. Although some studies enhanced the immune response ^30.31, other studies have failed to demonstrate the benefit of intra-lymphatic administrations ^32.33. The order of intra-lymphatic administration has been found to be particularly beneficial in immunotherapy of allergic patients. By changing the intra-lymphatic method, the number of injections for complete and successful immunotherapy can be reduced from approximately 50 subcutaneous injections over 3 years, only three injections within 2 months ^14,15. Because both injection dose rates can be greatly reduced, making allergen-specific intra-lymphatic immunotherapy, and since lymph nodes do not contain histamine-releasing mast cells, the techniques present safety benefits, and with the duration of short-term treatment, patient compliance is improved. Over the next years, allergies are perhaps a sign to see the most immediate benefit of this new vaccination and immunotherapy method.

Subscription Required.Please recommend JoVE to your librarian.

Treatment of sinusitis, rhinitis, tonsillitis and otitis media at an ENT in Bryansk

Symptoms of diseases of the tonsils (adenoids).

Adenoids (hypertrophy of the pharyngeal tonsil) are most commonly seen between the ages of 5 and 15, but can also occur in early childhood and older adults. The pharyngeal tonsil can be both in a state of true hypertrophy and in a state of acute or chronic inflammation.

Adenoids (adenoid growths, adenoid vegetation) – pathological enlargement (hyperplasia, hypertrophy) of the pharyngeal (nasopharyngeal) tonsil.They can occur in isolation or in combination with enlarged palatine tonsils.

The pharyngeal tonsil is well developed in childhood; From about 12 years old, it becomes smaller, and in adults it often completely atrophies.

Adenoids are most often observed in children 3-10 years old, but they can occur in the first years of life, and after puberty. The development of adenoids is facilitated by childhood infectious diseases (measles, scarlet fever, diphtheria), frequent viral and microbial inflammatory diseases of the upper respiratory tract, immunodeficiency states, a tendency to allergies, the role of a hereditary factor is not excluded.

A number of local and general disorders are associated with hypertrophy of the pharyngeal tonsil:
• Difficulty in nasal breathing
• growth disorders of the facial skeleton
• hearing and speech disorders
• dizziness
• sleep disorders, snoring
• distraction, forgetfulness
• subfebrile temperature

Sometimes there is also nocturnal urinary incontinence, laryngospasm, bronchial asthma, visual impairment, cardiovascular function and other disorders.

Adenoids are symptoms.

Violation of nasal breathing, profuse secretion of mucous secretions that fill the nasal passages and flow into the nasopharynx, chronic swelling and inflammation of the nasal mucosa.

Due to difficulty in nasal breathing, children sleep with their mouths open, sleep is often restless and accompanied by loud snoring; children get up sluggish, apathetic.

Schoolchildren often have a decline in academic performance due to weakened memory and attention.Adenoids, by blocking the pharyngeal openings of the Eustachian (auditory) tubes and disrupting normal ventilation of the middle ear, can cause hearing loss, sometimes significant. Speech is distorted, the voice loses its sonority and takes on a nasal tone. Young children have difficulty mastering speech. Frequent complaints of persistent headache as a result of obstructed outflow of blood and lymph from the brain, caused by congestion in the nasal cavity.

Constant discharge of mucous secretions from the nose causes maceration and swelling of the skin of the upper lip, and sometimes eczema.The mouth is constantly open, the lower jaw sags, the nasolabial folds are smoothed out, the facial expression in the later stages is not meaningful, saliva flows out of the corners of the mouth, which gives the child’s face a special expression, called “adenoid face” or “external adenoidism”. Constant breathing through the mouth leads to deformation of the facial skull. Such children may have an irregular bite, a high, so-called Gothic palate. As a result of prolonged difficulty in nasal breathing, the chest is deformed, becoming flattened and sunken.Lung ventilation is impaired, blood oxygenation decreases, the number of erythrocytes and hemoglobin content decreases.

With adenoids, the activity of the gastrointestinal tract is disrupted, anemia, bedwetting, chorea-like movements of the muscles of the face, laryngospasm, asthmatic attacks, and coughing attacks develop. Mainly in childhood, it can occur on its own or more often in combination with acute inflammation of the palatine tonsils, acute adenoiditis (tonsillitis of the pharyngeal tonsil), in which the body temperature can rise to 39 degrees and higher, there is a feeling of dryness, rawness, burning in the nasopharynx.

Along with a runny nose, nasal congestion in patients, there is a stuffing, and sometimes pain in the ears, paroxysmal cough at night. Regional lymph nodes (submandibular, cervical and occipital) are enlarged and painful on palpation.

In young children, signs of general intoxication, dyspepsia may appear. The disease lasts 3-5 days. A common complication of acute adenoiditis is eustachitis.

Due to frequent respiratory diseases, acute adenoiditis, especially with severe allergies, chronic adenoiditis occurs.In this case, a violation of the general condition of the patient is characteristic, the child becomes lethargic, loses his appetite, vomiting often occurs during meals. The flow of mucopurulent discharge from the nasopharynx into the underlying airways causes a persistent reflex cough, especially at night. Body temperature is often subfebrile, regional lymph nodes are enlarged.

The inflammatory process from the nasopharynx easily spreads to the paranasal sinuses, pharynx, larynx, underlying airways, as a result of which children often suffer from bronchopulmonary diseases.

For recognition, posterior rhinoscopy, digital examination of the nasopharynx and X-ray examination are used.

In terms of size, adenoids are divided into three degrees:
• I degree – small adenoids, cover the upper third of the opener
• Grade II – medium sized adenoids, covering two thirds of the opener
• III degree – large adenoids, covering the entire or almost the entire opener

The size of the adenoids does not always correspond to the pathological changes in the body caused by them.Sometimes adenoids of I-II degrees cause severe difficulty in breathing through the nose, hearing loss and other pathological changes. Adenoids differentiate from juvenile fibroids of the nasopharynx and other tumors in this area. Difficulty breathing through the nose occurs not only with adenoids, but also with curvature of the nasal septum, hypertrophic rhinitis, and neoplasms of the nasal cavity.

Recognizing conjunctivitis

10/13/2021

This article will consider the types of such a seemingly understandable and simple disease as conjunctivitis.

Infectious Conjunctivitis

Both viruses and bacteria can infect your eye and cause conjunctivitis. Infectious conjunctivitis is most common in children and the elderly. This is due to the fact that children tend to face a lot of infections in school, kindergartens, etc.

With age, people become more prone to infections, since the body’s defense system is no longer so strong. Viruses are thought to be a more common cause of conjunctivitis than bacteria.The type of virus that usually causes this disease is called adenovirus. You can get infectious conjunctivitis by being in close contact with another person who has it, so it’s important to keep an eye on this factor.

Sometimes babies develop conjunctivitis in the first few weeks after birth. This happens if, during labor , the infection is transmitted from the cervix of the uterus or of the vagina . It can also happen if the child has a response to treatment eyes .If your newborn baby is showing signs of an eye infection or are concerned about something, talk to your doctor , although it is likely that the maternal and child health nurse or maternity staff will probably find any problems early. …

Allergic conjunctivitis

There are four types of allergic conjunctivitis :

1. Seasonal allergic conjunctivitis – it affects both eyes and people often get fever at about the same time .

2. Perennial allergic conjunctivitis – people with this type of allergic conjunctivitis have daily symptoms in both eyes , often on waking, literally every morning. It can be caused by dust mite or animal hair allergy .

3. Contact dermatoconjunctivitis – This type of conjunctivitis irritates the eyelids and is most common in people who use eye drops.

4. Giant papillary conjunctivitis – common in people who use soft contact lenses, although this type of conjunctivitis can occur in people who use hard contact lenses. The disease also occurs in people who have undergone surgery on eyes .

Conjunctivitis due to irritants

You can get conjunctivitis if foreign bodies such as eyelashes or a piece of sand or chemicals such as chlorine get into your eyes .Foreign body conjunctivitis can only affect one of your eyes .

Conjunctivitis symptoms

Conjunctivitis can cause symptoms such as:

• soreness, often described as a burning sensation
• scleral redness
• blurred, blurry vision
• discharge from 95 eyes

are experiencing may also depend on the type of conjunctivitis you have.

If you have allergic conjunctivitis , you may also have:

If you have infectious conjunctivitis , you may also have:

• discharge from eyes , similar to pus, due to which eyelids may stick together, especially upon waking (if you have a bacterial infection)
• watery discharge that may be sharp in the morning but not like pus (if you have a viral infection)
• cold symptoms such as fever and sore throat
• swollen lymph nodes in front of your ears (lymph nodes are glands throughout your body that are part of your immune system ).

Seek help if severe pain or significant visual impairment occurs .

Navigation

Treatment of sarcoidosis in Germany – Symptoms and signs of the disease – Diagnosis of the disease at the Nordwest Clinic

Akin Atmacha, thoracic oncologist

Since 2017 – Head of the Department of Thoracic Oncology at the Clinic of Oncology and Hematology at the Nordwest Clinic.

More about the specialist →

Sarcoidosis (Boeck’s disease) is an inflammatory granulomatous systemic tissue disease related to rare ( orphan ). It can be found practically in any region, has a number of subtypes and various forms of flow. Common is the formation of benign nodular structures – granulomas. The most common (about 90% of cases) sarcoidosis affects the lungs, but also:

• liver;

90,081 hearts;

90,081 eyes;

• nervous system;
• lymph nodes;

90,081 leather.

In the Nordwest clinic, each patient is offered the latest treatment methods for this disease in Germany, as well as preventive check-ups that help prevent the development of such systemic pathologies and avoid their complications.

Causes of Sarcoidosis

The causes of the disease “Sarcoidosis” are not fully understood. It is obvious that an excessive inflammatory response of the body leads to the formation of granulomas.

It has been suggested that the readiness of the inflammatory system to form granulomas is significantly increased in sarcoidosis.Thus, even contact with bacteria that do not cause disease, such as propionic bacteria, in the presence of sarcoidosis leads to the formation of granulomas. This is partly due to genetics.

Sarcoidosis of the lungs can be caused by inhalation of harmful substances that activate their immune system, such as pollen, viruses, bacteria, fungal spores and chemicals.

Symptoms and signs of sarcoidosis

Symptoms, main manifestations, sarcoidosis depend on the forms and stages of the disease.

There are two main forms:

• Sharp;
• Chronic.

Acute sarcoidosis

Consists of 5% of all cases. Most often, the disease affects the lungs, arises and develops quickly and suddenly. Typical symptoms of this form are:

• temperature and performance degradation;
• cough;

90,081 muscle and joint pain;

• swelling of the lymph nodes in the lungs.

A subtype of acute sarcoidosis is Löfgren’s syndrome , in which there can be bilateral swelling of the lymph nodes at the root of the lung, erythema nodosum (red-purple skin nodules, primarily on the lower leg), and polyarthritis (inflammation of many joints).The course of this sarcoidosis is very intense, which makes it difficult to distinguish it from acute infections and systemic rheumatic diseases.

Joint inflammation (arthritis) in acute sarcoidosis occurs, as a rule, in the ankle area. It manifests itself mainly in pain when walking. There may be inflammation of several joints at the same time (polyarthritis).

Swelling of the lymph nodes in acute sarcoidosis is found in the region of the main bronchi and large pulmonary vessels.Such lymphadenopathy is usually asymptomatic, but clearly reveals itself on X-ray.

Chronic sarcoidosis

About 90% of patients have chronic sarcoidosis , most often affecting the lungs and regional lymph nodes. Most patients have no complaints, while others develop complaints slowly and imperceptibly: an irritating cough appears, increasing shortness of breath, and an X-ray examination shows swollen lymph nodes in the area of ​​the pulmonary gate (hilar bilateral lymphadenopathy).Other signs of chronic sarcoidosis include:

• slight temperature;

90,081 weight loss;

90,081 fatigue;

• joint pain.

Stages of sarcoidosis

In total, 5 stages of the disease are distinguished, depending on the degree of lung damage:

• Stage 0
  Radiography is normal, no lung involvement, but there are changes outside the chest that are typical of sarcoidosis.
• Stage 1
  There is swelling of the lymph nodes (chilar lymphadenopathy on both sides) between both lobes of the lungs, along the trachea and main bronchi. There is no damage to the lung tissue.
• Stage 2
  Swelling of the lymph nodes, as in stage 1. In addition, damage to the lungs with nodular tissue changes.
• Stage 3
  Lung involvement with pineal changes in the tissue, without swelling of the lymph nodes.
• Stage 4
  Irreversible pulmonary fibrosis: lung tissue is converted to connective tissue – scarring occurs.These consequences of sarcoidosis are irreversible.

Diagnosis of sarcoidosis

At the first symptoms and suspicions of possible sarcoidosis, the doctor of the Nordwest clinic conducts a detailed conversation with the patient, a physical examination and prescribes a series of examinations that are carried out as part of diagnostics in Germany for the patients of our hospital.

Since sarcoidosis is localized in most cases in the lungs and lymph nodes of this area, chest x-ray is prescribed, in which changes in lung tissue and enlarged lymph nodes are well defined.

Sarcoidosis of the lungs significantly impairs lung function. In the case of pulmonary fibrosis, the lungs are less elastic when inhaled, as confirmed by lung function tests .

To confirm the diagnosis, bronchoscopy and biopsy of lung tissue are often prescribed for further histological examination.

One of the most modern methods for diagnosing sarcoidosis is also the method of endobronchial ultrasound (EBUS). The Nordwest Clinic is one of the few in Germany where this research method is used.

Since sarcoidosis can affect almost all organs of the body, depending on the complaint, other methods of examination can be used. If kidney damage is suspected, a blood test is performed to determine kidney parameters, as well as a ultrasound examination . Cardiac function is examined using ECGs and echocardiography. Cerebrospinal fluid puncture may be considered if neurosarcoidosis is suspected.

With the help of computed tomography, the organs of the chest are visualized in much more detail than with X-ray, which makes it possible to more accurately confirm changes in the lung tissue and exclude other diseases as the cause of complaints, for example, lung cancer or tuberculosis.

Modern treatments for sarcoidosis

Not every case of sarcoidosis needs treatment. The disease can disappear spontaneously, especially in cases of acute course. It depends on the stage of the disease: the higher the stage, the less chance of self-healing.

The presence and severity of symptoms affects not only the course of sarcoidosis, but also the decision on therapy, as well as the analysis of prognosis regarding recovery, the presence or absence of complications. For minor complaints, regular follow-up is very often suggested.In cases where the disease affects the function of the lungs or heart, intensifies symptoms, damage to the kidneys or the nervous system, appropriate therapies are undertaken.

For acute sarcoidosis and severe symptoms, nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen are prescribed, which reduce fever and have anti-inflammatory and analgesic effects. For severe complaints, cortisone is used for a short time.

In chronic sarcoidosis, cortisone is used first and given for several months, followed by a slow taper.

In severe cases of sarcoidosis, other medications may be necessary. Some patients receive methotrexane or azathioprine. Both drugs are immunosuppressive: they suppress the immune system and stop the disease.

At the 4th stage of the disease and the development of pulmonary fibrosis, additional methods of treatment may be required. Depending on the severity of shortness of breath, bronchodilator drugs or oxygen therapy are prescribed. In rare cases, the severity of the lesion is so severe that only a lung transplant can help.

How much does sarcoidosis treatment cost in Germany

Prices for the treatment of sarcoidosis in Germany depend on the stage and complexity of the course of the disease. The therapy regimen is built on the basis of the clinical recommendations of the attending physician of the Nordwest clinic, who observes the patient from the moment he is admitted to the hospital until the moment he is discharged. To clarify information about where the treatment is being carried out, how to arrange hospitalization in our clinic, to carry out regular prophylaxis of sarcoidosis, as well as the cost of services, call 8 800 551 8099

Page not found – Sayan Medical College

I, the subject of personal data, in accordance with Federal Law of July 27, 2006 No. 152 “On Personal Data” I provide OGBPOU “Sayan Medical College” (hereinafter referred to as the Operator), located at Irkutsk Region., Sayansk, m / s Yuzhny, 120, consent to the processing of personal data specified by me in the form of a web chat, feedback on the site on the Internet, which is owned by the Operator.

1. The composition of the personal data I provide is as follows: Name, e-mail address.
2. The purposes of processing my personal data are: to ensure the exchange of short text messages in the online dialogue mode or the exchange of text messages via e-mail.
3. Consent is granted to perform the following actions (operations) with the personal data specified in this consent: collection, systematization, accumulation, storage, clarification (update, change), use, transfer (provision, access), blocking, deletion, destruction, carried out as with the use of automation tools (automated processing), and without the use of such tools (manual processing).
4. I understand and agree that providing the Operator with any information about myself that is not contact and not related to the purposes of this consent, as well as providing information related to state, banking and / or commercial secrets, information about racial and / or nationality, political views, religious or philosophical convictions, health status, intimate life is prohibited.
5. If I decide to provide the Operator with any information (any data), I undertake to provide only reliable and up-to-date information and have no right to mislead the Operator with regard to my identity, to provide false or inaccurate information about myself.
6. I understand and agree that the Operator does not verify the accuracy of the personal data provided by me and does not have the ability to assess my legal capacity and proceeds from the fact that I provide reliable personal data and keep such data up to date.
7. Consent is valid upon achievement of the processing goals or in case of loss of the need to achieve these goals, unless otherwise provided by federal law.
8. Consent can be withdrawn by me at any time on the basis of my written statement.

Seasonal allergy (hay fever) – symptoms, treatment, causes of hay fever

The beginning of the flowering period of plants for many is associated not with beauty and fragrance, but with a deterioration in well-being.The reason for this is hay fever, or hay fever. Both rural residents and residents of the megalopolis, children and adults suffer from this disease. And only comprehensive treatment helps to eliminate the cause of seasonal allergies and restore the joy of life.

Symptoms and diagnosis of pollinosis

Pollen seeds of flowering grasses and trees, spores of fungi are carried by the wind over considerable distances. And then, getting into the body, they cause an allergic reaction, which can manifest itself:

• Profuse lachrymation.
• Constant nasal congestion.
• Redness of the conjunctiva.
• Constant sneezing, profuse coryza.
• Obsessive cough.
• Suffocating attacks.
• Itching sensation in the eyelids, ears.
• Sometimes – headaches, rashes, abdominal pain.

Plant pollen is perceived by the body as a powerful allergen, a threat to health and well-being.Such harmless plants as alder, birch, wormwood, ragweed, etc. during the flowering period can cause severe allergies.

Today, medicine is aware of a variety of fungal, household, epidermal and more than 700 plant allergens, the impact of which leads to human sensitization.

If you observe one of the symptoms listed above, if your health worsens from early spring to late autumn, you should definitely consult an allergist.Diagnostics will help to identify plants, the pollen of which is an allergen for you, determine the tactics of life and receive appropriate treatment.

Treatment and prevention of pollinosis

If untreated, allergic inflammation can provoke a secondary infection, cause the development of pneumonia, bronchitis, bronchial asthma. Therefore, the treatment and prevention of seasonal allergic hay fever is an important task for the allergist and patient. On the basis of our clinic, highly qualified specialists are receiving treatment.You can get advice from an allergist-immunologist, as well as get help from doctors of related specialties: dermatologist, ophthalmologist, otorhinolaryngologist. Using the technique of skin scarification tests to a wide range of allergens (or blood tests) and other diagnostic measures, a diagnosis can be made.