Sinusitis

Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. Normally, sinuses are filled with air, but when sinuses become blocked and filled with fluid, germs (bacteria, viruses and fungi) can grow and cause an infection.

Conditions that can cause sinus blockage include the common cold, allergic rhinitis (swelling of the lining of the nose), nasal polyps (small growths in the lining of the nose) or a deviated septum (a shift in the nasal cavity).

There are different types of sinusitis, including:

• Acute sinusitis: A sudden onset of cold-like symptoms such as runny nose, stuffy nose and facial pain that does not go away after 7-10 days. Acute sinusitis typically lasts 4 weeks or less.
• Subacute sinusitis: An inflammation lasting 4 to 8 weeks.
• Chronic sinusitis: A condition characterized by sinus inflammation symptoms lasting 8 weeks or longer.
• Recurrent sinusitis: Several attacks within a year.

Who Gets Sinusitis?

About 37 million Americans suffer from at least one episode of sinusitis each year. People who have the following conditions have a higher risk of sinusitis:

• Nasal mucous membrane swelling as from a common cold
• Blockage of drainage ducts
• Structure differences that narrow the drainage ducts
• Conditions that result in an increased risk of infection

In children, common environmental factors that contribute to sinusitis include allergies, illness from other children at day care or school, pacifiers, bottle drinking while lying on one's back, and smoke in the environment.

In adults, the contributing factors are most frequently infections and smoking.

What Are the Signs and Symptoms of Acute Sinusitis?

The primary symptoms of acute sinusitis include:

• Facial pain/pressure
• Nasal stuffiness
• Nasal discharge
• Loss of smell
• Cough/congestion

Additional symptoms may include:

• Fever
• Bad breath
• Fatigue
• Dental pain

Acute sinusitis may be diagnosed when a person has two or more symptoms and/or the presence of thick, green or yellow nasal discharge.

What Are the Signs and Symptoms of Chronic Sinusitis?

People with chronic sinusitis may have the following symptoms for 8 weeks or more:

• Facial congestion/fullness
• A nasal obstruction/blockage
• Pus in the nasal cavity
• Fever
• Nasal discharge/discolored postnasal drainage

Additional symptoms may include:

• Headaches
• Bad breath
• Fatigue
• Dental pain

How Is Sinusitis Diagnosed?

To diagnose sinusitis, your doctor will review your symptoms and give you a physical examination.

The exam may include the doctor feeling and pressing your sinuses for tenderness. He or she may also tap your teeth to see if you have an inflamed paranasal sinus.

Other diagnostic tests may include a study of the mucus culture, nasal endoscopy (see below), X-rays, allergy testing or CT scan of the sinuses.

What Is Nasal Endoscopy?

A nasal endoscope is a special tube-like instrument equipped with tiny lights and cameras used to examine the interior of the nose and sinus drainage areas.

A nasal endoscopy allows your doctor to view the accessible areas of the sinus drainage pathways. Your nasal cavity may first be numbed using a local anesthetic (some cases do not require any anesthetic). A rigid or flexible endoscope is then placed in position to view the middle bone structure of the nasal cavity.

The procedure is used to observe signs of obstruction as well as detect nasal polyps hidden from routine nasal examination. During the endoscopic examination, the doctor also looks for any structural abnormalities that would cause you to suffer from recurrent sinusitis.

How Is Sinusitis Treated?

Treatment for sinusitis depends on the severity.

• Acute sinusitis. If you have a simple sinus infection, your health care provider may recommend treatment with decongestants like Sudafed and steam inhalations alone. Use of nonprescription decongestant nasal drops or sprays may also be effective in controlling symptoms. However, these medicines should not be used beyond their recommended use, usually four to five days, or they may actually increase congestion.If antibiotics are administered, they are usually given for 10 to 14 days. With treatment, the symptoms usually disappear and antibiotics are no longer required.
• Chronic sinusitis. Warm moist air may alleviate sinus congestion. A vaporizer or inhaling steam from a pan of boiling water (removed from heat) may also help. Warm compresses are useful to relieve pain in the nose and sinuses. Saline nose drops are also safe for home use. Use of nonprescription decongestant nasal drops or sprays might be effective in controlling symptoms, however, they should not be used beyond their recommended use. Antibiotics may also be prescribed.

Other Treatment Options

To reduce congestion, your doctor may prescribe nasal sprays (some may contain steroid sprays), nose drops or oral decongestant medicine. If you suffer from severe chronic sinusitis, oral steroids might be prescribed to reduce inflammation -- usually only when other medications have not worked. Antibiotics will be prescribed for any bacterial infection found in the sinuses (antibiotics are not effective against a viral infection). An antihistamine may be recommended for the treatment of allergies. Antifungal medicine may be prescribed for a fungal sinus infection.

Will I Need to Make Lifestyle Changes?

Smoking is never recommended, but if you do smoke, you should refrain during treatment for sinus problems. No special diet is required, but drinking extra fluids helps to thin secretions.

Is Sinus Surgery Necessary?

Mucus is developed by the body to moisten the sinus walls. In the sinus walls, the mucus is moved across tissue linings toward the opening of each sinus by millions of cilia (a hair-like extension of a cell). Irritation and swelling from an allergy can narrow the opening of the sinus and block mucus movement. If antibiotics and other medicines are not effective in opening the sinus, surgery may be necessary. Also, if there is a structural abnormality of the sinus such as nasal polyps, which can obstruct sinus drainage, surgery may be needed.

Surgery is performed under local or general anesthesia using an endoscope. Most people can return to normal activities within five to seven days following surgery. Full recovery usually takes about four to six weeks.

A procedure called a "turbinectomy" may also be performed to permanently shrink the swollen membranes of the nose. This is done in the doctor's office and takes only a few minutes. The anesthetic used is very similar to that used in routine dental procedures.

What Happens If Sinusitis Is Not Treated?

Delaying treatment for sinusitis will result in suffering from unnecessary pain and discomfort. In rare circumstances, untreated sinusitis can lead to meningitis or brain abscess and infection of the bone.

Poison Plant Allergies: Poison Ivy, Oak, and Sumac

Poison ivy, poison oak and poison sumac are plants that contain an irritating, oily sap called urushiol. Urushiol triggers an allergic reaction when it comes into contact with skin, resulting in an itchy rash, which can appear within hours of exposure or up to several days later. A person can be exposed to urushiol directly or by touching objects -- such as gardening tools, camping equipment and even a pet's fur -- that have come into contact with the sap of one of the poison plants.

Urushiol is found in all parts of these plants, including the leaves, stems and roots, and is even present after the plant has died. Urushiol is absorbed quickly into the skin. It can also be inhaled if the poison plants are burned. The smoke may expose not only the skin to the chemical but also the nasal passages, throat and lungs. Inhaled urushiol can cause a very serious allergic reaction.

The rash that results from the poison plants is a form of allergic contact dermatitis. (Dermatitis is swelling and irritation of the skin.) Skin is not automatically sensitive to urushiol. Sensitivity builds up after the skin is exposed to the substance. When initially exposed to urushiol, the skin alerts the immune system of the presence of the irritating chemical. (Usually, no visible reaction will occur the first time a person comes in contact with a poison plant.) The immune system then prepares a defensive reaction for the next time the skin encounters the substance. This sensitizes the skin so that new contact with urushiol causes an allergic reaction.

Poison ivy, poison oak and poison sumac can be found in most areas of the U.S., except Alaska, Hawaii, and the deserts of the Southwest. In some areas of the country (East, Midwest and South), poison ivy grows as a vine. In the northern and western U.S., and around the Great Lakes, it grows as a shrub. Each poison ivy leaf has three leaflets.

Poison oak closely resembles poison ivy, although it is usually more shrub-like, and its leaves are shaped somewhat like oak leaves. The undersides of the leaves are always a much lighter green than the surface and are covered with hair. Poison oak is more common in the western U.S.

Poison sumac grows as a woody shrub, with each stem containing 7 to 13 leaves arranged in pairs. Poison sumac can be distinguished from harmless sumac by its drooping clusters of green berries. Harmless sumac has red, upright berry clusters. Poison sumac is more common in wet, swampy areas.

What Are the Symptoms of a Poison Plant Reaction?

All three plants contain the same chemical, urushiol, and cause the same reaction, which generally occurs in the following phases:

1. Redness and itching of the skin.
2. A rash erupts on the skin, often in a pattern of streaks or patches from where the plant has come into contact with the skin.
3. The rash develops into red bumps, called papules, or large, oozing blisters.

How Common Are Poison Plant Allergies?

Poison ivy, poison oak and poison sumac are three of the most common causes of allergic contact dermatitis in North America. Some experts estimate that three out of four people are sensitive to the chemical found in these plants, although the degree of sensitivity varies. Some people are very sensitive and will have a quick reaction upon contact with a small amount of urushiol. For those who are less sensitive, exposure to a large amount of urushiol is necessary before a reaction develops. Cases of poison plant allergy occur most frequently during the spring, summer, and early fall when people spend more time outdoors.

How Are Reactions to Poison Plants Diagnosed?

An allergic reaction to a poison plant is diagnosed based on the typical pattern of symptoms and the appearance of the rash.

How Are Reactions to Poison Plants Treated?

An allergic reaction to a poison plant cannot be cured, but the symptoms can be treated. You may take cool showers and apply an over-the-counter lotion -- such as calamine lotion -- to help relieve the itch. If your reaction is more severe or involves mucus membranes (membranes found in the eyes, nose, mouth, and genitals), you may need a prescription medication, such as prednisone, to help control the reaction.

How Long Does a Poison Plant Rash Last?

Most rashes caused by poison ivy, poison oak, or poison sumac are mild and last from 5 to 12 days. In severe cases, the rash can last for 30 days or longer.

Does Immunotherapy Help With Poison Plant Allergies?

Immunotherapy is not available for allergies to poison ivy, poison oak and poison sumac.

How Can Poison Plant Reactions Be Prevented?

You can take steps to prevent exposure.

• Learn to identify poison ivy, poison oak and poison sumac, and avoid contact with them.
• Remove these plants from around your home, especially in areas where you may be working or playing.
• When walking in the woods or working in areas where these plants may grow, cover your skin as much as possible by wearing long pants, long-sleeves, shoes and socks.
• Do not let pets run in wooded areas where they may be exposed to the poison plants. They can carry urushiol back home on their fur.

Is a Poison Plant Rash Contagious?

Many people think a poison plant rash can be spread from one part of the body to another or from person to person. In general, this is not true. You can spread the rash only if you have urushiol on your hands. Also, it can take longer for the rash to appear on certain areas of the body, especially areas such as the soles of the feet where the skin is thicker. This may give the appearance that the rash has spread from one part of the body to another. You can also be re-exposed to the urushiol by touching gardening tools, sports equipment, or other items that were not cleaned after being in contact with the plants. Scratching or touching the rash and fluid from blisters will not cause the rash to spread because urushiol is not present in the blister fluid.

What Should I Do If I am Exposed to a Poison Plant?

If you think you may have been exposed to a poison plant:

• Remove your clothes.
• Wash all exposed areas with cool running water. Use soap and water if you can. Be sure to clean under your fingernails. In the woods, the water of a running stream can be an effective cleanser.
• Wash your clothing and all gardening tools, camping gear, sports equipment and other objects that came into contact with the plants.
• Bathe pets exposed to the plants.

When Should I Call the Doctor?

If any of the following occurs, seek immediate medical attention:

• You have symptoms of a severe reaction, such as severe swelling and/or difficulty breathing.
• You have been exposed to the smoke of burning poison ivy, poison oak or poison sumac.
• The rash covers more than one quarter of your body.
• The rash occurs on your face, lips, eyes or genitals.
• The initial treatment does not relieve the symptoms.
• You develop a fever and/or the rash shows signs of infection, such as increased tenderness, pus or yellow fluid oozing from the blisters, and an odor coming from the blisters.

Multiple Chemical Sensitivity

What Is Multiple Chemical Sensitivity?

Multiple chemical sensitivity (MCS) is the name given by some to a condition in which various symptoms reportedly appear after a person has been exposed to any of a wide range of chemicals. The exposure may occur as a major event, such as a chemical spill, or from long-term contact with low-levels of chemicals, such as in an office with poor ventilation. As a result of exposure, people with MCS develop sensitivity and have reactions to the chemicals even at levels most people can tolerate.

Other names for this condition are "environmental illness" and "sick building syndrome."

Is MCS a Real Disorder?

Many recognized medical groups and societies, including the CDC, the American Medical Association and the American Academy of Allergy, Asthma and Immunology, do not consider MCS a distinct physical disorder. There are several reasons for this.

First, there is a lack of clinical evidence to support a physical cause for the symptoms. In addition, people with MCS do not develop antibodies in response to chemical exposure, as is the case with an immune system, or allergic reaction. Further, people with MCS also have high rates of mental health disorders, including depression, anxiety and somatoform disorders -- mental disorders that are expressed through physical symptoms. About 50% of people with MCS meet the criteria for depression and/or anxiety disorders. Much of the controversy, then, centers on whether the symptoms associated with MCS are caused by physical or psychological factors.

What Are the Symptoms of MCS?

People with MCS have reported a wide range of symptoms, including:

• Headache
• Fatigue
• Dizziness
• Nausea
• Irritability
• Confusion
• Difficulty concentrating
• Intolerance to heat or cold
• Earache
• Stuffy head or congestion
• Itching
• Sneezing
• Sore throat
• Memory problems
• Breathing problems
• Changes in heart rhythm
• Chest pain
• Muscle pain and/or stiffness
• Bloating or gas
• Diarrhea
• Skin rash or hives
• Mood changes

How Common Is MCS?

Many healthcare practitioners do not recognize MCS as a disorder and, therefore, do not make a diagnosis of MCS. For this reason, it is not possible to assess how many people actually suffer from MCS. One estimate suggests that 2%-10% of people suffer some disruption in their lives because of MCS, although other experts believe these estimates are too high. The U.S. Environmental Protection Agency reported that about one-third of people working in sealed buildings claimed to be sensitive to one or more common chemicals. More women than men claim to have MCS, and it appears to occur most often in people between the ages of 30 and 50 years.

What Causes MCS?

The cause of MCS is unknown. One theory suggests that chemicals traveling in the air enter the nose and affect an area of the brain called the limbic system. The limbic system plays a role in emotions, motivated behavior, and memory, which may make a person more sensitive to a chemical odor previously encountered, a condition called cacosmia. However, this theory has not been proven.

Another theory suggests that the immune system is somehow damaged in people with MCS. Yet another theory, called "toxic-induced loss of tolerance" (TILT), suggests that acute or chronic exposure to chemicals causes some susceptible people to lose their tolerance for chemicals they previously could tolerate. Again, there is little evidence to support this theory.

People with MCS identify many products as chemical triggers, including:

• Tobacco smoke
• Perfume
• Traffic exhaust or gasoline fumes
• Nail polish remover
• Newspaper ink
• Hair spray
• Paint or paint thinner
• Insecticides
• Artificial colors, sweeteners and preservatives in food
• Adhesive tape
• New carpet
• Flame retardants on clothing and furniture (such as mattresses)
• Felt tip pens
• Chlorine in swimming pools

How Is MCS Diagnosed?

There are no tests to diagnose MCS. A doctor generally bases his or her diagnosis on the person's description of symptoms, usually following a complete medical history and physical examination. The doctor may use diagnostic tests, such as X-rays and blood tests, to rule out true allergies and other physical or mental health disorders as the cause of the symptoms.

How Is MCS Treated?

Approaches to treatment vary. Most healthcare providers recommend avoiding the chemicals or foods that seem to trigger reactions. Some providers refer people with MCS to psychiatrists or psychologists, mental health professionals specially trained to diagnose and treat mental health disorders.

In most cases, the best course of action is for the person to stay in regular contact with a trusted healthcare provider. Within this doctor-patient relationship, the doctor can monitor the symptoms and stay alert to any changes. The doctor's main approach is likely to focus on reassuring and supporting the person, and preventing unnecessary tests and treatments. It may be necessary, however, to treat some of the symptoms, such as headaches or pain.

Can MCS Be Prevented?

Because little is known about the cause of MCS symptoms, it is not known if the disorder can be prevented.

Latex Allergy

Latex, also known as rubber or natural latex, is derived from the milky sap of the rubber tree, found in Africa and Southeast Asia.

Latex allergy is an allergic reaction to substances in natural latex. Rubber gloves are the main source of allergic reactions, although latex is also used in other products such as condoms and some medical devices.

What Causes Latex Allergy?

The exact cause of latex allergy is unknown, but it is thought that repeated exposure to latex and rubber products may induce symptoms.

About 5% to 10% of healthcare workers have some form of allergy to latex.

Who Is Affected By Latex Allergy?

Other than healthcare workers, people at increased risk for developing latex allergy include those who have:

• A defect in their bone marrow cells.
• A deformed bladder or urinary tract.
• A history of multiple surgeries.
• A urinary catheter, which has a rubber tip.
• Allergy, asthma or eczema.
• Food allergies to bananas, avocados, kiwis or chestnuts.

Rubber industry workers and condom users are also at increased risk for developing a latex allergy.

How Do People Get Exposed?

Routes of exposure include:

• Through the skin, as occurs when latex gloves are worn.
• Through mucous membranes, such as the eyes, mouth, vagina and rectum.
• Through inhalation. Rubber gloves contain a powder that can be inhaled.
• Through the blood, as may occur when some medical devices containing rubber are used.

What Happens During a Latex Reaction?

There are three types of latex reactions:

• Irritant contact dermatitis. The least threatening type of latex reaction, classified as a non-allergenic skin reaction. It usually occurs as a result of repeated exposure to chemicals in latex gloves and results in dryness, itching, burning, scaling and lesions of the skin.
• Allergic contact dermatitis. A delayed reaction to additives used in latex processing, which results in the same type of reactions as irritant contact dermatitis (dryness, itching, burning, scaling and lesions of the skin), but the reaction is more severe, spreads to more parts of the body and lasts longer.
• Immediate allergic reaction (latex hypersensitivity). The most serious reaction to latex. It can show up as rhinitis with hay fever-like symptoms, conjunctivitis (pink eye), cramps, hives and severe itching. It is rare, but symptoms may progress to include rapid heartbeat, tremors, chest pain, difficulty breathing, low blood pressure, anaphylactic shock or potentially, death.

What Should I Do When a Latex-Allergy Reaction Occurs?

Allergic reactions to latex can range from skin redness and itching to more serious symptoms, such as hives or gastrointestinal problems. True allergic reactions to latex rarely progress to the life-threatening conditions such as low blood pressure, difficulty breathing or rapid heart rate. However, if left untreated, these conditions could potentially result in death.

If you experience severe symptoms, call your doctor or 911 immediately, or go to the nearest emergency room.

How Is Latex Allergy Diagnosed?

A latex allergy is diagnosed in people who:

• Have experienced signs or symptoms of allergic reaction (skin rash, hives, eye tearing or irritation, wheezing, itching, difficulty breathing) when exposed to latex or natural rubber products.
• Do not have signs or symptoms of latex allergy but are known to be at risk for latex allergy and have a positive blood or skin test for latex allergy.

Skin testing for latex allergy should only be done with the close supervision of an allergy specialist because of the risk of severe reactions.

How Is Latex Allergy Treated?

Reactions may be treated by removal of the latex product and drug treatment according to the type of symptoms developing. If the symptoms are irritant contact dermatitis, antihistamine and/or corticosteroid medicines may be enough to treat symptoms. Severe reactions should also be treated with epinephrine, intravenous fluids and other support by hospital or emergency personnel.

If you have a latex allergy, it is important for you to wear a MedicAlert bracelet and carry an emergency epinephrine syringe.

There is no cure for latex allergy, so the best treatment for this condition is prevention.

How Can I Make My Home Safe?

If you're at risk for serious reactions to latex, you must make many lifestyle changes to ensure a latex-safe environment. While it may require leading a more protected and isolated life, you can continue certain activities when precautions are taken. Here are some tips:

• Use basic latex alternatives (see below).
• Keep all shoes, boots and sneakers in covered containers.
• Never travel alone. Always travel with another person, especially to doctor appointments where you might accidentally come into contact with latex.
• Plan in advance to ensure latex avoidance at any family function or party.

Because a latex allergy becomes worse with each exposure, you should avoid products containing latex. While it is difficult to obtain full and accurate information on the latex content of products, you may become better informed by checking with suppliers before buying a product.

The following list highlights some (but not all) of the latex products you should avoid in the home:

• Rubber sink stoppers and sink mats
• Rubber or rubber-grip utensils
• Rubber electrical cords or water hoses
• Bath mats and floor rugs that have rubber backing
• Toothbrushes with rubber grips or handles
• Rubber tub toys
• Sanitary napkins (that contain rubber)
• Condoms/diaphragms
• Diapers that contain rubber
• Adult undergarments that contain rubber
• Waterproof bed pads containing rubber
• Undergarments, socks and other clothing with elastic bands that contain rubber
• Adhesives such as glue, paste, art supplies, glue pens
• Older Barbie dolls and other dolls that are made of rubber
• Rubber bands, mouse and keyboard cords, desktop and chair pads, rubber stamps
• Mouse and wrist pads containing rubber
• Keyboards and calculators with rubber keys or switches
• Pens with comfort grip or any rubber coating
• Remote controllers for TVs or VCRs with rubber grips or keys
• Camera, telescope or binocular eye pieces
• Bathing caps and elastic in bathing suits

What Products Should I Avoid Outside the Home?

The following list highlights some (but not all) of the latex products you should avoid outside the home:

• Grocery store checkout belts
• Restaurants where workers use latex gloves for food preparation (call ahead to ensure your safety)
• Balloons
• Auto races that emit tire and rubber particles
• ATM machine buttons (often made of rubber)

Other products containing rubber include:

• Tourniquets
• Blood pressure pads
• EKG pads
• Some adhesive bandages
• Dental devices

Latex Alternatives

There are many alternatives that can be used in place of latex. These include:

Latex Product	Alternative
Balloons	Mylar balloons
Baby toys	Plastic or cloth toys
Bottle nipples	Silicone nipples
Condoms	Sheep cecum condoms (for birth control only)
Elastic bands	Paper clips, string, or twine
Household gloves	Synthetic or cotton gloves
Raincoat	Nylon or synthetic waterproof coats
Shoes with rubber	Leather or synthetic shoes
Telephone cords	Clear cords

What Should I Do During Doctor Visits?

If you have a known latex allergy and must visit the doctor or dentist, inform the doctor of your latex allergy at least 24 hours before your scheduled appointment. The hospital or doctor's office should have a latex-free protocol that they follow for patients with latex allergies.

If you have to stay in the hospital, you will usually be given your own room, free of latex products.

Do I Have to Change My Diet?

Latex allergies may also cross over into food groups. Or if you are already allergic to certain foods, you may be at high risk for developing a latex allergy.

The following foods can trigger a latex-like allergic reaction because the proteins in them mimic latex proteins as they break down in the body:

Banana	Fig
Kiwi	Peach
Grape	Celery
Papaya	Tomato
Nectarine	Avocado
Melon	Potato
Cherry	Rye
Strawberry	Wheat
Plum	Chestnut
Pineapple	Hazelnut

Note: Not all people who have these food allergies will also have latex allergies.

Allergic Reactions to Insect Stings

Bee, wasp, yellow jacket, hornet or fire ant stings are the insect stings that most often trigger allergic reactions. However, most people are not allergic to insect stings and may mistake a normal sting reaction for an allergic reaction. By knowing the difference, you can prevent unnecessary worry and visits to the doctor.

The severity of an insect sting reaction varies from person to person. There are three types of reactions -- normal, localized and allergic:

• A normal reaction will result in pain, swelling and redness around the sting site.
• A large local reaction will result in swelling that extends beyond the sting site. For example, a person stung on the ankle may have swelling of the entire leg. While it often looks alarming, it is generally no more serious than a normal reaction.
• The most serious reaction to an insect sting is an allergic one (described below). This condition requires immediate medical attention.

What Are the Symptoms?

Symptoms of a severe allergic reaction (called an anaphylactic reaction) may include one or more of the following:

• Difficulty breathing
• Hives that appear as a red, itchy rash and spread to areas beyond the sting
• Swelling of the face, throat or mouth tissue
• Wheezing or difficulty swallowing
• Restlessness and anxiety
• Rapid pulse
• Dizziness or a sharp drop in blood pressure

Although severe allergic reactions are not that common, they can lead to shock, cardiac arrest, and unconsciousness in 10 minutes or less. This type of reaction can occur within minutes after a sting and can be fatal. Get emergency treatment as soon as possible.

A mild allergic reaction to an insect sting may cause one or more of the following symptoms at the site of the sting:

• Pain
• Redness
• Pimple-like spots
• Mild to moderate swelling
• Warmth at the sting site
• Itching

People who have experienced an allergic reaction to an insect sting have a 60% chance of a similar or worse reaction if they are stung again.

How Common Are Sting Allergies?

About 2 million Americans are allergic to the venom of stinging insects. Many of these individuals are at risk for life-threatening allergic reactions. Approximately 50 deaths each year in the U.S. are attributed to allergic reactions to insect stings.

How Are Normal or Localized Reactions Treated?

First, if stung on the hand, remove any rings from your fingers immediately.

If stung by a bee, the bee usually leaves a sac of venom and a stinger in your skin. Remove the stinger within 30 seconds to avoid receiving more venom. Gently scrape the sac and stinger out with a fingernail or a stiff-edged object like a credit card. Do not squeeze the sac or pull on the stinger -- this will cause the release of more venom into the skin.

Wash the stung area with soap and water, then apply an antiseptic.

Apply a soothing ointment, like a hydrocortisone cream or calamine lotion and cover the area with a dry, sterile bandage.

If swelling is a problem, apply an ice pack or cold compress to the area.

Take an over-the-counter oral antihistamine to reduce itching, swelling and hives. However, this medication should not be given to children under 2 years of age or to pregnant women without prior approval from a doctor.

To relieve pain, take a nonsteroidal anti-inflammatory medication such as ibuprofen.

In general, pregnant women should consult their doctors before taking any over-the-counter medicine.

Also, carefully read the warning label on any medicines before taking it. Parents of children and people with medical conditions should consult a pharmacist if they have questions about a medicine's use.

How Are Allergic Reactions Treated?

An allergic reaction is treated with epinephrine (adrenaline), either self-injected or administered by a doctor. Usually this injection will stop the development of severe allergic reaction.

In some cases, intravenous fluids, oxygen and other treatments are also necessary. Once stabilized, you are sometimes required to stay overnight at the hospital under close observation. People who have had previous allergic reactions must remember to carry epinephrine with them wherever they go.

Also, because one dose may not be enough to reverse the reaction, immediate medical attention following an insect sting is still recommended.

How Can I Avoid Being Stung?

You can lessen your chances of an insect sting by taking certain precautionary measures:

• Learn to recognize insect nests and avoid them. Yellow jackets nest in the ground in dirt mounds or old logs and walls. Honeybees nest in beehives. Hornets and wasps nest in bushes, trees, and on buildings.
• Wear shoes and socks when outdoors.
• Wear long-sleeved shirts, long pants, socks and shoes when in country or wooded areas.
• Avoid wearing perfumes or brightly colored clothing. They tend to attract insects.
• If you have severe allergies, you should never be alone when hiking, boating, swimming, golfing or otherwise involved outdoors because you might need prompt medical treatment if stung.
• Use insect screens on windows and doors at home. Use insect repellents. Spray bedrooms with aerosols containing insecticide before going to bed.
• Spray garbage cans regularly with insecticide and keep the cans covered.
• Avoid or remove insect-attracting plants and vines growing in and around the house.
• A severely allergic person should always wear a MedicAlert bracelet and keep a self-care kit (described below) on hand for emergency use in the case of severe symptoms. For more information on where to get a MedicAlert bracelet, you can call 1-800-ID-ALERT.

What Are Epinephrine Sting Kits?

Epinephrine self-administration kits are important for you to use immediately after being stung, before you get to a doctor for treatment. The two most common have the brand names Ana-Kit and Epi-Pen. However, these kits should not be used as a substitute for medical intervention. You should still see a doctor after being stung. Epinephrine alone is not always enough to reverse serious allergic sting reactions and may cause serious side effects in some people with heart conditions or people who are taking certain medicines.

You will need a prescription from your doctor to purchase one of these kits. Before using, be sure to let your doctor know about any medicine you are taking to prevent drug interactions.

How Can I Prevent an Allergic Reaction?

Allergic reactions to insect stings can be prevented with allergy shots. The treatment is about 97% effective in preventing future reactions and involves injecting gradually increasing doses of venom that stimulate your immune system to become resistant to a future allergic reaction.

If you've had an allergic reaction, it's important to talk to an allergist, a doctor who specializes in the diagnosis and treatment of allergic disease. Based on your history and test results, the allergist will determine if you are a candidate for immunotherapy treatment.

Hives (Urticaria and Angioedema)

Hives, also known as urticaria, are an outbreak of swollen, pale red bumps or patches (wheals) on the skin that appear suddenly -- either as a result of the body's adverse reaction to certain allergens, or for unknown reasons.

Hives usually cause itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to several days before fading.

Angioedema is similar to urticaria, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands and feet. It generally lasts longer than urticaria, but the swelling usually goes away in less than 24 hours.

Occasionally, severe, prolonged tissue swelling can be disfiguring. Rarely, angioedema of the throat, tongue or lungs can block the airways, causing difficulty breathing. This may become life threatening.

What Causes Hives and Angioedema?

Hives and angioedema form when, in response to histamine, blood plasma leaks out of small blood vessels in the skin. Histamine is a chemical released from specialized cells along the skin's blood vessels.

Allergic reactions, chemicals in foods, insect stings, sunlight exposure, or medicines can all cause histamine release. Sometimes it's impossible to find out exactly why hives have formed.

There are several different types of hives and angioedema, including:

• Acute urticaria and/or angiodema: Hives or swelling lasting less than six weeks. The most common causes are foods, medicines, latex, or infections. Insect bites and internal disease may also be responsible.
  The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, soy, wheat and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame.
  Medicines that can cause hives and angioedema include aspirin and other nonsteroidal anti-inflammatory medications such as ibuprofen, high blood pressure medications (ACE inhibitors), or painkillers such as codeine.

• Chronic urticaria and/or angioedema: Hives or swelling lasting more than six weeks. The cause of this type of hives is usually more difficult to identify than those causing acute urticaria and/or angioedema.
  Chronic urticaria and angioedema can affect other internal organs such as the lungs, muscles and gastrointestinal tract. Symptoms include muscle soreness, shortness of breath, vomiting and diarrhea.

• Physical urticaria: Hives caused by direct physical stimulation of the skin -- for example, cold, heat, sun exposure, vibration, pressure, sweating, and exercise. The hives usually occur right where the skin was stimulated and rarely appear anywhere else. Most of the hives appear within one hour after exposure.

• Dermatographism: Hives that form after firmly stroking or scratching the skin. These hives can also occur along with other forms of urticaria.

How Are Hives and Angioedema Diagnosed?

Your doctor will need to ask many questions in an attempt to find the possible cause. Since there are no specific tests for hives -- or the associated swelling of angioedema -- testing will depend on your medical history and a thorough examination by your primary care doctor or dermatologist.

Skin tests may be performed to determine the substance that you are allergic to. Routine blood tests are done to determine if a system-wide illness is present.

How Are Hives and Angioedema Treated?

The best treatment for hives and associated swelling is to identify and remove the trigger, but this is not an easy task. Antihistamines are usually prescribed by your doctor or dermatologist to provide relief from symptoms. These medications may also be taken on a regular schedule to help prevent hives and associated swelling from forming in the first place.

Chronic hives may be treated with antihistamines or a combination of medications. When antihistamines don't provide relief, oral corticosteroids may be prescribed.

For severe hive or angioedema outbreaks, an injection of epinephrine or a steroid medication may be needed.

How Can Hives Be Managed?

While you're waiting for the hives and swelling to disappear, here are some tips:

• Avoid hot water; use lukewarm water instead.
• Use gentle, mild soap.
• Apply cool compresses or wet cloths to the affected areas.
• Try to work and sleep in a cool room.
• Wear loose-fitting lightweight clothes.

When Should I Call the Doctor?

If hives or angioedema occur with any of the following symptoms, contact your doctor right away:

• Dizziness
• Wheezing
• Difficulty breathing
• Tightness in the chest
• Swelling of the tongue, lips, or face

Food Allergies

A food allergy occurs when your immune system responds defensively to a specific food protein that is not harmful to the body.

The first time you eat the offending food, your immune system responds by creating specific disease-fighting antibodies (called immunoglobulin E or IgE). When you eat the food again, the IgE antibodies spring into action, releasing large amounts of histamine in an effort to expel the "foreign invader" from your body. Histamine is a powerful chemical that can affect the respiratory system, gastrointestinal tract, skin or cardiovascular system.

What Are the Symptoms of a Food Allergy?

Symptoms may appear almost immediately, or up to two hours after you've eaten the food. Symptoms can include a tingling sensation of the mouth, swelling of the tongue and throat, hives, skin rashes, vomiting, abdominal cramps, difficulty breathing, diarrhea, a drop in blood pressure, or even a loss of consciousness. Severe reactions -- called anaphylaxis -- can result in death.

Which Foods Most Often Cause Allergic Reactions?

The following foods cause over 90% of food allergies - milk, eggs, fish, shellfish, peanuts, wheat, soy, and tree nuts (such as walnuts, pecans and almonds).

How Are Food Allergies Diagnosed?

Your doctor may do a radioallergosorbent blood test (RAST) to check the number of antibodies produced by your immune system. Elevated levels of certain types of antibodies can help your doctor identify specific food allergies.

The doctor may also perform an allergy skin test, also called a scratch test, to identify the substances that are causing your allergy symptoms.

By keeping a food diary, your doctor will have a much better starting point to determine the foods that could trigger your allergies. You may be asked to eliminate all potentially allergenic foods and then add them back to your diet one at a time to see if they prompt any reaction. This is called an "elimination and challenge diet."

How Are Food Allergies Treated?

The best way to cope with a food allergy is to strictly avoid the foods that cause a reaction. Mild reactions often will subside without treatment. For rashes, skin creams may ease discomfort while antihistamines can help reduce itching and other symptoms.

For more serious reactions, corticosteroids such as prednisone will help to reduce swelling. In life-threatening situations, an epinephrine injection can immediately begin to reverse symptoms and is the only effective treatment option.

How Can I Be Prepared?

Once you and your doctor have determined which foods you should avoid, stay away from them. However, it is important that you maintain a healthy, nutritious diet. Ask your doctor to recommend foods that will provide you with the necessary nutrients.

You should also be aware of the ingredients in processed foods. Be sure to read labels. A registered dietitian can help you learn how to read food labels to discover hidden sources of food allergens.

If you are prone to allergic reactions, ask your doctor to prescribe an epinephrine injection kit and carry it with you at all times.

Eczema

Eczema is term for a group of medical conditions that cause the skin to become inflamed or irritated.

The most common type of eczema is known as atopic dermatitis, or atopic eczema. Atopic refers to a group of diseases with an often inherited tendency to develop other allergic conditions, such as asthma and hay fever.

According to the National Institute of Allergy and Infectious Disease, the prevalence of atopic eczema is increasing and affects 9 to 30% of the U.S. population. It is particularly common in young children and infants. While many infants who develop the condition outgrow it by their second birthday, some people continue to experience symptoms on and off throughout life. With proper treatment, the disease can be controlled in the majority of sufferers.

What Are the Symptoms?

No matter which part of the skin is affected, eczema is almost always itchy. Sometimes the itching will start before the rash appears, but when it does the rash most commonly occurs on the face, knees, hands or feet. It may also affect other areas as well.

Affected areas usually appear very dry, thickened or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brown. Among darker-skinned people, eczema can affect pigmentation, making the affected area lighter or darker.

In infants, the itchy rash can produce an oozing, crusting condition that occurs mainly on the face and scalp, but patches may appear anywhere.

What Causes It?

The exact cause of eczema is unknown, but it's thought to be linked to an overactive response by the body's immune system to an irritant. It is this response that causes the symptoms of the disease.

In addition, eczema is commonly found in families with a history of other allergies or asthma.

Some people may suffer "flare-ups" of the itchy rash in response to certain substances or conditions. For some, coming into contact with rough or coarse materials may cause the skin to become itchy. For others, feeling too hot or too cold, exposure to certain household products like soap or detergent, or coming into contact with animal dander may cause an outbreak. Upper respiratory infections or colds may also be triggers. Stress may cause the condition to worsen.

Although there is no cure, most people can effectively manage their disease with medical treatment and by avoiding irritants. The condition is not contagious and can't be spread from person to person.

How Is It Diagnosed?

A pediatrician, dermatologist or your primary care provider can make a diagnosis of eczema. Since many people with eczema also suffer from allergies, your doctor may perform allergy tests to determine possible irritants or triggers. Children with eczema are especially likely to be tested for allergies.

How Is It Treated?

The goal of treatment is to relieve and prevent itching, which can lead to infection. Since the disease makes skin dry and itchy, lotions and creams are recommended to keep the skin moist. These solutions are usually applied when the skin is damp, such as after bathing, to help the skin retain moisture. Cold compresses may also be used to relieve itching.

Over-the-counter or prescription creams and ointments containing corticosteroids, such as hydrocortisone, are often prescribed to reduce inflammation. For severe cases, your doctor may prescribe oral corticosteroids. In addition, if the affected area becomes infected, your doctor may prescribe antibiotics to kill the infection-causing bacteria.

Other treatments include antihistamines to reduce severe itching, tar treatments (chemicals designed to reduce itching), phototherapy (therapy using ultraviolet light applied to the skin) and the drug cyclosporine for people whose condition doesn't respond to other treatments.

The FDA more recently has approved two drugs known as topical immunomodulators (TIMs) for the treatment of moderate-to-severe eczema. The drugs, Elidel and Protopic, are skin creams that work by altering the immune system response to prevent flare-ups.

On March 10, 2005, the FDA warned doctors to prescribe Elidel and Protopic with caution due to concerns over a possible cancer risk associated with their use.

As of January 2006, these two creams carry the FDA's strongest "black box" warning on their packaging to alert doctors and patients to these potential risks. The warning advises doctors to prescribe short-term use of Elidel and Protopic only after other available eczema treatments have failed in adults and children over the age of 2.

How Can Flare-ups Be Prevented?

Eczema outbreaks can usually be avoided or the severity lessened by following these simple tips.

• Moisturize frequently
• Avoid sudden changes in temperature or humidity
• Avoid sweating or overheating
• Reduce stress
• Avoid scratchy materials, such as wool
• Avoid harsh soaps, detergents and solvents
• Avoid environmental factors that trigger allergies (for example, pollen, mold, dust mites, and animal dander)
• Be aware of any foods that may cause an outbreak and avoid those foods

Allergies to Medications

Many drugs can cause adverse side effects, and certain medicines can trigger allergic reactions. In an allergic reaction, the immune system mistakenly responds to a drug by creating an immune response against it. The immune system recognizes the drug as a foreign substance and the body produces certain chemicals, such as large amounts of histamine in an attempt to expel the drug from the body.

What Are the Symptoms of Drug Allergy?

Symptoms can range from mild to life-threatening. Even in people who aren't allergic, many drugs can cause irritation, such as an upset stomach. But during an allergic reaction, the release of histamine can cause symptoms like hives, skin rash, itchy skin or eyes, congestion, and swelling in the mouth and throat.

A more severe reaction may include difficulty breathing, blueness of the skin, dizziness, fainting, anxiety, confusion, rapid pulse, nausea, diarrhea, and abdominal problems.

Which Drugs Most Often Cause an Allergic Reaction?

The most common drug associated with allergies is penicillin. Other antibiotics similar to penicillin can also trigger allergic reactions.

Other drugs commonly found to cause reactions include sulfa drugs, barbiturates, anticonvulsants, insulin, and iodine (found in many X-ray contrast dyes).

How Are Drug Allergies Diagnosed?

A doctor diagnoses a drug allergy by carefully reviewing your medical history and symptoms. If your doctor suspects that you are allergic to an antibiotic such as penicillin, he or she may do a skin test to confirm it. However, skin testing does not work for all drugs, and in some cases it could be dangerous. If you have had a severe, life-threatening reaction to a particular drug, your doctor will simply rule out that drug as a treatment option for you. Conducting an allergy test to determine if the initial reaction was a "true" allergic response isn't worth the risk.

How Are Drug Allergies Treated?

The primary goal when treating drug allergies is symptom relief. Symptoms such as rash, hives and itching can often be controlled with antihistamines, and occasionally corticosteroids.

For coughing and lung congestion, drugs called bronchodilators may be prescribed to widen the airways. For more serious anaphylactic symptoms -- life-threatening reactions including difficulty breathing or loss of consciousness -- epinephrine may be given.

Occasionally, desensitization is used for penicillin allergy. This technique decreases your body's sensitivity to particular allergy-causing agents. Tiny amounts of penicillin are injected periodically in increasingly larger amounts until your immune system learns to tolerate the drug.

If you are severely allergic to certain antibiotics, there are alternative antibiotics your doctor can prescribe.

How Can I Be Prepared?

If you have a drug allergy, you should always inform your healthcare provider before undergoing any type of treatment, including dental care. It is also a good idea to wear a MedicAlert bracelet or pendant, or carry a card that identifies your drug allergy. In cases of emergency, it could save your life.

Allergies and Cosmetics

Products such as moisturizers, shampoos, deodorants, make-up, colognes, and other cosmetics have become part of our daily grooming habits. The American Academy of Dermatology reports the average adult uses at least seven different cosmetic products each day. Although cosmetics can help us feel more beautiful, they can cause skin irritation or allergic reactions. Certain ingredients used in cosmetics, such as fragrances and preservatives, can act as antigens, substances that trigger an allergic reaction.

What Are the Symptoms of a Cosmetic Reaction?

There are two reactions that might occur following exposure to cosmetics: irritant contact dermatitis and allergic contact dermatitis. Contact dermatitis is a condition marked by areas of inflammation (redness, itching and swelling) that form after a substance comes into contact with your skin.

• Irritant contact dermatitis: This is more common than allergic contact dermatitis and can occur in anyone. It develops when an irritating or harsh substance actually damages the skin. Irritant contact dermatitis usually begins as patches of itchy, scaly skin or a red rash, but can develop into blisters that ooze, especially if the skin is further irritated from scratching. It generally occurs at the site of contact with the irritating substance. Areas where the outermost layer of skin is thin, such as the eyelids, or where the skin is dry and cracked are more susceptible to irritant contact dermatitis.
• Allergic contact dermatitis: This occurs in people who are allergic to a specific ingredient or ingredients in a product. Symptoms include redness, swelling, itching, and hive-like breakouts. In some cases, the skin becomes red and raw. The face, lips, eyes, ears, and neck are the most common sites for cosmetic allergies, although reactions may appear anywhere on the body.

The time it takes for symptoms of irritant contact dermatitis to appear varies. For stronger irritants, such as perfumes, a reaction may occur within minutes or hours of exposure. However, it may take days or weeks of continued exposure to a weaker irritant, such as soap, before symptoms appear. In some cases, a person can develop an allergic sensitivity to a product after years of use.

What Causes Cosmetic Reactions?

With irritant contact dermatitis, the skin breaks down when it comes into contact with harsh substances, most often chemicals that directly injure the outer layer of the skin, resulting in symptoms.

Allergic contact dermatitis occurs because the body's immune system is reacting against a specific substance (the allergen) that it considers foreign and harmful.

How Common Are Reactions to Cosmetics?

Serious allergic reactions associated with cosmetics are rare. However, it is not uncommon for a person to have a mild reaction or irritation to an ingredient in a cosmetic product. Studies suggest that up to 10% of the population will have some type of reaction to a cosmetic over the course of a lifetime. Reactions to cosmetics occur more often in women, most likely because women tend to use more cosmetic products than do men.

What Should I Do If I Have a Reaction?

If you have a reaction, stop using all cosmetics. When your symptoms are gone, start using them again, one product at a time. This may help you determine which product or products are responsible for the reaction. If you cannot identify the source of the reaction or if your symptoms do not go away after you stop using the cosmetics, consult your healthcare provider.

How Are Allergic Reactions Diagnosed?

Reactions are diagnosed by the appearance of symptoms and your history of exposure to various cosmetic products. Because most adults use many cosmetic products, identifying the product responsible for the reaction may be difficult. If your doctor suspects allergic contact dermatitis, he or she may use a patch skin test to identify the substances to which you are allergic.

How Are Cosmetic Reactions Treated?

Treatment generally involves avoiding the products causing the symptoms. Over-the-counter creams and ointments that contain cortisone, such as hydrocortisone (Cortisone 10) and hydrocortisone acetate (Cort-aid), may be used to help control itching, swelling, and redness. In more severe cases, a prescription-strength medication may be needed to relieve symptoms. If blistered skin becomes infected, an antibiotic medication may also be needed.

What Can I Do to Prevent Cosmetic Reactions?

There are several steps you can take to try and avoid cosmetic allergy reactions, including:

• Read the list of ingredients on all cosmetic products. If you find an ingredient that has caused a reaction in the past, don't use that product. Keep track of ingredients that have caused reactions, and look for products that do not contain those ingredients.
• When considering a new product, do a "mini-patch test" first to see if it causes a reaction. Put a sample of the product on your inner wrist or elbow and wait 24 hours to see if a reaction occurs.
• Keep it simple. Choose products with simple formulas. More ingredients mean more potential allergens. With fewer ingredients, it's also easier to pinpoint the source if you do have a reaction.
• Apply perfume to your clothes rather than your skin, and allow the perfume to dry before putting on the clothes.
• Be especially careful with makeup because it stays in contact with the skin for a long time. Look for products that are hypoallergenic, fragrance free, and non-comedogenic, although products with these labels may still cause reactions.

Making Sense of Product Labels

To get the best benefit from cosmetics and skin care products, it's important to be aware of each product's ingredients and to look for and avoid ingredients that are known allergens for you. To make this easier, the FDA requires cosmetic manufacturers to list the ingredients on the product label. Ingredients are listed in descending order of amount. Keep in mind, however, that trade secrets (including certain fragrances) do not have to be specifically listed.

Also, keep in mind that products labeled "unscented" or "fragrance free" may still contain small amounts of fragrances needed to cover the odor of other chemical ingredients. "Natural" generally means that the product includes ingredients extracted from plants or animal products rather than ingredients produced chemically. Products labeled "non-comedogenic" do not contain ingredients that commonly clog pores, which can lead to acne.

Labeling of cosmetics can be helpful when looking for specific ingredients, but be wary of certain product claims. For example, many products use the term "hypoallergenic," although there are no regulations or standards for use of this term. "Hypoallergenic" suggests that a product is less likely than another, similar product to cause an allergic reaction, but manufacturers are not required to prove this claim. In addition, products labeled "organic" are not less likely to cause an allergic reaction. Just remember: There is no cosmetic product that can guarantee never to produce an allergic reaction.

More Safety Tips:

• Always use good personal hygiene. Be sure to clean your hands and face before applying make-up.
• Never share make-up.
• If you want to test a product in the store, ask for a new, unused applicator and ask the salesperson to wipe the opening of the tester with alcohol.
• Keep cosmetic containers tightly closed, except when being used. Keep containers free of dust and dirt.
• Keep cosmetics away from heat and out of direct sunlight.
• Do not use eye make-up if you have an eye infection, such as conjunctivitis. Discard those products and use new ones when your infection is gone.
• Discard products if the color changes or they develop an odor. This may mean the preservatives in the products are no longer able to fight bacteria.
• If the consistency of a product changes, do not add water. Discard the product.
• Clean cosmetic brushes and applicators frequently.

Asthma and Allergies

Asthma is a disease of the branches of the windpipe (bronchial tubes), which carry air in and out of the lungs. There are several different types of asthma.

Allergic asthma is a type of asthma that is triggered by an allergy (for example, pollen or mold spores). According to the American Academy of Allergy, Asthma and Immunology, half of the 20 million Americans with asthma have allergic asthma.

Air is normally taken into the body through the nose and windpipe and into the bronchial tubes. At the end of the tubes are tiny air sacs called alveoli that deliver fresh air (oxygen) to the blood. The air sacs also collect stale air (carbon dioxide), which is exhaled out of the body. During normal breathing, the bands of muscle surrounding the airways are relaxed and air moves freely. But during an asthma episode or "attack," there are three main changes that stop air from moving freely into the airways:

• The bands of muscle that surround the airways tighten, causing them to narrow in what is called a "bronchospasm."
• The lining of the airways becomes swollen, or inflamed.
• The cells that line the airways produce more mucus, which is thicker than normal.

The narrowed airway traps stale air (carbon dioxide) in the lungs. As a result, people with asthma feel they cannot get enough air into the lungs. All of these changes make breathing difficult.

What Are the Most Common Symptoms of Asthma?

Symptoms strike when your airways undergo the three changes described above. Some people can go a long time between asthma episodes while others have some symptoms every day. Common symptoms of asthma include:

• Frequent cough, especially at night
• Shortness of breath
• Wheezing
• Chest tightness, pain, or pressure

Not every person with asthma has the same symptoms in the same way. You may not have all of these symptoms, or you may have different symptoms at different times. Your symptoms may also vary from one asthma episode to the next. Symptoms may be mild during one asthma episode and severe during another.

Mild asthma episodes are generally more common. Usually, the airways open up within a few minutes to a few hours. Severe episodes are less common, but last longer and require immediate medical help. It is important to recognize and treat even mild symptoms to help you prevent severe episodes and keep asthma in control.

If you suffer from allergies and asthma, a reaction to any offending allergy-causing substance can worsen asthma symptoms.

What Are the Early Warning Signs of an Asthma Attack?

Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These changes start before the more prominent symptoms of asthma and are the earliest signs that a person's asthma is worsening. Early warning signs and symptoms include:

• Frequent cough, especially at night
• Losing your breath easily or shortness of breath
• Feeling very tired or weak when exercising, in addition to wheezing, coughing, or shortness of breath
• Decreases or changes in peak expiratory flow, a measurement of how fast air comes out of your lungs when you exhale forcefully
• Signs of a cold or other upper respiratory infections, or allergies
• Difficulty sleeping

If you have any of these symptoms, seek treatment as soon as possible to prevent experiencing a severe asthma attack.

Who Gets Asthma?

Anyone can get asthma, although it tends to run in families. An estimated 20 million adults and children in the U.S. have asthma. For unknown reasons, this disease is becoming more widespread.

What Causes Asthma?

Asthma is a problem in the airways, but the exact cause is unknown. The airways in a person with asthma are very sensitive and react to many things, which are referred to as "triggers." Coming into contact with these triggers often produces asthma symptoms.

There are many kinds of asthma triggers. Reactions are different for each person and vary from time to time. Some people have many triggers while others have none that they can identify. One of the most important aspects of asthma control is avoiding triggers when possible.

Common asthma triggers include:

• Infections: colds, flu, sinus infections
• Exercise: very common in children*
• Weather: cold air, changes in temperature
• Tobacco smoke and air pollution
• Allergens: substances that cause allergic reactions in the lungs, including dust mites, pollens, pets, mold spores, foods and cockroaches
• Dust or items causing dust
• Strong odors from chemical products
• Strong emotions: things such as anxiety, crying, yelling or laughing hard
• Medicines: including aspirin, ibuprofen and beta blocker medications used to treat conditions including high blood pressure, migraines or glaucoma

*Note: Exercise is one trigger you should not avoid. With a good treatment plan, you can exercise as long and as much as desired, except during an asthma attack.

How Is Asthma Diagnosed?

Doctors can use a number of tests to diagnose asthma. First, the doctor reviews your medical history, symptoms, and general health. Next, tests may be given to check the general condition of your lungs, including:

• Chest X-ray in which a picture of the lungs is taken.
• Pulmonary function test (spirometry): A test that measures how well the lungs can take in air and how well this air can be exhaled (lung function). The Also measured is how efficiently the lungs can transfer oxygen into the blood. The patient blows into a tube placed between the lips.
• Peak expiratory flow: A test that measures the maximum amount of air that can be exhaled from the lungs. The patient blows into a hand-held device called a peak flow meter.
• Methacholine challenge test: A test used to see if the airways are sensitive to methacholine, an irritant that tightens the airways.
• Other tests, such as allergy tests, blood tests, sinus X-rays and other imaging scans, and esophageal (throat) pH tests may also be ordered. These tests can help your doctor find out if other conditions are affecting your asthma.

How Is Asthma Treated?

By avoiding asthma triggers, taking medicines and carefully monitoring daily asthma symptoms, asthma attacks can be avoided or at least limited. Proper use of medicines is the basis of good asthma control. Medicines used to treat asthma include bronchodilators, anti-inflammatories and leukotriene modifiers.

Bronchodilators

These medicines relax the muscle bands that tighten around the airways. They rapidly open the airways, letting more air in and out of the lungs and improving breathing.

Bronchodilators also help clear mucus from the lungs. As the airways open, the mucus moves more freely and can be coughed out more easily. In the short-acting form, bronchodilators relieve or stop asthma symptoms and are very helpful during an asthma attack. The three main types of bronchodilators are beta2 agonists, anticholinergics and theophylline.

Anti-inflammatories

These medicines, which include inhaled corticosteroids such as Azmacort, Flovent and Beclovent, reduce swelling and mucus production in the airways. As a result, airways are less sensitive and less likely to react to triggers. Anti-inflammatories are taken daily for several weeks before they begin to control asthma. These medicines lead to fewer symptoms, better airflow, less sensitive airways, less airway damage and fewer asthma episodes. If taken every day, they can control or prevent asthma symptoms.

Another type of anti-inflammatory asthma medication is cromolyn sodium. This medicine is a mast cell stabilizer, which means that it helps prevent the release of asthma-inducing chemicals from cells in the body known as mast cells. It is commonly used in children and for exercise-induced asthma.

Leukotriene modifiers

Leukotriene modifiers are newer asthma drugs and include the drugs Accolate and Singulair. Leukotrienes are chemicals that occur naturally in our bodies and cause tightening of airway muscles and production of mucus and fluid. Leukotriene modifiers work by limiting these reactions, improving airflow and reducing asthma symptoms. They are taken as pills (or as oral granules that can be mixed with food) one or two times a day and decrease the need for other asthma medications. The most common side effects are headache and nausea. Leukotriene modifiers may interact with other drugs, like Coumadin and theophylline. Inform your doctor about any medications you are taking.

How Are Asthma Medicines Taken?

Many asthma medicines are taken using a device called a "metered dose inhaler", a small aerosol canister in a plastic container that releases a burst of medication when pressed down from the top.

Several medicines can also be taken as a powder inhaled through the mouth from a device called a dry powder inhaler. Asthma medicines can also be taken as vapors, pills, liquids and shots.

What Else Should I Do to Help Control My Asthma?

It's also important to keep track of how well your lungs are functioning. Asthma symptoms are monitored using a peak flow meter -- a device that measures the maximum amount of air that comes out of your lungs when you exhale forcefully. This measurement is called peak expiratory flow (PEF) and is calculated in liters per minute.

The meter can alert you to changes in the airways that may be a sign of worsening asthma. By taking daily peak flow readings you can learn when to adjust medications to keep asthma under good control. Your doctor can also use this information to adjust your treatment plan.

Can Asthma Be Cured?

There's no cure for asthma, but it can be treated and controlled. In most cases, people with asthma can live free of symptoms by following their treatment plan.

What Research Is Being Done on Asthma?

There are many people studying asthma and how it can be controlled. A recent study by the National Institute of Allergy and Infectious Diseases found that cockroaches are a leading asthma trigger among children in inner-city areas. Recent studies have also focused on asthma in the elderly and pregnant women.

Anaphylaxis

Anaphylaxis is a serious, potentially life-threatening allergic response that is marked by swelling, hives, lowered blood pressure and dilated blood vessels. In severe cases, a person will go into shock. If anaphylactic shock isn't treated immediately, it can be fatal.

This condition occurs when the immune system creates specific disease-fighting antibodies (called immunoglobulin E or IgE) toward a substance that is normally harmless, such as food. When you are first exposed to the substance, your body does not react, but it does produce the antibodies. When you are exposed to the substance again, the antibodies spring into action, releasing large amounts of a protein called histamine. Histamine causes the symptoms described above.

What Are the Symptoms of Anaphylaxis?

Anaphylaxis may begin with severe itching of the eyes or face and, within minutes, progress to more serious symptoms. These symptoms include swallowing and breathing difficulties, abdominal pain, cramps, vomiting, diarrhea, hives and angioedema (swelling similar to hives, but the swelling is beneath the skin instead of on the surface).

If you have symptoms of anaphylaxis, seek emergency medical attention immediately. The condition can quickly result in an increased heart rate, sudden weakness, a drop in blood pressure, shock and ultimately unconsciousness and death.

What Are the Common Triggers of Anaphylaxis

Food is generally the most common cause of anaphylaxis. Common food triggers include nuts, shellfish (shrimp, lobster), dairy products, egg whites, and sesame seeds. Wasp or bee stings are also common causes of anaphylaxis.

Additionally, exercise can trigger anaphylaxis if the activity occurs after eating allergy-provoking food.

Pollens and other inhaled allergens (allergy-causing substances) rarely cause anaphylaxis.

Some substances can cause reactions -- called anaphylactoid reactions -- that are similar to and just as serious as anaphylaxis, but do not involve immunoglobulin E antibodies. Common causes are fish, latex, and some medications, such as penicillin.

How Is Anaphylaxis Diagnosed?

Anaphylaxis is diagnosed based on its symptoms. People with a history of allergic reactions may be at greater risk for developing a severe reaction in the future.

Skin testing may help confirm the substances that cause severe allergic reactions. However, this type of test may not be recommended if you have reason to suspect that you will have an anaphylactic reaction to the substance.

How Is Anaphylaxis Treated?

There is only one effective treatment for anaphylaxis -- epinephrine by injection. Epinephrine is adrenaline and it rapidly reverses anaphylactic symptoms. It is typically given through an automatic injection device. The most common injection site is the thigh.

If you are near someone who is going into anaphylactic shock, call for professional medical help immediately. CPR and other lifesaving measures may be required.

In addition to epinephrine, treatment for shock includes intravenous fluids and medicines that support the actions of the heart and circulatory system. After a person in shock is stabilized, antihistamines and steroids may be given to further reduce symptoms.

How Can I Be Prepared?

If you are allergic to bee stings or any other substances that cause anaphylaxis, you should always be prepared. Ask your doctor to prescribe an epinephrine injection kit and carry it with you at all times.

Also, it's important that you inform your healthcare provider of any drug allergies before undergoing any type of medical treatment, including dental care.

It is also a good idea to wear a MedicAlert bracelet or pendant, or carry a card that identifies your allergy. In cases of emergency, it could save your life.

Allergic Conjunctivitis

Conjunctivitis is one of the most common and treatable eye conditions in children and adults. Often called "pink eye," it is an inflammation of the conjunctiva, the tissue that lines the inside of the eyelid and helps keep the eyelid and eyeball moist.

Viruses, bacteria, irritating substances (shampoo, dirt, smoke, pool chlorine), sexually transmitted diseases (STDs) or allergens (substances that cause allergies) can all cause conjunctivitis. Pink eye caused by bacteria, viruses or STDs can spread easily from person to person but is not a serious health risk if diagnosed promptly; allergic conjunctivitis is not contagious.

It is important to find out whether your pink eye is caused by allergies or infection because each condition has different treatments. This article focuses on allergic conjunctivitis.

What Are the Symptoms of Allergic Conjunctivitis?

Symptoms of allergic conjunctivitis include:

• Redness in the white of the eye or inner eyelid
• Increased amount of tears
• Itchy eyes
• Blurred vision
• Swelling of the eyelid

See your ophthalmologist (a doctor and surgeon who is trained to treat eye conditions) optometrist (doctor trained to treat eye conditions) or family doctor if you have any of these persistent symptoms.

How Is Allergic Conjunctivitis Treated?

Allergy-associated conjunctivitis may disappear completely, either when the allergy is treated with antihistamines, or when the allergen is removed. Your doctor may recommend you use one or more of the following:

• Ocular (topical) decongestants: These medicines reduce redness by constricting small blood vessels in the eye. They are not recommended for long-term use. Using these drops for more than a few days can actually worsen symptoms.
• Ocular (topical) antihistamines: These medicines reduce redness, swelling and itching by blocking the actions of histamine, the chemical that causes these symptoms of allergy. They are available both over-the-counter and by prescription.
• Ocular (topical) steroids: When other medicines fail, your doctor may prescribe steroid eye drops to relieve the symptoms of conjunctivitis. These must be used with the supervision of your doctor since they can cause elevated pressure inside of the eye, which can lead to vision damage. Your doctor also must check for viral eye infections, such as herpes, before optical steroids are used. These drops can also increase the risk of cataracts, clouding of the lens of the eye that can impair vision.
• Cromolyn: This medicine works by preventing specialized cells from releasing histamine. It works best when started before symptoms occur.
• Immunotherapy: Allergy shots can be effective for treating allergic conjunctivitis.

What Can I Do to Relieve Symptoms?

To relieve symptoms of allergic conjunctivitis:

• Remove contact lenses, if you wear them.
• Place cold compresses on your eyes.
• Try nonprescription "artificial tears," a type of eye drop that may help relieve itching and burning (Note: Other types of eye drops may irritate the eyes and should not be used.) Do not use the same bottle of drops in the other eye if it is not affected.

The best defense against allergic conjunctivitis is a good offense: try to avoid substances that trigger your allergies.

Other Tips:

• Don't touch or rub the affected eye(s).
• Wash your hands often with soap and warm water.
• Wash your bed linens, pillowcases and towels in hot water and detergent to reduce allergens.
• Avoid wearing eye makeup.
• Don't share eye makeup with anyone else.
• Never wear another person's contact lens.
• Wear glasses instead of contact lenses to reduce irritation.
• Wash your hands before applying the eye drops or ointment to your eye or your child's eye.
• Do not use eye drops that were used in an infected eye in a non-infected eye.

Glossary of Terms

Adenoids: Glands or lymphoid tissue in the upper part of the throat behind the nose.

Adenoidectomy: The surgical removal of adenoids which may help prevent blockage of the nasal passageways and eustachian tubes. This may help to reduce recurrent sinus and ear infections, among other conditions. This is usually done as an outpatient procedure under general anesthesia.

Allergen: A substance that your body perceives as dangerous and causes an allergic reaction.

Allergic rhinitis: See Hay fever

Allergy: An exaggerated response to a substance or condition produced by the release of histamine or histamine-like substances in affected cells.

Allergy index: Measure of allergy sufferers who are affected by pollen in your region. Since some types of pollen may be more likely to cause allergies than others, a high allergy index does not necessarily correspond to a high pollen count.

Allergy shots: See Immunotherapy

Anaphylaxis: Severe, life-threatening allergic response that may include lowered blood pressure, swelling, and hives.

Angioedema: Swelling similar to urticaria (hives), but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the hands and feet.

Antibodies: Specialized proteins produced by white blood cells that circulate in the blood. Antibodies seek and attach to foreign proteins, microorganisms, or toxins in order to neutralize them. They are part of the immune system.

Antigen: A substance, usually a protein, which the body perceives as foreign.

Antihistamine: Medication that prevents symptoms of congestion, sneezing and itchy, runny nose by blocking histamine receptors.

Anti-inflammatory: Type of medication that reduces swelling and inflammation.

Asthma: A disease of the branches of the windpipe (bronchial tubes) that carry air in and out of the lungs. Asthma causes the airways to narrow, the lining of the airways to swell, and the cells that line the airways to produce more mucus. These changes make breathing difficult and cause a feeling of not getting enough air into the lungs.

Bronchodilators: Medications used to relax the muscle bands that tighten around the airways during an asthma episode. Bronchodilators also help clear mucus from the lungs.

Conjunctivitis: Also called "pink eye." Conjunctivitis is an inflammation of the conjunctiva, the tissue that lines the inside of the eyelid.

Dander, animal: Tiny scales shed from animal skin or hair. Dander floats in the air, settles on surfaces and makes up much household dust. Pet dander is a classic cause of allergic reactions.

Decongestant: Medication that shrinks swollen nasal tissues to relieve symptoms of nasal swelling, congestion and mucus secretion.

Dermatitis: Inflammation of the skin, either due to direct contact with an irritating substance or to an allergic reaction. Symptoms include redness, itching, and sometimes blistering.

Drug allergy: Allergic reaction to a specific medication. The most common cause of drug allergies is penicillin.

Dust mites: Microscopic insects that live in household dust and are common allergens. Dust mites live on dead skin cells and can be found in large numbers in mattresses, pillows, carpets, curtains and furniture.

Elimination diet: A diet in which certain foods are temporarily discontinued from the diet to rule out the cause of allergy symptoms.

ELISA (enzyme-linked immunosorbent assay): Blood test used to identify the substances that are causing your allergy symptoms and to estimate a relative sensitivity.

Epinephrine: A form of adrenaline medication used to treat severe allergic reactions, such as anaphylactic shock or insect stings. It is available in a self-injectable form or can be injected by a healthcare provider.

Food allergy: Allergy that occurs when the immune system responds defensively to a specific food protein that is not harmful to the body.

Hay fever: Allergic reaction caused by the pollens of ragweed, grasses and other plants whose pollen is spread by the wind.

HEPA: High-efficiency particulate air (HEPA) filter, which removes particles in the air by forcing it through screens containing microscopic pores.

Histamine: A naturally occurring substance that is released by the immune system after being exposed to an allergen. Histamine is responsible for many of the symptoms of an allergy.

Hives: See Urticaria

Hypoallergenic: Products formulated to contain the fewest possible allergens.

Immune system: The body's defense system that protects us against infections and foreign substances.

Immunotherapy: Also called allergy desensitization or allergy shots; immunotherapy is given to increase a person's tolerance to the substances that provoke allergy symptoms (allergens). Allergy shots reduce your sensitivity to certain substances but do not cure allergies. They are usually recommended for people who suffer from allergies more than three months a year.

Latex: Also known as rubber or natural latex. Latex is a milky fluid derived from the rubber tree. It is used in a wide variety of consumer products, including rubber gloves, tubing, rubber bands, etc.

Latex allergy: An allergy that develops after some sensitizing contact with latex.

Mast cell: A type of white cell that is involved in the allergic reaction. These cells release chemicals such as histamine.

Metered dose inhaler (MDI): Small aerosol canister in a plastic container that releases a burst of medication when pressed down from the top. Many asthma medications are taken using a MDI.

Mold: Parasitic, microscopic fungi that float in the air like pollen. Mold is a common trigger for allergies and can be found in damp areas, such as basements or bathrooms, as well as in grass, leaf piles, hay, mulch or under mushrooms.

Mold count: See Pollen and mold count

Myringotomy: Outpatient procedure in which small metal or plastic tubes are inserted through the eardrum to equalize pressure between the middle and outer ear.

Nasal endoscopy: A test that allows the doctor to view the nasal cavity to detect polyps or other abnormalities.

Nasal sprays: Medication used to prevent or treat nasal symptoms. Available by prescription or over-the-counter in decongestant, antihistamine, corticosteroid, or salt-water solution form. A mast cell (see above) stabilizer form is also available.

Otitis media: Bacterial or viral infection of the middle ear (the space behind the eardrum).

Otolaryngologist: A doctor who specializes in diagnosing and treating a variety of disorders of the ear, nose and throat.

Otoscope: A lighted instrument that lets the doctor see far down into the outer ear canal.

Pneumatic otoscope: An instrument that blows a puff of air into the ear canal to test eardrum movement.

Pollen: A fine, powdery substance released by plants and trees.

Pollen and mold counts: A measure of the amount of allergens in the air. The counts are usually reported for mold spores and three types of pollen: grasses, trees and weeds. The count is reported as grains per cubic meter of air and is translated into a corresponding level: absent, low, medium or high.

Pulmonary function test: A test that measures how well the lungs take in air and how well this air can be exhaled (lung function). Also measured is how efficiently the lungs transfer oxygen into the blood.

RAST (radioallergosorbent test): Blood test used to identify the substances that are causing your allergy symptoms and to estimate a relative sensitivity.

Sinusitis: Inflammation of the sinuses usually caused by bacterial infection. Acute sinusitis is the sudden onset of symptoms that can be treated with antibiotics and decongestants. Chronic sinusitis is characterized by multiple recurrences of sinusitis or infection that last s several weeks.

Tympanometry: A test in which sound and air pressure are used to check for disorders of the middle ear.

Urticaria (hives): Itchy, swollen, red bumps or patches on the skin that appear suddenly as a result of the body's adverse reaction to certain allergens. They can appear anywhere on the body including the face, lips, tongue, throat, or ears. Hives vary in size and can last for minutes or days.

Frequently Asked Questions

Print these questions and answers to discuss with your doctor.

1. What Types of Plants Produce the Most Allergenic Pollen?

The type of pollen that most commonly causes allergic reactions comes from plants (trees, grasses and weeds) that typically do not bear fruit or flowers. These plants produce small, light, dry pollen granules in large quantities that can be carried through the air for miles.

Common plant allergens include:

• Weeds, such as ragweed, sagebrush, redroot pigweed, lamb's quarters, goosefoot, tumbleweed (Russian thistle) and English plantain.
• Grasses, such as timothy grass, Kentucky blue grass, Johnson grass, Bermuda grass, redtop grass, orchard grass, sweet vernal grass, perennial rye, salt grass, velvet grass and fescue.
• Hardwood deciduous trees, such as oak, ash, elm, birch, maple, alder and hazel as well as hickory, pecan, box and mountain cedar. Juniper, cedar, cypress and sequoia trees are also likely to cause allergies.

2. What Does a Pollen Count Mean?

A pollen count is the measure of the amount of pollen in the air. Pollen counts are commonly included in local weather reports and are usually reported for mold spores and three types of pollen: grasses, trees, and weeds. The count is reported as grains of pollen per square meter of air collected over 24 hours. This number represents the concentration of all the pollen in the air in a certain area at a specific time. The pollen count is translated into a corresponding level: absent, low, medium or high.

In general, a "low" pollen count means that only people extremely sensitive to pollen will experience symptoms. A "medium" count means many people who are relatively sensitive to pollen will experience symptoms and a "high" count means most people with any sensitivity to pollen will experience symptoms.

Although the pollen count is an approximate value and fluctuates, it is useful as a general guide when you are trying to determine whether or not you should stay indoors to avoid pollen contact.

3. Should I Consider Moving to Decrease My Allergy Symptoms?

No. Moving to a different geographic climate will not help "cure" allergies. Most people who relocate to get away from pollens that cause their allergies tend to find that they eventually develop allergies to the plant pollens in the new area.

4. How Can I Tell If My Son Has Allergies or a Common Cold?

Symptoms of allergies and colds can be similar, but here's how to tell the difference:

Occurrence of symptoms:

Both allergies and colds cause symptoms of sneezing, congestion, runny nose, watery eyes, fatigue, and headaches. However, colds often cause symptoms one at a time: first sneezing, then a runny nose, and then congestion. Allergies cause symptoms that occur all at once.

Duration of symptoms:

Cold symptoms generally last from 7 to 10 days, whereas allergy symptoms continue as long as a person is exposed to the allergy-causing agent. Allergy symptoms may subside soon after elimination of allergen exposure.

Mucus discharge:

Colds may cause yellowish nasal discharge, suggesting an infectious cause. Allergies generally cause clear, thin, watery mucus discharge.

Sneezing:

Sneezing is a more common symptom of allergies, especially when sneezing occurs two or three times in a row.

Time of year:

Colds are more common during the winter months, whereas allergies are more common in the spring through the fall, when plants are pollinating.

Presence of a fever:

Colds may be accompanied by a fever, but allergies are not usually associated with a fever.

5. What Does It Mean When a Product Is Labeled "Hypoallergenic"?

"Hypo" means "under" or "less than," so "hypoallergenic" means a product is less likely to trigger an allergic reaction.

Many products that we use every day, such as cleansers and soaps, deodorants, makeup and even mouthwash, have ingredients that can irritate the skin or act as antigens (substances that trigger an allergic reaction). Exposure of the skin to these ingredients -- most often fragrances and chemicals used as preservatives -- can lead to a condition called contact dermatitis. Contact dermatitis appears as areas of redness, itching and swelling on the skin, and sometimes as a rash or blisters.

Many manufacturers of cosmetics and cleaning supplies now market their products as "hypoallergenic," meaning the products do not contain ingredients that are known to cause irritation or allergic reactions. However, manufacturers are not required to prove the claim that their products are hypoallergenic and there are currently no regulations or standards for manufacturers to follow.

Although choosing products that are hypoallergenic may help reduce the risk of contact dermatitis, no product can guarantee never to irritate the skin or produce an allergic reaction. It's always a good idea to test any new product before you use it, especially if you have had skin reactions in the past. To test it, simply put a sample of the product on your inner wrist or elbow and wait 24 hours to see if a reaction occurs.

6. Can Allergies Be Cured?

Allergies cannot be cured but the symptoms they cause can be treated and controlled. This may require making changes in your environment or behavior to avoid or reduce your exposure to certain allergens. Medication also may help relieve symptoms of an allergic reaction. Even with treatment, your body's immune system may continue to react when exposed to allergens. In some cases, however, children may outgrow their allergies, particularly those to food.

Immunotherapy, or allergy shots, is not a cure. Rather, the shots are a way to significantly lessen the symptoms caused by exposure to specific substances.

7. How Does Stress Affect Allergies?

Stress is your body's response to conflict or situations, both internal and external, that interfere with the normal balance in your life. Virtually all of the body's systems, including the digestive system, cardiovascular system, nervous system and immune system, make adjustments in response to stress. When you are feeling anxious or stressed, your body releases numerous hormones and other chemicals, including histamine. Histamine is a powerful chemical that can lead to allergy-like symptoms.

Stress does not cause allergies, but it can make an existing reaction worse by increasing the level of histamine in the bloodstream.