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Archive for October, 2017

allergies

Seasonal allergies are commonly referred to as allergic rhinitis a.k.a. “hay fever” if the nose is mostly affected and allergic conjunctivitis if the eyes are involved.

Allergic rhinitis affects up to 40 percent of children and 10 to 30 percent of adults in the United States. It is referred to as “seasonal” if symptoms occur at particular times of the year or “perennial” if it occurs year round.

Common symptoms of seasonal allergies include sneezing, itchy eyes, nasal congestion, headache, and fatigue.  These symptoms can have a tremendous negative impact on the quality of life and on productivity. American workers lose an estimated 6 million work days yearly to this disorder, as well as incurring costs of several billion dollars in medical care.

Seasonal allergies usually occur from spring to early fall, and are due to pollens from trees, grass and weeds.    Interestingly, in this neck of the woods people associate the now beautiful yellow blooming acacia trees as the main source of allergies at this time. However, the fact is that the acacia pollen is quite heavy and usually just falls to the ground. Coincidentally at this same time, Birch, oak and a number of grasses are the real allergy producing culprits.

Perennial allergies, occurring throughout most of the year, are caused by indoor factors such as dust mites, animal dander, and mold.

Nasal stuffiness from allergic rhinitis can cause swelling and obstruction of the sinuses which can lead to a sinus infection.

There is a strong association between allergic rhinitis and asthma.  Up to 50 percent of patients with asthma have allergic rhinitis. Sleep disorders in adults and a high proportion of ear infections in children are also associated with allergic rhinitis.

Treatment for people who think they have allergic rhinitis can begin with an over the counter antihistamine such as Benadryl or Chlortrimeton,  however, they are often associated with the bothersome side effect  of drowsiness.  They should be avoided in children below 2 years of age and in the elderly.    Newer  oral antihistamines such as Claritin, Allegra and Zyrtec, are now available without a prescription and cause significantly less side effects and are more conveniently dosed at once or twice a day.  Steroid nasal sprays such as Nasacort and Flonase are very effective and are now sold over the counter.

Seasonal allergies can also affect the eyes causing redness, tearing, itching, and swelling of the lids. This can be treated with cold compresses and with one of the newer oral antihistamines mentioned above. It would also be worth trying over the counter allergy eye drops such as Zaditor,  Alaway  or Naphcon A.  If these treatments aren’t working sufficiently, see your doctor who can help you decide what treatment is best for your symptoms.

 

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Poison Oak

PoisonOak

Having treated thousands of cases of poison oak in my career, I’d like to share with you what I’ve learned about this miserable affliction.

The poison oak plant which is so prevalent in our locale, contains an oil in its sap called urushiol. This oil is found in all parts of the plant; leaves, stems, and roots. Even in extremely minute quantities, like a billionth of a gram, it can cause a very severe allergic reaction to our skin. This usually occurs within 24-36 hours after exposure.

Eighty five percent of our population is susceptible to this rash and a lucky fifteen percent have a natural resistance to it.

You can be exposed to the oil by direct contact with any part of the plant, or by indirect contact with an object such as your own hands, clothing, tools, or anything that may have the urushiol oil on it. There have also been reported cases of smoke from burning poison oak, causing either a skin rash or a reaction in the lungs, although I have never seen this in any patient I’ve treated.

Once you have contact with the oil you have only a matter of minutes to wash it off before it will bind to the skin and begin the allergic rash. The best way to remove the oil from the skin is to rinse with lots of water and then wash with soap and water. Most any kind of soap will do. Also, wash any object which may have come in contact with the oil with soap and water, including the clothes you were wearing. And don’t forget to do the same to your shoes, tools and pets. Urushiol oil can remain active on inanimate objects for over a year.

There are a number of over the counter products including Technu and Zanfel, which are to be used on the skin after exposure to poison oak, to remove the oil. I have heard mixed reviews on their effectiveness. For now, I’ll stick with water and soap.

Poison oak rash never becomes systemic. It is medically called a “contact dermatitis,” and the only place where a rash can develop is where the urushiol oil has contacted the skin. Poison oak rash can affect almost any part of the body. The rash does not spread by touching it even if it is oozing a liquid, although it may seem to when it breaks out on new areas over a number of days. This may happen because the oil absorbs more slowly on thicker skin, such as the forearms, legs or trunk and faster on thinner kin such as the face and genitals.

Can poison oak rash be prevented before contact with the oil? Some allergy pills or shots have been used with limited success, but in general, they are no longer used, because of potentially serious side effects

A poison oak rash will always eventually clear up on its own if one is willing to wait it out. There are an abundance of home remedies to cure poison oak, none of which have been proven to be effective. However there is effective, proven, and safe medical treatment for those who wish not to suffer for several weeks. Your doctor may prescribe some form of a steroid cream which is stronger and much more effective than over-the-counter cortisone cream. If the rash is more serious and especially involving the face, systemic treatment may be necessary. This involves the use of cortisone pills called prednisone, which is my preferred treatment, or as a steroid shot. Either of these treatments is safe and very effective for most patients. Your doctor will help to determine the best treatment for your particular condition.

The bottom line is that you should avoid contact with poison oak, wash your skin and clothing as soon as possible if you do come in contact, and see your doctor for effective medical treatment if symptoms persist or worsen.

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Bee Stings

Bee

Our most common local stinging insects are yellow jackets and bees. Yellow jackets are attracted to our delicious picnic food and are more aggressive than bees. They sting defensively when they feel that their nests are threatened. They also sting when stepped on, sat upon, or have in some way been provoked.  If one is being attacked by many bees or yellow jackets, it is best to vacate the area and run away as fast as possible.  These insects are capable of flying up to 15 miles per hour and pursuing for distances of 50 to 100 yards.  So don’t run too slow or stop too soon!

Wasps, including yellow jackets, can sting multiple times and leave no stingers in its victim. The  honey bee  sacrifices its life with its sting because it leaves the stinger and part of its abdomen with the venom sack attached to the skin of the victim.  This stinging apparatus continues injecting venom into its victim for up to one minute after the sting.  This is why the new accepted method to remove the stinger is just to pull it out with your finger tips as fast as possible.  Trying to take the time to find something to scrape off the stinger as was previously recommended just wastes time and allows more venom to be injected at the sting site.  Tests have proven that pinching out a stinger doesn’t force out more venom.

Stings are exceptionally painful. The best local treatment is to immediately place an ice pack on the sting site for up to several hours.  Home remedies such as applying pastes of meat tenderizer, clay, toothpaste, aspirin and baking soda, have no proven benefit.  Taking an antihistamine such as Benadryl by mouth, may help with itching.

A local toxic reaction to the venom occurring within hours to days after the sting may involve redness and swelling of just a small area around the sting or a much larger reaction often involving an entire arm or leg. As bad as this may seem, it is not serious and not life threatening and will resolve on its own in a matter of days.  These reactions are sometimes mistaken for a secondary infection but this is very rarely the case and antibiotics are hardly ever necessary.  A sting on the face may cause worrisome swelling but is not dangerous. A sting inside the mouth or throat however can be quite serious and needs emergency treatment promptly.

Almost every person who is stung will have at least a mild reaction around the sting site.  Less than one percent of the population will have a severe allergic reaction.

Serious allergic reactions may occur within minutes or up to several hours after the sting. Usually the more serious the reaction, the sooner the symptoms begin. For those who have suffered a serious reaction to a sting I would recommend a consultation with your doctor who may recommend allergy shots to make one less sensitive. An injectable adrenaline kit such as an “Epipen” may be prescribed to those who have had a very serious prior sting.

What to do when stung:

  • Pull stinger out as fast as possible by any method using fingers is now allowable.
  • Remove self from vicinity of stinging insects as fast and far as possible.
  • Apply ice compresses to sting.
  • Take Benadryl by mouth as soon as possible
  • Call 911 if you experience:
  • swollen tongue or throat.
  • difficulty swallowing.
  • tight breathing.
  • feeling faint.
  • severe hives.

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Travel Health

Family going on a trip traveling by airplane

Traveling soon? Here’s some travel advice.

First of all be prepared before you travel:

  • Educate yourself about your destination; what will the weather be like? How are the sanitary conditions? Are there any safety or security issues? Will you need an electrical plug adapter?
  • Visit your doctor before you leave if you have any health concerns or chronic medical conditions. Make this visit at least 5-6 weeks ahead of time as you might need immunizations.
  • Make sure you have an adequate supply of your medications and pack them in a carry on rather than in luggage.
  • Bring along a list of all your current medications, allergies, and blood type.

Important issues while traveling include:

  • Prevent blood clots associated with prolonged sitting, by exercising your calf muscles while seated and/or get up and walk around every couple of hours.
  • Minimize jet lag by staying well hydrated, avoiding alcohol and caffeine. Get plenty of rest prior to departing and upon arrival to your destination adjust to the local schedule as fast as possible and expose yourself to bright lights at the same time of day as before departure.
  • Prevent traveler’s diarrhea by washing hands frequently, avoiding precooked food such as buffets, street vendor food, and any water that is not bottled from a reputable source. Your doctor may want to prescribe antibiotics to take with you in case you come down with diarrhea.
  • Motion sickness can be lessened by focusing on the horizon and not reading. Sit in the back of the vehicle and don’t ride facing the rear.
  • Avoid sunburn by bringing enough of an appropriate sunscreen and limiting time in sun, especially the first few days.

Do not travel if:

  • You have recently had heart attack or stroke.
  • You have had recent surgery.
  • You have significant respiratory disease such as asthma or emphysema.
  • You have had recent injury to any vital organs.
  • You are ill with a bad cough, vomiting, diarrhea or a fever of 100 degrees or above.

Take along a travel health kit to include those things you commonly use at home for symptoms of illness or injury.

Do your best to deal with often encountered misfortunes such as missed flights, lost luggage, bad weather, disappointing accommodations, etc. You have no control over most of these things and allowing yourself to get stressed out can only make you feel more miserable. Look beyond these situations and imagine the joy that you will experience during your trip.      Bon Voyage!

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