family practice issues and general life events

Posts tagged ‘eczema’

Allergies and why they matter

As we travel through this allergy season, I am actually having an easier time of it than usual, in what is apparently one of the worst in Southeastern Oklahoma in several years.  Due to the lack of a cold winter, we did not have the period to kill off the normal plants and decrease the load, so I have a great deal of patients in my office complaining of allergy symptoms that in many instances never had.

What exactly are allergies?

According to the Institute of Public Health allergies are defined as “an exaggerated immune response or reaction to substances that are generally not harmful.” 1.   The key to that definition is “generally.”  Because of that word we are aware that there are those that are harmful.  Today more than ever we hear about children who have anaphylactic reactions to foods such as peanuts and nuts.  And yes, I did mean to separate them, because a peanut is technically a member of the legume family and not a nut at all.  Other foods that commonly trigger an allergic reaction include shellfish, eggs, wheat, milk and soy.  These are not always as serious as anaphylaxis but they can be.   Today there is a big attempt to remove milk from the diet, and creates gluten free diet, and unless you are a celiac (allergic to the binding protein in wheat, rye and other common grains) it is found to be a limited benefit in others.  However, limiting your gluten intake may make you feel better, if only due to removing most of the processed food from your diet.  And for those that are allergic to soy, well this diet would cause more problems than not, since many of the replacement foods contain soy.

Another issue that is appearing with soy is that in males in may lead to hypogonadism and infertility.  Now these studies are early and they are still looking closer, but one of the beliefs is that the link may be the result of soy breaking into down into estrogen like compounds and at least temporarily decreasing the sperm count.  Soy can also as I learned in the past week cause anaphylaxis.

 

This picture is actually my son, 30 minutes after his school gave him a large dose of benedryl, which may have been more than the recommended dosage, but with his whole face swelling up, I think it was the better of the two choices.

I myself have food allergies, and hay fever, and everything else that goes with it.  I spent years wearing long sleeves in hot weather, and other ridiculous things to hide arms so that I didn’t have the ridiculous questions about the “track marks” on my arms, and “how I couldn’t hit the vein.”  This is my arm today

This is my arm today.  It actually is relatively under control  Yes you can see the eczema- but there are only a few spots that are terribly red and irritated.  And there is the scratch on the arm.  Must have done that in my sleep.  I am better most days now that I am older and more aware of the damage that I do so I can at least attempt not to scratch.  Those white spaces scarring from the years of scratching.  It makes my skin fairly tough, and hard to take blood, well at least getting through the skin- once through the veins are right there.  But this is enough of an issue that I had to argue with the people at the blood back that they could take my blood.  I mean there is a blood shortage, and you want to not take my blood because of a little scar tissue.  Once the needle is in the vein it all comes out the same

Anyway, other than the unsightly skin, and itchy, watery eyes, and sneezy nose- why do allergies matter?  I mean if those reasons are not enough.  The National Institute of Public health states that most children outgrow their allergies- I am not so sure.  I haven’t outgrown mine yet.  But the Allergy and Asthma Foundation of America estimates that allergies cost $14.5 billion a year.  This includes the direct costs of $1.3 billion for office visits and $11 billion for medication, both prescription and over the counter.  The rest are the indirect costs of missing of work and decreased productivity.  “For adults, allergies (hay fever) is the 5th leading chronic disease and a major cause of work absenteeism and “presenteeism,” resulting in nearly 4 million missed or lost workdays each year, resulting in a total cost of more than $700 million in total lost productivity.” 2  This makes allergies the 5th leading cause of doctor visits in the United States.

If possible removal of the allergen is recommended for those that suffer from allergies, and those that suffer heavily may benefit from allergy testing and immunotherapy.  At the very least, there might be an improvement in the allergy sufferers quality of life.

 

 

1. “Allergies” A.D.A.M.  Medical Encyclopedia  PUBMed Health  last reviewe October 2011, obtained online at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001815/(May 6, 2012)

2. Allergy Facts and Figures.  Asthma and Allergy Foundation of America found online at http://www.aafa.org/display.cfm?id=9&sub=30 (May 6, 2012)

 

 

Eczema and Atopic Skin Care

This is a matter that is very near to me.  I grew up with eczema, and at times it was bad enough that I would wear long sleeves in the summer to hide my arms covered in red bumps.  I didn’t like the looks, the questions, and the worst one being while in high school

“Are you shooting up, and just keep missing the vein?”

Not exactly comforting, especially at the age, when you are aware of every imperfection, and have buried yourselves in books and studying because you felt neither pretty, nor were you popular.  So if you weren’t those you had to be smart.  (Looking back, I am not sure what caused me to feel that way completely, since I had friends, and I did sports, but just never felt like I fit in)

And that was not the worse of the outbreaks.  That came during my second year of medical school, when after borrowing a shirt from my boyfriend (now my husband) that happened to be washed in a detergent, that I was allergic to, I broke out in hives.  Which would have been fine, had they just gone away with my normal routines, avoid too much wheat (especially pizza), moisturize with aveeno, oatmeal baths and steroid creme.  Except that it didn’t, and it took me on a year long quest to find a way to manage it better.  That was the year I discovered just how much stress can affect eczema as well.  And if you want to avoid stress, good luck with that in medical school.  After barely making it through the first year, I was set and convinced that I would have a better second year, and bring my grades up.  And even though it would not be numerically possible to make it to the top of the class, I could do it.

Anyway, it was through that journey that I discovered some basic things that could help keep it under control.  And that while flare ups happen, there are ways to minimize it.  And I learned that for an image obsessed culture, eczema can be horrible for one’s self worth and body image.  I wore a long sleeve wedding gown for instance because I did not want to chance a flare up that would show in my wedding pictures.

1.  Anyway, if possible avoid allergens.  Sometimes that is easier said than done.  If it is a food that is easily identified and removed, well great.  However, I had allergy testing done as a teenager, and my food allergies included wheat.  Good luck on diet that does not have wheat in it, in our culture.  I have done it for 18 months, and was fine, but not easy.  It might be easier now, with the gluten free fad (and I call it a fad, because it is not necessary for most on it, and the improvement in health probably results more from a removal of the preservatives from the diet, rather than the gluten itself)  But avoidance is the best step if possible.

2.  Take lukewarm showers and/or baths.  If you cannot tolerate that when you first jump in, well start warmer and then bring down the temperature as you continue to shower.  Though I don’t recommend it being too long of a shower, since water on the skin, can strangely enough dry it out.  Anyway the lower water temperature is due to the histamine that is released from higher temperatures on the surface of the skin.

3.  Do not use soap every day.  Soap is very drying and can lead to increase in irritation and itching on the skin.  Many people may find this to be gross, but unless you sweat heavily or have an intense body odor, daily soap usage is not necessary.

4.  Immediately after bathing rub yourself down with vasoline, and then pat dry.  The vasoline will help keep the moisture locked in, and doing it before you dry rather than after, will keep you from feeling terribly greasy.

5.  Use a good moisturizer, preferably without scent.  Cetaphil is my personal favorite, it is not as greasy and comes in a large container.  For those of you with babies, and are finding rashes, consider not using those that are “baby lotions.” While they are marketed for baby’s sensitive skin, that lovely smell associated with it often causes a baby to have a rash.  So either get unscented or use something else.

6.  Drink plenty of water, if you are dehydrated, you skin will be too

7.  Consider an over the counter antihistamine- If they do not make you too sedated, there is nothing wrong with using them.  Zyrtec, Allegra, and Claritin all went over the counter in their prescription form, and they range from non-sedating to less sedating.  Benedryl, itself is effective, though it causes many to sleep.  So some can only use it before going to bed.

8.  It is ok to try the over the counter hydrocortisone creme.  It is a good place to start.  Avoid you eye lids, and skin on the face is very thin, so consult your physician before use there.  Increased use of steroids, especially around the eyes could lead to cataracts later in life.

9.  I hesitate to write this, due to sun bathing leading to an increase risk of skin cancer.  But there are many that find UV light helpful for controlling their eczema.  Small doses with sunscreen on may help, but keep in mind that you do not want to burn and long term exposure or tanning will increase your risk for skin cancer, thereby trading one annoying skin condition for a potentially deadly one.

10. Talk to your doctor.  If the OTC medications are ineffective your doctor may be able to provide you with a stronger topical steroid, a different allergy medication, or the topical immunomodulators.  Occasionally steroids are needed either orally or through a needle if the outbreak is bad enough.  Or an antibiotic is needed if the rash has become infected.  Another medication that has had some success off-label is Singulair.  It is not approved for Atopic dermatitis, but it has been approved for both the treatment of asthma and allergic rhinitis.  But that is for your and your doctor to decide.  I have used it myself, on my son and with patients, and some really respond well to it.  However, since it is off-label, your insurance may not cover it for use.

11.  Another consideration for the most severe, is allergy testing followed by immunotherapy.  Sometimes it is not possible to remove all allergens from your life, and immunotherapy either via shots, and looking at some studies sub-lingual may be beneficial.  However, this is a two to four year commitment, so results will not be immediate.

There are no specific tests for eczema.  It is usually determined by both history and exam.  However, it is important to know that atopic individuals have an increased incidence of asthma and allergic rhinitis.  Your doctor might perform a spirometry if indicated.  And while eczema may be treated there is no cure for it.  It may flare up during times of stress or ingestion of new foods.  It is important to realize that this is a constant and often frustrating battle.  It is important that you keep a supply of your treatment available between flare ups, so that you don’t have to rush in for a steroid shot.  And in the case of children, remember it is possible for them to out grow it. 

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