Spring Eye Allergies

Spring has sprung and May and June in this part of the country means mowing (twice a week for some!), baseball, softball, golf and lake activities. The fescue grows tall and fast and the grass pollen levels usually peak around Memorial Day bringing much suffering and misery to many who spend time outdoors. Warmer temperatures and an early spring has resulted in high airborne levels of grass pollen in Missouri since early April.



The eyes are especially vulnerable to airborne allergens like grass pollen. Symptoms of eye allergies, or allergic conjunctivitis, include watery, itchy, red, sore, swollen and stinging of the eyes. Itching of the eyes is the most important symptom of allergic conjunctivitis. Without itching, it is much less likely that a person is suffering from allergies of the eyes. Both eyes are usually affected.



Seasonal allergic conjunctivitis (SAC) is the most common form of eye allergy, with grass and ragweed pollens being the most important seasonal triggers. Perennial or year round, allergic conjunctivitis (PAC) is also very common, with animal dander, feathers and dust mites being the most important triggers.





People with SAC usually note the onset of symptoms during the spring and fall, and frequently note nasal problems as well. Symptoms include itchy eyes, burning of the eyes and eye watering. In some cases, people notice sensitivity to the light and blurred vision. The eyes are usually red, and the eyelids may become swollen. When the inside of the eyelid (the conjunctiva) is also swollen, the eyes may have a watery, gelatinous-like appearance - called "chemosis". PAC typically occurs year-round, although many people notice some seasonal flares to their symptoms. The severity of PAC is less than that of SAC, and PAC is much more likely to be associated with perennial allergic rhinitis.





The diagnosis of allergic conjunctivitis is made with a history of symptoms suggestive of eye allergies, an examination by a healthcare professional with findings consistent with conjunctivitis, and allergy testing showing seasonal or perennial allergies. A response to typical medications is helpful in the ultimate diagnosis of allergic eye disease, and failure to respond to medications may lead to a search for a different diagnosis.



If avoidance of allergic triggers fails to prevent symptoms of allergic conjunctivitis, some people notice mild benefit from cold compresses on the eyes, and eyewashes with tear substitutes. However, medications may be necessary to treat the symptoms. Medications for allergic conjunctivitis include oral antihistamines and eye drops.



Many people with allergic eye disease will receive benefit from oral antihistamines, such as over-the-counter loratadine (Claritin®/Alavert®, generic forms), and cetirizine (Zyrtec®). Fexofenadine (Allegra® and generic forms, Levocetirizine (Xyzal®) and desloratadine (Clarinex®). Older, first-generation anti-histamines (such as Benadryl®) are also helpful, but are generally considered too sedating for routine use.


Over-the-counter eye drops. Medicated eye drops are available in over-the-counter and prescription forms. Over-the-counter eye drops for allergic conjunctivitis include decongestant (Visine®, Naphcon®, generic forms of naphazoline), and decongestant/anti-histamine combinations (Visine-A®, Naphcon-A®, generic forms of naphazoline/pheniramine).


Decongestant eye drops (with or without anti-histamines) should only be used for short periods of time, as overuse can lead to conjunctivitis medicamentosa (characterized as rebound eye redness/congestion and dependence on the eye drops). These eye drops should not be used by people with glaucoma, and used with caution by people with heart or blood pressure problems.


The Food and Drug Administration recently approved ketotifen eye drops(Zaditor®) for over-the-counter use. Unlike decongestant eye drops, ketotifen would not be expected to result in conjunctivitis medicamentosa with long-term use.


There are several prescription allergy eye drops available if needed. See your physician or eye care professional if symptoms are persistent or more than a minor nuisance.

Cottonwood allergy

"Cottonwood allergy" is a very common complaint and reason people visit an allergy specialist. However, this is usually a case of mistaken identity. Although cottonwood trees produce pollen that can cause significant allergy problems, cottonwood and most other trees release their pollen in the early spring. Cottonwood pollen is invisible. Cottonwoods also produce "tufts" or seeds that float through the air on warm summer days. When people experience allergy symptoms on these days they associate their symptoms with the floating tufts or seeds from the cottonwood tree. These tufts are not capable of causing significant respiratory allergy. Grass pollen, which is also invisible, peaks in the late spring and early summer coincident with the appearance of the cottonwood tufts. Grass pollen is the likely offender when "cottonwood allergy" is suspected.

Do hypoallergenic pets exist? The primary causes of allergic reactions to dogs and cats is not the hair or fur, but dander or old skin scales which are constantly shed into the environment. These allergens are small proteins that allergy sufferers seldom realize are circulating in the air, in carpetting, clinging to furniture, draperies and wall coverings. If a dog or cat has been in the home for a long time, its dander will be present in the entire house. Dander occurs in the epidermis, or the outer layer of skin. The epidermis of dogs and cats is thin, only a few cells thick. The cells turnover about every 21 days, the outer cells die and flake off as dander. In some breeds that are prone to dry and oily seborrhea, the epidermal turnover is 3 to 4 days. Dander is easily airborne and can be present in high enough levels to cause symptoms even if a pet is not present. Significant levels can be found in classrooms, even if a pet has never been in the room. Dander can persist in the environment even months after the pet has been removed. Up to 10% of the general population and 40% of allergic individuals react to cats and dogs. Allergy to cats is twice as common as allergy to dogs. In most areas of the country approximately 50% of homes will have a dog or cat living indoors. Many of the homes where there is no pet living inside still contain enough dander to cause an allergic reaction. There are 90 million cats and 75 million dogs in the US. 17% of cat owners and 5% of dog owners are sensitized to their pets' dander. Cat dander is generally more likely to cause allergies than dog dander. The vast majority of pet owners keep their pets despite being advised by their allergists to keep the pets outside of the house. Many let the animals sleep on their bed. Pet owners ask about available measures to reduce the accumulation of dander in the house. Some measures to reduce dander include moving the pet outside, restricting the pet to a certain are a in the home, frequent bathing of the pet, house cleaning, using a vacuum cleaner with a HEPA filter, or having multiple HEPA air filtration devices. No avoidance measure can compare with removal of the pet. Pet allergies are on the rise. More people are keeping indoor pets. Pet allergy can cause significant allergy problems, including asthma and eczema. Despite claims about certain breeds by people in the $50 billion pet industry, NO SCIENTIFIC EVIDENCE HAS BEEN PUBLISHED to support the claims of "hypoallergenic" dogs or cats. On the contrary, there are several good studies refuting this notion. When a danderless cat is developed, I will reconsider and blog all about it. Wait a minute...isn't that called an iguana?

MEOW???

Atopic dermatitis is an inflammatory, chronically relapsing, non-contagious and itching skin disorder. It commonly begins in childhood and is usually related to other allergy problems including hayfever, asthma, food allergy, etc.

The skin of a patient with atopic dermatitis is very dehydrated and reacts abnormally and easily to irritants, food, and environmental allergens and becomes red, flaky and very itchy. It may be vulnerable to surface infections caused by bacteria. Different areas of the skin may be affected during different stages of life.

Although there is no cure for atopic eczema, much about it is understood and it can be treated very effectively in the short term through a combination of prevention (learning what triggers the allergic reactions) and drug therapy.

Atopic dermatitis most often begins in childhood before age 5 and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Yet, it is estimated that 75% of the cases of atopic dermatitis improve by the time children reach adolescence, whereas 25% continue to have difficulties with the condition through adulthood.

Although atopic dermatitis can theoretically affect any part of the body, it tends to be more frequent on the hands and feet, on the ankles, wrists, face, neck and upper chest. Atopic dermatitis can also affect the skin around the eyes, including the eyelids.

In most patients, the usual symptoms that occur with this type of dermatitis are aggravated by a Staphylococcus aureus infection, dry skin, stress, low humidity and sweating, dust or sand or cigarette smoke. Also, the condition can be worsen by having long and hot baths or showers, solvents, cleaners or detergents and wool fabrics or clothing.

Atopic dermatitis is also known as infantile eczema, when it occurs in infants. Infantile eczema may continue into childhood and adolescence and it often involves an oozing, crusting rash mainly on the scalp and face, although it can occur anywhere on the body. The appearance of the rash tends to modify, becoming dryer in childhood and then scaly or thickened in adolescence while the itching is persistent.

Treatment is usually successful at controlling the symptoms

Atopic Dermatitis Action Plan


For more information about atopic drematitis, see next blog. This page concerns treatment.



1. Frequent hydration. Bathing is encouraged. Take at least one soaking luke warm soapless bath daily. Immediately after exiting bath proceed to #2.

2. Occulsive moisturization. Seal the water into the top layer of the skin using the medicaitons and moisturizers recommended. Each part of the skin, from head to toe should get treated with either the medicated preparations or the moisturizing agents:

Medications:

Triamcinolone cream
Triamcinolone ointment
Fluocinolide
Fluticasone
Mometasone
Tacrolimus (Protopic)
Pimecrolimus (Elidel)


3. Moisturizers:
Vanicream
Lubriderm
Eucerin
Aquaphor

4. Control of itching can be achieved using antihistamines such as:

Zyrtec
Xyzal
Hydroxyzine
Benadryl

5. Identify and address allergic triggers. In children especially, food allergy may be associated with atopic dermatitis or eczema.

6. Be aware that other conditions commonly occur with atopic dermatitis (asthma, allergic rhinitis)

7. Other therapeutic measures may need to be considered including bleach baths, systemic and topical antibiotic treatments if indicated.

8. Other common sense recommendations incldue wearing comfortably clothing, keeping finger nails short, using hypoallergenic laundry detergent, doubling rinsing clothes, using sunscreen.

9. Eat a balanced diet. Some studies have shown supplental vitamin E to be helpful. Ongoing investigations on probiotics and other nutritional interventions may provide more helpful information soon.

Honey is regurgitated stomach contents of bees. Bees feed on the sugar containing nectar of flowers and, in turn, carry pollen from plant to plant to facilitate reproduction. The honey allows storage of the sugars in the hive.

Pollen allergy is generally caused by plants which depend on the wind for reproduction, rahter than insects. Windborne pollen is much smaller than that of plants dependent on bee pollination. Honey contains various ingredients, including pollen allergens and components of honeybees. The pollen in local honey, however, does not usually contain significant pollens that cause most people problems like grass or ragweed since these plants are wind-pollinated.

In order to prove that a therapy works, it must be compared to placebo. There is one well-designed study comparing two different types of honey (locally-produced and nationally-produced) against placebo in people with pollen allergy. Unfortunately, there was no difference in allergy symptoms among the three groups of study participants. It was interesting, however, that nearly 1 in 3 of the volunteers dropped out of the study because they couldn’t tolerate eating one tablespoon of honey every day due to the overly sweet taste. There have been reports of people having severe allergic reactions to honey, possibly from the various pollen or venom components. More studies are needed to further investigate the possible benefits of honey for the treatment of allergies.

Honey-based products have been studied and approved for use in wound healing, of all things!

Over the counter (OTC) allergy medications are frequently used by patients to treat hayfever and other common ailments. A recent recall of many Children's allergy medications has generated a bit of concern among parents and consumers.

Manufacturing defects have led to the recall of 43 child and infant liquid formulations of Tylenol, Motrin, Zyrtec, and Benadryl by McNeil, a division of Johnson & Johnson.

No injuries or deaths have yet been reported. The voluntary recall follows an April 19 FDA inspection of a McNeil plant in Fort Washington, Pa. that uncovered manufacturing deficiencies.

Apparently some of the products included in the recall may contain a higher concentration of active ingredient than is specified; others may contain inactive ingredients that may not meet internal testing requirements; and others may contain impurities.

If children who have taken the recalled products have unusual symptoms, parents are urged to contact a health care professional.

Parents should not give children adult formulation of the medications. Alternative brands of the products, including generic medications, are available. Parents who have questions about alternative treatments should consult their child's pediatrician.

Recent rumors suggest that Allegra products may soon be available OTC, without a prescription.

The rising incidence of allergic diseases is a popular topic these days. The WHO estimates that 300 million people currently have asthma and 250,000 people die annually. This increase in asthma prevalence and severity over recent decades presents a significant challenge to public health. Pollen is an important trigger of some types of asthma, and both pollen quantity and season depend on climate and weather variables. Over the same period as the global rise in asthma, there have been considerable increases in atmospheric carbon dioxide concentration and global average surface temperature. Greater concentrations of carbon dioxide and other greenhouse gases result in higher temperatures and may increase pollen quantity and induce longer pollen seasons. Ozone, particulates, vehicle emmissions, and other pollutants have risen also. Pollen allergenicity can also increase as a result of these changes in climate. Exposure in early life to a more allergenic environment may also provoke the development of other atopic conditions, such as eczema and allergic rhinitis. Although the causes of allergy and asthma is complex, the recent global rise in these problems could be an early health effect of climate change. The problem is likely to worsen in the future according to scientists.

Dust mites cause many people to "Sneeze and Wheeze". About 20% of the population is significantly allergic to dust mite.

Dust mites are microscopic creatures (in the arthropod family)that feed on the scales of skin shed by humans and other animals. Their scientific name Dermatophagoides literally means "skin eaters." They thrive in warm, moist environments. They cannot be seen without the power of a microscope. They do not bite or cause disease but people can be highly allergic to proteins from their digestive tract. Matresses, pillows and carpet are major reservoirs for dust mites.
One square yard of your rug can contain as many as 100,000 dust mites. A typical mattress may be housing several million. Inhalation of air containing dust mite particles can cause severe allergic inflammation of the respiratory
tract and lead to chronic allergy problems such as sinus disease, asthma, and eczema.

Why don’t we like dust mites?
These creatures are indeed trouble, considering that exposure as a child or baby can cause a lifelong allergy to dust mites. Exposure as a young child can also cause other complications including asthma, eczema, and hay fever that will last for a lifetime. Paired with cat dander, cockroach droppings, and grass pollen, these allergic reactions and side effects can become almost unbearable for many people.

If dust mites cause you to wheeze, blame their digestive proteins. These secretions are very hard on the respiratory systems of us unwitting hosts. This secretion from the guts of the dust mites is extremely potent. There is no cure for allergies to dust mites. The only way to avoid allergy symptoms when it comes to dust mites is to prevent exposure in the first place. This means that it is important to learn a few things about them.

How do dust mites live?
Dust Mites have a life cycle of just 10 to 70 days. Females which have mated typically live for 50 - 70 days. And the average life cycle for a male is just 15 days.

Female dust mites will typically lay 75 - 100 eggs in the final weeks of her life cycle. Some dust mites lay their eggs in groups of up to 5 other females. Others do so alone. Once an egg hatches a larva with six legs is produced. The dust mite larva then transforms into a nymph with eight legs. After the nymph stages, an adult is produced with eight legs. At this point it looks like a microscopic spider.

Dust mites survive in mattresses and other warm, dusty environments. They consume the dander (flakes of skin) that are shed by humans and animals alike, making the dusty corner under the bed where the cat sleeps just as friendly to these creatures as the inside of a pillow. Dust mites tend to spend a third of their lives or more within the comfortable confines of a mattress.

A typical used mattress may have up to ten million dust mites living in it, and a pillow of only two years old can be composed of up to ten percent dust mite feces and carcasses. Carpets also tend to house large colonies of these household pests, making just about anything porous liable to support the life of these most abrasive of creatures.

Symptoms of Dust Mite Allergies
One of the most strongly allergenic materials that is found in the average household is dust. This allergy is often made a lot worse by the addition of the dropping and carcasses of microscopic creatures called dust mites. These creatures are solely responsible for the suffering of thousands of people across the world.

Since dust mites thrive mainly by embedding themselves into carpet, clothing, and other fabric fibers, they inhabit the same areas as humans. Human allergies to these pests stem mostly from the residue left from dust mites. As the colony of dust mites grows, so does the amount of decaying body parts and fecal waste left behind from them. These waste products are the root cause for the allergy and asthma symptoms caused by dust mites.

Symptoms of dust mites include a wide variety of sinus related problems. The most common symptoms are itchy, watery eyes, runny nose, itching and clogging of the ear canals, asthma, and many other respiratory related problems. Many of these symptoms appear at night, while a person sleeps. This is because millions of dust mites can live in a person’s bed by inhabiting the mattresses and pillows. When a person sleeps, they are in very close proximity to the agents that cause allergies, and by moving around in bed, people are unknowingly causing these particles to become airborne.

People who suffer from asthma often have a difficult time with dust mites. If they have allergies to dust mites, the allergy symptoms can often bring on severe asthmatic reactions. These reactions can present with symptoms such as respiratory congestion, wheezing, and even severe shortness of breath. Anyone suffering these conditions should be treated by a licensed physician or asthma specialist. More on dust mites allergies.

The adult female dermatophagoides farinae can lay up to eighty eggs, either one at a time or in small groups of about three to five eggs each. When the larva first comes out of the egg, it has six legs. However, after the first time they molt, they will have eight legs. This is their nymph stage and they actually go through two nymphal stages before reaching adulthood. The time period between the hatching and adulthood is approximately one month and the adult will survive up to another three months. Their life cycle is approximately four months in total.

While house dust mites will find haven in carpeting, mattresses, and sofas, they need to have water to survive. Without water or moistness, they will not survive and the dust mites tend to thrive in the humid months of the summer and in regions with high humidity. During the dry winter months or in areas of dry climates, the population of the dust mite diminishes.

As humans tend to shed approximately .20 ounces of dead skin a week, the dust mites are never lacking for food. When you add in pets to the household, the dust mites surely are in heaven. The mattress is one of the dust mites favorite places is due to the fact this is where humans, as well as some pets, spend almost a third of their time. Most go to bed with little clothing and the skin cells are shed, supplying the dust mites with plenty of food.

Some important environmental control measures should be considered to reduce dust mite exposure in the home:

1. Encase mattresses and pillows in dust mite-impermeable material.
2. Dehumidify. Dust mites go dormant when humidity is kept below 45%
3. Wash bedding frequently in hot water
4. Remove dust collecting items and furniture.
5. Remove carpet if able.
6. HEPA air filtration.

A recent European report reitirates an important fact about over-the-counter (OTC) medications like Benadryl. It warns that the older antihistamines in over-the-counter allergy medications -- the most common form of self-medication in allergic rhinitis -- may be hazardous to our health.

The findings suggest that first-generation H1-antihistamines not only make patients drowsy, but also reduce rapid eye movement (REM) sleep, impair learning, and reduce efficiency at work the next day. In addition, first-generation H1-antihistamines have been implicated in numerous civil aviation, motor vehicle, and boating accidents, and even deaths as a result of accidental or intentional overdosing in infants and young children. First-generation H1-antihistamines have also been linked to suicide cases in both teenagers and adults.

New generation antihistamines on the contrary have shown an equivalent efficacy to treat symptoms while clinical studies and patients report fewer adverse effects. The review ultimately questions whether, for consumer protection reasons, first generation H1-antihistamines should still be available as over-the-counter self-medication.

Antihistamines are most frequently used drugs for treating seasonal and chronic allergic diseases such as allergic rhinitis, urticaria, atopic dermatitis. More than 30% of the EU and US population are potential users, safety is thus paramount.

Patients, parents, physicians and consumers should remember that some medications may do more harm than good in certain situations.

It seems that people with asthma suffer to a much greater extent when they have the flu compared to non asthmatics. Most asthma is driven by allergy problems. Could there be a link between poorly controlled allergies and a worse case of the flu?

New research from UT Southwestern Medical Center suggests that allergic reactions to pet dander, dust mites and mold may prevent people with allergic asthma from generating a healthy immune response to respiratory viruses such as influenza.

"Our findings imply that the better your asthma is controlled, the more likely you are to have an appropriate response to a virus," said Dr. Michelle Gill, assistant professor of pediatrics and internal medicine at UT Southwestern and lead author of the study appearing online and in the June edition of The Journal of Immunology. "When individuals with asthma come in contact with an allergic trigger and a respiratory virus, the allergen may actually interfere with the immune response to the virus. This interruption in the antiviral response may contribute to exacerbations of asthma that are commonly associated with respiratory viral infections."

More than half of the 20 million people diagnosed with asthma in the U.S., including 2.5 million children, have been diagnosed with allergic asthma.

Fifty-six people ranging in age from 3 to 35 participated in the study. Twenty-six of the participants suffered from allergic asthma; the remaining 30 made up the control group. Most of the participants were African-American, and the mean age was 15 years in both the asthma and control groups. In addition, those in the asthma group had been diagnosed by a physician and had a positive skin test to at least one indoor allergen.

Researchers first isolated immune cells called dendritic cells from study participants. These cells are found in blood and tissues that are in contact with the environment, such as skin and the linings of the nose and lungs. When they encounter respiratory viruses such as flu, dendritic cells normally produce proteins that help the body mobilize the immune system and overcome the viral infection. When the dendritic cells first encounter an allergic stimulus, however, they are significantly impaired in their ability to produce such antiviral proteins.

When investigators exposed the dendritic cells from the study participants with allergic asthma to influenza, they found that the cells were unable to produce interferon, an immune system protein that plays a key role in fighting off repeated infections of the same virus. Interferon is what makes a person feel run down and tired when fighting viral infections.

The researchers speculate that the immune-suppressing effect of the allergic stimulation of dendritic cells might be related to the high levels of a molecule called IgE normally found in people with allergic asthma. Among the subjects participating in this study, elevated IgE levels were associated with impaired capacity of dendritic cells to produce interferon when exposed to flu.

It is important to address allergies, maximize asthma control and receive annual influenza vaccinations.