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Acid Reflux

Acid reflux or GERD occurs when gas, liquid or food particles in the stomach return back up the esophagus (food tube) into the back of the throat (pharynx), mouth, nose, sinuses, middle ear tube (Eustachian tube), or middle ear. This results in irritation (inflammation) and discomfort of these areas. It is important to note that patients don’t always feel the irritation and the symptoms can be ‘silent’. When this occurs, your doctor might see evidence on your physical exam or note other symptoms that are concerning for reflux.

When the reflux enters the upper airway, it is called laryngeal pharyngeal reflux or LPR. When this occurs, it is called GERD/LPR. Unfortunately, up to 60% of the population will have reflux one or more times per week.

As many as 75% of individuals with asthma are at a higher risk of experiencing acid reflux symptoms. In fact, asthmatics are twice as likely to have GERD. Many severe asthmatics have GERD that makes their asthma more challenging to treat. The stomach contents may trigger nerves associated with asthma (particularly cough) or can actually enter the airways (aspiration) resulting in spasm, irritation and asthma symptoms. For these reasons, reflux needs to be considered in individuals with asthma.

Signs and Symptoms of GERD/LPR

  • Nasal congestion and sometimes runny nose
  • Postnasal drainage
  • Cough
  • Hoarseness (particularly in the morning), throat irritation/burning
  • Unusual or bitter taste in the mouth or the back of the throat (brackish water)
  • Difficulty swallowing or choking (particularly at night)  Recurrent sore throat, pneumonia, bronchitis, sinusitis, or ear infections
  • Constant throat clearing
  • Bad breath (halitosis)
  • Burning chest pain (can mimic heart attacks)
  • Abdominal fullness, gas, or belching after meals
  • Chest pain, burning or tightness in the chest after lying down or bending over

If GERD/LPR is diagnosed, your physician may recommend using medications to help block the effects of acid secretion. Anti-acids (like Rolaids or Tums) weaken and neutralize the acid in your stomach, but don’t affect the production of acid and don’t work to prevent symptoms. H2 blockers (like Zantac or Pepcid) lessen the production of acid in your stomach and help prevent symptoms. They tend to work longer but are not quick to act so they don’t alleviate symptoms quickly. Proton Pump Inhibitors or PPIs (like Prilosec, omeprazole or Nexium) are longer acting and make acid less prevalent in the gut. They work by preventing symptoms and must be taken on an empty stomach 30 minutes prior to eating.

All medications including those for acid reflux have potential side effects and these can be discussed with your provider.

Measures That May Help Alleviate Symptoms of GERD/LPR:

  • Elevate the head of your bed 6-8 inches (This can be done by placing the top bedposts on cinder blocks or using a wedge under the top of the mattress. Elevating your head on pillows is not as effective.)  Eat smaller, more frequent meals rather than large ones.
  • No eating or drinking at least 3-4 hours before bedtime.
  • Drinking fluids of any type before bedtime can result in stretching the stomach opening resulting in reflux.
  • Do not skip meals. This can actually result in a 15% increase in daily caloric intake. Skipping meals usually result in overeating of the remaining meals, which can overfill your stomach and increase acid reflux.
  • Lose weight, if needed. We know that those who are overweight do not respond as well to GERD meds as those who are of healthy weight.
  • Avoid bending over, straining, constipation or wearing tight clothes around the abdomen.

Eliminate the following foods and beverages (totally, if all possible)

  • Caffeinated and/or decaffeinated products
  • Alcohol
  • Carbonated beverages of any type
  • Chocolate
  • Mint (includes gums and toothpaste)
  • All types of citrus
  • Fried foods (includes many spicy or fatty foods)
  • Nicotine of any type
  • Dairy

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Facts and Figures about Allergies

May is allergy and asthma awareness month. This information is from the Asthma and Allergy Foundation of America. 

What Is an Allergy?

  • An allergy is when your immune system reacts to a foreign substance, called an allergen. It could be something you eat, inhale into your lungs, inject into your body, or touch.
  • An allergic reaction can cause coughing, sneezing, hives, rashes, itchy eyes, a runny nose, and a scratchy throat. In severe cases, it can cause low blood pressure, breathing trouble, asthma attacks, and even death if not treated promptly.
  • There is no cure for allergies. You can manage allergies with prevention and treatment.
  • Allergies are among the country’s most common, but overlooked, diseases.

How Common Are Allergies?

  • More than 50 million people in the U.S. experience various types of allergies each year.
  • Allergies are the sixth leading cause of chronic illness in the U.S.

How Many People Seek Medical Care for Allergies?

  • Allergic conditions are one of the most common health issues affecting children in the U.S.
  • Each year in the U.S., it is estimated that anaphylaxis (a severe allergic reaction) to food results in 90,000 emergency room visits.

How Many People Die From Allergies?

  • The most common triggers for anaphylaxis are medicines, food, and insect stings. Medicines cause the most allergy-related deaths.
  • Black people and older adults in the U.S. have the highest rates of death due to allergic reactions to medicines, food, or unknown allergens.

What Are the Costs of Allergies?

  • The cost of nasal allergies is between $3 billion and $4 billion each year.
  • Food allergies cost about $25 billion each year.

What Are Indoor and Outdoor Allergies?

  • Indoor and outdoor allergies can lead to sinus swelling/pain, itchy/watery eyes, nasal congestion, and sneezing. Airborne allergens can cause seasonal (sometimes called “hay fever” or “rose fever”) or constant (called “persistent”) allergies.
  • Many people with allergies often have more than one type of allergy. The most common indoor/outdoor allergy triggers are: tree pollen, grass pollen, weed pollen, mold spores, dust mites, cockroaches, cat and dog dander, and rodent urine.

How Common Are Seasonal Allergies?

  • In 2018, approximately 24 million people in the U.S. were diagnosed with seasonal allergic rhinitis (hay fever). This equals around 8% (19.2 million) of adults and 7% (5.2 million) of children.
  • Seasonal allergic rhinitis is an allergic reaction to pollen from trees, grasses, and weeds. This type of rhinitis occurs mainly in the spring and fall when pollen from trees, grasses, and weeds are in the air.
  • In 2018, white children were more likely to have hay fever than Black children.
  • The same triggers for indoor/outdoor allergies also often cause eye allergies.

How Common Are Skin Allergies?

Skin allergies include skin inflammation, eczema, hives, chronic hives, and contact allergies. Plants like poison ivy, poison oak, and poison sumac are the most common skin contact allergy triggers and cause symptoms days after the exposure. But skin contact with cockroaches and dust mites, certain foods, or latex may also cause skin allergy symptoms.

  • In 2018, 9.2 million children had skin allergies.
  • Children birth to age 4 are most likely to have skin allergies.
  • In 2018, Black children in the U.S. were more likely to have skin allergies than white children.

How Common Are Food Allergies?

Nine foods cause most food allergy reactions. They are milk, soy, eggs, wheat, peanuts, tree nuts, sesame, fish, and shellfish.

  • About 32 million people have food allergies in the U.S.8,9 o About 26 million (10.8%) U.S. adults have food allergies.8 o About 5.6 million (7.6%) U.S. children have food allergies.
  • In 2018, 4.8 million (6.5%) children under 18 years of age had food allergies over the previous 12 months.
  • In 2018, 6% of Black and Hispanic children had food allergies over the previous 12 months, compared to 6.6% of white children.7 o Food allergy has increased among U.S. children over the past 20 years, with the greatest increase in Black children.
  • Milk is the most common allergen for children, followed by egg and peanut.
  • Shellfish is the most common allergen for adults, followed by peanut and tree nut.
  • Sesame is a rising food allergy. It impacts an estimated 1 million people in the United States. It was declared a major allergen in the United States in 2021.

How Common Are Drug Allergies?

  • Severe drug reactions account for 3% to 6% of all hospital admissions worldwide. Drug allergy accounts for less than 10% of these severe drug reactions.
  • The most commonly reported drug allergy is to penicillin, with up to 10% of people saying they are allergic to these drugs. However, less than 10% of these people (or less than 1% of 3 the total population) are actually allergic to penicillin drugs when evaluated for these allergies.

How Common Is Latex Allergy?

  • About 4.3% of the general population has a latex allergy.
  • Latex allergy is more common in certain occupations. Approximately 9.7% of health care workers have a latex allergy.

How Common Is Insect Allergy?

People who have insect allergies are often allergic to bee, wasp, and ant stings. Cockroaches and dust mites may also cause nasal or skin allergy symptoms.

  • Insect sting allergies affect 5% of the population.
  • As many as 100 deaths occur each year in the United States due to insect sting anaphylaxis.

The post Facts and Figures about Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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