Eczema

Eczema is frequently called atopic dermatitis because it was noted to occur in individuals with allergic symptoms, e.g., allergic rhinitis (hay fever) and asthma. The term atopic simply means allergic. Even though eczema was considered to be an allergic problem, allergy seems to be less likely as our understanding of the disease increases. Physicians know that eczema is a very complex disease and contains allergic as well as non-allergic elements in different individuals. As a result, the treatment of every individual may vary.

While the causes of eczema continue to be investigated, certain things are known about the disease. The skin is much more easily irritated than normal skin. Dryness of the skin is a primary component and results in significant itching. Eczema is known as “the itch that rashes”. Itching is made worse by irritants on the skin. Winter months are particularly bothersome because of the dry winter air. Flares in the summer months can occur after exercise because sweat is a significant irritant. Citrus or some vegetables, e.g., tomato, can act as a primary irritant when they touch the skin. Stress in some individuals can affect the skin. While emotional factors may play a role in flaring eczema, they are not considered a primary source of causing the onset of eczema, if it is not already present.

Eczema occurs in about 3% of the population. In about 80% of those individuals, the onset occurs in the first year of life. One-half are free of disease by age 2 years, about one-fourth by the end of adolescence, and the remaining one-fourth will continue to have eczema into adult life. Some individuals do not have the onset of symptoms until adolescence or adulthood.

Treatment is multifaceted and includes lifestyle modification as well as various types of medication. A portion of treatment will be listed in the accompanying tables. Adequate attention to clothing, diet manipulation, and attention to the emotional well-being of the affected patient are very important. It is preferable for a patient with eczema to wear clothing which will not irritate the skin; soft cotton material would be best. The room temperature should be kept moderate with controlled humidity (between 35-50%). Overheating and perspiration should be avoided.

Some investigators believe there is a genetic tendency for eczema with approximately 50% of eczema patients ultimately developing allergic rhinitis and/or asthma. This is compared to about 20% without the presence of eczema. While allergy skin testing and allergy injection treatment are usually helpful in cases of allergic rhinitis and/or asthma, it is generally agreed that this is often not the case with eczema. In some individuals, starting allergy shots for allergic rhinitis and/or asthma may actually result in significant flaring of the eczema.

Prevention

Trim fingernails short

Cotton gloves at night if needed to decrease scratching

Clothing should be double rinsed after washing to remove all residual detergent (irritants)

Avoid excessive room temperatures

Wear light, non-occlusive clothing (e.g., cotton instead of polyester)

Keep the bedroom moderate (cool) and avoid excessive bed clothing

Allergen contact or ingestion avoidance (e.g., foods, pets, dust mite) can reduce stimulation of the skin

Treatment

Bathing for moisturization, e.g., soaking in tepid water for 30-45 minutes at least once daily and if possible 2-3 times.

Within 2 minutes after getting out of the tub, a lubricating cream or ointment should be applied to help hold the moisture in the skin. Examples include Aquaphor, Curel, Moisturel, Eucerin, Keri, Lubriderm, Acid Mantle, Unibase, Vanicream, petrolatum, and chilled Noxzema,etc. Newer medications include Triceram/Certopic, Impruv, Mimyx, Nourica Repair, Cerave, Atopiclair, and Hylira. Some of the newer medications are by prescription only. None of the medications in the above list contain steroids.

In general, lotions should be avoided since they contain alcohol which may sting and provide limited moisture.

If marked irritation or weeping areas are present, wet wraps with a drying solution (e.g., Burrow’s solution, one tablet mixed in one quart of water is available by prescription) will avoid the stinging or burning sensation that can occur with bathing.

Addition of oil or similar substances to the bath water generally has little effect on increasing moisturization.

Pat dry with a soft towel; do not “rub” dry since this will remove natural, protective oils from the skin.

Showers do not add moisture to the skin and actually remove the protective oils from the skin resulting in increased dryness.

Topical steroids are the mainstay of therapy for more severe eczema. Ointments or creams are generally used.

Nonsteroidal medications that help the immune system in the skin may be necessary either in addition to or in place of topical steroids if the topical steroids are not adequate for relief. Examples of the nonsteroidal medications are Elidel and Protopic.

Antibiotics, topical and/or oral, may be needed if the lesions become infected. An alternative to antibiotics is the use of Clorox baths. One-quarter to one-half cup of Clorox in a full bath provides antibacterial activity that will treat all known bacterial infections. No resistant bacteria to Clorox are known.

Don’t Forget the Drinks if you have Food Allergies

Managing food allergies requires constant avoidance of allergens, emergency preparedness and effective communication. Going out to eat with food allergies can be challenging but is completely doable. When it comes to avoiding allergens while out to eat, the focus in the minds of patrons and eating establishments is often the food, but it is important to keep in mind that beverages can contain allergens as well. Outlined below are key points and tips to consider before you take your sips.

Avoid Cross Contact
Remember that allergens can remain in someone's saliva for several hours after eating and for some people even small amounts of an allergen can cause a severe allergic reaction. To prevent the chance of cross contact drink from your own cup and don't share with others around you. Also remember cross contact can occur with drink stirrers, shakers and other utensils used to mix drinks as with condiments like sprigs of mint or slices of fruit.

Be Aware of All Ingredients Added to the Beverage
This is especially true in the case of mixed drinks. For example if you are allergic to dairy and cream is added to your pina colada, then this can cause an allergic reaction. Some drinks contain raw egg whites - the white 'fuzz' of a Pisco sour, for example, is from beaten egg whites. Raw eggs are particularly dangerous in people with egg allergies.

Know What Ingredients Are in the Beverage
The drink itself may have an allergen in it (for example, wheat in beer). Things to consider here are that since alcohol is not regulated by the Food and Drug Administration (FDA), beverage companies that are bottling alcoholic products do not need to follow current labeling laws and do not need to disclose allergens. In fact, many alcoholic beverages do not list ingredients at all. This certainly becomes an issue for those allergic to wheat, rye, and barley as well as those with celiac disease who need to avoid wheat, rye and barley because of gluten. Similar concerns can arise with wine. If ingredients are unclear then consider calling the company for a list of ingredients. Distilled alcohol is a bit less of an issue but still worth discussing with your healthcare team.

Consider Sulfites
Also, keep in mind that sulfites can exacerbate asthma and in rare cases can cause allergic reactions. Sulfites are commonly found in many alcoholic beverages including wine, beer, ciders and drink mixes added to the alcohol.

Know Alcohol’s Effects
Another issue to take into consideration is the effect of the alcohol itself. Alcohol can decrease our ability to make good decisions and communicate effectively. Other things to consider are that alcohol can decrease the threshold level to trigger an allergic reaction, can decrease the time to develop an allergic reaction, and increase severity. However, alcohol itself is an unlikely allergen.

If you have been prescribed an epinephrine autoinjector, remember to carry this with you at all times, even if you're just going out for a drink.

This article is for educational purposes only. Talk to your healthcare provider before any change in food allergy management.

Find out more about food allergies.

The post Don’t Forget the Drinks if you have Food Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

111

Tags: News

Eczema

Eczema

Prevention

Treatment

Conditions Treated

Recent News

Don’t Forget the Drinks if you have Food Allergies

Notice of Nondiscrimination

GET SOCIAL

USEFUL LINKS

CONTACT US

Main Office