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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.

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Food Allergies and Theme Parks

By Eve Chen, USA TODAY

There’s a lot more to theme park food than funnel cakes and turkey legs. Many parks pride themselves on their array of dining options for guests, but not just for flavor. More than 6% of Americans have a food allergy, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics. The most common food allergens are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans and sesame, according to the U.S. Food and Drug Administration. With those, allergy-safe options can be a matter of life and death.

“I had my first reaction when I was a baby to nuts, and I’ve had serious reactions since that have brought me to the ER – thankfully not too many in recent years,” said Allie Bahn, who helps travelers with food allergies through her Miss Allergic Reactor website and Allergy Travels Facebook group. Bahn has four of the top nine food allergies and other specific allergens, like potatoes. “It can be certainly life-threatening, so it’s different than avoiding foods just because of something bothering your stomach.”

Here are seven ways travelers with food allergies can safely navigate theme parks and what parks are doing to help:

Do your research.

Some parks flag top allergens on their websites and apps.

“It’s listed by restaurant, by item, and it talks about each item what would be the allergen that could be present in that item … A lot of folks who have been living with allergies know what they can and can’t eat, and they’re just looking for a map of ‘Where can I get what I need?’ ” said Cedar Fair corporate chef Charles Walker, who helped roll out new dietary guides for guests earlier this year. As someone with food allergies himself and family members with food allergies, Walker added, “This was near and dear to my heart to really make sure this guest-facing platform was very user-friendly.”

For more personalized help, Cedar Fair’s parks and many others have phone lines and email addresses listed on their websites just for guests with special dietary needs.

“I’m a big fan of contacting places ahead of time,” Bahn said.

Don’t go hungry.

Bahn recommends eating a hearty meal before heading to the park. “So you already have something nice and warm in your stomach, hoping that you’ll be able to find something (else) when you’re there,” she said. She also recommends having plans for a meal after leaving the park, so at least those two meals are covered.

Pack snacks. Not all parks allow outside food, but when permitted, Bahn recommends packing snacks for backup. “Don’t make assumptions that you definitely can’t eat. I think there’s always the ability to try to do as much research ahead of time and then see how it goes once you get there, but having a plan in place is always really helpful,” she said.

Always carry medication or epinephrine. Bahn says she’s carried an epinephrine auto-injector with her for as long as she can remember. “Don’t lock it up in a locker where you can’t quickly access it in case of an emergency,” she said. “It should be on you at all times.”

Ask questions.

“Ask if they have ingredients that you can see,” Bahn said. Some park restaurants have binders of ingredients guests can look at, but it’s best to confirm everything is up to date with chefs, who are happy to speak with guests with food allergies. Sometimes, when creating menus, chefs will intentionally avoid using common allergens like peanuts to make foods more accessible. Chefs can also sometimes adjust dishes for allergies.

“Our festival chefs will go through (the menu) and make sure, based off of the dietary needs, if a dish is safe, if there’s anything (the guest) can have from those kiosks, or if there’s a way, we can make that dish for them safe,” said Kevin Downing, executive chef of EPCOT Festivals at Walt Disney World. Cedar Fair’s Walker echoed, “If you have a very, very specific allergy, we’ll do whatever we can to accommodate.”

Advocate for yourself.

“Explain your food allergies. Advocate for yourself,” Bahn said. She recommends carrying a Chef Card that can be given to chefs, stating each allergy, its severity, and the need for clean utensils and surfaces to be used in food preparation to avoid possible cross-contamination. “It makes everybody’s life, I think, a lot easier and really gets the point across that this is a severe food allergy and not just dietary preference,” she said.

When an allergy-related order comes into Connections Eatery kitchen at EPCOT, Chef Scott Tosh said. “It prints up special, so the special diets-trained cast member will prepare that food. We put an allergy pick in it. If there’s two items – one’s allergy, one’s not – we serve them with separate trays.” Bahn said Disney parks have always been great with her needs, even when she was a kid and people were generally less aware of food allergies.

Trust your gut.

Bahn recommends double-checking all food before digging in.

“I think I have been able to sort of save myself from some potential reactions because of advocating and double checking, trusting my gut,” Bahn said of no place in particular. “There’s plenty of times where I’ve decided not to eat, even if I’ve ordered something because I just felt like I didn’t get all my questions answered in a way that I felt was safe. And that’s OK too. Being able to politely and kindly decide not to eat and walk away and make a different plan is OK, as well. It’s your safety. It’s your health.”

https://www.usatoday.com/story/travel/experience/theme-parks/2023/12/14/food-allergies-theme-park-tips/70911517007/

The post Food Allergies and Theme Parks appeared first on Oklahoma Allergy and Asthma Clinic.

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