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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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Pregnancy and Allergies

A woman’s body experiences many changes when pregnant. Some women may develop allergies during pregnancy. It’s more common for women to already have allergies before conception.

Can allergies worsen during pregnancy?

About one-third of moms-to-be find their allergy symptoms get worse during pregnancy. The same number of women said their allergies stayed the same. Another one-third found their symptoms actually improved during pregnancy.

Common Symptoms

Symptoms are basically the same for those not pregnant which includes: itchy, watery eyes; sneezing; sore or itchy throat; runny nose and sinus congestion.

Stuffy Nose

Many pregnant women can develop stuffy noses. Nasal congestion normally starts in the second trimester cause mucus membranes to swell and soften. Some doctors call it pregnancy rhinitis.

Pregnancy rhinitis can feel like a cold or an allergy. It can also cause nosebleeds during pregnancy and even a post nasal drip that can cause coughing and even gag at nighttime. Typically, pregnancy rhinitis goes away after the pregnancy ends.

What is the difference between allergies and pregnancy rhinitis? For those who have allergies, symptoms experienced included congestion, coughing, sneezing and itchy eyes. If itchiness and sneezing isn’t causing issues, it could be hormone-related pregnancy congestion. Discuss any issues you are having with your doctor.

Allergy Medicines for Pregnant Women

Women need to be very careful taking any medications during pregnancy and most importantly during the first trimester. It’s important to discuss any allergy medications with your doctor. Reducing allergens in the home without using medications could be a first line of defense for the mom-to-be. Allergy proofing the home, avoiding allergy triggers and trying a saline nasal spray, nasal irrigation or nasal strips.

After the first trimester – oral antihistamines treat nasal and eye allergy symptoms of allergic rhinitis.

Considered safe for pregnancy according to multiple studies – Loratadine and cetirizine are second-generation antihistamines. These drugs do not cause drowsiness like first-generation oral antihistamines do – chlorpheniramine, diphenhydramine and tripelennamine.

Corticosteroid nasal sprays are mostly safe and can be prescribed to pregnant women with moderate to severe allergy symptoms that last more than a few days. Budesonide is considered the safest. Mometasone and fluticasone are also considered safe.

Decongestant nasal sprays can cause issues. Some studies point to a risk of birth defects when pregnant women use these products. They are not recommended during pregnancy especially in the first trimester.

Pregnant women should avoid any antihistamine nasal sprays since there is not enough research to prove their safety.

Always discuss which nasal spray might be right and any medication risks to the pregnant woman and her baby with her physician.

Allergy Shots during Pregnancy

Women can continue allergy shots that began before they were pregnant. They should stay at the current dose during pregnancy and if there are any reactions, the allergist may reduce allergy shot dosage. Generally, it is best not to begin allergy shots during pregnancy which can trigger changes in an already-changing immune system and may cause a systemic reaction.

Anaphylaxis treatment is the same during pregnancy as for non-pregnant women with food, insect venom or latex allergy. Use epinephrine at the first sign of symptoms.

Breastfeeding and Allergy Medications

Medications used during pregnancy can be continued while nursing. The baby gets less medicine through the breast mile than in the womb. Your allergist can discuss the best medications for nursing moms to use.

Do Allergies Cross Over to the Baby while Pregnant?

Allergy symptoms experienced by the mom during pregnancy are not believed to have an impact on the baby and developing allergies. Genetics play a major factor in developing allergies. For children with a parent or sibling with allergies, they have an increased risk of getting allergies.

A pregnant mother’s diet can be a factor in developing the child’s allergic rhinitis, food allergies, asthma or eczema. One study found that moms who ate plenty of food-based vitamin D reduced the child’s risk of developing allergic rhinitis. Foods with lots of vitamin D include dairy products, cereals, fish, eggs and mushrooms.

Reducing Allergy Symptoms without Taking Medications

Stay away from people who are smoking which can make allergies worse. Plus, secondhand smoke is not good for mom or her baby.

Pollen Allergies – stay inside as much as possible. Try wearing wrap-around sunglasses to keep pollen out of the eyes. Coming back inside, take off shoes, washing hands and face and changing clothes will help keep the pollen off. Put clothes in the wash. Shower and wash hair before bedtime to reduce nighttime symptoms.

Dust allergies – have someone clean the home regularly (if possible) and use a HEPA filter vacuum. A wet mop and a sweeper can help avoid stirring up the dust. Microfiber is better than a duster to trap the dust.

Pet allergies – for those allergic to their own pets, try to make one room that is pet-free.

Avoidance diets do not prevent allergic disease according to the American Academy of Pediatrics. This means that pregnant women shouldn’t worry about avoiding common food allergens such as peanuts, tree nuts, milk or wheat. Studies have shown that consuming peanuts, milk and wheat in the first and second trimesters can reduce the risk of a child developing a peanut allergy, allergic rhinitis and asthma. Unfortunately, no specific diet or food can prevent allergic disease.

Always discuss with your doctor before making any changes in diet during pregnancy.

The post Pregnancy and Allergies appeared first on Oklahoma Allergy and Asthma Clinic.

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