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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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Winter Allergies: What Causes Them and How You Can Get Relief

From EverydayHealth.com

Yes, you can suffer symptoms of seasonal allergies in winter, too.

Most people don’t associate winter with allergies, but allergies persist into and through the cold months. Though it’s important to know that winter allergies do pose slightly different problems than they do during other seasons. (And knowing how to avoid them or minimize triggers can help keep you feeling your best all winter long.)

 

What Causes Allergies During the Winter

“You don’t have pollens in winter,” says Douglas H. Jones, MD, of the Rocky Mountain Allergy, Asthma, and Immunology Group in Layton, Utah. So outdoor winter allergies aren’t such a cause for concern. “But you still have the indoor [allergens].” And if you’re spending more time indoors during cold weather, you might notice an increase in allergy symptoms, such as sneezing, wheezing, and itchy, watery eyes. According to the American Academy of Allergy, Asthma, and Immunology, common indoor allergens (that might trigger symptoms in winter) include: (1)

  • Dander It’s the dander (dead skin flakes), not the hair of household pets such as cats and dogs, that can cause acute or chronic allergic reactions in people.
  • Dust Mites These microscopic bugs might be the most common cause of year-round indoor allergies, notes the Allergy and Asthma Foundation of America. (2Dust mites thrive in bedding, carpeting, and the upholstered furniture inside your home.
  • Indoor Mold We all breathe in mold spores, but for those with an allergy, exposure can trigger sneezing, congestion, and itchiness. Mold and mildew favor damp areas, like basements and bathrooms.
  • Cockroach Droppings These persistent pests can live anywhere, and while they’re not a sign of an unhygienic or unsanitary household, it’s important to keep food well-contained and be vigilant about cleaning up crumbs. Fixing leaky faucets and pipes and sealing up cracks and crevices in your home can help keep cockroaches away.

Matthew A. Rank, MD, an allergy expert with the Mayo Clinic in Phoenix, Arizona, says that although specific data is hard to pin down, roughly 5 to 20 percent of Americans suffer from some form of winter allergy.

What You Can Do to Prevent Winter Allergies

A big problem with winter allergies is that cold-weather lifestyles can turn a simple allergic reaction into something worse, says Dr. Jones.

“People are turning up their heaters, which makes the indoor air even drier,” he says, “and that leads to dry noses, which increases the incidence of nosebleeds and skin cracking” — which in turn boosts infection risk when someone’s nasal passages are already inflamed from allergies. Jones recommends using nasal saline rinses to lower the risk of contracting a secondary viral infection.

It may not be possible to get rid of winter allergies entirely, but you can reduce exposure to allergens, at least in your own surroundings. Jones, Dr. Rank, and other allergy experts offer these tips for minimizing indoor allergen exposure in winter:

  • Use a humidifier to reduce dryness in the air, but don’t turn your home into a rain forest: Dust mites thrive in humidity over 60 percent and temperatures of 60 to 85 degrees Fahrenheit. Mold also grows faster in high humidity. Rank recommends a maximum humidity of 50 percent.
  • Avoid wall-to-wall carpeting, which provides a favorable environment for dust mites. Use area rugs instead.
  • Clean, dust, and vacuum regularly, using a vacuum with a high-efficiency particulate air (HEPA) filter.
  • Wash sheets weekly in hot water — at least 130 degrees Fahrenheit — to kill dust mites, and use hypoallergenic cases for mattresses and pillows to keep dust mites trapped.
  • To minimize dander, bathe pets once a week — though not more often, as more frequent bathing can dry out a pet’s coat and skin — and keep animals out of the bedroom of anyone in the house who has allergies.

If you’ve done all you can to allergy-proof your home but you still have symptoms, it might not be your fault, Jones adds. Public areas, such as workplaces, can have the same allergy-inducing conditions as your home: dry air, dust, and dust mites. In addition, pet owners often get dander on their clothes and unwittingly transport it into public places. The level of cat dander in public places is high enough to trigger allergy, Jones says.

Winter Allergies Versus a Cold

During the winter, it can be difficult to distinguish an allergy from a cold. Both share symptoms, such as sneezing, runny nose, and congestion. But colds are viral infections, while an allergy is your body’s immune system response to an irritant or trigger.

According to the National Institutes of Health (NIH), colds don’t usually last more than a couple of weeks, while allergies will continue as long as the allergen is present. (3) And symptoms like itchy, watery eyes are typically a sign of an allergy, not a cold or the flu, while aches and fever are not associated with allergies. A cough sometimes comes with allergies but is more commonly a sign of a cold, and when it’s more severe, the flu.

 

Treatment Options for Winter Allergy Symptoms

To treat allergy symptoms, Jones cautions against older over-the-counter (OTC) medicines, which, he says, can do more harm than good.

“Some of these drugs have too many side effects,” he notes, “and people don’t really understand how to match their symptoms to the product. They just know they feel bad and want to feel better.”

For example, some OTC allergy drugs contain decongestants, like pseudoephedrine, which can raise a user’s heart rate. The active ingredient in the antihistamine Benadryl — diphenhydramine — causes some tissues to dry out and promotes urinary retention, Jones says. “So people with prostate problems, who may have trouble urinating, find that that condition worsens when they take diphenhydramine.”

Jones says that better options are decongestants that contain loratadine (such as Claritin) and cetirizine (like Zyrtec), two drugs that moved from prescription to OTC status in recent years. Prescription steroid nasal sprays (some of which are also now available over-the-counter) tend to be more effective than antihistamine tablets, adds Rank, though individual responses vary and the two types of drugs are often used in combination.

Talk to your doctor and your pharmacist before taking any over-the-counter medication, to discuss whether it’s appropriate for your symptoms and potential side effects.

The American Academy of Allergy, Asthma, and Immunology notes that if you have a pet allergy, you might consider immunotherapy ­— allergy shots or tablets — that can potentially desensitize you to the allergen and provide lasting relief. (4)

The post Winter Allergies: What Causes Them and How You Can Get Relief appeared first on Oklahoma Allergy and Asthma Clinic.

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