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Clinical Specialties
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Allergies

DEFINITION

Allergies are an overreaction of the immune system that results in itchy eyes, runny nose, sneezing, hives, and, sometimes, extreme swelling called anaphylaxis. Allergies can affect your sinuses, skin, gastrointestinal tract and airways. The immune system normally works in the body to protect us from things that might do us harm, like bacteria or other infections. As part of this immune system, the body produces antibodies which serve to catch things in the body that should not be there, like harmful bacteria. The type of antibody that is overproduced in people with allergies is called IgE. When the body comes in to contact with allergens (like pet dander, pollen or insect stings), it reacts with full force to block them like it would against an infection by gathering up the allergen, releasing histamine, and giving you symptoms of allergies. There are many common allergens (substances that trigger allergies): pollen, pet or animal dander, dust mites living in our homes, mold, certain foods like peanuts, bug stings like bee or wasp, certain medications like penicillin, detergents, latex or other things our body touches. Risk factors for developing allergies include: family members with allergies or asthma, young age, or already have some allergies or asthma. If you have allergies, you may be at higher risk for other medical conditions like anaphylaxis (a severe allergic reaction which may lead to swelling in the throat which restricts breathing), allergies to other substances, asthma (a condition characterized by difficulty breathing and wheezing), atopic dermatitis or eczema (a condition characterized by itchy patches of skin), infections of the sinuses or ears, and fungal infections in the sinuses or lungs (allergic fungal sinusitis and allergic bronchopulmonary aspergillosis). Allergies cannot be cured, but many treatment options exist to decrease allergy symptoms.

SYMPTOMS
Runny nose, itchy eyes, tearing of the eyes, congestion, headache, itchy skin, red skin, flaky skin, itching or tingling of the mouth, swelling of lips, swelling of tongue, swelling of throat, swelling of face, hives, anaphylaxis, swelling at site of bee sting, chest tightness, wheezing, difficulty breathing

DIAGNOSIS
The diagnosis of allergies is based mostly on clinical history and physical exam. The doctor may request that you keep a diary of your allergy symptoms and what might be triggering them like foods or exposures. Your doctor or allergist may recommend trying to remove potential allergens to see if symptoms improve. To find the cause of allergies, an allergist may recommend a skin prick test. The skin prick test uses a set of tiny needles which inject very small amounts of allergen under the skin. If any of those areas become inflamed or swollen, the doctor can tell which allergens cause your allergies. Your physician will have you wait in the office after placing these allergens in the skin to monitor your reaction. Sometimes, a blood test can also be done to look for antibodies to common allergens. If other conditions are expected, your doctor may want to do some other testing.

TREATMENT
Treatment of allergies usually starts with avoiding contact with whatever allergen causes symptoms. Sometimes, avoiding the allergen is very difficult (as with allergies to pollens or pet dander). If allergens cannot be avoided, medications to treat symptoms include over-the-counter medications like diphenhydramine (Benadryl) or loratidine (Claritin) as well as prescriptions medications and nasal sprays. These prescription medications include steroids, antihistamines, decongestants, leukotriene modifiers and cromolyn sodium which all work to decrease symptoms from allergies in different ways. Your allergist may recommend special shots called immunotherapy designed to decrease your allergy symptoms. These shots are purified allergen given over a period of years to desensitize the body to the allergen. When anaphylaxis occurs, it is extremely important to have prompt medical care. In the meantime, an injection of epinephrine should be given in the thigh as soon as possible to prevent death. Anaphylaxis is an emergency. Any person with anaphylaxis should go immediately to the emergency room.

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