Blog: Eastern Carolina Blog http://www.allergypartners.com/easterncarolina/blog/Lists/Posts/MonthlyArchive.aspx RSS feed for the Eastern Carolina Blog list. Wed, 19 Jun 2013 21:43:17 GMT Microsoft SharePoint Foundation RSS Generator 60 en-US Blog: Eastern Carolina Blog http://www.allergypartners.com/easterncarolina/blog/_layouts/images/siteIcon.png http://www.allergypartners.com/easterncarolina/blog/Lists/Posts/MonthlyArchive.aspx Stinging Insect Allergy http://www.allergypartners.com/easterncarolina/blog/Lists/Posts/ViewPost.aspx?ID=24 Body:

 

Stinging insect allergy affects approximately 3% of adults and 0.4-0.8% of children in the United States, with 40-100 people in the United States dying each year from a sting reaction. This type of allergy may develop at any age, is not inherited, and can occur whether or not one has other types of allergies. People with a severe allergic reaction to an insect sting have usually tolerated a prior sting; it is rare to have a life-threatening reaction the first time a person is stung. The insects responsible for the most serious allergic reactions are honey bees, wasps, hornets, yellow jackets, and fire ants. Bumblebees rarely sting.

 

 
Reactions to insect stings fall into two categories: anaphylaxis and large local reactions.
Anaphylaxis is defined as a sudden onset life-threatening allergic reaction. Onset of symptoms can be immediately to within 2 hours after a sting. Symptoms may include hives, swelling, difficulty breathing, wheezing, coughing, a feeling of throat closing or throat tightness, nausea, vomiting, low blood pressure, lightheadedness, shock, or loss of consciousness. In other words, any symptoms distant to the site of a sting may be life-threatening. However, if a person is stung and only has swelling at the site of the sting with no other symptoms, this is called a large local reaction.
 
People who have a large local reaction to a sting are not at increased risk of a life-threatening reaction to future stings; they do not necessarily need evaluation or treatment by an allergist. However, once a person has had a severe reaction to a sting (anaphylaxis), there is a 50-65% chance of having a similar or more severe reaction if stung in the future. Anyone who has experienced symptoms consistent with anaphylaxis after an insect sting (or symptoms distant to the sting site) should be referred to an allergist. They will need an evaluation and consideration for venom-specific immunotherapy in order to minimize the likelihood of future reactions. The exception is children under 16 years of age who only develop hives but no other symptoms after a sting. They are not at increased risk of anaphylaxis with future stings, and do not need an allergy evaluation or consideration for treatment with venom-specific immunotherapy.
 
The allergist will take a detailed history to confirm the nature of the sting reaction. The insect culprit will be identified if possible. Insect allergy is then diagnosed with venom allergen skin prick and intradermal testing. Occasionally, blood testing for venom allergy may be performed to complement skin testing. Because there is cross-reactivity between some venoms and it is not always possible to identify the insect responsible for the reaction, testing for all relevant venoms is usually performed. Venom skin testing accurately identifies >90% of stinging insect venom sensitivities.
 
Treatment and Practical Tips
Treatment of stinging insect venom allergy consists of venom-specific immunotherapy, the recommendation to carry injectible epinephrine, and observing general avoidance measures to reduce the risk of being stung in the future. The allergist may also provide a written anaphylaxis action plan and recommend obtaining a medical-alert bracelet which states that the wearer has stinging insect venom allergy.
 
Venom-specific immunotherapy reduces the risk of an allergic reaction to a future sting from 50-65% to under 5%. It exposes the patient’s immune system to gradually increasing doses of the venom(s) to which they are allergic. This produces tolerance to the venom(s) that protects them against anaphylaxis if stung again. Venom-specific immunotherapy is typically given for 3-5 years. It is 98% effective in preventing future systemic reactions and is the standard of care for treating venom-allergic patients. Venom immunotherapy can be a life-saving therapy.
 
Epinephrine is the cornerstone of treatment for all forms of anaphylaxis. All patients with a history of stinging insect venom anaphylaxis should carry epinephrine at all times and be properly instructed in its use. Epinephrine should be administered immediately at the onset of any life-threatening symptoms consistent with anaphylaxis and should be followed by transport to the nearest emergency room for additional care. Because epinephrine is short-acting (15-20 minutes), symptoms of anaphylaxis may recur after the epinephrine wears off. The use of this medicine is therefore considered a temporizing measure, not a substitute for seeking medical care. An antihistamine such as Benadryl should also be used, but only after epinephrine has been given.
 
General avoidance measures to reduce the future risk of a sting include the following:
 
1. Avoid wearing perfumes and scented lotions, which may attract insects.
2. Wear shoes (closed-toed) outdoors at all times.
3. If eating outdoors, keep food covered until eaten, and leave the clean-up to others.
4. Exercise caution when eating sweet foods and drinks (sodas, juices) outdoors.
5. Avoid or exercise caution around pools, picnic tables, and trash cans.
6. If possible, leave yard-work, gardening, and landscaping to others; otherwise proceed with extreme caution.

 7. Have periodic inspection of your home and property by a professional pest company or non-allergic relative or friend to exterminate nests.

 

 
 
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Category: Tips; Prevention; Immunotherapy; Treatments
Published: 6/18/2013 9:33 AM
Intro: Stinging insect allergy affects approximately 3% of adults and 0.4-0.8% of children in the United States, with 40-100 people in the United States dying each year from a sting reaction. This type of allergy may develop at any age, is not inherited, and can occur whether or not one has other types of allergies
]]> Lynda A. Matthews Tips; Prevention; Immunotherapy; Treatments Tue, 18 Jun 2013 13:38:57 GMT http://www.allergypartners.com/easterncarolina/blog/Lists/Posts/ViewPost.aspx?ID=24 Exercise-Induced Asthma http://www.allergypartners.com/easterncarolina/blog/Lists/Posts/ViewPost.aspx?ID=23 Body:

 

Do you have problems with coughing, wheezing, or chest tightness when you exercise? Do you feel very tired and short of breath when you exert yourself? Some people wrongly believe that they are just out of shape when, in fact, they may have exercise-induced asthma. About 18 million Americans have asthma and, of those, 80% will have increased symptoms with exercise. In non-asthmatics, up to 15% experience asthma symptoms with exercise and 40% of people with nasal allergies may experience exercise-induced asthma symptoms.
 
What is Exercise-Induced Asthma?
Exercise-induced asthma (EIA) is a reaction of the lungs caused by exercise. The bronchial tubes become irritated and constrict, also known as bronchospasm. Excess mucus is also formed contributing to the blockage of the airway and congestion. It is thought that when you exercise the airway is cooled and dried rapidly which sets off the reaction in some people. Although chronic asthma sufferers are more likely to have EIA, the presence of EIA does not lead to chronic asthma.
 
Symptoms and Triggers
Symptoms of EIA include shortness of breath during or after exercise, coughing, wheezing, chest tightness or pain, and extreme fatigue. Symptoms usually start within 5-20 minutes after starting exercise and may last for 30-60 minutes. Sometimes symptoms start only after activity has stopped however. “Locker room cough”, or a cough that occurs after exercise, is a common form of exercise induced asthma. Shortness of breath, from poor conditioning, usually resolve within a few minutes of rest. People with EIA are overly sensitive to sudden changes in temperature and humidity. Colder, drier air is usually more of a problem. Nasal breathing helps warm and humidify the air you breathe so mouth-breathing with exercise reduces the moisture and humidity of the air that reaches your lungs. Air pollution, high pollen counts, and viral upper respiratory infections can also worsen wheezing with exercise.
 
Diagnosis
You should talk to your doctor if you think you may have EIA. You will need a good history and physical which often leads to the diagnosis. You may have a resting lung function test to make sure you have no chronic asthma. You may also have a breathing test after exercise, although this test may not be positive in everyone with EIA. A trial of bronchodilator therapy prior to exercise may be used to help determine whether you have EIA. Chest pain may be a symptom of EIA, but it is important for your doctor to rule out cardiovascular disease as well.
 
Treatment and Practical Tips
There are things that you can do to reduce the chance of having symptoms. Staying out of cold, dry air is a big fac­tor so train indoors if possible. If you do exercise in the cold, try to breathe through the nose as much as possible, wear a mask or scarf, and avoid exercise in the cold if you have a respiratory infection. Warming up 45-60 minutes before training or playing may help. Taking frequent, short breaks can help. Avoid training or playing outside on days with high pollution or pollen counts. Certain sports are tolerated more than others. Swimming is usually tolerated well due to the humidity of a pool. Lower intensity sports like golf, baseball, and weight lifting are better tolerated. Sports with short bursts of energy such as baseball, football, wrestling, gymnastics, and short-term tack events are better tolerated than soccer, basketball, hockey, skiing, and long-distance running. Always have your asthma medications with you!
 
The first step of treatment is the use of an inhaled short-acting bronchodilator medicine 15-20 minutes before exercise. These include albuterol, pirbuterol, and levalbuterol and are effective in 80-90% of patients, have a rapid onset of action, and last for 4-6 hours. If symptoms are not controlled by these short-acting medications, a daily medication may have to be used to prevent inflammation and responsiveness of the airway.
 

 

Most importantly, you should be evaluated and continue to exercise. Exercise and training will improve fitness, reduce the amount of breathing needed with exercise, and allow you to exert yourself at a higher intensity before symptoms begin.

 

 
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Category: Managing Asthma; Tips; Treatments
Published: 6/11/2013 3:05 PM
Intro: Do you have problems with coughing, wheezing, or chest tightness when you exercise? Do you feel very tired and short of breath when you exert yourself? Some people wrongly believe that they are just out of shape when, in fact, they may have exercise-induced asthma
]]> Lynda A. Matthews Managing Asthma; Tips; Treatments Tue, 11 Jun 2013 19:07:05 GMT http://www.allergypartners.com/easterncarolina/blog/Lists/Posts/ViewPost.aspx?ID=23