Are you reacting to your favorite perfume or deodorant? You may have an allergy to your fragrance and not realize it. A perfume and deodorant allergy is often misunderstood and reactions to fragrances are incorrectly labeled as an allergy. However, there is a difference between irritation caused by fragrances and an actual allergy. It is important to identify whether you have a perfume or deodorant allergy although the symptoms may seem similar to irritation to a fragrance. An allergy is often a more serious reaction and you should take the necessary measures to avoid the trigger fragrance altogether.
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A latex allergy is a hypersensitivity reaction to natural rubber latex found in a variety of household, work-related and medical items. Latex is a commonly occurring substance in modern life and particularly in the health care industry. Exposure to latex is therefore often unavoidable. While it does not cause any irritation nor pose a threat to most people, some individuals have varying degrees of hypersensitivity to latex. It can lead to minor symptoms like itching of the skin or can even progress to widespread and severe systemic manifestations which may be life threatening.
Pneumonitis is the term for inflammation of the lungs, involving the respiratory and often the terminal bronchioles as well. This may arise as a result of trauma (chemical/physical), allergic reactions, airborne particles and drugs. It is often confused with pneumonia – pneumonitis is a broad term that includes lung inflammation from any cause while pneumonia is often reserved for lung inflammation due to an infection. However, the term pneumonia is more popular and to some extent has replaced the word pneumonitis to describe lung inflammation arising from infectious and non-infectious causes. Pneumoconiosis is lung disease caused by the inhalation of mineral (inorganic) dusts and may be seen as a type of pneumonitis.
There are various allergy medications used to reduce the immunological response seen in allergies. The most common and well known of these allergy medicines are antihistamines, with corticosteroids being used with increasing frequency to prevent exacerbations in common allergic diseases.
However, antihistamines and corticosteroids are not the only types of medications to treat allergic reactions. Other allergy medicines include mast cell stabilizers, leukotriene pathway inhibitors and anti-IgE antibodies. Adrenaline is used in severe allergic reactions and anaphylaxis.
Corticosteroids have a significant role in the management of allergies due to its broad anti-inflammatory action, which reduces the immunological response in allergic diseases. This is invaluable in the long term management of allergic diseases. Corticosteroids reduce the duration and severity of acute exacerbations in chronic allergic diseases like allergic rhinitis.
Anti-allergic Actions of Corticosteroids
Corticosteroids considerably reduce the manifestations of inflammation associated with an allergy. This is primarily due to its intense effects on the inflammatory cells and suppressive effects on the mediators of allergic response.
What are antihistamines?
Antihistamines are those drugs that block the H1 histamine receptors and not the other histamine receptors like H2, H3 and H4. It is also known as a H1-receptor blocker. These drugs act by block the histamine-induced responses in allergic reactions. It is the most widely used allergy medicine for most of the common allergic diseases.
Several H1-blockers are currently available many of which are over-the-counter drugs. Antihistamines are generally divided into first-generation and second-generation drugs. A strong sedative effect of the older first generation antihistamines is one of the most distinguishing features between the two groups.
First Generation Antihistamines
The first generation antihistamines are the older group of antihistamines and are often used as ‘sleeping aids’ because of its strong sedative actions. Although the sedative effect of antihistamines are sometimes desired, like in a patient with allergic rhinitis who is having difficulty sleeping, generally the use of these drugs should be limited in a person who is driving or operating heavy machinery.
Some of the first generation antihistamines also block other receptors like cholinergic (muscarinic) receptors and alpha adrenergic receptors. The anticholinergic effect also helps with nasal and bronchial secretions, in preventing nausea and vomiting (including motion sickness and vomiting associated with pregnancy), vestibular disturbances and in treatment of drug-induced movement disorders.
Doxepin is an antihistamine with additional antidepressant actions. Most of the first-generation antihistamines exert its actions for about 6 hours, but a few like chlorpheniraminecan act for about 24 hours.
The first-generation antihistamines include :
- tripelennamine clemastine
Some of the first-generation antihistamines (like promethazine, dimenhydrinate, diphenhydramine) which are available for parenteral use, may be used intravenously in emergency indications.
Second Generation Antihistamines
The newer antihistamines are called second-generation antihistamines. These drugs have significantly less sedative effects compared to older generation antihistamines. The limited distribution of these drugs to the brain due to low lipid solubility is one of the main reasons for its reduced sedative effects. Many physicians prefer the non-sedative second-generation antihistamine for out-patient use.
Most of the second-generation antihistamines are given once daily as it has a long duration of action, but are relatively more expensive than first generation drugs.
The second-generation antihistamines available for oral use include :
Azelastine (nasal spray and eye drops) and levocabastine (eye drops) are available for topical use alone.
Actions of Antihistamines
All antihistamines competitively block histamine H1 receptors and this action is primarily responsible for the benefits of antihistamines in allergy treatment. In allergic diseases, the H1 receptor blockage is instrumental in control of the histamine-induced symptoms like itching, swelling and redness.
In addition, the first generation antihistamines also have anti-cholinergic effects which may be beneficial for other symptoms like bronchial and nasal secretions, even if it not due to an allergic reaction. The second-generation antihistamines like cetrizine inhibit the release of histamine from mast cells by an unknown mechanism and may contribute to the beneficial effects in treatment of allergic diseases.
Uses of Antihistamines (Indications)
Antihistamines have been considered as highly valued agents for prevention or treatment of a wide variety of allergic disorders. Antihistamines are most useful in acute types of allergies that present with symptoms of rhinitis, urticaria, and conjunctivitis in which histamine is considered to be the primary immune mediator involved.
The non-sedating second generation antihistamines are preferred drugs in hay fever, but drugs like chlorpheniramine may be used. Some patients prefer slightly sedative antihistamines in order to have a peaceful sleep while suffering from allergic diseases with symptoms of sneezing, rhinitis, conjunctivitis or itching of skin, nose or throat. At times these sedative actions help to ease the symptoms like an itching sensation in chronic urticaria or atopic dermatitis.
Antihistamines are only of limited use in treating angioedema that has already developed, but may be of use in preventing angioedema if treated prior to the exposure to allergen. In life threatening angioedema, adrenaline is the drug of choice and intravenous antihistamines have only an adjuvant role.
Treatment of anaphylaxis is primarily with adrenaline and antihistamines may play an adjuvant role. Pretreatment with antihistamines can prevent or minimize anaphylactic reactions but after onset of anaphylaxis, antihistamines can only be of use in controlling itching or urticaria. Antihistamines have a minimal role in allergic asthma in which several immune mediators in addition to histamine are involved.
Insect bites, food allergy and drug allergy which are characterized by itch, urticaria and angioedema benefit from antihistamines. Pretreatment with antihistamines prevent such allergic responses to a great extent.
Motion Sickness and Vertigo
The anticholinergic actions of first-generation H1 blockers make them one of the most important agents available for the prevention of motion sickness. The useful antihistamine drugs in motion sickness are promethazine, dimenhydrinate, diphenhydramine, cyclizine and meclizine, the last two having a milder sedative effect. Effectiveness of H1 blockers in preventing motion sickness is increased when combined with ephedrine. Treatment with antihistamines after the onset of motion sickness is seldom useful.
Dimenhydrinate and meclizine are also found to be useful in vertigo and other vestibular disturbances like Meniere’s disease.
Nausea and Vomiting
Doxylamine in combination with pyridoxine was available in the United States for morning sickness (nausea and vomiting associated with pregnancy), but was withdrawn from markets owing to a controversy regarding possible abnormalities in fetus. Hydroxyzine, cyclizine and promethazine are other antihistamines that have been used in pregnancy-induced vomiting (vomiting during pregnancy).
Promethazine may also be of use in post-operative or chemotherapy-induced nausea and vomiting, but less preferred now due to availability of better drugs.
Antihistamines are available over-the-counter and have strong sedative actions. This has led to the use of some of the first-generation antihistamines as sleeping aids. Diphenhydramine is also present in some of the proprietary remedies for sleeplessness that are available over-the-counter. The sedative antihistamines may also be used as mild anxiolytic (anti-anxiety medication).
Common Cold and Flu
Antihistamines are popular drugs used in the common cold and flu despite the fact that it can do more harm than good. The nasal discharge in common cold may be relieved by the drying effect due to the anticholinergic actions of the older antihistamines. The excessive drying of nasal secretions in common cold can result in stagnation of the secretions and subsequent bacterial infection.
Side Effects of Antihistamines
The most important undesirable effect of antihistamines is sedation although some patients may consider it a desirable effect and make use of the drug as a sleeping aid. The sedative effect of antihistamines is addictive with alcohol or other CNS (central nervous system) depressants and can lead to dangerous depression of the brain. For safety reasons, the sedative antihistamines are contraindicated during driving or while operating machinery.
Anticholinergic effects (like dry mouth, blurred vision, urinary retention) are other common side effects seen with antihistamines. Related side effects can include dizziness, incoordination, fatigue and double vision (diplopia). Occasionally in children, antihistamines can result in CNS stimulation resulting in sleeplessness, excitation, euphoria and convulsions. The sedative effects and anticholinergic effects are mostly seen with the first generation antihistamines.
The digestive tract related adverse effects account for other common side effects. This includes nausea, vomiting, appetite loss, constipation or diarrhea and abdominal discomfort.
Antihistamines itself can occasionally cause a drug allergy and is more frequently seen with topical agents. The drug allergy can be in the form of contact dermatitis or photosensitivity. Very rarely antihistamines can result in reduced white blood cells (leukopenia or agranulocytosis). Some of the antihistamines (like azelastine, hydroxyzine) have been found to produce teratogenic effects in animals and hence its use in pregnant women is not recommended. Infants of nursing mothers taking antihistamines may show drowsiness or irritability.
Patients without co-existing depression may show intolerance to doxepin. Antihistamines like astemizole and terfenadine were linked cardiac arrhythmias, which led to its withdrawal in the United States. Enhanced cardiac arrhythmic potential with these drugs were seen when combined with antifungal drugs like ketoconazole and antibiotics like erythromycin.
The common allergic reactions and diseases are :
- allergic asthma
- allergic rhinitis (hay fever, perennial rhinitis)
- urticaria (hives)
- allergic contact dermatitis
- food allergies
- drug allergy
Allergic rhinitis is a common chronic disease characterized by repeated attacks of itching of the nose, runny nose and sneezing. It is often associated with allergic conjunctivitis – watering, itching and redness of eyes. Allergic rhinitis develops due to allergic reactions to allergens in the air (like pollen) that can get attached to the mucosa of nose and the conjunctiva.
The seasonal allergic rhinitis (also called hay fever) results from an allergy to seasonal pollen while perennial allergic rhinitis is believed to result from sensitivity to house mite dust or other allergens present throughout the year.
What is an allergy?
An allergy or hypersensitivity is one of the most common ailments that arises due to abnormal functioning of the immune system. It is a result of exposure to a specific antigen (allergen) by a sensitized person who has already developed antibodies against the allergen in question.
The interaction of the allergen with the antibody can result in an allergic reaction in many of these sensitized individuals. However, not ever person harboring specific antibodies to certain allergens develops an allergic reaction – some are only sensitized but it does not progress to an allergic reaction.
What are the types of allergic reactions?
There are four types of allergic (hypersensitivity) reactions based on the mechanism of the reaction. The types I, II, and III allergic reactions are antibody mediated reactions, while type IV is a T-cell mediated reaction.
Types of Angioedema
Angioedema can be characterized as :
This is an immune reaction to an allergen. Symptoms may appear within the first 2 hours after exposure to the allergen and usually settle within 3 days. Urticaria is usually present but not always.
This type of angioedema is associated with certain types of autoimmune diseases, infections, malignant tumors and diseases causing increased lymphocyte populations. It tends to occur later in life, usually after the fourth decade, and may persist as long as the underlying disease is present (chronic in nature). Urticaria may be present.
This is inherited type of angioedema and the symptoms usually present before the age of 20 years. It typically occurs in episodes, which can be quite severe and affect multiple systems simultaneously.
Drug Induced Angioedema
This is a non-allergenic type of angioedema and occurs within days or weeks (sometimes longer) after starting a certain type of medication. Urticaria is not present.
Symptoms are similar to acute allergic angioedema.
CarolAN Asked :
I am not a person who gets sick often and as far as possible I try to stay away from drugs and let my body heal naturally. Recently I used penicillin and I noticed a bit of shortness of breath. I also became more anxious but I am not sure if this was anxiety due to the shortness of breath or worry about the condition I had. I had no other issues with penicillin so I did not mention it to my doctor at the time.
This infection recurred a little while later and I started taking penicillin again. I did tell my pharmacist about this shortness of breath and anxiety and he told me that it could be an allergy to penicillin and sulfa drugs and I should speak to my doctor. I did not speak to my doctor and I noticed the same symptoms again but it went away when I finished the course of tablets.
What Is Nasal Congestion?
Nasal congestion, commonly called blocked or stuffy nose, refers to blockage of nasal passages caused by swelling of nasal mucous layer. Apart from nasal congestion, there are other causes of blocked nose.
Causes of Nasal Congestion
A cause of blocked nose may be suspected from symptoms, their duration, circumstances preceding blockage and effect of treatment trials. When the cause is not obvious, a doctor should be visited. Main causes include:
- Non-allergic rhinitis: emotions, cigarette smoke, medications, irritant gases, hormones, pregnancy, drug addiction, spicy foods…
Tingling or Numb Lips
Lip tingling is abnormal feeling, and lip numbness is decreased or absent feeling in the lip. Both sensations, medically called paresthesia, arise from conditions affecting sensory nerves in the lips, but usually not from neurological diseases. Skin diseases also rarely cause tingling or numbness but rather itch, burning or pain in the lips.
Main causes of tingling and numb lips are listed below.
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