ALLERGIES

An allergy is an exaggerated immune response or reaction to substances that are generally not harmful.

Causes

Both genes and environmental factors play a role in allergies.

The immune system normally protects the body against harmful substances, such as bacteria and viruses. It also reacts to foreign substances called allergens, which are generally harmless and in most people do not cause a problem.

But in a person with allergies, the immune response is oversensitive. When it recognizes an allergen, it releases chemicals such as histamines. which fight off the allergen. This causes allergy symptoms.

Common allergens include:

• Drugs
• Dust
• Food
• Insect bites
• Mold
• Pet dander
• Pollen

A specific allergy is not usually passed down through families (inherited). However, if both your parents have allergies, you are likely to have allergies. The chance is greater if your mother has allergies.

Allergies may make certain medical conditions such as sinus problems, eczema, and asthma worse.

Symptoms

Allergy symptoms may include:

• Breathing problems (coughing, shortness of breath)
• Burning, tearing, or itchy eyes
• Conjunctivitis (red, swollen eyes)
• Coughing
• Diarrhea
• Headache
• Hives
• Itching of the nose, mouth, throat, skin, or any other area
• Runny nose
• Skin rashes
• Stomach cramps
• Vomiting
• Wheezing

Exams and Tests

The health care provider will perform a physical exam and ask questions, such as when the allergy occurs.

Allergy testing may be needed to find out whether the symptoms are an actual allergy or are caused by other problems. For example, eating contaminated food may cause symptoms similar to food allergies. Some medications (such as aspirin and ampicillin) can produce non-allergic reactions, including rashes. A runny nose or cough may actually be due to an infection.

Skin testing is the most common method of allergy testing. One type of skin testing is the prick test. It involves placing a small amount of the suspected allergy-causing substances on the skin, and then slightly pricking the area so the substance moves under the skin. The skin is closely watched for signs of a reaction, which include swelling and redness. Skin testing may be an option for some young children and infants.

Other types of skin tests include patch testing and intradermal testing.

Treatment

Severe allergic reactions (anaphylaxis) need to be treated with a medicine called epinephrine, which can be life saving when given right away. The best way to reduce symptoms is to avoid what causes your allergies. This is especially important for food and drug allergies.

There are several types of medications to prevent and treat allergies. Which medicine your doctor recommends depends on the type and severity of your symptoms, your age, and overall health.

Illnesses that are caused by allergies (such as asthma, hay fever, and eczema) may need other treatments.

Medications that can be used to treat allergies include antihistamines, corticosteroids, decongestants.

Prevention

Breastfeeding children for at least 4 months or more may help prevent a cow's milk allergy and wheezing in early childhood.

For most children, changing the diet or using special formulas does not seem to prevent allergies. If a parent, brother, sister, or other family member has a history of eczema and allergies, discuss feeding with your child's doctor. When you introduce solid foods and what foods you give your baby can help prevent some allergies.

There is also evidence that infants who are exposed to certain allergens in the air (such as dust mites and cat dander) may be less likely to develop allergies. This is called the "hygiene hypothesis." It came from the observation that infants on farms tend to have fewer allergies than those who grow up in more sterile environments. However, older children do not seem to benefit.

Once allergies have developed, treating the allergies and carefully avoiding allergy triggers can prevent reactions in the future.

Allergy Treatment

Allergy Treatment

Step 1: Consultation

Your first step is to see a board-certified allergist-immunologist. You may be sent by your primary care physician, or find an allergist certified by the American College of Allergy, Asthma and Immunology (ACAAI) in your area. 

Step 2: Testing

Your allergist will obtain a detailed medical history, examine you and evaluate your symptoms. Skin tests or allergy blood tests may be needed to find out the causes of your allergic symptoms. Based on the entire clinical evaluation, a diagnosis is made.

Step 3: Treatment

This is the step where your allergic symptoms and you get better. Allergy treatments are of three types: Prevention. Medication. Immunotherapy.

Prevention: Once identified, the cause of the symptoms may be avoided or removed from your life. For example, a particular food can be avoided, or a pet can be removed from the home or kept away from sleeping areas.

Some causes of allergic symptoms, such as pollen, molds and dust mites, cannot be completely eliminated and are difficult to avoid. Exposure can be reduced, however, by environmental control measures prescribed by your allergist.

Medication: Although prevention comes first, more may be needed. Medications are usually used to decrease allergy symptoms and improve the patient's quality of life. Improvements in drugs have eliminated most of the side effects from older drugs.

Immunotherapy ("allergy shots"): If a specific allergy is identified and it cannot be avoided or medications are not sufficient to restore your health, the allergic symptoms may be controlled or eliminated with allergy shots.

Allergy shots have been used since 1911. The treatment is a method for increasing the allergic patient's natural resistance (tolerance) to the things that are triggering the allergic reactions.

This treatment involves injections of small amounts of purified "extracts" of the substances that are causing allergic reactions. For example, the extracts may be derived from pollens, mold spores, animal dander, dust mites or insect venom.

Allergy shots stimulate the immune system to fight allergies safely, effectively and naturally. Beginning with small doses and increasing them gradually on a weekly or biweekly basis, the therapy continues until a maintenance level is achieved. Then, a maintenance dose is injected every few weeks.

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Cephalosporins Allergy

CEPHALOSPORINS ALLERGY

Cephalosporins are -lactam antibiotics that differ from the penicillins in that the B ring is a 6-membered dihydrothiazine ring.

Cephalosporin antibiotics are widely prescribed for common infections such as bronchitis, otitis media, pneumonia, and cellulitis. They are also administered as first-line prophylaxis for many types of surgical procedures. A relative contraindication to these agents is a history of allergy to penicillin.

Cross-Reactivity with Penicillin

Because penicillin-related compounds are produced by the cephalosporium mold, early cephalosporin antibiotics contained trace amounts of penicillin. Thus, penicillin contamination may have led early studies to cephalosporins allergy and penicillin allergy to overestimate the degree of cross-reactivity.

Studies suggest that the risk of cephalosporins allergy in patients with a history of allergy to penicillin may be up to eight times as high as the risk in those with no history of allergy to penicillin. The studies also suggest that patients with a history of penicillins allergy but negative skin tests are not at increased risk for cephalosporins allergy. Thus, testing for a penicillin allergy may be useful in patients with a history of allergy to penicillin who require cephalosporin therapy.

The product label for all cephalosporin antibiotics states,

Before therapy with [the cephalosporin] is instituted, careful inquiry should be made to determine whether the patient has had previous hypersensitivity reactions to [the cephalosporin], other cephalosporins, penicillins, or other drugs. If [this product] is to be administered to penicillin-sensitive patients, caution should be exercised because cross-hypersensitivity among beta-lactam antibiotics has been clearly documented and may occur in up to 10% of patients with a history of penicillin allergy.

Tests for Cephalosporins Allergy

Attempts to develop a skin test for cephalosporins allergy have been unsuccessful, and skin testing with the native drug alone has little predictive value. No anti-cephalosporin IgE antibody assays are available clinically. Skin tests for allergy to penicillin can be useful in evaluating patients with a history of cephalosporins allergy.

Recommendations for Patients with Cephalosporins Allergy

If the skin test is negative, they can receive penicillin or cephallosporin; if it is positive, they should either receive an alternative medication or undergo desensitization to penicillin.

A patient who has had cephalosporins allergy should not receive that cephalosporin again. Cross-reactivity (or the absence of it) between a cephalosporin and other beta-lactam antibiotics can be explained in part by the structure of the side chains.

Test dosing consists of the administration of a small dose of the drug, less than the dose that potentially would cause a serious reaction, followed by relatively large incremental increases in the dose until the full therapeutic dose is given. The administration of a cephalosporin to a patient who is potentially allergic to that drug is hazardous and is not recommended.

Conclusions

Patients with a history of cephalosporins allergy or penicillin may be at increased risk for a reaction to cephalosporins. Skin testing for an allergy to penicillin may be helpful in patients with a history of such cephalosporins allergy. The majority of these patients have negative tests and should not be at increased risk for a reaction to cephalosporins.

Penicillin Allergy

PENICILLIN ALLERGY

Penicillin is one of the most commonly prescribed antibiotics. It is part of a family of antibiotics known as beta lactams, and there are many individual medications in this family: Penicillin G, nafcillin, oxacillin, cloxacillin and dicloxacillin, ampicillin, amoxicillin, carbenicillin, ticarcillin, and piperacillin. Anyone who has penicillin allergy  should be presumed to be allergic to all penicillins and should avoid the entire group, unless they have been specifically evaluated for this problem.

Penicillin Allergy Reaction.

Allergic  reactions to Penicillin may range from mildly annoying to life threatening. Penicillin allergy reactions — occurs when the immune system begins to recognize a drug as something "foreign". Several different symptoms can indicate penicillin allergy include : hives (raised, intensely itchy spots that come and go over hours), angioedema (swelling of the tissue under the skin, commonly around the face), throat tightness, wheezing, coughing, and trouble breathing from asthma-like reactions (narrowing of the airways into the lungs), Anaphylaxis — it is a sudden, potentially life-threatening allergic reaction.

Penicillin Allergy Diagnosed

A detailed history is of utmost importance when diagnosing drug allergies. The symptoms, drug history and the timing of reaction in relation to drug administration will help to pinpoint the offending drug and the type of reaction.

Skin testing for penicillin allergy should be done for sensitize patient. The skin is pricked and injected with weak solutions of the various preparations of penicillin and observed for a reaction.

If skin testing is NOT available, options for people who has penicillin allergy  include:

• Take a different antibiotic

·         Challenge test for patient with penicillin allergy(starting with a very small dose of the antibiotic given by mouth. If the person tolerates the smallest dose, a larger dose is given every 30 to 60 minutes until he/she has signs of an allergic reaction or the full dose is given. If the person tolerates the full dose, he or she is not allergic to the antibiotic)

·         Desensitization (a process of giving a medication in a controlled and gradual manner, which allows the person to tolerate it temporarily without an allergic reaction.

Based on study done by Adrian Y. WU Department of Medicine, Queen Mary Hospital,  Patients with penicillin allergy  are 10 times more likely to become allergic to other drugs. This susceptibility not only applies to anaphylactic type reactions, but also extends to drug rashes, exfoliative dermatitis, toxic epidermal necrolysis and Stevens-Johnson syndrome.  So, if you one who has penicillin allergy, the main treatment is avoidance of future use of penicillin and related antibiotics.