Irregular Periods/Secondary Amenorrhoea

What are irregular periods?

An average menstrual cycle lasts approximately 28 days, although most women have menstrual cycles that vary and can range from slightly longer to slightly shorter than the stipulated average.

Menstrual cycles are temperamental at times. While some women may notice the gap between the end of their last periods and the start of their next period constantly changing, others may have missing or infrequent menses. 

There are two types of irregular periods, these are:


Amenorrhoea, also known as the absence of menses and can be further categorised into:

Oligomenorrhoea, also known as infrequent irregular menses and is defined by fewer than 6-8 periods per year.

 irregular periods
Irregular or absent periods can be a sign of underlying medical conditions.

What are the symptoms of irregular periods?

Women with irregular periods may experience the following symptoms:

If you are experiencing any of the above symptoms, you are advised to consult your doctor to evaluate your symptoms further.

What causes irregular periods?

Irregular periods can be normal in some women. However, for others, there may be underlying medical conditions that require intervention/attention to re-establish a normal period cycle.

Below are some common medical causes of irregular or ceasing of periods: 

Be honest and open when sharing your medical history with your doctor. This will help him/her come to the most accurate diagnosis with regards to your irregular periods.

absent periods
Irregular periods can be regular again for some women if the underlying cause is treated.

When should I see a doctor for irregular periods? Should I be worried if I have irregular periods?

You are advised to seek medical attention if your period:

How are irregular periods diagnosed?

Irregular periods and the underlying cause(s) can be diagnosed with clinical history and physical examination which involves a full body examination including abdominal and pelvic examinations. 

Depending on your condition, you may be required to undergo the following:

For sexually active patients, a pregnancy test will be offered. Depending on individual cases, further investigations such as blood tests, hormonal tests, ultrasound of the pelvis, MRI of the brain, and genetic testing may also be advised or conducted. 

pap smear
Pap smears can be used to identify underlying medical reasons for irregular periods.

What are the treatment options for irregular periods?

The goal of treatment is to treat the underlying condition and restore fertility in women who are in the reproductive phase of their life. How can we make irregular periods regular? This depends on the cause of the irregular periods. 

Let’s take a look at some general treatment options for irregular periods:

Do speak to your doctor for further understanding on individual treatment and management of your irregular periods.

What is a healthy diet and lifestyle for irregular periods?

You are advised to consider moderate exercise; some women can restore a regular menstrual cycle with healthy moderate exercise. Exercises such as yoga, have also been clinically proven to alleviate premenstrual syndrome (PMS) symptoms as there is an increase in the production of endorphin and serotonin, commonly known as the ‘happy’ hormones.

In terms of diet, a healthy balanced diet, high in fibre, omega-3 fatty acids, calcium, and vitamin D is also important. Fatty meals high in saturated fats, salt, carbohydrates, and caffeine should be reduced or avoided.

You are encouraged to discuss your daily lifestyle when sharing your concerns regarding irregular periods with your doctor. 

healthy lifestyle
Healthy lifestyle choices can improve your life in more ways than one, from regulating your menstrual cycle to improving your overall wellbeing.

Can I get pregnant if I have irregular periods?

Some women with irregular periods may have difficulty in getting pregnant as they may not ovulate regularly. Hence, it is good practice to speak to your doctor if your menstrual cycle is abnormal.

Depending on individual medical circumstances, your doctor may advise hormonal medication or fertility treatment to facilitate the process of conceiving naturally.

Are irregular periods normal?

Some women may notice their period irregularity since young/puberty— this can be normal. Occasionally, period cycles may also become irregular due to stress, lifestyle changes, medical conditions, illnesses, vaccinations, etc.

You are encouraged to discuss your symptoms with your doctor so that he/she can come up with a concerted plan to screen for any underlying medical issues that may be the cause of your irregular periods and manage accordingly.

Hay Fever

Hay Fever is also medically termed as rhinitis. It can be divided into Allergic Rhinitis and Non-Allergic Rhinitis.

Allergic Rhinitis occurs when the immune system wrongly identifies a harmless substance as an allergen and responded exaggeratingly by releasing histamines and other chemical mediators causing symptoms in the nose, the roof of mouth, throat, eyes, ears and skin.

Allergic Rhinitis can occur together with allergic conjunctivitis. It can exacerbate lung disease such as asthma in people who suffers from both conditions.

Non-Allergic Rhinitis, as the name suggested, is a condition that does not involve the immune system. People with Non-Allergic Rhinitis has similar symptoms of runny nose and nasal congestion, without a trigger. This tends to occur in the adult.


Indoor allergens cause perennial allergic rhinitis, meaning the symptoms can occur all year round. Common allergens include:

Outdoor allergens cause seasonal allergic rhinitis as it occurs the different time of the year when the pollen level is high in the air. Typically, in countries with four seasons, the symptoms tend to flare during spring and fall.

Irritants such as smoke, open burning, strong odours, change of humidity and temperature of the air can trigger allergic rhinitis by causing inflammation of the nose linings, hence sensitizing the nose to irritants.


Typical symptoms include:


Your doctor will take a thorough medical history and allergy history, physically examine you. Your doctor will enquire on your lifestyle, home and work environment. An allergy diary may be useful. You may be offered allergy testing such as skin prick tests and allergy RAST blood tests to determine the triggers of your allergic rhinitis. Sometimes, your doctor may even refer you to an allergist or immunologist.


By identifying the culprit allergens, your doctor will work with you to develop a strategy to avoid the allergens as much as you can. In triggers that are inevitable such as in the case of seasonal allergic rhinitis, you may be recommended to start medications before you have contact with the allergens to prevent developing allergic rhinitis or reduce the severity of the symptoms.

Medical treatment options for hay fever include:

Consult your doctor if you have a sensitive snuffly nose! Take care.

Drug Allergy

The same medication may not cause any reaction to a person, yet may cause unforeseen allergic reactions to another person. An allergic reaction occurs when the body’s immune system mistaken a harmless substance as an allergen, in the case of a medication, triggering a cascade of allergic events.

What are the Common Medications that can produce Allergic Reactions?

What are the Symptoms of Drug Allergy?

Drug Allergy manifestations differ individually, with a wide spectrum of symptoms such as

In severe end spectrum of drug allergy, one can potentially develop anaphylaxis that if not being reversed and treated on time, can lead to death. You should seek immediate medical attention if you suspect of having anaphylaxis.

A drug history and a history of relevant symptoms are important. It would be useful to obtain the timeline relation between the start of the culprit of medication and the onset of the symptoms. Often, you may be taking multiple drugs concurrently. Your doctor will work with you to produce a drug chart to see the correlation between the drug and allergy symptoms. 

You may develop various different adverse reactions to medications that can range from stomach upset from aspirin to diarrhoea caused by antibiotics. Some people who are taking certain blood pressure medication such as ACE-I (Angiotensin-Converting Enzyme Inhibitors), can develop cough, facial and tongue swelling.

What do I expect when I consult my doctor for Drug Allergy?

Allergy testing such as skin prick tests, blood tests, or even an oral challenge test may be offered to certain suitable patients. Your doctor may work together with immunologist or allergist to further evaluate your Drug Allergy.

What are the Treatment and Management of Drug Allergies?

When drug allergic reactions occur, the offending drug should be stopped. Your doctor is likely to prescribe you antihistamine, corticosteroid or even epinephrine during serious allergic reactions.

In circumstances where there is no other alternative medication available, and the allergic medication is essential, you may be offered a desensitization procedure. Your doctor will gradually introduce the medication in small doses and monitor closely for any adverse reaction to achieve the maximum possible dose that you can tolerate and simultaneously aiming to achieve a therapeutic dose.

You may have come across the below, if not, it may be worth spending a minute of time reading.

Adverse Drug Reactions (ADRs)

ADRs: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS Syndrome)

DRESS syndrome, as the name suggests, is a serious Drug Allergy that causes skin rash and involves other body systems. One can present with fever, facial swelling, rash, kidney or liver injury and swollen lymph nodes. Patients with DRESS have abnormal blood cells counts with elevated levels of eosinophils. Eosinophils are blood cells that are associated with allergic conditions.

Almost any drug can cause DRESS syndrome. However, antibiotics, allopurinol (anti-gout medication) and anti-epileptic medications are commonly associated with DRESS syndrome. DRESS syndrome typically starts after 2 to 6 weeks of starting a person on the culprit drug.

DRESS syndrome is a condition that is usually managed in the tertiary hospital setting with the involvement of the Dermatology and Immunology/Allergist department. The key step is to stop the culprit medication. Oral or even injection steroid may be used to suppress the allergy reaction and prevent further damage to body organs. The treatment of steroid may be needed for weeks or even up to months, and DRESS patients will need long term to follow up with specialist care.

ADRs: Stevens-Johnson Syndrome & Toxic Epidermal Necrolysis

Steven-Johnson Syndrome (SJS) is a rare, yet potentially fatal skin emergency condition.  SHS can progress into an even more severe form of a condition known as Toxic Epidermal Necrolysis (TEN). Both conditions occur with extensive skin and mucous membrane reaction to a particular medication, or a pre-existing bacterial infection or illness.

Although SJS and TEN can affect any age group, the elderly, people with HIV or Herpes are more at risk.

One can present with flu-like symptoms such as fever, cough, aching, headache, eye burning sensation. This is followed with red to a purplish painful skin rash that spreads quickly over the face and body. The rash subsequently progresses into skin blisters. Blisters can also involve the eyes, mouth and genitals. Skin layers may shed away, giving the appearance of skin being burned.

This is a very severe emergency condition, and one should seek hospital medical attention immediately.

Although Drug Allergies can be unforeseen, especially when a person is taking a new medication, it is important to keep your doctors, dentists and pharmacists updated on any known drug allergies. One should always be constantly vigilant on the symptoms and red flags of Drug Allergies. In doubt, speak to your doctors.

Take care.

HIV Treatment

HIV is caused by a virus known as a retrovirus. The combination of medications used to treat HIV is known as antiretroviral therapy (ART).

Although there remains no cure for HIV infection, ART enables people with HIV to live a normal, healthy and quality life. ART controls and reduces the amount of virus in a person’s body fluids and blood, hence, slows down the progression into AIDS and death.

ART is recommended to everyone with HIV, regardless of at what stage, and how healthy the person is. ART also reduces an infected person’s risk of spreading HIV to others.

ART usually comes in a combination of 3 or more drugs. With medical advancement, there are available options of 1 pill to combine multiple drugs together.

When should I start HIV treatment?

You should begin antiretroviral therapy (ART) as soon as possible after the diagnosis of HIV infection. Any delay of treatment will allow HIV virus to continue to destroy your immune system, putting yourself at higher risk of developing AIDS.

What do I expect when I consult my doctor on HIV treatment?

Your doctor will take into account your other concurrent medical conditions and any other medicines that you may be taking as there may be interactions with ART.

You will need more regular follow up with your doctor at the initial stage of starting of ART treatment. You will be offered regular blood tests to monitor whether you are responding well to the ART treatment. 

Two important blood tests are:

Most people who take HIV ART treatment daily are able to reach undetectable HIV viral load within 6 months of starting treatment. Following ART treatment, the CD4 lymphocyte cells count usually rise slowly. These 2 blood tests will determine whether HIV infection is well controlled.

Often, your doctor may recommend you to change your HIV medicine if notice your medication is not working as well as they should. You should let your doctor know if you or your partner is pregnant or planning for pregnancy.

What are the common side effects of HIV treatment ART?

Some common side effects that you may experience:

Do I still need to continue my HIV medication if my viral load is undetectable?

YES. When your HIV viral load has diminished and reached an undetectable level when you are on ART, it means your treatment is working, and you should continue your medication. If you stop your ART, the HIV virus will no longer be suppressed and it will multiply rapidly. It is important to keep your viral load at an undetectable level so that you can remain healthy, and this slows down the progression to AIDS. Also, an undetectable viral load places you at low risk of transmitting HIV to other people.

What are the perks of taking HIV medicine regularly?

What should I do if I miss my dose of HIV medicine?

It is important to reiterate the imperativeness of taking your HIV medicine regularly. This is the only way to keep your HIV viral load low and CD4 lymphocytes cell count high. A poor compliant of medicine will allow HIV virus to multiply fast, damage your immune system, and place you at higher risk for AIDS.

The Change of Allergy Paradigm

From Avoidance to Early Exposure of Allergenic Food

The concept of early avoidance as prevention of future allergy has been challenged over recent years.

The presence of peanut allergy has increased over the past decade in countries that recommend peanuts avoidance during pregnancy, breastfeeding and during the infancy period of the baby. Peanut allergy affects approximately 1.5% of young children and tends to be diagnosed in those aged less than 2 years old.

Two groundbreaking research programs- LEAP and LEAP ON trials

LEAP (Learning Early About Peanut Allergy) is a randomized controlled clinical study performed by the Immune Tolerant Network (ITN) sponsored by the National Institute of Allergy and Infectious Diseases to find ways to prevent peanut allergy in young children. 

The study investigated over 600 children between age 4 to 11 months of age who are high risk for allergy to peanut. The risk severity is based on the history of egg allergy and/or severe eczema. The children are randomly separated into two groups- children who consume peanut-containing snack food 3 times a week, and children who avoid peanuts.

LEAP study revealed 17% of children who avoided peanut developed peanut allergy by the age of 5 years. Interestingly, only 3% of children who consumed peanut snack food developed a peanut allergy by 5 years of age. It showed the effectiveness of preventing peanut allergy by 80% later in life in high-risk infants who continuously consumed peanut beginning of their first 11 months of age in comparison to non-peanut consumers. 

LEAP ON study is a follow-up study from the original LEAP study to investigate whether the children who had consumed peanut for over 4 years had persistent protection against peanut allergy when they stopped eating peanut.  The study followed up 556 children from the original children in LEAP for a one-year period of peanut avoidance. After a year of avoiding peanuts, children from original peanut consumers showed only 4.8% of peanut allergy while 18.6% of the children with original peanut avoidance showed peanut allergy.

Encouraging Early Exposure of Allergenic Food in High-Risk Infants

The findings from LEAP and LEAP ON trials have challenged the old school of thoughts of avoiding allergenic food in early infancy in preventing the development of food allergy. Food guidelines over the world have been revamped, embracing and shifting food allergy concept to encouraging early repeated exposure of a child’s immune system to peanut at an early age, to allow the body to learn, adapt and tolerate peanut.

The Canadian Pediatric Society advises in their food guideline in early 2019 to offer babies with the risk of allergies, common allergenic food such as peanut butter and eggs, around the age of 6 months old, but not earlier than 4 months old.

In the United States, the food guidelines since 2017 have been recommending the introduction of peanuts in the early days of infancy to avoid peanut allergies.

In Singapore, common allergenic foods include eggs, peanuts and shellfish. It is advisable by most paediatricians for commencing common allergenic food between 4 to 6 months of age, and this should not be delayed beyond 6 months of age. Breastfeeding should be encouraged at least up to the first 6 months or even up to a year. Pregnant mothers are not advised to avoid allergenic food as the evidence remains inconclusive in reducing the risk of allergies in children.

Importantly, your children should receive a healthy balanced diet.

Speak to your doctor, or an allergist to find out more.

Allergy Immunotherapy

Allergy Immunotherapy modifies a person’s body immune response towards allergens, hence easing allergy symptoms. Allergy immunotherapy is effective against IgE-mediated allergy, and benefits in particular individuals with a limited type (1 or 2) of allergies.

How is Allergy Immunotherapy delivered to a person?

Allergy Immunotherapy Shots
Immunotherapy shots are delivered via injections in high dosed standardized vaccines containing the allergen every month. Over time, the dose is gradually increased for the body’s immune system to adapt. As there is a risk of unforeseen severe allergic reactions such as anaphylaxis, immunotherapy shots should only be given by a trained doctor or immunologist in a controlled setting clinic with standby resuscitation facilities available. The duration of Immunotherapy shots is usually 3-5 years.

Sublingual immunotherapy (SLIT)
SLIT is emerging as an effective and safe alternative to Allergy Immunotherapy Shots. Furthermore, SLIT has the advantage of self-administration of medication by the patient himself at home.  As the name suggests, sprays or tablets containing allergens are administered under the tongue daily. 

The choice of whether considering immunotherapy shots vs sublingual immunotherapy can be determined by the patient’s preference with prudent guidance from the trained physician.

Who should consider Allergy Immunotherapy?

You can consider Allergy Immunotherapy if you are:

Who are the contraindicated for Allergy Immunotherapy?

You should avoid Allergy Immunotherapy if:

Is Allergy Immunotherapy Effective?

Medical reviews have shown significant improvement in allergy symptoms with immunotherapy, with the reduction in requiring rescue medication, and general improvement of quality of life. Also, immunotherapy has shown long term benefits by modifying the underlying cause of allergy condition. There are several research studies that showed continue long-term benefit of reduction of allergy up to 7-8 years following discontinuation of immunotherapy.

Allergy Immunotherapy is a proven effective treatment for allergic conditions such as allergic rhinitis, asthma, insect sting allergy, and certain individuals with eczema in particularly allergic to airborne allergens such as house dust mite, and animal dander.

Is Allergy Immunotherapy safe?

The limitation of immunotherapy shots lies on the risk of possible systemic allergic reactions, such as anaphylaxis that can be fatal. Risks factors for systemic reactions include a history of previous systemic reactions, the presence of asthma, a history of high sensitivity allergen exposure.

SLIT is a safer option. SLIT is associated with localized symptoms such as itching and tingling of the tongue or mouth, tongue and lip swelling in 50% of patients. The symptoms usually resolve within 1-2 weeks after commencement of treatment.

Allergy Immunotherapy remains a novel, exciting, highly effective and promising area for both trained physicians and patients with allergy, seeking for long term control and remission of allergy. Speak to your doctor to understand further.

Anaphylaxis: All I Need to Know

What are the Common Causes of Anaphylaxis?

What are the Signs and Symptoms of Anaphylaxis?

Recognizing the signs and symptoms of anaphylaxis are important. This can be life-saving. Involvement in any of the 2 systems of the body should lead to prompt immediate treatment with epinephrine.

What are the Treatments for Anaphylaxis?




Asthma Inhalers

How can I Prepare and Prevent Anaphylaxis?

Prevention is always better than cure

Prepare and Be Ready

Recognize and Act on Anaphylaxis Promptly

Remember, anaphylaxis is completely reversible if managed promptly. However, any delay in anaphylaxis can be lethal.

Take care, stay safe.

Sublingual Immunotherapy (SLIT)

It is useful in allergic respiratory diseases such as allergic rhinitis and asthma. It is suitable for adults, and even children above the age of 2. The medication is administered beneath the tongue.

Why Should I consider Sublingual Immunotherapy (SLIT)?

SLIT Oraltek® Spray

Oraltek® Spray is a type of sublingual Immunotherapy that can be administered via a spray underneath the tongue. It comes in a vial with a spray nozzle containing extracts from particular allergens.

How to Use Oraltek® Spray?

  1. Hold the spray with your dominant hand.
  2. Raise your tongue and direct the nozzle spray underneath your tongue.
  3. Hold the medicated solution in your mouth for 1-2 minutes before swallowing.
  4. Avoid oral intake, mouth rinsing or teeth brushing for the next 15- 30 minutes after administering the medication.
  5. Store the spray well.
  6. Repeat the procedure daily.

Do I Need to Stop Other Allergy Medications when I am on Sublingual Immunotherapy?

You do not usually need to stop your other medications for allergy treatment. However, over time, you may need less of your medications as the sublingual immunotherapy has effectively reduced your allergy symptoms.

If you are concerned with any medications interacting with sublingual immunotherapy, you can speak to your doctor.

Does Oraltek® Spray actually work?

The effectiveness of the treatment correlates with the length of treatment. Good medication compliance promises a better long-run sustaining effect of reduced allergy symptoms or even an allergy cure.

You are expected to see some functional results within the first year of treatment.

You should:

If after one year of treatment, you do not achieve the above end results, you should speak to your doctor to revise the diagnosis and treatment plan.

What are the Risks and Side Effects of Oraltek® Spray?

You may experience temporary side effects such as mild itching, burning sensation or swelling over the administered site. However, as the spray covers a wide surface area of the mouth, the side effects are lesser in comparison on tablets or drops.

If you encounter such symptoms, you should still continue to treat through with the spray, as the symptoms resolve spontaneously with repeated use of the spray.

How long do I need to use Oraltek® Spray? Can I abort the treatment before the recommended time frame?

The recommended duration of treatment is 3-5 years. In the event of you stopping the treatment before 3 years, the effectivity of allergy improvement may not sustain over time.

Where should I keep my Oraltek® Spray?

You are advised to keep the spray in the refrigerator at a temperature of 2-8C. Having said that, the spay is safe and stable at a temperature below 25C.

Any Travelling Tips when on Oraltek® Spray?

It is relatively hassle-free. You are allowed to hand carry when travel by air, and stored it in a small bag with an ice cube.

You should avoid stopping the treatment for more than 1 week. 

Is there are other options of Sublingual Immunotherapy?

Yes, speak to your doctor, there are tablets form as well.

Understanding Human Immunodeficiency Virus (HIV)

AIDS (Acquired Immune Deficiency Syndrome) is used to describe a condition when a HIV person has a severely damaged immune system, leading to potentially life-threatening illness and infections.

Currently, unfortunately, there is no cure for HIV, but there are effective medications to help most people with HIV to control the virus and live a long and quality healthy life.

Early diagnosis and good control of HIV are important to prevent develop AIDS.

What are the symptoms of HIV infection?

Approximately 2-6 weeks after HIV infection, some people may experience transient, flu-like symptoms. 

80% of people who are infected with HIV may experience flu-like symptoms such as:

If you have several of these symptoms and you are at risk of HIV infection for the past few weeks, you should get yourself tested for HIV.

The symptoms will eventually disappear, and one may experience no symptoms for years. The HIV virus may silently damage your immune system until much later stage. When the immune system has become severely weakened, you may develop symptoms such as:

How is HIV transmitted from one person to another person?

Most cases of HIV are spread by having sex with another person with HIV without the use of a condom. A HIV infected person without symptoms can still transfer the disease to another person. A HIV infected person who is on HIV treatment can significantly reduce the risk of transmission of disease to others.

Sexual contact
As mentioned, most people acquire the HIV virus through unprotected vaginal or anal sex.
Although you can get HIV through unprotected oral sex, the risk is lower.

It is riskier if:

Other modes of transmission of HIV include:

Some categories of people are particularly high risk of acquiring HIV, this include:

HIV virus thrives in blood and some body fluids. To acquire HIV, one of these infected fluid need to get into your bloodstream.

Body fluids that may contain HIV to infect others include:

Interestingly, body fluids such as saliva, sweat, urine do not contain sufficient virus to infect other people. Hence HIV cannot be transmitted through:

How does HIV infect a body?

Once inside the bloodstream, the HIV virus can attach itself to an immune system cell known as CD4 lymphocyte cell. (CD4 lymphocytes protects the body from bacteria, germs and viruses). Once attached to the CD4 lymphocytes, the virus enters the cells, replicate and make thousands of copies of itself. In the midst of this, the viral copies will kill the CD4 lymphocytes. This process continues until eventually, the CD4 lymphocytes cells die, and the number of the cells (CD4 counts) will diminish to a dangerous level where the immune system stops working.

This can take up to 10 years, where an infected person can feel perfectly well.

What is the connection between HIV and other STIs?

Having other STIs are a risk factor of getting and transmitting HIV.

If you are HIV negative but have another STI, you are 3 times likely to acquire HIV if you have unprotected sex with someone with HIV. If the STI causes skin irritation, skin breaks or sores, this will allow HIV virus easier to enter the body during sexual contact. In STIs that does not cause breaks or open wounds in a person, you still have a higher risk of acquiring HIV as STIs can cause body inflammation leading to increase the number of immune cells to be used as target cells for HIV.

If you are HIV positive and have another STI, you are about 3 times likely to transmit HIV through sexual contact. This is because you have increased concentration of HIV in the semen and genital fluid in comparison to an HIV person without STI.

Are lesbians or women who have sex with women at risk of HIV?

Case reports of female-to-female transmission of HIV are sparse. Having said that, vaginal fluid and menstrual blood can contain HIV and exposure to these fluids with vagina or mouth can still possibly spread HIV.

Food Allergy

The body defence mechanism has mistaken certain protein in certain food as a threat, hence producing an abnormal immune response towards the food. This can affect both adults and children.

The incidence of food allergies has increased tremendously over the past few decades. The actual reason remains elucidated, but it is postulated that there are evolutionary changes in a typical child’s diet over the past 30-40 years. Another belief involves the ‘hygiene hypothesis’. In our new generation, children are increasingly growing up in a ‘germ-free’ environment. This leads to the body immune system not developing well, as it is not exposed to germs in their early stages of life. When the person is introduced to a certain food in their later life, allergy occurs.

What are the Types of Food Allergies?

IgE-mediated food allergy
The most common type. A specific food triggers the body’s immune system to produce an antibody known as immunoglobulin E (IgE). A patient can develop allergic symptoms a few seconds or minutes after consuming the food. There is a greater risk of anaphylaxis in this type of food allergy.

None-IgE-mediated food allergy
This is less common. This type of food allergy is not caused by immunoglobulin E, but other cells of the immune system.  The allergy reaction takes longer (up to hours and days) to develop after eating the culprit food.

Oral allergy syndrome (pollen-food syndrome)
This occurs in people developing allergy reaction such as itch, swelling over their mouth and throat, directly after eating fresh vegetables and fruits. The body’s immune system produces allergy antibodies against certain proteins in fresh fruits, vegetable, and mistaken them for pollen. Anaphylaxis can occur. The symptoms of oral allergy syndrome can resolve by cooking fruits and vegetables.

Exercise-induced food allergy
Interestingly, food allergy can be triggered in certain people after eating a particular food and then exercising. In severe cases, anaphylaxis can occur, and this is termed food-dependent exercise-induced anaphylaxis. Avoiding certain food or avoid eating a few hours before exercising can prevent this type of allergy.

What are the Symptoms of Food Allergy?

Often food allergic reactions are mild, though they can present with life-threatening symptoms that one should be aware of.

IgE-mediated food allergy causes symptoms within few seconds to minutes after eating a certain food. Common symptoms include:

Anaphylaxis is a serious allergy condition, that any delay in treatment can result in fatality. Having said that, it is completely reversible if managed promptly.
Call 995, if you think yourself or anyone has symptoms of anaphylaxis such as:

None-IgE-mediated food allergy causes allergic reaction much slower after ingesting the food. This can sometimes take up to hours or even days after ingesting the food. Symptoms include:

Is Food Intolerance same as Food Allergy?

No, they are different.

What are the foods that commonly cause Food Allergies?

Almost any food can cause allergic reaction, however common food that can cause an allergic reaction include:

What do I expect when I consult my doctor on Food allergy?

Your doctor will enquire further on your symptoms of allergy and history of exposure to the food. Your doctor may offer you skin-prick testing, blood test, or even place you on a food elimination diet. 

Skin-prick test
This test allows a possible allergen to come into contact with the cells of your immune system through the skin. This is performed by a drop of a standardized extract of the food on the forearm. The skin over the tested area is pierced by a small lancet. The test is nearly painless, though you may feel mild discomfort. Any itching, redness and swelling may indicate a positive reaction.

There is a small theoretical risk of anaphylaxis in a skin-prick test. Your doctor will weigh out the risks and benefits of the procedure before offering to you. The test is usually performed in a controlled setting such as an allergy clinic, GP clinic or hospital.

IgE blood test
This is an alternative to skin-prick test, to measure the amount of allergic antibodies present in a person’s blood.

Food elimination diet
Your doctor will advise you to avoid consuming the possible food that causes allergy for 2-6 weeks. The food is later then reintroduced. A positive test suggesting food allergy or intolerance is when the symptoms resolved with food avoidance and recur with food re-introduction.

Depending on individual cases, your doctor may refer you to an Allergist for further evaluation.

What are the Treatment Options for Food Allergies?

The key is to identify the food allergy and avoid the culprit food altogether.
You may be asked to work together with your doctor for a food diary and management plan:

Injectable Epinephrine
In cases of anaphylaxis, your doctor will prescribe you an epinephrine pen (Epi-pen). Your doctor will teach you how to self-administer the medication in the event of anaphylaxis allergic reaction. This is a life-saving medication that acts quickly to improve breathing, and swelling over face and lips within seconds. You can repeat inject the medication every 5-15 minutes as needed. You must then go immediately to the Emergency Department for further acute care.

Living with Food Allergy

While food allergy has no cure, here are some measures to deal with it:

Take care, eat well.

Pet Allergies

Furthermore, the fur of pets can act as a reservoir for pollen and mould spores. These proteins when coming into direct contact on a person’s skin or being inhaled can behave as allergens to a body’s immune system, triggering allergic reactions. Common allergic medical conditions associated with Pet Allergies include allergic rhinitis, asthma, eczema, and hives.

Contrary to many believe, there are no actual ‘hypoallergenic breeds’ of cats and dogs. The length of the animal’s hair or the amount of hair or fur shed do no determine the allergenic potential.

What are the Symptoms of Pet Allergies?

Pet Allergy symptoms can occur during, and shortly after contact with a pet. The symptoms tend to last long even when the animal is gone. This is because the dander can stay in the air, on the surrounding furniture or on your clothes for a long while.

Common symptoms include:

You may have chronic symptoms discussed above if you are exposed to your pet on a long term basis.

What do I expect when I consult my doctor for Pet Allergies?

Your doctor will obtain the relevant allergy history. Allergy testing in the form of blood tests and skin prick test may be offered by your doctor/ allergist to confirm the allergy.

What are the Treatment Options for Pet Allergies?

As of any type of allergies, avoidance of trigger is key. Often, staying away from your pet is not an option, you may consider symptomatic relievers such as antihistamines, decongestants, and corticosteroids. 

Pet allergy can be a long term concern if you own the pet. Symptomatic relievers may not be an ideal solution. You may consider speaking to your doctor/ allergist for immunotherapy allergy shots as a long term solution.

What can I do to minimize Pet Allergies?

Living with HIV

Despite the association of HIV with fear, stigma, discrimination, and other repercussions, it is a condition that many are able to live a normal and quality life with the proper taking of HIV medication.

Healthy Living

Aside from taking your HIV medication regularly, you should lead a healthy general lifestyle such as:

You should ensure your flu vaccination up to date yearly, and you are recommended pneumococcal vaccination.

Get Support for your mental well-being

Being diagnosed with HIV can be a life-changing event. It can cause tremendous emotional distress. One may commonly feel anger, hopeless, depress and anxious. You are not alone. Seek help, speak to your doctor. Your doctor will address your concerns and expectations. You may be linked up with trained counsellor or psychologist to give you further emotional support.

Some people find it helpful to speak to others who have HIV via support groups or internet chatroom.

Tell my partner or former partners about my HIV

It is common to feel angry, upset, or even embarrassed about disclosing HIV health status to your current or former partners. Having said that, it is important to inform your current sexual partner or any sexual partners regarding your HIV status, so that they will get tested and treated. Untreated HIV can lead to serious illness (AIDS) and death.

If you have any concerns, you may speak to your doctor for further advice. Your doctor will advise you to disclose your status to your future partners and how you can reduce the risk of transmitting the virus to others.

Do I need to tell my employer?

No, there is no legal obligation to inform your employer of your HIV status, unless you are at a frontline job that performs invasive procedures.

HIV and Pregnancy

If you are pregnant:

If you are planning a pregnancy:

Opportunistic Infections

If your immune system is damaged by HIV virus, you are at risk of developing certain infections that a person with an intact immune system will not. The name opportunistic infections are termed to infections that occur when your immune system is very weakened.

The four main types of opportunistic infections are:

People with HIV are also at risk of certain cancer such as cancer of the lymphatic system (Lymphoma), Kaposi’s sarcoma.

Regular follow up with your doctor and compliant to your HIV medicine is important to maintain your immune system and prevent opportunistic infections.

Take care, stay well.

Latex Allergy

This allergy is common among healthcare workers, people who have undergone multiple surgeries, rubber industry workers, laboratory workers, hairdressers, housekeeping workers, food handlers, and gardeners.

Latex is a watery milky sap that is derived and tapped from rubber trees. It is processed with other chemicals to enhance its elasticity. Rubber latex can be found in rubber gloves, rubber bands, erasers, balloons, and condoms.

In Latex Allergy, the body’s immune system perceives latex as an allergen and triggers a cascade of an allergic reaction. Half of the people with Latex Allergy have an allergy to other common allergies.

What are the Symptoms of Latex Allergy?

The reaction symptoms can range from mild to very severe, including life-threatening anaphylaxis reaction. The severity of Latex Allergy can worsen with repeated exposure of the latex substance as the body’s immune system is sensitized by latex during the past exposure, and recognizes the allergen during subsequent exposures.

Delayed reaction
In this reaction, the allergic symptoms tend to occur 12-36 hours after exposure to latex and manifest as contact dermatitis. One can present with red, itchy and scaly raw skin. The symptoms tend to be localized over the exposed skin area, and they are not life-threatening.

Immediate reaction
This type of allergic reaction occurs in people who have been exposed to latex and the body’s immune system is sensitized to latex and able to recognize the allergen on subsequent exposure, leading to more severe immune responses such as:

In severe life-threatening case, anaphylaxis can occur within minutes of exposure to latex. Anaphylaxis symptoms typically involve more than one body system, with manifestations of:

*Call 995 or seek medical assistance immediately if you suspect anaphylaxis.

What do I expect when I see my doctor for Latex Allergy?

Your doctor will enquire a thorough medical and allergy history. In certain clear cut cases, a history of latex exposure followed by a reaction may suffice to diagnose the allergy. In other cases, your doctor may offer you allergy testing such as skin prick test, patch tests and RAST blood tests to determine your allergy triggers.

What are the Treatment Options for Latex Allergy?

Avoidance is key.
Consider Substitutes:

Mild skin reactions can be relieved with oral antihistamine and topical corticosteroids.

People with anaphylaxis secondary to Latex Allergy to carry auto-injectable epinephrine (Epipen) in case of a severe life-threatening emergency. They should be taught how to self-administer the injection. Those suspected of anaphylaxis should seek medical help as soon as possible to prevent a fatality.

Insect Sting Allergy

Common insect stings in Singapore come from yellow jackets, hornets, wasps, and honey bees. After stinging human’s skin, the insects leave behind their stingers. The stingers are best removed by a scraping action, rather than a pulling motion to prevent further squeezing of more venom into the affected skin.

The body’s immune system reacts differently towards insect stings. Reactions can range from simple painful swelling and redness to severe life-threatening conditions such as anaphylaxis. A person who has experienced an allergic reaction to insect sting has a 40-60% chance of a similar or even more severe reaction for each subsequent sting.

What are the Symptoms of AN Insect Sting Allergy?

Most people sustain localized pain, redness, and swelling over the affected area of an insect sting.

In the case of an Insect Sting Allergy, the immune system overreacts to the sting, leading to possible symptoms of anaphylaxis with symptoms involving more than one body system such as:

Insect stings can also cause a toxic reaction. This is not an allergic reaction, rather, the body perceives the insect venom as a poison. Having said that, both toxic reaction and allergy reaction from insect stings can cause similar symptoms in the affected person. In a severe toxic reaction, one can have fainting spells, shock, seizure, or even succumb to the reaction.

What do I expect when I consult my doctor for AN Insect Sting Allergy?

Your doctor will obtain a thorough history of your current and previous stings. It will be useful to inform your doctor about how many stings you have had, the reactions from the stings, and how long the reaction lasted in the past. In certain circumstances, your doctor may offer skin prick tests or blood tests to an insect venom panel.

What are the Treatment Options for Insect Stings Allergy?

It is important to avoid contact with insects in the first place. If you are allergic to insect stings, take precautionary measures against this.

Anaphylaxis and Immediate Treatment
If you have an anaphylactic reaction, please ask for help and call 995 as you will need immediate medical attention. This can be life-threatening. Immediate epinephrine injection can be life-saving. Aside from delivering epinephrine, other emergency medications include antihistamine, corticosteroids, intravenous fluids, and oxygen. Anaphylaxis patients usually need to be admitted to the hospital overnight for observation.

Long Term Treatment with Venom Immunotherapy
This is a form of long term management. It is a procedure done by trained doctors or allergists by the gradual introduction of incremental venom doses to a person. This is with the theory of repeated exposure to the venom will reduce a person’s immune system sensitivity towards the venom, hence reducing the risk of a future allergic reaction.

Immunotherapy in the form of allergy shots is introduced to build tolerance and 97% protection against the future sting. This therapy is particularly useful to those who are active outdoor individuals for both recreational activities or work-related activities.

How can I avoid Insect Sting?

Most insect stings in Singapore are from yellow jackets, hornets, honey bees, wasps.

Here are some tips for sharing:

Once stung, twice shy! Be careful, and avoid insect stings! Take care!

Health Screening: Don’t Leave Cancer To Chance

A major component of health screening involves cancer screening. Cancer remains a leading cause of morbidity and mortality in Singapore, accounting for 29.7% of deaths in 2015 according to the National Registry of Disease Office of Singapore.

The thought of screening for cancer can be distressing. One may even argue that by identifying cancer, it will be life-changing, life-defining, even death-sentenced without a cure to the problem. On the flipped side, even without curative treatment to the disease, early detection promises a better disease prognosis and a better quality of life with current modern medicine in comparison to cancer cases that are detected at late stages.

In certain cancers, early screening can in fact be life-saving. This is where health screening comes in place. Screening has been shown to be effective in early detection of colon cancer, breast cancers and cervical cancer. This article is written in the hope to give certain guidance and recommendation to people on choosing cancer screening packages.

Should I undergo Cancer Screening?

You should consider if you are


Every reason to screen for colon cancer, breast cancer and cervical cancer!

Colon cancer

You are recommended for a colonoscopy for everyone at the age of 50 and every 10 years thereafter. Your doctor may advise you for an earlier colonoscopy procedure if you have symptoms or family risk factors of colon cancer.

Colonoscopy, though not completely risk-free, is not overtly scary. Colonoscopy is a planned procedure arranged between you and your endoscopist. Prior to the procedure, you are advised to drink a medicine liquid 1 to 2 days prior procedure to clear out your bowels. You will be given sedation throughout the procedure to ease your discomfort. The procedure itself takes about 15 to 30 minutes, allowing your doctor to visualize your colon intestinal walls, and take sample biopsies or remove small polyps during the procedure.

Breast cancer

You are recommended for a yearly mammogram at the age of 40 until the age of 50, then every 2 years repeating mammogram until the age of 69. Although Ultrasound breasts are not routinely performed, it may be recommended by your doctor if clinically indicated. In high risks individuals, your doctor may recommend you to do MRI breasts.

Many people find mammogram is a painful test. Mammogram though is not the most comfortable test, is useful in identifying cancerous areas of the breasts. Breast cancer is one of the cancers with a good survival rate if detect and managed early.

Cervical Cancer

You are recommended cervical cancer screening from the age of 25 onwards if you have ever had sexual contact. You are recommended for pap smear test at least once every 3 years. You are also advised for HPV test every 5 years if you are sexually active and over the age of 30.

While pap smear and HPV tests can be uncomfortable, early treatment is curative. Early treatment of cervical cancer is particularly important to women during their reproduction years for future conceive and childbearing.

What cancer symptoms or warning signs I should be aware of?

While cancer is most often asymptomatic, you should speak to your doctor if you experience


Health screening is not completely without risks. False-positive results can cause anxiety and require further tests that involve further risks and cost. In false negative tests, it may give a person a false sense of security.

Speak to your doctor before deciding any tests for cancer screening- don’t leave cancer to chance.

Health Screening: Beware of Metabolic Syndrome

Health screening allows screening for potential health conditions, striving at prevention and early management of asymptomatic health diseases, including Metabolic Syndrome.

Metabolic Syndrome also is known as Syndrome X, is made up of risk factors that if left unattended can potentially lead to chronic conditions such as cardiovascular diseases and cerebrovascular diseases. Metabolic Syndrome is a silent killer that is often not addressed until a major disastrous event such as a heart attack or stroke strikes with debilitating irreversible complications including death.

What exactly is Metabolic Syndrome?

You have Metabolic Syndrome if you have 3 or more characteristics below:

What are the risks factors of Metabolic Syndrome?

What are the signs and symptoms of Metabolic Syndrome?

As mentioned, it is an insidious condition that most people present without any symptoms. Some may show an obvious physical appearance of obesity with a large waistline and ‘pear-shaped’ body.


Why should I screen for Metabolic Syndrome?

Metabolic Syndrome has 2 components- the fixed factors and flexible factors. The fixed factors are how we are genetically born and programmed with such as our race, age and family medical conditions that we are unable to change. Having said that, it is not all doomed, and we should not leave our health to fate. Flexible factors include one’s cholesterol, blood pressure, glucose level, body weight and personal lifestyle. We can make a major difference in the outcome by managing these flexible factors.

Health screening for Metabolic Syndrome involves screening for personal and family risks factors. This involves doctors review, both histories taking and physical examinations, batteries of blood tests investigations, blood pressure measurement, weight and height measurement, body fat percentage measurement and baseline ECG. In certain high-risk groups, your doctor may advise you further investigations or specialist input.

Screening for Metabolic Syndrome is aimed at managing the flexible factors of a person, reducing the chance of developing catastrophic conditions such as heart attack and stroke. By understanding one’s risks factors and health situation, your doctor can further advise you on both non-pharmacological (with lifestyle and dietary modification) and pharmacological (if required) changes.

Take charge of your health today, screen for Metabolic Syndrome!