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In Singapore, egg allergy is one of the most common food allergies seen in young infants and children, together with cow’s milk allergy. A person develops an allergic reaction to eggs when the body inadvertently recognises egg proteins as a foreign or dangerous substance and mounts an exaggerated immunological response. 

The clinical manifestation of egg allergy can range from mild symptoms such as hives, rhinitis, and eczema to severe life-threatening allergic reactions such as anaphylaxis. Thankfully, most people with an egg allergy experience mild symptoms, and most children who experience an egg allergy tend to outgrow the symptoms over time.

egg allergy child
Children tend to outgrow an egg allergy.

What are the symptoms of an egg allergy?

The allergic response to eggs may vary from one person to another. Symptoms may occur within minutes or hours following consuming eggs or food which contains eggs. 

Most allergic symptoms are mild, though occasionally, one can develop life-threatening symptoms following the consumption of eggs. Allergy symptoms can affect multiple organs of the body:

Dermatological symptoms

Respiratory symptoms

Gastrointestinal symptoms

Rarely, one may develop anaphylaxis. This is a very serious medical condition that warrants immediate medical attention as one can succumb to the allergy.

egg allergy symptoms
Individuals with an egg allergy may experience hives or wheal skin lesions after consuming eggs or foods that contain eggs.

Symptoms are systemic; always remember the algorithm A-B-C:

If you or your loved ones develop any symptoms of A-B-C, please seek medical assistance immediately. Don’t delay; anaphylaxis is reversible if managed promptly.

What are the risk factors for developing an egg allergy?

egg allergy
Egg allergies are more common in individuals with a family history.

Which part of the egg causes the allergy? The white or the yolk?

The proteins found in an egg's white and yolk can cause an allergic reaction, though it is far more common for one to be allergic to the white of the egg.

Allergen proteins in the egg white, such as ovomucoid, ovalbumin, ovotransferrin, and lysozyme, are allergens commonly associated with egg allergies.

The egg yolk contains a protein known as alpha-livetin. This protein plays a role in an allergy condition known as bird-egg syndrome. This is a condition where a person is firstly exposed and sensitised to airborne related bird allergens, with a subsequent secondary exposure and sensitisation to egg yolk protein. Patients with this medical condition present with respiratory symptoms such as asthma or rhinitis following exposure to the bird and eating the eggs.

So why do we develop an allergic reaction from the egg proteins? Simply put, the ability to cause allergy to the protein can be correlated to their resistance against the gut's digestive enzymes and heat. The more robust the egg proteins are against heat and digestive enzymes, the more likely they can elicit an immune response. This is seen in people who are allergic to ovamucoid protein, which is more ‘heat-stable’ and ‘stable against digestive enzymes’, where they may have more persistent allergy symptoms than people who are allergic to other types of egg proteins.

bird-egg syndrome allergy
Bird-egg syndrome causes individuals to develop respiratory symptoms such as asthma and allergic rhinitis after exposure to birds or their eggs.

When should I see my doctor regarding egg allergy?

If you develop the allergy symptoms discussed above and are concerned about egg allergy, you can visit your doctor to test for the possible allergy. Your doctor may work with you to review the potential allergies based on your symptoms and advise accordingly.

How can I diagnose an egg allergy?

Diagnosis of egg allergy is based on a strong history and physical symptoms of allergy and the positive correlation with egg consumption.  Depending on the individual case, your doctor may advise you for allergy tests in the form of skin prick or blood (RAST) tests to evaluate the possible allergy further. 

There are available allergy tests for the whole egg, the egg white, the egg yolk, or even the individual egg proteins. You may be advised to temporarily eliminate eggs from your diet and reintroduce them back to your diet later under medical guidance.

How can I treat an egg allergy?

The only treatment for food allergies is avoiding the food particles that cause the allergy- in the case of egg allergy –  to avoid eggs.

For mild symptoms, your doctor may prescribe antihistamines and other symptomatic relievers to manage your allergy symptoms. In those who are at risk of anaphylaxis, your doctor may prescribe you an adrenaline injection pen to use in dire circumstances. 

In the case of food allergy, it is important to read food labels before consuming food. While eating out, it is always important to remind the kitchen/chef of your food allergy. If you are breastfeeding and your child has an egg allergy, do avoid food that contains eggs, as the allergic protein can be passed on through breast milk to your child.

breastmilk allergies
Food allergens may pass to your baby through breast milk.

Is a well-cooked/ processed egg suitable for a person with an egg allergy?

Medical literature reveals that patients with an egg allergy may be able to tolerate highly heated or baked/processed eggs (muffins/cookies). This is due to the possible denaturing of the allergenic protein by high heat, allowing patients to tolerate food with eggs. However, it is difficult to identify such a group of patients unless the patients are determined through an oral food challenge test

This should be practised cautiously as severe allergy can occur during oral food challenge tests. You are advised to discuss with your doctor before trying processed or high-heated eggs if you have a history of egg allergy.

Vaccination Safety and Egg Allergy

What have I learnt today…

References:

  1. Caubet JC, Wang J. Current understanding of egg allergy. Pediatr Clin North Am. 2011 Apr;58(2):427-43.
  2. Konstantinou GN, Giavi S, Kalobatsou A, et al. Consumption of heat-treated egg by children allergic or sensitised to egg can affect the natural course of egg allergy: hypothesis-generating observations. J Allergy Clin Immunol. 2008;122(2):414–5.
  3. Lemon-Mule H, Sampson HA, Sicherer SH, et al. Immunologic changes in children with egg allergy ingesting extensively heated eggs. J Allergy Clin Immunol. 2008;122(5):977,983, e1. 
  4. https://www.cdc.gov/flu/prevent/egg-allergies.htm
  5. https://www.healthhub.sg/live-healthy/influenza_vaccine_for_your_child#:~:text=The%20influenza%20vaccine%20is%20also,tenderness%20at%20the%20injection%20site.
  6. National Advisory Committee on Immunization (NACI). Egg allergy and MMR vaccine: New recommendations from the National Advisory Committee on Immunization. Can J Infect Dis. 1996 Sep;7(5):289-90.
  7. https://www.cdc.gov/yellowfever/qa/index.html#novaccine

Real-life scenario: You may have had an amazing trip overseas, met terrific people, and explored new places, but you start noticing skin rashes [1] and itching upon returning home. Could this be due to bedbug bites, especially since there is a major global resurgence? Or could this be something else — like an STD instead?

In this article, we delve into bedbug bite symptoms, ways to manage these symptoms, and possible differentials besides diagnosing bedbug bites.

bed bug
Bed bugs commonly come out during the day to feed on a person’s skin and blood.

What are bedbugs?

Bedbugs, also known as Cimex lectularius, are tiny, brown-reddish insects [2] that hide in the crevices of mattresses, bed frames, headboards, cupboards, or box springs. Although they can come out any time of the day, they tend to creep out at night to feed and suck on the victim’s skin and blood. Bedbug bites and saliva can trigger an immune response in the victim’s skin, leading to an inflammatory response.

Bedbug bites are more common [3] in people with poorer hygiene, lower socioeconomic status, and living in homeless shelters, hotels, and/or hospitals.

In recent months, we have noted a global resurgence of bedbug infestations affecting major cities, including Paris, London, and New York. The adventurous hitchhiker is also making progressive headlines of infestations in Asia countries, including Korea and our beloved home, Singapore.

What are the signs and symptoms of bedbug bites?

In more severe cases, one may develop a secondary immune allergic reaction, known as an ‘id’ reaction, with presentation of the following:

If you are experiencing a skin rash and are uncertain of the cause of your condition, do reach out to your physician for evaluation and treatment. Bedbug bites are a treatable condition.

bed bugs rash
Rashes linked to bed bug bites may spread to other body parts.

When should I see a doctor for bed bug bites?

If you are experiencing any bedbug bite or allergic symptoms stated above or are concerned about other differentials such as STDs, please contact your doctor for further evaluation.

What should I expect when I see my doctor for bed bug bites?

Your doctor will obtain a relevant history regarding your rash. Your social history, including recent travel history and sexual history, maybe enquired to aid the diagnosis. Your doctor will then examine the rash, which may involve examining your mouth, eyes, or even your genital region. 

Depending on individual conditions, your doctor may offer skin tests in the form of a scrape or swab. If an infection is suspected, further tests in the form of blood and/or urine tests may be offered.

Where can I find bedbugs?

As their name suggests, bedbugs tend to thrive near our sleeping environment. You may be able to find bedbugs infesting [5] the bed, mattresses, headboards, box springs, clothing, cabinet, luggage, carpet, or boxes near your bed.

A recent travel history to bedbug-infested cities may increase the risk of contracting bedbug bites. Individuals who live in dormitories, sheltered homes, cruises, hotels, and/or trains may also be slightly predisposed to bedbug bites.

mattress bedbugs
The bed and mattresses can be infestation spots for bed bugs

Are bedbugs a type of STD? What are the differences between the two?

Bedbug bites are not STDs. As the name suggests, bedbug bites are due to insect bites leading to a skin inflammatory response. In STD, the infection is contracted [6] from sexual intercourse, such as in the form of oral, vaginal, or anal sex. Bedbug bites are not transmissible from one human to another. STDs can be passed on between people if they are not treated and there is sex involved.

Can bedbugs spread STDs after biting a person with STDs?

Fact of the day: bedbugs do not carry and spread STDs. STDs are transmitted through sexual contact and passed between people. Having said that, rashes caused by STDs occasionally mimic rashes from a bedbug bite. Hence, it is important to consider screening for STDs if there is a risk of exposure.

What are the similarities between bedbugs and STDs?

STD rash (by condition)Bedbug bites rash
SyphilisWidespread red bumps, scaly and itchy. Can mimic any skin condition.Widespread discrete red bumps, itchy, can be scaly due to repeated scratching
HIVFaint red dots which blanche when touchedRed bumps which tend to be raised, palpable, and itchy but can mimic HIV rash
ScabiesRed itchy bumps, excoriated, with mite ‘burrows’ seenRed, itchy bumps, excoriated, can be linear in appearance – like scabies
Herpes Grouped or clustered blisters (fluid-filled lesions)In severe bedbug bites, blisters can be seen as part of an allergic response or as a result of intense scratching
Chlamydia GonorrhoeaCan occasionally present with pustules (white) bumpsLess commonly present with pustules- though this may occur as a result of secondary bacterial infection

Bear in mind the appearance of the rash for both bedbug bites and STDs can be medically quite technical. Sometimes, even a trained pair of eyes can find it difficult to differentiate between them.

The suspected differential can be confirmed or ruled out through appropriate tests. Discuss with your doctor whether appropriate tests are required for your skin presentation.

How are bedbug bites treated?

Thankfully, most bedbug bites are not dangerous. Treatment includes antihistamines, topical steroids, and soothing moisturiser. In severe cases of bedbug bites, especially with an allergic reaction, your doctor may prescribe a short course of oral steroids to clear off the symptoms. Oral antibiotics may be considered for individuals with secondary bacterial infections.

topical treatment
Topical steroids can be used to treat bedbug bites.

How can I get rid of bedbugs?

Affected clothing or objects should be washed at a high temperature, around 60℃ and tumble dried at a high temperature. Placing affected items in an extremely cold environment, such as the freezer (-18℃), is another method to eradicate bedbugs.

You may consider contacting pest control services to eradicate bedbugs from your living space effectively.

How to prevent bedbug bites?

The fun fact of the day: bedbugs tend to bite over exposed areas of the skin; they seldom burrow beneath clothing. Wearing covered/long-sleeved clothing or pyjamas may reduce the chances of getting bitten by bedbugs.

When you are living abroad or in a hotel, check for bedbugs! Inspect the crevices of the bed(s) or mattress(es) for possible bedbugs or bedbug particles. Place your bags and luggage on the dressers or luggage rack, keeping them away from the bed. If you suspect bedbugs are in your belongings after travelling, you can consider placing them in a plastic ziplock bag and sealing them up.

When you return home from abroad, unpack your luggage or bags on concrete/solid surfaces such as the bathroom floor, garage, or at the entrance.

bedbugs prevention
Place your luggage on a raised hard surface when staying at hotels.

Are bedbugs still bugging you after reading this article?

It is reassuring to know that there are effective medical options for managing the symptoms secondary to both bedbug bites and other disguised diagnoses such as STDs. Being safe is key. Reach out to your medical physicians for further consultation and to confirm your skin diagnosis.

References

  1. “Skin Rash and Lesions – General - STI Guidelines Australia,” STI Guidelines Australia, November 9, 2021, https://sti.guidelines.org.au/syndromes/skin-rash-and-lesions-general/.
  2. Ennis AC, Pearson-Shaver AL. Bedbug Bites. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538128/
  3. “Some Singapore Pest Control Firms Report Increase in Bedbug Infestations, Expect More to Come,” CNA, 2023, https://www.channelnewsasia.com/singapore/bed-bugs-treatment-awareness-singapore-hotels-homes-dormitories-3916956.
  4. Doggett SL, Dwyer DE, Peñas PF, Russell RC. Bed bugs: clinical relevance and control options. Clin Microbiol Rev. 2012 Jan;25(1):164-92. doi: 10.1128/CMR.05015-11. PMID: 22232375; PMCID: PMC3255965.
  5. “Whats-Bugging-You,” Healthhub.sg, 2016, https://www.healthhub.sg/live-healthy/whats-bugging-you.
  6. “Sexually Transmitted Diseases - Information from CDC,” 2024, https://www.cdc.gov/std/default.htm.

Pets are man’s best friend. What if you have allergies and have always wanted a cat or a dog? These days, we commonly hear the term ‘hypoallergenic pets’. Is this truly the solution for pet lovers with long-standing allergy symptoms? 

This article explores the term 'hypoallergenic pets' and clinical and non-clinical treatment options for managing pet allergic symptoms.

hypoallergenic pets
Do hypoallergenic pets really exist?

How does a pet cause allergic symptoms in humans? 

An allergic reaction is an exaggerated body response towards an innocuous substance upon exposure to the substance through the respiratory system, skin or mucous membrane. In the case of pet allergies, it is often not the ‘dander or fur’ of the pet that causes the allergic reaction but rather the protein in the pet’s urine or saliva. These proteins can attach themselves to the pet dander. When the hair is shed periodically, the particles will be disseminated onto the surrounding environment, such as the carpet, linen, bed, sofa, furniture, etc. When a person is in contact with the particles through direct touch onto the skin or mucous membrane or breathing, the body mounts an inflammatory exaggerated immune response leading to allergic symptoms.

To make things worse, pet danders also create an environment to capture various airborne particles such as dust mite particles, mould spores, or pollen that may also potentiate allergic reactions. 

What does it mean by 'hypoallergenic pet'? 

Pets such as cats and dogs have been marketed as ‘hypoallergenic breeds'. Essentially, this means the hypoallergenic pets shed less than other ‘normal breeds’. Less dander shedding will lead to less or minimal protein allergens released in our living environment, hence reducing the risk of allergies. 

However, it is worth noting that even hypoallergenic pets are not entirely ‘shed-free’; hence, they are not ‘allergen-free’ either, and one can still develop allergic symptoms. Also, the length and amount of the animal fur do not determine the allergic response. Allergic symptoms can still occur even if a person obtains a hypoallergenic pet.

sphynx cat
It is a common misconception that hairless breeds of cats are hypoallergenic.

What is the common allergic response due to pet dander?

Allergy can present a spectrum of symptoms affecting various organs of the affected person. The severity of individual allergic symptoms varies from person to person – some may present with mild symptoms. In contrast, others may develop symptoms that disrupt their daily function or require clinical intervention.

Allergic reactions from pet dander allergies include:

Pet dander allergic symptoms are usually exacerbated when a person is in contact with the animal. However, the allergic symptoms frequently persist even when the pet is no longer physically present. This is due to the remnants of the dander in the surrounding environment and the impracticality of removing or altogether avoiding the allergen (dander).  

pet allergy
Pet allergy symptoms include sneezing, coughing, wheezing, itching, watery eyes, etc.

How can I confirm my allergies?

You are advised to see your doctor, who will obtain a medical and social history to understand the possible correlation between the triggering allergens and your symptoms. Depending on your condition, your doctor may offer you a skin prick test or IgE RAST blood test to rule in or rule out the concerning allergens.

When pet dander allergies are of concern, your doctor may offer an allergy test to test for pet dander, dust mites, mould and other common airborne allergens. Your doctor can advise you further on treatment and management of the allergies from the results.

How can I manage pet dander-related airborne allergies at home?

Here are some tips to reduce pet allergens in your living environment: 

saliva pet allergy
Saliva contains a protein that causes pet allergies.

Are there medical treatments to manage pet dander allergies?

Patients do commonly seek medical support for pet allergies for two reasons:

Thankfully, there are effective medical treatment options to manage pet allergy symptoms. 

Your doctor must understand your history and the correlation of the allergy symptoms with the pet. Depending on individual risk of exposure, your doctor may offer an allergy test in the form of a skin prick test or blood RAST test to confirm the pet allergies or possible concurrent air-borne allergies such as dust mite or mould allergies. 

Your doctor may offer symptomatic medications such as antihistamines, steroidal tablets, topical creams, nose sprays and inhalers to relieve your symptoms immediately. In patients with positive allergy tests for pet allergies or airborne allergies, your doctor may discuss the medical option of immunotherapy

The role of immunotherapy in managing pet dander allergies

The idea of immunotherapy is re-educating and re-setting the immune system. As mentioned, in allergy, the body’s immune system develops an exaggerated inflammatory response towards a generally harmless substance. In immunotherapy, one strives to re-challenge the immune response with repeated small dose exposure of an allergen to the body and de-sensitize the immune response towards the allergen. Over time, this leads to a down-regulation of the immune response against the allergen, significantly reducing or resolving the clinical allergic symptoms. 

When used under the proper supervision of a physician, immunotherapy is safe and is a clinically evidence-based long-term treatment for airborne allergies. It has been proven to alleviate and treat allergic rhinitis, allergic conjunctivitis, and asthma associated with air allergens. Immunotherapy reduces reliance on symptomatic or 'rescue' medications in allergy patients and minimises the patient's medication burden in the long run. With allergy symptoms under control, the affected person's quality of life can be improved.

Final word for pet lovers and allergies…

If you struggle between your allergic health and your love for your pets, consider speaking to your physician to understand more about allergy testing and immunotherapy treatment. 

References

  1. Virtanen T. Immunotherapy for pet allergies. Hum Vaccin Immunother. 2018 Apr 3;14(4):807-814. doi: 10.1080/21645515.2017.1409315. Epub 2017 Dec 21. 
  2. Persaud Y, Memon RJ, Savliwala MN. Allergy Immunotherapy. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535367/
  3. Corren J. Allergic rhinitis and asthma: how important is the link? J Allergy Clin Immunol. 1997 Feb;99(2):S781-6. 
  4. Klimek L, Pfaar O, Bousquet J, Senti G, Kündig T. Allergen immunotherapy in allergic rhinitis: current use and future trends. Expert Rev Clin Immunol. 2017 Sep;13(9):897-906. 
  5. Şahin E, Bafaqeeh SA, Güven SG, Çetinkaya EA, Muluk NB, Coşkun ZO, Lopatin A, Kar M, Pinarbasli MO, Cingi C. Mechanism of action of allergen immunotherapy. Am J Rhinol Allergy. 2016 Sep 1;30(5):1-3.
  6. Oktemer T, Altıntoprak N, Muluk NB, Senturk M, Kar M, Bafaqeeh SA, Bellussi L, Passali D, Cingi C. Clinical efficacy of immunotherapy in allergic rhinitis. Am J Rhinol Allergy. 2016 Sep 1;30(5):4-7.

‘Doctor, there are tiny bubbles on my palms, and they are extremely itchy. I cannot sleep! Am I allergic to something?’ This is a common encounter in the consultation room. This article explores hand eczema – a common skin inflammation and its correlation with our diet.

What is Pompholyx/Dyshidrotic eczema?

Pompholyx is a type of eczema, also known as dyshidrotic eczema. It is a type of skin condition that affects the hands and feet. Eczema is a chronic inflammatory skin condition that causes intermittent itchy red rashes (of various forms) that can occur on any part of the skin. In pompholyx, eczema mainly targets the palms of the hand and soles of the feet. It is commonly seen in women and those under the age of 40.

hand eczema
Hand eczema is commonly seen in women and those under 40.

What does pompholyx/dyshidrotic eczema look like?

In dyshidrotic eczema, one presents with deep-seated tiny, multiple watery blisters that are immensely itchy and uncomfortable over the hands and feet. Over time, the blisters can become weepy, especially when broken, and one will be susceptible to bacterial infection. This further causes skin inflammation with swelling, discomfort, pain and itch. The weepy affected area will eventually dry out, leaving the skin dry and flaky with painful fissures and cracks. Patients with chronic symptoms of dyshidrotic eczema can have abnormal nail folds (skin surrounding the nails) and nail changes.

dyshidrotic eczema
Flaky and cracked skin is common in individuals with hand eczema.

What are the possible triggers for pompholyx/dyshidrotic eczema?

The exact reasons for developing pompholyx remain unknown. Patients who develop dyshidrotic eczema are generally more atopy (sensitised to the surroundings – be it environment or food). They can be associated with atopic eczema, allergic rhinitis, and asthma and may have a family history of atopy as well.

Potential triggers of dyshidrotic eczema include the following:

As individual patients may have different triggers and genetic predispositions, it is worth speaking to your trusted doctor regarding your symptoms, and your doctor can guide you further on the possible triggers in your case.

Food allergies and pompholyx/dyshidrotic eczema

Although the clinical evidence between eczema and food allergies remains much to be elucidated, it is worth exploring the relationship between dietary intake of nickel and dyshidrotic eczema.

Nickel is one of the common elementary microminerals found in most of our staple diets. It is clinically observed that nickel in diet can predispose an atopic person to dermatitis (skin inflammation), with the hands being one of the common sites associated with nickel dermatitis. A diet low in nickel has shown improvement in eczema conditions. Regarding pathophysiology, exposure to nickel may lead to ‘sensitisation’ of the body against nickel. Over time, with repeated exposure to nickel from the diet, the body develops an allergic reaction that manifests as skin inflammation.

dietary nickel allergy
Dietary nickel is present in many foods, which may make it challenging to eliminate nickel from your diet completely.

Most dietary nickel comes from plant-based food. Food that are high in nickel content includes chocolate, oatmeal, rye, buckwheat, tea, liquorice, chickpeas, soya, nuts, almonds, lentils and legumes, broccoli, onion, garlic, leafy green vegetables, canned and processed food. (This is pretty much everything we eat daily!)

As nickel can be found in nearly all food, completely eliminating nickel from our daily diet is not feasible. However, the risk of exposure and sensitising a person with nickel in the context of dermatitis can be reduced with prudent food selection and a diet with low nickel concentration.

The caveat is that a low nickel diet does not guarantee a complete clear-up of dermatitis. Instead, a mindful diet practised over time may be associated with lesser or milder eczema flare-ups. 

You can speak to your doctor to understand further the association between food allergy and your skin condition. Depending on individual risks and skin conditions, your doctor may discuss further on allergy testing to evaluate further.

What may be expected when you see your doctor for dyshidrotic eczema?

Your doctor will obtain a relevant history of your symptoms and examine the rash on your hands and feet. Depending on the presentation and index of suspicion, your doctor may offer you other tests such as bacteria or fungal swab/scrape test or even scabies/syphilis screen to rule out other differential. If there is an allergy concern, your doctor may even offer you a skin prick test or blood RAST test. Do visit your doctor if you have a rash that does not resolve.

What will happen if I don’t treat dyshidrotic eczema?

Generally, dyshidrotic eczema is not a life-threatening condition. However, chronic severe eczema is known to be associated with significant reduction and impairment of quality of life. This is because the affected inflamed skin will become flaky and dry, and open wounds/bleeding may occur. The associated itch with dyshidrotic eczema can be intense and unbearable, which can impede the daily function of the affected body part.

feet eczema
If left untreated, dyshidrotic eczema can result in an intense and unbearable itch, impeding the daily function of the affected area.

What may mimic pompholyx/dyshidrotic eczema?

As dyshidrotic eczema presents with blisters over the hands and feet, the condition also mimics various infective conditions such as herpes, syphilis, or even hand-foot-mouth disease. Other differentials that have a similar appearance to dyshidrotic eczema include allergy/irritant skin inflammatory conditions and autoimmune blistering skin conditions.

It is worth letting your doctor look at the rash that affects your hands and feet. The medical treatment differs depending on the individual medical condition. If you are experiencing severe pompholyx/dyshidrotic eczema, see a healthcare professional rather than self-medicating with various ointments, creams, and over-the-counter medication that may worsen the condition further.

What is the treatment offered for pompholyx/ dyshidrotic eczema?

Treatment for pompholyx/dyshidrotic eczema depends on various factors such as severity, underlying conditions, and the individual's overall health. In general, treatment involves the following: 

eczema steroids
Topical steroids might be prescribed to help alleviate your symptoms.

In severe dyshidrotic eczema or recalcitrant cases, second-line treatment such as phototherapy or oral immunosuppressants may be required to control the symptoms. You are advised to speak to your doctor regarding the symptoms and treatment you have tried. While the above is a general guide to treating dyshidrotic eczema, your doctor may tweak the treatment regimen to suit your condition and needs.

What should I do at home if I have pompholyx/dyshidrotic eczema?

If your pompholyx/dyshidrotic eczema is mild or you would like to try and manage your symptoms, consider the following:

Some note-worthy thoughts…

Some people suffer only once in a lifetime episode of dyshidrotic eczema/pompholyx. Unfortunately, others may have a recurring and frustrating journey of skin inflammation. Good patient education on this common benign skin inflammatory condition is key for managing their skin with appropriate treatment and minimum exposure to possible triggers, including food triggers.

If you would like to learn more about eczema, dyshidrotic eczema, food allergy, or allergy in general, do feel free to reach out to your trusted clinician

References

  1. Sharma AD. Low nickel diet in dermatology. Indian J Dermatol. 2013 May;58(3):240. 
  2. Guillet MH, Wierzbicka E, Guillet S, Dagregorio G, Guillet G. A 3-Year Causative Study of Pompholyx in 120 Patients. Arch Dermatol. 2007;143(12):1504–1508. 
  3. Sharma AD. Disulfiram and low nickel diet in the management of hand eczema: A clinical study. Indian J Dermatol Venereol Leprol. 2006;72:113–8.
  4. Gawkrodger D J, Cook S W, Fell G S, Hunter J A. Nickel dermatitis: the reaction to oral nickel challenge. Br J Dermatol 1986: 115 33–38.
  5. https://www.nhs.uk/conditions/pompholyx/
  6. https://patient.info/skin-conditions/atopic-eczema/pompholyx
contact dermatitis
Contact dermatitis presents itself as distressed skin inflammation.

What prompted this article is an episode of distressing skin inflammation by one of the authors of this blog. For some background information, this writer is a creature of repetitive habits without a shadow of a doubt. After a recent change in one of the facial topical products, the skin over their face started to become red, inflamed, painful, and very itchy after just three days of use.

The skin is the largest organ in our body. While building a good skin barrier layer takes months to years, acute contact dermatitis can lead to an evident and sudden skin deterioration due to an acute skin barrier breakdown. This can happen to anybody.

In this article, we delve into the types of contact dermatitis, causes of the condition, ways to minimise developing contact dermatitis, and tips to rescue the affected skin.

What is contact dermatitis?

As the name suggests, contact dermatitis is defined as a skin inflammatory condition due to direct contact with the application of substances onto the skin’s surface. Contact dermatitis can occur on any part of the body, though the hands, face, and feet are frequently affected.

There are two types of contact dermatitis: irritant contact dermatitis and allergic contact dermatitis.

dermatitis on feet
The feet are a commonly affected area for contact dermatitis.

What are the symptoms of contact dermatitis?

Patients with contact dermatitis tend to present with:

What causes contact dermatitis?

The skin rash response during contact dermatitis is a negative inflammatory response from one or more external agents in touch or contact with the skin. This leads to a vicious cycle of weakening the skin barrier, inflammation over the skin, and further impairing the skin's protective layer.

In irritant contact dermatitis, the external agents present as irritants that corrode the normal skin barrier, leading to a skin inflammatory response. The most common irritants include water, strong chemicals (acid or alkalis), detergents, solvents, and abrasives (repeated friction). Strong irritants cause immediate breakdown of the skin barrier, leading to a skin reaction within hours after exposure. Generally, after repetitive and cumulative exposure to irritants over months and years, individuals may notice a more subtle skin reaction over time.

In allergic contact dermatitis, an interesting delayed allergic response takes place. This is known as a type 4 hypersensitivity allergic reaction. To begin with, patients with allergic contact dermatitis tend to have eczema with a weaker overall skin barrier. The introduction of external substances to the skin allows even easier access due to a weakened skin barrier. The substance is recognised by T-cells (immune cells) in the body, and upon repeated exposure to an external substance, the body’s immune system is reinforced and re-challenged with the external substances, leading to the development of an allergic skin response.

In allergic contact dermatitis, auto-sensitisation may even occur due to the awakening of the immune system, leading to a generalised spread of the rash. For example, a person may start with a facial rash due to direct contact with an allergen substance on the face; there may be a further spread of rash throughout the body and lower limbs due to auto-sensitisation.

Although irritant and allergic contact dermatitis is often discussed and explained separately, clinical practice commonly sees both causes occur simultaneously.

In irritant and allergic contact dermatitis, the skin barrier is compromised as the skin integrity is no longer at its best. This can be due to irritated skin or an allergic response. Subsequently, the skin will continue to deteriorate by a physical manifestation of increased damage.

skin rash
A rash can start at the face and spread to the rest of the body.

What are the common irritants and allergens that cause contact dermatitis?

Common irritants that cause contact dermatitis include:

Common allergens that cause contact dermatitis include:

If you are unsure of which of these are causing the above symptoms, a skin prick allergy test is a simple and accurate way to detect allergies. Allergy treatment will follow depending on the results.

makeup allergy
Makeup is a common allergen that can result in contact dermatitis.

What are the differences between irritant contact dermatitis and allergic contact dermatitis?

There are few tell-tail signs to differentiate the presentation between irritation and allergic contact dermatitis, though often the presentation may not be as clear-cut and may co-exist simultaneously.

 Irritant contact dermatitisAllergic contact dermatitis
Common sitesHandsExposed areas of the skin
Borders of skin rashStrictly confined to the exposure siteDemarcated borders, though, may spread to the peripherals and become generalised
Clinical symptoms (Acute)Intense stinging, pain, then eventually itchingItching, which can lead to pain
Clinical symptoms (Chronic)Itching and painItching and pain
Appearance (Acute)Redness, blisters, broken skin, erosions crust, and scalingRedness bumps, broken skin, crust, and scaling
Appearance (Chronic)Bumps, crust, scales, fissuresBumps, patches, scaling, crust
Timeline (Acute)Rapid, within hours after exposure12 to 72 hours after exposure

How is contact dermatitis managed?

The key to managing contact dermatitis is to eliminate and stop the offending substance(s) that plays a role in contact dermatitis.

In the real world, sometimes, complete elimination of the offending substance(s) may not be feasible due to the nature of certain occupations, or common irritants such as water or dust may not be wholly avoided. However, understanding the possible culprit(s) is important, as unnecessary exposure to irritants or allergens can be minimised. 

For example, in the case of water irritants, one should avoid repetitive unnecessary washing and use protective hand gloves when available and possible. If your workplace allows, consider protective gear or even a change of job roles to avoid exposure to offending substances.

Patients with contact dermatitis should be encouraged to repeatedly use moisturiser and barrier cream to maintain the skin barrier integrity. Avoid moisturisers with plant-based proteins, chemicals, or even fragrances. In active inflammation cases, topical steroids or even oral steroids may be required to manage the condition.

It is a knee-jerk reflex when the skin condition deteriorates, and we wish to troubleshoot it with various medications and creams on the affected area(s). Often, this may lead to further introduction of more irritants or allergens that potentially worsen inflamed skin. It is important to take a step back and remind ourselves that in contact dermatitis, less is more. Stop triggering substance(s) and avoid further aggravation!

steroids
Topical steroids may be prescribed to help manage the condition and its symptoms.

Can we manage contact dermatitis?

The outcome of contact dermatitis depends on whether the triggering external substance(s) can be avoided. If this is achievable, one can prevent further episodes of dermatitis. This may be challenging, as there may be more than one offending factor involved in contact dermatitis, and complete avoidance of the offending factors may be impractical.

Speak to your doctor if you are dealing with contact dermatitis. Your doctor can guide you further in evaluating the root of your condition and ways to manage the symptoms.

References

  1. Richard P. Usatine MD and Marcela Riojas MD. Diagnosis and Management of Contact Dermatitis. Am Fam Physician. 2010;82(3):249-255
  2. Johansen JD, Frosch PJ, Lepoittevin JP (eds). Contact Dermatitis 5th Ed. 2010; Berlin. Springer. A comprehensive detailed up-to-date reference book.
  3. Britton JE, Wilkinson SM, English JE, et al. The British standard series of contact dermatitis allergens. Br J Dermatol 2003; 148: 259-64.
  4. Johnston GA, Exton LS, Mohd Mustapa MF, Slack JA, Coulson IH, English JS, Bourke JF. British association of Dermatologists Guidelines for the management of Contact Dermatitis 2017. BJD 2017 Feb 176 (2) 317-329.       

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.

WHAT COMMON ALLERGENS CAN TRIGGER ALLERGIC RHINITIS?

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.

WHAT ARE THE SYMPTOMS OF HAY FEVER?

Typical symptoms include:

WHAT DO I EXPECT WHEN I CONSULT MY DOCTOR FOR HAY FEVER?

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.

WHAT ARE THE TREATMENT OPTIONS FOR HAY FEVER?

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.

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.

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 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.

Afterword...
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.

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.

Lady suffering from Anaphylaxis

What are the Treatments for Anaphylaxis?

Epinephrine

Antihistamines

Steroids

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.

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.

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?

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.

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.

Picture of an insect 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!

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