Clinical Examination Of Hayfever
Initial observation may reveal a dull, nasal voice resulting from blockage of the nose. The eyes may be red and watery, and dark circles may be evident below the eyes due to congestion of the nasal veins. A horizontal crease may be noticeable on the outside of the nose, particularly in children, as a result of frequent wiping. The nose is examined using a nasal speculum or an otoscope with an attachment for the nose. This allows the inside of the nose to be viewed directly.
In people with allergic rhinitis the lining of the nose is usually pale and swollen, however there may be areas of redness, which may be due to infection or rhinitis medicamentosa . Secretions are usually thin, watery and colourless. Thicker mucous which is yellow or green may indicate an infection. The nasal septum which separates the two sides of the nose should also be examined to look for any deviation or perforation.
The doctor will also look for evidence of any masses, such as nasal polyps, which may restrict the flow of air through the nose and cause breathing difficulties. The ears and throat should be examined to look for signs of inflammation or infection such as redness or pus. The GP may press gently on your forehead and cheeks. If this is painful there may be an infection of the underlying sinuses.
Harm Of Gcs In Children
There is limited knowledge of risks of using systemic GCS in pediatric CRS or ARS compared to pediatric asthma. As an example, the Childhood Asthma Management Program trial followed the annual bone mineral accretion of 877 children with mild-to-moderate asthma . Oral GCS bursts produced a dosage-dependent reduction in bone mineral accretion and an increase in risk for osteopenia for 0, 14, and 5 courses, respectively, in boys. The authors conclude that multiple oral GCS bursts over a period of years can produce a dosage-dependent reduction in bone mineral accretion and increased risk for osteopenia in children with asthma. 780 children with asthma were followed for a mean of 4.3 years and it was shown that boys with lower vitamin D levels are significantly more susceptible to the negative effects of GCS on bone mineral accretion over time . Regarding studies investigating GCS AEs in upper airway disease, the trial from Ozturk also looked at self-reported AEs during the 15-day course of oral MP . In this trial no clinically significant AEs were reported. At the end of the treatment, the mean weight change did not differ statistically significantly between the groups. No data of monitored AEs, nor that of long-term outcomes, nor that of bacterial culture were available in this study.
Allergic To Cortisone Prednisone
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Why Is My Dog Itching
Most dogs and cats itch for one of these six reasons:
An effective diagnostic and treatment plan for itchy skin, therefore, should ideally account for all six of these causes of itch at the same time.
What Is A Food Allergy
Cat or Dog Food allergy is one type of adverse immunologic reaction to a substance in the diet . In most cases, a protein, such as chicken, lamb, beef or fish is the culprit, though any carbohydrate, fat or dietary supplement may be an allergen. It is NOT a reaction to a specific brand of food, or a result of switching diets. Most commercial and home-cooked diets, treats, and raw-foods share ingredients that may be allergens, no matter how high quality they are.
The pet may have been fed the offending allergen for over two years before developing signs of a food allergy. Food allergy can occur at any age, in any breed or gender, and patients may react to one or two items or several.
Efficacy Of Systemic Gcs In Pediatric Crs And Ars
Three clinical trials can be found in literature that investigated the use of oral GCS in the pediatric rhinosinusitis population, of which only one is controlled .
This controlled study involved 48 children with CRSsNP and investigated the effect of oral GCS as an add-on to antibiotics. 22 participants received either 30-day course of oral amoxicillinclavulanate and 15-day course of oral MP and 23 participants received only antibiotics and a placebo. The mean change of total symptom score and CT score was significantly higher after treatment with oral GCS and antibiotics compared with placebo and antibiotics . There was also a significant beneficial effect of oral GCS in cough, nasal obstruction and post-nasal drainage symptom scores. Complete clinical recovery after 30 days of treatment was obtained in significantly more subjects receiving MP . Recurrence of symptoms 6 months after the end of treatment was not statistically significant between the groups.
Mechanism Of Action Of Ics
ICS are widely used and prescribed in both adults and children, usually in long-term treatments. Therefore, the safety of these drugs is of some importance for both general practitioners and specialists. The mechanism of action of glucocorticosteroids is directed to specific nuclear receptors, which induce and modulate the transcription of specific target genes. These genes encode for cytokines, lipocortin-1, endothelin, b-adrenoceptors, iNOS, endopeptidases, and so on. Several transcription factors are involved in this mechanism . ICS exert their clinical and anti-inflammatory actions depending on a wide range of variables, including the status of the nasal and bronchial wall , the pharmacodynamic-pharmacokinetic properties of the drug , the delivery system , the patients cooperation , and the dosage regimen . These factors also determine the severity and frequency of side-effects .
Keep Your Seasonal Allergies In Check
Seasonal allergies can be frustrating. When spring crawls in, many people begin to experience all-too-familiar itchy and watery eyes, runny nose, and congestion. Symptoms of seasonal allergies are the result of an immune system in overdrive in response to pollen and other allergens. Those bothersome symptoms are intended to protect you from unwanted foreign particles, but in this situation they end up causing misery. There are quite a few options when it comes to controlling allergy symptoms, but we want to watch out for a few that can be quite dangerous when used incorrectly.
Practice Parameters For Managing Allergic Rhinitis
Am Fam Physician. 2009 Jul 1;80:79-85.
Guideline source: American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology
Literature search described? Yes
Evidence rating system used? Yes
Rhinitis affects between 10 and 30 percent of adults and 40 percent of children in the United States. It is characterized by one or more of the following nasal symptoms: congestion, rhinorrhea , sneezing, and itching. Rhinitis may affect a patient’s quality of life through fatigue, headache, cognitive impairment, and sleep disturbance; therefore, it is considered a significant cause of morbidity, medical treatment costs, reduced work productivity, and missed school days.
Allergic rhinitis may be seasonal or perennial. Seasonal allergic rhinitis is caused by seasonal allergens. Perennial allergic rhinitis may be caused by dust mites, molds, animal allergens, occupational allergens, or pollen. Risk factors for allergic rhinitis include a family history of atopy, serum immunoglobulin E levels greater than 100 IU per mL before six years of age, higher socioeconomic class, and a positive allergy skin prick test. The diagnosis of rhinitis includes a history of symptoms and a physical examination. Skin testing for specific IgE antibody is the preferred diagnostic test to provide evidence of an allergic cause of the patient’s symptoms.
Treating Itchy Skin In Dogs And Cats Step 1 Rule Out Food Allergies
Cat and dog food allergy is one of those topics that gets a lot of press, but is frequently misunderstood. One of the most frustrating things for me as a veterinarian is to stand in the pet food stores and listen to the employees educate well-intentioned pet owners about what diet is best for their food allergic dog or cat. They mean well, but so much of what they are learning about cat and dog food allergy is PR that is handed down from the pet food companies. For example, the most frequent thing I hear is you need to feed your pet a grain-free diet if it has food allergies. While some pets are indeed allergic to grain, the vast majority of food allergic pets are primarily allergic to their PROTEIN source, NOT grain.
There is no such thing as a hypoallergenic dog food at the pet store.
Do not let the friendly pet store employee convince you otherwise.
Instead, the only rational way to diagnose a food allergy in a dog, is with an elimination diet trial.
Nasal And Oral Corticosteroids For Allergies
Overview of corticosteroids for allergies
Corticosteroids are a form of steroids used to treat swelling and inflammation from allergies, as well as allergic asthma. Theyre often referred to as steroids, but theyre not the same types of products abused by some athletes. Corticosteroids may be used for a range of allergies. They may be taken for a short-term or a long-term basis, depending on the severity of your condition.
These drugs are primarily used for ongoing illnesses. Theyre especially useful for treating inflammation, a long-term underlying effect of many conditions like allergies. Corticosteroids mimic the effects of cortisol, which is a stress hormone. Your adrenal glands excrete it to help your body minimize the effects of inflammation and other patterns related to stress.
Doctors typically prescribe this medication in either a nasal or oral form for allergies. While inhaled and injected forms are available, they arent typically used for allergies. Read on to learn more about the differences between nasal and oral corticosteroids, and how to determine which is best for your condition.
How Does The Hay Fever Jab Work
For around 10% of people though, these medications do not relieve their symptoms and some of them opt for the hay fever jab, a steroid injection marketed as Kenalog. It works by suppressing the body’s immune response to histamines and thus relieving symptoms.
“Sufferers of hay fever may consider the hay fever injection, offered by some private clinics,” explains Dr Farah Gilani, a GP. “This is an injection of a steroid called triamcinolone into a large muscle in the body. Once the steroid is injected, it slowly leaks from the muscle for three to eight weeks and travels throughout the body, theoretically offering relief from hay fever symptoms.”
Gilani says there are many anecdotal accounts by individuals who report significant improvements in their symptoms with this injection. David Clare from Lincolnshire has had positive results.
“I get the steroid injection for hay fever every year, although my GP only allows one course per year, due to the side effects,” states Clare. “I find getting it just before the worst month is best, and keeps my symptoms at bay for a month. During this time, I feel just as I would in autumn and winter, so it is a quite a relief!”
Clare still has to take either side of the injection, but says that over-the-counter and prescribed medicines have never really worked for him.
“Only the jab does the job,” he adds. “For that reason, I find it worth the cost and the potential side effects .”
The pros and cons of the hay fever injection
How Is Cat Or Dog Food Allergy Diagnosed What Types Of Tests Would A Vet Do To Identify And Treat A Food Allergy
It is important to understand that currently there is no accurate test to determine if a pet has a food allergy. Simply switching from one commercial brand to another is not sufficient, as these diets have many shared ingredients. The only reliable method of diagnosing a food allergy is undergoing an elimination diet trial. This means that your pet will be fed a special prescription diet from your veterinarian containing a single new animal or vegetable protein, such as rabbit or beans; and a single new carbohydrate, such as yams or green peas. Some of the commercial elimination diets contain common proteins that have been altered so the body doesnt recognize them as allergens. There are blood tests available that claim to be able to determine if your pet has food allergies, and if so, what he or she is allergic to. These tests have MINIMAL if any correlation to true food allergies, so please dont waste your money or your time.
Regardless of the diet chosen, it needs to be fed absolutely strictly for a period of 8-12 weeks to see improvement. No other treats, supplements or foods can be fed or even mistakenly ingested during this period. There should be absolutely no exposure to other pets food or food bowls. During the diet trial skin infections or other sources of itch and discomfort will be addressed by the veterinarian.
SUMMARY: How to perform an 8 week elimination diet trial
Even just a bite or two of chicken may invalidate the diet trial.
Naturopathic Approach To Allergies
The naturopathic approach to allergies is to identify why the individual has the allergy, and then treat the root cause of the problem.
If you are suffering from allergies that were present since birth or came back all of a sudden, or suspect that you may be suffering from allergies to the environment or certain foods, we can help you identify what caused the allergy to come about in the first place and help you treat the cause, we can also help you to decrease allergenic reactions to the environment and foods using natural supplements, along with other naturopathic modalities.
Alternative therapies help to reduce inflammation, minimize hypersensitivity reactions, modulate the immune system and heal the digestive tract.
How Does Prednisone Work For Asthma
Prednisone is an . It suppresses the immune system.1-4 Prednisone works by acting like cortisol , a natural corticosteroid made by the body in the adrenal glands.4 It is used as both a short-term and long-term treatment depending on the dose.1,2
Discuss Prednisone With Your Doctor
Your doctor can advise you on how to safely take any needed drugs and any instructions regarding food, and use.1 Your doctor may suggest a low-salt, high potassium, or high calcium diet.3
Do not get immunizations without your doctor’s approval, especially live vaccines including measles, mumps, rubella , rotavirus, yellow fever, chickenpox, and some types of and typhoid vaccines.1,2
Before starting treatment with prednisone, discuss all of your health conditions with your doctor, especially:1-4
- Hypersensitivity to prednisone
- Other types of allergies including foods, dyes, preservatives, or animals
- Eye conditions including cataracts, glaucoma, or infections
- Heart conditions including high blood pressure and congestive heart failure
- Diabetes or high blood sugar
- Active bacterial, viral, and fungal infections
- Stomach or intestinal problems including ulcers, diverticulitis, or colitis
- History of tuberculosis, malaria, osteoporosis, thyroid or muscle disorders
Prednisone is indicated for adults and children.1-3 Tell your doctor if you are or plan to become while using prednisone. Effective birth control to prevent pregnancy should be practiced while using prednisone. It should be used while breastfeeding only if the potential benefit justifies any potential risks to the baby.1
Be sure to talk to your doctor if you have any questions about your medication regimen.1,2
Treating Itchy Skin In Dogs And Cats Step 2 Eliminate Skin Parasites
Veterinary Treatment Of Itchy Skin Caused By Seasonal Allergies Or Dust Mites
Primary therapy for dust mite allergies in pets is similar to that of inhalant allergies.
Here is how allergy testing and desensitization works:
Allergy testing and desensitation appears to be helpful in about 80% of patients receiving the treatments, at reducing the length and severity of allergy attacks throughout the pets lifetime.
Allergies are never cured, only managed.
If you loved this post, please share it with your friends on Facebook and Twitter, or if youre not in the Indianapolis and Carmel Indiana area, print out a copy and take it in to your local veterinarian to discuss your options.
If you do live in the Indianapolis / Carmel area, please schedule your first appointment today by calling Leos Pet Care today at 721-7387
Side Effects Of Oral Corticosteroids
Some of the side effects of oral corticosteroids are similar to nasal versions. However, medications taken by mouth tend to have a wider range of potential adverse effects. These include:
- joint pain
- decreased immunity
Some of these side effects go away on their own. However, you should tell your doctor about any reaction to oral corticosteroids to prevent further complications.
Mechanisms And Actions Of Gcs
Corticosteroids, which are produced by the adrenal glands, can be classified as glucocorticoids and mineralocorticoids. Cortisol is the endogenous glucocorticoid in humans, naturally derived from cholesterol metabolism upon stimulation by the hypothalamicpituitaryadrenal axis , which is regulated initially by the circadian rhythm, but also by negative feedback by glucocorticoids and glucocorticoid increment induced by stressors such as pain, inflammation or infections .
The hypothalamicpituitaryadrenal axis. Stress stimuli induce the production of CRH by the hypothalamus. CRH induces the production of ACTH by the pituitary gland which stimulates the production of glucocorticoids in the adrenal gland cortex. Cortisol acts on many cells, tissues, and organs including the immune system. The excessive release of cortisol as well as proinflammatory cytokines have a negative feedback on the central nervous system by inhibiting this circadian cycle. CRH corticotrophin releasing hormone, ACTH adrenocorticotrophin hormone
Benefit And Risk Of Use Of Gcs In Pediatric Populations
Inflammatory diseases of the nose and paranasal sinuses in children include upper respiratory tract infections, chronic rhinitis, ARS and CRS. ARS is defined as increase of sinonasal symptoms after 5 days of infection or persistent symptoms after 10 days and characterized by the sudden onset of two or more of the symptoms for less than 12 weeks . Bacterial infection is expected when at least 3 symptoms are present among which discoloured discharge, purulent secretion in nasal cavity, severe local pain with a unilateral predominance, fever, elevated C-reactive protein or erythrocyte sedimentation rate, and double sickening . The definition of pediatric CRS differs from adult CRS by the symptom of cough and is defined by the presence of two or more symptoms, one of which should be either nasal obstruction or nasal discharge with/without facial pain/pressure with/without cough, lasting for at least 12 weeks . The diagnosis is confirmed by either nasal endoscopy showing edema, purulent drainage or nasal polyps in the middle meatus or CT scan showing ostiomeatal complex or sinus opacification. Of note, the presence of nasal polyps is much less common in pediatric patients than in adult patients with CRS .
The Pros And Cons Of The Hay Fever Injection
For one in four people, the arrival of warmer weather marks the beginning of an annual struggle against hay fever. Some sufferers swear by a yearly ‘hay fever injection’, offered by some private clinics. But is it effective? And more importantly, is it safe?
Reviewed byDr Sarah Jarvis MBE
17-May-19·4 mins read
Hay fever is caused by an allergic reaction to pollen. When it comes into contact with the mouth, eyes, nose or throat, the body reacts by making specific antibodies. Hay fever affects people at different times depending on which pollen they are allergic to. The majority of people are allergic to grass pollen, so will experience their worst symptoms between May and June; tree pollen affects people in late spring between March and May; while others are affected by weed and mould pollens in the autumn.
The condition is characterised by sneezing and , a runny or blocked nose, red watery eyes, itchy throat, mouth, nose, eyes or ears, headaches and sometimes a feeling of fatigue or tiredness. Sufferers may also experience a wheeze and tightness in the chest.
Many people manage their symptoms by taking simple steps to stop the pollen reaching them – wraparound sunglasses to protect the eyes, or Vaseline around the nostrils – or by taking over-the-counter antihistamine drops or tablets, and using a nasal spray.
What Is Hayfever Or Seasonal Rhinitis
Allergic rhinitis is an allergic disease which affects many people worldwide. Rhinitis means inflammation of the nose, whilst the term allergic describes a normal but exaggerated response to a substance. It may be , which means symptoms are present throughout the year, or seasonal, with symptoms peaking during the months of spring and summer when pollen levels are at their highest.
Seasonal rhinitis, also known as hayfever, is characterised by irritation and congestion or watering of the nose, itchy eyes, ears and throat, and sneezing. It occurs due to an exaggerated response to an environmental trigger which results in inflammation of the lining of the nose .In the case of seasonal rhinitis, pollen is the most common trigger, hence symptoms are usually experienced during the spring and summer months when the pollen season is at its peak.
What Are The Downsides
The injection was historically available on the NHS, explains Gilani, but it is no longer offered due to a lack of robust evidence supporting its efficacy.
Plus, the treatment can cause a potentially long list of side effects including raised blood pressure, water retention, skin rashes and muscle weakness. Other unwanted secondary effects include swelling, breathing difficulties, abdominal pain, insomnia and taste disturbance.
“Once the steroid has been injected, nothing can be done to prevent it from spreading through the body over the following weeks, even if side effects are experienced,” states Gilani. “In addition, it is contra-indicated in some patients, such as those who have stomach ulcers, diabetes or an active infection.”
For these reasons, charity Allergy UK does not endorse the injection. “The steroid injection is not recommended as it is a high-dose steroid given by an intramuscular injection and once injected, the amount of steroid cannot be removed and it comes with a high side-effect profile.
“Many patients like it as it does help with their hay fever symptoms and that is why you can get it privately, but it is not given on the NHS in allergy services as the recommendations are to give immunotherapy for severe hay fever,” their spokesperson continues.
Treating Itchy Skin In Dogs And Cats Step 4 Antihistamines And Prednisone
is currently our drug of choice to reduce your dogs itch while were treating the bacteria, yeast, and parasites that may be complicating her itchy skin, and while were running the 8 week elimination diet trial test.
Our intention is not for you to keep your dog on prednisone for the rest of her life, but rather to keep her from getting miserable while were getting to the bottom of whats causing her allergies.
Your veterinarian may also recommend human antihistamines to be given at the same time as prednisone to reduce itching.