Conditions

allergy_iconAllergies General

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An allergy is a disorder of the immune system in which an exaggerated response occurs when a person is exposed to normally harmless environmental substances known as allergens.

An allergic person produces a specific type of antibody called immunoglobulin E, or IgE, in response to normally harmless substances such as certain foods or medicines, pollen, animal dander and mold. These IgE antibodies cause allergic reactions. If a person is exposed again to the allergen, the IgE antibodies stimulate cells called mast cells to release chemicals including histamine to destroy the “foreign” substance.

The release of histamine causes typical allergy symptoms such as runny nose; itchy, watery eyes; sneezing; asthma symptoms; hives; and, in severe cases, a drop in blood pressure. This is why antihistamines are the mainstay of treatment for allergies.

About 50 million Americans, or 1 in 6 people, have environmental allergies, or allergic rhinitis. Allergic disorders are the sixth leading cause of chronic illness in the United States, according to the Allergy Report from the American Academy of Allergy, Asthma and Immunology.

People with seasonal allergic rhinitis (hay fever) experience symptoms during the time of year when certain allergens are in the air outdoors. There are several allergy seasons: springtime, when plants bloom and tree pollen counts soar; summer, the season for grass and weed pollen allergies; and autumn, the time for ragweed and mold allergies. Perennial allergies, or year-round allergies, are typically caused by indoor allergies to dust mites, mold, cockroaches and pet dander.

A specific allergy is not usually inherited, but your tendency to develop allergies is often passed down through families. If both parents have allergies, their child is likely to have allergies. However, your chance of developing allergies seems to be greater if your mother has allergies.

There are two main theories. One blames our increasing immune system sensitivity to the many synthetic chemicals in today’s society. Another theory, known as the “hygiene hypothesis,” states that the human immune system is becoming more reactive to allergens because of modern hygiene and health care. Our immune system is designed to fight off viruses, bacteria, parasites and other microbes. However, with modern hygiene, sanitation, vaccines, antibiotics and health care, our immune system does not have many invaders to fight off, and so its attention and energy are re-directed to normally harmless foreign substances.

It normally works the other way around – people can grow into allergies. There are cases in which one allergy replaces another, such as with childhood food allergies. Children normally suffer from food allergies more than adults. Once they grow up, they may get rid of food allergies but then be affected by seasonal or environmental allergies. About 85% of children outgrow food allergies to milk, soy, egg and wheat, but only 20% outgrow a peanut allergy. Up to half of young children outgrow their asthma, but many find that their symptoms return later in life. For most children, eczema improves during childhood.

Allergic reactions can develop at any age, no matter how old you are. Since repeated exposure to certain allergens can cause an allergic reaction, it makes sense to develop allergies when you’re older, as you’ve had more time to be in contact with dust, dander, mold and pollen.

In some cases, yes. Severe and untreated hay fever may lead to asthma, sinusitis and other serious conditions. Atopic dermatitis or eczema can spread to secondary skin infections if they are not treated properly, and untreated asthma can lead to chronic symptoms. Early detection and treatment of all allergic diseases is important.

Allergies cannot be cured, but symptoms can be controlled using a combination of avoidance measures and medications, and allergen immunotherapy (allergy shots) when necessary.

An allergist/immunologist is a pediatrician or internist who has undergone two to three years of special training in the diagnosis and treatment of allergic and immunologic diseases. To understand what you are allergic to, an allergist will:

  • Take a personalized patient history, including a thorough record of the illness, a family history, and information on home and work/school environments
  • Perform allergy testing
  • Possibly perform other laboratory tests

An allergist can create a management plan with you for better control of your environment and your symptoms. Your plan may also include proper medication and, if necessary, allergen immunotherapy (allergy shots).

Avoidance is the best treatment for any allergic disease. If you avoid the allergen, you’ll avoid the allergic reaction. Diagnosis and education are crucial steps in allergen avoidance. Educated allergy and asthma sufferers fare much better than those who do not understand their condition.

Asthmafs_icon_asthma

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Asthma is a chronic inflammatory lung disease that can cause repeated episodes of cough, wheezing and breathing difficulty. Asthma can be triggered by allergens, infection, exercise, cold air and other factors. About 15 million adults and children have asthma. It is one of the most common chronic diseases of childhood, affecting more than 6 million children..

During an asthma attack, the air passages become swollen and narrow and produce a thick mucous. At the same time, the muscles around the airways become tight. The tightening of the muscles, called bronchospasm, causes the airways to become even narrower.

Each person’s symptoms are different, but everyone must pay attention to the early warning signs of asthma to recognize that an asthma episode may be developing. These signs may include breathing changes or coughing, feeling tired, having less energy for exercise and having lower peak flow meter numbers. A peak flow meter is an easy-to-use plastic device that measures how well air moves out of your lungs.

Common signs and symptoms of an acute asthma episode include:

  • Coughing
  • Wheezing (although it may be absent)
  • Chest tightness
  • Shortness of breath
  • Increased breathing rate

Severe asthma symptoms require immediate attention and can be a life-threatening emergency. Signs of severe symptoms include:

  • Severe cough, shortness of breath, chest tightness and/or wheezing
  • Difficulty speaking in full sentences
  • Hard and fast breathing
  • Nasal flaring
  • Chest and neck muscles pulling in when breathing
  • Lips or fingernails turning gray or blue
  • Regular check-ups with your doctor are very important, even if you have been symptom free.
  • Take all your prescribed asthma medications. There are two types of asthma medicines:
    • Long-term control medications – These are taken daily on a long-term basis. They maintain control of persistent asthma by lessening the chronic inflammatory aspect of asthma.
    • Quick-relief medications – These are short-acting beta agonists (SABAs). They relax airway muscles to provide quick relief.
  • Children should follow a written asthma action plan written by you and your child’s doctor. It should list what medications to give your child to keep his or her asthma under control. It should also list what to do when your child’s asthma worsens, including what medications to give and when to contact your child’s doctor or go to the emergency room.
  • Monitor your child’s asthma with a peak flow meter. Peak flow monitoring is considered for children around 6 years and older with moderate or severe persistent asthma, a history of severe episodes or perceived airflow obstruction and worsening asthma. This easy-to-use plastic device measures how well air moves out of your child’s lungs. The peak flow number and your symptoms are used as a guide to help manage your child’s asthma.
  • Identify your triggers for asthma. Everyone’s asthma triggers are different. An allergist can help you pinpoint them. Once you know your triggers, you can better avoid them to help control your asthma.

Environmental Allergiesallergy_icon

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Environmental allergies are generally known as allergic rhinitis. This is an allergic reaction that occurs in the nose when allergens in the air trigger the release of histamine. Histamine causes inflammation that leads to nasal congestion and swelling of the nasal membranes, which can then block or reduce normal sinus drainage.

  • Seasonal, which occur mainly during pollen seasons. Common allergens are tree, grass and weed pollens.
  • Perennial, which occur year round. Common allergens are mold, animal dander and dust mites.

Each patient may experience symptoms differently, but they can include:

  • Sneezing
  • Congestion
  • Runny nose
  • Itchy nose, throat, eyes and ears
  • Nosebleeds
  • Clear drainage from the nose

Children with perennial allergic rhinitis may also have recurrent ear infections, snoring, a habit of breathing through the mouth, fatigue and poor performance in school.

Allergic rhinitis can lead to recurrent or chronic sinusitis. The nasal obstruction and inflammation associated with allergic rhinitis interrupts the normal clearing of mucus from your nasal passages, which causes the sinus cavities to become clogged with mucus. Common symptoms include:

  • Thick yellowish/green nasal discharge
  • Headache
  • Facial pain
  • Nasal congestion
  • Loss of smell
  • Fatigue
  • Fever

Sinusitis may be considered acute (lasting less than 4 weeks), subacute (four to eight weeks), chronic (eight weeks or longer) or recurrent (three or more episodes of acute sinusitis per year).

After an allergy specialist has performed skin prick testing and/or blood testing to identify possible airborne allergens that trigger your rhinitis, you should avoid exposure to these allergens. Such measures may include remaining indoors when the pollen count is high and on windy days, dust-proofing the home and keeping animals out of the bedroom.

Treatment options may include the use of:

  • Antihistamines
  • Corticosteroid nasal sprays
  • Decongestants

Allergy shots, also known as allergen immunotherapy, may be recommended if avoidance and medications are not effective.

Food Allergiesfood_allergies

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Food allergies develop when the immune system, for unknown reasons, fights against a particular food protein even though it is harmless. There are many people with food intolerances, which cause symptoms such as minor skin rashes or stomach upset. Food allergies, which trigger the immune system, are less common and more severe. True food allergy can cause anaphylaxis – a serious allergic reaction that is rapid in onset and may cause death.

If you have a true food allergy, there is always a chance for anaphylaxis. Symptoms usually appear a few minutes to 1-2 hours after eating the food. The following are the most common symptoms of anaphylaxis, but each person may experience symptoms differently.

  • Anxiety
  • Facial and/or lip swelling
  • Throat itchiness and/or swelling
  • Hives all over the body
  • Nausea and vomiting
  • Stomach cramps
  • Shortness of breath
  • Wheezing
  • Coughing
  • Sneezing
  • Drop in blood pressure
  • Dizziness and/or fainting
  • Loss of consciousness

Food allergies are on the rise. There is much ongoing research to learn more about the causes. The following factors make food allergies more likely:

  • Family history: Many children with food allergies come from families with a history of food allergies, hay fever or asthma.
  • Eczema: Many children who have food allergies also have eczema.
  • Young age: Food allergies occur most often in infants and toddlers.

Eight foods account for up to 90% of all food-allergic reactions. They include:

  • Peanuts
  • Tree nuts (such as almonds, cashews, walnuts, pecans, hazelnuts, Brazil nuts and pistachios)
  • Fish
  • Shellfish
  • Milk
  • Egg
  • Soy
  • Wheat

A person is usually diagnosed with a food allergy after having a reaction that requires medical attention. If it is not clear what food caused the reaction, skin prick testing and/or ImmunoCAP blood testing may be performed to identify the food allergen. Elimination diets, which involve removing certain foods from the patient’s diet, may also be implemented.

A person is usually diagnosed with a food allergy after having a reaction that requires medical attention. If it is not clear what food caused the reaction, skin prick testing and/or ImmunoCAP blood testing may be performed to identify the food allergen. Elimination diets, which involve removing certain foods from the patient’s diet, may also be implemented.

How is a food allergy treated?

There is no cure for food allergies, although many children do outgrow them. Here are some precautions you can take:

  • Avoid the food: The only treatment is complete avoidance of the specific foods that trigger the allergy.
  • Ask about ingredients: People with food allergies must always inquire about ingredients when eating away from home.
  • Read food labels: It is important to read food labels carefully. The United States has adopted food labeling rules that ensure that the common food allergens are listed in familiar language.
  • Wear a medical alert bracelet: These inform health care workers and others of food allergies. They can be purchased in most drugstores or online.
  • Be prepared for emergencies: Anaphylactic reactions caused by food allergies can be potentially life threatening. Fortunately, anaphylaxis can be treated with an injection of epinephrine, which can halt the progression of systemic symptoms and stop the reaction. Those with food allergies must carry and know how to use injectable epinephrine and antihistamines to treat reactions due to accidental ingestion.

Drug Allergiesicon-key-drug

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A drug allergy is an allergic reaction that occurs when the body’s immune system produces antibodies and activates disease-fighting cells in response to a specific drug. In the development of a drug allergy, the immune system is triggered by the first exposure to the medication. A future exposure causes an immune response, including the production of allergic antibodies and release of histamine. So, drug allergy reactions occur after a person has been previously exposed to the drug one or more times without any allergic reaction.

Everyone reacts to medications differently. One person may develop a rash, while another person on the same drug may have no adverse reaction. All medications have the potential to cause side effects, but only about 5% to 10% of adverse reactions to drugs are allergic. Reactions to medications can range from mild to life threatening.

Most allergic reactions occur within one hour of taking the medication, and involve the following signs and symptoms:

  • Hives (itchy, slightly red and swollen patches on the skin)
  • Skin rash
  • Itching of the lips, tongue and/or face
  • Sensitivity of the skin to sunlight (an itchy and scaly rash when skin is exposed to sun)
  • Low blood pressure, wheezing and other signs, which may indicate a potentially life-threatening reaction known as anaphylaxis

Antibiotics are the most common cause of anaphylaxis, but more recently, chemotherapy drugs and monoclonal antibodies have also been shown to do so.

Fortunately, at long last, we now have the ability to test for penicillin and penicillin derivatives through a simple skin test. If the history and testing align, the diagnosis is confirmed in about 97% of cases. Diagnosis of other drug allergies is done mostly through a patient’s medical history. Allergists are specifically trained for this.

Drug rashes are the body’s reaction to certain medications. The type of rash that occurs depends on the type of drug that is causing it. Rashes can range from mild to severe.

Rarely, drug rashes may result in blisters. These blisters can be a sign of a more serious condition, so they require medical attention.

Serum sickness is a delayed type of drug allergy that occurs a week or more after exposure to a medication. The immune system misidentifies a protein in the drug as a potentially harmful substance, and it develops an immune response to fight it, causing inflammation and other symptoms.

Symptoms of serum sickness do not develop until seven to 21 days after the first exposure to the drug. However, people may develop symptoms in one to three days if they have previously taken the medication. Within one to two weeks of taking a medication, the following signs and symptoms may be present:

  • Fever
  • Muscle and joint aches
  • Swollen throat glands (lymph nodes)
  • Changes in urine color

The first step in treating a drug allergy is to stop the drug that is causing the reaction. Mild allergy symptoms such as hives and itching may be relieved with antihistamines. Topical corticosteroids may also be recommended. If asthma-like symptoms such as cough or wheezing are present, a bronchodilator such as albuterol may be prescribed.

Insect Sting Allergiesparasite-512

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Venom is the substance injected into the skin during an insect bite or sting.

If you or your child has had a serious reaction to an insect sting in the past, then testing for an allergy to venom is necessary. Allergy testing is performed for five stinging insects: the white-faced hornet, yellow hornet, yellow jacket, honey bee and wasp.

When most people are stung by an insect, the site of the sting develops redness, swelling and itching. However, when people are allergic to insect stings, their immune system overreacts to the venom by producing allergic antibodies called immunoglobulin E (IgE). This triggers the release of substances including histamine that then cause an allergic reaction.

For some people, especially adults, stings may be life threatening and can result in anaphylaxis. The symptoms of a severe allergic reaction may include itching and hives, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea.

The most effective way to prevent stings is to stay away from stinging insects. These insects are most likely to sting if their homes are disturbed. It is worthwhile to have nests around your home destroyed.

Here are a few tips for avoiding insect stings:

  • If flying stinging insects are close to you, remain calm and move slowly away.
  • Avoid wearing brightly colored clothing and perfume when outdoors.
  • The smell of food attracts insects, so be careful when cooking, eating or drinking sweet drinks.
  • Keep food covered until eaten.
  • Wear closed-toe shoes outdoors.
  • Avoid loose-fitting garments that can trap insects between clothing and skin.

If the insect left its stinger in your skin, remove the stinger within 30 seconds to avoid receiving more venom. The stinger and its sac may be removed with a quick scrape of your fingernail.

To treat local reactions to insect stings:

  • Raise the affected limb and apply a cold compress to reduce swelling and pain.
  • Gently clean the area with soap and water to prevent secondary infections.
  • Use topical steroid ointments or oral antihistamines to relieve itching.

To treat severe reactions to insect stings:

  • Learn how and when to self-administer epinephrine. An auto-injectable epinephrine pen can be prescribed by your allergist.
  • Always carry an epinephrine pen.
  • Remember that epinephrine is a rescue medication only, and that you must still have someone take you to the emergency room immediately if you are stung.
  • Consider wearing a medical alert bracelet that identifies you as allergic to venom.
  • In most cases, insect venom allergy shots (or immunotherapy) are almost 100% effective in preventing severe reactions. Your allergist will discuss the best form of treatment after appropriate testing has been performed.

Eczema LPRODMAIN_174242_ICON-Eczema

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Eczema, or atopic dermatitis, is a chronic allergic skin condition mainly affecting infants and children. It often begins within the first year of life, with 60% of cases occurring by age 1 and up to 90% of cases by age 5. It may last until adolescence or adulthood. If eczema is diagnosed in adulthood, it is generally a long-term or recurring condition. Fifty percent to 75% of patients with eczema may eventually develop hay fever and/or asthma.

The main feature of eczema is itchy, dry skin that scales and flakes. Often, there is a personal or family history of eczema, hay fever, hives, food allergies or asthma. When skin itchiness is not controlled, an “itch/scratch cycle” leads to continued rubbing and scratching and subsequent thickening of the skin called lichenification.

The location of eczema on the body changes with age. In infants and young children, the cheeks, neck, knees and elbows are typically affected. In older children and adults, the hands, feet and areas inside the elbows and knees may be affected.

Symptoms may also include:

  • Dry, leathery, scaly skin
  • Intense itching
  • Blisters with oozing and crusting
  • Raw areas of the skin from scratching
  • Skin color changes
  • Skin redness or inflammation

Aggravating factors may include:

  • Exposure to environmental allergens
  • Exposure to food allergens, especially in infants
  • Stress
  • Temperature changes
  • Clothing materials such as wool and synthetic fibers

There is no specific test for eczema. The diagnosis is based on skin appearance and on personal and family history.

There is no cure for eczema. The main goal of treatment is to remove any irritants and to decrease the amount of dryness and irritation of the skin.

Some specific treatments include:

  • Daily baths using less soap than usual. After bathing, it is important to trap the moisture in the skin by applying a lubricating moisturizer while it is damp.
  • Topical steroid creams to help decrease inflammation in the skin and thus reduce itching and swelling.
  • Topical immunomodulators, which are steroid-sparing topical medicines, may be prescribed in some cases. These include tacrolimus (Protopic) and pimecrolimus (Elidel).
  • Antihistamines such as diphenhydramine (Benadryl) or hydroxyzine (Atarax) to help decrease the amount of itching. These medications may cause drowsiness.
  • Topical and/or oral antibiotics for skin that has become infected from frequent scratching. It is important to keep fingernails short.

Hivesskin-mouth-isi-icon

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Hives, also known as urticaria, is a condition in which swollen, red, itchy areas appear on the skin. It is usually due to an allergic reaction from eating certain foods or taking certain medications. Hives vary in size from less than an inch to a few inches. They may be on one area of the body or all over the body. They can last minutes to hours, or even several days before fading.

Angioedema is an allergic reaction similar to hives, but it causes swelling deeper in the layers of the skin. It commonly affects the hands, feet, genitals and face (lips and eyes). It generally lasts longer than hives (which can occur simultaneously) but the swelling usually goes away in 24 hours. In rare cases, angioedema may involve the throat and tongue, blocking the airway and causing breathing difficulty. This can become a life-threatening emergency.

Hives and angioedema occur when histamine is released from special cells found along the skin’s blood vessels. In response to histamine, plasma leaks out from these blood vessels in the skin. Allergic reactions to things like foods, medicines, insect stings and sunlight exposure can cause histamine release. Sometimes it is impossible to determine exactly why hives have formed.

  • Acute urticaria and/or angioedema are hives or swelling lasting less than six weeks. The most common causes are foods, medicines, latex or infections. Foods that commonly cause hives are milk, eggs, soy, wheat, fish, shellfish and peanuts. Medicines that can cause hives include penicillin, sulfa medications, anti-seizure medications and non-steroidal anti-inflammatory drugs (NSAIDs, such aspirin and ibuprofen).
  • Chronic urticaria and/or angioedema are recurrent hives, lasting longer than six weeks. The cause is usually more difficult to identify. Causes may be similar to acute urticaria, but may also include autoimmunity, viral infections and malignancy.
  • Physical urticaria is hives caused by direct physical stimulation of the skin. Common causes are exposure to sunlight, heat, cold air or water, vibration, pressure, sweating and exercise.
  • Dermatographism is hives caused by scratching the skin, continual stroking of the skin or wearing tight-fitting clothes that rub the skin. These hives may be found in conjunction with other types of hives.
  • Hereditary angioedema is a rare form of angioedema passed on in families. It can cause painful, non-itchy swelling of the skin, and it may involve the face, extremities, genitals, tongue and throat.

Avoidance of the allergen is the best treatment. If it is caused by a medication, strict avoidance is necessary.

Physicians may recommend antihistamines to decrease histamine release, which can lessen the symptoms of hives and/or angioedema. They may be prescribed on a regular schedule to prevent symptoms. Chronic hives may be treated with antihistamines or a combination of medications. For severe hives and angioedema, an injection of epinephrine may be needed.

Immunodeficiency29-512

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Immunodeficiency refers to a group of diseases in which the immune system does not function normally. A normal immune system will attack what is seen as a foreign invader, like bacteria and viruses. When the immune system does not work properly, a person is more likely to suffer from frequent and longer-lasting infections, often from organisms that usually don’t make most people sick. Most cases of immunodeficiency are acquired (“secondary”), but some people are born with defects in the immune system (a “primary” immunodeficiency).

People with immunodeficiency disorders experience recurrent ear infections, sinusitis, bronchitis or pneumonia. It is common for children with immunodeficiencies to develop thrush (a fungal infection of the mouth) and other infections of the skin and mucous membranes in the eyes, mouth and genital area. Gastrointestinal infections may cause diarrhea, weight loss and failure to thrive.

A patient will have a comprehensive assessment, including a medical history, a complete physical examination and laboratory tests. The type of infection that a patient has experienced helps to determine the type of immunodeficiency disorder.

There is no cure for immunodeficiency disorders. The goal of treatment is to control infections and maintain the patient’s quality of life. Infections are treated with antibiotics, which are sometimes taken on a regular schedule for preventive treatment. Patients with low antibody levels may be given injections of immunoglobulins (antibodies) to increase antibody levels.

Anaphylaxislifesaving-icon3

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Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. The reaction can occur a few seconds to as long as an hour after exposure to the allergen. It is a medical emergency, and in most cases it requires immediate treatment and then follow-up care by an allergist. Anaphylaxis is triggered when the immune system overreacts to a normally harmless substance such as food or medicines. The symptoms may be mild to severe and affect various body organ systems.

Each person may experience symptoms of anaphylaxis differently. The most common symptoms include:

  • Respiratory system: chest tightness, shortness of breath, wheezing, throat tightness, cough, itchy mouth/throat, nasal congestion
  • Cardiac system: low heart rate, pale/blue color, dizziness, low blood pressure, lightheadedness
  • Skin and mucous membranes: hives all over body, swelling, itchiness, redness, itchy/watery/red eyes
  • Gastrointestinal system: nausea, vomiting, diarrhea, stomach ache
  • Other symptoms: anxiety, feeling of “impending doom”

The most dangerous symptoms, which should prompt an urgent 9-1-1 call, include breathing difficulty, loss of consciousness and low blood pressure. All of these can be fatal.

The allergen triggering anaphylaxis can vary for each allergic person. However, some of the more common causes of anaphylaxis include:

  • Foods – Any food can cause an allergic reaction, but the foods that cause the most cases of anaphylaxis are peanuts, tree nuts (such as walnuts, cashews and almonds), shellfish, fish, milk and eggs.
  • Medications – Any medication can cause an allergic reaction. However, common medications that cause anaphylaxis are antibiotics and anti-seizure medications.
  • Stinging insects – Yellow jackets, honeybees, paper wasps, hornets and fire ants can inject venom during a sting causing a severe and even fatal reaction in some people.
  • Latex – Some products made from natural rubber contain latex allergens that can cause a severe allergic reaction in sensitive individuals.

Anaphylaxis is a medical emergency and immediate medical attention is necessary. The sooner the reaction is treated, the less severe it will become.

Those with a severe allergy may be prescribed epinephrine autoinjectors, which are shots of adrenaline that relieve breathing problems and improve heart rate and blood pressure. This medication should be carried at all times. Antihistamines such as diphenhydramine (Benadryl) may also be given for itching and hives. Oral steroids may be given to reduce further allergic inflammation.

Those with severe allergies should wear a medical alert bracelet or necklace that identifies the allergy in case of an anaphylactic reaction. Family, friends, employers, and school staff should be informed and educated about the allergy. This way, they will be able to recognize the problem and better assist if a reaction occurs.

Sources: AAAAI.org and ACAAI.org