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Month: December 2019

Eczema Exacerbations

patient with eczemaWhat are some of the causes?

As we enter into the season of colder days and nights in the Washington, DC metropolitan area, we are exposed to colder and drier air.  The cold and dry air in conjunction with lower humidity levels predispose individuals to flare-ups of eczematous skin conditions.

Layers of clothing during outdoor activities and returning to overheated homes can trigger a cycle of sweating, itching, scratching, and irritation.  Dry heat from our furnaces will evaporate the normal protective oils of one’s skin which may lead to cracking of the skin.

The smoke emitted by indoor fireplaces and wood burning stoves in combination with exposure to dust and dust mites may cause exacerbations of allergies, eczema, and asthma in individuals predisposed to these conditions.  Parched air can dry up the normal moisture in the mucus membranes leading to nose bleeds as well as a burning sensation in the eyes. 

The pile of wet leaves in people’s yards create a breeding ground for the molds to grow and their spores may trigger allergic rhinitis (i.e., hay fever), asthma, and eczema (i.e., atopic dermatitis) in sensitized individuals.  The wool in one’s sweaters can irritate sensitive skin and cause itching (i.e., pruritus) and rashes.

Other common triggers of eczema may include hot water, smoke, sweat, extreme temperatures, perfumes, colognes, cleaning solutions, scented laundry detergent, scented candles, scented soaps, scented shampoos, scented dryer sheets, fabric softeners, pets, molds, pollens, skin infections, stress, and certain foods in people with known food sensitivities.

What can be done in order to improve the situation?

Thorough and regular moisturizing of the skin with emollients (e.g., creams, ointments, lotions, gels) is the best protection against flare- ups of individuals with eczema.  Thick oil-based creams and/or ointments generally help protect the skin from excessive dryness better than water-based lotions. “Soak and seal” methods are efficacious in helping prevent the loss of moisture from the skin.

Direct exposures to sources of dry heat (e.g., radiant warmers) should be avoided.  If the HVAC system does not have a central humidifier, an ultrasonic water vaporizer in the bedrooms, especially during nights, will reduce excessive dryness of the mucus membranes and the skin.

Long, hot showers can strip the skin of its natural oils.  Shorter, lukewarm showers or baths are skin-friendly. Milder soaps, detergents, and shampoos without fragrances are kinder to the skin.

Woolen and synthetic clothes can irritate the skin and cause itching when they are in direct contact with skin.  Natural fabrics such as cotton and cashmere are less likely to cause flare-ups of itching and rashes while in direct contact with skin.

In spite of above measures, if eczema does flare-up, one may need to use medications in order to control eczema.  Below are a list of several medications used to treat eczema:

1.) In order to manage eczema, it is very common to use topical anti-inflammatory medications (e.g., topical corticosteroids) for a short period of time.

2.) The itching usually responds well to first generation antihistamine medications.

3.) Second generation antihistamines may also help and have the advantage of being generally non-sedating.

4.) Eucrisa (crisaborole) ointment 2% is a nonsteroidal cream that is quite efficacious in the treatment of eczema and has very few side effects.    The most common side effect is a mild burning or stinging sensation of the skin where the ointment is applied. Eucrisa ointment 2% is indicated in the treatment of eczema in children ages 2 years of age and older as well as in adults.

5.) Topical immunosuppresants are commonly used in both children and adults.  The two most common medications in this class include Protopic (tacrolimus) ointment and Elidel (pimecrolimus) ointment.  They are both fairly effective and are steroid-free. Protopic can be used in children 2 years of age and older as well as in adults.  Elidel is approved for children 3 months of age and older as well as for adults.

6.) Rarely, a short course of oral corticosteroids may be necessary during severe exacerbations of eczema, although the use of oral corticosteroids is generally avoided due to the potential side effects that corticosteroids can produce.

7.) If all else fails, there is a class of medications called “biologicals” that may be utilized and has been very effective in the treatment of eczema.  Dupixent (dupilumab) is currently the only biological that is FDA-approved to treat moderate-to severe-eczema. It is currently approved for adolescents (12 years of age and above) as well as for adults.  Of note, Dupixent also is approved for the treatment of asthma in patients 12 years of age and older, as well as in adults with chronic rhinosinusitis with nasal polyps (CRSwNP).

The board certified allergy specialists at Black & Kletz Allergy have expertise in diagnosing and treating eczema as well as other skin conditions [i.e., hives (urticaria), contact dermatitis, poison ivy].  We are board certified to treat both pediatric and adult patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than a half a century.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  For an appointment, please call our office directly or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from eczema or other skin-related disorder, we are here to help alleviate or hopefully end these unwanted symptoms that have been so bothersome, so that you can enjoy a better quality of life.  Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a friendly and professional environment.

Cat, Dog, and Other Pet Allergies

German Shepherd Dog and cat togetherTwenty percent of the U.S population have cat allergies and 10% of the population have dog allergies.  In the U.S., the most common pet are dogs, which are followed by cats as the second most common pet. Approximately 70% of homes having at least one pet.  This is a higher percentage of homes with pets than in the past as more and more families are acquiring pets. In addition to cats and dogs, some other common pets include birds (e.g., parakeets, parrots), fish, rabbits, rodents (e.g., guinea pigs, hamsters, gerbils, chinchillas, rats, mice) reptiles (e.g., snakes, lizards, turtles, geckos), hermit crabs, ferrets, horses, and spiders.  Horses normally do not live in people’s homes, but they may be rather allergenic. In recent years, there is a fad of owning miniature horses which in some cases do live in their owner’s house. This is probably not a good idea in general, but for those who are allergic to horses, it is especially unwise.

Allergies to pets are in fact really an allergy to the specific proteins that are produced by a particular pet.  In dogs, the major protein responsible for allergies to dogs is called “Can f 1.” This protein produced by dogs is most commonly found in the dog’s dander, saliva, and urine.  In cats, the major proteins associated with allergies are known as “Fel d 1” and “Fel d 4.” These two proteins are responsible for most of the suffering in individuals with cat allergies.  Similarly, most of the proteins that cause allergies in cats are concentrated in the sebaceous glands in the skin (i.e., dander), the saliva, and the urine. Unlike dogs, cat dander tends to “stick” to things such as walls, carpeting, clothing, bedding, etc. and is commonly transported from the home to home or home to work environments.  If the Fel d 1 protein is measured on a cat owner’s clothing, bedding, or upholstered furniture at work, it is likely that the protein will be found. In addition, it may take months for these proteins to dissipate and become undetectable, despite a thorough cleaning of the home, due the stick-to-itiveness of cat dander. Note that since the protein is also found in urine, cat litter boxes are a rich source of these proteins and allergic individuals should avoid exposure to litter boxes.  In dogs, fortunately the protein Can f 1 is not as “sticky” as the cat proteins, but still can adhere to walls, clothing, carpeting, bedding, etc. Interestingly, there is an increased incidence of horse allergy in some individuals that have cat and/or dog allergies due to a common protein that is shared between all three animals. In rodents, in addition to the allergenic protein being present in the urine, dander, and saliva, certain rodents such as mice contain allergenic proteins in their mouse droppings.

In addition to pet allergies, there are additional potential medical hazards to consider when owning certain pets.  Mice and rats carry many diseases such as the bubonic plague, Hantavirus pulmonary syndrome (HPS), leptospirosis, tularemia, rat bite fever (RBF), lymphocytic choriomeningitis, salmonellosis, and Lassa fever.  Exposure to birds can cause infections and diseases such as psittacosis, salmonellosis, allergic alveolitis, campylobacteriosis, avian flu, avian tuberculosis, Newcastle disease, cryptosporidiosis, and giardiasis.  Reptiles can irritate one’s skin. Snakes can cause life-threatening allergic reactions from the venom that is introduced from a snake bite.

As a general rule, if an individual is allergic to a specific pet, it is advisable not to own that pet.  Even though this seems pretty obvious, a majority of individuals still choose to either acquire a pet or keep an existing pet that they own despite that the pet causes unwanted allergy symptoms.  This is understandable, although not advisable, since a pet becomes a member of the family and often causes great happiness.

One myth to debunk is that there are “hypoallergenic” cats and dogs to get if one is allergic to such a pet.  While some pet-allergic individuals feel that they have reduced allergic symptoms around short-haired cats and/or dogs that do not shed (e.g., poodles), most scientific studies do not support this phenomena.

Obviously, the best way to combat pet allergies is to completely avoid them as mentioned above.  If this is not an option, one can take some measures to reduce their exposure to the allergens that cause pet allergies.  Brushing your cat or dog frequently and bathing your cat or dog often will help reduce the levels of cat and proteins. It is also advisable to prevent the pet from entering your bedroom.

The symptoms of pet allergies are similar to any other type of environmental allergy.  The symptoms may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy eyes, watery eyes, redness of the eyes, puffy eyes, headaches, sinus congestion, itchy skin (i.e., pruritus), hives (i.e., urticaria), wheezing, chest tightness, coughing, and/or shortness of breath.

The treatment of pet allergies begins with avoidance of the offending pet as previously mentioned.  Medications used for the management of pet allergies may include antihistamines, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, and/or asthma inhalers.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are very effective in treating pet allergies as they are also very efficacious in the management of dust mite, mold, and pollen allergies.  They work in 80-85% of patients with allergies and have been used in the U.S. for more than 100 years.

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both adults and children with pet allergies.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call our office or you can click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy has been serving the asthma and allergy needs of the DC metro area community for more than 50 years and we strive to offer high quality allergy and asthma care in a compassionate professional environment.