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Month: January 2020

Unusual and Uncommon Allergies

Most everyone is aware of the classic and common allergies that many individuals suffer from routinely.  Allergies to dust mites, molds, pollens, pets, and/or cockroaches usually manifest themselves as symptoms of allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), and/or asthma.  Food allergies are not uncommon and it commonly known that the most common food allergens are milk, egg, soy, wheat, peanuts, tree nuts, fish, and shellfish.  When people think of allergies of the skin, they often think of atopic dermatitis (i.e., eczema), allergic contact dermatitis (i.e., poison ivy, poison oak, poison sumac, cosmetic allergy), and hives (i.e., urticaria).  All of these allergies are relatively common but there are a number of allergies that are uncommon and/or unusual that are very interesting.  It is some of these more unusual and uncommon allergies that we will explore in the following paragraphs.

Uncommon Food Allergies:

  • Oral Allergy Syndrome (Pollen Fruit Syndrome; Pollen/Food-Associated Syndrome):  An allergic reaction in the mouth usually causing itching that occurs in certain allergic individuals that have certain pollen allergies. Classic examples include birch tree allergies and reactions to raw apples, kiwi, apricots, cherries, peaches, plums, pears, avocados, celery, and/or carrots.  Ragweed allergies and reactions to melons, cucumbers, zucchini and bananas.  In this disorder, the raw fruit or vegetable looks similar structurally to the pollen and the body “thinks” that the food is the pollen and an allergic reaction (e.g., itchy mouth) occurs.  Interestingly, if the food is cooked and or processed, the individual can usually tolerate the food without any symptoms.
  • Mammalian Meat Allergy:  Some individuals that are bitten by a Lone Star tick may develop a meat allergy due to the development of an antibody to a carbohydrate called galactose-alpha-1,3-galactose (i.e., alpha-gal).  This carbohydrate is found on all mammalian meat (e.g., beef, pork, lamb, venison, whale). When an individual with the alpha-gal antibody eats any mammalian meat, the meat triggers the release of the chemical called histamine.  It is the histamine that causes the allergic symptoms which usually appear 4-8 hours after the consumption of the meat. Symptoms may include generalized itching (i.e., pruritus), hives, and/or swelling (i.e., angioedema).
  • Chamomile Tea:  Chamomile is related to ragweed and some ragweed-sensitive individuals may also react to chamomile tea and chamomile lotions.  Symptoms can range from allergic rhinitis symptoms to anaphylactic shock, although it is rare to have such a violent reaction.
  • Gelatin Allergy:  Some individuals are allergic to gelatin; however, this allergy is rare.  Gelatin is a protein formed when connective tissue from animals is boiled.  Some individuals are allergic to this protein and when exposed, they can have an allergic reaction that may also be quite severe.  Gelatin may be found in chewy candies, frosted cereals, and in some vaccinations such as the flu shot.
  • Wine:  Certain individuals are hypersensitive to sulfating agents used in processing certain foods, beverages, and drugs.  Sulfur dioxide and several forms of inorganic sulfites that release sulfur dioxide when used as food ingredients are known collectively as sulfating agents.  The preservative sulfite is used in the production of wine and other foods. Some individuals, especially asthmatics, are sensitive to sulfites and should avoid certain foods that may contain sulfites such as sauces, gravies, soups, wine vinegar, processed meats, dried/frozen/canned fruits and vegetables, and occasionally salad bars.
  • Hot Dogs and Deli Meats:  Hot dogs and various deli meats are highly processed foods that contain many additives.  An allergic reaction after eating these meats could be due to any of these added ingredients.  It is believed however that nitrate and nitrite additives are generally the cause in most instances.
  • Water:  Yes, individuals can be allergic to water.  It is quite rare, however, there are some individuals who have a condition called aquagenic urticaria.  If one has this malady, the contact with water will cause itching and hives. There is no optimum treatment for this disorder at the present time

Uncommon Non-Food Allergies:

  • Latex Allergy:  Latex or natural rubber allergies can range from a mild irritation of the skin to a severe anaphylactic reaction.  Common latex products include latex gloves, condoms, dental dams, adhesive bandages, balloons, waistbands, tires, and pacifiers, to name a few.  It is interesting to note that there are similar proteins in natural rubber latex and certain foods (e.g., avocados, chestnuts, papaya, bananas, kiwis), so cross-reactivity can occur.
  • Sex:  There are individuals that have a disorder called seminal fluid hypersensitivity whereby they are allergic to the seminal fluid of a particular person.  It is generally an allergy to a specific man’s seminal fluid and not necessarily to all men. The symptoms can range from just a minor irritation on the skin, to hives, to anaphylaxis.  Symptoms can be avoided with the use of condoms. Many times, in vitro fertilization is needed in order for the couple to conceive without risk to the allergic individual.
  • Sunlight:  A small percentage of the population have a sensitivity to sunlight where they may develop hives, itchy skin, rash, nausea, and/or headache.  Solar urticaria is a condition where hives form upon exposure to sunlight.
  • Exercise:  Exercise may trigger a generalized itching, hives, swelling, asthma, and/or anaphylaxis, depending on the person.  These conditions are called, exercise-induced pruritus, exercise-induced urticaria, exercise-induced angioedema, exercise-induced asthma, and exercise-induced anaphylaxis respectively.  In some instances, an individual must exercise in the cold air for symptoms to occur. In others, a specific food must be eaten a few hours before exercise in order for there to be an allergic reaction.  This is called food-dependent-exercise-induced urticaria. An example of this is a person who can eat celery without problems and they can exercise without problems. However, if they eat celery within 2 hours before exercise, they will develop hives.  Patients with these conditions should never exercise alone and if they exercise, should always stop exercising at the first sign or symptom of their allergy.
  • Cold:  Cold can be a trigger for some individuals to develop generalized itching, hives, swelling, asthma, and/or anaphylaxis.  The names of the corresponding conditions are cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, cold-induced asthma, and cold-induced anaphylaxis respectively.  Similar to exercise above, these patients should avoid the cold, if possible.
  • Money:  Individual with nickel allergy may develop allergic contact dermatitis from handling coins.  Metal allergy is not that uncommon, but having reactions to holding coins is fairly uncommon.  Obviously, the condition is more prevalent in individuals who handle money more often such as bank tellers and cashiers.
  • Scratches:  Some individuals have a disorder called dermatographism where a simple scratch or pressure on the skin will cause the affected area to develop hives in a linear pattern to match the scratch.  The name dermatographism means “skin writing” so it is possible to write a word on the individuals’ skin just by writing the word using a fingernail on the skin. Approximately 5 minutes later, the word is visible in a reddish and raised fashion.

There are more uncommon allergies than mentioned above, but the ones listed above give some indication of the diversity of unusual allergies.  Individuals can be allergic to almost anything. It is a combination of the patient’s awareness of their symptoms and situation in conjunction with the allergist’s knowledge that is needed in order to diagnose and then prevent and/or treat such unusual allergies.

The board certified allergists at Black & Kletz Allergy have 3 office locations in the Washington, Northern Virginia, and Maryland metropolitan area.  The allergy doctors at Black & Kletz Allergy treat both pediatric and adult patients.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  The McLean office has 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 or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy have been helping patients with hay fever, asthma, sinus disease, eczema, hives, insect sting allergies, immunological disorders, medication allergies, and food allergies for more than 50 years.  If you suffer from any allergy, whether unusual or not, it is our mission to improve your quality of life by reducing or preventing your undesirable and annoying allergy symptoms.

Keratoconjunctivitis and Eye Allergies

Keratoconjunctivitis is term used to describe inflammation of the cornea and conjunctiva.  Keratitis specifically is the inflammation of the cornea (i.e., the transparent dome that covers the pupil and the iris of the eye). Conjunctivitis, on the other hand, is the inflammation of the conjunctiva [i.e., the thin membrane covering the sclera (i.e., the white of the eye) as well as the lining of the inner part of the eyelids].  It is more commonly referred to as “pink eye.” Keratoconjunctivitis is one of the most common causes of red and irritated eyes as millions of individuals visit doctors for this condition every year.

Most of the cases of keratoconjunctivitis and conjunctivitis are due to allergies.  Conjunctivitis due to allergies is referred to as allergic conjunctivitis.  Infections are another common cause of keratoconjunctivitis and conjunctivitis with viruses accounting for most of the infections across all age groups.  Of note, conjunctivitis caused by bacteria is more common in children. Other infectious agents may include a parasite or a fungus. It should also be noted that an injury to the eye can inflame the cornea or conjunctiva without a secondary infection.

Types of Keratoconjunctivitis:

Keratoconjunctivitis sicca is also commonly known as dry eye syndrome.  Dry eye occurs when either the eye does not produce enough tears or when the tears evaporate too quickly.  It can also occur when there is an imbalance in the tear mixture.  Tears are comprised of water, fatty oils, and mucus. Individuals need the correct mixture of all three of these ingredients in order to properly nourish one’s eyes.  Some of the more common causes may include allergies, contact lens use, pregnancy, meibomian gland (i.e., glands in eyelids that excrete oil into the tears) dysfunction, and certain medications such as (e.g., antihistamines, some blood pressure medications, hormone replacement therapy, antidepressants).

Epidemic keratoconjunctivitis (EKC) is an eye infection caused by a specific virus called the human adenovirus.  It is also known as “adenoviral keratoconjunctivitis” or just “viral keratoconjunctivitis.”

The incubation period of EKC is long and it is very contagious.  It tends to spread quite easily especially when individuals are in close quarters (e.g., dormitories, hospitals, schools, arenas, movie theaters).

There’s no specific treatment for EKC.  Symptoms typically last a few weeks in duration before abating.  Adenoviruses may also target the digestive, respiratory, and genitourinary tracts.

Vernal keratoconjunctivitis (VKC) is a recurrent, chronic allergic inflammation of the eyes.  It generally results in small, round bumps known as giant papillae underneath the eyelid.  VKC generally affects the upper eyelids more than the lower eyelids. The symptoms are much more common in the Spring with the arrival of pollen, particularly tree and/or grass pollen.

The cause is thought to be an allergic disorder, but may also involve genetic and/or immune system disorders.  It is more common in tropical environments and is more common in boys than in girls.

Atopic keratoconjunctivitis (AKC) is a chronic inflammatory disease of the eye that usually affects patients with a history of atopic dermatitis (i.e., eczema).  Males are affected with AKC more often than females, and it is more likely to involve the lower eyelids more than the upper eyelids.

Symptoms characteristically worsen in the Winters.  Without treatment, AKC may lead to serious complications such as:

  • Ulceration
  • Keratoconus (i.e., thinning and bulging cornea)
  • Corneal vascularization (i.e., growth of new blood vessels into the cornea

Herpetic keratoconjunctivitis is an infection caused by the herpes simplex virus, particularly Type 1.  Touching one’s eyes after touching a cold sore may transfer the virus to the eyes.

Allergic keratoconjunctivitis refers to any keratoconjunctivitis caused by an allergen.  Vernal keratoconjunctivitis and atopic keratoconjunctivitis, for example, are included in this group.  The allergies can be seasonal or perennial in nature.

Symptoms of Keratoconjunctivitis:

Symptoms range from mild to severe.  The symptoms may vary depending on the cause.  Some symptoms associated with keratoconjunctivitis may include:

  • Redness
  • Itchiness/Burning
  • Puffy eyelids
  • Discharge from the eyes (i.e., watery eyes)
  • Stickiness of the eyes (i.e., eyes become “glued shut”)
  • Light sensitivity (i.e., photophobia)
  • Dryness
  • “Foreign body” sensation in the eyes
  • Blurry of vision (usually mild)

Diagnosis of Keratoconjunctivitis:

The diagnosis can be made based on the medical history, symptoms, and visual inspection of the eyes.  Depending on the initial findings, a physician may also want to examine:

  • Visual acuity
  • Under the eyelids
  • Ocular pressure
  • Pupillary reactions
  • Discharge of the eyes
  • Corneal sensation

In some cases, one may need to be tested for:

  • Allergens
  • Viruses
  • Autoimmune disorders
  • Genetic conditions

 

Treatment of Keratoconjunctivitis:

Treating the symptoms:

One may need a combination of therapies which may include:

  • Topical antihistamines or mast cell stabilizers
  • Preservative-free lubricating gels and ointments
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Topical corticosteroids

In cases of severe keratoconjunctivitis sicca, punctal plugs may be inserted to reduce the drainage of the tears into the nose. 

Treating the underlying condition(s):

Some viral infections, such as herpes, may require treatment with topical or oral antiviral medications.  Any underlying autoimmune or genetic conditions may also need specific treatments.

Black & Kletz Allergy has board certified allergists in 3 convenient locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area.  The allergists are trained and very familiar with allergic eye disorders such as mentioned above.  The allergy specialists at Black & Kletz Allergy diagnose and treat both adults and children.  We offer on-site parking in our Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA locations.  The Washington, DC and McLean, VA offices are Metro accessible and the McLean office has a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line.  If you are experiencing what appears to be allergy symptoms associated with your eyes, please call us to schedule an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been serving the needs of allergy and asthma sufferers in the Washington, DC metro area for more than 5 decades.