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Month: March 2020

What Can Be Done for Hives?

Hives (i.e., urticaria) are a fairly common occurrence which is usually very annoying to the individual who suffers from them. They are often called “welts” by the general public and “wheals” by allergists. Hives are itchy, red blotches on the skin that are usually raised. Some affected individuals may experience a burning sensation while others notice a stinging sensation. Hives, in some instances, may be flat and not raised. The size of an individual hive may range from very small to rather large. They can also coalesce with other hives to create giant “plaques” of hives. Hives can be various shapes and are usually not symmetrical. They often look like mosquito bites but without the actual bite. They can occur anywhere externally on the body (e.g., face, neck, extremities, back, abdomen) or be located internally (e.g., throat, intestines). When they are internal, symptoms such as swelling of the throat, abdominal pain, or diarrhea may ensue. When hives occur on the lips, tongue, eyes, or ears, it is not uncommon for the individual to notice only swelling of these body parts. This swelling is termed angioedema. Angioedema is essentially a hive that is in the deeper tissue layers. As a result, the lesion appears as a swelling, opposed to a hive. Either way, both are bothersome to the person who is afflicted with either or both of them.

Hives are basically grouped into two main categories, although there are actually more than two. The first category is referred to as acute urticaria. Acute urticaria is a condition where the hives occur for 6 weeks or less. If hives linger on and persist for more than 6 weeks, they are called chronic urticaria. Some cases of hives may last for months and even years in a small percentage of patients. Approximately 25% of the general population in the U.S. develop hives at some point in their lives. Each episode of hives generally last less than 24 hours in duration but may last for days or weeks in certain circumstances.

The diagnosis of hives begins with a comprehensive history and physical examination by a board certified allergist such as the allergists at Black & Kletz Allergy. The workup for hives will vary depending on what was discovered in the history and physical examination in conjunction with how long the hives have been present. For many individuals, a medication allergy is to blame. For others, a food may be the culprit. For those who present with chronic urticarial (i.e., hives that have persisted for more than 6 weeks), bloodwork is generally needed in order to rule out a multitude of diseases and conditions that are known to cause hives. Despite all of the bloodwork done on a patient with chronic urticaria, approximately 95% of these individuals will have normal test results. If the workup is completely negative, the term idiopathic chronic urticaria is used as a diagnosis. This basically is a fancy way of saying that no identifiable cause was discovered to cause the hives of that individual. Some of the conditions that are known to be associated with chronic urticaria include thyroid disorders, autoimmune disorders (e.g., systemic lupus erythematosus, Sjögren’s syndrome, rheumatoid arthritis), hepatitis B, other infections, cancers, complement disorders, and physical elements (e.g., heat, cold, pressure, exercise, vibration), to name a few.

The treatment of hives can range from avoidance to using medications. Antihistamines are usually the first line of defense of most cases of hives. Beta-2 agonists such as Pepcid (famotidine) are often utilized to enhance the effect of the antihistamine when an antihistamine alone is not enough to prevent hives. Leukotriene antagonists [e.g. Singulair (montelukast)] are often added to the regimen is difficult-to-treat hives. In recalcitrant disease, oral corticosteroids may be used to bring the hives under control for a short time since the use of long-term steroids is not ideal because of the risks and many side effects that may develop. Xolair (omalizumab) injections are used for idiopathic chronic urticaria in patients where other therapy is unsuccessful. Xolair injections Xolair are very effective in the management of chronic hives.

The board certified allergists at Black & Kletz Allergy have had more than 50 years of experience in diagnosing and treating asthma in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We treat both children and adults and have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at all of our office locations. The Washington, DC and McLean, VA offices are also Metro accessible. We offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call one of our offices or alternatively you may click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy are happy to help you diagnose and treat your asthma as well as any other allergy-related or immunological condition that you might have.

Latex Allergy

Allergic reactions on exposure to latex occur in approximately 1 to 3% of the general population in the United States.

Natural rubber latex comes from the sap of the rubber tree, Hevea brasiliensis. Allergic reactions to products made with latex develop in persons who become sensitized to proteins contained in natural rubber latex. “Synthetic latex” on the do not contain these proteins and do not cause reactions. Synthetic latex is often found in some paints and in some hand products.

There are over 40,000 products that contain natural rubber latex. Some of the common products that contain natural rubber latex which could trigger an allergic reaction in a sensitized individual on exposure include:

  • Elastic
  • Balloons
  • Condoms
  • Koosh Balls
  • Dental dams
  • Rubber bands
  • Latex gloves
  • Therapy bands
  • Bandage adhesives
  • Rubber accelerators
  • Red rubber catheters
  • Vial Stoppers, IV tubing, Stethoscopes
  • Baby bottles, nipples, pacifiers etc.

Latex allergy generally develops after repeated exposure to medical and/or consumer products containing natural rubber latex. Healthcare workers, spina bifida patients, workers with occupational exposure, and patients with multiple surgeries are at high risk for developing sensitivity to natural rubber.

Symptoms:

Latex allergy can cause two different type of allergic reactions:

  • Immediate hypersensitivity – A reaction which are mediated by the IgE antibody (i.e., Type I reaction). The symptoms may be mild initially but get progressively more severe with repeated exposures. Initial symptoms typically may include itching (i.e., pruritus), redness of the skin, hives (i.e., urticaria), itchy eyes, itchy throat, runny nose, and/or nasal congestion beginning within a few minutes after exposure to latex. It may lead to asthma symptoms such as chest tightness, coughing, wheezing, and/or shortness of breath. The more severe reactions are life-threatening episodes known as anaphylaxis, which involves multiple organ systems. Anaphylaxis may lead to low blood pressure, loss of consciousness, even be fatal.
  • Allergic contact dermatitis – A delayed type hypersensitivity allergic reaction mediated by T-lymphocytes (i.e., Type IV reaction). This type of reaction predominantly causing skin rashes. It is usually caused by certain chemicals used in the manufacturing process. The symptoms usually manifest a few days after exposure and can mimic poison ivy-like reactions causing blisters and eczema-like rashes.

Direct physical contact with latex products is not needed to trigger an allergic reaction. Inhalation of airborne latex particles can occur when latex proteins combine with the powder from products and form aerosolized particles that become airborne. These particles get into the eyes, nose, mouth, and/or lungs where the protein may be absorbed through these moist mucous membranes. Anaphylaxis and severe asthmatic reactions have been caused by inhaling latex proteins in the air resulting from the powder in the latex glove.

Cross Reactivity:
Up to 50% of patients sensitized to latex also can react adversely to certain foods on exposure. Bananas, avocados, and kiwis are the most common foods that cause allergic reactions in latex-sensitive individuals. Less commonly, latex-sensitive individuals may also react to potatoes, tomatoes, figs, and bell peppers.

Diagnosis:
Elevated levels of specific antibody to the latex protein in an individual’s serum (i.e., blood) in the context of the clinical presentation of sensitivity to rubber products, usually confirms the diagnosis of immediate hypersensitivity to latex. There is no FDA approved skin test antigen for latex allergy diagnosis at this time. Contact sensitivity to latex is primarily diagnosed based on the history of exposure and subsequent development of skin lesions.

Treatment:
As there is no desensitization available for latex allergy. Avoidance of exposure is the predominant modality of preventing allergic reactions. Patients with confirmed latex sensitivity should wear a medical bracelet indicating the condition. They should also carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) for use in case of anaphylactic reactions. It should be noted that if one is to use the self-injectable epinephrine device, that individual should go immediately to the closest emergency room for follow up.

Prevention:
Switching from latex gloves to powder-free low protein latex gloves and non-latex gloves in health care settings (e.g., medical offices, dental offices, hospitals) have dramatically reduced the incidence of severe reactions in the past several years. Awareness of all products possibly containing natural rubber and avoiding them is the only certain way of preventing serious reactions to latex.

The board certified allergists at Black and Kletz Allergy have over 5 decades of experience in diagnosing and treating allergic conditions including latex allergy.  We treat both adult and pediatric patients.  Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible. We offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call one of our offices or alternatively you may click Request an Appointment and we will respond within 24 hours by the next business day.  If you have or suspect a latex allergy or have other allergies, asthma, and/or immunological conditions, we would be delighted to help you as we have been serving the greater Washington, DC metropolitan area for many decades.