Patient Education

These printable handouts are for educational purposes only. They are not substitutes for consultation with your doctor. We strongly recommend that you consult with your doctor before implementing any of the suggestions in these handouts. Clicking on some of the links below will take you to outside web sites. We will be adding new information in the future; Please visit us periodically to learn more.

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Allergy & Immunology Articles by Dr. Asokan

Dr. Asokan writes allergy and immunology articles in Kingman Daily Miner Newspaper at biweekly intervals. They are published under Health & Fitness section. Please read them.

Allergy Injections

In this article, we will look at specific Allergen Immunotherapy (SIT), commonly known as allergy injections as a choice of treatment for allergy sufferers. Leonard Noon, a British doctor, introduced allergen immunotherapy in 1911. His student, John Freedman, popularized the idea subsequently. Now, this is practiced all over the world, and millions of adults and children have benefited from it. It is a time-tested and proven tactics for allergy sufferers!

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Allergic Rhinitis

Allergies, including allergic rhinitis, affect an estimated 40 to 50 million people in the United States. Some allergies may interfere with day-to-day activities or lessen the quality of life.

The allergist-immunologist, with his or her specialized training and expertise in managing allergies, allergic rhinitis, and asthma, can develop a treatment plan for your individual condition. The goal will be to enable you to lead a life that is as normal and symptom-free as possible.

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Allergies a Rite of Spring Part 1

Finally, spring is here! Do you or your loved ones suffer from significant nasal allergies- also known as hay fever? Does it affect the quality of your life, sleep, work or education? Do you suffer from recurrent sinus infections or asthma that is allergy induced? Do you spend hundreds of dollars every year treating allergies or its complications? Then read on! Help is available!

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Allergies a Rite of Spring Part 2

In the last article, we learned about triggers and testing for allergic rhinitis and animal dander and dust mite avoidance measures. In this article, we will explore pollen avoidance measures.

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Allergies a Rite of Spring Part 3

In the last two articles, we explored various triggers for allergic rhinitis and how to avoid them. In this article, we will look at different treatment modalities that are available to treat nasal allergies.
Histamine is your enemy, but antihistamines may not be your friend!

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Fall Allergy

Fall is approaching. About 20-30% of people suffer from allergic rhinitis also known as hay fever. If you are one of them, please read on! There is evidence that allergic diseases are on the rise globally. Exact reasons for this are not clear. Allergic rhinitis can have a significant impact on the quality of your life in addition to placing an enormous economic burden on the society due to treatment costs and missed days of work.

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Finally Spring Is Here! Help is Around the Corner

Finally, spring is here, and there is magic in the air! You see bright colored flowers and green vegetation that tempt you to spend most of your time outdoors— gardening, playing sports, or hiking. However, be careful if you happen to be one of the millions of people who suffer from allergies! Individuals with allergies can encounter many problems during springtime activities.

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Get A Handle On Your Allergies

Spring is approaching. About 20-30% of people suffer from allergic rhinitis also known as hay fever. If you are one of them, please read on! There is evidence that allergic diseases are on the rise globally. Exact reasons for this are not clear. Allergic rhinitis can have a significant impact on the quality of your life in addition to placing an enormous economic burden on the society due to treatment costs and missed days of work.

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Lets Fight The Allergy Epidemic Together

Allergic diseases result from the interaction between genes and environment. You inherit allergic genes from your parents. A child has 25% chance of developing allergies if one parent has allergies or asthma and 50-60% chance if both parents have them. Genes by themselves can not cause allergies or asthma. Exposure to allergy-causing substances (allergens) is required before allergies develop.

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Mold Allergy

Molds (also known as fungi) can cause serious health problems. Molds make spores reproduce. The spores get in the air. On inhaling them, allergy-prone individuals develop symptoms of allergic rhinitis, sinusitis, and asthma. Molds also make toxic substances. Inhaling the toxic substances may cause serious health concerns.

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Medications to Stop Before Allergy Skin Test

Antihistamines including prescription and over the counter ones will negatively affect the outcome of skin tests. These medications have to be stopped as outlined below before you show up for a skin test appointment. As the skin tests are usually done on the same day as your first visit to our office, it is important that you consider the information below before scheduling an appointment.

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Spring is Here! Help Around the Corner

Finally, spring is here, and there is magic in the air! You see bright colored flowers and green vegetation that tempt you to spend most of your time outdoors— gardening, playing sports, or hiking. However, be careful if you happen to be one of the millions of people who suffer from allergies! Individuals with allergies can encounter many problems during springtime activities.

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Preventing Development of Allergy in Children

Allergic diseases are on the rise worldwide. Reasons for this epidemic are not clear. Several intervention studies to examine the effects of indoor allergen elimination on the incidence of asthma are underway in children followed prospectively from birth. The results will have a substantial impact on public health policies because they will discover whether considering indoor allergen elimination as an important element of primary prevention of various allergic diseases is meaningful.

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Rhinitis and asthma could harm your sleep

Sleep disorders are common. It is estimated that 20 million Americans (1 in 15) are affected by sleep apnea. Good sleep is essential for our physical and emotional well-being. Lack of satisfactory and enough quality sleep could lead to fatigue, headaches, poor concentration and daytime sleepiness. This could also result in impairment of work and learning. Sleep-disordered breathing is associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, diabetes, and sleep deprived driving accidents. This also translates into 23 billion in health care costs a year. Sleep apnea is more prevalent in men who are also obese.

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Lack of Smell and Taste

Inability to smell or taste food is a great misfortune. Both smell and taste are important for savoring food. Remember the last time when you had a bad cold, how miserable you felt because of not being able to taste or smell food. Inability to taste food could cause anxiety, depression and even nutritional shortages because of reduced food intake. Being unable to smell could also place your life at risk by being not able to smell smoke in a fire or gas leaks. You can develop food poisoning by eating spoiled food if you are unable to detect it. The medical name for lessened capacity to smell is hyposmia and for the absence of smell is anosmia. According to one report, 2.7 million Americans have problems with their sense of smell.

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Saline Nasal Irrigation

Saline nasal irrigation with an NETI pot is an age-old and time-tested technique used by millions of practitioners of Yoga over thousands of years in India. Its popularity is increasing all over the world in recent years. Many published articles in the recent medical literature confirm its many benefits. A recent survey among doctors in family practice in Wisconsin stated that 87% of the survey participants approved the use of saline nasal irrigation as an ancillary treatment for various upper respiratory diseases.

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Allergic Conjunctivitis

The conjunctiva is the outer lining of eyeballs. When it is red and inflamed, it is known as conjunctivitis. There are many reasons for conjunctivitis. Pink or red eye is often caused by viral and other infections. Usually, it starts in one eye and subsequently spreads to the opposite eye. It is characterized by redness, pain, difficulty seeing bright lights, sticky and crusty secretions and sometimes by the development of visual difficulties.

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Sinusitis is an inflammation of the skin that lines paranasal sinuses. The paranasal sinuses are pairs of hollow cavities in the skull that are of varying shapes and sizes. They are located around the nose and communicate with the nose through tiny openings. There are four pairs of sinuses: Maxillary, ethmoid, frontal and sphenoid. They are lined by cells that bear fine, hairlike cilia and by mucus-secreting goblet cells. The cilia by beating in a wave-like motion propel the mucus towards the openings of sinuses and into the nasal cavity.

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Nasal Polyps

If you have constant symptoms of nasal stuffiness, runny nose, sneezing, reduced sense of smell and taste; it could signify the presence of nasal polyps and not just allergies. While it is considered an uncommon condition, as many as 4% of adults may suffer from nasal polyps.

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Asthma is common and places a tremendous economic burden on society. Its prevalence is increasing worldwide. About 22 million Americans suffer from asthma. Collectively, people who have asthma have more than 497,000 hospitalizations annually. In the year 2002 alone, 4,261 people died of asthma.

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Exercise And Asthma

For the Stone Age man, physical activity needed for hunting and escaping from wild animals was of paramount importance for daily survival. As the ancient man settled along river banks and raised colonies of people and before the advent of machines, physical exercise was still required for agriculture, farming and raising cattle. With further progress in civilization, physical activity was emphasized in dance and music, sports, military tactics and training and martial arts. With the advent of machines and division of labor, for the first time physical exercise became an option rather than a necessity.

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Childhood Asthma

Asthma is the most common serious chronic disease of childhood, affecting nearly five million children in the United States. Characterized by coughing, chest tightness, shortness of breath and wheezing, asthma is the cause of almost three million physician visits and 200,000 hospitalizations each year. In infants and children, asthma may appear as a cough, rapid or noisy breathing in and out, or chest congestion, without the other symptoms seen in adults.

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Vocal Cord Dysfunction (VCD) Could Masquerade As Asthma

Apparently the “asthma attacks” come without warning. During these episodes his throat
constricts, and he has difficulty breathing, swallowing and talking. He becomes hoarse
temporarily. The attacks last for minutes and resolve on their own. The albuterol that
has helped before to relieve his asthma symptoms does not seem to be as effective
nowadays. There are times when he gets several of these episodes in a day, and there are times when weeks go by without these “attacks”.

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How to Use a Peak Flow Meter

Find Your Personal Best Peak Flow Number

Your personal best peak flow number is the highest peak flow number you can achieve over a 2-week period when your asthma is under good control. Good control is when you feel good and do not have any asthma symptoms.

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A spacer is a cylinder shaped tube that hooks onto a metered dose inhaler. Unless you use your inhaler in exactly the right way, much of the medication may end up on your tongue, at the back of your throat, or in the air. Use of an or holding chamber (or spacer device) can help this problem.The inhaler "puff" consists of particles made up of medication and propellant. These particles are relatively large at first and are readily deposited on the tongue and back of the throat. The Spacer Device allows the propellant to evaporate, leaving smaller particles of medication behind. When you breath in through the Spacer, these smaller particles stay suspended in the air longer. This allows more of these particles to travel deeply into the smallest airways.

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Chronic Cough

Coughing occasionally is not harmful!

All of us cough for few days following upper respiratory infections, bronchitis or exposure to irritants such as smoke, paint, perfumes, etc.. In such cases a cough is transient and is not harmful. Have you ever wondered what makes us cough? A cough is a built in reflex to protect airways from foreign bodies and excess mucus build up. The cough reflex starts following irritation of nerve endings in the throat, voice box or bronchial tubes. The nerve endings transmit the irritation to the brain. The brain sends a counter impulse that makes the chest muscles and diaphragm (the muscle that partitions chest from the stomach) contract forcefully against closed vocal cords. When the pressure is built up sufficiently, the vocal cords relax and open suddenly, resulting in the explosive release of increased pressure. This clears the airways of mucus and foreign body that caused the irritation in the first place.

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NIOX MINO®- a boon for patients with asthma

Asthma is a reversible airway obstruction in the lungs. According to one report, between 1993 and 1995 it caused 174 deaths, 164000 hospitalizations, 570000 ER visits, over 3 million physician visits and required over 8 million prescriptions written for it. It also doubled in prevalence from 8.5 million total affected people in 1980 to 17 million in 1998. Obviously it is a common and significant health problem faced by individuals around the world.

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Gastroesophageal Reflux Disease (GERD)

About 19 million Americans suffer from gastroesophageal reflux disease (GERD), also known as GERD or acid reflux disease. In many it could be silent, and the patient may not be aware of the problem unless treated or tested. In this article, we will see how GERD could cause respiratory symptoms such as a chronic cough, persistent hoarseness, and laryngeal spasm and make preexisting asthma worse. During human development before birth, both lungs and esophagus and stomach develop from a common primordial tube. Therefore, it is not surprising that one can influence the other significantly.

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The unusual symptoms of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is common. At least 20% of respondents in one survey reported heartburn weekly. Of this 10% have endoscopic evidence of esophagitis (inflamed esophagus from acid erosion) according to another estimate. It is estimated that GERD accounts for more than 1.8 million outpatient office visits a year in the USA. It accounts for nearly $10 billion in annual costs for diagnosis and treatment. It also undermines the quality of life more than arthritis, myocardial infarction, heart failure and hypertension.

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General skin care

Hydration of the skin is paramount in keeping the integrity of the skin. A dry skin results in itching and scratching leading to the formation of rash and secondary skin infection which in turn can aggravate the skin symptoms. Therefore, the following measures are recommended Short, tepid showers for 10 minutes once or twice daily are recommended. Prolonged baths, especially bubble baths are discouraged as they may cause irritation and further drying of the skin. After the shower, the skin should be pat-dried gently using a soft towel and not rubbed vigorously.

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Uncontrolled eczema could impair the quality of your life!

What is it?

Atopic dermatitis (AD), also known as eczema is a chronic inflammatory condition of the skin. As part of the atopic spectrum, it is related to asthma and allergic rhinitis. In the majority of cases, it has its onset under the age of one although it may occur for the first time at any age. The affected skin gets dry, itchy, red, weepy, and crusty.

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Contact Dermatitis

A typical scenario: John cuts his hand accidentally while doing household work. After cleaning the wound with hydrogen peroxide, he applies a triple antibiotic cream and covers the cut with a band-aid. Three days later the wound looks worse. Thinking it is infected, he does more of the same once more. A week later he ends up with his doctor who diagnoses contact dermatitis due to hydrogen peroxide (an irritant) or neomycin (in the triple antibiotic cream) or adhesive in the band-aid (both neomycin and glue in the adhesive are potential allergy-causing substances). Does it sound familiar? If yes, please read on.

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Urticaria and Angioedema

What are hives?
Hives are small to large, red and itchy skin bumps. They are caused by liberation of histamine and other chemicals from diverse cells in the skin. When a similar process affects deeper layers of the skin, a diffuse swelling- angioedema occurs. Hives can occur anywhere from head to foot. Angioedema typically occurs wherever there are loose layers of skin- eyelids, lips, face, tongue, throat, intestines, genitals or hands and feet. In patients who develop hives or angioedema, about 40% have hives only, 50% have both, and 10% have angioedema only. Similar triggers cause both hives and angioedema.

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Food Allergy

Food allergy is a common and serious health problem. It is estimated that 8% of children and 2% of adults suffer from food allergy in this country. An estimated 400 people die every year due to food allergy

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OAS Could be a Sign of Underlying Pollen Allergy

Oral Allergy Syndrome (OAS) is a condition where people who are highly allergic to pollens develop symptoms of itching, swelling and hives involving lips, mouth, tongue and throat when they eat fresh fruits or vegetables. In the majority of such patients, the symptoms are confined to mouth and throat. However in 3% of patients, the symptoms could be more generalized resembling a systemic allergic reaction (anaphylaxis). Therefore, some doctors would like to call this condition, Pollen Food Syndrome. This term, according to them better explains the real nature of the problem.

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Think before you eat that shrimp!

Tom has significant allergic asthma for many years. He takes three different asthma medications daily. He and his wife invited several of their friends to a local restaurant to celebrate Tom’s 50th birthday. Shrimp, salad with lettuce and wine were served. Soon after the dinner Tom experienced an acute exacerbation of asthma. He used his rescue inhaler (albuterol) with no relief. He was rushed to a local hospital, received appropriate treatment and made a complete recovery. The ER physician who treated Tom advised him to avoid eating foods rich in sulfites in future.

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Food Additive Allergy

Many food and drug additives are used in the United States. As of this writing, 2922 food additives and 773 drug additives are officially allowed by the FDA. The food additives serve many functions including nutritive, coloring, flavoring and antimicrobial functions, and some of the additives serve more than one purpose. Similarly, the drug additives are used as coloring, flavoring, emulsifier or thickener agents, binding agents, and preservatives. Although many additives may be utilized in a given food or drug, usually the amount is tiny with few exceptions (example sugar). Virtually all intentionally added ingredients must be declared in the ingredient statement according to US regulation. The ingredient statement lists all of the ingredients in the composite food product in descending order of predominance. However, a few groups of elements are allowed to be declared collectively without a listing of all of the individual components; examples would include spices, natural flavors, and artificial flavors.

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MSG Allergy: Fact or Myth?

MSG is the sodium salt of glutamic acid (one of the most common amino acids in proteins). It is a popular flavor enhancer that is added to many foods. However, it is important to remember that being a common amino acid, it also occurs naturally in almost all foods. Reports of MSG sensitivity have existed for many years in this country. It is curious to know that MSG sensitivity has not been reported by food regulatory agencies in other parts of the world beyond the United States, where MSG is more commonly consumed in the diet.

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Latex Allergy

Scenario 1: Mark is a six-year-old who has hemophilia (a rare genetically acquired bleeding disorder) since birth. He has been getting monthly infusions of factor 8 replacement therapy through a vein at his local health care facility without any problem. However during the last two infusions Mark developed generalized hives, itching, swelling of lips and eyelids and slight difficulty breathing. The injections were stopped immediately, and he was treated successfully with several allergy medications. Mark is referred to an allergist to rule out allergy to factor 8. Surprisingly, the evaluation shows that Mark is allergic to latex (in the gloves worn by nurses) and not to factor 8! Nowadays Mark gets the factor 8 infusions in latex-free environments without any difficulty.

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Medication Allergy Simplified

Adverse reactions to medications are common. They are divided into predictable adverse reactions, which account for more than 75% of medication adverse effects and unpredictable adverse reactions that account for the rest. Anticipated adverse reactions are understood based on known pharmacological properties of drugs and can potentially be avoided by reading medication literature carefully. Examples of predictable adverse reactions include Overdose (liver failure from taking too much Tylenol or NSAIDs), Side effects (sedation from Benadryl or palpitations and insomnia from Sudafed), Secondary or indirect effects (yeast infections from using antibiotics) and Medication interactions (simultaneous use of erythromycin and theophylline or digoxin make blood levels of the later go up).

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Aspirin and NSAID's May Not Be Safe for Everyone

Aspirin and NSAIDs can cause both antibodies (IgE) mediated actual allergic reactions and non-antibody mediated pseudoallergic reactions. In IgE-mediated reactions, a specific IgE antibody directed against NSAID (ibuprofen for example) is formed following initial exposure to the medication. This is called sensitization. The following sensitization, subsequent exposure to the same drug could result in an actual allergic reaction consisting of hives, swelling of lips, eyes, tongue and throat, respiratory difficulties, low blood pressure and even death. Real IgE-mediated allergy to NSAIDs is rare, and usually there will be a history of prior exposure to the drug in question in such patients. The allergy is also often specific for the medication in question, and other forms of NSAIDs are tolerated well.

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Penicillin Allergy

Discovery of penicillin

Sir Alexander Fleming discovered penicillin in 1928. Fleming was a Scottish bacteriologist involved in the study of bacteria. For research and diagnostic purposes, he grew Staphylococcus (a gram-positive bacterium) in Petri dishes containing a solid medium with nutrients to support the growth of bacteria. One day Fleming noted there were no bacteria growing in a Petri dish that was next to a window and exposed to the elements. He also found that a mold called Penicillium was growing in the Petri dish instead of the bacteria. He rightly decided the mold Penicillium somehow be preventing the growth of Staphylococcal bacteria. Later he proved the mold was making a substance, which he named penicillin that was inhibiting the growth of bacteria. For this discovery, he gained a Nobel Prize in Medicine in 1945. In 1999, Time magazine named Fleming one of the hundred most important people of the twentieth century who changed the course of history.

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Take the sting out of bee stings!

Summer is not far away! Stinging insects are more active during summer and early fall. Know their habitat and follow the guidelines given here to avoid stings. Honeybees, bumblebees, wasps, yellow jackets, hornets and fire ants belong to Hymenoptera family of stinging insects. Honeybees are found near orchards. Yellow jacket nests are found on the ground typically around garbage. Hornets and wasps are found in bushes, trees, windowsills, and roofs. Fire ants build their mounds in the field and are very difficult to eradicate. When their habitat is disturbed, these insects sting their victims and inject venom. This is different from mosquitoes, fleas, etc. which bite their victims. About 2 million Americans are allergic to stinging insects. More than 500,000 people enter hospital emergency rooms every year to receive care for insect stings. About 40 people die annually because of allergic reactions to stings.

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What is Anaphylaxis?

Anaphylaxis is a severe allergic reaction - the end of the allergic spectrum. The whole body is affected, usually within minutes of exposure to the allergen but sometimes after hours. Causes include food, insect stings and drugs.

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Exercise-Induced Anaphylaxis

In the last article, we understood that exercise could make asthma worse in some persons. In this article, we will see how exercise could be associated with hives and anaphylaxis. Anaphylaxis is an extreme allergic reaction affecting the whole body. Exercise-induced anaphylaxis was first described in some accomplished athletes. The following exercise, some of these athletes experienced full body itching, hives, swelling, wheezing and drop in blood pressure. To make it more confusing, these athletes did not experience anaphylaxis every time they exercised. Most of these people were highly allergic to environmental allergens such as pollen. However, exercising indoors did not prevent these reactions from happening. It is clear that exercise is associated with the release of histamine from mast cells in the body where it is typically stored. How exercise makes, the release of histamine possible is not clear. It is not due to increasing body heat during exercise.

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Anaphylaxis and how EpiPen contributes to overcoming it EpiPen is used to treat anaphylaxis. Anaphylaxis is an acute systemic allergic reaction that could potentially result in death. The symptoms of anaphylaxis include itching, flushing, hives and angioedema, cough, wheezing, difficulty breathing and tightness in the chest, swelling and tightness in the throat, nausea, vomiting, abdominal pain or cramps and diarrhea and low blood pressure which results in dizziness or fainting. It is not necessary for a patient to experience all symptoms during an allergic reaction.

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The following are downloadable published articles:

Are You Tired of Coughing? (PDF) Immunodeficiency Diseases - Part 1 (PDF)
Do You Have Asthma? (PDF) Immunodeficiency Diseases - Part 2 (PDF)
Do You Suffer From Hives? (PDF) Immunodeficiency Diseases - Part 3 (PDF)
IgA Deficiency (PDF) Swine Flu (PDF)
Immune Deficiency (PDF) Pneumococcal Vaccine (PDF)
Shingles Vaccine (PDF)  


Educational Materials

Allergy and asthma medications Nasal Sprays (PDF)
Allergy control measures

Keep your bedrooms dust free
Mold proof your home

Allergy injections Allergy Injections (PDF)
Allergy tests

Allergy skin tests (PDF)
Patch tests (PDF)
Pulmonary function tests (PDF)

Atopic Dermatitis (Eczema) Atopic Dermatitis (PDF)
General Topics  
Know your allergenic plants
Primary Immunodeficiency

Primary Immunodeficiency diseases: (External Links)


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