Allergy Resources

ECZEMA (ATOPIC DERMATITIS)

WHAT IS IT? Atopic dermatitis is a common skin disease frequently seen in allergic patients, especially young children. It usually begins in infancy and consists of itchy, red patches on the skin that may crust, scale or ooze. As many as 50% of patients may outgrow this disorder. In the very young it usually appears on the face, torso and legs. In childhood, the rash may affect the elbow and knee creases, neck, wrists, ankles and feet. In adolescence, the rash may be more prominent on the hands, feet and face. WHAT CAUSES ECZEMA? The exact cause is unknown; however, it tends to run in allergic families. The skin in people with eczema cannot hold onto water like normal skin. Allergies to common food and inhaled allergens can make eczema worse. It then becomes important to avoid foods that have been identified as playing a role, and good environmental control beginning as early as possible. HOW DO YOU TREAT IT? “Soaking and greasing” is very important. First, use only a milk soap such as Dove or no soap at all. Tepid water rather than hot water is recommended as hot water may cause itching. Use of bath oil such as Alpha Keri bath oil or cottonseed oil is good to soak in. Patients may bathe 1-2 times per day. After getting out of the bathtub, pat dry instead of rubbing dry. Immediately apply a moisturizer to lock in the water. Good brands are Vani Cream, Aveeno, CeraVe, Exederm, Lubriderm, or another cream that has been prescribed by your doctor. Soft cotton fabrics are recommended as some wool, silk, or polyesters may be scratchy and cause itching. Mild soaps and detergents should be used for washing clothes and fabric softeners should be avoided, as these can be irritating to the skin. Avoidance measures should be implemented when foods or inhaled allergens such as dust mite or pet dander have been identified. Foods which are suspected or have been proven through an elimination diet to aggravate the conditions are: dairy products, eggs, chocolate, tree nuts, peanuts, peanut butter, tomatoes, ketchup, and other tomato products, citrus fruits and juices. Oral antihistamines help reduce the itch associated with eczema. It can cause drowsiness but usually clears up after being on the medication for a few days. Apply topical steroids as directed by your physician. Antibiotics may be needed as infections can frequently occur with this disorder in all stages. These infections produce redness and itching and may cause crusting, oozing and ulcers.

What is a latex allergy? A latex allergy is an allergy to proteins found in products made with natural rubber latex. What is natural rubber latex? Natural rubber latex is a kind of rubber that is made from the sap of the rubber tree. Natural rubber latex is in many products, especially those used in the hospital. This information here is about natural rubber latex which will now be referenced as “latex”. Where is latex found? In the hospital, latex can be found in gloves, catheters, blood pressure cuffs and many other products. You will find latex in items such as:

• rubber balloons (shiny foil Mylar balloons are safe to use)
• some baby soothers, such as bottle nipples & pacifiers
• some Band-Aids
• some toys such as rubber balls
• condoms and diaphragms
• rubber cleaning gloves

Can a latex allergy be treated? There is no cure for a latex allergy. The best treatment is to avoid latex. Treatment is based on the symptoms or reaction you have after you are exposed to latex. Talk with your doctor about medication you can take to reduce allergy symptoms. What can I do to reduce my risks of a latex reaction?

• Remove all latex products from your environment. Replace these with non-latex products.
• Tell your doctors, dentist, pharmacist, and health care workers that you have a latex allergy before any treatments.
• Ask to have the first appointment of the day to reduce your risks. Latex particles can float around in the air.
• Talk to your employer about how you can work in a reduced latex environment. If you need help to explain this to your employer, talk with your doctor.
• You may need to avoid certain foods such as bananas, avocados, kiwi, and water chestnuts.
• When traveling where medical supplies are limited, it is best to carry your own non-latex gloves and supplies.

Are there different levels of reactions to latex? Yes, there are different levels of reactions with a latex allergy ranging from mild to severe. It is difficult to tell how severe a reaction will be after contact with latex. A severe reaction may occur even when you have had only a mild reaction in the past. Can my latex allergy get worse? Yes, it can get worse if you continue to be exposed to latex. Can a latex allergy be life threatening? Yes, some people may have severe reactions that are life threatening. A severe reaction to latex requires that you go to an emergency department or hospital. These symptoms can be:

• hives all over your body
• breathing problems such as wheezing, shortness of breath or a tight feeling in your chest.

If you have had a severe reaction or have tested highly sensitive, you will need to carry medication with you at all times. You also need to wear a medical alert bracelet. The alert bracelet should say: “Severe Allergy to Natural Rubber Latex” How do I get exposed to latex?             These are some of the ways you might be exposed to latex:

• by direct contact through broken skin or mucous membranes such as surgery or dental work, or blowing up a balloon
• during pelvic exams and pap smears when latex gloves are used
• having an enema when latex gloves or products are used
• using special catheters made from latex

Precautionary steps:

• Check with your pharmacist if any product you bought or consider buying in the drug store has latex in it.
• Talk with your surgeon before surgery about reducing your latex exposure in the operating room.

Am I at risk? You are at risk of an allergy if you have used or have been frequently exposed to products containing latex. This could be in your home, at your job, or in the hospital or dental office. Children with certain medical problems such as spina bifida have a higher risk for a latex allergy. Allergies to some foods may alert you that you may be allergic to latex. These foods are bananas, kiwi, water chestnuts and avocados. These foods may cause an itchy throat, throat swelling and/or diarrhea. If you have hay fever, asthma, or other allergies, you are more at risk of developing a latex allergy. How would I know if I am allergic to latex? Latex allergies often start with a rash, hives or swelling on the skin where latex has touched you. This could be on your hands if you were wearing gloves or swelling of your lips if you blew up a balloon. You may experience hay fever type symptoms such as itchy swollen eyes, runny nose and sneezing when exposed to latex. More severe reactions would be breathing problems such as coughing, wheezing, shortness of breath or a tight feeling in your chest when exposed to latex. You may have these symptoms after a dentist puts a gloved hand in your mouth.         What do I do if I think I might have a latex allergy? If you think you might have a latex allergy, talk with your nurse, doctor or health care worker. It is important to do this when you first come to the hospital/office. You will be asked more detailed questions about the types of products that affect you. To confirm whether you are allergic to latex, you will be given a blood test. Your doctor will then discuss the results of that test with you.

Natural rubber produced from the milky sap (latex) of the tree Hevea brasiliensis is a common component of numerous home products and medical supplies, including surgical gloves and catheters. While delayed reactions to latex–containing products are often traced to additives, immediate reactions are closely associated with protein components of the natural rubber latex materials. Allergies to latex and multiple fruits or vegetables have been recently documented to produce patterns of allergic cross-reactivity. While the details of the clinical relationship between latex and food allergies await further study, food allergies have been found to coexist with latex sensitivities for some people. There may be cross-reactivity between latex and the following food and inhalants: Degree of Association or Prevalence:

MOLD:

The public’s concern about indoor exposure to mold has increased as they become aware that exposure to mold can cause a variety of health effects and symptoms including allergic reactions.

MOLD FACTS:

Molds are ubiquitous and can cause a variety of health effects. They’re found both indoors and outdoors. Many molds spread by making lightweight spores that travel through air. Some molds make spores and release them regularly; others produce spores that are not dispersed until they are dry. Some molds produce mycotoxins.

INDOOR MOLD GROWTH:

Once a source of mold is present indoors, growth depends on several factors:

• Moisture is key for mold growth.
• Molds find nourishment from porous building materials, furnishings and dust.
• Most molds prefer temperatures between 40– 100 degrees Fahrenheit.
• Exterior air is the most common source of molds indoors.
• People and pets may also bring mold indoors.

 PREVENTING INDOOR MOLD PROBLEMS:

Controlling moisture in the environment may control indoor mold growth.

• Run the bathroom fan and/or open a window when bathing.
• Vent appliances that produce moisture like clothes dryers to the outside of the building.
• Do not carpet bathrooms.

Prevent condensation on horizontal surfaces, on walls and in walls by providing adequate ventilation.

• Cover cold surfaces, such as cold water pipes with insulation to prevent condensation.
• Move large objects away from the inside of exterior walls to provide for good air circulation.
• Clean and dry building materials within 24-48 hours if they become wet.
• Provide drainage and slope away from the building foundation to prevent water from collecting around the foundation.

Follow a regular maintenance schedule so that sources of water leaks or excess moisture can be fixed as soon as they occur.

• Vacuum and clean your home regularly
• Clean and repair roof gutters regularly

CAN MOLD AFFECT HEALTH?

Mold can affect the health of any individual. However, there are factors which increase the likelihood of illness:

• Age (infant, children and elderly)
• Pregnancy
• Allergy
• Asthma
• Chronic lung disease
• Immunosuppresion
• Smoking or exposure to environmental tobacco smoke.
• Exposure to chemicals or other volatiles in the environment.

 HEALTH AFFECTS CAUSED BY MOLD:

Health effects caused by mold may include:

• Irritation
• Allergies or immunological reactions:
  • Allergic rhinitis (runny nose).
  • Asthma- mold can increase asthma symptoms, or act as a trigger in people with mold allergies.
  • Hypersensitivity pneumonitis is an inflammatory disease of the lungs with flu-like symptoms. It may develop over time causing permanent lung damage.
  • Allergic Bronchopulmonary Mycosis occurs in severe asthmatics when certain molds such as Aspergillus grow in the respiratory tree.

Toxic effects – result from an exposure to certain toxin-producing species of mold. Toxins can be released when mold contaminated surfaces are disturbed or cleaned.

• Organic Dust Toxic Syndrome- often an occupational related illness characterized by respiratory distress following large exposure to small particles of dust containing mold spores.

Infections – certain molds are known to cause human disease.

• Pneumonia or worsening of chronic lung infections (such as cystic fibrosis.)
• Fungal lung disease due to occupational or recreational exposure to mold

 SEEKING MEDICAL ADVICE:

The health care provider may recommend:

• General physical exam
• Chest x-ray
• Pulmonary function test
• Allergy testing
• Serum mold antibody tests for IgE and IgG
• Lung biopsy, if needed

You may need to consult with a specialist in environmental, occupational or industrial medicine, or infectious disease, or pulmonary medicine.

 ENVIRONMENTAL ASSESSMENT:

The environmental assessment includes:

• Determining the source and extent of water intrusion.
• Determining the types of mold present.
• Obtaining recommendations for remediation by a qualified mold remediation contractor.

LIMITING EXPOSURE:

Can it be contained? If the mold growth is over a small area it can be covered with plastic and taped down until remediation can take place. If containment is not possible, relocate residents until remediation is completed and clearance has been given. Use accepted indoor air quality methods to prevent further contamination during:

• Environmental assessment
• Testing
• Remediation

During remediation, every effort should be made not to disturb moldy areas, which may result in further contamination. Workers should use personal protective equipment when cleaning up contamination. Remediation should not be carried out while occupants are present.

CONSIDERATION FOR RELOCATION:

When an area with mold cannot be contained and daily activities will result in exposure to mold, people most at risk for adverse health effects are STRONGLY advised to relocate until mold problem is remediated.

 REMEDIATION:

Recommendations for scope of remediation work and procedures should include:

1. Identifying and removing the source of moisture.
2. Determining the type of clean-up method.
3. Assuring workers on site have and wear personal protective equipment.
4. Erecting containment areas.
5. Relocating occupants during repair or remediation work.
6. Disposing of mold debris in regular landfill.
7. Determining suitability for re-occupancy.

 SUGGESTED HOUSING & BUILDING STANDARDS:

When faced with a home or building suspected of having indoor mold growth, the landlord or homeowner should:

• Find the source of moisture.
• Clean up and dry water damaged structures within 24 – 48 hours of event. Repair or replace damaged materials as needed.
• Contain areas with mold so that it will not be disturbed.
• Relocate residents until remediation is complete if moldy areas will be disturbed by daily activities.
• Relocate residents immediately if they are at high risk of adverse health effects due to mold exposure.
• Avoid worker or resident exposure to mold or mold containing dust during assessment, clean up and repair work.
• Submit a remediation action plan to building officials.
• Consult with an indoor air quality investigator or a qualified mold remediation contractor.

RESOURCES www.epa.gov   A Brief Guide to Mold, Moisture and Your Home; Mold Remediation in Schools and Commercial Buildings; Indoor Air Pollution: An Introduction for Health Professionals. www.atsdr.cdc.gov Case Study in Environmental Health: Taking an Exposure History, 6/2000.

SINUSITIS: This is a condition in which the air-filled spaces in the skull (sinuses) become inflamed. There are many possible causes of inflammation, such as a viral infection with or without secondary bacterial or fungal infection, allergy, and/or inhalant irritant exposure. Once the nasal lining and sinuses are inflamed, symptoms of nasal and sinus congestion may increase significantly when there is exposure to non-specific factors such as: temperature change, barometric pressure change (especially air travel), odor exposure, hormonal change and emotional stress. Viral upper respiratory tract infection (URI) is the most common cause of sinusitis. Symptoms typically are those of nasal congestion, runny nose, postnasal drip, sore throat, sinus congestion and sinus congestion pain. Three to four days of a yellow/greenish discharge is not uncommon. If sinus drainage can be maintained and secretions remain thin, there is no need for antibiotic treatment. Studies have shown that 50% of x-ray proven sinus infections will clear without antibiotics as long as there is adequate sinus drainage. Patients with recurrent and chronic sinusitis should be evaluated for conditions that may predispose them to episodes of rhinitis and/or to poor sinus drainage. These may include an evaluation of allergy, work-related exposure to inhalant irritants, infection exposure, defects in immunity, and abnormal sinus anatomy. Finding the cause of sinusitis is essential and may possibly prevent future episodes of sinus infection. RECOMMENDATIONS:

1. Drink 6-9 glasses of fluid per day.
2. Avoid use of antihistamines (Actifed, Benadryl, Dimetapp, Claritin, Allegra, Zyrtec, etc.) as these drugs will dry and thicken secretions that inhibit adequate drainage.
3. Do saline nasal rinses twice a day or more.
4. Topical nasal decongestants such as Afrin for 2-4 days on a twice a day basis can be helpful to allow saline and/or nasal steroids to enter the nasal cavity in order to reduce inflammation and promote good drainage.
5. Decongestant medication such as Sudafed with or without a mucous-thinning medicine such as Robitussin can improve sinus drainage.
6. Decongestant medications may be used in patients with high blood pressure for 3-5 days as long as the blood pressure can be monitored and is well controlled with blood pressure medication.
7. Nasal steroid sprays can be used to reduce inflammation.
8. Antibiotics are best prescribed after the sinus infection has been given a chance to clear with the above measures. Preference is to wait at least seven days after onset or until the sinus infection has begun to trigger a significant asthma episode.
9. Once antibiotics are prescribed, it is not unusual to require a 2-4 week course of treatment. Chronic sinusitis may require six weeks of therapy.

Asthma (AZ-muh) is a long-term disease that affects your airways. Airways are the tubes that carry air in and out of your lungs. If you have asthma, your airways can become swollen and inflamed. Swelling is a reaction to things that you are allergic to or find irritating. When the airways react, they get narrower and less air flows through to your lungs. This makes breathing hard and causes wheezing. This is called an asthma attack. Attacks are also called flare-ups, exacerbations, or episodes. There is no cure for asthma. Over time and working with your caregiver, asthma can be controlled so that you have fewer symptoms. Taking care of your asthma is an important part of your life. Controlling it means taking medicines as directed by your caregivers and staying away from things that bother your airways such as cigarette smoke. Your asthma may change with time, and may get better or worse. Your treatment plan may need to be changed if your asthma changes. Controlling your asthma should allow you to continue your usual activities. With treatment, asthma can be managed so you are able to live a normal life. What causes asthma?  Caregivers do not exactly know what causes asthma. Caregivers know that if other people in your family have asthma, you are more likely to have it.

The source of allergens and irritants listed below may make your asthma symptoms worse, and may trigger an asthma attack:

Allergens:

• Animal dander
• Cockroaches and their droppings
• Dust or dust mites
• Molds
• Pollen from plants

Irritants:

• Air pollution.
• Cigarette smoke.
• Cold air or changes in weather.
• Scented products such as perfumes, deodorants, and strong odors from painting or cooking.
• Strong emotional expression such as crying or laughing hard.
• Stress.

Others:

• A condition called gastroesophageal reflux disease or “GERD”. This causes heartburn and can worsen asthma symptoms, especially at night.
• Food or beverages containing sulfites such as dried fruits and wine.
• Medicines such as aspirin, non-steroidal anti-inflammatory drugs or “NSAID”, and blood pressure medicine such as beta-blockers.
• Certain activities can also cause exercise-induced asthma.
• Viral or bacterial infections, especially of the upper airways.

You may not have all of these symptoms, or your symptoms may change. Your symptoms may also vary from one asthma episode to the next. Symptoms may be mild during one asthma episode and severe during another. Common signs and symptoms of asthma include:

• Coughing:  This is often worse at night or early in the morning making it difficult to sleep.
• Wheezing:  A whistling or squeaky sound when you breathe.
• Chest tightness:  This can feel like something is squeezing or sitting on your chest.
• Difficulty breathing:  You may have problems breathing or feel out of breath. You may feel like you cannot get enough air in or out of your lungs.

Most people with asthma have warning signs before symptoms appear. The warning signs are not the same for everyone. Your own warning signs may even be different from time to time. By learning what your warning signs are, you can start treatment sooner. This may keep you from having a serious asthma attack.

The following are some of the warning signs of an asthma attack:

• Breathing faster than normal
• Difficulty sleeping
• Fast heartbeat
• Feeling more tired than usual
• Itchy or sore throat
• Shortness of breath during exercise

You may need one or more of the following tests:

• Allergy testing:  Allergy tests are used to help you learn what causes your allergic reactions. There are many methods of allergy testing such as skin tests, elimination-type tests, and the radioallergosorbent test or “RAST”.
• Chest x-ray:   This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs.
• Pulmonary function tests:    Pulmonary function tests, also called PFTs, help caregivers learn how well your lungs work. PFTs may also help your caregivers decide on the best treatment for you. During the tests, you breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. This helps caregivers see how well your lungs are moving and working.

Caregivers often classify your asthma with varying levels of severity. This is based on your symptoms, how often your asthma attacks occur, and the readings from your peak flow meter.

• Mild intermittent:
  • Asthma symptoms occur twice a week or less.
  • Nighttime symptoms occur twice a month or less.
  • Asthma attacks last a few hours to a few days with varying intensity. You may have no symptoms between attacks.
  • PEF reading variability of less than 20 percent.

• Mild persistent:
  • Asthma symptoms occur twice a week or more but not everyday.
  • Nighttime symptoms occur more than twice a month.
  • Asthma attacks may slow your daily activities.
  • PEF reading variability of 20 percent to 30 percent.

• Moderate persistent:
  • Asthma symptoms occur daily.
  • You use your quick-relief medicines daily.
  • Nighttime symptoms occur more than once a week.
  • Asthma attacks occur twice a week or more, and get in the way of your daily activities.
  • PEF reading variability of more than 30 percent.

• Severe persistent:
  • You have asthma symptoms throughout the day on most days.
  • You have symptoms on most nights.
  • Asthma attacks happen almost all the time limiting your daily activities.
  • PEF reading variability of more than 30 percent.

A peak flow meter is a small, plastic, tube-like device that you carry with you. This measures how well air moves out of your lungs, also called your  peak expiratory flow or “PEF” . Using the peak flow meter  correctly  will help you better monitor and manage your asthma. Ask caregivers for more information on how to use the peak flow meter. Ask caregivers to explain how the PEF reading variabilitiy can help you learn the level of your asthma severity.

You and your caregiver will make a plan to treat your asthma. You may need any of the following to control your asthma:

• Quick-relief medicines:  These medicines are taken to quickly open your airways and to treat other symptoms. Quick-relief medicines are also called bronchodilators. Bronchodilators relax the muscles that have tightened around the airways. These allow the airways to open wider, making it easier to breathe. These medicines are used to treat asthma attacks.

• Long-term control medicines:  These medicines are taken every day to control asthma that does not go away. These medicines help decrease inflammation of the airways. Inflammation occurs when your airways swell and tighten. Inhaled steroid medicines are commonly used for long-term control of asthma.

Asthma is a life-changing disease for you and your family. Accepting that you have asthma may be difficult. You and those around you may feel scared, confused, and anxious. These feelings are normal. Talk to your caregiver, family, or friends about your feelings. You may also want to join a support group with other people who have asthma. Ask your caregiver for contact information for support groups.

Contact the following for more information:

• American Academy of Allergy, Asthma, and Immunology

• American College of Allergy, Asthma, and Immunology

• National Asthma Education and Prevention Program , National Heart, Lung and Blood Institute  , National Asthma Education and Prevention Program

The instructions below may seem severe, but experience has shown that an environment free of those substances to which a patient is allergic for even a part of a twenty-four period will be substantially beneficial. It is frequently impractical to control the dust factor throughout the home or your place of work but sleeping quarters do lend themselves to rigid and necessary control. The dust in a bedroom, for specific reasons, is more allergenic than the dust from other rooms of the home. Pillows, mattresses, box springs, bed pads, blankets, bedspreads, comforters, quilts, upholstered furniture, rugs, and drapes all break down and may produce a substance of allergic importance.

DUST:

1. The room should contain only one bed. Remove all upholstered furniture, rugs, pads, stuffed toys, and dust catching objects. Remove all stored clothing, toys, packages, and other articles from the closet. The closet should contain only contain clothing that is in current use and should be as dust-free as the room. The closet should not be used for storage.
2. Vacuum the mattress thoroughly, including the box springs, once or twice a month.
3. Do not use comforters or quilts on the bed. Washable cotton, rayon or other synthetic fiber blankets are best. Washable throw rugs may be used if kept clean.
4. Keep the room dust free with frequent vacuuming and a weekly wiping down with an oil or damp cloth.
5. Close and permanently seal all furnace-type outlets in the room; otherwise, the room will become filled with dust-ladened air during the operation of the furnace. Change furnace filters frequently.
6. Consider a filtration system; either portable for your bedroom, especially if you are a renter, or a central system (an attachment to the heating/air conditioning system). Call or ask us for details.
7. Cover all pillows, mattresses, and box springs with plastic encasings. Microfiber is best to look for when shopping for encasings. Call or ask us for details

FEATHERS: Pillows, blankets, and mattresses containing feather and/or down should not be used. Duvet covers on feather/down comforters would be helpful, but the cover should be washed every two weeks in hot water. WOOL: No wool blankets or rugs in the bedroom.

TIPS TO ALLEVIATE ALLERGY SYMPTOMS ASSOCIATED WITH NEW CARPET

Many of our patients ask us about having new carpet installed in their homes and what can be done to alleviate symptoms related to new carpet. Our first choice is that you do not choose carpet but rather, a hard flooring surface like wood, tile, or linoleum. Using area rugs can more easily be cleaned and replaced and can help “warm” up a room. Unfortunately, too many people still insist using carpet in their bedrooms. For those, we offer you this advice: New carpet can be a source of chemical emissions. In addition to the carpet, the padding and adhesives all emit volatile organic compounds. Some people report symptoms such as upper respiratory irritations, headaches, fatigue, skin rashes, shortness of breath and cough which they associate with new carpet installation. The distinct odor of new carpet is usually attributed to the chemical 4-phenylcyclohexene (4-PC). This chemical can be detected at very low levels, but does not result in an unpleasant odor for everyone. Usually, the odor dissipates within a few days of installation.

Recommended Actions:

1. CONSULT with your retailer before installation. Ask for help in selecting carpet, padding, and adhesives that are gas-less and produce fewer emissions.
2. REQUEST that the carpet installer follow the Carpet and Rug Institute’s installation guidelines.
3. BEFORE installing the carpet, ask the retailer to unroll and air out the carpet in a well-ventilated area.
4. HAVE the sensitive person leave the premises during and immediately after carpet installation for several days if practical.
5. INCREASE VENTILATION!!! Open the windows and doors, and use fans to increase the amount of fresh air exchange. Use the HVAC system in fan mode for 2-3 days after installation to clear the air.
6. USE an air purifier that has a HEPA and Carbon filter to remove particulates and harmful emissions resulting from the new carpet.
7. VACUUM new carpet frequently. Use a HEPA vacuum cleaner.
8. CHANGE furnace filters frequently (we recommend once a month).

Avoid all eggs including any food which may contain eggs such as:

• Batters, Bavarian creams, bouillons, bread and breaded foods
• Cakes, cake flours, candies (except hard or homemade), cookies, creamed pies, custards
• Dessert powders, doughnuts, dried eggs in prepared foods and dumplings
• Fritters, frostings, French toast
• Hollandaise sauce, hamburger mix
• Ices, ice creams, icings
• Meat loaf, muffins
• Pancakes, pancake flour, puddings, pretzels
• Root beer
• Salad dressings, sauces, sausages, sherbet, soufflés, soups
• Tartar sauce, timbales
• Waffle, waffle mixes
• Miscellaneous: Albumin, Globulin, “Egg Beaters” and “Scramblers” (contain egg whites)

Dietary Modifications For Food Induced Migraines

Foods that contain vasoactive amines, i.e., tyramine, phenylethylamine, have been associated with exacerbation of migraine headaches. These are mainly fermented foods with these chemicals being the product formed by bacterial breakdown of amino acids.

ELIMINATE from your diet:

1. Chocolate, cocoa – These foods contain large amounts of phenylethylamine and are a food most commonly associated with exacerbation of migraines.
2. All ripened, i.e., fermented cheeses. Unfermented cheese such as cottage cheese and cream cheese are safe, as is yogurt.
3. Avocados, bananas, figs – These fruits contain large amounts of tyramine, particularly if over-ripe; there are also large amounts of tyramine in banana peels.
4. Fermented sausage such as bologna, pepperoni, salami, aged beef, have a high tyramine content.
5. White wines generally do not contain much tyramine, but more is found in many red wines. There are other chemicals in wine which may contribute to headaches so avoid wine or drink only small amounts.
6. Beer and ale – Major domestic brands do not contain appreciable amounts. Some imported brands have high levels of tyramine. Non-alcoholic beer may contain tyramine and should be avoided.
7. Soy sauce contains large amounts of tyramine. Reactions have occurred with Teriyaki.
8. Dried fish – Fish is safe if fresh. Dried products contain large amounts of tyramine. Caution is required in restaurants.
9. Bean curd – Fermented bean curds, fermented soybean and soybean paste all contain large amounts of tyramine.
10. Miso soup has caused reaction.
11. Liver – Safe if fresh but rapidly accumulates tyramine. Caution is required in restaurants.
12. Soups – Protein extracts. Avoid liquid and powered protein dietary supplements as they contain large amounts of tyramine. Prepared soups generally contain protein as extract and they should be avoided.
13. Yeast extracts – Dietary supplements, i.e., marmite, contains large amounts. Yeast in baked goods is safe.
14. Fava bean (broad beans, “Italian green beans”). These contain dopamine, particularly, when over-ripe and must be avoided.
15. Ginseng – This does not contain tyramine but has been associated with headaches.
16. Shrimp paste must be avoided. Contains large amounts of tyramine.
17. Caviar can be eaten only if it is vacuum packed and eaten fresh.

What is a gluten-free diet? Gluten is a general name for storage proteins found in wheat, rye, barley, and oats. Gluten may cause health problems for some people. A gluten-free diet is a diet including foods and drinks that do not contain gluten. A diet without gluten should be followed if you have celiac (SE-le-ak) disease, or dermatitis herpetiformis (her-pet-i-FORM-is). Dermatitis herpetiformis is a skin condition that is also called DH. A gluten-free diet should also be followed if you are allergic (al-ER-jik) to wheat. People who need this diet to treat a medical condition usually need to follow it their entire life. With celiac disease, eating too much gluten may cause you to have diarrhea and stomach pain. You may also be very sad most of the time, or become angry easily. It is possible for you to have celiac disease but have no symptoms. Even so, you are still at risk for medical problems. With DH, you may have very itchy rashes which may blister. These symptoms may come and go, but you should still follow a gluten-free diet. Following this diet may decrease the amount of medicine that you need to take for DH. What can I do to make a gluten-free diet part of my lifestyle?   Changing what you eat and drink may be difficult at first. Think of these changes as “lifestyle” changes, not just “diet” changes. You may need to make these changes part of your daily routine. Following a gluten-free diet may help you feel better. Choose a variety of items on this diet so that you do not get tired of having the same items every day. Keep a list of items allowed on this diet in your kitchen to remind you about the diet. Carry a list of items allowed on this diet with you to remind you about the diet when you are away from home. Tell your family or friends about this diet so that they can remind you about the diet. Ask your caregiver, a dietitian (di-e-TISH-an), or a nutritionist (noo-TRI-shun-ist) any questions you may have about your diet plan. A dietitian or nutritionist works with you to find the right diet plan for you. Dietitians and nutritionists can also help to make your new diet a regular part of your life. Always read the ingredient labels on products before buying any packaged food.  Gluten is found in many foods and drinks. It may not be clear which foods contain gluten. As a general rule, avoid all foods that contain wheat or the wheat-related grains. This includes spelt, triticale, and kamut. You will also need to avoid foods and drinks with rye, barley, and possibly oats. You should avoid eating many grain, pasta, and cereal products, along with most processed foods. Even while following these guidelines, a gluten-free diet can still be well-balanced, and contain a variety of foods. At first, it may take more time to shop for groceries, and plan and prepare meals. Over time, you will learn what products to buy for a gluten-free diet. For more information about a gluten-free diet, you may want to contact the following: Celiac Disease Foundation13251 Ventura Boulevard, Suite 1Studio City,  CA 91604Phone: 1-818-990-2354Web Address:  http://www.celiac.org Canadian Celiac Foundation190 Brittania Rd. EastMississauga,  ON L4Z 1W6Phone: 1-905-507-6203Web Address:  www.celiac.ca What should I avoid eating and drinking while on a gluten-free diet?  

Breads and starches:

• Bread crumbs
• Cereals, including muesli, oatmeal, farina, and other hot cereals
• Couscous
• Crackers, and trail mixes with small crackers
• Packaged rice and noodle mixes
• Pretzels
• Some rice cakes, rice crackers, and popcorn cakes
• Wheat or flour tortillas
• Avoid all breads, cereals, pastas, baked items, and mixes that contain these grains or ingredients:
• Barley, bulgur
• Cereals with added malt extract and malt flavoring, such as Cheerios
• Wheat flours, including white flour, gluten flour, graham flour, high protein flour, and pastry flour
• Gluten, vital gluten
• Kamut
• Oats, oat bran
• Rye
• Semolina
• Spelt
• Triticale
• Wheat bran or flour, wheatgerm, or unnamed starch
• Wheat flours, including white flour, durum flour, gluten flour, graham flour, high protein flour, and pastry flour

Dairy Foods: 

• Chocolate drinks, hot cocoa mixes, and chocolate milk.
• Malted milk drinks.
• Processed cheeses.
• Some puddings, ice creams, frozen and flavored yogurts.

Fruits and vegetables: Baby food fruits with starch added.

• Breaded vegetables.
• Cream soups or vegetables with flour.
• Fruit jams, jellies, sauces, spreads, or syrups with thickeners.
• Fruit pies, pastries, and cobblers made with any of the grains listed in the breads and starches section.
• Some French-fried potatoes (especially those in restaurants), and flavored potato chips.

Meat and other protein sources:

• Breaded meat, fish, or poultry.
• Canned baked beans.
• Casseroles made with flour or pasta.
• Chicken, turkey, or other deli meats and roasts made with processed vegetable protein.
• Corned beef.
• Foods with macaroni, noodles, or pastas made from types of flour listed in the breads and starches section.
• Imitation seafood, imitation bacon.
• Meat dishes that include flours listed in the breads and starches section, such as meatloaf, Swiss steak, or meatballs.
• Meats or meat dishes containing soup base or bouillon made with certain ingredients (in the Checklist for the Patient section).
• Packaged meats made with flour (such as cold cuts, lunch meats, hot dogs, sandwich spreads, pates, sausages, canned or imitation meats).

Fats, soups, sauces, and seasonings:

• Any soup made with noodles.
• Certain salad dressings, such as malt vinegar. Read the label before buying the product.
• Chip dips.
• Gravies and sauces made with flour.
• Most canned and dry soup mixes, as well as soup bases or bouillon mixes with yeast or vegetable protein.
• Rice syrup.
• Seasoning mixes.
• Some brands of chili sauce and steak sauce.
• Soy sauce made with meat.

Desserts:

• All cookies, pies, pastries, and cakes made with any type of flour listed in the breads and starches section.
• Fruit pies thickened with flour.
• Ice cream and ice cream cones.
• Licorice and jellybeans.

Other:

• Additives, preservatives, and stabilizers found in processed foods, medicines and mouthwash.
• Beer, ale, and malt liquor.
• Cereal beverages (Postum & Ovaltine).
• Certain imported foods. Imported foods labeled “gluten-free” may still contain wheat starch.
• Flavored coffees.
• Instant coffee made with wheat.
• Medicines that contain gluten. Ask your caregiver if any medicine that you are taking contains gluten before taking it. Vitamins may also contain gluten.
• Non-dairy creamers.
• Pickled foods.
• Prepared mustard.
• Some instant natural beverages.
• Some spice blends such as curry powder, ground pepper mixes, and herb seasonings.
• Sweets and candies made with certain ingredients (in the Checklist for the Patient).

Checklist for the Patient: Take this list with you when you shop. Look for products with “gluten-free” written on the label. It may not be clear what products contain gluten.

This list contains items to look for when reading food and drink labels. Avoid buying products that have one or more of these ingredients:

__ Caramel flavoring, or non-United States manufactured caramel coloring

__ Cereal extract or additive

__ Cereal protein

__ Edible starch or wheat starch

__ Emulsifiers

__ Flour

__ Fillers

__ Hydrolyzed, hydrogenated, or texturized vegetable or plant protein (HVP or HPP)

__ Dextrin

__ Malt, malt flavoring, or malt extract

__ Mono-glycerides or di-glycerides

__ Stabilizers, such as gluten stabilizers

__ Thickeners, such as modified food starch

__ Vegetable gum or protein, such as oat gum

What can I eat and drink while on a gluten-free diet? While on a gluten-free diet, it is very important to read the ingredient label on packaged foods before buying the product. Less-processed foods or things you make yourself should be safer to eat than packaged foods. While oats were not included in a gluten-free diet in the past, newer research finds that oats may be safe on this diet. Ask your caregiver about adding oats to your diet. Breads, cereals, pasta, and baked items made with potato, rice, soy, and bean flour may be eaten on a gluten-free diet. Some gluten-free cereals include Arrowhead Mills Corn Flakes and Health Valley Rice Crunch-Ems. Products with garbanzo, potato, rice, soy, and tapioca flour may be eaten. Foods made with nut flour and millet may also be eaten. Brown, white, and wild rice without sauces may be included in a gluten-free diet. Rice products, such as rice cakes, rice crackers, and puffed rice may also be eaten. Rice cereals, cream of rice cereal, and rice polish may be eaten. Corn products, such as cornmeal, corn flour, corn tortillas, or corn cereals may be included in a gluten-free diet. Popcorn and popcorn cakes may also be eaten if they do not contain any gluten ingredients. Ingredients such as corn starch and potato starch are also OK when selecting foods. Gluten-free flours, baking mixes, and baked foods may be selected and included in this diet. Arrowroot powder, amaranth, buckwheat, hominy, quinoa, and tapioca are also allowed on a gluten-free diet. Plain meat, fish, fruits and vegetables are safe to eat while following this diet. Choose fresh, frozen, or canned meat, fish, fruits and vegetables. For packaged items, choose foods that do not have ingredients listed on the Checklist of ingredients to avoid. Ketchup, distilled vinegar, and some mustards are safe to include with meals. Ingredients such as maltodextrin and soy sauce that is labeled “gluten-free” may also be included. Caramel coloring made in the United States, and most syrups and jellies may be included in a gluten-free diet. Some chocolate drinks may also be enjoyed. Read labels on these items to make sure they can be included in your diet. Over time, you may learn how to prepare a variety of enjoyable and healthy meals and snacks. To learn more about recipes for a gluten-free diet and order gluten-free products, you may contact the following: Celiac Sprue Association

P.O. Box 31700

Omaha,  NE 68131

Phone: 1-402-558-0600 Web Address:  http://www.csaceliacs.org  

What other diet guidelines should I follow? When you eat away from home, ask the waiter, chef or host how the foods and drinks that you are about to eat are prepared. Bring a list of the ingredients, foods, and drinks not allowed on a gluten-free diet. Ask if any of these ingredients, foods or drinks are in the meal. If they are, ask for other foods and drinks that are OK to have while on a gluten-free diet. Call your caregiver if you have questions or concerns about your illness, medicine, or a gluten-free diet.

Here is a sample diet for one day:

Early morning snack:   Banana.

Breakfast:   Soft boiled eggs, gluten-free toast with butter, milk.

Morning snack:   Gluten-free rice cakes.

Mid-day meal:   Tuna salad with tomato and lettuce. Apple.

Afternoon snack:   Carrot sticks.

Evening meal:   Broiled chicken, baked potato, green beans. Baked apple. Evening snack:   Gluten-free rice crackers and sliced Swiss cheese.

Risks: With celiac disease, eating too much gluten may cause you to have bloating, diarrhea, and stomach pain. You may also feel sad most of time or become angry easily. Your teeth may lose their white color. Eating gluten will cause problems in your small intestine (bowel). This may make you unable to get the nutrition your body needs, even while following a healthy diet. There may be weight loss, and children may not grow or develop correctly. Following a gluten-free diet when you have celiac disease may stop your symptoms. It may also heal bowel problems and prevent the development of additional bowel problems from developing. You may feel better, and healing may start within days of starting the diet. Some people with celiac disease will not improve even if a gluten-free diet is carefully followed. This is because their intestines are too damaged and are unable to heal. You may need to have other treatments and take medicines to help treat celiac disease. People with DH often have the same intestinal damage as those with celiac disease, but not the same symptoms. People with DH who do not follow a gluten-free diet may have a very itchy, blistering skin condition. If you are allergic to wheat and do not follow a gluten-free diet, you may have an allergic reaction. This may include a rash, sneezing, watery eyes and nose, itching, swelling and hives. This may lead to trouble breathing and unconsciousness (unable to be awakened from sleep). The symptoms may begin minutes or hours after eating wheat products, and they may lead to death.

Sample Diet:                                                                                                    

Breakfast:

• Boiled Rice
• Sugar (1/2 teaspoon)
• Sliced Chicken
• Rice Cake with Pure Peach Jam (1 teaspoon)

Lunch:  

• Sliced Turkey
• Boiled Potato
• Steamed Carrots/Lettuce, Celery Salad

Dinner: 

• Chicken
• Rice
• Cauliflower
• Apple

Beverage:         Water

Substitutions allowed for the items above: Chicken, Pork, Turkey, Potato, Rice, Banana, Apple, Pears, Peaches, Apricots, Cabbage, Lettuce, Cauliflower,Celery, Cucumber, Carrots, Onions and small amounts of sugar (2 teaspoons/day) ALL FRUITS AND VEGETABLES NEED TO BE COOKED, BAKED, STEAMED, OR POACHED

Comments:

1. This diet should be adhered for a 3-week trial to decide if it makes any difference.  If it makes no difference, you can likely dismiss food as a cause of the problem.
2. If the conclusion has been formed that a low allergy diet is beneficial, it is then necessary to see what foods may be responsible. A good way to start is to reintroduce those foods least likely to cause symptoms. Start at the top of the list. Next, begin to work your way down.
3. If the low allergy diet is not feasible, you might decide on a 3-week trial following your usual diet at home, but exclude all milk and dairy products (including goats milk) and grains (rice is okay).

When Reintroducing Foods, Start From Top to Bottom. Introduce 1 item every 3 days.

• Celery
• Cauliflower
• Lettuce
• Cabbages
• Duck
• Plums
• Onions
• Apricots
• Yeast
• Rice
• Turkey
• Peaches
• Carrots
• Bananas
• Cucumber
• Other Nuts
• Coffee
• Tea
• Potatoes
• Chicken
• Pears
• Pork
• Apples
• Malt
• Peas
• Beans
• Beef
• Sugar
• Pineapple
• Ham/Bacon
• Tomatoes
• Melons
• Oats
• Fish
• Eggs
• Cow’s Cheese
• Oranges
• Wheat
• Grapes
• Chocolate
• Cow’s Milk
• Soy
• Colorant & Preservatives

Simplified Low Nickel Diet

GRAINS TO AVOID:  Whole wheat bread, multigrain breads, multigrain cereals, wheat bran, wheat germ, whole wheat pasta, oats, OATMEAL, buckwheat, seeds

VEGETABLES  TO AVOID:  BEANS, LENTILS, PEAS, SOYBEANS, SOY PRODUCTS, (TOFU, SOY SAUCE), bean sprouts, brussel sprouts, asparagus, broccoli, cauliflower, spinach, CANNED vegetables

FRUITS TO AVOID:  CANNED fruit cocktail, pears, bananas, CANNED fruits

MILK & DAIRY TO AVOID:  Chocolate Milk

 MEATS TO AVOID:  Shellfish, processed meats with fillers or coatings,  CANNED meats or fish

 OTHER SOURCES OF DIETARY NICKEL TO AVOID: 

1.   Chocolate and cocoa powder (especially DARK CHOCOLATE)
2.   All nuts (especially PEANUTS)
3.   Canned foods in general
4.   Stainless steel cookware used for cooking acidic foods
5.   Vitamins containing nickel
6.   The first quart of tap water drawn from each faucet in the morning
7.   Black tea
8.   All seeds
9.   Commercial salad dressings

WAYS TO PREVENT YOUR BODY FROM ABSORBING THE NICKEL YOU EAT:

1.  Take vitamin C supplement with each meal
2.  Eat a high iron diet

Formula Substitutes for Patients with Milk Allergy*

*From Crawford, L.V.: Allergy diets. In: Bierman, C.W., Pearlman, D.S., eds. Allergic Diseases of Infancy, Childhood and Aldolescence. Philadelphia: Saunders, 1980: 395.

Mold – Free Diet/Foods to Avoid

• Dried and candied fruit
• Melons
• Cheese
• Beer and wine
• Pickled and smoked meats and fish
• Mushrooms
• Soured breads and rolls
• Soy sauce
• Vinegar and vinegar-containing foods
• Cider
• Canned tomatoes

MEDICATIONS TO AVOID WITH MAST CELL DISEASES

 Avoid drugs that may cause mast cell degranulation and histamine release.

These are some common ones.

• Alcohol
• Dextran
• Polymyxin B
• Morphine
• Codeine
• Scopolamine
• d-tubocurarine
• Procaine
• Iodonated Contrast materials
• NSAIDs (nonsteroidal anti-inflammatory agents)

Cutaneous mastocytosis and urticaria pigmentosa can improve with sun exposure and antihistamines.

Patients should avoid mast-cell degranulating drugs (NSAIDs, opiates, alcohol, procaine, polymyxin B, codeine, aspirin, morphine, iodonated contrast materials), spicy foods and cheeses, extreme temperatures, anxiety, stressful situations that may trigger mast cell release, hot showers.

Patients should carry Epi-pens in case of anaphylaxis.

Elimination Diet and Medications in Recurrent/Chronic Urticaria and Angioedema  Low Salicylate/Low Preservatives/Low Artificial Coloring Diet: The aim of this diet is to keep the intake of salicylates, preservatives, and artificial colors to a minimum. Salicylates occur naturally in many fruits and vegetables, herbs and spices, and are frequently used in artificial flavorings, perfumes, toothpaste, and medications (aspirin). Preservatives are added to food to prolong shelf life. For example, benzoates are used in fruit juices; sorbate or sulphur dioxide in dried fruits, fruit salads, and sausage mince; nitrites in processed meats; propionate in yeast products; and antioxidants in oils and margarines. Colorings such as tartrazine, erythrosine and sunset yellow are commonly used in commercial foods.

 Food List and Medications

Foods Allowed

Beverages:

• Decaffeinated coffee, milk, cocoa, malt, mineral water, unpreserved lemonade, tonic water, whiskey, gin, vodka.

Bread:

• Any plain unpreserved breads, rolls or muffins.
• Homemade pastry

Cakes and Cookies

• Plain, homemade and commercial cakes and cookies (using allowed ingredients).

 Fish:

• Fresh, frozen or canned fish and seafood.

Flour:

• All flours except corn based flours. Uncolored pasta, e.g. spaghetti

Fruit:

• Pears, apples (1/day only), papaya, bananas. Fruit can be fresh, frozen or canned (in syrup or water). Pick ripe fruit and do not eat skin.

Jams:

• All other jams, conserves and jellies (including lemon butter).

Meat:

• Beef, lamb, veal, pork, mince, poultry (no skin) and rabbit.

Nuts:

• Cashews (raw, dry, or roasted)

 Soups:

• Homemade soups from allowed ingredients.

Sugars and Sweets:

• Golden syrup, maple syrup. Sugar (white, brown, icing). Malt.

Vegetables:

• White potatoes (no skin). Beans (French, string). Brussels sprouts, cabbage, celery, chives, parsley, lettuce, peas, bean sprouts, leeks, shallots, garlic. Dried legumes, e.g. lentils, soybeans, chick peas, split peas.

 Candies and Chocolates:

• White jelly beans/marshmallows, plain caramels/toffees, milk/dark chocolate and carob.

Cereals:

• All cereals except corn. Commercial breakfast cereals which do not contain dried fruit, corn or coloring.

Chips:

• Unpreserved, plain potato chips and crisps. Homemade potato chips.

Condiments:

• Parsley, garlic, soy sauce, salt, vanilla essence, citric acid.

Dairy:

• Butter, all cream, all plain milks (including condensed, powdered and evaporated). Plain and vanilla yogurt. Ice cream – homemade or commercial vanilla, chocolate and banana flavored without coloring.

Desserts:

• Homemade desserts from allowed ingredients, e.g. steamed puddings, vanilla junket, egg custard.

Eggs:

• Egg

Fats:

• Butter, margarine, oils, (safflower, sunflower, olive and canola).
• Homemade salad dressing.

1. Obtain an Epi-Pen or similar device for the self-administration of epinephrine (adrenaline); read the instructions and understand it’s use. We would be happy to review this with you.
2. If stung, DO NOT immediately inject yourself with epinephrine; you have time to wait for certain premonitory signs and symptoms such as diffuse itching, particularly in the palms of your hands or soles of your feet, cough, dizziness, sweating and/or scratchy or swelling throat. If these occur, in addition to self- administering the adrenaline, you should also go to the emergency room.
3. If there are hornet/wasps nests on your property, they should be removed.
4. You should alter your behavior to avoid exposure to stinging insects and being stung. These include:

•  Always wear full shoe coverings (75% of all bee stings occur on the feet).
• Avoid eating outdoors or attending outdoor meals, i.e., picnics (both bees and yellow jackets are strongly attracted to foods, especially garbage cans).
• Avoid mowing lawns. This causes the ground to vibrate and may provoke yellow jackets to attack.

Current Recommendations for Prevention of Food Allergies:

1. No maternal dietary restrictions during pregnancy are necessary with a possible exception of excluding peanuts.
2. Continue breast-feeding for the first year of life or longer, may use hypoallergenic formulas for supplementation.
3. While breast-feeding, avoid peanuts and tree nuts and possibly eliminate eggs, cow’s milk, fish, and perhaps others from diet.
4. Solid foods should not be introduced to high-risk infants until four months of age. Dairy delayed until 1 year, eggs until 2 years, and peanuts, nuts, and fish until 3 years.

 Current Recommendations to Prevent Asthma and Environmental Allergens:

1. Breast-feed during the first 4-6 months of life.
2. Administer probiotics to mothers during pregnancy and breast-feeding. They can increase the protective potential of breast milk against development of eczema during the first two years of life. (Probiotics are live microbial food ingredients that are beneficial to health e.g. Lactobacillus)
3. Delay exposure to cow’s milk and other highly allergenic foods. Avoid solid foods until four months of age.
4. Avoid exposure to tobacco smoke (also during pregnancy).
5. Begin dust-mite avoidance early.
6. Encourage diets rich in antioxidants and omega-3 fatty acids. An Australian study showed that children who ate fish at least once a week were at least 30-70% lees likely to have asthma than children who ate fish less often.  (Antioxidants – Vitamin C and selenium mainly provided by fresh fruits and vegetables. Omega-3 fatty acids – found in fish)

Adopted from Brett E. Stanaland, M.D., F.A.A.A.A.I. Therapeutic Measures for Prevention of Allergic Rhinitis/Asthma Development. Allergy and Asthma Proc. Vol. 25, No.1, Jan-Feb 2004.