Urticaria

Causes of urticaria

There are distinct types of urticaria:

• Acute urticaria may be caused by an allergy and can last between several hours and six weeks
• Chronic urticaria isn't usually caused by an allergy and persists beyond six weeks
• Physical urticaria is triggered by physical factors and lasts only an hour or two

The most likely triggers for acute urticaria are allergies to pets, horses, latex and foods, such as shellfish and nuts in adults and eggs and cow's milk in children. 

Other possible causes include bee or wasp stings, and allergies to medicines such as antibiotics, blood pressure pills and aspirin. 

Viral infections, such as glandular fever and herpes, dental and sinus infections, fungal infections, blood transfusions and vaccines can also cause acute urticaria. 

The cause of chronic urticaria is often more difficult to identify. Most cases are called chronic idiopathic urticaria, which means they're caused by the body's unexplainable development of antibodies to itself (auto-antibodies).

Chronic bacterial and parasitic infections, long-term use of blood pressure drugs, underlying thyroid disease and autoimmune diseases such as lupus can provoke urticaria. 

Chronic urticaria is often accompanied by coexistent physical urticaria, triggered by environmental exposure to heat, cold, sunlight, vibration, pressure on the skin or even exercise.

Most people with urticaria have such sensitive skin that any rubbing will cause raised red lines to develop. This is called dermatographism.

Urticaria symptoms

The rash is very itchy and consists of a number of raised pale bumpy weals surrounded by red skin. Ordinary urticaria tends to move about or migrate all over the skin surface. In chronic cases, the itchiness may cause sleepless nights and lead to depression. 

The condition tends to settle and then relapse again at times of viral illness, stress and after taking medication that contains aspirin. This chronic pattern may recur for many years.

Tissue swelling, called angioedema, may occur with urticaria. This affects the lax tissues around the eyelids, lips, neck and groin. Occasionally, an inherited deficiency of the C1 esterase inhibitor enzyme leads to marked swelling without urticaria. This rare condition is called hereditary angioedema.

If urticaria doesn't disappear after a few weeks, or doesn't respond to antihistamine medication, and is accompanied by any other health problem, see your GP. Blood tests may be able to identify an allergy or underlying immune disease.

Urticaria treatments

High doses of non-sedating antihistamines may be necessary for prolonged periods of up to six weeks or more. Short courses of oral steroids are occasionally required to settle severe symptoms. 

Try to avoid general urticaria triggers such as stress, alcohol, aspirin, hot baths, rapid temperature changes, tight clothing and junk or processed foods containing sulphur dioxide, sodium benzoate, salicylate and tartrazine. 

Avoid tomatoes, strawberries, strong cheese, dark fish and fermented foods. Although these 'pseudo-allergens' aren't the primary cause of urticaria, they do tend to aggravate it.

The new leukotriene receptor antagonist medications used in asthma may also help urticaria if used in conjunction with antihistamines.

If there's no response to conventional treatment, a specialist should investigate other possible underlying illnesses, such as lupus, thyroid disease and chronic infections.

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Eye allergies

Hay fever eyes

Seasonal allergic conjunctivitis is the eye equivalent of hay fever and affects up to 25 per cent of the general population. The eyes become itchy, watery and red in the summer pollen season, usually from exposure to grass and tree pollen.

Vernal conjunctivitis is a more severe form of this disease seen in children. The eyes are sticky with a stringy discharge, and it's painful, especially when opening the eyes on waking. 

The inner membranes of the eyelid swell and the conjunctiva develops a cobblestone appearance. Corneal damage may occur if the condition is left untreated. 

Perennial allergic conjunctivitis tends to occur all year round, with house dust mite and cat allergies. The symptoms are usually milder than those in seasonal allergic conjunctivitis. 

Eczema eyes

Although rare, atopic keratoconjunctivitis is the most severe manifestation of allergic eye disease. It occurs predominantly in adult males and is the eye equivalent of severe eczema. 

This persistent condition results in constant itching, dry eyes and blurred vision. It's associated with corneal swelling and scarring. Eyelid eczema and infection are common, and lens cataracts may develop over time.

Contact lens allergy

 Contact lens wearers may develop giant papillary conjunctivitis, triggered by constant local irritation by the contact lenses on the conjunctival surfaces. The lining of the upper eyelid is usually most affected. Disposable contact lenses may help settle symptoms, but occasionally wearing contact lens has to be suspended. 

Never use steroid eye drops unless under the direct supervision of a doctor. Although they're effective for treating eye allergies, they can lead to unwanted side-effects such as glaucoma and cataract formation.

They may also encourage infections of the eye, with resultant corneal scarring.

Eye allergy treatments

Regular use of anti-allergy eye drops such as sodium chromoglycate, nedocromil, olopatidine and lodoxamide can help to treat mild seasonal disease. 

Non-sedating oral antihistamines - cetirizine, loratadine, mizolastine and fexofenadine - can also help, especially when there's an associated nasal allergy. 

Corticosteroid eye drops occasionally have to be used for more severe eye allergies, but this should be for short periods only.

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Drug allergies

Types of reaction

Adverse reactions to drugs can be divided into three groups:

• Those not related to the drug at all, but coincidental and due to other factors, for example, rashes or nausea associated with the disease and not the medication
• Common predictable reactions, such as from taking an overdose, or owing to side effects or interactions with other medications (known as type A drug reactions)
• Uncommon and unpredictable reactions, of which many are allergic reactions involving the immune system and may be either immediate or delayed (type B drug reactions)

Allergic reactions vary from slight rashes to severe anaphylactic immune reactions, such as those seen with penicillin, blood transfusions and intravenous fluids.

Other medicines can trigger histamine release in the body by non-immune mechanisms. No diagnostic blood tests are available for these. 

Medications implicated here include aspirin and anti-inflammatory drugs, morphine and the opiate family, anaesthetics and some fluids given intravenously during x-ray.

Drugs that cause allergic reactions include:

• Antibiotics - penicillin, sulphonamides, tetracycline, chloramphenicol and cephalosporins
• Heart drugs - ACE inhibitors, quinidine, amiodarone, methyldopa
• Anaesthetic drugs - muscle relaxants, thiopentone, halothane
• Morphine derivatives - morphine, pethidine and codeine
• Aspirin-like drugs - diclofenac, ibuprofen, indomethacin
• Cancer chemotherapy drugs - cisplatin, cyclophosphamide, methotrexate
• Antiseptics - chlorhexidine, iodine
• Vaccines - such as tetanus toxoid and diphtheria vaccine
• Preservatives and colourings in medication - such as sulphites, sodium benzoate and tartrazine
• Anti-epileptic, anti-tuberculosis medication, heparin, insulin, enzymes and latex

Although commonly reported, allergic reactions to dental local anaesthetics are uncommon and adverse reactions are usually from the additives (sulphites or parabens) or a side-effect of the adrenaline (especially if the anaesthetic is inadvertently injected into a vein instead of the skin).

Symptoms of drug allergies

Most reactions occur within one hour and involve a measles-like itchy rash or urticaria with swelling (angioedema). 

A severe life-threatening reaction may involve fever and generalised skin blistering with peeling (toxic epidermal necrolysis and Stevens-Johnson syndrome). A reaction may progress to life-threatening anaphylaxis and even death. 

Delayed reactions can develop up to two weeks after exposure to the drug, with generalised dermatitis and damage to vital organs such as the kidneys, liver and blood cells. 

Some medications can cause a fixed drug eruption, with a patch of rash occurring at the same spot every time you take that particular drug.

Drug allergy treatments

Treatment involves immediate withdrawal of the implicated drug, followed by antihistamine medication. In cases of anaphylaxis, the prompt use of adrenaline and steroids is life-saving.

Most medications are chemicals that bind with various proteins in our body, called haptens. It's this drug/hapten complex that may trigger an allergic reaction. 

As a consequence, these reactions are difficult to recreate on the skin or in a blood test, so blood testing for drug allergies is unreliable and inaccurate, with false positive and negative results. 

Sometimes the drug will only cause a reaction under specific circumstances. For example, amoxicillin when given in glandular fever may trigger a generalised rash, while tetracycline in association with direct sun exposure may trigger a rash. 

Only penicillin, amoxicillin, sulphonamide and cephalosporin allergy can be checked by skin and RAST testing, and in such cases still has only 50 per cent reliability. 

To confirm an allergy to a drug, intradermal skin testing, followed by drug provocation tests (DPT) in hospital, is needed. This is time-consuming and expensive, and may trigger a severe allergic reaction. A blood test called tryptase can confirm an allergic reaction has taken place if done immediately.

Patch tests on the skin can test sensitivity to certain skin medications such as local anaesthetics, neomycin, lanolin and paraben preservatives.

Preventing drug allergies

If you're allergic to a member of a family of drugs such as penicillin or aspirin, all other members of that family should be avoided unless negative provocation challenge tests have been performed.

If you're allergic to penicillin, use the erythromycin family of antibiotics instead. The same goes for allergy to anti-inflammatory medication such as ibuprofen - only use paracetamol.

It's possible to have an allergic reaction to almost any drug, including paracetamol, so only use medication if absolutely necessary or if it has been specifically prescribed to you.

Additives such as colourings and preservatives are used in the manufacture of drugs (just as they are in foods) and occasionally these (rather than the antibiotics itself) can cause an allergic reaction. 

All additives used within the European Community are an E number, but unfortunately different manufacturers may used different additives or E numbers when making the same type of antibiotic. If you have an allergy to an E number the only way to be sure that a medicine (or processed food) is safe, is to check exactly which E numbers are contained in it. 

Never use someone else's medication unless you have taken medical advice and are sure it's safe to use.

Occasionally, when it's vital that a penicillin-allergic person receives penicillin, 'rush' penicillin immunotherapy or desensitisation may be undertaken in a hospital ITU unit. 

This involves injecting the person with penicillin, starting with minute traces and doubling the dose every few minutes until a state of tolerance is achieved and the full dose can be administered safely. This is a dangerous procedure, but if the health risks of the disease outweigh the allergy, it may be necessary.

Latex allergy

Latex protein from the rubber tree has many uses, especially in the medical environment. Latex allergy affects about ten per cent of healthcare workers and can cause allergic conjunctivitis, contact dermatitis, hives, allergic rhinitis, asthma and even anaphylaxis within minutes of exposure.

Reactions may occur when blowing up a balloon or wearing rubber gloves or even using a latex condom. Latex can also be found in rubber handles, shoes, baby bottle nipples, dummies, clothing elastic and a host of medical equipment. 

Some people are so highly sensitive to latex they develop allergies to latex-related foods, such as avocado, kiwi, banana and chestnuts. 

Testing can be done by RAST, skin-prick and challenge tests. There are a number of alternative latex-free products such as neoprene, vinyl and plastic, and latex is slowly being phased out of rubberised goods.

If you have a latex allergy, make sure you inform your GP, dentist and surgeon and wear a MedicAlert bracelet.

Salicylate intolerance

In certain genetically predisposed people, aspirin (salicylate) and related non-steroidal anti-inflammatory medications (ibuprofen, diclofenac, mefenamic acid and indometacin) cause allergy-like reactions by blocking a certain metabolic pathway in the body.

This leads to an excessive production of leukotriene inflammatory chemicals in the blood. These leukotrienes can trigger asthma attacks in adults, cause urticaria and angioedema swelling, and encourage the growth of nasal polyps that block the nose and cause chronic rhinitis.

About 20 per cent of asthmatic adults are sensitive to aspirin (otherwise known as salicylate). Dietary salicylate naturally occurs in berry fruits, spices and strong tea, and if taken in excess may aggravate symptoms in salicylate-sensitive people.

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Coeliac disease

Causes of coeliac disease

Coeliac disease is caused by a reaction to gluten, a protein found in wheat, and other similar proteins found in rye, barley and oats. These proteins damage the small finger-like projections (villi) that line the small intestine and play a significant role in digestion. When damaged and inflamed, the villi are unable to absorb food properly, which often causes diarrhoea and malnutrition.

Symptoms of coeliac disease

Diarrhoea is one of the most common symptoms to affect people of all ages with coeliac disease. 

Children may not gain weight or grow properly, while adults may find they lose weight. Malabsorption can also leave people tired and weak, because of anaemia caused by iron or folate deficiency.

Other possible symptoms include mouth ulcers, vomiting and abdominal pain. An itchy rash on the elbows and knees, called dermatitis herpetiformis, may occur.

Possible long-term problems include infertility, osteoporosis and bowel cancer.

Who's affected by coeliac disease?

The average incidence in the UK is one in 100 people and men and women seem to be affected equally. 

The condition runs in families and was once thought to affect only children. However, many adults are now being diagnosed with the disease. It's particularly common between the ages of 30 and 45. 

Coeliac disease is more common among people with type 1 (insulin-dependent) diabetes, autoimmune thyroid disease, osteoporosis, ulcerative colitis and epilepsy. 

People from the west of Ireland are more often affected, as are those from the Punjab region of India, Pakistan, the Middle East and North Africa.

It's important to consult your GP if you suspect coeliac disease. It's possible people who think they have wheat intolerance may have undiagnosed coeliac disease.

Preventing coeliac disease

Breastfeeding and delaying the introduction of foods containing gluten until after four months may prevent children from developing coeliac disease, but there's no definitive way to stop it developing.

Diagnosing coeliac disease

A specialised blood test has been developed to help doctors decide whether or not a patient has coeliac disease. 

In the past, anyone suspected of having the condition would've had a biopsy taken from the intestine by a hospital specialist. Although this is still necessary to confirm diagnosis, it's usually only done when the blood test has demonstrated that coeliac disease is the likely cause of symptoms.

Treatments for coeliac disease

There's no cure for coeliac disease, but it can be controlled by following a gluten-free diet for life. This allows the damaged villi to recover and nutrients can then be absorbed normally again and symptoms disappear. 

The risk of someone with coeliac disease developing bowel cancer is believed to be no more than that of someone who doesn't have coeliac disease, provided they stick to a gluten-free diet.

It's essential to consult a dietician to understand which foods are gluten-free (fruit, vegetables, fresh meat, fish, cheese, eggs, and milk) and which contain wheat, barley and rye, and should be avoided or replaced with products such as rice or corn flour. Recipe books and gluten-free foods are readily available. 

Regular tests are recommended to check for osteoporosis, so that appropriate treatment can be given if necessary. A diet rich in calcium and vitamin D and regular weight-bearing exercise are essential to help prevent osteoporosis from developing.

Scientists in the UK are studying the effects of gluten on the intestine. In future, it may be possible to block the damaging effects of gluten on the gut, so people with coeliac disease are able to eat any food they wish.

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Food allergies

Common food allergies

In children, common allergy-provoking foods include cow's milk protein, egg white from hens, wheat, soya bean, cod fish and peanuts.

In adults, nuts including Brazil, almond, hazelnut, peanut and walnut are common allergens. Seafood such as fish, mussels, crab, prawn, shrimp and squid may also cause allergic reactions.

Localised oral allergies may occur in young adults in association with silver birch tree pollen allergy. They get an itchy mouth and throat on eating certain fresh fruit (apple, cherry, peach and nectarine), raw vegetables (carrot, celery and potato) and nuts. 

Symptoms of food allergies

Typically, an immediate food allergic reaction will involve the immune system. Within minutes, traces of the offending food in the diet can trigger generalised rashes, itching, diarrhoea, vomiting, swelling of the lips and soft tissues, breathing difficulties and even shock.

Peanut anaphylaxis is a good example where traces of the food are absorbed in the mouth or intestine. This leads to the rapid release of histamine from cells and allergic tissue swelling.

Delayed reactions to food may also occur, which can aggravate eczema in infants. Coeliac disease is a delayed immune reaction to the gluten part of wheat. 

This damages the intestinal lining, resulting in abdominal bloating, discomfort, diarrhoea or constipation. It also decreases absorption of essential foods from the intestine resulting in anaemia, lethargy and nutritional deficiencies. These changes may be subtle and can easily be missed.

Food intolerance

Food intolerance reactions are of slower onset than allergic reactions, don't involve the immune system and aren't usually life threatening. They're often called pseudo-allergic reactions.

Lactose intolerance, for example, is the inability to digest the cow's milk sugar lactose, caused by deficiency of the sugar-digesting enzyme lactase in the intestine. 

This is common in people of southern European or African descent and results in smelly diarrhoea, pain and bloating after drinking cow's milk or taking in dairy products. Lactose intolerance doesn't cause rashes, weight gain or lethargy.

Natural histamine may be absorbed too rapidly from food in the diet and effectively lead to a histamine 'rush' with headaches, palpitations and flushing that mimics an allergy.

Then there are adverse reactions to chemical preservatives and additives in food, such as sulphites, sodium benzoate, salicylate, monosodium glutamate (MSG), caffeine and tartrazine.

These reactions are usually dose-related, with small amounts of the food being tolerated but larger amounts leading to reactions such as urticaria, flushing, abdominal pain, vomiting and diarrhoea.

Food toxicity and aversion

Natural poisons occur in some foods, such as mushrooms and potatoes. Bacteria in putrefying meat and fish can cause toxic food poisoning.

These reactions occur in all people who consume the toxic foodstuff and don't involve any digestive intolerance or an immune reaction.

Some people have a food aversion and convince themselves, with no sound basis, that they're 'food allergic' and will vomit if given the particular food. If the food is concealed or hidden, they consume it with no ill effects. 

Their reaction is psychological and it can be difficult to convince them that they're not allergic to a particular food.

Diagnosing food allergy and intolerance

Food allergy can be diagnosed by means of skin-prick tests to various foods or by a RAST (radioallergosorbent test) on a blood sample. Skin testing with fresh food extracts is more accurate. 

The gold standard in food allergy testing is the double-blind placebo-controlled food challenge (DBPCFC) under careful supervision in a hospital, but it is time consuming and costly.

If no food can be identified, but an allergic reaction is strongly suspected, an elimination diet lasting two to four weeks should be instituted. This involves eating only a limited number of foods that are unlikely to cause allergies, such as lamb, rice, pears and sweet potato.

Once the allergic symptoms settle, foods are slowly reintroduced one at a time to identify the offending substance. This should only be done under the supervision of a dietician, as children can end up in a state of malnutrition on a prolonged restriction diet.

Food intolerances to pseudo-allergens are difficult to diagnose as there are no reliable blood or skin tests available. 

Preventing food allergies

For high-risk families (those with severely allergic parents or siblings), it's recommended pregnant women avoid cigarette smoking and prepare to breastfeed exclusively.

Exclusive breastfeeding seems to reduce the incidence of allergies, especially allergic infantile eczema.

Although in the past doctors have advocated that breastfeeding mothers avoid allergenic foods such as cow’s milk, hen's eggs and nuts, as traces may appear in breast milk, recent studies indicate it makes little or no difference to allergies what the mother consumes in her diet while pregnant or breastfeeding.

Expert allergists and consultant dieticians have pointed out that avoiding all potentially allergy-provoking foods after weaning is more likely to cause malnutrition and less likely to have any long-term benefit for preventing allergies.

There's good evidence that exclusive breastfeeding for the first four to six months has some allergy-protection effects, but avoiding potentially allergy-provoking foods such as cow's milk, hen's egg, wheat, soy, fish and nuts in the infant's diet beyond this period offers no benefit to the allergy-prone child.

Infant dietary advice has been a controversial area of allergy and, despite previous recommendations to avoid cow's milk and eggs in the first year and peanuts or nuts for up to three years, the current evidence indicates this practice will have no beneficial effect in preventing allergy.

A healthy, nutritious diet is more important for a growing child and avoiding certain basic foods offers no benefit to the allergy-prone child unless he or she has a diagnosed food allergy. But it's prudent to slowly introduce new foods one at a time into a baby's diet and if any adverse reaction is noted (such as rashes, swelling or vomiting), immediately discuss this with your GP or practice dietician who may then refer your child for appropriate food-allergy tests.

Once a food allergy has been confirmed, the most effective preventive treatment is complete avoidance of that food. If the food can't be avoided, oral sodium cromoglicate may be taken continuously, but it is expensive and only moderately effective in preventing adverse food reactions.

Sodium cromoglicate is very safe and can be bought without prescription.

Dietary diary

Before visiting your GP or an allergy clinic, it's important to keep a detailed diary of all foods consumed and symptoms over a two-week period. This should list all meals, snacks, drinks, medication and supplements taken. Any allergy symptoms should be recorded with a note of time and intensity. 

The allergy clinic nurse or dietician will go through the diary with you, looking for a pattern of reactivity and causal relationship of symptoms to foods and drinks. 

This diary and your personal allergy history are important in directing allergy tests to the correct culprits. Allergy testing without a good personal allergy history is usually unhelpful and often leads to an incorrect food-allergy diagnosis. 

Simple elimination and restriction diets

In suspected food allergy, with the aid of your detailed food diary and symptoms, you'll often be able to isolate a particular food as the cause of your allergy. It's then recommended you eliminate all sources of that foodstuff for two weeks to confirm diagnoses.

If your assumption is correct, elimination of that food should lead to full symptom relief and reintroduction of that food should bring the symptoms back. If that doesn't occur, you have implicated the wrong food and need to consider other possible culprits. 

If cow's milk is eliminated from the diet, calcium needs to be supplemented in growing children. Glucose (as in sugar) doesn't provoke allergies and shouldn't therefore be eliminated from the diet. 

Sometimes children and adults may have typical food allergy symptoms attributed to meals, but despite keeping a thorough food diary remain unable to identify any culprit foods. A short, two-week 'hypo-allergenic' or restriction diet is then recommended. This contains only foods that are unlikely to cause allergies. 

If this diet is continued beyond two weeks, calcium, vitamins and essential oils need to be supplemented under the supervision of a qualified dietician. Such diets will lead to malnutrition in infants and small children and should only be done under medical supervision.

A typical restriction diet includes:

• Meat - chicken, turkey or lamb
• Rice - cooked rice, rice cereal, rice cakes, fortified rice milk
• Cooked vegetables - sweet potato, carrot, squash, parsnip, beetroot, asparagus
• Cooked fruits - cooked or stewed apricots, apples, pears and peaches
• Fresh juices - dilute fresh grape and apple juice or bottled water

Avoid all food additives, preservatives and added colourings.

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Eczema

Atopic dermatitis

This condition (also called atopic eczema or infantile eczema) affects people with dry and rough skin (keratosis pilaris) and may be caused by a variety of allergens. It often starts in early childhood, around three months of age, and tends to run in atopic families.

Possible causes include:

• Food allergy, which plays an important role in children under one year but not in adults
• Cow's milk, hen's eggs and peanuts are the foods most likely to exacerbate infantile eczema
• House dust mites tend to aggravate eczema in older children and adults
• Pet dander exposure, such as to cats, dogs and other furry animals, may play a role
• Certain bacteria may cause sudden, severe outbreaks of eczema

Contact dermatitis

This condition affects mainly adults. It occurs on skin contact with a chemical substance and takes 24 hours to develop.

There are two types of contact dermatitis:

• Allergic contact dermatitis - the skin becomes sensitised to something over a period of time and an allergic reaction occurs on re-exposure
• Irritant contact dermatitis - occurs when the skin comes in contact with something that strips away its natural oils and makes the skin red, dry, cracked and itchy

Irritant contact dermatitis is not an allergy.

An estimated one in 12 adults and one in five school-age children have eczema. According to the Health & Safety Executive, occupational dermatitis (irritant contact dermatitis caused by sensitivity to substances at work) accounts for up to a third of all working days lost by British industry.

The most common causes of allergic contact dermatitis are:

• Nickel in jewellery and on clothing fasteners and studs
• Rubber and building materials such as cement, solvents and glues
• Ingredients found in cosmetics, hair dyes and perfumes

The most common causes of irritant contact dermatitis include:

• Soaps, detergents and fabric conditioners
• Shampoos
• Disinfectants and bleaches

Eczema symptoms

In mild cases, eczema is nothing more than a slightly irritating patch of sore skin, but in severe cases extensive areas of skin may become inflamed and unbearably itchy. 

Some people with these symptoms develop problems such as depression with low self-esteem, and have difficulty coping at school or work. 

 

People with eczema are also more prone to herpes, skin fungal and wart infections.

Up to half of all babies with widespread atopic eczema will later develop asthma and rhinitis as the eczema improves. This phenomenon is referred to as the 'allergic march'.

Diagnosing the cause of eczema

If you have contact dermatitis, you must try to identify the cause so you can avoid it. Patch testing with various chemicals can help in this. 

If you have atopic eczema, you may be able to find out what you're allergic to by having special skin-prick tests for environmental and food allergens. Once an allergen has been identified, practical steps can be taken to avoid it.

Eczema treatments

Completely avoid the substance that triggers the eczematous rash and treat any existing rash with medium potency steroid ointments and moisturising emollients. 

Atopic eczema is usually a little more difficult to treat and you may need to try a number of different treatments, or a combination of treatments, before finding which one works best for you. 

People with atopic eczema should bath regularly using liberal amounts of emollients (moisturising creams, ointments, lotions and bath oils) to soften and hydrate the skin. Ointments work much better than creams on dry eczematous skin, but are greasy. 

Avoid perfumed moisturisers and those with added lanolin.

Outbreaks of eczema should be treated with adequate amounts of steroid ointments to reduce skin inflammation. These will only make the eczema better if used continuously for five to seven days.

Don't be afraid to use steroid ointments - they'll clear the eczema so moisturiser can continue to protect the skin. Moisturisers and creams alone won't settle active eczema.

You may be given antihistamine medication to make your skin less itchy. This should also help you to sleep better at night by reducing itching. In severe atopic eczema, you may be given a short course of oral steroid tablets to get the inflammation under control. 

Antibiotics may occasionally be needed to treat impetigo and eczema flare-ups caused by staphylococcus and streptococcus bacteria. 

'Wet wrapping' is sometimes used overnight, particularly on children, if emollients and steroid creams alone are not effective. The treatment involves applying wet tubular bandages over emollients and steroid creams to aid their absorption. It also helps to relieve itching and prevent scratching. 

Evening primrose oil (or gamolenic acid) has been used to treat atopic eczema, but with disappointing results. 

Some results from trials using Chinese herbal medicine to treat eczema have been encouraging, but it's important to remember that just because a treatment is 'herbal' or 'natural' doesn't mean it's safe for everyone. 

Reducing intake of histamine-containing foods, such as tomato, berries, strong cheese, chocolate, Marmite and dark-meat fish, may reduce itching and redness.

Newer non-steroidal eczema creams, called tacrolimus and pimecrolimus, seem to be effective for clearing eczema on sensitive skin such as the face, and have no steroid side-effects. 

There's mounting evidence that supplementing probiotic 'good bacteria' in a child's early diet will reduce the risks of developing eczema. Adding omega-3 essential oils to the diet may also be beneficial.

If you have atopic eczema you may find the following useful:

• Take lukewarm baths with emollients, but don't stay in the water too long
• Pat the skin dry with a towel - never rub eczematous skin dry
• Avoid soap, detergents and shampoo - use aqueous cream instead of soap
• Wear cotton fabrics next to your skin - avoid wool and polyester
• Wear loose rather than tight-fitting clothes
• Clip your fingernails and don't scratch or rub your skin
• Avoid sports that make you sweat a lot
• Try to stay calm and relaxed because stress can make eczema worse

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Anaphylaxis

Causes of anaphylaxis

No one's sure why some people get anaphylaxis and others don't. It usually happens to people who are known to have an allergy. The most common cause is eating a food to which you're allergic. 

Peanuts and tree nuts (such as almonds, Brazil nuts, hazelnuts and walnuts) are the foods most likely to provoke a reaction. Anaphylaxis can also be triggered by fish, shellfish, eggs and cow's milk. 

Even eating a tiny amount of a particular food can cause anaphylaxis. 

Allergy to from bee and wasp stings can cause anaphylaxis too, as can allergy to latex rubber and drugs such as antibiotics.

Sometimes, anaphylaxis only occurs under certain conditions. Exercise-induced anaphylaxis (EIA), for example, only occurs after increased levels of exercise. One sub-type of EIA, food-dependent EIA, only occurs when a person has eaten a certain food that they are sensitive too and then they exercise - the food or exercise alone does not produce symptoms. 

There are even variations in this - in specific-food EIA a specific food (such as wheat, celery or shellfish) is known to be the offending allergen, but in non–specific-food EIA no specific food is known, but eating any food prior to exercise causes symptoms of EIA. Another type of EIA is medication-dependent exercise-induced anaphylaxis where the reaction is triggered when someone taking certain drugs exercises. 

Certain anaphylaxis-prone individuals are unable to identify any obvious trigger. The anaphylaxis can occur for no apparent reason and is called idiopathic anaphylaxis. 

Symptoms of anaphylaxis

The initial reaction is swelling and itching of the area the allergen has entered. So food initially causes swelling and itching of the mouth and throat, while a wasp sting will cause intense itching and swelling around the sting. In EIA, the skin becomes generally warm, itchy and red. 

A generalised reaction rapidly follows within minutes and a raised itchy rash spreads over the whole body. The face and soft tissues begin to swell and breathing becomes difficult as the throat closes. 

The person becomes very agitated – people describe a 'feeling of impending doom' - and their blood pressure begins to drop. At this point the victim collapses and loses consciousness.

Anaphylaxis in adults tend to affect blood circulation, with loss of pressure and shock. Children tend to develop wheezing and fatal airway obstruction. Food-allergic children with coexistent asthma have a higher anaphylaxis risk.

In anaphylaxis, the symptoms develop within a few minutes of contact with the allergen, so immediate treatment is essential. 

Anaphylaxis treatments

Anaphylaxis requires emergency treatment because the symptoms of respiratory obstruction and shock develop so quickly. An injection of adrenaline must be given to raise blood pressure, relieve breathing difficulties and reduce swelling. 

As long as this is done promptly, people normally recover quickly, but anyone who's had anaphylaxis should go to hospital for observation regardless. They may need further treatment - such as antihistamines, corticosteroids and, occasionally, oxygen and intravenous therapy - when the adrenaline wears off.

Preventing anaphylaxis

If you've ever had anaphylaxis you must be referred to an allergy clinic for full assessment and to identify the cause of the reaction.

If you or someone you know is prone to anaphylaxis, the following precautions should be taken to prevent future anaphylactic reactions:

• Have your own preloaded adrenaline auto-injector
• Carry your medicines with you at all times and make sure you're familiar with how to use them
• Inform other people at home, work or college about your allergy and where you keep your medicines and how they're used
• Make sure your medication is easily accessible and check its use-by date regularly - adrenaline in an autoinjector has a limited shelf life (usually 18 or 24 months depending on the make) and can become inactive fairly rapidly after the use-by date. An out of date adrenaline auto-injector is better than no adrenaline at all but to be sure, you should see your GP regularly to arrange for them to supply you with a new one
• Wear a MedicAlert bracelet or necklace to inform emergency medical staff of your condition

You may need to repeat this procedure with your second auto-injector if there's no improvement of symptoms after five minutes. Do this on your way to A&E.

It's worth knowing that adrenaline auto-injectors are one of a short list of medicines which can be used, in an emergency, on someone other than the person they were prescribed for. So if a person unexpectedly has an anaphylactic reaction, it may help to see if anyone else is carrying adrenaline.

What about future risks?

If you have one anaphylactic reaction, there's no predicting how severe subsequent reactions may be. They may be identical, more or less severe. Coexistent asthma is a risk factor for more severe reactions.

You're unlikely to outgrow anaphylaxis and will need to take constant precautions. Never assume you'll be OK because you haven't had a severe reaction for a long time.

Following food anaphylaxis, check for hidden ingredients on labels and take care with restaurant and takeaway meals. Nuts and eggs, for example, may have a variety of names and are often added to processed foods. It's wise to see a dietician for help with excluding all allergy-provoking foods from your diet.

Not all unpleasant reactions are anaphylaxis. Sometimes panic attacks, hysteria, inhaling a food particle, epileptic seizures, fish toxins, lung clots (pulmonary embolism), fainting spells and heart attacks can closely resemble anaphylactic reactions.

First aid for anaphylaxis

Although emergency medical help is essential, there are things that must be done to improve survival chances. If the person affected is conscious and having breathing difficulties, help them sit up. If they're shocked with low blood pressure, they're better off lying flat with their legs raised. 

If the person is unconscious, check their airways and breathing, and put them in the recovery position. 

If you know that the person is susceptible to anaphylaxis, ask if they carry a preloaded adrenaline syringe. If necessary, help the person inject it into their thigh muscle. Then dial 999 for an ambulance and tell the controller you think the person may have anaphylaxis. If available, antihistamines and steroids should also be given.

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Allergic rhinitis

Causes of allergic rhinitis

More and more people are developing allergic rhinitis because pets and central heating in winter encourage the growth of house dust mites. As a consequence, many people have symptoms all year round, while others have winter seasonal symptoms. As with asthma and eczema, it can run in atopic families.

Perennial allergic rhinitis starts in early childhood and occurs all year round. It's caused by allergy to the aerosolised droppings (faeces) of house dust mites and pet skin flakes (dander). Occasionally, indoor mould spores and, in rare cases, food allergy can be causes. 

Symptoms of allergic rhinitis

The following symptoms can be observed:

• Symptoms of a 'permanent cold'
• Blocked stuffy nose
• Headaches and earache
• Constant sore throats and postnasal drip
• Sleep disturbances and snoring
• Loss of taste and smell
• Poor concentration

Eye symptoms are uncommon.

Allergic rhinitis treatments

Low-dose steroid nasal sprays and nose drops are the most effective treatment, but need to be used continuously on a daily basis throughout the year (unlike in hay fever, when the treatment is only necessary during the pollen season). 

Decongestant tablets and sprays will help relieve a stuffy, blocked nose with catarrh, but can cause rebound blocking and should be used for short periods only . 

Antihistamine medication may help, but it's more effective for hay fever. Low-dose steroid nasal sprays are more effective in perennial allergic rhinitis. An ipratropium nasal spray effectively treats the constantly 'dripping' nose seen in vasometer rhinitis. 

Desensitisation immunotherapy, when available, might be considered in severe house dust mite allergic rhinitis. However, it is less effective than grass pollen desensitisation. 

Preventing allergic rhinitis

The only way to prevent perennial allergic rhinitis is to avoid the allergen that causes it, so allergy testing is important to identify the exact indoor allergen that provokes the allergy.

House dust mite eradication measures can help if special attention is paid to the bedroom:

• Synthetic pillows and duvets are better than feather fills
• Old mattresses harbour up to 10,000 house dust mites, so use mite impermeable barrier mattress covers
• Wash pillow cases and covers at 60°C
• Use a vacuum cleaner fitted with a HEPA filter
• Choose hardwood and laminate flooring, not heavy pile carpets
• Discourage soft toys and clutter
• Regularly air the bedroom to reduce humidity

For severe pet allergies, it's best to remove the pet from the home permanently. Cat allergen spreads in the air throughout the home, even if the cat is restricted to specific areas. 

Although short-haired and female pets carry less dander on their fur, any furry pets can trigger allergies, including rabbits, guinea pigs, hamsters, gerbils and mice.

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First Aid procedures: asthma attack

What is it?

Asthma is caused by a swelling of the airway linings. The airways narrow, causing difficulties breathing out.

Symptoms

• Severe difficulty breathing
• Wheezing
• Distress and anxiety
• Exhaustion from effort of breathing
• Grey/blue skin
• Dry cough

First aid aims

• Ease casualty's breathing
• Get emergency help, if needed

Actions

• If this is their first attack, reassure casualty and help them to relax
• Encourage them to use their inhaler (if available)
• Ask them to breathe slowly and deeply
• Help them to sit down and relax. If indoors, open the windows to ensure a supply of fresh air.
• If the attack does not ease in a few minutes, advise them to take another dose from their inhaler.

Further action

If the attack is severe, or the casualty does not respond to medication, call 999.

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Asthma treatments

Main asthma treatments

There are two main treatments for asthma: preventers and relievers. These come in a variety of delivery devices called inhalers, which enable you to breathe the medicine in through your mouth, directly into your lungs. The addition of a spacer device increases the medication delivered to the lungs.

Asthma preventers

Preventers are designed to quell swelling and inflammation in the airways and reduce mucus. This also reduces the sensitivity of the airways and so minimises potential damage.

The protective effect is built up gradually over a period of about a fortnight. Your medication must be taken daily to maintain protection, even if you are not experiencing symptoms.

Most preventers are based on corticosteroids, usually known as steroids. These are completely different from the anabolic steroids sometimes used by bodybuilders and athletes.

Most common types of preventer are inhaled steroids. These can include beclomethasone, budesonide, fluticasone. Occasionally, if your asthma is acute and severe, you may be given a short course of steroids taken as tablets, or even an injection. There are other non-steroid preventers, usually used for children, such as sodium cromoglycate and nedocromil sodium. They are usually taken three to four times a day and are not generally as effective as steroids.

Many people worry about the side-effects of steroids. High doses taken over a long period can have significant side-effects. For this reason, doctors will be careful to prescribe the lowest possible dose needed to control your asthma.

Potential side effects of asthma preventers

The main side effects are hoarseness and an increased risk of mouth and throat infections caused by thrush, a yeast that lives normally on the body's mucous membranes.

Using the inhaler before brushing your teeth and rinsing your mouth out afterwards helps to avoid this. Using a 'spacer' makes it easier to inhale the drug, and so helps reduce the risks of steroids being absorbed into your body.

Asthma relievers

Relievers are drugs that relax and open up the airways - medically known as bronchodilators - making it easier to breath. These are prescribed for the relief of asthma symptoms during an actual asthma attack, when peak flow readings are low and before exercise or activity to reduce the risk of an attack.

Because these drugs do not reduce swelling and inflammation of airways, you may also need to take a preventer.

Some relievers alleviate symptoms almost instantly (rescue relievers). Others have a longer lasting action (long-lasting relievers). The latter may be prescribed if wheezing, breathing difficulties and coughing persist despite using a preventer and a rescue reliever - or if symptoms come on in the night - nocturnal asthma.

Common rescue relievers are salbutamol and terbutaline. Another type of reliever (most often prescribed for babies under two and for older people) is called ipratropium bromide.

Long-acting relievers include oxitropium, salmeterol, and eformoterol, all of which are inhaled. Occasionally, theophylline-based drugs are taken by mouth, so tablets may be prescribed.

Potential side effects of asthma relievers

Side effects are usually mild and pass away quickly. The main ones are a slightly increased heartbeat, and muscle trembling, especially in the hands. Some oral relievers may cause dry mouth, blurred vision, difficulties passing urine, or constipation. Theophylline-based drugs, which relax the muscles in the walls of the airways, can occasionally cause nausea, more rapid heart rate, a nettle-like rash, dizziness, nervousness, headaches, irritability or restlessness.

Always report any unusual symptoms to your doctor.

Inhaled asthma medication

Most asthma treatments are inhaled. There are several different types of inhalers, but the main ones are aerosol-based (often called puffers) and dry powder inhalers.

• Puffers - the medication is mixed into a liquid and forced under pressure into a small aerosol canister. Once activated (usually by pushing down the canister, although breath activated devices are increasingly available) the liquid evaporates, leaving the active ingredient that you inhale. A measured dose of the drug is released every time the canister is pushed down. Both relievers and preventers can be given via a puffer.
• Dry powder inhalers - the drug that comes in dry powder form is contained in a capsule. When the device is activated, the capsule breaks and the powder may be inhaled. In some inhalers the powder is contained inside a disk or compartment.
• Spacers - because it can be hard to coordinate your breathing with an inhaler, you may be prescribed a spacer. This device allows more medication to enter your lungs than would be possible using an inhaler alone. It's usually a large plastic chamber in two halves, which click together, with a mouthpiece at one end and a hole at the other end where the inhaler is attached. The drug is released into the spacer chamber from the inhaler device, and then enters your body as you breathe in through the mouthpiece.
• Nebulisers - a machine in which air or oxygen is forced through the liquid form of a drug, creating a mist, which is then inhaled through a mask or mouthpiece. It's used to administer high doses of reliever in an emergency and sometimes for children who are too young to use an inhaler.

Other asthma medication

There are a number of medicines that are taken in pill form, including eukotriene receptor antagonists, theophyllines and steroids . Your doctor will be able to advise you when and why these may be necessary for you.

If your asthma is really bad, your doctor may also prescribe a short course of steroid tables to calm down your inflamed airways.

New anti-inflammatory tablet-form medication for asthma includes the leukotriene receptor antagonists. These are particularly useful for brittle asthma and those with aspirin-sensitive asthma.

Omalizumab is a new injection treatment for asthma that works by dampening down the allergic reaction in those with severe persistent allergic asthma.

Dealing with an asthma attack

• Remove yourself from any conditions or situations that trigger your asthma. Treatment is not as effective in the presence of a trigger.
• Take a couple of puffs of your reliever (usually the blue inhaler) , using a spacer if you have one. Stay calm and relaxed and breathe slowly to reduce fatigue.
• Rest sitting up. It's harder to breathe lying down. Loosen any tight clothing. Rest your hands on your knees to help support your back.
• If you have no immediate improvement, take another puff of your reliever inhaler every minute for 5 minutes or until symptoms improve.
• Wait five to ten minutes to see if the attack eases. Measure your peak flow to see if your reading is improving. If it does, you can resume what you were doing. If the reliever has not taken effect within 15 minutes, call your doctor or call an ambulance on 999. Carry on using the reliever every minute until help arrives.

Never put off seeking medical help because of fear of making a fuss or being a nuisance.

Hospital treatment for asthma

If you need hospital treatment, take your medication (and your asthma management plan, if you have one) with you. The doctor will need to know what steroids you have taken, whether you used a nebuliser and if you are taking the drug theophylline.

On arrival, the doctor will examine you and check your pulse, oxygen saturation blood pressure and peak flow, and listen to your chest. You may also have a test to check blood levels of oxygen and carbon dioxide.

Treatment will usually begin with a nebuliser to improve your peak flow reading. If you have to be admitted, a chest x-ray may be done to check for damage to your lungs. On the ward, you'll probably have nebulised bronchodilator treatment and steroid injections. Oxygen may be needed and, in severe cases, artificial ventilation.

Helping someone having an asthma attack

If you're with someone who is having an asthma attack, try to stay calm. Make sure they take their reliever medicine. Listen to them, reassure them and encourage them to breathe slowly and deeply. If the person has a peak flow meter use this to monitor their condition.

Don't try to lie them down as this constricts the breathing passages. If the reliever has no effect after five -ten minutes, or if the peak flow meter falls to less than 50 per cent of the expected reading, you should call a doctor or ambulance immediately. You should also do this if the person becomes distressed or unable to speak properly.

Call for medical help immediately if the person's:

• Symptoms worsen even after taking medication.
• Peak flow number decreases or doesn't improve after treatment.
• Breathing becomes increasingly difficult and the chest and neck are depressed with each breath.
• Having difficulty walking or talking and has to stop what they're doing.
• Lips, tongue or fingernails take on a blue or grey tinge.

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Asthma triggers

Identifying asthma triggers

Trigger factors, such as allergens and activities, can bring on asthma symptoms. Some triggers involve specific irritants, such as cigarette smoke, certain foods or chemicals, while others are non-specific, such as cold air, exercise and emotions.

Often more than one trigger is involved. For example, if you're sensitive to certain foods, these can make your bronchi more sensitive, if you then breathe in cigarette smoke it can trigger an attack.

A good way to identify your triggers is to keep a diary and write down any symptoms (such as cough, wheeze, difficulty breathing, peak flow readings) together with any potential triggers you've been exposed to (such as traffic fumes, a change in the weather, a cold or cough).

Show these notes to your doctor or practice nurse. You may also wish to ask your doctor about allergy testing as it may be useful.

Knowing how to avoid your triggers can help you to reduce the likelihood and intensity of an attack. If your asthma is caused by an allergy, you may be able to find out what you're allergic to by having special tests such as skin prick testing to common allergens, and then taking practical steps to avoid the allergen.

Remember, never stop taking your preventer medication, even when your symptoms are stable.

Airborne irritants

Any substances you breathe in can become an allergen. These might include:

• Traffic fumes
• Smoke from cigarettes, bonfires and incinerators
• Animal dander, for example from dogs and cats
• House dust mites
• Pollen, from trees and grasses
• Industrial fumes, especially those containing sulphur dioxide
• Paint fumes
• Household chemicals, such as those found in air fresheners and aerosols
• Natural gas, fumes from cavity wall insulation
• Perfumed cosmetics
• Strongly scented flowers

Asthma and cigarette smoke

Cigarette smoke contains a number of different chemicals and gases that can irritate the lungs. The more inflamed your lungs, the greater the risk cigarette smoke will make your symptoms worse.

Some ways to reduce the effects of cigarettes:

• Stop smoking - this is especially important if you're a parent or planning to have a baby. Children whose mothers smoke are more likely to have asthma
• Avoid passive smoking as best you can
• Always have your reliever with you
• Ask people not to smoke in your presence, especially if you start to develop asthma symptoms

Asthma and cold air

This is a non-specific trigger. Changes in air temperature, especially going from a warm room into cold air outside, often provoke symptoms. You could try to do the following:

• Take a couple of puffs of your reliever before going outside
• Cover your mouth and nose with a scarf
• Use your preventer exactly as prescribed to reduce the risk of attacks due to cold air

Asthma and exercise

Some asthmatics find exercise brings on an attack and may need to use their reliever before starting any exercise.

Asthma and drugs

Certain prescription and over-the-counter drugs may trigger asthma attacks. They include aspirin and non-steroidal anti-inflammatory drugs such as ibuprofen and beta blockers used to treat heart disease and glaucoma. You should:

• Avoid drugs that may cause asthma symptoms
• Always remind your doctor about your asthma when being prescribed drugs
• Tell the pharmacist you have asthma if you're buying over-the-counter drugs

Asthma and emotions

Crying, getting excited or upset, and even laughing can all trigger symptoms, especially in small children. Using your medicines as recommended by your doctor will help you avoid problems.

Asthma and house dust mites

These tiny animals live on discarded flakes of human skin. Although some people with asthma react to the mites themselves, most are sensitive to the layer of protein that covers the mites' faeces.

Old sofas, armchairs, mattresses and fitted carpets all harbour mites, which thrive in the warm, damp atmosphere of today's centrally heated homes.

Although it's impossible to eliminate house dust mite dung entirely, there are many things you can do to reduce it:

• Hard floors, such as lino, wood or tiles, are easier to clean and keep dust free than carpets
• Rugs should be washed regularly and hung out to dry in the sunshine
• Special mattress and pillow covers are available
• Wash blankets and duvets regularly and hang outside to dry
• Air your bedroom daily by opening windows to reduce moisture levels, and wash curtains regularly
• Soft toys should be washed and dried (preferably) in a tumble dryer. Placing them in a plastic bag in your freezer, one day a week, will also help reduce the number of mites.

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What is asthma?

Asthma affects the small airways (bronchioles) that carry air in and out of the lungs. If you have asthma your airways can become inflamed, swollen and constricted (or narrowed) and excess mucus is produced.

More than 5.2 million people in the UK are being treated for asthma and about 1.1 million of these are children. Asthma affects approximately one in 12 adults and one in eight children in the UK. This means there is a person with asthma in one in five households in the UK. It can affect almost anyone, at any age, anywhere although it tends to be worse in children and young adults.

Asthma is becoming increasingly common in the developed world and is now the most common chronic condition in the west. Aspects of the modern environment that are thought to be contributing factors include:

• Air pollution
• Processed foods
• Centrally heated and double-glazed houses (ideal breeding grounds for house dust mites)

Asthma symptoms

An asthma attack describes the symptoms of tightness in the chest, a wheezing or whistling noise in the chest, coughing and difficulty breathing that occur when the airways become narrowed, inflamed and blocked by plugs of mucus.

An attack can occur suddenly. However, many people with asthma learn to recognise the warning symptoms - such as an itchy nose or itchy skin, dizziness or light-headedness, or an irritating cough.

Learning the warning signs can often alert someone with asthma in time to take preventive action.

Asthma is a chronic condition, which means attacks occur over a long period of time. Although there are times when acute episodes strike asthmatics, most people can say there are long periods during which they have few, if any, symptoms.

The main symptoms of asthma are:

• Coughing
• Wheezing
• Shortness of breath
• Tight feeling in the chest

Causes of asthma

Asthma has many different causes, but scientists still don't know exactly what these are. You may have oversensitive airways, a family history of asthma or be allergic to one or more asthma triggers.

Some doctors believe the airways become oversensitive because cells in the lungs are damaged by viruses. Others believe the initial damage is caused by an allergic reaction causing the lungs to overreact to viral infections.

One of the most common predisposing factors for asthma is an allergy to:

• House dust mites
• Mould spores
• Pollen
• Pets
• Food allergies

Most people find there are several things that can trigger their asthma.

Genetics and asthma

Asthma tends to run in families that are prone to allergies. So, belonging to a family where some members have asthma and others have other allergies, such as eczema, hay fever or allergic rhinitis, makes a person more likely to have asthma themselves.

However, because there are so many factors involved, it can be difficult to predict exactly who in a family will develop the condition.

Although asthmatic and allergic tendencies are inherited, there is no single gene involved. Rather, there are a number of different ones that react with factors in your environment to trigger the onset of asthma.

Scientists are searching for the genes involved in asthma that may eventually lead to a cure.

Environmental factors and asthma

Environmental factors that increase the risk of developing asthma include:

• Exposure to allergens during pregnancy (for example from foods in the mother's diet) that sensitise the unborn baby's immune system
• Infections such as colds during early life
• Being brought up in a house where there is a pet (especially a cat)
• Being introduced to certain foods such as cow's milk and eggs at a young age
• Being born at a time of year when the pollen count is high
• Being exposed to cigarette smoke in the uterus or early life - babies whose mothers smoke are twice as likely to develop asthma
• Air pollution

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Allergic asthma

Causes of asthma

Asthma often runs in atopic families. Children are also more likely to develop asthma if their mother smoked during pregnancy or while breastfeeding. 

Most people find several things trigger their asthma. Some of the most common predisposing factors for asthma are allergies to:

• House dust mites
• Mould spores
• Pollen
• Pets
• Food or food preservatives

Asthma triggers include:

• Viral infections, such as colds and flu
• Cigarette smoke
• Certain forms of exercise, such as running
• Exposure to cold, dry air
• Laughing and other emotions
• Medication containing aspirin
• Drinks containing sulphur dioxide, such as squashes and lemon barley water

Symptoms of asthma

The main symptoms are coughing, wheezing, shortness of breath and a tight feeling in the chest.

Asthma treatments

There are two main treatments for asthma:

• Relievers - salbutamol and terbutaline
• Preventers - beclomethasone, budesonide, fluticasone, mometasone and ciclesonide

These come in a variety of delivery devices, such as aerosol or powder inhalers and nebulisers. You breathe the medicine in through your mouth, directly into your lungs.

Relievers are drugs called bronchodilators (based on adrenaline) that relax the muscles which surround the airways, making it easier to breathe. You should take these as directed by your doctor as soon as symptoms appear. 

Taking a dose of the reliever inhaler before exercise will increase your stamina and prevent breathing difficulty.

Preventers are drugs (usually low-dose steroids) that reduce inflammation in the airways and make them less sensitive. This means you're less likely to react when exposed to a trigger. 

The protective effect of this medicine is built up over a period of time, so you must take your preventer regularly, as directed by your doctor. 

Combination preventer and long-acting reliever (formoterol and salmeterol) inhalers have become popular and seem to be particularly good at controlling more severe and persistent asthma.

If your asthma is really bad, your doctor may also prescribe a short course of steroid tablets to calm your inflamed airways.

Newer anti-inflammatory medication includes leukotriene receptor antagonists (montelukast and zafirlukast), which are particularly useful for brittle asthma and patients with aspirin-sensitive asthma.

The most recent addition to the list of possible treatments for asthma is a new injection medication (omalizumab) for those with severe allergic asthma, which works by dampening down the IgE allergic reaction.

An older orally administered bronchodilator, theophylline, isn't often used these days owing to its unpredictable toxic side-effects and need for blood testing.

There is little scientific evidence to support the use of breathing exercises, such as Buteyko, in the treatment of asthma. However, some people with asthma find breathing exercises calm their symptoms and reduce their need for reliever medication.

You can help to avoid asthma attacks by taking preventer medicine regularly and avoiding your triggers. You can also monitor your asthma by asking your doctor to provide you with a peak flow meter, a simple device that measures the amount of breath in your lungs.  

Most childhood asthma is caused by an allergy. Skin-prick and RAST tests may be able to discover the allergen. Practical steps can then be taken to avoid it, be it house dust mites, cats, dogs or other pets. Even mould spores and pollen grains can trigger seasonal asthma attacks. 

If you're prone to sudden or severe asthma attacks, keep asthma diary cards and a peak flow meter on hand to monitor your lung airflow so you can take early action. 

Discuss an asthma action plan with your GP, who may issue an emergency supply of oral steroid pills. You may need to increase your medication dosage if your peak flow measurement drops steadily.

Remember, never stop taking your preventer medication, even when your symptoms are stable. Don't wait until your symptoms get worse - they'll be harder to treat.

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