Family Allergy Asthma & Sinus Care is located in Charlotte, NC, (Pineville), Enjoy our Educational Blog:

7/24/2015: Mosquiteos: how to prevent them from biting!

It is mosquito season as I sit on my porch watching these mini-vampires hover over me and my laptop.  The problem with mosquito bites is:

Transmission of infections:

  • West Nile Virus:  last year (2014) there were 1 presumptive viremic blood donor in North Carolina.                            http://www.cdc.gov/westnile/statsmaps/finalmapsdata/index.html
  • St. Louis encephalitis (actually most cases have occurred in Texas) is caused by a bite from a virus-infected mosquito and can cause brain inflammation especially in the elderly.  In contrast, in Western Equine Encephalitis the viral infection is more severe in infants and young children but can also be spread to horses by infected mosquitoes.  There is no vaccine or specific licensed treatment for these infections.
  • In other parts of the world, Dengue fever, Yellow fever and malaria are commonly spread by infected mosquitoes.

Allergic reactions:

  • Most people are sensitized to mosquito saliva from bites during childhood.  The usual skin symptoms are hive- like reactions at the site of the bite or papules (bumps) that occur several hours later.
  • Severe generalized (anaphylactic) reactions to mosquito bites are very rare.
  • Skeeter Syndrome is an intense local allergic reaction to the polypeptides in mosquito saliva.  Frequently there is associated fever and the misdiagnosis of cellulitis (skin infection) is made and antibiotics unnecessarily prescribed.  This reaction is more common in children less than 4 years old.

So, what are our options for preventing mosquitoes from biting us?

The Scientific data on treatments is scarce and most scientific studies have taken place in the laboratory as “arm in the cage” testing rather than in the field as a real life scenario.

Vitamin B1 (Thiamine):  100 mg (1000x the usual daily dose of Vitamin B1) of this water-soluble vitamin once a day can repel mosquitoes from biting for several hours.  According to Stewart Harvey, PhD from Salt Lake City, “the repellent effect is attributed to a foul odor, undetected by humans, unless one smells the bottle. Biting insects, which are attracted by carbon dioxide, are repelled. Mosquitoes, deer flies, horse flies, and chiggers are repelled. It is not known whether arachnids are repelled, although deer ticks seem to be.”  Some of the advantages are less expensive, does not rub off on clothes, well tolerated and non-oily.  Thiamine might not properly enter the body in people who have liver problems or drink a lot of alcohol.  An overdose of over 1000 mg of Vitamin B1 could lead to skin rash, allergic reaction, agitation, insomnia, or heart palpitations.  The only study I found that showed Vitamin B1 did not work was published in 1969.

DEET (N,N-diethyl-3-methylbenzamide): This compound was developed by the U.S. Army after jungle warfare in WWII.  For the past 60 years, this chemical has been effective and with a strong safety record.  In an article from the New England Journal of Medicine in 2002, reports “DEET-based repellents remain the gold standard of protection under circumstances in which it is crucial to be protected against arthropod bites that might transmit disease.”  The chemical is commonly found in mosquito repellents and the duration of action is directly correlated with the concentration.  The higher the concentration, the longer the duration of action.  The American Academy of Pediatrics advises against using repellents with DEET concentrations higher than 30% on any child.

DEET + Permethrin:  For our U.S. military troops, the Department of Defense Insect Repellent System includes DEET-containing repellant applied directly to the skin and permethrin applied to the battle uniform.  This prevents arthropod (insects and spiders) bites.  The permethrin last longer when applied to the battle uniforms than onto the skin.

Picaridin:  this synthetic compound repels insects, ticks and chiggers. It was first made available in the 1980s. It was made to resemble the natural compound piperine, which is found in the same group of plants that make black pepper. Picaridin has been widely used as an insect repellent in Europe and Australia, but only since 2005, has it been available in the U.S.   Picaridin is available as pump spray, wipes, liquids and aerosols. For more information, go to:  http://npic.orst.edu/factsheets/PicaridinGen.html

Botanicals

  • Oil of Citranella:  Some people apply diluted citronella oil directly to their skin to keep mosquitoes and other insects away.  The duration of action however is short, about 20 minutes.  It is also used in tiny amounts in foods and beverages as a flavoring.  In manufacturing, citronella oil is used as a fragrance in cosmetics and soaps.  Citronella oil should NOT be eaten in large amounts (a toddler died after swallowing insect repellent containing citronella oil) or inhaled as it could lead to lung damage.
  • Other essential oils:  Oils of Lemon Eucalyptus, regular eucalyptus, cinnamon and castor have been used as natural mosquito repellants.   There is insufficient data on use in pregnancy, breast feeding and young children and caution must be used as these are potent oils that may irritate the skin and therefore require diluting in products (other than water).

At Family Allergy Asthma & Sinus Care, our goal is to help prevent itching, including itching from bug and mosquito bites.  I hope this information helps keep the pesky mosquitoes from dining on you!

Nickel Allergy

Questions:

  • That rash near the umbilicus (medical word for “belly button”) that is red, itchy and keeps coming back may be related to the snap on those blue jeans or that fancy Montana belt buckle.  This could be a reaction to…
  • Those new ear rings from Uncle Wiggley have resulted in itchy, weeping, oozing reactions on the ear lobes.  This could be from…
  • That cool silvery watch and watchband looks great! Why is there an itchy red rash developing on the wrist?
  • I have braces, headgear and now a rash on my face.  Could it be related to my orthodontic appliance?
  • That widespread rash keeps coming and going.  Could it be from what I’m eating?

Answer:

Nickel.  Allergic contact dermatitis from nickel affects 10-15% of the population worldwide. This type of allergy is called a Type IV T-cell mediated delayed-type hypersensitivity reaction.  Nickel allergy is 2 to 6 times more common in women than men. It is also more common in younger individuals and those without pollen or food allergy. The skin reaction occurs at sites where the skin contacts nickel contained in many metals including:

  • Costume jewelry, snaps, necklaces, belt buckles, watches and watchbands, and eye glasses
  • Coins (a nickel contains 25% nickel and 75% copper); during WWII there was NO nickel in nickels-needed for war effort!
  • Cosmetics
  • Orthodontic appliances and wires
  • Foods: nickel occurs in elevated amounts in legumes, nuts, seeds, grains, potatoes, dark chocolate/cocoa powder and fish.  Levels may be especially high in canned fruits, vegetables, meats and fish.  Tap water and some vitamins contain nickel.

I hope this blog was a nickel’s worth of free advice!

Spilling the beans on bean allergy!
Do beans agree with you?  If not, read on.  Beans are just one type of edible legume.  Other well known legumes include alfalfa, clover, peas, lentils, lupins, mesquite, carob, soybeans, peanut, tamarind and the woody climbing vine wisteria.

While there are over 40,000 types of beans in the gene banks, a small number of bean varieties are used for human consumption.  The common bean belongs to the genus/species Phaseolus vulgaris which includes pinto bean, kidney bean, black bean and green bean.  Other common beans are the fava (broad) bean (Vicia faba), lima bean (Phaseolus lunatus), and chickpea or garbanzo bean (Ciser arietinum).  Beans are an important source of protein and proteins are responsible for triggering allergies!  Interestingly, as common as beans are in the human diet, allergic reactions are uncommon.  Even though peanuts are legumes, in a U.S. study performed years ago, only 5% of children with a peanut allergy had allergic reactions to other beans tested.

In India and the Mediterranean, lentils and chickpeas have been reported to be the most common legume triggering allergic reactions in young children.  Thankfully, no anaphylactic reactions were reported.  Legume allergy, mainly to lentils and chickpeas, is the 5th most common cause of food allergy in Spanish children.  In the U.S., severe bean allergy or anaphylaxis is rare or rarely reported.  Click here to read a case report on bean anaphylaxis in an adult patient:  http://www.jacionline.org/article/S0091-6749(98)70365-3/fulltext#article

Adverse reactions to beans:

  • Allergic: hives and skin reactions are the most common followed by rhinitis and asthma especially in children. Bean anaphylaxis in children has not been published in the medical literature.  There is much cross reactivity between chickpea, lentil and pea but less similarities between these legumes and beans.
  • Non-Allergic: Flatulence or “gas” is the result of the bacterial fermentation of resistant starches or oligosaccharides when the usual enzymes in the gut cannot digest these carbohydrates.  This is very common and although not dangerous can be embarrassing especially in a public setting.

Treatment for Bean Allergy:

As with other food allergies, identifying and avoiding the specific bean and those beans that are cross reactive is the primary approach.  Being ready in case of an accidental exposure with self-injectable epinephrine is of paramount importance in those individuals at risk for anaphylaxis.  Cooked beans can be more allergenic than raw beans and even bean protein inhaled from cooking fumes may trigger an allergic reaction such as asthma.

At Family Allergy Asthma & Sinus Care, we investigate a wide variety of food-induced allergic reactions.  If you suspect you have had allergic reactions to beans (non-flatulent) or any other food, contact us, we can help!

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These educational information does not take the place of your physician's advice.


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