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Eczema

Eczema is frequently called atopic dermatitis because it was noted to occur in individuals with allergic symptoms, e.g., allergic rhinitis (hay fever) and asthma. The term atopic simply means allergic. Even though eczema was considered to be an allergic problem, allergy seems to be less likely as our understanding of the disease increases. Physicians know that eczema is a very complex disease and contains allergic as well as non-allergic elements in different individuals. As a result, the treatment of every individual may vary.

While the causes of eczema continue to be investigated, certain things are known about the disease. The skin is much more easily irritated than normal skin. Dryness of the skin is a primary component and results in significant itching. Eczema is known as “the itch that rashes”. Itching is made worse by irritants on the skin. Winter months are particularly bothersome because of the dry winter air. Flares in the summer months can occur after exercise because sweat is a significant irritant. Citrus or some vegetables, e.g., tomato, can act as a primary irritant when they touch the skin. Stress in some individuals can affect the skin. While emotional factors may play a role in flaring eczema, they are not considered a primary source of causing the onset of eczema, if it is not already present.

Eczema occurs in about 3% of the population. In about 80% of those individuals, the onset occurs in the first year of life. One-half are free of disease by age 2 years, about one-fourth by the end of adolescence, and the remaining one-fourth will continue to have eczema into adult life. Some individuals do not have the onset of symptoms until adolescence or adulthood.

Treatment is multifaceted and includes lifestyle modification as well as various types of medication. A portion of treatment will be listed in the accompanying tables. Adequate attention to clothing, diet manipulation, and attention to the emotional well-being of the affected patient are very important. It is preferable for a patient with eczema to wear clothing which will not irritate the skin; soft cotton material would be best. The room temperature should be kept moderate with controlled humidity (between 35-50%). Overheating and perspiration should be avoided.

Some investigators believe there is a genetic tendency for eczema with approximately 50% of eczema patients ultimately developing allergic rhinitis and/or asthma. This is compared to about 20% without the presence of eczema. While allergy skin testing and allergy injection treatment are usually helpful in cases of allergic rhinitis and/or asthma, it is generally agreed that this is often not the case with eczema. In some individuals, starting allergy shots for allergic rhinitis and/or asthma may actually result in significant flaring of the eczema.

Prevention

  • Trim fingernails short
  • Cotton gloves at night if needed to decrease scratching
  • Clothing should be double rinsed after washing to remove all residual detergent (irritants)
  • Avoid excessive room temperatures
  • Wear light, non-occlusive clothing (e.g., cotton instead of polyester)
  • Keep the bedroom moderate (cool) and avoid excessive bed clothing
  • Allergen contact or ingestion avoidance (e.g., foods, pets, dust mite) can reduce stimulation of the skin

Treatment

  • Bathing for moisturization, e.g., soaking in tepid water for 30-45 minutes at least once daily and if possible 2-3 times.
  • Within 2 minutes after getting out of the tub, a lubricating cream or ointment should be applied to help hold the moisture in the skin. Examples include Aquaphor, Curel, Moisturel, Eucerin, Keri, Lubriderm, Acid Mantle, Unibase, Vanicream, petrolatum, and chilled Noxzema,etc. Newer medications include Triceram/Certopic, Impruv, Mimyx, Nourica Repair, Cerave, Atopiclair, and Hylira. Some of the newer medications are by prescription only. None of the medications in the above list contain steroids.
  • In general, lotions should be avoided since they contain alcohol which may sting and provide limited moisture.
  • If marked irritation or weeping areas are present, wet wraps with a drying solution (e.g., Burrow’s solution, one tablet mixed in one quart of water is available by prescription) will avoid the stinging or burning sensation that can occur with bathing.
  • Addition of oil or similar substances to the bath water generally has little effect on increasing moisturization.
  • Pat dry with a soft towel; do not “rub” dry since this will remove natural, protective oils from the skin.
  • Showers do not add moisture to the skin and actually remove the protective oils from the skin resulting in increased dryness.
  • Topical steroids are the mainstay of therapy for more severe eczema. Ointments or creams are generally used.
  • Nonsteroidal medications that help the immune system in the skin may be necessary either in addition to or in place of topical steroids if the topical steroids are not adequate for relief. Examples of the nonsteroidal medications are Elidel and Protopic.
  • Antibiotics, topical and/or oral, may be needed if the lesions become infected. An alternative to antibiotics is the use of Clorox baths. One-quarter to one-half cup of Clorox in a full bath provides antibacterial activity that will treat all known bacterial infections. No resistant bacteria to Clorox are known.

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Not a Cold. Not the Flu. It’s Cedar Fever! Who Knew?

Runny nose, coughing, watery eyes – These are the symptoms Tess (not her real name) just couldn’t seem to shake.

The congestion set in after raking leaves.  Her first thought was, “Wow, I have caught a cold.”

But those pesky cold symptoms lingered.  She worried that perhaps she had contracted Covid, as some friends had tested positive for it recently. She felt fine but tested anyhow. Five negative Covid tests later, she was finally convinced it was not Covid.

So, it was not Covid. It was not a cold, and it was not influenza either. What was it?

It turns out the culprit was not a virus at all.  Tess was suffering from something called Cedar Fever.

“Cedar Fever is not really a fever and it is not a virus,” said Maya Gharfeh, MD, FACAAI, FAAAAI. “It is an allergic reaction to pollen from cedar trees, which do grow in abundance in this state and region. For some, the pollen triggers an allergic reaction.”

Most people worry about allergies in the spring and summer, but for some people, like me, allergies can also occur and sometimes be severe in the winter months too.

Cedar Fever

If you live in Oklahoma, Texas, Arkansas or Missouri or somewhere where these trees are common and have a sensitivity to the pollen, you may notice seasonal allergy symptoms from these trees in the winter months.

Millions of cedar trees release large amounts of pollen each year, with pollen production typically reaching a peak in mid-January.  Tree experts know that when it is dry and windy, pollen cones open and release pollen grains. Some people have even captured video and pictures of the pollen clouds blowing off trees. 

What Are the Symptoms of Cedar Fever?

Dr. Gharfeh explained cedar fever is often confused with a cold or flu because of the time of year when it is most prevalent.

Cedar Fever symptoms are like many common allergy symptoms, and may include a runny nose or nasal congestion, itchiness, and sneezing. As the name suggests, some people may notice a warmer body temperature as part of their symptoms.

“We are talking about a mildly elevated body temperature or feeling slightly warm,” Gharfeh stressed. “If you are experiencing a high fever, it is likely that it is something more than allergies and you should see a primary care provider if those symptoms don’t fade.”

Here are a few other symptoms that sometimes occur with Cedar Fever:

  • Sore throat
  • Coughing
  • Difficulty smelling
  • Plugged ears
How Do You Treat Cedar Fever?

Cedar fever should not put you at risk for any health complications, but the symptoms can be uncomfortable.

“As with so many allergies, the appropriate treatment depends upon the patient and the severity of his or her symptoms,” Gharfeh explained.

Common treatments at home may include:

  • Prescription medications
  • Over-the-counter antihistamines
  • Over-the-counter medications

“For some simple over-the-counter medications are sufficient, but if you find that those medications are not enough, it might be time to talk with your doctor or an allergy specialist,” Gharfeh said. “At the Oklahoma Allergy and Asthma Clinic, we have 100 years of experience helping people navigate life with allergies. We are able to help determine the best treatment for your allergies, which may include stronger prescription medications.”

Prevention of Cedar Fever

Gharfeh explained that for those most susceptible to Cedar Fever, avoiding pollen as much as possible can help.  Here are a few strategies that may help:

  • Avoid outdoor activities when tree pollen counts are high
  • Close windows and change air filters often to reduce pollen levels in your home
  • If you need to do yard work, wear a mask to reduce exposure to cedar pollen
  • Vacuum and clean your home regularly to reduce indoor allergens

Tess has learned to watch the pollen counts displayed daily by the official Oklahoma Allergy and Asthma Clinic website, taking precautions when the tree pollen counts elevate, especially to medium (yellow on the graph) or higher.  The clinic’s pollen count is posted daily Monday through Friday and can be found here: https://oklahomaallergy.com/allergy-report/

With a simple pollen count check daily and some allergy medications, Tess finds she is better able to maneuver Cedar Fever season.

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Oklahoma Allergy and Asthma Clinic celebrates its 100th Anniversary this year. Founded in 1925, the clinic has a century of patient-focused, state-of-the-art allergy and asthma care. Today, the clinic is home to 13 allergy and asthma specialists, caring for tens of thousands of patients a year from across Oklahoma, the region and nation.  OAAC also has earned the Better Business Bureau’s Torch Award for Business Ethics, the Oklahoman’s Community’s Choice Award for Top Allergy Clinic, 405 Magazine’s Best OKC Allergy Clinic and the Journal Record’s Reader’s Rankings Award, among others. In addition, the clinic remains a staunch supporter of the community through organizations such as Allied Arts, United Way, the Oklahoma City Philharmonic and Museum of Art, Ronald McDonald House Charities of OKC, Toby Keith Foundation, Positive Tomorrows and more.

The post Not a Cold. Not the Flu. It’s Cedar Fever! Who Knew? appeared first on Oklahoma Allergy and Asthma Clinic.

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