What is the best food for skin allergies
What does serious skin breakdown glance like?
Metal hypersensitivity is a disorder of the immune system. It is a common condition that affects 10% to 15% of the population. It can produce a variety of symptoms, including rashes, swelling, or pain due to contact with certain metals (see the symptoms and complications section, below).
In addition to the local skin reactions, metal hypersensitivity can also manifest itself as more chronic conditions such as fibromyalgia and chronic fatigue syndrome. There are numerous local and systemic symptoms that, when considered together, can be caused by metal hypersensitivities.
It is estimated that up to 17% of women and 3% of men are allergic to nickel and that 1% to 3% of people are allergic to cobalt and chromium.
These types of reactions can be localized reactions that are limited to one area, but they can also be more generalized and affect other more distant parts of the body.
Making the Diagnosis
Your doctor may suspect metal hypersensitivities based on a combination of your personal history and your signs and symptoms. To determine possible causes of metal exposure, your doctor may enquire if you own any type of implants, if you smoke, or if you regularly use any cosmetics.
Aside from a thorough personal history, your doctor may also order laboratory tests to confirm whether you own a metal hypersensitivity.
These tests generally involve giving a blood sample at a laboratory. The laboratory technicians will test the white blood cells for their activity against metal ions by using radioisotopes and microscopically observing physical changes within the cells. If the test shows that the white blood cells own increased activity when exposed to the metal ions, it indicates the presence of a metal hypersensitivity.
A dermatologist can also conduct an allergy test in which they expose various metal ions to your skin to test for a hypersensitivity reaction. This allergy test, which is similar to a regular "scratch test," is often done as a "patch test." The metal ions that are believed to be causing the allergic reaction are applied to a patch, which is then placed on the skin.
The patch is left in put for 48 hours, after which it is removed from the skin at a return visit to the doctor. Skin that is red or irritated under the patch may be an indication of an allergy.
Identifying and treating minor skin breakdown
Is the area of damage under a brace?
If redness persists greater than 20 minutes after removing the brace, do not wear the brace. Own your therapist or orthotist assess the brace to see if it can be adjusted or whether it will need to be remade. Children may need adjustments or replacement of braces as often as every four to six months during growth spurts.
Braces will often require adjustment, if you own lost or gained weight, own increased spasticity, decreased range of motion or worsening scoliosis.
Is the damage being caused by pressure during sitting?
Pressure areas caused by sitting often happen on your ischeal tuberocities (sitting bones), lower back, shoulder blades or the back of the heels. If the skin sore is being caused by sitting, check your wheelchair cushion. Do you own a pressure relieving cushion prescribed by your health care provider? Is it inflated correctly? Some cushions require frequent monitoring of inflation and can leak. Could the cushion be placed backward in the chair? Is it in excellent repair?
Some cushions own gel in them that can get hard or squished out of put. If you own a therapeutic cushion and are still having difficulty with pressure on your sitting bones, see if you can attempt diverse cushions with pressure mapping. Pressure mapping equipment allows clinicians to visually identify your specific pressure areas when sitting on diverse cushions. Then the cushion that works best for you can be ordered.
Pressure mapping can also be helpful, if you own a condition that can make seating hard. Conditions, such as scoliosis or a dislocated hip can make the pressure on you sitting bones unequal. Depending on how bad the skin breakdown is you may need to stay out of your wheelchair for a period of time to permit the area to heal.
Treating redness or minor skin breakdown
If the skin is open, contact your health care provider for wound care instructions.
These instructions will generally include cleaning the area with soap and water or a saline solution, keeping the area dry, and eliminating the cause of the problem. Do not use hydrogen peroxide or iodine as these products damage new skin cells in the wound. They may prescribe special dressing that will optimize healing. If not, cover the area with a non-stick dressing, such as a Telfa pad to protect it from clothing. Change the dressing one to two times per day or if it gets soiled. Check your skin frequently to be certain the area is not getting worse. Minor burns can also cause blistering and can be treated in the same manner.
If the burn covers a large surface area, you should seek care in the emergency room. Once a treatment plan has been established, you must identify and attempt to remove the source of the irritation to the affected area as much as possible.
What does minor skin breakdown glance like?
Skin breakdown starts out as a red or purple spot on fair skin or a shiny, purple, blue or darker spot on dark skin, which does not fade or go away within 20 minutes.
When you press on the spot with your finger, it does not become lighter (blanch). It may feel warmer or cooler than the skin around it. The spot may feel hard or squishy under your fingers and may glance swollen. If you own sensation, it may be itchy or painful. At first, it may not glance love much, especially if the skin is not broken or open, but it can get a lot worse. If your skin becomes blistered, scabbed or has a little open area on the surface, this is more serious, as it indicates that the tissue underneath has begun to die.
At this stage, the progression of skin break below is reversible: the skin will return to normal as soon as the cause of the irritation is found and eliminated and the skin is properly cared for. If these steps are not taken, the damage can rapidly progress to a dangerous level where infection can attack the underlying tissue and bone, posing a serious risk to your health.
Does the area of damage glance more love a scrape or a tear?
If the area looks more love a scrape or tear, it may be caused by friction or sheer from sliding below in bed or wheelchair or from dragging your bottom with transfers. If you own had a change in your physical status, consider returning to physical therapy for a “tune up” focusing on increasing your strength, flexibility, and transfer technique. If you are dependent on others for part or every of your transfers, there is equipment that can be helpful to prevent sheer injury. This includes transfer boards, starting with simple slippery wood boards to a b-easy board with a sliding disk, a mechanical lifting device or overhead track lift systems. Your physical therapist and occupational therapist can assist you identify equipment that will be most helpful for you and teach you and your care givers how to safely use this equipment.
A hospital bed that raises and lowers and has an elevating head and foot relax can be helpful, especially if you require assistance from others for bathing, positioning and transfers. The ability to lift and lower the bed will protect your caregiver’s back and often allows for level or “downhill” transfers, avoiding sheer injuries. Manual (hand crank) hospital beds or semi-electric hospital beds (hand crank to lift and lower the bed and electric to elevate the head and foot) are often covered by insurance with a excellent letter of medical necessity from your health care provider. Enquire your health care provider to order a fully electric hospital bed, if you are unable to operate a hand crank independently.
Your health care provider should indicate that you require assistance with transfers and bed mobility and require frequent repositioning to prevent costly skin breakdown. If you prefer not to own a hospital bed, you can permanently lift the height of your entire bed so that it is even with your wheelchair using blocks of wood, bricks or bed leg adjusters that can be purchased.
Is the damage being caused by pressure from lying on the area?
The areas most vulnerable when lying are the back of the head (in young children), ankles, knees, hips or shoulder blades.
If so, avoid positioning on the affected area. If you own difficulty with red areas despite frequent turning, there are various pressure relieving mattresses that can be prescribed by your health care provider to distribute pressure better than a regular mattress. Unfortunately, if you own never had any skin breakdown, it is hard to get insurance coverage for this type of specialty mattress. If you own had skin breakdown, coverage is often available.
Is the redness or breakdown in the diaper (perineal) area?
Skin breakdown in the perineal area is generally caused by too much moisture often from sweating or irritation from urine and stool.
Skin problems in this area start out as redness and swelling (rash) and can progress to vesicles or pimples with oozing, crusting or scaling. Once the skin is open, there is increased risk for infection. Perineal skin care should be done as soon as possible after a bowel and/or bladder accident. Gently wash the area with soap that is indicated for the perineal area. Regular bar soap or antibacterial soap used for routine skin care can dry out this skin. The skin in this area will need moisturization with products such as glycerin, lanolin or mineral oil to replace natural moisture that is lost with frequent cleaning. A skin barrier ointment or creams should be used to protect the skin from moisture or irritation.
If the redness or rash final longer than three days, has areas of multiple red bumps or pimples, or if you own oozing pimples that develop into a honey-colored crusted area, you should be seen by a heath professional as you may need treatment for a yeast infection or an antibiotic.
Under-pads or absorbent briefs can be used as endless as they wick moisture away, rather than trapping the moisture against the skin. Lastly, attempt to identify the cause of the skin irritation, especially if from frequent bowel or bladder accidents.
Symptoms and Complications
Signs and symptoms of metal hypersensitivities can range from little and localized to more severe and generalized.
Limited reactions can appear as a contact dermatitis on the skin that has been exposed to the metal. The skin may appear red, swollen, and itchy. Hives and rashes may also develop.
More severe metal hypersensitivity reactions generally happen from prolonged exposure to a metal allergen through implants or metal ions that are inhaled or eaten.
These reactions often cause chronic joint or muscle pain, inflammation, and swelling, leading to generalized fatigue and lack of energy.
In addition, fibromyalgia (pain without known cause) and chronic fatigue syndrome can also be seen in people with metal hypersensitivities.
Common symptoms of metal hypersensitivity include:
- reddening of skin
- chronic fatigue
- muscle pain
- cognitive impairment
- chronic inflammation
- joint pain
- blistering of the skin
The following symptoms and conditions own been linked to metal hypersensitivity.
If you own any of these conditions, you may wish to speak to your doctor about the possibility of a metal hypersensitivity:
- chronic fatigue syndrome
- rheumatoid arthritis
How can I hold my skin healthy?
Use therapeutic surfaces
Therapeutic surfaces, such as a pressure relieving wheelchair cushion or a pressure relieving mattress will reduce or relieve pressure, promote blood flow to tissues and enable proper positioning.
Make certain that you use equipment the way it is recommended and that it fits correctly. When seated in a wheelchair, make certain the cushion is properly positioned and inflated and that you are sitting every the way back in the wheelchair.
Keep skin clean and dry
Bathe frequently using mild soap. Avoid extremely boiling water as it dries skin. Dry your skin by patting rather than rubbing. Change undergarments or pads as soon as possible after a bowel or bladder accident.
Prevent mechanical Injury
Prevent mechanical injury to the skin from friction and shearing forces during repositioning and transfers.
Lift, don’t slide. Lowering the head of the bed will assist minimize sheer and friction from sliding below in bed. Lift the entire bed up to the proper height to facilitate level surface transfers to and from a wheelchair. If necessary, use assistive devices, such as transfer boards or mechanical lifts to assist with transfers. Your physical or occupational therapist can assist you with training and obtaining the correct equipment. Ensure that clothing fits comfortably and does not own pressure points, such as snaps, thick seams or pockets. Be certain that clothing is smoothed below under the bottom and back so you don’t get pressure points from bunched fabric.
Hold bed sheets as wrinkle free as possible.
Take responsibility for you own skin care
The first line of defense in keeping your skin healthy is to take responsibility for your own skin care. If you are at risk for skin breakdown, you will need to develop a daily routine for monitoring and caring for your skin. You should do a finish inspection of your skin every day. If you are unable to assess your own skin, you should be knowledgeable about the areas of your body where you are most vulnerable to skin breakdown and be certain that your care givers are checking these areas for you and reporting the status of your skin.
The most common areas for skin breakdown (pressure points) in adults are the sacrum/coccyx (tailbone), heels, elbows, lateral maleollus (outside of the ankle), greater trocater (hip bone) or the bottom of the femur (outside and inside of the knee) and the ischial tuberosities (the bones we sit on).
Pressure points for children are diverse and based on age and development (7). For infants and children less than three years of age, the head makes up a greater portion of the entire body weight and surface areas. When they are placed on their backs, the occipital region (back of the head) becomes the primary pressure point. When placed on their side, the ears are also extremely susceptible. For older children, the sacrum (lower spine) and calcaneous (the heel of the foot) are most at risk (9).
Develop a excellent home rehabilitation program
A regular daily therapy program will contribute to your overall health and well being, as well as reduce the risk of skin breakdown.
A excellent program should include therapy to increase muscle mass and strength, improve your flexibility, improve your cardiovascular endurance, and increase your circulation. An activity based program that includes components of weight bearing and/or gait training, functional electrical stimulation biking, as well as strengthening and stretching activities are beneficial to assist prevent skin breakdown.
Use of the Wii gaming system in creative ways for “Wiihab” can assist with improving strength, balance and endurance. Aquatic therapy and horseback riding therapy are also beneficial, in addition to being fun.
Eat a healthy diet
Eat a healthy diet and drink lots of fluids, especially water. Hold your body weight in a healthy range. People that are overweight or underweight tend to own more problems with skin breakdown. Excellent nutrition will assist make your skin more resistant to breakdown and you will be more likely to heal and fight off infection should it happen. Eat the correct kinds of foods.
This means a balanced diet with servings from every food groups. For healthy skin it is especially significant to get enough of the following nutrients in your diet:
- Zinc (seafood, meat and eggs)
- Vitamin C (citrus fruits, strawberries, broccoli)
- Omega 3 fatty acids (salmon, mackerel, flaxseed)
- Vitamin A (Vegetables that are dark green or dark orange in color)
- Protein (meat, eggs, cheese, and soy products)
Extra calories, especially from protein, are significant for repairing damaged tissues if you do own skin breakdown.
If you are concerned that you do not get enough of these foods in your diet, you can speak with a nutritionist or your health care provider about supplementation.
Teach children to take responsibility for their own skin care
Parents of children at risk for skin breakdown need to be certain to check their children’s skin every day. This can become more hard as children enter their teen years, develop more modesty and are interested (or insistent) on being more independent in their own care. This may be an area that parents need to insist on participation as skin breakdown can progress from minor to serious literally overnight in a kid (or in an adult for that matter).
If you own made daily skin inspection a part of your child’s routine since the onset of paralysis, this should be less of an issue. Be certain that they own the equipment, such as a mirror on a flexible wand, to examine their own skin with your oversight, if at every possible.
Avoid prolonged pressure on any one spot
Reposition frequently. When seated in a wheelchair, do weight shifts every 15 minutes.
When lying in bed, reposition every 2 4 hours. Use pillows or wedges behind your back and between bony areas, such as knees and ankles. “Float” your heels and ankles off of the bed by supporting your lower leg with a pillow. Hold the head of the bed up less than 30 degrees to prevent shearing of skin from sliding below or the need to be pulled back up. If you use a wheelchair most of the day, avoid lying on your back at night.
Instead, turn side to side to give your backside a break. Better yet, sleep on your stomach, if this position is comfortable and you are capable to breathe safely. When positioned on your stomach, you own fewer pressure points, and can generally turn less frequently. Being on your stomach gives your backside a break, and allows you to stretch your hip flexor muscles and hamstring muscles, every for the price of one!
Keep muscle spasms under control
Some muscle spasms can be beneficial as they assist you change position, if you can’t move yourself. Too much muscle spasticity can cause rubbing and friction, especially when you are in bed at night.
Talk with your care provider about how to best manage spasticity. Exercise and range of motion are two excellent ways to reduce spasticity. Make certain orthotics (braces) are fitting properly, that they are worn correctly, and that the straps are fastened properly to prevent friction or pressure. Be certain that your bladder and bowel programs are working well as increased spasticity can be caused by a urinary tract infection or constipation. Spasticity can also increase when you own a burn or skin breakdown.
The symptoms of metal hypersensitivity are caused when the body’s immune system starts to view metal ions as foreign threats. The cells that make up the immune system normally kill foreign bacteria and viruses by causing inflammation.
If they start attacking metal ions that you touch, eat, inhale, or own implanted in you, they can produce a variety of symptoms (see the symptoms and complications section, below).
Potential metal allergens (triggers of allergic reactions) are extremely common in everyday life. Typical sources such as watches, coins, and jewellery come readily to mind. However, there are also other less obvious sources of metal in our daily lives. For example, cosmetic products and contact lens solutions may also contain metals that can trigger a reaction at the area of contact.
Nickel is one of the most frequent allergens, causing significant local contact dermatitis (skin reddening and itching). Cobalt, copper, and chromium are also common culprits. These metals can be found in consumer items such as jewellery, cell phones, and clothing items.
Aside from everyday items, medical devices also contain possible allergens such as chromium and titanium. Older dental implants and fillings are often made of metals. A few intra-uterine devices (IUDs) for birth control are made of copper and can also cause hypersensitivities. Implantable devices such as artificial knees, artificial hips, pacemakers, stents, and fracture plates, rods, or pins may contain metals that can cause metal hypersensitivity reactions.
These reactions are often more severe in nature when the allergens own been implanted within the body for an extended period of time.
In addition, people who already own an autoimmune disorder (a disorder where the immune system is overactive) can own a higher risk of a metal hypersensitivity, as their immune system is in a constant state of activity.
Frequently Asked Questions about Food Protein-Induced Enterocolitis Syndrome (FPIES)
Many allergens that trigger allergic rhinitis are airborne, so you can’t always avoid them.
If your symptoms can’t be well-controlled by simply avoiding triggers, your allergist may recommend medications that reduce nasal congestion, sneezing, and an itchy and runny nose. They are available in numerous forms — oral tablets, liquid medication, nasal sprays and eyedrops. Some medications may own side effects, so discuss these treatments with your allergist so they can assist you live the life you want.
Immunotherapy may be recommended for people who don’t reply well to treatment with medications or who experience side effects from medications, who own allergen exposure that is unavoidable or who desire a more permanent solution to their allergies.
Immunotherapy can be extremely effective in controlling allergic symptoms, but it doesn’t assist the symptoms produced by nonallergic rhinitis.
Two types of immunotherapy are available: allergy shots and sublingual (under-the-tongue) tablets.
- Allergy shots: A treatment program, which can take three to five years, consists of injections of a diluted allergy extract, istered frequently in increasing doses until a maintenance dose is reached. Then the injection schedule is changed so that the same dose is given with longer intervals between injections.
Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure and sometimes can actually make skin test reactions vanish. As resistance develops over several months, symptoms should improve.
- Sublingual tablets: This type of immunotherapy was approved by the Food and Drug istration in Starting several months before allergy season begins, patients dissolve a tablet under the tongue daily. Treatment can continue for as endless as three years.
Only a few allergens (certain grass and ragweed pollens and home dust mite) can be treated now with this method, but it is a promising therapy for the future.
Decongestants assist relieve the stuffiness and pressure caused by swollen nasal tissue. They do not contain antihistamines, so they do not cause antihistaminic side effects. They do not relieve other symptoms of allergic rhinitis. Oral decongestants are available as prescription and nonprescription medications and are often found in combination with antihistamines or other medications.
It is not unusual for patients using decongestants to experience insomnia if they take the medication in the afternoon or evening. If this occurs, a dose reduction may be needed. At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications to manage emotional or behavioral problems should discuss this with their allergist before using decongestants. Patients with high blood pressure or heart disease should check with their allergist before using. Pregnant patients should also check with their allergist before starting decongestants.
Nonprescription decongestant nasal sprays work within minutes and final for hours, but you should not use them for more than a few days at a time unless instructed by your allergist.
Prolonged use can cause rhinitis medicamentosa, or rebound swelling of the nasal tissue. Stopping the use of the decongestant nasal spray will cure that swelling, provided that there is no underlying disorder.
Oral decongestants are found in numerous over-the-counter (OTC) and prescription medications, and may be the treatment of choice for nasal congestion. They don’t cause rhinitis medicamentosa but need to be avoided by some patients with high blood pressure. If you own high blood pressure or heart problems, check with your allergist before using them.
Antihistamines are commonly used to treat allergic rhinitis.
These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes put. Although other chemicals are involved, histamine is primarily responsible for causing the symptoms. Antihistamines are found in eyedrops, nasal sprays and, most commonly, oral tablets and syrup.
Antihistamines assist to relieve nasal allergy symptoms such as:
- Sneezing and an itchy, runny nose
- Eye itching, burning, tearing and redness
- Itchy skin, hives and eczema
There are dozens of antihistamines; some are available over the counter, while others require a prescription. Patients reply to them in a wide variety of ways.
Generally, the newer (second-generation) products work well and produce only minor side effects.
Some people discover that an antihistamine becomes less effective as the allergy season worsens or as their allergies change over time. If you discover that an antihistamine is becoming less effective, tell your allergist, who may recommend a diverse type or strength of antihistamine. If you own excessive nasal dryness or thick nasal mucus, consult an allergist before taking antihistamines. Contact your allergist for advice if an antihistamine causes drowsiness or other side effects.
Proper use: Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 12 to 24 hours.
The short-acting antihistamines are often most helpful if taken 30 minutes before an anticipated exposure to an allergen (such as at a picnic during ragweed season). Timed-release antihistamines are better suited to long-term use for those who need daily medications. Proper use of these drugs is just as significant as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for numerous later doses to reduce established symptoms. Numerous times a patient will tell that he or she “took one, and it didn’t work.” If the patient had taken the antihistamine regularly for three to four days to build up blood levels of the medication, it might own been effective.
Side effects: Older (first-generation) antihistamines may cause drowsiness or performance impairment, which can lead to accidents and personal injury.
Even when these medications are taken only at bedtime, they can still cause considerable impairment the following day, even in people who do not feel drowsy. For this reason, it is significant that you do not drive a car or work with dangerous machinery when you take a potentially sedating antihistamine. Some of the newer antihistamines do not cause drowsiness.
A frequent side effect is excessive dryness of the mouth, nose and eyes. Less common side effects include restlessness, nervousness, overexcitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances, decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea, increased or decreased urination, urinary retention, high or low blood pressure, nightmares (especially in children), sore throat, unusual bleeding or bruising, chest tightness or palpitations.
Men with prostate enlargement may encounter urinary problems while on antihistamines. Consult your allergist if these reactions occur.
- Do not use more than one antihistamine at a time, unless prescribed.
- Alcohol and tranquilizers increase the sedation side effects of antihistamines.
- Some antihistamines appear to be safe to take during pregnancy, but there own not been enough studies to determine the absolute safety of antihistamines in pregnancy. Again, consult your allergist or your obstetrician if you must take antihistamines.
- Know how the medication affects you before working with heavy machinery, driving or doing other performance-intensive tasks; some products can slow your reaction time.
- While antihistamines own been taken safely by millions of people in the final 50 years, don’t take antihistamines before telling your allergist if you are allergic to, or intolerant of, any medicine; are pregnant or intend to become pregnant while using this medication; are breast-feeding; own glaucoma or an enlarged prostate; or are ill.
- Follow your allergist’s instructions.
- Keep these medications out of the reach of children.
- Never take anyone else’s medication.
Intranasal corticosteroids are the single most effective drug class for treating allergic rhinitis.
They can significantly reduce nasal congestion as well as sneezing, itching and a runny nose.
Ask your allergist about whether these medications are appropriate and safe for you. These sprays are designed to avoid the side effects that may happen from steroids that are taken by mouth or injection. Take care not to spray the medication against the middle portion of the nose (the nasal septum).
The most common side effects are local irritation and nasal bleeding. Some older preparations own been shown to own some effect on children’s growth; data about some newer steroids don’t indicate an effect on growth.
Leukatriene pathway inhibitors
Leukotriene pathway inhibitors (montelukast, zafirlukast and zileuton) block the action of leukotriene, a substance in the body that can cause symptoms of allergic rhinitis. These drugs are also used to treat asthma.
Nonprescription saline nasal sprays will assist counteract symptoms such as dry nasal passages or thick nasal mucus. Unlike decongestant nasal sprays, a saline nasal spray can be used as often as it is needed.
Sometimes an allergist may recommend washing (douching) the nasal passage. There are numerous OTC delivery systems for saline rinses, including neti pots and saline rinse bottles.
Nasal cromolyn blocks the body’s release of allergy-causing substances. It does not work in every patients. The full dose is four times daily, and improvement of symptoms may take several weeks. Nasal cromolyn can assist prevent allergic nasal reactions if taken prior to an allergen exposure.
Nasal ipratropium bromide spray can assist reduce nasal drainage from allergic rhinitis or some forms of nonallergic rhinitis.
Eye allergy preparations and eyedrops
Eye allergy preparations may be helpful when the eyes are affected by the same allergens that trigger rhinitis, causing redness, swelling, watery eyes and itching.
OTC eyedrops and oral medications are commonly used for short-term relief of some eye allergy symptoms. They may not relieve every symptoms, though, and prolonged use of some of these drops may actually cause your condition to worsen.
Prescription eyedrops and oral medications also are used to treat eye allergies. Prescription eyedrops provide both short- and long-term targeted relief of eye allergy symptoms, and can be used to manage them.
Check with your allergist or pharmacist if you are unsure about a specific drug or formula.
Does FPIES Require Epinephrine?
Not generally, because epinephrine reverses IgE-mediated symptoms, and FPIES is not IgE-mediated.
Based on the patient’s history, some doctors might prescribe epinephrine to reverse specific symptoms of shock (e.g., low blood pressure). However, this is only prescribed in specific cases.
What is Shock and What are the Symptoms?
Shock is a life-threatening condition. Shock may develop as the result of sudden illness, injury, or bleeding. When the body cannot get enough blood to the vital organs, it goes into shock.
Signs of shock include:
Weakness, dizziness, and fainting.
Cool, pale, clammy skin.
Weak, quick pulse.
Shallow, quick breathing.
Low blood pressure.
Extreme thirst, nausea, or vomiting.
Confusion or anxiety.
What Does IgE vs Cell Mediated Mean?
IgE stands for Immunoglobulin E.
It is a type of antibody, formed to protect the body from infection, that functions in allergic reactions. IgE-mediated reactions are considered immediate hypersensitivity immune system reactions, while cell mediated reactions are considered delayed hypersensitivity. Antibodies are not involved in cell mediated reactions. For the purpose of understanding FPIES, you can disregard every you know about IgE-mediated reactions.
Is FPIES A Lifelong Condition?
Numerous children outgrow FPIES by about age three.
Note, however, that the time varies per individual and the offending food, so statistics are a guide, but not an absolute. In one study, % of children with FPIES reactions to barley had outgrown and were tolerating barley by age three. However, only 40% of those with FPIES to rice, and 60% to dairy tolerated it by the same age.
How Do You Treat an FPIES Reaction?
Always follow your doctor’s emergency plan pertaining to your specific situation. Rapid dehydration and shock are medical emergencies. If your kid is experiencing symptoms of FPIES or shock, immediately contact your local emergency services (). If you are uncertain if your kid is in need of emergency services, contact or your physician for guidance.
The most critical treatment during an FPIES reaction is intravenous (IV) fluids, because of the risk and prevalence of dehydration. Children experiencing more severe symptoms may also need steroids and in-hospital monitoring. Mild reactions may be capable to be treated at home with oral electrolyte re-hydration (e.g., Pedialyte®).
What is a Typical FPIES Reaction?
As with every things, each kid is diverse, and the range, severity and duration of symptoms may vary from reaction to reaction.
Unlike traditional IgE-mediated allergies, FPIES reactions do not manifest with itching, hives, swelling, coughing or wheezing, etc. Symptoms typically only involve the gastrointestinal system, and other body organs are not involved. FPIES reactions almost always start with delayed onset vomiting (usually two hours after ingestion, sometimes as tardy as eight hours after). Symptoms can range from mild (an increase in reflux and several days of runny stools) to life threatening (shock). In severe cases, after repeatedly vomiting, children often start vomiting bile. Commonly, diarrhea follows and can final up to several days. In the worst reactions (about 20% of the time), the kid has such severe vomiting and diarrhea that s/he rapidly becomes seriously dehydrated and may go into shock.
How is FPIES Diagnosed?
FPIES is hard to diagnose, unless the reaction has happened more than once, as it is diagnosed by symptom presentation.
Typically, foods that trigger FPIES reactions are negative with standard skin and blood allergy tests (SPT, RAST) because they glance for IgE-mediated responses. However, as stated before, FPIES is not IgE-mediated.
Atopy patch testing (APT) is being studied for its effectiveness in diagnosing FPIES, as well as predicting if the problem food is no longer a trigger. Thus, the outcome of APT may determine if the kid is a potential candidate for an oral food challenge (OFC). APT involves placing the trigger food in a metal cap, which is left on the skin for 48 hours.
The skin is then watched for symptoms in the following days after removal. Please consult your child’s doctor to discuss if APT is indicated in your situation.
What is FPIES?
FPIES is a non-IgE mediated immune reaction in the gastrointestinal system to one or more specific foods, commonly characterized by profuse vomiting and diarrhea. FPIES is presumed to be cell mediated. Poor growth may happen with continual ingestion. Upon removing the problem food(s), every FPIES symptoms subside. (Note: Having FPIES does not preclude one from having other allergies/intolerances with the food.) The most common FPIES triggers are cow’s milk (dairy) and soy.
However, any food can cause an FPIES reaction, even those not commonly considered allergens, such as rice, oat and barley.
A kid with FPIES may experience what appears to be a severe stomach bug, but the «bug» only starts a couple hours after the offending food is given. Numerous FPIES parents own rushed their children to the ER, limp from extreme, repeated projectile vomiting, only to be told, «It’s the stomach flu.» However, the next time they feed their children the same solids, the dramatic symptoms return.
How Do I know If My Kid Has Outgrown FPIES?
Together with your child’s doctor, you should determine if/when it is likely that your kid may own outgrown any triggers.
Obviously, determining if a kid has outgrown a trigger is something that needs to be evaluated on a food-by-food basis. As stated earlier, APT testing may be an option to assess oral challenge readiness. Another factor for you and your doctor to consider is if your kid would physically be capable to handle a possible failed challenge.
When the time comes to orally challenge an FPIES trigger, most doctors familiar with FPIES will desire to schedule an in-office food challenge.
Some doctors (especially those not practicing in a hospital clinic setting) may select to challenge in the hospital, with an IV already in put, in case of emergency. Each doctor may own his or her own protocol, but an FPIES trigger is something you should definitely NOT challenge without discussing thoroughly with your doctor.
Be aware that if a kid passes the in-office portion of the challenge, it does not mean this food is automatically guaranteed «safe.» If a child’s delay in reaction is fairly short, a kid may fail an FPIES food challenge while still at the office/hospital.
For those with longer reaction times, it may not be until later that day that symptoms manifest. Some may react up to three days later. Delay times may vary by food as well. If a kid has FPIES to multiple foods, one food may trigger symptoms within four hours; a diverse food may not trigger symptoms until six or eight hours after ingestion.
When Do FPIES Reactions Occur?
FPIES reactions often show up in the first weeks or months of life, or at an older age for the exclusively breastfed kid.
Reactions generally happen upon introducing first solid foods, such as baby cereals or formulas, which are typically made with dairy or soy. (Infant formulas are considered solids for FPIES purposes.) While a kid may own allergies and intolerances to food proteins they are exposed to through breastmilk, FPIES reactions generally don’t happen from breastmilk, regardless of the mother’s diet. An FPIES reaction typically takes put when the kid has directly ingested the trigger food(s).
How is FPIES Diverse From MSPI, MSPIES, MPIES, Etc.?
MPIES (milk-protein induced enterocolitis syndrome) is FPIES to cow’s milk only.
MSPIES (milk- and soy-protein induced enterocolitis syndrome) is FPIES to milk and soy. Some doctors do create these subdivisions, while others declare that milk and soy are simply the two most common FPIES triggers and give the diagnosis of «FPIES to milk and/or soy.»
MSPI is milk and soy protein intolerance. Symptoms are those of allergic colitis and can include colic, vomiting, diarrhea and blood in stools. These reactions are not as severe or immediate as an FPIES reaction.
Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM.
(). Atopy Patch Test for the Diagnosis of Food Protein-Induced Enterocolitis Syndrome. Pediatric Allergy and Immunology – Retrieved on December 31, from
Burks, AW. (). Don’t Feed Her That! Diagnosing and Managing Pediatric Food Allergy. Pediatric Basics. Gerber Products Company: Retrieved on December 31, from
Moore, D. Food Protein-Induced Enterocolitis Syndrome. (, April 11). Retrieved on December 31, from
Sicherer, SH. (). Food Protein-Induced Enterocolitis Syndrome: Case Presentations and Management Lessons.
Journal of Allergy and Clinical Immunology Vol. , Retrieved on December 31, from
Nowak-Wegrzyn, A., Sampson, HA, Wood, RA, Sicherer, SH. MD, Robert A. Wood, MD and Scott H. Sicherer, MD. (). Food Protein-Induced Enterocolitis Syndrome Caused by Solid Food Proteins. Pediatrics. Vol. 4: Retrieved on December 31, from #T1.
Nocerino, A., Guandalini, S. (, April 11). Protein Intolerance. Retrieved on December 31, from WebMD Medical Reference from Healthwise. (, May 31).
Shock, Topic Overview. Retrieved on December 31, from
American Academy of Allergy, Asthma and Immunology. (). Tips to Remember: What is an Allergic Reaction? Retrieved on December 31, from
Sicherer, SH. (). Understanding and Managing Your Child’s Food Allergies. A Johns Hopkins Press Health Book.
Medical Review February
The first approach in managing seasonal or perennial forms of hay fever should be to avoid the allergens that trigger symptoms.
- Avoid using window fans that can draw pollens and molds into the house.
- Stay indoors as much as possible when pollen counts are at their peak, generally during the midmorning and early evening (this may vary according to plant pollen), and when wind is blowing pollens around.
- Wear a pollen mask (such as a NIOSH-rated 95 filter mask) when mowing the lawn, raking leaves or gardening, and take appropriate medication beforehand.
- Don’t hang clothing outdoors to dry; pollen may cling to towels and sheets.
- Wear glasses or sunglasses when outdoors to minimize the quantity of pollen getting into your eyes.
- Try not to rub your eyes; doing so will irritate them and could make your symptoms worse.
- Reduce exposure to dust mites, especially in the bedroom.
Use “mite-proof” covers for pillows, comforters and duvets, and mattresses and box springs. Wash your bedding frequently, using boiling water (at least degrees Fahrenheit).
- Keep windows closed, and use air conditioning in your car and home. Make certain to hold your air conditioning unit clean.
- To limit exposure to mold, hold the humidity in your home low (between 30 and 50 percent) and clean your bathrooms, kitchen and basement regularly.
Use a dehumidifier, especially in the basement and in other damp, humid places, and empty and clean it often. If mold is visible, clean it with mild detergent and a 5 percent bleach solution as directed by an allergist.
- Clean floors with a damp rag or mop, rather than dry-dusting or sweeping.
Exposure to pets
- Wash your hands immediately after petting any animals; wash your clothes after visiting friends with pets.
- If you are allergic to a household pet, hold the animal out of your home as much as possible.
If the pet must be inside, hold it out of the bedroom so you are not exposed to animal allergens while you sleep.
- Close the air ducts to your bedroom if you own forced-air or central heating or cooling. Replace carpeting with hardwood, tile or linoleum, every of which are easier to hold dander-free.
What Does FPIES Stand For?
FPIES is Food Protein-Induced Enterocolitis Syndrome. It is commonly pronounced «F-Pies», as in «apple pies», though some physicians may refer to it as FIES (pronounced «fees», considering food-protein as one word). Enterocolitis is inflammation involving both the little intestine and the colon (large intestine).
How Do You Care for a Kid With FPIES?
Treatment varies, depending on the patient and his/her specific reactions.
Often, infants who own reacted to both dairy and soy formulas will be placed on hypoallergenic or elemental formula. Some children do well breastfeeding. Other children who own fewer triggers may just strictly avoid the offending food(s).
New foods are generally introduced extremely slowly, one food at a time, for an extended period of time per food. Some doctors recommend trialing a single food for up to three weeks before introducing another.
Because it’s a rare, but serious condition, in the event of an emergency, it is vital to get the correct treatment.
Some doctors provide their patients with a letter containing a brief description of FPIES and its proper treatment. In the event of a reaction, this letter can be taken to the ER with the child.
What are Some Common FPIES Triggers?
The most common FPIES triggers are traditional first foods, such as dairy and soy. Other common triggers are rice, oat, barley, green beans, peas, sweet potatoes, squash, chicken and turkey. A reaction to one common food does not mean that every of the common foods will be an issue, but patients are often advised to proceed with caution with those foods.
Note that while the above foods are the most prevalent, they are not exclusive triggers. Any food has the potential to trigger an FPIES reaction. Even trace amounts can cause a reaction.
Treatments that are not recommended for allergic rhinitis
- Antibiotics: Effective for the treatment of bacterial infections, antibiotics do not affect the course of uncomplicated common colds (a viral infection) and are of no benefit for noninfectious rhinitis, including allergic rhinitis.
- Nasal surgery: Surgery is not a treatment for allergic rhinitis, but it may assist if patients own nasal polyps or chronic sinusitis that is not responsive to antibiotics or nasal steroid sprays.
Skin is the largest organ covering the entire exterior of the body.
It receives one third of the body’s blood circulation. Your skin is tough and pliable, forming the body’s protective shield against heat, light, chemical and physical action. It plays an athletic role with the immune system, protecting us from infection. Your skin maintains a stable internal environment and is significant in maintaining a proper temperature for the body to function well. In addition to providing protection and internal regulation, your skin gathers sensory information from the environment, allowing you to feel painful and pleasant stimulation. Your skin also stores water, fat, and vitamin D.
The skin consists of three layers: Epidermis, dermis, and subcutaneous tissue.
The outermost layer, the epidermis, is composed mostly of dead skin cells that are constantly being shed and replaced. The dermis or second layer has sweat glands, oil glands, nerve endings, and little blood vessels called capillaries, which are every woven together by a protein called collagen. Collagen provides nourishment and support for skin cells. The nerves ending in this layer transmit sensations of pain, itch, touch and pleasure. The hair follicles also originate in this layer. Destruction of either the epidermis or dermis can leave the body open and susceptible to infection. The subcutaneous adipose tissue is the deepest layer of skin and is a layer of fat and collagen that houses larger blood vessels and nerves.
This layer is significant in controlling the temperature of the skin itself and the body and protects the body from injury by acting as a shock absorber. The thickness of this layer varies throughout the body and from person to person. Underneath the subcutaneous tissue lays muscle and bone.
For the most part, the skin is tough, pliable and resistant to injury. If the skin becomes injured or broken, it is generally extremely resilient and has an amazing ability to self-repair and heal. Despite this resiliency, the skin is susceptible to breakdown, if subjected to prolonged abuses, such as excessive pressure, shear force, friction or moisture.
This is a major concern for persons with transverse myelitis or other neuroimmunologic conditions that cause paralysis and/or decreased sensation.
For people with paralysis, the skin is at increased risk for breakdown for several reasons. Paralysis itself affects the skin and underlying tissue. There is loss of collagen which weakens the skin and makes it less elastic. The lack of muscle function around boney areas of the body leads to muscle atrophy, resulting in less padding, which in turn, adds to the risk of skin breakdown.
People with paralysis often own difficulty shifting their weight, repositioning themselves, or transferring without assistance.
Impaired sensation is often present, limiting the ability to sense when to make a weight shift or position adjustment. People with impaired sensation are also vulnerable to injury from numerous other hazards, such as, heat, freezing, sun and trauma. Loss of sensation put an individual at risk for burns from extremely ordinary activities, such as using a lap top computer sitting directly on your lap or sitting too shut to a fireplace. Injury can be caused from things that are too freezing such as, ice packs or freezing exposure causing frostbite. Ingrown toenails can become infected and sunburn can become severe without feeling it.
When limited mobility is coupled with decreased sensation, a person is more likely to develop a specific type of skin breakdown called a pressure ulcer.
According to the National Pressure Ulcer Advisory Panel, a pressure ulcer is defined as a localized injury to the skin and/or underlying tissue generally over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction (1). Pressure ulcers are one of the leading causes of complication across the life span of persons with paralysis (2). Up to 95 % of adults with spinal cord injury will develop at least one serious pressure ulcer at some time during their life (3).
Skin breakdown can range from minor scrapes, cuts, tears, blisters or burns to the most serious pressure ulcers with the destruction of tissue below to and even including the bone.
A pressure ulcer, especially one that requires surgery, such as a muscle flap or skin graft, can cost thousands of dollars to treat, require lengthy hospitalization, and weeks to months away from family, work, school or community activities. It has been estimated that for persons with spinal cord injury the cost of care for pressure ulcers is about $ to billion dollars annually (4).
With a concerted effort, skin breakdown is, for the most part, preventable. It can happen, however, even in people who maintain the most diligent care and use the proper equipment.
If skin breakdown is identified early, when still in the minor stages, and if the cause of the breakdown can be identified and eliminated, healing should happen fairly quickly. If it is not identified in its early stages, skin breakdown can rapidly progress from minor to serious.
Skin breakdown is caused in several diverse ways, including friction, shear, moisture and pressure. These causes can happen individually or in combination. Friction, moisture and sheer are identified as contributing factors to pressure ulcers (5). A friction injury occurs when the skin rubs on surfaces, such as a bed sheet, arm relax or brace and has the appearance of a scrape, abrasion or blister.
This type of injury is typically seen on the heels and elbows and may result from repositioning, propping or rubbing due to increased spasticity.
A shearing injury occurs with dragging or sliding of a body part across a surface and has the appearance of a cut or tear. This type of injury can happen from dragging your bottom during a transfer or sliding below in bed when the head of the bed is elevated. With the sliding force, bone is moved against the subcutaneous tissue while the epidermis and dermis remains essentially in the same position; against the supporting surface such as a wheelchair or bed. This action causes occlusion of the blood vessels, decreasing blood flow, oxygen and nourishment to the skin, which eventually leads to breakdown.
Sometimes a shear injury will actually tear the tissue over the tailbone and with unrelieved pressure will become a pressure ulcer.
Too much moisture over-hydrates the skin, making it feeble and more sensitive to friction, shear and breakdown (think about being in the tub or pool for a endless time). Primary sources of excess skin moisture include sweating, bowel and bladder accidents, and drainage from wounds.
Pressure ulcers happen when skin, soft tissue and blood vessels are compressed or squeezed between a bony prominence (such as your tailbone) and an external surface (such as your wheelchair cushion).
With compression of these vessels, the blood that nourishes the cells and takes away waste is cut off, starving the tissue of oxygen and vital nutrients. Without food and oxygen, tissue dies and skin breakdown begins. The body tries to compensate by sending more blood to the area. This process results in redness and swelling, places even more pressure on the blood vessels, and further endangers the health of the skin and underlying tissue. Ultimately, a pressure ulcer forms. Increased pressure over short periods of time and slight pressure over endless periods of time own been shown to cause equal amounts of damage.
Many factors own been identified as responsible for the development of skin breakdown and pressure ulcer formation.
In addition to immobility, impaired sensation and the external factors described above, numerous internal contributing factors own been identified. These internal factors include poor nutrition and hydration, weight, impaired circulation and oxygenation, impaired cognition or thinking, substance abuse, depression and age (6, 7). Nutritional factors significant to prevent or heal wounds include a balanced diet with an adequate intake of protein, vitamin C, vitamin A, and zinc, as well as an adequate intake of fluids (8).
When a person is overweight, additional pounds put additional pressure on vulnerable skin areas increasing the risk of compression of blood vessels. Individuals that are underweight often own decreased muscle mass with less fat padding over boney areas leaving them vulnerable to skin breakdown. Smoking, diabetes, anemia and other vascular conditions every lead to decreased circulation, increasing risk for skin breakdown. Individuals who are depressed or own impaired thinking and judgment due to substance abuse are less likely to be vigilant with regard to significant self-care issues, such as skin health. Young children generally own more resilient and elastic skin and more baby fat and padding so they often own extremely little difficulty with skin break below.
As children move into adolescence, their skin loses some of its elasticity. They generally own more body weight, putting more stress on pressure areas, such as the ischeal tuberosicties and tailbone with sitting. Teens often start to own more difficulty with skin breakdown. As we continue to age, our skin becomes increasingly less pliable and resilient. We experience the loss of collagen and muscle mass, as well as decreased circulation, making the skin more vulnerable. The elderly are most prone to skin tears and stripping due to fragile, thin, and vulnerable skin.
In addition, incontinence may become a more frequent issue for bedridden or ill persons, increasing problems with moisture as described above.