Ask the OnCall+ Experts: Allergies

June 16, 2009 -- Thank you for your submission! Come back to see if your question was answered.

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Your Questions Answered

Question: I have sinus headaches that cause my eyes to hurt, which in turn affects my vision. I take Allegra, which eases it a little. Could you tell me what medications are out there, or do I need to see a specialist?

Question: We suggest you take a look at our index of questions on seasonal allergies and sinusitis. Take care!

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Question: Does bleach help psoriasis as it does eczema?

Answer: Patients with ezcema are prone to overgrowth of bacteria such as staphylococcus aureus. This leads to chronic infection and inflammation and worsens the eczema.

Bleach acts as a anti-bacterial agent. The report that you are referring to was done by my colleague and pediatric dermatology expert, Dr. Amy Paller at Northwestern. The diluted bleach baths (half a cup per full standard tub of water) decreased signs of infection and improved the eczema on the skin of children.

Get Answers To All Your Allergy Questions at the ABC News OnCall+ Allergy Center

Some, not all patients with psorasis or other skin diseases can have bacterial overgrowth. We don't have all the answers, and to my knowledge, similar studies have not been done in patients with psoraisis. It is plausible that if a specific psoriasis patient is prone to a secondary infection with staphylococcus aureus (documented by a skin culture) -- that patient may benefit from diluted bleach baths.

- Dr. Theresa Pacheco, Professor of Dermatology, University of Colorado Denver School of Medicine

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Question: Why is sublingual immunotherapy not as widely available or promoted in the U.S. as it is in Europe?

Answer: Currently there are no approved allergy extracts used for sublingual immunotherapy (SLIT) in the U.S. Investigators in Europe several years ago began to study in clinical trials and then use in clinical practice SLIT. Overall, the use of SLIT in Europe is quite high but it varies considerably by country.

SLIT has been used with off-label products in the U.S. for a long time but the concentration of the allergen in the individual patient's SLIT was generally quite low. The doses used were often below what is used now and not found to be effective.

There are studies being conducted now in the U.S., so we will see these results in the next few years.

- Dr. Wesley Burks, Chief of Pediatric Allergy and Immunology, Duke University Medical Center

Your Allergy Questions Answered

Question: What causes scabies? Why does it return even after treatment? Do scabies mites only need skin contact to survive, and wouldn't they die if they were not in contact with skin?

Answer: Scabies is caused by an infestation of the skin by the mite Sarcoptes scabiei. Transmission of scabies is usually from person to person by direct skin contact. They can survive off a host for 24-36 hours or even longer in colder, humid environments. It is not common, but there have been authenticated reports of scabies being contracted by wearing or handling heavily contaminated clothing or by close contact with bed linens on which an infested individual has slept. Symptoms, primarily itching, typically begin three to four weeks after infestation. In patients who have previously been infested with scabies, symptoms may start within one to three days after reinfestation.

The reason for the "return" of the scabies may be due to incomplete treatment. First-line treatments for adults include topical permethrin cream or oral ivermectin. Household and close personal contacts must be treated simultaneously.

Immediately after treatment, all bed linens and clothing worn by the patient within the past several days need to be washed in hot water and dried in a hot dryer, sent to the dry cleaners, or bagged in plastic bags for a couple of weeks. The itching from the scabies may persist for two to three weeks after successful treatment. Thus, persistent itching does not necessarily indicate persistent or recurrent infestation.

Ivermectin is a single-dose oral treatment, which is usually repeated two weeks later. Ivermectin is not recommended for pregnant or lactating women or children below 15 kilograms.

If using permethrin cream, it must be applied on all body parts from the neck down, including the area under the nails. In children and older adults, the hairline, temples, neck and forehead should be treated. The cream has to remain in place at least eight hours before washing off. Permethrin is usually a single-application treatment but may be repeated in two weeks if there is still evidence of live mites.

If one of the above treatment regimens has been meticulously followed, and the individual again contracts scabies, it would more than likely be a new infestation.

- Dr. Dana Wallace, Vice President, American College of Allergy, Asthma & Immunology (ACAAI)

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Question: What is the best treatment for poison ivy?

Answer: Poison ivy is a contact dermatitis caused by the plants of the genus Toxicodendron (which means "poisonous tree"). Urushiol is the allergic agent in the toxic oil (oleoresin) of the poison ivy plant.

If the oleoresin is washed off within 10 minutes, 50 percent can be removed. Intense itching and redness of the skin followed by bumps and blisters usually develop within 48 hours of skin contact with the toxic oil. While the initial rash usually occurs in the area of skin contact with the oleoresin, subsequent lesions develop in remote body areas due to the systemic allergic response. The fluid from the blisters does not "spread" the rash.

Treatment consist of oral antihistamines and topical soothing lotions, such as calamine lotion. For milder cases, a high-potency topical corticosteroid may be helpful. More severe cases usually require the use of oral steroids, usually for two to three weeks, as a shorter course will often be followed by rebound dermatitis. Antibiotics are used only if there is evidence of secondary infection.

- Dr. Dana Wallace, Vice President, American College of Allergy, Asthma & Immunology (ACAAI)

Your Allergy Questions Answered

Question: This question is for Dr. Marty Becker. When you were on the show, you were about to tell us about a fatty acid supplement for dog allergies but got interrupted. What it the supplement? I have a guide dog that is suffering from allergies. Please Help!

Answer: When it comes to fatty acid supplements, not all products are -- as they say -- "apples to apples." It's easy for a company to put veterinary-approved on a label but much harder to pass the rigorous tests and trials that would actually cause a veterinarian to prescribe one product.

In the veterinary practice I work at, we recommend a product called Dermcaps from Dermapet. Ask your vet which product, if any, is best for your itchy pet. Just know that if the fatty acid supplements don't work, your veterinarian has many more itch/scratch/lick-busting tools available. Your pet's itching can and should end soon.

- Dr. Marty Becker, Veterinarian and Adjunct Professor, Washington State University College of Veterinary Medicine

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Question: For many years now, both my husband and I have a suspicion that I may have Celiac disease and would like to know what test or tests we should make inquiry of when presenting this idea to my physician.

Answer: Research has shown that it can take from 12 months to 9 years on average for a patient who has chronic bowel complaints to be diagnosed with celiac disease. This means that physicians should consider the diagnosis in patients with undiagnosed bowel or other complaints. Although there are a number of blood tests called 'serologic screening" tests for celiac disease, none of the blood tests are definitive.

Experts agree that an intestinal biopsy and a good response to a gluten-free diet is essential to make the diagnosis. That means every person who may have the diagnosis should have an intestinal biopsy of the small intestine which will show typical abnormalities found only in celiac patients. The person should also try a gluten-free diet which will help the symptoms considerably if the diagnosis is correct.

Warm regards,

Dr. Marie Savard, ABC News Medical Contributor

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