What is the cause of skin allergy

Sensitive skin presents in a wide variety of ways with:

  1. subjective symptoms such as stinging, itching, burning
  2. and/or visible skin changes such as redness, dryness, scaling, peeling, bumps, hives.

Often, complaints of sensitive skin relate only to the face. Products that are tolerated on other sites cause irritation and rashes; eyelids are especially sensitive. Armpits, groin and genitals may also be more sensitive than other areas because of thinner skin.


Causes of sensitive skin

There are a number of recognised medical causes of sensitive skin

Aquagenic pruritus

In aquagenic pruritus, the skin becomes itchy following contact with water of any temperature.

Rosacea

Rosacea is a common facial skin condition characterised by some or every of the following clinical features:

  1. Flushing and blushing
  2. Persistent redness/broken capillaries (telangiectasia)
  3. Acne-like rash of bumps and pimples
  4. Localised facial swelling
  5. Skin sensitivity

The skin sensitivity in this condition can present as skin redness or irritation after application to the face of the person’s usual cosmetics and skin care products, often after years of uneventful use of the same product.

Irritant contact dermatitis

Two forms of ICD show no clinical changes and these are therefore worth mentioning in more detail.

1.

Subjective/sensory irritation, also known as sensorineural irritation
This is characterised by sensory discomfort such as itching, stinging, tingling or burning, but in the absence of any clinical or histological evidence of inflammation. Involvement of nerves and blood vessels contribute to the development of the symptoms. Lactic acid and propylene glycol in cosmetic agents are common causes of this. The threshold for developing symptoms following application of these chemicals to the skin varies between individuals and does not correlate with the person’s susceptibility to other forms of skin irritation. It is generally of acute onset.

Avoiding the irritant or using personal protective equipment such as gloves, and the frequent use of generous amounts of moisturiser generally results in a excellent outcome.

2. Non-erythematous irritation, also called suberythematous irritation
This form of irritant contact dermatitis differs from subjective irritation in that, although the person experiences similar symptoms and no rash is visible, there are changes of inflammation seen on skin biopsy. It often develops slowly and discomfort is experienced with multiple chemicals. Cocamidopropyl betaine and coconut diethanolamide are recognised causes of this and are common ingredients in cosmetics.

The outcome with this form of ICD is variable.

Dry skin

Dry skin from any cause is irritable and sensitive. Skin may be dry due to:

  1. genetic reasons i.e., ichthyosis
  2. environmental factors such as low humidity or excessive washing
  3. general health issues such as thyroid disease
  4. medications.

Dry skin tends to be itchy, especially if overheated. The person is often using a number of products topically to attempt to improve this, and may therefore also develop a contact dermatitis.

Dermographism

Contact urticaria

Contact urticaria is a form of hives triggered by skin contact with an agent that causes immediate swelling and redness and resolves over hours.

It can be confirmed by prick testing. There are irritant and allergic forms of contact urticaria.

Rosacea

Allergic contact dermatitis (ACD)

Allergic contact dermatitis is a skin reaction following the development of an allergic response to an externally applied agent and is less common than irritant contact dermatitis. It typically develops increasing intensity with time. Some chemicals are known to commonly cause an allergic reaction but generally it is only in occasional or rare individuals that such a reaction develops. The causative agent can be identified by patch testing.

Contact urticaria

Irritant contact dermatitis (ICD)

The term sensitive skin most often refers to a form of irritant contact dermatitis.

This is defined as an inflammatory response of the skin to (an) externally applied agent(s) or factor(s) without requiring prior sensitisation, i.e., it is not due to allergy.

What is the cause of skin allergy

Examples of such agents/factors include:

  1. Skin irritants, of which wet work is the most significant. Although some chemicals can cause skin irritation in most people if exposed, it is generally a combination of several mild irritant agents/factors adding up to ICD.
  2. Irritating body fluids such as sweat, urine and faeces.
  3. Environmental factors such as heat, freezing, low humidity and ultraviolet light.
  4. Mechanical factors eg friction, pressure, vibration and occlusion.

However host factors also influence susceptibility and these include age, sex, skin site and history of eczema.

Ten clinical types of ICD own been recognised, of which 8 present with clinically visible changes in the skin.

Dry skin

Eczema/dermatitis

All forms of eczema or dermatitis (atopic, seborrhoeic, asteatotic, venous, etc.) can result in sensitive, easily irritated skin as the skin barrier has been disturbed, allowing external factors to penetrate.

Eczema skin is generally itchy with a visible rash, which can further react to water, temperature, humidity and other environmental factors. Thus the presence of a second problem such as an irritant or allergic contact dermatitis to a product being applied to the skin may be overlooked. Eczema of any type is a well recognised predisposing factor for the development of irritant contact dermatitis.

Allergic contact dermatitis to rubber gloves

Physical urticaria and dermographism

Physical urticaria refers to hives triggered by a physical event such as pressure, heat, freezing or vibration.

Thus the person may erupt in a red rash while taking a boiling shower for example. In this case, it is a reaction to the temperature of the water, and not to water itself, and the rash resolves within an hour after cooling.

Dermographism literally means to be capable to record on the skin. The skin becomes red and puffy after a scratch.

Eczema


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:

  1. chronic fatigue
  2. cognitive impairment
  3. fibromyalgia
  4. reddening of skin
  5. rash
  6. blistering of the skin
  7. depression
  8. chronic inflammation
  9. muscle pain
  10. hives
  11. joint pain
  12. swelling

Related conditions

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:

  1. chronic fatigue syndrome
  2. eczema
  3. fibromyalgia
  4. osteomyelitis
  5. rheumatoid arthritis


Causes

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.


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.

What is the cause of skin allergy

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.

What is the cause of skin allergy

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.


Treatment and Prevention

Treatment of metal hypersensitivity is highly individualized, as the allergens and reactions can be extremely diverse from person to person.

Skin hypersensitivities can often be resolved by avoiding the item that causes the reaction. If the dermatitis is more significant, the doctor can also prescribe corticosteroid creams and ointments to reduce the local inflammation. The doctor can also prescribe oral antihistamines to further reduce the allergic reaction. Oral corticosteroids can also be used, but they can cause problematic side effects.

Systemic reactions are more hard to resolve, as they are often caused by implants. Removal of the implant is sometimes considered when a non-metal replacement is available and may be used. For example, a plastic-based dental filling material may be used to replace a previous metal dental filling.

What is the cause of skin allergy

However, if the allergy is caused by an artificial knee or hip, replacement with a non-metal option is rarely done due to the difficulty of replacement. For these situations, treatment generally involves both topical (surface-applied) and oral medications to reduce the allergic reaction. Due to the hard nature of treating systemic metal allergies, doctors sometimes recommend a hypersensitivity test before an implant is chosen.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only.

Always seek the advice of your physician or other qualified health provider with any questions you may own regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Metal-Hypersensitivity

Allergy Diagnostic Testing

Updated: July 2014
Originally posted: November 2007

Dr. John Oppenheimer
Director of Clinical Research,
Pulmonary and Allergy Associates
Denville, NJ, USA

Prof. Stephen Durham
Department Allergy and Respiratory Medicine,
Imperial College, London, UK

Dr. Harold Nelson
National Jewish Medical and Research Center
Denver, CO, USA

Dr.

Ole D. Wolthers
Clinical Institute, Health, Aarhus University
Asthma and Allergy Clinic, Children’s Clinic Randers
Randers, Denmark

Credit for the first skin testing goes to Charles H. Blackley, who in 1865 abraded a quarter-inch area of his skin with a lancet, applied grass pollen on a piece of wet lint, and covered the scarified area with an occlusive bandage. This resulted in intense itching and a extremely large cutaneous response.

Percutaneous skin test ranks first in confirming the presence of IgE-mediated sensitization in the allergist's office.

This should come as no surprise, as it has numerous advantages. Skin testing is minimally invasive, and when it is performed correctly it has excellent reproducibility, is easily quantified, and allows the evaluation of multiple allergens at one session. The results correlates within vivochallenges.in vitrotesting is an alternative, generally a back up tool for diagnosing allergic illness. Skin testing alone or in combination within vitrotesting is relied upon for the evaluation of allergic rhinitis, asthma, eczema, food allergy, insect sting allergy, drug allergy (especially beta-lactam and local anesthetic allergy), occupational disease and anaphylaxis.

However, the reliability of these tests depends on a number of factors. In the case of skin testing, it is significant that the technician performing the skin tests and the clinician ordering or interpreting these tests are aware of the advantages and pitfalls of the type of skin testing, the device used, the location of the tests on the body, the extracts used and the potential for suppression of the skin response by medications used to treat allergies or depression. These issues own been reviewed elsewhere in greater detail.1Forin vitrotesting, it is imperative that quality standards be met.

These include calibration of the assay, training and experience of the technician and the use of quality allergens in the solid phase.2As in any diagnostic test, it is of paramount importance that the clinician consider the positive and negative predictive worth of the tests performed. These tests should always be considered as adjuncts to the medical history and physical exam in formulating the diagnosis in each individual case, bearing in mind that both test types can yield untrue positive or, less commonly, untrue negative results.

Comparing in vivo to in vitro Testing:

The preponderance of comparative studies protest skin tests to be more sensitive thanin vitrotests.

However, the majority of these studies were performed with earlier generationin vitrotests. The newerin vitrotests produce higher test sensitivity and specificity13by using a matrix capsule containing antigen bound to a hydrophilic carrier to produce enhanced specific IgE binding with lower nonspecific IgE binding.2Levels of specific IgE measured by diverse commercial assays are not equivalent, as each assay differs in the composition of allergen reagents, methods of measurement and standardization procedures.

The advantages ofin vitrotesting are largely related to use in patients with extensive dermatoses (e.g., atopic dermatitis), resulting in an inability to act out tests on unaffected skin, or in patients who are unable to discontinue medicines that block the histamine response, i.e., antihistamines or tricyclic antidepressants.

The disadvantages ofin vitrotesting include a potential decrease in sensitivity, added cost, and lack of immediate and visible response. Performing bothin vitroandin vivotests may yield improved sensitivity.15

Recording and Scoring of Skin Test Results

Skin test results are often reported by clinicians in semi-quantitative terms. They may record results only as positive or negative, or express them on a 0 to 4+ scale without any indication of the size of the reactions that these numbers represent. However, allergy patients may own to change their allergist for numerous reasons, and it is significant that records of prior allergy testing be interpretable by the receiving physician.

At the extremely least, a record of skin testing should contain sufficient information to permit another physician to interpret the results and avoid the need to repeat skin testing. Standardized forms own been developed and are available through the American Academy of Allergy Asthma and Immunology website (for an exampleAAAAI's Skin Test and Immunotherapy Forms).

Although the area of the wheal and erythema are the most precise measurements, the longest diameter or two diameters at correct angles to each other correlate with area (r > 0.9).8The importance of performing such measurements is exemplified by the study of McCann and Ownby in which allergists were asked to interpret photographs of skin test reactions.

The scoring and interpretation of the skin test results varied greatly.9The authors of this study reinforce the thought that the most dependable method of reporting a skin test reaction is to measure and record the reaction size. At the extremely minimum, skin test results should be graded 0 to 4+, and the criteria for each grade of reaction clearly stated along with the skin test results.

Various investigators propose diverse criteria for interpreting a skin test response as positive. To assess the reliability of diverse means of interpreting the results of skin prick testing, Vanto and colleagues studied a group of 202 children sensitive to dogs.10A determination of sensitivity to dog was based on a composite score derived from the history, RAST, and bronchial or conjunctival allergen challenges.

Although in this study the overall efficacy was greatest with the histamine reference method (in which the allergy skin test response is compared to a histamine control, with a positive response considered to be a response at least as grand as that of the histamine control), maximal sensitivity was achieved when using a cutoff of a wheal 3 mm. If a clinician wishes to maximize sensitivity, the latter criterion would be most useful; however, adjustment must be made for the device used. Therefore, the criteria for a positive test should be: 1) the larger of a 3 mm mean wheal diameter or 2) equal to or greater than the 99th percentile reaction with that device at negative control sites (see Table 1).

Methods of Skin Testing

Skin testing may be performed using either the prick/puncture (percutaneous) or intradermal (intracutaneous) technique.

Intradermal testing is far more sensitive than prick/puncture testing, which means that it requires about 1000-fold less concentrated extracts than those used for prick/puncture testing to achieve a similar response. Although direct comparisons indicate that intradermal testing is more reproducible than percutaneous testing, there are numerous factors that favor the routine use of percutaneous allergy tests. These include economy of time, patient comfort and patient safety. Percutaneous testing allows the use of extract in 50% glycerin, which provides greater extract stability. Intradermal testing cannot use this diluent, as it may incite a false-positive irritant response.

However, the most significant consideration is that results of percutaneous testing correlate better with clinical allergy. The higher sensitivity of intradermal skin tests does not generally offer added benefit, since the results of skin prick tests performed with potent extracts are of sufficient sensitivity for use in clinical practice.

Two studies reinforce this concept.3,4Each study compared intradermal with skin prick tests by correlating their results with patients' responses to natural exposure to allergen as well as by allergen challenge testing.

In the first study, three groups of patients with seasonal rhinitis were compared. These subjects were classified into 3 groups based on their degree of sensitization to Timothy grass pollen. They were either skin prick test positive, only intradermal test positive, or were negative by both skin prick and intradermal testing. Both nasal allergen provocation testing and symptom scores during the pollen season correlated best with a positive skin prick test (>60% of subjects with positive skin prick tests had symptoms on allergen exposure). The frequency of positive nasal provocation (11%) and symptom scores (21%) in subjects with positive intradermal testing alone were not diverse from subjects who were skin prick test and intradermal test negative.

The authors conclude that under the conditions of this study, the presence of a positive intradermal skin test response to Timothy grass in the presence of a negative skin prick test did not indicate the presence of clinically significant sensitivity to this grass.

In the second study, patients were challenged with cat exposure for one hour.4Both positive skin prick tests andin vitrotests to cat were highly predictive of the development of symptoms upon allergen exposure in the cat challenge room.4Subjects with a negative skin prick test were just as likely to own a positive challenge result if they had a negative intradermal skin test (31%) as subjects with a positive intradermal skin test (24%).

The authors conclude that, at least with regard to cat allergy, major therapeutic decisions, such as environmental control or immunotherapy, should never be based on a positive intradermal skin test alone.

Both of these studies were performed in adults and both relied upon skin testing with relatively potent allergens (Timothy grass and cat). The clinical applicability of these results to less potent allergens, such as dog, or to younger patients (especially infants) is a matter of clinical judgment, because no specific evidence is available for these groups.

Proficiency Testing

Like every other laboratory tests, it is imperative that quality assurance standards be met to ensure that the testing technique produces precise results.

To confirm such standards, it is recommended that every technicians performing skin testing undergo evaluation of their technique.11 Certainly, it would be comforting to know that skin test technicians achieve some degree of consistency in skin test performance. Although there are no formal standards available for skin test proficiency testing, several publications propose some possible criteria. European publications propose a coefficient of variation of less than 20% following repeated skin test control applications, and the Childhood Asthma Management Program study requires that a coefficient of variation of less than 30% be attained with repeated testing with histamine and consistently negative reactions to saline to confirm proficiency in skin testing.

The National Committee for Clinical Laboratory Standards recommends quality control procedures for daily performance ofin vitroallergy testing, with a recommended coefficient of variation of less than or equal to 15%.2Even with such calibration and the increased use of automation,in vitroassays still own flaws.

Williams and colleagues examined the performance of 6 large commercial laboratories on tests of blinded samples of the same sera, both diluted and non-diluted.12They found that only two of the laboratories demonstrated acceptable precision and accuracy.

Skin Testing Devices

Whereas intradermal skin tests are always performed using a hypodermic syringe and needle, percutaneous tests may be performed with a variety of devices. Comparisons of percutaneous devices own been reviewed elsewhere in greater detail.5 Some devices own a single stylus with one or several points, whereas others own multiple heads and permit up to 10 tests to be accomplished with one application.

The degree of skin trauma created by these devices for percutaneous testing varies and so may result in differences in the size of positive reactions, and the likelihood of producing a reaction at the site of the negative control. Thus, they require diverse criteria for what constitutes a positive reaction (see Table 1).

Table 1.

What is the cause of skin allergy

Wheal size indicating a positive response to skin tests using various devices.a

a Positive response is defined as a wheal greater than 99% of wheals generated by the istration of saline to the subject's back by the same operator. Adapted from ref. 14.
b HS = Hollister Steir, Greer = Greer laboratories, Lincoln = Lincoln Diagnostics, ALK = ALK America, ALO = Labs of Ohio

"Gold Standard" Confirmation of Allergy

Although there are challenge protocols available in the research setting to confirm allergic rhinitis and asthma, the standard tool available to the clinician is a careful history and physical exam.

Skin testing correlates with results of nasal challenge and with bronchial challenges when allowance is made for nonspecific airway responsiveness.

When evaluating potential food allergy, the clinical history is the initial screening, with skin testing orin vitrotests used to corroborate the history. Oral food challenges represent the "gold standard" for the confirmation of food allergy. These can be performed as open challenges or in a single- or double-blind fashion. Food challenges are not without risk and thus require that appropriate supportive care be available. Several studies protest that the magnitude of thein vitrotest or the skin test reaction size may be useful in determining the utility of performing a food challenge.16,17One additional advantage of skin testing for food allergies is the ability to act out skin testing with the unused food, "prick-prick" test.

Several reports protest that unused foods provide greater sensitivity for certain foods.18, 19This is particularly significant in assessing allergy to fruit; however, useful results own also been demonstrated for other foods, including seafood, peanut, tree nuts, vegetables, milk and eggs.

Molecular-based allergy diagnostic

It is hoped that the predictive worth of allergy diagnostic testing can be improved with the use of molecular-based allergy diagnostics. This methodology is used to map the allergen sensitization of a patient at the epitope level, using purified natural or recombinant allergenic molecules (components) 20,21Molecular-based allergy diagnostics is available either using singleplex platforms which utilize panels of single allergens together with the corresponding allergen extract or can also be performed using multiplex technology to measure serum IgE antibodies against multiple allergens in a single assay 20-22 The technique allows for the testing of a large number of allergens using a little quantity of serum (as little as 20 µL; conventional specific IgE tests use 50 µL per allergen).

Currently one multiplex platform is available on the market (the Immuno-Solid phase Allergen Chip (ISAC) platform) 23,24 Though a higher degree of variability in low IgE levels own been found, ISAC results own been similar to those obtained from singleplex platforms 25,26 At low serum IgE levels singleplex platforms may be more sensitive than ISAC and thus this should be considered when interpreting testing using the ISAC. Although more than 130 epitopes own been identified, the clinical relevance of numerous of these is not known. Evidence, however, has been provided for use of several epitopes in clinical practice, such as peanut.

In numerous cases of peanut sensitization detected solely by prick skin testing or by whole allergen specific IgE it is hard to decide whether true allergy exists versus sensitization with no clinical symptoms as a manifestation of cross reactivity to pollen.

In such cases there is excellent evidence for analyzing IgE to the epitopes Ara h 2 (genuine IgE mediated allergy) and Ara h 8 (Bet v 1 (birch pollen) homologue; a marker of cross-reactivity) 27,28 IgE sensitization to Ara h 2 often correlates with positive IgE against Ara h 1 and Ara h 3. If there were IgE antibodies in serum to Ara h 2 and/or Ara h 1/Ara h 3, more than 95% of patients own reported symptoms when ingesting peanuts 29 If there was IgE only to Ara h 2 and not to Ara h 1, 3 or 8, 87% reported symptoms. Whether there may be a threshold level of serum IgE to Ara h 2 above which peanut allergy may be diagnosed with a sufficient sensitivity and specificity which may forsake the need for oral provocation remains to be prospectively evaluated 30If there was only IgE to Ara h 8 and not to Ara h 1, 2 or 3 only around 18% of patients own reported symptoms, and these were generally extremely mild 29 More serious symptoms cannot be ruled out, however, in Ara h 8 sensitized patients.

In the event of itching and swelling in the mouth and throat both Ara h 2 and Ara h 8 should be sure, and, at the same time, assessment of sensitization to birch pollen should be made by analyzing IgE to Bet v 1.

Bet v 1, PR-10 protein is the major allergen in birch pollen and approximately 95% of birch pollen sensitized patients own specific IgE antibodies to Bet v 1 31 Specific IgE to Bet v 1 may also be found in patients with primary sensitization to other tree pollens (e.g.

elm: Aln g 1; hazel pollen: Cor a 1) as well as to foods (hazelnut, apple, soy, peanut (Ara h 8), kiwi, celery). IgE antibodies to Bet v 2 (profilin) and/or Bet v 4 (calcium-binding protein) are markers of cross-reactivity 31 and as opposed to Bet v 1 if increased are indicators that the patient is primarily sensitized to another pollen. IgE to Bet v 2 is a marker of cross-reactivity with numerous pollens and vegetable foods 32 while IgE to Bet v 4 is a marker of cross-reactivity only with other pollen allergens 33

IgE antibodies to Phl p 1 and Phl p 5 are specific markers for sensitization to Phleum pratense (Timothy grass).

Phl p 7 (calcium-binding protein) and Phl p 12 (profilin) are markers of cross-reactivity with fruits and vegetables. Increased IgE to these components and not to Phl p 1 and/or Phl p 5 indicates primary sensitization to a diverse species of grass pollen than Phleum pratense 34 It has been suggested that if relevant symptoms are present in addition to elevated IgE Phl p 1 and p 5 levels immunotherapy with phleum pratense extract would likely be clinically effective because phleum pratense extracts contain mainly Phl p5 and p6 24,35

Molecular-based allergy diagnostics are also likely to be of utility when considering immunotherapy for dust mite allergy.

Der p 1 and Der p 2 are the most significant component markers for sensitization to home dust mites 36as more than 80-90% of patients allergic to home dust mites own IgE antibodies to these epitopes. Approximately 10% of patients allergic to home dust mites, however, own increased IgE levels to Der p 10 37 These patients will not benefit from specific immunotherapy since home mite extracts contain mainly Der p 1 and Der p 2 and variable or low amounts of Der p 10. Whether molecular-based allergy diagnostics may increase the effect ratio of immunotherapy of Phleum pratense and houst dust mite allergic patients has not, however, been tested in prospectively planned trials.

Positive IgE to both bee and wasp venom is often due to cross-reactivity between cross-reactive carbohydrate-determining reagents (CCD) 38 shared in these two species.

In the frequently occurring clinical situation of an uncertain history and positive IgE to both allergens, determination of specific molecular epitopes may be of aid. An increase in both Api m 1 and Ves v 5 would indicate a true double sensitization and immunotherapy with both bee and wasp extracts would be indicated 38,39

Understanding the paucity of data, a recent consensus document concluded that molecular-based allergy diagnosis may be considered for investigation of 20

  1. Oppenheimer J. Devices for epicutaneous skin testing. in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders 2001, p 263-72.
  2. MS Dykewicz, JK Lemmon, DL Keaney.

    Comparison of the Multi-Test II and Skintestor Omni allergy skin test devices. Ann Allergy Asthma Immunol 2007; 98:559-62

  3. Sampson H Update on food allergy Jl Every Clin Immunol 2004;113: 805-819
  4. Pittner G, Vrtala S, Thomas WR et al. Component-resolved diagnosis of house-dust mite allergy with purified natural and recombinant mite allergens. Clin Exp allergy 2004;34:597-603.
  5. Valenta R, Hayek B, Seiberler S et al. Calcium-binding allergens: from plants to man. Int Arch Allergy Immunol 1998;117:160-6.
  6. patients with insect allergy (Api m1; Ves v5).
  7. Williams, PB ; Barnes, J; Szeinbach, S; Sullivan, T Analytic precision and accuracy of commercial immunoassays for specific IgE: Establishing a standard J Every Clin Immunol 2000;105:1221-30
  8. Dreborg S.

    ed. Skin tests used in type I allergy testing Position paper. Allergy 1989;44:s1-59.

  9. Nicolaou N, Murray C, Belgrave D et al. Quantification of specific IgE to whole peanut extract and peanut components in prediction of peanut alergy. J Allergy Clin Immunol 2011:127:684-5.
  10. Yoon I-K, Martin BL, Carr WW. A comparison of two single-headed and two multi-headed allergen skin test devices. Allergy Asthma Proc 2006;27:473-8.
  11. Ferrer M, Sanz ML, Sastre et al.

    Molecular diagnosis in allergologgy: application of the microarray technique. J Investig Allergol Clin Immunol 2009;19(suppl 1):19-24.

  12. Turkeltaub P. Performance standards for allergen skin testing: An approach to proficiency testing in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders 2001, p321-8.
  13. Swoboda I, Twaroch T, Valenta R, Grote M. Tree pollen allergens. Clin Allergy Immunol 2008;21:87-105.
  14. Bilo BM, Rueff F, Mobech H, Bonifazi F, Oude-Elberink JN.

    Diagnosis of hymenoptera venom allergy. Allergy 2005;60:1339-49.

  15. Martinez A, Asturias JA, Monteseirin J et al. The allergenic relevance of profilin (Ole e 2) from Olea europaea pollen. Allergy 2002;57(suppl 71):17-23.
  16. Wolthers OD. Component-resolved diagnosis in pediatrics. ISRN Pediatrics 2012; 2012:806920. doi: 10.5402/2012/806920. Epub 2012 Aug 5.
  17. Vanto T. Efficacy of diverse skin test methods in diagnosis of allergy to dogs. Ann Every 1982:49:340
  18. Liebermann JA, Glaumann S, Batelson S, Borres MP, Sampson HA, Nilsson C. The utility of peanut components in the diagnosis of IgE-mediated peanut allergy among distinct populations.

    J Allergy Clin Immunol Pract 2013; Jan;1(1):75-82. doi: 10.1016/j.jaip.2012.11.002. Epub 2012 Dec 27.

  19. Flinterman AE, van Hoffen E, den Hartog Jager CF et al. Children with peanut allergy recognize predominantly Ara h 2 and Ara h 6, which remains stable over time. Clin Exp Allergy 2007;37:1221-8.
  20. Rosen JP, Selcow JE, Mendelson LM et al. Skin testing with natural foods in patients suspected of having food allergies: Is it a necessity?

    Jl Every Clin Immunol 1994;93:1068.

  21. Nelson HS, Oppenheimer JJ, Buchmeier A, et al. An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass. J Allergy Clin Immunol 97:1193-1201, 1996.
  22. Sporik, R0, Hill DJ, Hosking, CS0 Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin and Exp Every 2000;30:1540-6
  23. Adkinson NF Jr. The radioallergosorbent test in 1981-limitations and refinements Jl Every Clin Immunol 1981;67:87-9
  24. Ortolani C, Ispano M., Pastorello EA.,. Ansaloni R, Magri GC Comparison of results of skin prick tests (with unused foods and commercial food extracts) and RAST in 100 patients with oral allergy syndrome Jl Every Clin Immunol 1989;83:683-90
  25. Meliol G, Bonifazi F, Bonni S, et al.

    The ImmunoCAP ISAC molecular allergologyappraoch in adult multi-sensitized Italian parents with respiratory symptoms. Clin Biochem 2011; 44:1005-1011.

  26. Gadisseur R, Chapelle JP, Cavalier E: A new tool in the field of in-vitro diagnosis of allergy: preliminary results in the comparison of ImmunoCAP© with the ImmucoCAP© ISAC. Clin Chem Lab Med 2011;49:277-280.
  27. Droste JH, Kerkhof M, de Monchy JGR et al.

    Association of skin test reactivity, specific IgE, entire IgE, and eosinophils with nasal symptoms in a community-based population study J Every Clin Immunol 1996;97:922-32

  28. Eller E, Bindslev-Jensen C. Clinical worth of component-resolved diagnostics in peanut-allergic patients. Allergy. 2013 Feb;68(2):190-4. doi: 10.1111/all.12075. Epub 2012 Dec 14.
  29. McCann WA, Ownby, DR. The reproducibility of the allergy skin test scoring and interpretation by board-certified/board-eligible allergists. Ann Every Asthma Immunol 2002;89:368-71
  30. Yunginger, J.

    MD a; Ahlstedt, S; Eggleston, P. et al. Quantitative IgE antibody assays in allergic diseases JACI 2000;105:1077-84

  31. Wood RA, Phipatanakul W, Hamilton RG, Eggleston PA. A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy. J Allergy Clin Immunol 103:773-9, 1999.
  32. selected cases of suspected peanut allergy, birch pollen allergy and associated cross-reactivity (Ara h2, h8 (h1, h3) (Bet v1, v2, v4).
  33. Sastre J. Molecular diagnosis in allergy. Clin Exper Allergy 2010;40(10):1442-60.
  34. Canonica GW, Ansetegui IJ, Pawankar R, et al. A WAO-ARIA-GA2LEN consensus document on molecular-based allergy diagnostics.

    WAOJ 2013;&:1-17.

  35. Fernandes J, Reshef A, Patton L, Ayuso R, Reese G, Lehrer SB. Immunoglobulin E antibody reactivity to the major shrimp allergen, tropomysin, in unexposed Orthodox Jews. Clin Exp Allergy 2003;33:956-61.
  36. patients and triggering allergens for specific immunotherapy, specifically
    — grass, (Phl p1, p5, p12)
    — home dust mites, (Der p1, p2, p10)
    — hymenoptera venom (Api m1; Ves v5).
  37. Ownby DR.

    Computerized measurement of allergen-induced skin reactions. J Allergy Clin Immunol 69:536-8, 1982;

  38. Hiller R, Laffer S, Harwanegg C, Huber M, et al. Microarrayed molecules: diagnostic gatekeepers for allergy treatment. FASEB J 2002;16:414-416
  39. Constantin C, Quirce S, Poorafshar M et al. Micro-arrayed wheat seed and grass pollen allergens for component-resolved diagnosis. Allergy 2009;64:1030-7.
  40. Oppenheimer J, Nelson HS. Skin Testing. Ann Every Asthma Immunol. 2006;96:S6-12.
  41. Hejl C, Wurtzen PA, Kleine-Tebbe J, Johansen N, Broge L, Ipsen H.

    Phleum pratense alone is sufficient for allergen-specific immunotherapy against allergy to pooideae grass pollens. Clin Exp Allergy 2009;39:752-9.

  42. De Graaf DC, Aerts M, Danneels E, Devreese B. Bee, wasp and ant venomics pave the way for a component-resolved diagnosis of sting allergy. J Proteomics 2009;72:145-54.

Rather than classic testing, alternative molecular-based allergy diagnostics should be seen as an adjunct to the traditional whole allergen specific IgE tests. It is significant to remember that numerous patients can still be sufficiently assessed using conventional prick skin testing or specific IgE to whole allergens in the blood in addition to a thorough history and clinical examination 20 The clinical significance of sensitization detected via molecular-based allergy diagnostics should only be used in relation to the clinical history and physical signs.

ISAC testing is likely to be most useful in poly-sensitized patients for evaluation of sensitization to cross-reacting food and airborne allergens. Prospectively planned studies should be undertaken to determine to what extent such extensive panel screening may be helpful in clinical practice. Robust evidence has not yet been provided to prove that molecular-based allergy diagnostics can be utilized in lieu of oral challenge testing in food allergy.

ConclusionDiagnostic testing remains an essential tool for the evaluation of the allergic patient.

Several variables should be controlled to produce more dependable skin test results and improve the predictive values of allergy skin testing. It is also imperative that allergists ensure that the results of skin testing are dependable by conducting proficiency testing. In addition, the results must be properly documented to make them easily understandable by others. Similar standards must be applied toin vitrotesting; as in the case of skin testing, it is imperative that the ordering physician be familiar with the operating characteristics that thein vitrolab employs.

Lastly, it is likely that in the future, molecular based allergy diagnostics will frolic a bigger role in the evaluation of allergic patients.

References

  • MS Dykewicz, JK Lemmon, DL Keaney. Comparison of the Multi-Test II and Skintestor Omni allergy skin test devices. Ann Allergy Asthma Immunol 2007; 98:559-62
  • McCann WA, Ownby, DR. The reproducibility of the allergy skin test scoring and interpretation by board-certified/board-eligible allergists.

    Ann Every Asthma Immunol 2002;89:368-71

  • Ortolani C, Ispano M., Pastorello EA.,.

    What is the cause of skin allergy

    Ansaloni R, Magri GC Comparison of results of skin prick tests (with unused foods and commercial food extracts) and RAST in 100 patients with oral allergy syndrome Jl Every Clin Immunol 1989;83:683-90

  • Pittner G, Vrtala S, Thomas WR et al. Component-resolved diagnosis of house-dust mite allergy with purified natural and recombinant mite allergens. Clin Exp allergy 2004;34:597-603.
  • Valenta R, Hayek B, Seiberler S et al. Calcium-binding allergens: from plants to man. Int Arch Allergy Immunol 1998;117:160-6.
  • Yunginger, J. MD a; Ahlstedt, S; Eggleston, P. et al. Quantitative IgE antibody assays in allergic diseases JACI 2000;105:1077-84
  • Oppenheimer J, Nelson HS.

    Skin Testing. Ann Every Asthma Immunol. 2006;96:S6-12.

  • Wood RA, Phipatanakul W, Hamilton RG, Eggleston PA. A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy. J Allergy Clin Immunol 103:773-9, 1999.
  • Eller E, Bindslev-Jensen C. Clinical worth of component-resolved diagnostics in peanut-allergic patients. Allergy. 2013 Feb;68(2):190-4. doi: 10.1111/all.12075. Epub 2012 Dec 14.
  • Vanto T. Efficacy of diverse skin test methods in diagnosis of allergy to dogs. Ann Every 1982:49:340
  • Meliol G, Bonifazi F, Bonni S, et al. The ImmunoCAP ISAC molecular allergologyappraoch in adult multi-sensitized Italian parents with respiratory symptoms.

    Clin Biochem 2011; 44:1005-1011.

  • Adkinson NF Jr. The radioallergosorbent test in 1981-limitations and refinements Jl Every Clin Immunol 1981;67:87-9
  • Martinez A, Asturias JA, Monteseirin J et al. The allergenic relevance of profilin (Ole e 2) from Olea europaea pollen. Allergy 2002;57(suppl 71):17-23.
  • Bilo BM, Rueff F, Mobech H, Bonifazi F, Oude-Elberink JN. Diagnosis of hymenoptera venom allergy. Allergy 2005;60:1339-49.
  • Swoboda I, Twaroch T, Valenta R, Grote M.

    Tree pollen allergens. Clin Allergy Immunol 2008;21:87-105.

  • Hiller R, Laffer S, Harwanegg C, Huber M, et al. Microarrayed molecules: diagnostic gatekeepers for allergy treatment. FASEB J 2002;16:414-416
  • Williams, PB ; Barnes, J; Szeinbach, S; Sullivan, T Analytic precision and accuracy of commercial immunoassays for specific IgE: Establishing a standard J Every Clin Immunol 2000;105:1221-30
  • Liebermann JA, Glaumann S, Batelson S, Borres MP, Sampson HA, Nilsson C. The utility of peanut components in the diagnosis of IgE-mediated peanut allergy among distinct populations. J Allergy Clin Immunol Pract 2013; Jan;1(1):75-82. doi: 10.1016/j.jaip.2012.11.002. Epub 2012 Dec 27.
  • Nicolaou N, Murray C, Belgrave D et al.

    Quantification of specific IgE to whole peanut extract and peanut components in prediction of peanut alergy. J Allergy Clin Immunol 2011:127:684-5.

  • Canonica GW, Ansetegui IJ, Pawankar R, et al. A WAO-ARIA-GA2LEN consensus document on molecular-based allergy diagnostics. WAOJ 2013;&:1-17.
  • Yoon I-K, Martin BL, Carr WW. A comparison of two single-headed and two multi-headed allergen skin test devices. Allergy Asthma Proc 2006;27:473-8.
  • Sporik, R0, Hill DJ, Hosking, CS0 Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children.

    Clin and Exp Every 2000;30:1540-6

  • Droste JH, Kerkhof M, de Monchy JGR et al. Association of skin test reactivity, specific IgE, entire IgE, and eosinophils with nasal symptoms in a community-based population study J Every Clin Immunol 1996;97:922-32
  • Wolthers OD. Component-resolved diagnosis in pediatrics. ISRN Pediatrics 2012; 2012:806920. doi: 10.5402/2012/806920. Epub 2012 Aug 5.
  • Gadisseur R, Chapelle JP, Cavalier E: A new tool in the field of in-vitro diagnosis of allergy: preliminary results in the comparison of ImmunoCAP© with the ImmucoCAP© ISAC. Clin Chem Lab Med 2011;49:277-280.
  • Flinterman AE, van Hoffen E, den Hartog Jager CF et al.

    Children with peanut allergy recognize predominantly Ara h 2 and Ara h 6, which remains stable over time. Clin Exp Allergy 2007;37:1221-8.

  • Sampson H Update on food allergy Jl Every Clin Immunol 2004;113: 805-819
  • Sastre J. Molecular diagnosis in allergy. Clin Exper Allergy 2010;40(10):1442-60.
  • Turkeltaub P. Performance standards for allergen skin testing: An approach to proficiency testing in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders 2001, p321-8.
  • Nelson HS, Oppenheimer JJ, Buchmeier A, et al.

    An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass. J Allergy Clin Immunol 97:1193-1201, 1996.

  • Ownby DR. Computerized measurement of allergen-induced skin reactions. J Allergy Clin Immunol 69:536-8, 1982;
  • Dreborg S. ed. Skin tests used in type I allergy testing Position paper. Allergy 1989;44:s1-59.
  • Constantin C, Quirce S, Poorafshar M et al. Micro-arrayed wheat seed and grass pollen allergens for component-resolved diagnosis. Allergy 2009;64:1030-7.
  • Ferrer M, Sanz ML, Sastre et al.

    Molecular diagnosis in allergologgy: application of the microarray technique. J Investig Allergol Clin Immunol 2009;19(suppl 1):19-24.

  • Fernandes J, Reshef A, Patton L, Ayuso R, Reese G, Lehrer SB. Immunoglobulin E antibody reactivity to the major shrimp allergen, tropomysin, in unexposed Orthodox Jews. Clin Exp Allergy 2003;33:956-61.
  • Oppenheimer J. Devices for epicutaneous skin testing. in Skin Testing Dolen W (ed): Immunology and Allergy Clinics of North America Philadelphia, WB Saunders 2001, p 263-72.
  • Rosen JP, Selcow JE, Mendelson LM et al. Skin testing with natural foods in patients suspected of having food allergies: Is it a necessity?

    Jl Every Clin Immunol 1994;93:1068.

  • Hejl C, Wurtzen PA, Kleine-Tebbe J, Johansen N, Broge L, Ipsen H. Phleum pratense alone is sufficient for allergen-specific immunotherapy against allergy to pooideae grass pollens. Clin Exp Allergy 2009;39:752-9.
  • De Graaf DC, Aerts M, Danneels E, Devreese B. Bee, wasp and ant venomics pave the way for a component-resolved diagnosis of sting allergy. J Proteomics 2009;72:145-54.

People who suffer itching with no clear cause may own previously unrecognized immune system defects.

In a little study of such patients, researchers from the Middle for the Study of Itch at Washington University School of Medicine in St. Louis identified immune system irregularities that may immediate the urge to scratch.

The findings are reported in the May issue of The Journal of the American Academy of Dermatology.

“As doctors, we throw things love antihistamines, ointments and lotions at patients who suffer chronic itching, but if there is something profoundly abnormal about the immune system — as it appears there is — then we can’t solve the itching until we address those underlying causes,” said principal investigator Brian S.

Kim, MD, an assistant professor of medicine in the Division of Dermatology. “The immune system needs to be in balance, and we hope to discover ways to restore that balance in patients with this extremely debilitating condition.”

The researchers took blood samples and skin biopsies from a little sample of patients — only four are reported in the study — to glance for immune problems. They found “an incredible quantity of dysfunction,” Kim said, adding that he has seen similar defects in numerous additional patients not included in the current study.

The four patients researchers zeroed in on were ages 75 to 90. In blood samples, three of those four had high levels of the protein IgE — an immunoglobulin that is a marker of inflammation.

Immunoglobulins are antibodies deployed by the immune system to fight infections. Elevated levels of IgE often are seen in patients with allergies.

The researchers also noted extremely low levels of an immunoglobulin known as IgG; abnormally low counts of a type of immune cell called a CD8 T-cell; and an elevated number of immune cells called eosinophils, which are markers of allergic inflammation.

“Curiously, none of these patients had any history of allergic disorders,” Kim said. “We often see similarly high counts of eosinophils in patients with eczema, but the patients we studied didn’t own eczema.

They didn’t even own a rash. Only itching.”

Kim explained that dermatologists frequently take skin biopsies when a patient has a rash, but with chronic itching of unknown origin, which doctors call chronic idiopathic pruritis, there is nothing evident to biopsy.

The study’s first author, Amy Xu, a medical student in Kim’s lab, said most patients with this type of unexplained, chronic itching tend to be older and develop itching problems later in life.

“It may be caused by some sort of wear and tear on the immune system,” Xu said.

Because of the little number of patients in the study, it’s too soon to draw firm conclusions, but the itching may be an indication that something else in the body is going incorrect, Kim said.

“We own begun working on a mouse model in which the animals own similar defects,” he said.

“We desire to study whether these changes in the immune system create only itching or whether they could be signs that some other problem is present.”


Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report.

Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Originally published by the School of Medicine

First author Amy Xu and principal investigator Brian S. Kim, MD, found that immune system defects may assist explain chronic itching in some patients. (Photo: Robert Boston/School of Medicine)

What is sensitive skin?

Sensitive skin is a lay term rather than a medical diagnosis. It is generally used to describe skin with reduced tolerance to the application of cosmetics and personal care products.

In surveys, approximately 50% of women and 40% of men may report having sensitive skin.

People who suffer itching with no clear cause may own previously unrecognized immune system defects. In a little study of such patients, researchers from the Middle for the Study of Itch at Washington University School of Medicine in St. Louis identified immune system irregularities that may immediate the urge to scratch.

The findings are reported in the May issue of The Journal of the American Academy of Dermatology.

“As doctors, we throw things love antihistamines, ointments and lotions at patients who suffer chronic itching, but if there is something profoundly abnormal about the immune system — as it appears there is — then we can’t solve the itching until we address those underlying causes,” said principal investigator Brian S.

Kim, MD, an assistant professor of medicine in the Division of Dermatology. “The immune system needs to be in balance, and we hope to discover ways to restore that balance in patients with this extremely debilitating condition.”

The researchers took blood samples and skin biopsies from a little sample of patients — only four are reported in the study — to glance for immune problems. They found “an incredible quantity of dysfunction,” Kim said, adding that he has seen similar defects in numerous additional patients not included in the current study.

The four patients researchers zeroed in on were ages 75 to 90.

In blood samples, three of those four had high levels of the protein IgE — an immunoglobulin that is a marker of inflammation. Immunoglobulins are antibodies deployed by the immune system to fight infections. Elevated levels of IgE often are seen in patients with allergies.

The researchers also noted extremely low levels of an immunoglobulin known as IgG; abnormally low counts of a type of immune cell called a CD8 T-cell; and an elevated number of immune cells called eosinophils, which are markers of allergic inflammation.

“Curiously, none of these patients had any history of allergic disorders,” Kim said. “We often see similarly high counts of eosinophils in patients with eczema, but the patients we studied didn’t own eczema.

They didn’t even own a rash. Only itching.”

Kim explained that dermatologists frequently take skin biopsies when a patient has a rash, but with chronic itching of unknown origin, which doctors call chronic idiopathic pruritis, there is nothing evident to biopsy.

The study’s first author, Amy Xu, a medical student in Kim’s lab, said most patients with this type of unexplained, chronic itching tend to be older and develop itching problems later in life.

“It may be caused by some sort of wear and tear on the immune system,” Xu said.

Because of the little number of patients in the study, it’s too soon to draw firm conclusions, but the itching may be an indication that something else in the body is going incorrect, Kim said.

“We own begun working on a mouse model in which the animals own similar defects,” he said.

“We desire to study whether these changes in the immune system create only itching or whether they could be signs that some other problem is present.”


Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals.

What is the cause of skin allergy

The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Originally published by the School of Medicine

First author Amy Xu and principal investigator Brian S.

Kim, MD, found that immune system defects may assist explain chronic itching in some patients. (Photo: Robert Boston/School of Medicine)

What is sensitive skin?

Sensitive skin is a lay term rather than a medical diagnosis. It is generally used to describe skin with reduced tolerance to the application of cosmetics and personal care products. In surveys, approximately 50% of women and 40% of men may report having sensitive skin.


Caring for one patient at a time

If you are love most people, you hate the thought of walking into a crowded waiting room at the doctor’s office – and facing a endless wait before the doctor or nurse practitioner can see you.

After every, your time is just as valuable as theirs. Maybe that’s why thousands of patients own chosen Allergic & Asthmatic Comprehensive Care of New Jersey (AACCNJ).

At AACCNJ, our medical director, Eric S. Applebaum, MD, schedules and sees one patient at a time. That’s how he has done it for over 20 years. Dr. Applebaum strives to be on time for your scheduled appointment as he also understands the worth of your time.

It’s not unusual for Dr. Applebaum to spend a full hour with each patient, answering their questions, explaining treatment options and simply getting to know them as individuals. He believes that’s the best way to accurately diagnose their conditions and assist them overcome the limitations their allergies and asthma put upon them.

Dr.

Applebaum provides comprehensive care for the full spectrum of allergy and asthma conditions and symptoms, including:
• Food allergies • Seasonal allergies • Pollen allergy • Atopic dermatitis • Eczema • Skin rash • Hives
• Allergic rhinitis (hay fever) • Chronic sinusitis • Nasal congestion • Asthma • Coughing • Wheezing

AACCNJ serves the Mountain Lakes and Parsippany Troy Hills communities of Parsippany, Denville, Montville (Morris County, NJ), Passaic (Passaic County, NJ).

Discover today’s most effective allergy and asthma treatment.

Believe Eric S. Applebaum, MD, for comprehensive allergy, asthma and immunology care and advanced solutions. Call us at 973.335.1700 in Parsippany or use our online Request an Appointment form to schedule your consultation.

The Facts

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.


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