More Work-related Allergies

Imagine that you are a masonry worker and if you have developed contact dermatitis due to cement, you would have to choose between continuing with your work or to be extremely careful to avoid contact with cement. That is a difficult thing to do.

There are many such work related allergies, each with it's dilemma. One teacher patient of mine had hand allergy due to the use of chalk (I thought we dont use chalk in the classroom anymore!) and another young school girl had allergic conjunctivitis (itchy red eyes) who was also allergic to chalk. She got much better when she went to university. I suppose they don't use chalk there anymore.

Grass pollen allergies are common in farmers and are difficult to manage.

There are also many work-related allergies occuring in factories such as chrome allery of hands (especially in cement factories), work dust allergy (for work that have a lot of dust), paint and turpentine allergy (common in furniture workers) and the list goes on and on.

Lesson: IT IS NOT UNCOMMON FOR YOUR WORK TO CAUSE YOU ALLEGIES

My learning continues.

Multiple Allergies and Growing Up

This young man first saw me at the age of 12 with very severe eczema and he was feeling terrible and really, who can blame him?

He was first diagnosed to have house dust mite, egg and milk allery and later with the help of his mum and himself, we gradually realised that he also had chrome, nickel, alcohol, detergent and mint allergy. That's quite a number.

His condition improved with time but he was not happy as he was the smallest boy in class and by 15 had not attained puberty. I assured him that with the elimination of his allergies, he would grow. Of course, being the awkward age of 15, I wasn't sure if he believed me.

Imagine my pride that he is now grown and training for a triathron! In fact when I met him at the park where I have my weekly walks, he challenged me for a race (with handicap of course... I'm past my prime) with the bet that if he won, further medical fees would be waived. Clever boy.

Because he was getting better in the course of his treatment, he also mentioned that he wanted me to stay alive as long as he lives so that he would always be well. What a compliment, I thought.

Allergies May Have Multiple Causes. Doctor and Patient Detective Collaboration Helps.

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The Extremes of Allergies

An allergy can present as two extreme manifestations; I had two cases today to demonstrate my point.

One young man came to see me for a patch of thickened skin rash at the back of his neck, about the size of a ten-cent coin. He was diagnosed to have chromium allergy (i.e. allergy to chrome). It was due to a chain he was wearing for some time, a gift from his girlfriend.

The other patient had seen me 5 years ago and was diagnosed as having egg allergy and has actually got well after treatment by me. This time, he had a scaly rash all over his scalp, his face and his whole body. His condition is known as exfoliative dermatitis, a severe allergic reaction. His present severe manifestation is in contrast with what he experienced 5 years ago - only a mild skin rash. This illustrates the unpredictability of allergy.

I can remember some other cases I've had of extreme allergic manifestations.

Many years ago, one patient of mine had an allergy to yellow dye additive (as found in certain foods) and was admitted to a hospital for an anaphylactic reaction (i.e. allergic shock) in Sydney after taking some butter for breakfast. After that incident, she kept an Epipen (Epinephrine Auto-Injector) with her. She had another attack in Kuala Lumpur when she was back in Malaysia but after I prescribed her with probiotic, she has never had another attack since. 

Another patient is the daughter of a squash buddy of mine who had peanut-induced anaphylactic shock, which can cause death very rapidly, like 5 minutes. He brought her to see me, and after treatment, she has not had an attack since.

Allergy can range from the very mild to very life treatening

My learning continues...

A Phone-y Allergy

Recently, I had an interesting case of a 14-year old girl who had seen me before for egg allergy and has done exceedingly well (her generalized skin rash had gone)

This time her mother brought her from KL to see me because she had a rash on her right ear. It was obvious that she had eczema on her right earlobe but what what was the cause? Her rash had reduced after treatment by a few visits to a local doctor but recurred after the cream was stopped. I tested her and found that she was now allergic to chrome and nickel. But why only the right ear? It puzzled me.

Her mother told me that she forbade her children to use jewelry of any kind and all of them did own not any mobile phone as she did not believe that they should be using mobile phones at her age.

That was my 'Aha' moment.

I requested her mother to leave us alone for a moment and when she had gone, I asked the girl whether she had been using her friend's mobile phone. She was a little hesitant to admit it, but she did. When I took out my aging mobile phone and asked her if it looked like that, her eyes widened and she nodded. 

My phone had a chrome border around it.

It's not hard to deduce the resourcefulness of a pretty young girl of 14 who had been banned from owning a mobile phone. The diagnosis was easy but the tricky part was to convince the mother to get her a cheap mobile phone and to cover the phone with a case!

It is common to have a child start with one or two allergens and left undetected and untreated, he/she would developed more and more sensitivities to other allergens, especially with the number of the allergens that can be found in our food these days. Also, our daily use of washing chemicals is phenomenal. Worth noting is that a skin allergy can develop into to asthma or colic (pain in the abdomen).   

                                   

Remember the Allergy March: Allergy begets allergy and has to be treated early

My learning continues.