Skin Rashes and Non-Allergic Causes

Recently I saw a number of skin rashes of the hands and feet and legs that were not caused by allergy but due to infestation by mites. Mites can be transferred from human to human or from pets to human.

Itchy rashes can be caused by parasites and fungal infestation. Each of these have their particular manifestation. Psoriasis can be at times itchy. So is a very particular skin condition called dermatitis herpetiformis which is extremely itchy.

So remember, not all itchy skin rashes are caused by allergy and therefore a diagnosis is not always straightforward.

And my learning continues...

Same Allergies, Different Symptoms

There were two patients who saw me on the same day with latex or rubber allergy who presented with different manifestation on their legs and feet.

One with his lower limbs with red, angry looking, wet lesions with skin infections.

The other with dry, thickened and scaly lesions.

The lesson:

Our bodily reactions manifest differently from persons to persons when exposed to the same allergic substance. I have observed this time and time again.

My learning continues.

Allergy in Piety

I had an interesting case of a middle age Malay lady who came to see me because of an extremely itchy thickened lesions at both of her knees and some parts of her ankle. My investigative skills were challenged, but I finally solved it.

Turns out, her allergy was due to her prayer mat which she use to kneel and the cause of the allergy was due to the new detergent she uses to wash her mat. Asking her to revert back to her old detergent solved her problem.

You never know where allergy can pop up!

My learning continues....

*Cough* *Cough*

Chronic cough can be caused by allergy, but it's not always the case.

Recently I saw a young man who had a chronic cough. I did a chest X-ray, and it showed a tumor that was eventually diagnosed as germinal cell cancer. Luckily for him, this tumor is very treatable.

Another case was a middle age man who was diagnosed with tuberculosis from the chest X-ray. In another case, a man with a prolonged runny nose turned out to have a cancer of his throat.

The lesson is to do at least some simple tests to rule out other conditions before thinking of allergy.

My learning continues

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.

Work-related Allergies

I saw a patient many years ago with allergy of his hands and discovered his allergy was due to the chemical he was using to soak his bean sprouts in. Asking him to use gloves stopped his allergy. That one was simple enough.

Another interesting case was a farmer who had a cough for months and had seen many doctors including a respiratory doctor but he did not get any better.

I asked him to bring to my clinic all the pesticides and fungicides that he used on his vegetables and watermelon and lo and behold, he was found to be allergic to a number of these. I advised him to avoid going to the farm and so his son went instead and eventually, his cough disappeared.I advised him to wear a particular mask if he ever wants to go the farm.

I have kept the pesticide and fungicide solutions but interestingly, except for a few patients, most were not allergic to them.

Lesson: BEWARE OF PESTICIDES AND FUNGICIDES

and my learning continues...

Chinese Herbs and Jaundice

Today, I want to highlight two quite similar and extremely interesting cases.

First was a patient who was referred to me by her brother-in-law who is a close friend of mine and another the father of one of my dance instructors. Both came to see me rather ill with severe jaundice, meaning their livers were not functioning and their skins were as yellow as pumpkins.

Both of them were admitted to private hospitals and the doctors were puzzled as to the cause of their condition as the blood tests showed their liver was inflammed but the cause was not known (most these cases are due to hepatitis A or B).

Their problems were quickly resolved when I asked them whether they were taking any chinese herbs or medicine. The lady was taking a kind of Chinese pill for a long time for her knee pain, and the old man was taking a Chinese herb for general good health. I tested them against their respective Chinese herbs and true enough, they sensitivity to the herbs proved positive. I then made them antidotes and within a week, their jaundice disappeared and they were smiling when they came back to see me, not yellow anymore.

Lesson: BEWARE OF THE DANGERS OF CHINESE HERBS AND MEDICINE

My learning continues.

Hives (Urticaria)

When you suddenly develop extreme itchiness together with swelling of your body in patches or lumps, chances are you have hives (or in medical terms, urticaria).

This condition can progress further to swelling of the eyes and face and worse still, go to a very dangerous condition of the patient collapsing within minutes with difficulty in breathing. This is called anaphylaxis or allergic shock.

Fortunately for most patients, they only have transient hives but unfortunately, most do not know the cause.

Generally, most hives are caused by various drug reactions but some are caused by food, in particular seafoods of various kinds, colour additives and eggs.

There is also a kind of hives caused by PHYSICAL means, such as cold, heat or even physical contact. This condition is called Physical Urticaria.

The treatment of urticaria includes the avoidance of the causative factors and the treatment of a superficial fungus which causing the condition.

Lesson: HIVES TREATMENT INCLUDES TREATMENT OF A SUPERFICIAL FUNGAL INFECTION

And my learning continues.

Yellow Yellow Allergic Fellow

One of the most difficult food substance to avoid in food allergy is those connected with yellow color additive (E110: Sunset Yellow and E102: Tartrazine).

These additives have caused untold misery to countless patients of mine. One is a lady from my hometown whose allergy to colour additive manifested as eczema all over her body.

I have learned a lot of what type of food to avoid from my consultation with her:

• Most junk food contains these additives and therefore they are no-no
• Cooking oils are also a major problem as a lot of them contains these addictives (hence the 'golden yellow' look)
• Olive and sunflowerseed oils generally do not contain them
• Most butter and margarines have these additives and therefore pastries and cakes made with these ingredients must be avoided.
• So is local Malaysian coffee (as most are roasted with margarine) and tea as they may contain yellow additives
• Most of the commercial prepared yellow mee (egg noodles) have the E102 and E110 additives

This lady now cooks with lard (to avoid the colour additives) and she goes to a particular restaurant which cooks for her specially using the oil she places at the restaurant for her food. She also told me that the task is difficult but the reward is satisfying as she made a complete recovery even though it took her some time and a number of relapses.

Lesson: E110 AND E102 ARE YELLOW COLOR ADDITIVES AND VERY COMMON FOOD ALLERGENS

My learning continues.

Hair Dye and Allergy to Beauty Products

As a result of the ladies fashion of having their hair dyed, my number of patients for hair dye allergy has grown exponentially; I probably have a few hundreds of such patients.

The reason of hair dye allergy is basically due to the chemicals to make the hair dye. There are very few cases of such allergy when using henna hair dyes but which young lady (or man) wants to use henna dyes these days?

As a result, I literally have hundreds of antidotes each for a particular patient. Don't forget that hair dyes remains on your head for a period of months. However, most hair dye allergy do not manifeast immediately. Indeed, most of them start to cause itchy rash around the face and neck only a few months later.

Cosmetics (Beauty products) are also a major problem causing rash around the face and it may not be itchy but present as acne-like lesions. Look at your cosmetic bottle and see how many chemicals are shown as ingredients (and note that the company does not need to show all the ingredients!). I find the major problem of cosmetic allrgy arises when one changes ones cosmetic to another type, typically someone one who want to upgrade to more expensive ones.

One example is a patient, as a ressult of her husband doing very well, decided to change to a very expensive brand. Unfortunately she became sensitive to these and have to give up and I advised her to go back to her old range.

Lesson: DONT CHANGE YOUR COSMETICS AND HAIR OR SKIN PRODUCTS IF THEY ARE SERVING YOU WELL

My learning continues...

Yeast Allergy in Foods

I've a substantial number of patients with yeast allergy.

The obvious question would be what to avoid. The basic thing would be to avoid most kind of bread or products containing bread like croutons and fried food with bread crumbs. Any alcohol drink will have yeast as its ingredients and must be avoided. Less common known products that contains small amount of yeast include instant noodles, pau (chinese steamed buns) and other buns, over-ripe grapes and raisins and for those who are very sensitive to yeast, yogurt products and even vinegar. Soya sauces can also cause reactions.

With my patients I tell them to bring the products for muscle testing to see if they can consume them or not.

In most cultures, we have got so accustomed to eating bread and drinking some alcohol that abstaining from these become not such an easy task.

Lesson: AVOIDANCE OF YEAST IN FOOD REQUIRES DETERMINATION AND PLANNING

and my learning continues...

Egg Allergy and Avoidance

Lets say you (or your child) has been diagnosed with egg allergy and you have been told to totally avoid eggs, as ingestion of eggs will cause your allergy to worsen.

It is very easy to say, "avoid eggs at all cost" but in practice, it takes a lot of effort to do so.

Lets examine what type of food has eggs:

• All fried food that contains batters (flour with eggs added) e.g. goreng pisang (banana fritters)
• Most pastries and bread contains eggs
• Most types of biscuits in its content or they are glazed with eggs
• Mee noodles (egg noodles - the yellow ones) especially those instant ones
• Ice cream, chocolates, cakes and the list goes on and on

I am still learning from my patients which foods contain eggs and which do not. Reading labels on the food packet usually does not help (as there is no law on strict labelling in Malaysia, but your country may have it) and as such imported food need not state all the ingredients. So if you are unsure whether a particular food has egg or not, avoid it!

Lession: FOOD AVOIDANCE IS NO EASY TASK BUT ABSOLUTELY NECESSARY

and my learning continues...

Rubber Allergy

Many years ago, one of my dance instructors showed me her feet - it was scaly around her toes and sole.

"Aha", my first thought was a fungal infection, but tests showed it was not. Muscle testing revealed that she was sensitive to rubber products, particularly her socks. She was wearing '100% cotton' socks but since it was stretchable, I was sure it had rubber components in it. She cleverly went to hunt for a pair of socks that did not have rubber but was made of cotton spandex and simply enough, her allergy was cured.

The big problem of rubber allergy is when the rash is at your undergarment areas such as your bra region. Boxer shorts help but even that some still gets the rash and i have advised for these to go back to the 'good-old-days' undies that my dad used i.e. those which you need to tie with strings and these are specially sown. Not especially cool or fashionable, but it will help tremendously in the long run.

Lesson: The simple key to contact-based allergy is avoidance.

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.

My learning continues.

Food & Acne

Having those pesky pimples in your teens is such a nuisance.

Apart from mediacation for the treatment, there are those who develop acne as a the result of using the wrong facial products or taking drugs which predisposes to pimples. There are also those whose acne are actually are caused by sensitivity to certain foods. In all the cases I test them for any food that can aggravate or cause them. Generally, the food to avoid are:

• fried food
• nuts
• chilis
• chocolates
• caffeinated drinks

Also remember to cleanse your face which tends to be greasy as often as your can especially after when you sweat.

Certain Foods Are Best Avoided When You Have Acne

...and my learning continues

General Allergy Advice

I need to stress this particular point that allergy begets allergy and this is the 'Allergic March', meaning that the allergy can become worse, other allergies may appear or you may become allergic to new substances.

I recently consulted a young 3-year-old girl who was having yeast allergy and did fantastically well with treatment. However, the allergy returned when her mum gave her some sour plum to eat.

SOUR PLUM??

For a 3-year-old??

Oh well.

My general advice for allergy would be:

• to avoid at all cost the food you or your child is allergic to
• not to introduce any other foodstuff which does not add any value to the child or your health such as junk food, flavored drinks and food and processed foods (these have preservatives, coloring and binding substances that should be avoided)
• to consume good fresh food, fruits and vegetables
• to avoid using complex soaps, shampoos, toothpastes and supplements (they are not unnecessary unless detected that they are short of them - to be discussed later)

For Allergic Persons, Simple Is Good

… and my learning continues.

Relapses of Allergy

Recently, the wife of a very good friend of mine came to see me again after she had a relapse of her abdominal bloatedness. She had the problem after her uterus was removed. It was obvious to me that after her operation, she was given a powerful dose of antibiotics and although that killed the bad bacteria that could cause problems, that also killed most of her good gut bacteria and promoted the growth of candida.

She was also found to have soya allergy and was asked to avoid yeast and sugar as they promote the growth of candida. Along with probiotics and her strict adherence to my instructions, her results were amazing.

She remained well for a number of years but unfortunately she had a very bad chest infection and she was given antibiotic and the whole problem started again. She is doing well again and hopefully will remain so.

Another similar case I saw a few weeks ago is a former military attache to the Singapore government. He had severe abdominal symptoms and went to see many gastroenterologists but he was not getting better. I tested him and found him to have yeast allergy as well as candidiasis. 

This guy has a really a very sweet tooth, so I duly advised him to refrain from sugars and yeast and guess what, I met him last night at a common good friends dinner and he is doing very well. 

This begs the question, "How long must one be on the drops or probiotics?" The answer is, it is difficult to know but if one is exposed to the allergen too quickly after 'getting better', the allergy returns.

Another case will illustrate my point:

A lady lawyer whom I saw many years ago with rather severe multiple allergies, loves cats and she has a number of them in her home. Her allergy has improved with treatment but she continues seeing me for her drops, antidotes for her cat allergy and though she has an occasional rash, it is never severe. 

                                                                                        

Allergy can relapse if the causes are activated.

And my learning continues..... 

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...

Running Noses

Many people have been suffering from a running or stuffy nose for a very, very long time and have been on antihistamine or nasal sprays. A lot of sufferers have resigned themselves to the fact that they have to suffer such symptoms forever. 

They do not have to.

There are two main categories of causes:

1. Temperature changes 
2. Allergens in the atmosphere.

The culprits are usually due to house dust mites, moulds (airborne spores), pet dander, dust particles, smoke/smog, grass and plant pollen (the grass pollen in the east differ from those which cause seasonal rhinitis/runny nose in the west) and in my part of the world (Malaysia) I have found that joss sticks, mosquito repellents (coils or electric) can also cause this problem.          

Unlike food, airborne allergens are difficult to avoid totally. It is possible to desensitise the sufferer ageist the allergen by producing holistic drops which neutralise the effect of the allergen, thereby decreasing the sensitvity to the allergen.

There are also patients who get running nose by consuming coffee or tea, exposure to perfumes and even seafood but these causes are less common.

Most nasal allergy are caused by airborne allergens

My learning continues.......

Why Treatment Sometimes Fails

When I was a young houseman working in Johor Bahru, I would always remember what my boss Datuk Lim Kee Jin often said: 

"When medical treatment fails, remember the dictum that either the diagnosis was wrong, or the drug used was wrong, or the dosage was wrong, or the time for treatment was wrong, or some other complications or other medical conditions have been missed out."  

Applying this principle to why allergy treatment sometimes 'fails' in my practice, the diagnosis may not be allergy but a fungal or parasitic infection or the wrong dose was prescribed, meaning that the neutralising dose of the treatment may be wrong. 

It is often the expectation of patients to get well quickly but most of the time in treating the cause of allergies, it takes considerable time and effort. 

Here's an example: let's say we have diagnosed the offending allergen to be yeast. Now, the cornerstone of treatment would be total avoidance of the foods with yeast. It's not as easy as it sounds, as avoiding yeast means avoiding bread, most biscuits, 'pau' (Chinese pastry), certain roti canai (Indian breads), alcohol and most vitamins (many of them are manufactured from yeast) can be a daunting task for a lot of patients. 

The period of abstinence can be very long i.e. I prescribe a period of one year after the condition completely heals. It may seem a long and daunting task but there are many, many out there who have done that. And achieving a cure is worth the effort.       

In some cases there may be more than one substance that is causing the allergy. I have always advocated that a food log be kept and if there is a breakout, one can then suspect the allergen and then discuss with me. I often learn from my patients as to what to avoid and this helps me to pass the information to newer patients.

Failure of allergy treatment needs further investigaion by Doctor and Patient

And my learning continues.