Itches, coughs, sneezes, rashes and sores

3 June 2012

Many of us will experience some form of intolerance in our lifetime - and with one in five people suffering from hay fever in the UK, the start of summer is a good time to think about the prevention and treatment of allergies.

And with the help from our allergies Doctor Michael Radcliffe, your allergy questions were answered in our expert live chat on Wednesday 30 May.

As a specialist in allergy medicine, and an advisor to Allergy UK, Dr Radcliffe provided expert insight on a wide range of conditions - including asthma, hay fever, mouth, throat and skin allergy, and allergies to foods, pollens, drugs and rubber latex. Here's what he had to say:

Jenny asked: I have been suffering with a cough which seems to be caused through nasal drip into my throat for the last six weeks (and have suffered at this time of year for the third year in a row). I have been prescribed anti-histamines, a steroid inhaler, a nose-spray and many other drugs but none of these seem to work, although, some days I am a little better and then next day I might be worse - I do not cough once I am asleep however. Is there anything else I can do to alleviate the symptoms and what do you think this might be an allergy to? It has been suggested it could be tree pollen. I do not have cold symptoms such as a runny nose, I can breathe through my nose but my throat sometimes gets sore from coughing. If it is an allergy, what can I do next year to prevent the symptoms?
Dr. Radcliffe: Persistent cough is often blamed on 'post-nasal drip' and this is a common cause.  Antihistamine and nasal spray treatment usually works. When there is also bronchial irritability as well: an asthma spray is sometimes needed to complete the cure. Although these are not typical hay fever symptoms, the seasonal occurrence may be an important clue and allergy tests should be done.
Fiona: Hi Dr. Radcliffe, I suffer from eczema on my palms and I've been told this is slightly different from other forms of eczema. Do you know why this could be?
Dr. Radcliffe: Hello Fiona, strange isn't it that you only get eczema on your palms. Eczema is an odd condition and there are many different distribution patterns, but this is definitely one of them. Did you get eczema when you were small, and do you also suffer from asthma or hay fever?
Fiona: I have asthma, but it only seems to occur in an attack once every few years! I've always had dry/sensitive skin - but the eczema has only ever been on my palms and it started when I was 16. No hay fever though.
Dr Michael Radcliffe: Fiona, it is unlikely that an allergy is causing this problem, although what you handle will certainly aggravate it. For example, I expect you find it gets worse when your hands get repeatedly wet, and I expect you have to use a moisturiser to keep up the resistance of your skin.
Fiona: Yes I use a moisturiser - thanks, glad to hear that it's probably not an allergy
Sussex Best: Hi there, I do! I suffer from allergic rhinitis and sneeze a lot during the night. If I take Antihistamines every day, I'm fine and have had these prescribed for that purpose. Are there any reasons why I shouldn't be doing this in the long term?
Dr. Michael Radcliffe: The newer antihistamines appear to be very safe for long-term use if you can't discover or remove the cause. Two questions - I see that you call it 'allergic rhinitis' but do you know what is the allergy causing it? Which antihistamine do you use?
Sussex Best: I've had allergy tests; the main culprit was the house dust mite which appears to be very difficult to remove, despite a concerted effort. I'm using Cetirizine Hydrochloride (10mg a day)
Dr. Radcliffe: Have you removed carpets, soft furnishings and heavy curtains from your bedroom? If not, you will have made little impact on the dust mite level. Cetirizine is good, but some people get a bit drowsy with it, but at night that should not be a problem: Levocetirizine does not do this.
Sussex Best: Thanks, I take it at bedtime so drowsiness isn't a problem! Thanks for your help. PS - Good service AXA.
Seamus:  Hi Dr. Radcliffe, have you heard of Bowen therapy?
Dr. Radcliffe: Hello Seamus, Bowen therapy is a complementary treatment that uses physical techniques to improve health isn't it?
Seamus: Yes it is, I've found it to be very useful in lessening my hay-fever, doesn't seem like much is being done at all but it has really made a difference to me and others that I treat. I have also found Bowen to be helpful with asthma too, along with cutting out dairy. Is there any evidence for dairy to be an aggravating factor in asthma and allergies?
Dr. Radcliffe: evidence for milk aggravating asthma and rhinitis is weak; although my experience is that many are affected. The only test is trial of avoidance.
Qwerty 22: Dr. Radcliffe, every time I eat something my tongue splits and makes funny indents. I keep going to my doctor who tells me it's an infection and prescribes me mouth wash however it doesn't help and it also makes my tongue split and indent. I can't pin point what foods make this happen as I'm finding it's happening with more and more foods, any idea what this could be?
Dr. Radcliffe: Your question has me puzzled as I am not an oral expert. I know about allergic mouth conditions, but this is unlikely to be due to allergy. I would suggest that you ask your doctor to refer you to the department of oral medicine at your local hospital: you can't suffer like this without having a diagnosis.
Lindor1: Hi, I suffer from severe bloating and stomach discomfort. My doctor has advised me to go on a gluten free, dairy free diet, also no red meat. They suspect I have intolerances to these. I have done this for almost 4 weeks and do feel a lot better. How do I know for sure if I have gluten or dairy intolerance? Also, if I can definitely confirm that this is what the problem is, does this mean I will never be able to eat these particular food types again?
Dr. Radcliffe: Food intolerance can only be identified by trial and error. So now you put the foods back one at a time and see what happens. This is certainly not a food 'allergy' and so it will be a perfectly safe thing to do. Put back meat first: it will not be the cause. Then put back milk and if your symptoms return within a day avoid it again while you put back wheat. People who continue to avoid milk need to think about calcium: see a dietician if you are unsure.
Lindor1: I had been told by somebody that you could have tests done which would give you some idea of your food intolerances? Is this the case, as I would obviously prefer to do this than to have to put up with the pain and discomfort if I eat the wrong foods?
Dr. Radcliffe: The tests are too unreliable to trust - believe me I have seen too many patients confused by them. If you fork out for them - what happens next - you go on an exclusion diet to check on the results. The test may have spotted correct culprits, wrong culprits and missed culprits. Better to try a safe exclusion diet from the start.
Lindor1: Thank you so much, I will save my money and carry on with the exclusion diet and use trial and error as you suggested.
Nick B: Hi Dr. Radcliffe, you may already have answered a question around this but is there one recommended method of combating hay fever? Or is this really down to just different things work for different people? At the moment I take the 'one a day' Benadryl tablets and use a Sudafed congestion spray twice a day (works surprisingly well even though it isn't designed for Hay fever - I think) but this combination still doesn't seem to work that well if the pollen count is high. Any other suggestions?
Dr. Radcliffe: Cetirizine (one a day Benadryl) is good for mild hay fever, but I consider it as a back for the more severely affected patient who needs a daily corticosteroid nasal spray to suppress the condition while it continues. For high pollen count days - to make it possible to go out when you might otherwise stay at home - look at the Nasal Air Guard as some people find it really useful.
J. Davidson: Hi Dr. Radcliffe - How can you tell whether your child has an allergy or a cold? Symptoms are very similar...
Dr. Radcliffe: Good question - when you find the answer, can you let me know?
Ben: Is it true that you can be allergic to bananas? When I eat them my lips get quite sore and feel like they swell at bit?
Dr. Radcliffe: Do you have any problem with allergy to rubber latex (e.g. rubber gloves)? Do you suffer similar symptoms with avocados or kiwi fruit? Do you get hay fever early (e.g. April)?
Ben: I'm fine with rubber latex - to be honest it's been a long time since I've had kiwi - but sometimes apples have an effect.
Dr Radcliffe: I would test you to all these items. Primary banana allergy is unusual but banana allergy secondary to latex sensitisation is common. You can have latex sensitisation without symptoms. Banana allergy can also be secondary to birch pollen allergy (Spring hay fever) but this is less common. In this secondary type of food allergy, cooking the food usually solves the problem - not sure I fancy cooked banana though!
Ben: Thanks Dr. Radcliffe. I do get hay fever - not badly - but this could explain it!
Jenny: I'm on a diet and would like to work out what foods I'm allergic to that might make me put on weight e.g. wheat allergies etc. How do I figure this out?
Dr. Radcliffe: Food allergy and food intolerance are very different. Food allergy can be tested for, but food intolerance can only be spotted by trial and error. Is there any food that you crave? For some people it is wheat and when they avoid it in all its forms they feel more energetic, less bloated and the craving disappears! I have seen dramatic weight reduction as a consequence of this, although this is rather unusual.
Nick B: Thanks very much for the advice. I hear some people just have an injection each year but are these proven? Also what are your views on honey, do you think eating local honey a lot in the build up to summer months if effective or just a myth?
Dr. Radcliffe: A strong steroid injection used to be given for very severe hay fever and it would give complete relief, but only for 3-4 weeks at most. But the side effects now rule this out. Very severe hay fever that does not respond to simpler treatments can still be treated by a short course of steroid tablets - justifiable for exams or weddings for example. I have no views on Honey (although have just seen a patient with a severe allergy to it!).
504096: My daughter 3½ has GORD - minimal reflux has shown up on Barium Swallow - could the projectile vomiting be an allergy and if so what steps should we be asking the paediatrician to take? She is taking Gaviscon advanced and Omeprazol that relieve some of the symptoms but not all.
Dr. Radcliffe: Similar symptoms are common in this age group. Mechanical causes used to be blamed, but research is beginning to show that a hidden (i.e. standard tests don't help) food allergy is sometimes the cause. The condition is known as 'eosinophilic oesophagitis' and you should ask the paediatrician if this might be the answer.
The Lazy Girl Blog: Hi, I have very bad eczema on my legs, I've used all kinds of creams, changed my diet, but nothing works. Does he have any tips?
Dr. Radcliffe: Is it just your legs? Do they get very itchy and are you always having to scratch them - eg rubbing your leg with the other ankle when in bed?
The Lazy Girl Blog: It is just my legs, they do get itchy -more at night in this heat. For example I'm getting more patches of eczema, at the bottom half of my leg.
Dr. Radcliffe (For The Lazy Girl Blog): This could be a mild case of the condition neurodermatitis (also known as lichen simplex). It is a chronic form of dermatitis in which chronic itching and scratching cause the skin to thicken and dry. Neurodermatitis results in a constant scratch-itch cycle. A scratch-itch cycle happens when a small itch causes scratching which increases the itch, leading to more scratching. The initial cause of the itch can be anything - an insect bite, tight clothing or dry skin. If it is this, the cure is to get a nurse to apply a soothing bandage (e.g. a calamine bandage) with a firm bandage over the top to keep it in place and to stop the scratching for long enough that the skin completely heals. Ask your GP or the nurse at your surgery if they agree.
Fiona: My sister has just been told that what she has thought for years was allergies to certain fruits (mouth swelling and tongue going blue) is actually caused by too much histamine in the body and is not an allergy to one thing in particular. Why does this happen and how can she stop it? She goes back for more tests soon, but in the meantime it's quite worrying and she avoids anything with tropical or citrus fruit in it just in case.
Dr. Radcliffe: Is this swelling itchy, and are you certain it ONLY happens when she has eaten fruits. If so, it would help to know which ones and if hazelnuts do the same thing.
Fiona: It happens quite a lot and she seems to think it's mostly when she drinks fruit drinks or eats strawberries/kiwis/mangos etc. She gets itchy arms and legs sometimes but not sure if that's related. I don't think this happens when she eats hazelnuts as I know she eats a cereal with hazelnut in it most days.
Dr. Radcliffe: This could well be the condition known as pollen food syndrome, a type of oral allergy that mostly affects people sensitised to birch pollen. Oral symptoms are usual and are due to birch allergen homologues on the proteins of certain nuts (hazel nut, almond, walnut and pecan nut), uncooked fruits (apples, apricots, pears, cherries, kiwi, mango, plums, peaches, nectarines), uncooked vegetables (carrots and celery, and the handling of raw potatoes and parsnips) and certain spices. However, must patients suffer only mild symptoms, and are only affected by a few of these items.
Do you happen to know if your sister gets hay fever in April. If she does, it makes this explanation even more likely
Fiona: I'm not sure about hay fever in April, but she does sneeze and get congested a lot. I'll pass this information on - very interesting and it would explain the sporadic swelling etc
678353: I'm allergic to tetanus but I don't really know what it means...! Nobody's ever explained the implications to me. Any insight is gratefully received!
Dr. Radcliffe: I guess you once reacted badly when you had a tetanus vaccine dose. It is important to know that if you get a nasty wound you will be offered a tetanus booster at the hospital and your uncertain history of a vaccine reaction will complicate things. Most likely the information will still be there at your GP surgery - not on the computer (unless this happened in the last 10-15 years) - it will be in your medical record envelope. Go to see the practice nurse and ask her about this.
Jacob: My partner thinks she's allergic to duck down / feather bedding but I would like to upgrade from synthetic bedding that goes all lumpy... is there anything you can recommend?
Dr. Radcliffe: Allergy to feather bedding is high in people's minds, but rare in practice. Allergy to house dust mites is FAR commoner, and feather bedding is actually the best kind to have if you are allergic to house dust mites! It seems that house dust mites avoid it. Two suggestions: either she should get tested to feathers and dust mites, or get hollofibre bedding - the sort that doesn't go lumpy.
Kirsten: Hi Dr. Radcliffe. I bought a bracelet, think it is made from nickel - and has irritated the skin on my wrist. Are there other metals I should avoid?
Dr. Radcliffe: Nickel allergy is common - especially in women. The bracelet will probably contain some, but silver and gold jewellery (e.g. 9 ct gold) also do. Chrome allergy also occurs, but is much less common.
Sarah: Hi Dr. Radcliffe. Can children as young as four get hay fever? My son seems to be pretty 'snuffly' and 'sneezy' at the moment without any underlying virus. I'm reluctant to give him Piriton regularly. Is there anything else I should do?
Dr. Radcliffe: They sure can! I don't like Piriton:  it is too drowsy making. But Zirtek Allergy Solution (cetirizine - banana flavoured) can be given once daily (longer duration of effect than Piriton) to children over 2 years.
Sarah: Thanks for that; I'll get some. Will my GP prescribe it or do I have to buy it? The Piriton has its plus points at bedtime!
Dr. Radcliffe: I think you can buy it, check with the Pharmacist. The GP would probably prescribe a non-trade-name version, but would first want to see if the hay fever explanation was likely to be correct!
A question from an AXA PPP Twitter follower: What is the best preventative to take on holiday to avoid getting stung by mosquitoes? Is there a star product you can recommend?
Dr Radcliffe: I use 50% DEET and it works well, although I am not fond of using it. But this is for when I go to malaria areas, I don't have a big problem with severe bite reactions. If I did, I would take an antihistamine (e.g. cetirizine) every day whilst away - still get bitten - most likely suffer very much less.
A question from an AXA PPP Twitter follower: I suffer from hay fever and the only thing that appears to shift it is Piriton, but it makes me so drowsy! Is there an equally strong alternative or perhaps a natural remedy i can try?
Dr Radcliffe: I am amazed that people still use Piriton - it causes considerable drowsiness and it worries me that people take it and then drive their car! The newer antihistamines either cause a bit of drowsiness or none at all. In my experience loratadine (Clarityn), levocetirizine (Xyzal) and fexofenadine (Telfast) cause the least drowsiness. Not all of them need a doctor's prescription, although some do.
Claire, a blogger from The Lazy Girl's Guide to Life asked: I have eczema. Do you have any tips and tricks which may finally help ease the itch, as well as the unsightly rash I encounter on flare ups?
Dr Radcliffe: A huge question Claire, and it would need a clinical assessment to answer it properly.  There are new treatments around, for example newly introduced antihistamines that may work better (and with less side effect) than the older ones.  If your condition warrants it, there are anti-inflammatory creams and courses of tablets that are sometimes advised although the long-established principals of keeping affected skin away from regular wetting and really well-moisturised with your best tolerated emollient still apply.
Michelle, a blogger from Peachy Palate asked: Are we born with a predisposition to develop and allergy or is it purely down to environmental factors, and can certain environments or eating certain foods cause allergies to develop in children?
Dr Radcliffe: This is very well answered by my allergist colleague Dr Diana Church on the website.
Eleanor, a blogger from Eating Like a Horse asked: I'd like to ask about lactose intolerance/allergy. I know newly-diagnosed coeliacs are often lactose intolerant until their damaged small intestines heal but how common is it after that and how is it properly diagnosed?
Dr Radcliffe: The real answer is that we are not really sure.  Testing is imprecise, and the best method in my view is to spend a few weeks on a very strict milk and lactose free diet. 
Lactose intolerance (it is not allergy) infers lactose maldigestion with the result that intact lactose reaches the large bowel where it initiates anaerobic digestion (fermentation).  Recent studies suggest that lactose intolerance causes a much wider range of gut and systemic symptoms than has previously been recognised.  In severe cases symptoms will certainly include gas, gut pain, diarrhoea or constipation.  However severe headaches, fatigue, reduced cognitive function and even joint and muscle pain might all occur and if so the explanation might be the production of toxic metabolites from gut bacteria, as a result of the anaerobic digestion of carbohydrates and other foods, not absorbed in the small intestine.
Lauren, a blogger from Powered by Peanut Butter asked: Why are allergies more prevalent nowadays than in the past?
Dr Radcliffe: This is very well answered by my allergist colleague Dr Diana Church on the website.