Care of Common ENT problems in Young children.

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Everyone hates it when their small child falls ill. Small children cannot tell what’s troubling them, they cry a lot, stop eating, and in coughs and colds they vomit while coughing. As shown above, the ear, nose and throat are connected so ENT problems are interrelated.

Coughs, colds are at a peak when children interact with other children in the play group. As they grow older, their immunity builds up and they fall less sick. The following are common problems in small children:

Respiratory Viral infections

Common cold viruses, flu viruses, measles, chicken pox, mumps, etc. These make the child sick and prone to allergies.

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Allergies

Allergies to dust, pollen, fungi and various foods are present

Food allergies are more common in children such as peanut, egg, wheat, milk, tree nuts, soya and seafood. These have to be identified as soon as possible and avoidance measure should be followed

The Child should have Epi-pen ready for prompt use in case of food allergy for an anaphylactic attack

( Please refer to the previous blogs on allergies)

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Adenoids and Tonsils

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Infections of the tonsils and adenoids are very common in small children. The tonsils and adenoids are protective mechanisms of the body and help prevent spread of infection to the rest of the body. After the age of 5-7 years, the frequency of infections will go down and the tonsils and adenoids should become small in size

However, tonsils and adenoids become cause of concern if,

  • The child has repeated severe infections at least once a month.
  • The tonsils and adenoids are so huge that the child finds it difficult to breath especially during sleep.(childhood sleep apnea)
  • Tonsillar infection and blocked nose persist after 7 years of age.
  • Enlarged adenoids lead to chronic mouth breathing if untreated at the proper time. This affects the development of the face leading to typical ‘adenoid face’ , mouth open, the cheek bones don’t grow as they should leading to flattening of the face, high arched roof of the mouth and dental problems

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The misconception is that children will ‘outgrow’ these infections, and so sometimes surgery is delayed. If the child is very sick it is advisable to go for adenotonsillectomy due to the following reasons:

  • Infected tonsils and adenoids carry a lot of bacteria. They no longer can ‘protect’ the body.  In fact they become more dangerous as infection from them can spread to the body and can lead to complications like rheumatic heart disease
  • The cosmetic appearance of the face is changed
  • The child has to suffer unnecessarily

Tonsils and adenoids can be removed by Coblator Assisted Surgery.  It is a plasma wand, and at near normal temperature tissue is ablated with minimal bleeding.

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Adenoids are no longer scraped out like as was done earlier. This was a blind procedure and remnants used to cause adenoids to regrow. The surgery is done by visualizing the adenoids with an angled endoscope which is either inserted through the nose or through the mouth after pulling the palate back. They are removed under vision, leading to a complete removal and no recurrence.

Otitis Media

Frequent colds lead to fluid build up in the middle ear.

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Acute Otitis media is frequent in small children as the tube connecting the ear and the throat is more horizontal and wider and opens up easily leading to more fluid collection

Smaller children cannot tell what is wrong.

  • They keep on crying and may or may not clutch their ear. The pain is relieved with proper antibiotics and decongestant medications.
  • In extreme cases the fluid , sometimes bloody, comes out through  a small pinpoint hole in the ear drum and the pain is relieved.
  • This is a relief since the pus can even reach the brain and other structures, if this does not happen

Chronic otitis media or otitis media with effusion.

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  • In some cases, especially small children with chronic allergies, there is a collection of clear fluid behind the ear drum, leading to difficulty in hearing. This fluid should subside with treatment for 2 or more months.
  • In extreme cases a grommet or a ventilation tube is placed for the fluid to drain off. This grommet extrudes itself within a year or can be removed easily by the ENT doctor.

Discharging Ear

Sometimes pus coming from the ear does not dry completely. With frequent colds and infections a hole in the ear drum forms. This is common with flu, chicken pox, and measles or similar viral infections.

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  • In chronic cases a pus culture/ sensitivity is done to determine the organism and to start the proper antibiotic. In case of hole in the ear drum Tympanoplasty surgery is advisable.
  • Surgery in young adults and at an earlier age is more successful because as time goes by, the bones of hearing become stiff, scar tissue forms and healing is affected.

Cholesteatoma

If coughs and colds persist for a long time, part of the ear drum gets pulled inside due to vacuum. This skin of the ear drum forms a pouch which starts expanding and growing inside the bone of the middle ear known as the mastoid cavity. This is called a cholesteatoma.

Choleasteatomas can also be at birth. these are formed by small ‘pearls’ or sacs of skin embedded in the mastoid bone. As the child grows, these pearls grow too and expand and cause infection in the middle ear.

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Cholesteatomas don’t get better with medicine alone. If untreated they can reach the brain, the organs of balance and the facial nerve, the nerve which deals with movement of the face. In extreme cases the hearing of the ear is already damaged.

The child has to be operated. The disease is completely removed from the middle ear and the bone, with care taken to preserve important structures.

The above article is for information only. Please contact your doctor for expert advice and managment

Winter is coming: basic skin care tips

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So we’re done with monsoon, and the Indian summer and October heat has finally set in. Navratri is on and everyone is in the mood to dance.

All the humidity is out of the air, and within a few weeks the weather should turn for the cold.  So after the summer heat and muggy monsoon, everyone is looking forward to enjoy the winter weather

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With the dry weather 2 problems have come up

1: Dry skin

2: Allergies

1: Dry Skin

Dryness of skin leads to

  • Thick dark patches of dry skin. This is common in areas like the elbow and knee, and especially in the folds around the neck, behind the ear.
  • Irritation and itching
  • Rashes and hives
  • Allergic problems and skin infections

Prevention is better than cure. Skin types are of two types, dry and oily. People with oily skin require a different set of care, such as washing frequently with mild soaps, using mild skin care solutions.

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  • For people with dry skin, proper moisturizing should start early. Use a gentle non-perfumed moisturizer. You can use coconut, olive oil or sesame seed oil too. Any time you have contact with water, your skin loses moisture. Long periods of skin contact makes your skin wrinkly. Especially if your hands have been in water for too long. you should moisturize
  • After a bath
  • If you have been working in water for too long
  • After swimming or water sports
  • Don’t use heavy makeup or harsh cosmetics, chemicals will worsen contact irritation
  • Astringents and alcohol based solutions with dry and harden your skin if used in excess

Get your thyroid levels checked

Hypothyroidism leads to dry skin. Thyroid supplements will help you and even in losing weight.

Avoid synthetic fabrics:

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Synthetic polymer fabrics have a lot of static electricity in dry weather. That worsens your dry skin and leads to rashes.

Allergies:

Though some people find winter months pleasant, others will have their allergies worsened.

Dry dust gets airborne and causes sneezing, itching, watering of eyes.

Some grasses and plants have their flower and pollen season in winter.

With proper care, you should not be stopped from enjoying the pleasant winter season.

Food Allergies? The never ending Debate.

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What is food allergy? What is the difference between food allergies and intolerance?

There are a lot of definitions about food allergies. In simple term food allergy means that the immune system overreacts to certain proteins or allergens in food.

Who are the people who need to know most about food allergies?

  • Children with food allergy and their caregivers
  • Healthcare providers
  • Food service staff and managers from settings at risk for allergic reactions to foods
  • Early childhood
  • School principals, teachers, school staff and volunteers

What are the symptoms of food allergy?

  • Vomiting
  • Diarrhea
  • Rashes
  • Urticaria and angiodema
  • Swelling of the airway, low blood pressure
  • Anaphylactic shock

In chronic conditions  a chronic allergic inflammation of the esophagus known as eosinophilic esophagitis, with symptoms of food impaction, vomiting, and heartburn.

What are the other symptoms similar to allergy?

  • Lactose and gluten intolerance
  • Attention deficit hyperactivity disorder ADHD in children
  • Energy drinks and colas
  • Some fruits like bananas contain substances which can cause a reaction similar to allergy.

What is the difference between allergy and intolerance?What is gluten and lactose intolerance?

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In intolerance the body does not have the enzymes to digest certain foods.

In lactose intolerance the body lacks the enzyme lactase which digests lactose, or milk sugar. Such patients cannot consume milk or dairy products like cheese, yoghurt,etc

Symptoms of lactose intolerance are:

  • Gas
  • Diarrhea
  • Bloating of the stomach
  • Stomach cramps
  • Rumbling of stomach
  • Feeling sick

In this case major dietary changes will help. Milk and milk products have to be eliminated from the diet.

Lactase substitutes

In addition to dietary changes, you may also find it useful to take liquid drops, tablets or capsules that contain lactase substitutes. These are available from most health foods shops.

Lactase substitutes replace the lactase your small intestine isn’t producing, which can reduce your symptoms by helping your body break down any lactose in your diet more easily.

Lactase substitutes can either be added to milk or taken just before eating a meal containing lactose.

Gluten intolerance or Celiac disease

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This is an autoimmune disorder where your immune system reacts abnormally to gluten

If you eat eat food containing gluten like wheat, barley and rye, your immune system will act on the lining of your digestive organs like stomach and intestines, destroying the delicate highly absorbent cells. This can lead to long term complications like malnutrition and permanent damage to the stomach lining.

Symptoms are

  • Gas, abdominal bloating
  • Diarrhea
  • Constipation
  • Pale, foul smelling stool
  • Vomiting, diarrhea
  • Stomach pain

Gluten intolerance can affect growth and development. It can cause emotional disorders too.

The treatment is avoiding food that contains gluten.

What are the common foods that cause allergies?

The eight common foods which cause allergies are:

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  • Milk
  • Wheat
  • Peanuts
  • Tree nuts
  • Egg
  • Soy
  • Shellfish
  • Seafood

Identifying food allergies is extremely important because a single whiff or contact can cause a severe life threatening reaction called anaphylaxis.

What is anaphylaxis?

 

It is a severe shock reaction which happens in food allergies. The symptoms are:

  • Sudden drop of blood pressure with increase in heart rate
  • Swelling of lips and wind pipe
  • Cardiac arrest
  • Nausea, vomiting
  • Feeling of anxiety or as if something is “not right”
  • Rashes, angioedema, hives.

The immediate treatment is injection of adrenaline deep intramuscular in the upper and outer part of the thigh. In western countries epi-pen auto-injectors are available which patients have to carry all times.  Dose is advised

Sometime the patient has to be intubated or a tracheostomy( an opening in the neck where a tube is placed so that the patient can breathe directly)has to be performed in emergency to improve breathing.

Treatment of food allergies

Primary the food allergies have to be identified. Your doctor will ask you a lot of questions,

Allergy skin prick testing is done to identify the exact food causing allergies.

Avoidance is the primary treatment of food allergy. Proper identification of food allergies and reading of labels of processed foods available in the market should be done.

Some patients get a severe anaphylactic reaction to the smell of seafood or peanuts.

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How to prevent food allergies?

  • To prevent allergies in infants solid foods should not be introduced early.
  • The hygiene hypothesis comes to play, that if small children are allowed to play in nature and with pets have fewer chances of developing allergies when they grow older
  • Children can outgrow allergies to milk, egg, soy and wheat.
  • Seafood and peanut allergies can persist through life.
  • Food allergies in adults may last lifelong.

Immunotherapy for food allergy

Subcutaneous immunotherapy for food allergies is highly risky due to the extreme high risk for anaphylaxis involved

 

Oral immunotherapy (OIT) for food allergy

  • Oral immunotherapy (OIT) is a potential treatment for food allergy (also known as desensitisation) that involves administering gradually increasing amounts of food allergen under medical supervision.
  • It is important that patients and their families are aware that OIT methods are not currently standardised or approved for routine treatment of food allergy globally. There are concerns about a high (or unknown) risk of potential harm in patients with severe food allergy, as well as considerable cost implications.
  • There have been recent social media reports about the use of OIT as a potential treatment for food allergy, particularly in the USA. However, currently there are no OIT methods approved by the Food and Drug Administration (FDA) to treat food allergy in the USA. These methods are still under development and until these are approved, experts do not recommend OIT for use outside of clinical trials.
  • Currently there are several clinical trials on OIT for food allergy underway in Australia and other countries. The trials aim to develop standardised and proven methods to maximise benefit and reduce the risk of potential harm in patients with severe food allergy. These trials are all hospital based due to high rates of allergic reactions, including anaphylaxis, and other adverse reactions. Until these trials are completed, with methods, safety and effectiveness determined, ASCIA recommends that OIT for food allergy should not be performed outside of clinical trials.
  • The possible benefits from OIT are desensitisation and tolerance. Published trials show that OIT for food allergy can result in desensitisation in many patients. This is a temporary state of protection that allows an increased amount of food allergen to be eaten without having an allergic reaction. However, it requires regular eating of the food and may still result in allergic reactions, including anaphylaxis, and other adverse reactions.
  • Published trials have shown a limited ability for OIT to result in ongoing tolerance and permanent benefit. Tolerance is the ability to eat a food allergen without allergic reactions, that continues after OIT is stopped and does not require regular eating of the food.
  • Until OIT for food allergy is proven and standardised for routine use, and shown to be safe to undertake at home, avoidance of confirmed food allergens is essential for the management of food allergy.

The same facts as above apply for sublingual immunotherapy

https://www.allergy.org.au/patients/allergy-treatment/oral-immunotherapy-for-food-allergy.

The above article is for information purpose only. Please contact your doctor for expert management

Hearing problems in Adults

Adults can have hearing problems …

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  • After a viral infection
  • After taking some medication which can affect the organ of hearing
  • Accidents and injuries
  • chronic infections of the ear and ear discharge
  • A condition called otosclerosis
  • Related to advanced age

How to detect hearing loss in Adults?

  • Proper history taking can note the cause, whether the hearing loss is sudden or over a period of time
  • examination of the ear drum
  • Pure tone Audiometry, Impedance audiometry are done to detect the level of hearing and whether there is fluid collection behind the ear drum.

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How to treat hearing loss in Adults?

The treatment depends upon the cause. It’s better to start the treatment as early as possible.

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  • A pure nerve deafness can be treated with a proper hearing aid. The latest hearing aids work well
  • In extreme hearing loss, sometimes hearing aids are of no use. Cochlear implants work well for such patients
  • Otosclerosis can be corrected with good stapes surgery

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  • in case of a hole in the ear drum, good tympanoplasty surgery will help.

The above article is for information only. In case you have a problem, please get a check up done by your specialist and your hearing checked.

International Deafness Awareness Week

Imagine a world of total silence.We need to realize that our ears and hearing are equally important to us as much as vision.

If we don’t hear we are face the following problems

  • We cannot communicate with each other.
  • We cannot learn speech or languages.
  • We are exposed to danger since we cannot hear alarms, approaching vehicles, etc.
  • We are not able to enjoy music or watch movies.

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International Week of the Deaf (IWDeaf)

is an initiative of the WFD and was first launched in 1958 in Rome, Italy. It is celebrated annually by the global Deaf Community on the last full week of September to commemorate the same month the first World Congress of the WFD was held. IWDeaf is celebrated through various activities by respective Deaf Communities worldwide. These activities call for participation and involvement of various stakeholders including families, peers, governmental bodies, professional sign language interpreters, and DPOs.

23 rd September is known as World Sign Language day.

The last Sunday of September is the Day of the Deaf.

How can one detect hearing loss?

Loss of hearing can affect you at any age. It can happen from birth, in young children, adults and the elderly. Proper awareness can help you detect this problem and get remedies.

What are the risks for hearing loss in small children?

  • Marriages among close relatives. This increases the risk of genetic disorders.
  • If either of the parents or a sibling is not hearing, there is a big chance of the child being deaf.
  • Viral infections, mumps, measles, rubella, chickenpox, meningitis, etc. All these illness have a high risk of the virus affecting the nerves of hearing and the middle ear. Get your child properly vaccinated!
  • Frequent colds, ear discharge in children. For these problems you should check with your doctor. Sometimes the child could require medication or a surgery which can solve the problem.
  • Falls or injuries to the head and ears
  • Loud noises

Child specialist and ENT doctors work together for this. Psychiatric assessment of the child is needed to know if the child really can hear, whether there is a attention deficit hyperactivity disorder,(ADHD), or any other reason the child is not paying attention

The earlier, the better!

Hearing loss and ear discharge in small children should be treated as early as possible. Children learn languages from after 1 year of age, it is this period that proper remedial measures should be started and not later. Once this age is passed the hearing aid or cochlear implant would be of no use as the child would hear sounds, but not understand the meaning of them.

Babies and small children don’t speak, they can’t tell what is wrong with them. How do we find out that they have a hearing problem?

Special charts are available like the one below.

 

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The parents should be alert and if any time a hearing disorder is detected, they should immediately consult with their child specialist.

How is hearing checked for small children?

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In some countries other than India, as a routine Neonatal Echo screening is done. This is a portable hand held device, and even nursing and technical staff can use it to. We recommend that as many as possible newborns get this test done, for early prevention. If at any chance hearing loss is suspected, the test is repeated after 6 months, and if it is still showing problems, the Brain Stem Evoked Response Audiometry (BERA) test is recommended.

BERA TEST

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This test is a Highly accurate computerised way of detecting hearing loss in children.

In this test signals are sent to the inner ear and the response is measured in the brain with special leads similar to an ECG. It is safe and non invasive and an OPD procedure.However, it takes some time as the child is required to sleep during the test. Some children require to be sedated.

How can we treat deafness in small children?

Deafness is treatable if taken care at the proper time. For small children it requires teamwork between the doctors, therapists and the parents of the child

  • If the child is found to be hearing to a certain extent, proper hearing aids work well.
  • Parents should talk to their child constantly. Children learn by repeating.
  • If the child has a stronger issue, a Cochlear implant will definitely help. Due to improved care and proper anesthetic techniques, cochlear implant surgery can be done at an earlier age.

What are Cochlear Implants?

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A cochlear implant is an electronic medical device which can replace the function of the damaged inner ear.

A hearing aid makes you hear better by making sounds louder, but a cochlear implant bypasses the damaged or defective structures of the ear and transmits signals directly to the brain.

 

Insect allergies and Mosquito Control

Summer holidays were on. Lots of flowers were in bloom, and bees were buzzing around. Dhara, 8 years old, was playing in the garden with her friends.  All of them were wearing brightly colored frocks. Suddenly Dhara started screaming in pain and crying. Her mother brought her inside. On examination she had found to have a bee sting. This was not the first time that it had happened. She started having itching and hives, and swelling at the site of the sting. Her parents immediately rushed her to the hospital, and treatment was started. She had to stay for a day in the hospital and was fine.

Insects stings of  bees, wasps, fire ants, etc can give a severe allergic reactions

 

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When you’re stung for the first time, there may not be a severe reaction.  Your immune system gets sensitized, so the next time round, chances are get a more severe reaction than the first. This reaction could be fatal too so it’s advisable that you attend your emergency department immediately.

What insects to look out for?

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  •   Yellow jackets are black with yellow markings, found in various climates. Their nests are usually located underground, but sometimes found in the walls of buildings, cracks in masonry or in woodpiles.•    Honeybees have round, fuzzy bodies with dark brown and yellow markings. They can be found in honeycombs in trees, old tires or other partially protected sites.

    •    Paper wasps are slender with black, brown, red and yellow markings. They live in a circular comb under eaves, behind shutters or in shrubs and woodpiles.

    •    Hornets are black or brown with white, orange or yellow markings. Their nests are gray or brown and are usually found in trees.

    •    Fire ants are reddish-brown ants living in large mounds, mostly in warmer climates. They attack with little warning, inserting highly concentrated toxins that cause burning and pain.

What symptoms to look out for?

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There will be pain, swelling and redness at the site of the insect bite. This is normal and with anti allergic tablets can be controlled.

You should be concerned if the following symptoms develop

  • Swelling of the face, throat or tongue
    •    Difficulty breathing
    •    Dizziness
    •    Stomach cramps
    •    Nausea or diarrhea
    •    Itchiness and hives over large areas of the body

This could be a part of a fatal reaction called Anaphylaxis and immediate medical attention is required.

A single insect sting, or attack by a swarm of bees can cause a severe reaction like fever, nausea, fainting, seizures, shock and even death.

A serum sickness type of reaction, fever, rashes, joint pain, etc can be seen too. It might take a few days even.

Preventive measures for insect stings:

Insects sting only when they are injured or feel that they are attacked.

  • Destroy any beehives or wasp nests near to you. You may require good pest control services.
  • If you spot stinging insects, remain calm and quiet, and slowly move away.
  • Avoid brightly colored clothes and perfume. The insects could be attracted to you, thinking that you are a flower.
  • Bees get attracted to sweet things. Keep soft drinks and sodas covered. Food should be covered to protect from insects.
  • Wear closed shoes to avoid stepping on anything.
  • Avoid loose- fitting clothes where insects can crawl between the skin and clothing.

https://www.aaaai.org/conditions-and-treatments/allergies/stinging-insect-allergy

Mosquito bites

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Mosquitoes are one of the deadliest insects.

Their bites not only cause itching, but they spread diseases such as malaria, Dengue, Chikungunya, Yellow fever, Zika Virus, filariasis and many other deadly diseases.

They are common in tropical countries.

Mosquitoes are commonly seen during dusk and early morning. They like dark places and hide in corners.

Outdoors in gardens and where there is excess vegetation mosquitoes are fairly common. They bite children playing in parks, etc.

How to avoid mosquitoes:

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First and foremost, they should not be allowed to breed.

  • Mosquitoes lay eggs in water. Their larvae hatch and breed in water. To stop them from breeding, unnecessary pooling , stagnation of water should be prevented.
  • Fish tanks should be cleaned periodically, and covered.
  • water collects in old garbage, tyres, etc. That should not be allowed
  • Puddles and potholes are to be filled in. Fountains and fish ponds should be drained if not in use.
  • Junk and clutter should be eliminated in the house. Mosquitoes tend to hide in corners, below tables, behind curtains,etc

How to avoid mosquito bites:

  • Mosquitoes get attracted to dark clothing, so wear light colored clothes.
  • The room should be bright. Bed-sheets and curtains should be light colored
  • Use of natural mosquito repellent cream.
  • Mosquito repellent sprays and plug in devices can prevent mosquitoes entering a room, but the fumes can cause allergies. Use them with discretion, such as during evening. after spraying open the doors and windows and turn on the fan. Allow the fumes to disperse.
  • Early morning and late evening keep the doors and windows closed.

USE A MOSQUITO NET WHILE SLEEPING

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Immunotherapy

Venom immunotherapy for honey bees, wasps and fire ants has found to have a good result.

Should Fluffy be given a new home? how to deal with pet allergies.

Pets. They’re part of our family.  Getting rid of a pet is unthinkable.

The hygiene hypothesis:

If children play with animals at a younger age, they become more resistant to developing allergies as they grow up. Especially kids growing up on a farm.

Cats: It’s well known that the primary allergen, Fel D1 is the main culprit for allergy to cats. Cat saliva causes allergy, cats constantly lick themselves, and their saliva sticks to their fur.

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For minimizing allergy to pets,

  • Pet hairs should be reduced. proper cleaning and use of vacuum cleaners.
  • Wash the pets regularly.
  •  Pets should not be allowed to sleep on the bed
  • Avoid handling the pet. Wash your hands if you do.
  • High efficiciency particulate (HEPA) filters help in reducing allergen levels over a period of time. Especially in the bedroom.

Pet allergies can develop over time. You may not be allergic to your dog but in a period of 2 years there’s a good chance that you can get allergic to it.

Other animals that can cause allergy

Horses, cattle, parrots, hamsters, etc.

Rats:

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Rats are everywhere, in drains,

Domestic pets, rat urine and faeces have allergenic material.

  • Proper pest control,
  • avoid open food lying around,
  • proper hygiene
  •  blocking of points of entry to rats should be done.
  • store garbage in closed containers. Proper garbage disposal

In labs and such areas, use gloves while handling

Pigeons

Feathers and pigeon droppings.

More than causing dirt, fungus grows on pigeon droppings which adds to the allergy.

How to avoid pigeons.

  • Install pigeon netting in galleries especially if you are staying in high rise buildings.
  • Pigeons lay eggs on AC units. Put pieces of glass or barbed wire so that they don’t sit and roost over there.
  • Don’t encourage feeding of pigeons. Pigeons are fed grains, etc. on basis of religious purposes. But these pigeons are responsible for allergy/asthma and spread of disease

https://acaai.org/allergies/types/pet-allergy