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By D. Achmed. Charleston Southern.

Research shows an association between thunderstorm activity and worsening of allergy and asthma symptoms; one study found a 3 percent increase in emergency-room visits for asthma attacks in the 24 hours following thunderstorms generic quetiapine 100mg without a prescription treatment bulging disc.1 As the researchers explained: Urban babies exposed to cockroach purchase quetiapine 50 mg free shipping symptoms multiple myeloma, mouse purchase quetiapine 50mg medications qhs, and cat allergens (via house dust) purchase quetiapine 200mg on-line medicine 44 159, as well as to certain types of bacteria, during their first year of life were less likely to suffer from wheezing and allergies at the age of 3. Dust-mite exposure reduced the incidence of allergy by 63 percent among infants at high risk of allergies, lending more support to the hygiene hypothesis. Pollen and mold particles that may otherwise be too big to get into your lungs suddenly become broken up by a thunderstorm, allowing entrance into your lungs, which can lead to thunderstorm asthma” Research shows an association between thunderstorm activity and worsening of allergy and asthma symptoms. Regular use of nasal corticosteroid sprays is more effective than antihistamine tablets for severe hay fever, and both treatments can be used together. If you wheeze during spring or have severe hay fever, see your doctor for appropriate advice. Other allergens such as fungal spores, massive humidity and temperature changes over a short period can also affect some people with asthma and other respiratory diseases during a thunderstorm. Not all thunderstorms, even on days with high pollen counts, trigger thunderstorm asthma. When it rains or is humid, pollen grains can absorb moisture and burst open, releasing hundreds of small pollen allergen particles that can penetrate deep into the small airways of the lung. Thunderstorm asthma is thought to be triggered by massive loads of small pollen allergen particles being released into the air during some thunderstorms that have rapid changes in wind, temperature and humidity. Unlike intact pollen, these smaller particles are capable of reaching the small airways of the lung and triggering asthma attacks. Other allergen carrying particles including atmospheric pollutants (as small as 0.1 micrometre diameter) can carry grass and tree pollen allergens. Intact pollen grains (generally 12-60 micrometre diameter) are usually trapped in the upper airways and do not reach the lungs. A single hectare of ryegrass pasture, for example, will release hundreds of kilograms of pollen per season. Around 1 in 4 people with allergic rhinitis also have asthma. He cited studies that suggest that climate warming might put more pollen in the air and cause more strong thunderstorms with heavy rains and strong winds. One important tenet of allergy and asthma is that different patients have different allergic sensitivities,” Matsui said. Experts are not certain about the exact mechanics of thunderstorm asthma They hypothesize that heavy thunderstorm winds create updrafts that lift pollen and mold particles from the ground. And after rains, the trees, weeds and grasses in our canyons wake up and send out pollen clouds.” Different plants release pollen at different times in the year; tree pollen is released late March to mid-May, grass pollen from mid-May to July and weed pollen from the end of June to September. For those of us who do suffer with hay fever, it can be a good idea to regularly check the pollen forecast. Cats and dogs can be allergic to pollen too but while the cause of the allergies is the same in pets as it is in humans, the signs can be a little different. What are the symptoms of hay fever? Running through this field after a rainy day would be hell for a hay fever sufferer. Mr Madge said: "It is a combination of factors, partly meteorological - the sort of conditions that contribute to pollen release and spread - and also the fact that we have got the grass season." Hay fever season is underway and judging by social media posts it is a lot worse this year than it has been previously. Hay fever is is an allergic reaction. As the cloud comes down, it kind of swoops up from the ground and drives up the mold,” said Dr. Thomas Mertz with Allergy and Asthma Associates. Nearly 600 adults and more than 1,100 children were surveyed, their homes were inspected for dampness and mold growth, and air samples were taken of mold spore counts. "A single big bird can cause a lot of problems for people, and often they will not realize it because allergy can take a long time to develop," he says. If you need antibiotics for sinusitis every spring, you may have a pollen allergy, says Dr. Nguyen, who recommends a visit to the allergist. Adults can become allergic to pets or pollen after years of allergy-free living. Stuffed animals are cute, cuddly, and unfortunately, major magnets for dust, a common allergy trigger. Using an air conditioner in your car can cut the amount of pollen you breathe by as much as 30%, says Myngoc Nguyen, MD, chief of allergy at Kaiser Permanente Medical Center, Northern California. Unlike pollen, which appears only in the warm weather months, mold can lurk in your house year-round. Other common weed allergens are sagebrush, found predominantly in the west, pigweed and goosefoot pollen. 1. Trees produce pollen, the dust-like, male reproductive parts of plants that cause most allergies. Once they are diagnosed with a seasonal allergy, an individual allergy treatment program can be prescribed for their relief,” Dr. Bassett said. Paul Ratner, M.D., Medical Director of Sylvana Research in San Antonio, Texas, said A dry and cold winter followed by recent heavy rains has resulted in a slightly delayed onset of spring tree pollens. About 40 million Americans suffer from hay fever,” a disease that allergists prefer to call allergic rhinitis,” because HAY is not to blame and FEVER is rarely a symptom. About 40 million Americans suffer from "hay fever," a disease that allergists prefer to call "allergic rhinitis," because HAY is not to blame and FEVER is rarely a symptom. A better scenario would be a daily rain shower over several days, as alternating rain and dry weather may again cause symptoms. Rain can wash off air-borne pollens and make them unavailable for inhalation. Our current dry weather has also increased pollution, which also causes nasal and eye irritation, regardless of allergies. Well, in response, I can say dry weather is an ideal environment for tree, grass, and weed pollens, and even a slight breeze will cause them to move around. During a dry and windy season, those with allergies would probably rather stay indoors in the comfort of an air-conditioned room. Public areas, such as workplaces, can have the same allergy-inducing conditions as your home: dry air, dust, and dust mites. A big problem with winter allergies is that cold-weather lifestyles can turn a simple allergic reaction into something worse, says Dr. Jones. Humidity has been primarily linked to one of the most common allergens; mold. On one hand rain can bring relief by reducing pollen counts. Rain has been linked to the release of seasonal pollens. How does rain make allergy symptoms worse? Winter weather increases the time you spend indoors, which increases your exposure to indoor allergens. Pollen production may be low during winter but other allergens become more prominent during those times. However, if you suffer from mold and dust mite allergies winter is the beginning of a very long 89-day period.

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A caring allergy specialist can offer a solution to your symptoms order quetiapine 200 mg online symptoms gastritis. Symptoms do not get better with home treatments cheap quetiapine 300 mg on-line medicine cabinets with lights. If you or someone you love has these symptoms cheap quetiapine 200 mg mastercard treatment plan for ptsd, you should call and schedule an appointment with our allergy specialist generic 200 mg quetiapine free shipping medicine 1900s spruce cough balsam fir. Itchy nose, eyes, ear canals, nose, soft palate and/or skin. Spring and fall tend to be the two main hay fever seasons. Found equally in men and women, hay fever is generally seasonal. Approximately 15% to 20% of Americans suffer from hay fever to some degree. Nasal polyps (small malignant growths of the nose) Having other allergic conditions (such as asthma or eczema) Repeatedly being exposed to particular allergens. Molds are not seasonal, as they are present year long in the majority of the United States, and these allergens grow outdoors and indoors. Differences in rainfall and temperatures, from one year to the next, affect pollen amounts in the air within any given season. If your symptoms still bother you, ask your doctor if immunotherapy might help you. For itchy, watery eyes; sneezing; or a runny, itchy nose, try a non-sedating over-the-counter antihistamine , like fexofenadine (such as Allegra) or loratadine (such as Claritin). Another way to relieve a stuffy nose is a nasal or oral decongestant (such as Sudafed PE). A steroid nasal spray can also help with red, itchy, watery eyes. To relieve a stuffy nose, use a steroid nasal spray (such as Nasacort). The following home treatment measures may help relieve your symptoms: Rinsing your eyes with cool water or saline eyedrops to remove clinging pollen after you come indoors. Wearing a pollen mask or dust mask if you need to mow the lawn. Limiting the time you spend outside when pollen counts are high (during midday and afternoon). Drainage from the nose down the back of the throat (post-nasal drip). Dark circles under the eyes ("allergic shiners"). What are the symptoms of seasonal allergies? Seasonal allergies occur at the same time of the year every year, if you continue to live in the same part of the country. These medications may include nasal corticosteroid sprays, antihistamine pills, nasal antihistamine sprays or decongestant pills. The National Allergy BureauTM (NAB) provides the most accurate and reliable pollen and mold levels from approximately 80 counting stations throughout the United States, two counting stations in Canada and two counting stations in Argentina. • Itching in the nose, roof of the mouth, throat, eyes. This condition differs from allergic rhinitis because the immune system is not involved. If you have allergic rhinitis, your immune system mistakenly identifies a typically harmless substance as an intruder. If you have seasonal or perennial hay fever, schedule an appointment by calling 478-787-4728. Also, try to avoid being outside on high pollen days, particularly during windy days and thunderstorms. You can use the Medicine Finder to check the active ingredients in hay fever medicines. Saline solution (salt water) drops or spray may also be useful to wash away pollen in the nose and help with a blocked or stuffy nose. Corticosteroid spray is particularly useful for more severe hay fever. For mild hay fever, an antihistamine may be the only medicine you need. Choose the best hay fever medicine for you. Use recirculated air in the car, especially when pollen levels are high, or keep the windows closed. This will help protect your eyes from irritation and flush out any pollen. Stay indoors as much as possible in spring when the pollen count forecast is high, and on windy days or after thunderstorms. This helps trap pollen and stops it reaching the inner lining of your nose. The symptoms include a blocked and itchy nose and sneezing. Improvement of the allergy symptoms with medications. Allergic rhinitis also influences other diseases. The costs of this disease process are measured in the multiple billions of dollars annually (doctor visits, missed work/school days, and medication costs). (Medical Xpress) - Though much of the beauty of spring is its vivid colors, rosy-red eyes and noses aren’t usually considered a welcome part of the landscape. Avoid alcohol - beer, wine and spirits contain histamine, the chemical that sets off allergy symptoms in the body. Wraparound sunglasses to stop pollen from getting in the eyes. For the next five days, the pollen count is forecast to be very high across England and Wales and low in Scotland and northern England. Rainfall decreases pollen concentration in the air, particularly if it rains heavily in the morning. Image caption Pollen counts are forecast to be very high in the coming days. Pollen is made up of fine, microscopic grains released into the air by grass, plants and trees. Certain times of the day have higher pollens levels. Common triggers include cleaning products, chemical fumes, certain types of dust, and corrosive gases.

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Dimethylglycinuria is a newly recognised inborn error of metabolism that causes a fishy odor discount quetiapine 200mg with visa medications osteoarthritis pain. The Remember defective enzyme is the dimethylglycine dehydroge- nase order quetiapine 100mg on line medicine 5513, which catalyzes the conversion of this compound The diagnostic black pigment of alkaptonuria is to sarcosine order 100 mg quetiapine with visa symptoms 8 weeks. Trimethylamine was diaper safe 50mg quetiapine medications and pregnancy, or a positive test for reducing substance may absent from the patient’s urine. Pale, dilute, or watery urine results from a plentiful fluid intake or diuresis as in diabetes B1. Very dark urine or concentrated Physicians since at least the time of Hippocrates have urine results from dehydration. Pale urine with a high recognized that the color of the urine may be the clue specific gravity suggests diabetes mellitus. It was Garrod’s recognition with a low specific gravity suggests the presence of uro- of the significance of the dark urine of patients and bilin or bilirubin and is best checked by analysis of the families with alkaptonuria that led to the conceptual- blood for bilirubin. Urine in this way, and many patients reach adulthood and may, of course, be red because of hematuria, but this is clinical arthritis before the diagnosis is made. This is readily recognized by microscopic analysis, and such a the result of many factors, among them that the black specimen is not the subject of differential diagnosis by pigment forms with time and oxygen, and that flushing color. The most famous make this visual diagnosis, it is best to alkalinize and example of this is the black water fever of malaria. In times past when infants wore cloth diapers, which were laundered with strong alka- line soap, the conditions were perfect, and the diagno- B1. Now they wear plastic disposable dia- In addition to alkaptonuria, hemoglobinuria and myo- pers, many of which turn pink on contact with alkapto- globinuria both produce brown or dark urine and both nuric urine. So, we can still make the diagnosis early are detected by the dipstix for hemoglobin or by the by examining the diaper. Hemoglobin in the urine is often Alkaptonuric urine also gives a positive test for accompanied by hematuria. Hemoglobinuria in the reducing substance and is glucose-negative, and this absence of red cells in the urine is accompanied by may be an alerting signal for the diagnosis. Homogentisic evidence of hemolysis, such as anemia, reticulocyto- acid also reduces the silver in photographic emulsion, sis, or hyperbilirubinemia, while myoglobinuria is and alkaptonuric urine has been used to develop a pho- often accompanied by muscle pains or cramps and tograph, an interesting qualitative test for the diagnosis. It manifests a variable Hematuria Microscopic phenotype from nonimmune hydrops fetalis to a mild Hemoglobinuria Guaiac, benzidine History adult-onset form with only photosensitive cutaneous Beets lesions. The disease is often first recognized because of (anthrocyanins) a pink, red, or brown stain in the diapers. These patients Congenital Blood, urine, stool, also develop erythrodontia in which a red fluorescence erythropoietic uroporphyrin, of the teeth is visible with ultraviolet illumination. The anthrocyani- Red dyes (Monday History nuria of beet ingestion is quite common. Red dyes, disorder, such as rhodamine B, used to color foods and cold rhodamine B) drinks have led to red urine of so many children after a Red diaper 24–36 h of Culture syndrome oxidation Neomycin Rx weekend party that the condition was termed the (Serratia after Monday morning disorder of children. In the neonatal Phenolphthalein History period, distinct red spots in the diaper were seen where pH sensitive crystals of ammonium urate dried out. In previous days Green-blue urine when cloth diapers were used and accumulated for a Blue diaper Tryptophan while before laundering, a red diaper syndrome was syndrome malabsorption recognized in which the color developed after 24h of (indigotin) incubation and came from the growth of the chro- Indicanuria Indole-acetic aciduria mobacterium, Seratia marcescens, which does not Biliverdin Serum bilirubin produce pigment in the infant’s intestine, but only after (obstructive aerobic growth at 25–30°C. Red stools may also be jaundice) seen after the ingestion of red crayons, and in some Methylene blue History patients receiving cefdinir, in most but not all of whom (ingestion, Rx) receive oral iron. Orange sand Urate overproduc- Chemical assay for tion (urates uric acid, blood may stain and urine diaper red Hypoxanthine-guanine B1. Blue color was seen in the attack of myoglobinuria should signal a work-up for a blue diaper syndrome. It is also absorption of tryptophan was described in two siblings seen in enzyme defects localized to muscle, such as who also had hypercalcemia and nephrocalcinosis. The blue color Anemia (macrocytic) Disturbances in cobalamin or comes from the oxidative conjugation of two molecules folic acid metabolism or transport of indican to indigotin, or indigo blue, a water insolu- Reticulocytosis Glycolysis defects, disorders of ble dye. The excretion of indole products is increased the g-glutamyl cycle by an oral tryptophan load. The condition must be very Vacuolized lymphocytes Lysosomal storage disorders rare because further patients have not been reported ↑ Alkaline phosphatase Hypoparathyreoidism, bile acid since the initial report in 1964. Indoles including indi- synthesis defects ↓ Cholesterol A-, hypobetalipoproteinemia, can are also found in the urine of patients with Hartnup sterol synthesis defects, disease, in which there is defective renal tubular reab- peroxisomal disorders sorption, as well as intestinal absorption of a number of ↑ Triglycerides Glycogen storage disorders, amino acids including tryptophan, but blue diapers or lipoprotein disorders, e. Indigo-carmine is enal tyrosinemia another blue dye that may find its way into food stuffs. Particularly in patients with unusual deficiency and unexplained symptoms they may be indicative of ↓ Creatinine Creatine synthesis defect an inborn error of metabolism and can help to direct ↑ Iron, transferrin Hemochromatosis, peroxisomal disorders specific diagnostic investigations. It is imperative to exclude disor- cialist metabolic investigations are not warranted. Multisystem or progressive disorders Psychosocial factors should be taken into consideration are much more likely to be caused by inborn errors of when the diagnostic work-up is planned. In the worst case, a specific diagnosis with a doomed prognosis that shat- ters the expectations of the parents can even damage Key References the parent–child relationship. Key Facts Disorders which present with potentially lethal meta- › The classic presentation of inborn errors of bolic emergencies usually do so first in the neonatal metabolism is with a free period of apparent period or early infancy. In fact, we have felt that prior health that may last days or even years, but it to the advent of programs of expanded neonatal screen- is followed by overwhelming life threatening ing a large number of such infants probably die(d) disease. Catabolism may also be induced › Initial laboratory evaluation needs only the rou- by surgery or injury. The duress of birth may be suffi- tine clinical laboratory to establish acidosis or ciently catabolic to induce an early neonatal attack. In the disorders of fatty acid oxidation, epi- ent with episodes of acute life-threatening illness. This sodes of metabolic emergency are brought on by fast- is the mode of presentation of a considerable number ing. This can be when the infant begins to sleep longer, of inherited metabolic diseases (Table B2. It is or more commonly, when intercurrent infection leads particularly characteristic of the organic acidurias, the to vomiting or failure to feed. The lactic acidemias may present in tion in infancy, often in the neonatal period, followed by recurrent episodes of metabolic decompensation usually with infection. There may be rapid pro- of ketones in the urine does not rule it out; the blood gression through lethargy to coma, or there may be level of 3-hydroxybutyrate is a better indicator of the convulsions. A normal pH in the blood does not rule important in early discrimination are the electrolytes out lactic acidemia; the pH usually remains neutral and the ammonia. More importantly, neutropenia with or with- trolytes on the presence or absence of metabolic acido- out thrombocytopenia or even with pancytopenia is sis. In general, it is advisable to get everything on the characteristic of organic acidemia, while patients with list on admission of the patient suspected of having a mitochondrial disease often develop thrombocytosis. Today in most developed without acidosis indicates that a urea cycle defect should countries this disorder is discovered through routine be followed up by amino acid analysis of the plasma and neonatal screening for the defective enzyme. This can be done by testing for blood in the urine is also useful in detecting organic acid analysis or better by a specific assay for hemoglobinuria and myoglobinuria, the latter indicat- orotic acid. In an infant found to have an elevated plasma ing a crisis in a disorder of fatty acid oxidation. Following initial testing num cofactor deficiency, which may present with indicating a disorder of fatty acid oxidation, definitive intractable seizures shortly after birth. Then if the initial indicators point to an In most of these patients, quantification of concentra- area of metabolic disease, these samples can be pro- tions of carnitine in blood and urine is useful. These infants are usually Lactate, pyruvate born healthy, and there is classically a hiatus, or period Calcium of apparent well-being, before the onset of symptoms. Nevertheless, within 24 h of the first symp- Complete blood count tom the infant is usually admitted to the intensive care Urine unit with artificial ventilation begun. Ketones Reducing substance Dinitrophenyl hydrazine Remember Sulfites (sulfite test) Acute life-threatening neonatal illness following a Benzidine, guaiac hiatus in which the infant appears well is a strong Store at −20°C (−4°F) indicator of the presence of inherited metabolic Urine disease.

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