Preventing Influenza Transmission at Home

A recent article at the Annals of Internal Medicine published an article studying the use of hand hygiene and facemasks in preventing flu transmission at home. The investigators from the University of Hong Kong School of Public Health randomized household members of patients diagnosed to have influenza, to three arms - control group(lifestyle measures), control plus hand hygiene only, and control plus hand hygiene and facemasks. The findings revealed that hand hygiene and facemaskes can reduce influenza virus transmission if implemented early after symptoms start in the index household member. The full article can be reviewed at the Annals of Internal Medicine site.

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Updated Schedule for Allergy Shots

We will be closed the following days due to the holidays

November 26 and 27, 2009 - Closed

December 1, 2009 - Closed at 2:30 PM

December 24 and 25, 2009 - Closed

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Most Patients With Vaccine Allergy May Be Safely Vaccinated

From Medscape Medical News

By Laurie Barclay, MD

October 20, 2009 — Most patients with vaccine allergy may be safely vaccinated, according to a practice parameter published in the October issue of the Annals of Allergy, Asthma & Immunology. However, the new guidelines also recommend that patients with suspected allergy to vaccines or vaccine components be evaluated by an allergist or immunologist vs simply avoiding future immunizations, which could leave patients at higher risk for infectious disease.

The new recommendations were issued by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.

"Local, injection site reactions and constitutional symptoms, especially fever, are common after vaccinations and do not contraindicate future doses," chief editor John M. Kelso, MD, from the Division of Allergy, Asthma & Immunology at Scripps Clinic in San Diego, California, said in a news release.

Summary Statements in the Parameter

Specific summary statements in the parameter include the following:

1. Mild local reactions, fever, and other constitutional symptoms after vaccinations occur often and are not a contraindication to subsequent doses.
2. Anaphylactic reactions after vaccination are rare, with incidence of approximately 1 per million doses.
3. Even if the vaccine is not clearly the cause, all serious events occurring after vaccine administration should be reported to the Vaccine Adverse Event Reporting System.
4. Measurement of IgG antibody levels to the immunizing antigen in a vaccine suspected of causing a serious adverse reaction can determine if levels are protective and whether subsequent doses are needed.
5. Ideally, all suspected anaphylactic reactions to vaccines should be evaluated so that the responsible allergen may be identified.
6. Gelatin, egg protein, or other vaccine components are more likely than the immunizing agent itself to cause IgE-mediated reactions to vaccines.
7. Immediate-type allergy skin testing should be performed in patients who appear to have had an anaphylactic reaction after vaccination. This testing should help confirm that the reaction was IgE mediated and identify the responsible vaccine component.
8. If the intradermal skin test result is negative, it is extremely unlikely that the patient has IgE antibody to any vaccine component, and the patient can be vaccinated in the usual manner. In a patient with a history suggesting anaphylactic reaction, however, it is prudent to vaccinate with the patient under observation and to have epinephrine and other emergency treatment available.
9. In patients with history and skin tests results suggesting an IgE-mediated reaction to a vaccine but who need additional doses of the suspected vaccine or other vaccines with shared ingredients, the clinician can consider administering the vaccine in graded doses while observing the patient.
10. There are other less common but more serious reactions to vaccines, but only a few represent absolute contraindications to future doses.
11. Pregnant women should not be given live vaccines.
12. Live vaccines should generally not be given to immunocompromised persons.
13. Epidemiologic studies have not supported associations between specific vaccines or vaccination in general with long-term sequelae such as atopy, autism, and multiple sclerosis.

"The 2 key points of the practice parameter are that (1) patients with suspected allergy to vaccines or vaccine components should be evaluated by an allergist/immunologist and (2) most patients with suspected allergy to vaccines can receive vaccination safely," the guidelines authors conclude.

Ann Allergy Asthma Immunol. 2009;103:S1-14.

FDA Warns Against H1N1 Flu Supplements

from WebMD — a health information Web site for patients

Daniel J. DeNoon

October 19, 2009 — Beware fake "Tamiflu" sold over the Internet, the FDA warns.

The FDA recently bought five different products advertised online as "Tamiflu" or as treatments for the 2009 H1N1 swine flu.

Some of the pills contained only talc and acetaminophen. Some had various amounts of oseltamivir, the active ingredient in Tamiflu. None was the real thing; all are illegal in the U.S.

Moreover, all the fake "Tamiflu" products arrived by mail too late to do any good -- even if they had been the real thing.

"Medicines purchased from web sites operating outside the law put consumers at increased risk due to a higher potential that the products will be counterfeit, impure, contaminated, or have too little or too much of the active ingredient," FDA Commissioner Margaret Hamburg, MD, says in a news release.

There are only two drugs approved by the FDA for treatment of H1N1 swine flu: Tamiflu and Relenza. Both drugs are available only by prescription.

SOURCES:

News release, FDA.

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Abraham Research - Diabetes Type 2 Study

If you’re having trouble controlling your diabetes, consider participating in HARMONY, a research
study evaluating an investigational diabetes medication that’s taken only once a week.

You can find out more about the study at the HARMONY Type 2 Diabetes Research site.

If interested call Abraham Research at 859-371-3797 to speak to a Research Coordinator

www.AbrahamResearch.com

Daily Nebulizers Advised for Preschoolers With Frequent Wheezing

From Reuters Health Information

NEW YORK (Reuters Health) Oct 09 - The most effective way to manage frequent wheezing in preschool children is regular treatment with nebulized glucocorticoids, according to a report in the October issue of Allergy.

The authors of the report also suggest that as-needed use of a bronchodilator and glucocorticoid combination, which is commonly practiced, may be an alternative.

Dr. Leonardo M. Fabbri, of the University of Modena and Reggio Emilia, Italy, and colleagues conducted a trial in which 276 children ages 1 to 4 years with frequent wheeze were randomized to nebulized treatment with one of three regimens for 12 weeks: 400 mcg beclomethasone twice daily plus 2500 mcg salbutamol as needed; placebo plus a combination of 800 mcg beclomethasone/1600 mcg salbutamol as needed, or placebo plus 2500 mcg salbutamol as needed.

The primary outcome measure -- percentage of symptom-free days -- was significantly higher with daily beclomethasone (69.6%) compared with as-needed salbutamol (61.0%; p = 0.034).

Regular treatment with nebulized beclomethasone also improved several secondary outcomes, including nocturnal wakening and exacerbations.

There was no difference in percentage of symptom-free days between children with or without risk factors for asthma.

Allergy 2009;64:1463-1471.

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Worst Cities for Allergies 2009

Top Worst 10 Cities for Allergies and Asthma for 2009

1. St. Louis, MO
2. Milwaukee, WI
3. Birmingham, AL
4. Chattanooga, TN
5. Charlotte, NC
6. Memphis, TN
7. Knoxville, TN
8. McAllen, TX
9. Atlanta, GA
10. Little Rock, AR

See the rest of the top 100 cities worse for allergies at the AAFA website

Asthma-Swine Flu Q&A

Just wanted to direct you to a website, Asthma UK, that gives good, easy to understand advice for asthmatics who have questions on the H1N1 flu. My advice to all my asthma patients is that they need to get the seasonal influenza and H1N1 influenza vaccines. Also remember that children and pregnant women are high risk groups for the swine flu. Stay well, stay healthy.

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Seasonal Ragweed Allergy?

We are looking for participants for a study on investigational sublingual immunotherapy. To qualify you must be:

• 18 - 50 years old
• Received treatment for the condition for at least 2 years including the previous ragweed season
• Not on immunotherapy(allergy shots) within the last 5 years.

Please call 859-371-3797 and ask for the research coordinator.

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Personal Protection

A unique handy non-alcohol based, antibacterial/antiviral spray is available out there. This spray is currently being used by EMS/EMT, Law Enforcement and Health Care providers as an antiseptic agent that can be sprayed, even into the face, in the event of an accidental exposure to body fluids, such as blood, sputum or urine. This solution is non-alcohol based thus, non-irritating, and safe enough to be sprayed into the face for accidental exposure to potentially infectious fluids. Check their website at www.myclyns.com for more details.

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Immunotherapy Tablet Gives Fast, Durable Relief From Grass Allergens

From Reuters Health Information

By Scott Baltic

NEW YORK (Reuters Health) Sep 29 - A high-dose sublingual tablet containing allergens produced by the pollen of five grass species significantly decreases common allergy symptoms compared with placebo, from the first month of treatment forward, according to a report in the September issue of the Journal of Allergy and Clinical Immunology.

The immunotherapy tablet, Oralair Grasses, includes allergen extracts from five grasses: orchard, meadow, perennial rye, sweet vernal and timothy grasses. Oralair Grasses is manufactured by Stallergenes, Antony, France and marketed in Europe. It is not yet approved for use in the United States.

The tablet is safe and easy for patients to use, Dr. Friedrich Horak of the Medical University of Vienna, Austria told Reuters Health by e-mail, and is potent over a short treatment period, though only for grass pollen allergies. The once-daily treatment, he added, gives the advantage of good patient compliance.

The study is reportedly the first to evaluate the efficacy and onset of action of this desensitization tablet in an allergy challenge chamber. The chamber provides controlled conditions for measuring individuals' responses to a specific allergen concentration for a set period of time.

The randomized, placebo-controlled, double-blind trial recruited 89 participants between 18 and 50 years of age with histories of seasonal grass-pollen allergies. The 45 subjects in the treatment group received one immunotherapy tablet daily for the four month trial period.

Each participant underwent a two-hour baseline grass-pollen allergen challenge in the chamber before treatment began, and then again at one week and one, two and four months after starting treatment.

The primary outcome was the participants' average rhinoconjunctivitis total symptom score, which measures sneezing, runny nose, itchy nose, nasal congestion, itchy eyes and tearing.

A statistically significant improvement was seen in the treatment group after the first month, which was maintained at two and four months. Further, the total symptom score in the treatment group decreased at each successive challenge. In the patients showing the best clinical response to treatment, specific IgG (but not IgE) values were higher.

There were no serious adverse events.

J Allergy Clin Immunol 2009;124:471-477.

Flu Vaccines now Available

Get ready for the flu season. We are now giving the seasonal influenza vaccine injections. Call our office 859 371 3797 to find out how you can get your flu shots.

Updated September Schedule for Allergy Shots

We will not be giving allergy injections on these dates.

September 7, 2009, Closed

September 16, 2009, Closed after 12 Noon

Nasal Provocation Test Useful in Diagnosing Latex Allergy

Latex allergies affects many workers(especially health workers), and has a significant impact on productivity and loss of work. There is no commercially available diagnostic method to confirm IgE-mediated latex hypersensitivity. Allergy specialist in the community have tried the latex glove test but has poor validity, and serum IgE titers to latex can be ordered but has poor sensitivity. A latex allergen skin prick test has been used for investigational purposes but is not commercially available. The nasal provocation test is interesting but requires further studies.

From Reuters Health Information

NEW YORK (Reuters Health) Jul 21 - The nasal provocation test is more sensitive than the glove test for diagnosing natural rubber latex allergy, according to a report in the June issue of Allergy.

However, a standard nasal provocation method has yet to be established, according to Dr. Mehmet Unsel and researchers from Ege University Medical Faculty, Izmir, Turkey.

The nasal provocation test was positive in 84.6% and negative in 15.4% of patients with positive skin prick test to natural rubber latex, the authors report, compared with 50% positive and 50% negative glove responses.

Nasal provocation test results were negative in patients with positive skin prick tests to other inhaler allergens and in a control group with no allergic diseases.

Using skin prick test positivity to natural rubber latex and a history of natural rubber latex-associated rhinitis as the gold standard for diagnosing natural rubber latex allergy, nasal provocation test had a sensitivity of 96%, specificity of 100%, negative predictive value of 98%, and positive predicative value of 100%, the investigators note.

In comparison, the glove use test had a sensitivity of 81%, specificity of 90%, negative predictive value of 75%, and positive predictive value of 93%.

"Nasal provocation test was successfully used for the first time in the diagnosis of natural rubber latex allergy," the authors conclude.

Allergy 2009;64:862-867.

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Allergy Control Products

A reader asked where one can obtain the dust mite pillow and mattress encasings. There are several vendors that sell their products in the internet. Most of my patients have obtained their allergy control supplies from these sites.

Allergy Control Products

National Allergy

These encasings have evolved over the past decades. In the past, recommendations were made to wrap one's mattress and pillow with plastic. Now, who can sleep with plastic wrapped on your bed and pillow? The newer encasings are tightly woven sheets that breathe just like regular fabric, and serve as an excellent barrier to getting exposed to the dust mite allergen(excretions).

As a disclaimer, I do not have any financial relationship with these companies and have nothing to gain financially from this posting. Just glad that I can help

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Dust Mite Allergen Avoidance

A lot of times after allergy skin testing, when a patient finds out one is allergic to dust mite allergen the usual reaction is eeek! And then the patient asks if these microscopic insects bite. So, here is the low down on the dust mite allergen.

When we are told that we are allergic to the dust mite allergen it means that we are allergic to the dust mite excretions. Dust mites feed on our skin flakes. They do not bite. We spend at least 8 hours a day in our beds. Thus, the highest concentration of human skin flakes are in our beds, and therefore, the highest concentration of dust mites and their excretions will be in our beds. That is why when we give environmental control recommendation for dust mites we focus on the premise of minimizing exposure to the dust mites and their excretions.

Avoidance measures that have been shown to be effective in dust mite allergen control.

• Pillow, mattress and box-spring allergen proof covers. These tightly woven dust mite encassements serve as a barrier method to prevent exposure to the allergen. Getting a new mattress is not a viable method since it will be repopulated with dust mites an a few months.
• Wash beddings frequently in hot water(130 degrees F) or use special detergents that remove allergens(eg. Allersearch allergen wash)
  
• Choose wood or tiled floors instead of carpeting
• Use vacuum cleaners with a HEPA filtration system or one with double-lining bags. Vacuum at least twice a week
• Use a dehumidifier in conjunction with your air-conditioner. Maintain humidity levels between 30-50% year round.

A link to the AAAAI is available on indoor allergen control. Ask your allergist for more information on dust mite control.

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Australian Army Fined $200K over Teen's Peanut Allergy Death

We need to be constant advocates for those who suffer from food allergies. One death is too many. Read the article below taken from the Fairfax Digital Network

Army fined over teen's peanut allergy death
Fairfax Digital Network
By Selma Milovanovic
June 30, 2009

The Australian Army has been fined more than $200,000 over the death of a teenager from a peanut allergy at a cadets' school camp in May 2007.

Nathan Francis, 13, was a year nine student at Scotch College.

Regardless of his mother writing to the camp organisers that Nathan suffered from a severe peanut allergy he was given a lunch of beef satay on the first day of the camp and died shortly after.

In the Federal Court this morning, Justice Tony North ordered that the Commonwealth should pay $210,100 to the public purse.

The case came about when Comcare, a government workplace safety agency, sued the Commonwealth for a breach of the Occupational Health and Safety Act.

The Commonwealth, through the Chief of Army, was responsible for running the camp.

Justice North urged that the Victorian Coroner hold an inquest into Nathan's death to examine the role of Scotch College and its staff who manned the camp.

The school has promised to take steps to prevent the recurrence of another incident on the same camp in which six boys were lost in the forest for hours without radio contact.

Justice North adjourned that undertaking for one year.

The court heard WorkSafe Victoria had decided not to prosecute the school.

Justice North described the case as "every parent's worst nightmare" and commended Nathan's parents, Brian and Jessica, for their bravery during the proceedings.

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Physical Activity, BMI and Asthma

After posting on the effect of weight or BMI on asthma yesterday, I noticed an article on the Annals of Allergy, Asthma and Immunology on the role of physical activity and weight on adults with asthma. These investigators in Toronto, Canada surveyed asthmatic and non-asthmatic adults on their health care utilization, their level of physical activity and BMI. See abstract for details.

The authors concluded that higher physical activity levels was associated with lower usage of health care in both asthmatics and controls. They also determined that for those with asthma, higher physical activity had a positive impact on lessening overnight hospital stays, while BOTH BMI and physical activity had a positive influence on out-patient physician visits.

I've seen overprotective parents not allowing their children to participate in physical activities due to a fear of an exacerbation. The key is to aggressive asthma control so one can perform physical activities to the fullest. Obviously eating right and keeping the weight down are helpful, too.

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Does Weight have an Impact on Asthma?

There were 3 articles in the June issue of the Journal of Allergy and Clinical Immunology(JACI) that investigated the effect of weight or BMI on asthma. Interesting implications could be garnered from these published articles. Abstracts of these articles can be seen at JACI online

Key implications taken from these articles include.

• Currently being overweight in children is associated with dyspnea and bronchial hyperresponsiveness(BHR) at preschool and school age.
• Being overweight does not have a lasting effect on childhood dyspnea and BHR if the child develops a normal weight. See abstract on Scholtens' article.
  
• There is an association between central obesity and the presence and severity of asthma thus, measuring waist circumference should be considered, in addition to weight and height to better assess obesity and asthma risk. See abstract
  
• There is a modest association between an increased BMI and reduced therapeutic effect of inhaled corticosteroid containing regimens indicating that there might be a reduced response to ICS-containing medications. See abstract.

Thus cut back on those carbs and calories, get your kids active and yank them away from TV and video games.

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Updated July Allergy Injections Schedule

Just a reminder. Due to vacations we will not be giving allergy shots on these days.

July 22, Wednesday CLOSED

July 29, Wednesday CLOSED

Call (859)371-3797 for any questions

Dilute Bleach Baths Plus Intranasal Mupirocin Eases Eczema Severity in Children

From Reuters Health Information

NEW YORK (Reuters Health) Apr 28 - In children with severe atopic dermatitis prone to infections, a regimen of dilute sodium hypochlorite baths and intermittent intranasal mupirocin reduces disease severity, according to physicians at the Feinberg School of Medicine in Chicago.
"We and others have found anecdotally the addition of dilute sodium hypochlorite baths to be helpful in decreasing infection rates and disease severity" in children with eczema, Dr. Amy S. Paller and associates note, but theirs is the first controlled trial of this strategy.

Their study in the May issue of Pediatrics included 22 patients ages 9 months to 17 years with moderate to severe atopic dermatitis and bacterial skin infections. On average, one third of body surface area was affected, and the mean Eczema Area and Severity Index (EASI) score was 19.7. Lesions in most patients were positive for Staphylococcus aureus.

All patients were initially treated for 2 weeks with oral cephalexin, and continued topical anti-inflammatory medication and emollient therapy throughout the 3-month trial.

Nine patients were assigned to the treatment arm, and they bathed in a dilute bleach solution for 5-10 minutes twice a week; the dilution was 0.5 cup of 6% bleach in 40 gallons water, with final concentration 0.005%. Additional plain-water baths were not restricted. In this group, mupirocin ointment was applied intranasally twice daily for 5 consecutive days per month.

Thirteen control patients bathed in plain water and used petrolatum instead of mupirocin.

Compared to the control group, the treatment group showed significantly greater improvement on the EASI scores: -10.4 vs -2.5 at 1 month (p = 0.017) and -15.3 vs -3.2 at 3 months (p = 0.004).

The percentage of body surface area affected also significantly declined in the treatment group, by 23.7% at 3 months, versus 3% in the placebo group (p = 0.004).

Tolerability to the dilute bleach baths was "excellent," the authors say, although early on, infected lesions were made more painful. One patient who complained of skin irritation stopped the baths. However, after he developed a methicillin-resistant S. aureus skin infection requiring hospitalization, he resumed treatment, with no reported adverse effects.

Active treatment did not eradicate S. aureus, however, leading Dr. Paller and her team to suggest that longer duration of this treatment strategy may be required.

Pediatrics 2009;123:e808-e814.


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July 2009 Allergy Injections Schedule Update

Due to vacations we will not be giving allergy injections at Fragge Allergy and Asthma Clinics on these dates

July 3, Friday CLOSED

July 22, Wednesday CLOSED

July 29, Wednesday CLOSED

Call 371-3797 for any questions



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New Safety Labelling for Leukotriene Modifiers

This article was taken from WebMD Health News

June 12, 2009 — The FDA today asked makers of Singulair, Accolate, Zyflo, and Zyflo CR to include a precaution on those drugs' labels about reports of behavior and mood changes.

Singulair is used to treat asthma and symptoms of allergic rhinitis. Accolate, Zyflo, and Zyflo CR are used to treat asthma.

All four drugs are leukotriene inhibitors, which affect the leukotriene pathway, which is involved in the body's response to inflammatory stimuli (such as breathing in an allergen).

The FDA notes that some patients using those drugs have reported neuropsychiatric events (behavior or mood changes) including agitation, aggression, anxiousness, dream abnormalities and hallucinations, depression, insomnia, irritability, restlessness, suicidal thinking and behavior (including suicide), and tremor.

The FDA has already reviewed data from clinical trials about suicide risk in patients taking leukotriene inhibitors.

In that review, which the FDA released in January 2009, the FDA said it found no sign of a link between Singulair, Accolate, Zyflo, or Zyflo CR and suicide risk. At the time, the FDA said it was still reviewing clinical data on other behavioral and mood events.

FDA's Advice

On its web site, the FDA has posted the following advice about leukotriene inhibitors for patients and health care providers:

Patients and health care professionals should be aware of the potential for neuropsyschiatric events with these medications.

Patients should talk with their health care provider if these events occur.

Health care professionals should consider discontinuing these medications if patients develop neuropsychiatric symptoms.

Singulair is made by the drug company Merck. In a statement posted on its web site, Merck says that it has updated Singulair's prescribing information about adverse events reported after the drug went on the market, including the types of neuropsychiatric events mentioned today by the FDA.

"Merck will continue to work with the FDA to revise the prescribing information for Singulair in the United States to include a precaution related to those events," states Merck, adding that it is "confident in the safety and efficacy of Singulair, a medicine that has been prescribed to tens of millions of patients with asthma and allergic rhinitis since its approval more than 11 years ago."

Accolate is made by AstraZeneca. Zyflo and Zyflo CR are made by Cornerstone Pharmaceuticals. Those drug companies were not immediately available for comment on the FDA's label change request.

SOURCES:

News release, FDA.

WebMD Health News: "FDA: No Suicide Risk From Singulair."

Statement, Merck.

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FDA Recall

The U.S. Food and Drug Administration (FDA) today advised consumers to stop using three products marketed over-the-counter as cold remedies because they are associated with the loss of sense of smell (anosmia). Anosmia may be long-lasting or permanent.

The products are:
--Zicam Cold Remedy Nasal Gel
--Zicam Cold Remedy Nasal Swabs
--Zicam Cold Remedy Swabs, Kids Size (a discontinued product)

The FDA has received more than 130 reports of loss of sense of smell associated with the use of these three Zicam products. In these reports, many people who experienced a loss of smell said the condition occurred with the first dose; others reported a loss of the sense of smell after multiple uses of the products.

People who have experienced a loss of sense of smell or other problems after use of the affected Zicam products should contact their health care professional. The loss of sense of smell can adversely affect a person's quality of life, and can limit the ability to detect the smell of gas or smoke or other signs of danger in the environment.

The FDA has issued Matrixx Initiatives, maker of these Zicam products, a warning letter telling it that these products cannot be marketed without FDA approval.

For more information visit
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm166834.htm

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All the Huff About HFA Inhalers

A certain George made a comment on this blog about asthma patients complaining that they are having problems with their HFA inhalers. They state that their HFA inhalers do not work as well as their CFC inhalers. Check the multiple links he has below(under Comments in the Spring Tips) and get involved if you agree.

I think it is equally important to point out that the evidence is there to show that the amount of albuterol delivered by the HFA and CFC inhalers are comparable. It may be worth checking the FDA's website on this for a balanced take on this case. Go to http://www.fda.gov/cder/mdi/albuterol.htm

Spring Allergies

We had a teaser last weekend with temperatures hitting the 70's, and now were back to the 40's agian. But many allergy sufferers started to feel the effects, although for only a few days, of the tree pollens in the air. We've already been getting calls of patients' eyes getting red, swelling and excruciatly itching, and some complaining of sneezing, runny nose and nasal and throat itching. Pollen allergy season hits very hard here in the Midwest thus various practical measures need to be taken if you know you have pollen allergies.

A few outdoor pollen allergy tips include:

• Avoid the outdoors in the late mornings, during the times pollens peak in the day


• Its best to go outdoors immediately after it rains because the air gets washed and the air pollen counts drop dramatically


• Keep window and doors closed to prevent the millions of pollen grains from entering your home


• Install high-efficiency filters such as HEPA or electrostatic filters into your furnace, and allow your HVAC fan to run on the constant "on" setting rather than the intermittent "auto" setting.


• If possible delegate outside work to someone not afflicted by pollen allergies


• Wear a mask if doing work outdoors such as yardwork or gardening is unavoidable


• Remove clothing and wash after doing outdoor tasks


• Wash your hair, face, arms. or shower immediately working outdoors

If these measures do not help and your symptoms persist despite taking various over the counter antihistamines such as Loratidine or Cetirizine, then it is time to see an allergist.