Common Causes Of Scalp itch (Gatal Kepala)

 

Common causes of scalp itchyness

Klinik Dr ShahAn Original Article by:Dr.Shahjahan Bin Kassim

Food Allergies

Introduction
Allergies to a single food item or food group is a frequent occurrence that we may know someone who suffers from it. While food allergies occur commonly in babies and the young; in reality, it can occur at any age. The Center For Disease Control (CDC) USA estimates it affects 4-6% of children and 6% of the adult population. Common foods that one can be allergic to vary in countries; perhaps due to different diets. Some food allergies are common however across the world (Tab. 1).

Symptoms
Allergies occur when our normal healthy immune system (that normally protects us from infections) overreacts to certain proteins in food. The overactive immune system releases many chemicals designed to disable food protein. These immune chemicals are related to eating certain foods. It's not clearly understood why an individual develops food allergy all of a sudden. When a sensitive individual eats an allergic food, he/she develops the allergic symptoms usually within a few minutes. This type of immune reaction is called an immediate reaction. The reaction may be mild such as itch and tingling sensation of lips or more severe such as swelling around eyes, lip swelling and in severe cases, throat swelling. Food allergy can cause very serious reaction including breathing difficulty and even death. This is called anaphylaxis. Sadly there have been a number of accidental deaths related to food allergy in the west.

Common allergy symptoms include :

• Vomiting and/or stomach cramps
• Hives - hot swelling on the skin
• Shortness of breath
• Wheezing while breathing (non-asthmatic) *
• Repetitive cough- unable to speak without coughing *
• Shock or circulatory collapse *
• Tight, hoarse throat; trouble swallowing *
• Swelling of the tongue, affecting the ability to talk or breathe *
• Weak pulse *
• Pale or blue colouring of skin *
• Dizziness or feeling faint *

* Seek immediate medical attention if you have these symptoms -Anaphylaxis

Triggers Of Allergies

Although any food can cause an allergic reaction, these top 8 food groups account for 90% of food allergies:

Table 1

1. Egg :       

                                          

• Albumin (also spelled albumen)
• Egg (dried, powdered, solids, white, yolk)
• Lysozyme
• Mayonnaise
• Meringue (meringue powder)
• Ovalbumin
• Surimi

    

        Eggs are sometimes found in the following processed food:

• Baked goods (although some people can tolerate these foods—consult with your allergist)- Pastries
• Egg substitutes
• Ice cream
• Lecithin
• Marzipan
• Marshmallows
• Pasta
• Noodles (Egg noodles)

2. Milk :

     Cows Milk Protein Allergy (CMPA) often cause allergy in newborns and infants. Children can 

develop an allergy to 2 main proteins in cows milk- Casein & Whey. CMPA allergy children cause chronic diarrhea & vomiting when fed formula milk. Formula milk manufacturers have now developed special milk for children with CMPA allergy, such as partially hydrolyzed or extensively hydrolyzed formula. These new formulas are free from milk Casein & Whey. However, such formulas are expensive. It must be noted there is >90% similarity between cows & Goats milk- thus CMPA children should never be fed with Goats milk as a substitute.

  3. Peanuts :

      While peanut allergies are common in the west and Australia, its numbers are increasing in the developing world. Peanut allergy can provoke a life-threatening allergic reaction (Anaphylaxis) in certain individuals. While in reality, peanut belongs to the legume family, it does share its allergy with other nut families such as Brazil & Almond nut. There are many proteins in a peanut that cause allergies; the most toxic allergenic protein belongs to ARA group (Arachis hypogaea). Ara h3 protein is of particular significance in that its heat stable. Heat stable Ara h3 allergic protein does not degrade when the peanut is roasted or fried-which means roasted & fried peanut may cause more allergies than an unroasted peanut. As roasted groundnuts(peanuts) are used in many processed packaged food, one must be careful when purchasing (think pastries, cookies, candy bars, cereals & granolas). Severe anaphylactic reactions ( throat swelling,difficulty of breathing, wheezing, etc)  may occur of these food items that were accidentally consumed by a peanut-allergic individual. In addition, in rare cases, a person with a peanut allergy may also have allergies to other nuts such as almond, brazil nuts (1) Therefore, individuals suspected of peanut allergy must seek an allergist for proper investigation and management.



 4. Tree Nuts:
            Tree nuts are a group of eight nuts: almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pistachios, and walnuts. Some individuals may develop a single nut allergy while others may develop multiple allergies (cross reactivity) to all nuts. It's best to see your allergist to determine your allergy type.

                             Source of chart : Jcionline.org

Next : Food Allergy - Part 2- Tests for Food Allergies











Bibiliography
1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962743/

An Original Article By:

Klinik Dr Shah 

Dr.Shahjahan Bin Kassim Mbbs, Di Derm (Lon), Msc Alelrgy (Imperial)

How Can We Test For Allergies

       

       Yes, allergies are a common occurrence. It can manifest in many forms such as on skin(Eczema), respiratory(Rhinitis/Asthma) and even our digestive system(Gut-food allergy).

As almost anything can cause an allergic reaction, it can be frustrating form patients who often suffer silently for years.

        Consulting an allergist (allergy doctor) is a good first step to find out the allergies we have; how to avoid them & how to best manage it. Some allergies may disappear spontaneously after weeks or months while others may be persistent. In addition, allergy may be from an Exogenous-outside origin ( dust mite allergy) or it may an Endogenous (from within our body-immune system overdrive)

In addition, an allergic reaction may be caused by a single or multiple allergens. All of these factors make it a challenge for your doctor to arrive at a diagnosis from a single visit. Let's take a  look at what tests are available in Malaysia and its pros & cons(if any):

TEST	REMARKS
Allergy History	The most important step in narrowing the search for allergens
Physical Examination	Again- a vital step to identifying allergy location, severity and possible other underlying immune disorder
Allergy Test- Skin Prick Test	Accurate method to confirm or rule of if you have a specific allergy- can perform up to 20 allergens at a time. Pros: 1. It’s a painless procedure and may 2. Test within  20 minutes.       3.Results are read the same day
Blood Test(Specific IgE antibody)	Blood Test is done as a screening test of allergies when we can’t identify the suspect allergen.       Pro:  Many tests can be done(>100 test)     Con:-             -Not as accurate as the skin test -         Higher cost -         Results may take up to a week
Skin Patch Test	Test to identify chemical & metal allergies Allergens are applied on the skin directly and results are read after 48 hours Pro: Accurate                                   Con: can’t be done is patient has extensive eczema
Challenge Test	If skin & blood test is not conclusive - a challenge test is performed. Suspected food or allergen is either applied on the skin; inhaled or ingested in front of medical personal to record the allergic reaction. Done only in limited conditions. Best done in a hospital with an emergency facility.

          Skin prick test is relatively simple and easy to perform when the reagents are available (watch the video)

Hence, there are many tests available at Allergy clinics that help identify what our allergies are and how we can avoid them. Allergy avoidance will definitely improve the allergy symptoms such as asthma frequency and improvement of skin texture of an eczema patient.

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Urticaria - Hives & Angioedema

What are they?
Hives (urticaria) are sudden breakouts of intense red often blotchy skin swelling. They can occur almost anywhere on the skin surface (including scalp) but occur most commonly on limbs and trunk.
They vary in size from mico dots to large discoid shape. The hive surface may be hot and itch intensely, and in some cases may burn and sting. Scratching may worsen the itch. The reactions last for a few minutes to a few weeks. Rarely, they last more than 6 weeks (chronic hives). It's said that acute urticaria affects 20% of the world population at least once in their lifetime.
Patients suffering from hives suffer through the day and night, losing sleep and are often frustrated and even depressed.

What Causes Hives?
The swellings in an acute episode usually come on within a few minutes and last for a few hours, only to completely resolve (disappear) within hours. So what happens during an episode? Disregarding the trigger(s), there are a series of events that occur within our immune system. The primary event is the release of an inflammatory (swelling) chemical called Histamine by our immune system. When an allergen (Eg dust mite protein) comes into contact with the immune system, it triggers a chain reaction within the immune cells (namely the mast cells), which results in the release of Histamine (Simplified explanation).
Histamine, in turn, causes the tiny blood vessels (capillaries) just under the skin to dilate that causes local skin cells to retain fluid (swelling/heat). Histamine also stimulates the skin nerve endings that cause intense itchiness. Scratching causes more tissue swelling and thus more itchiness.
 Possible causes of hives:

1. Foods                                                Milk, Egg, Nuts, Seafood, Fruits, Spices
2. Drugs                                                Antibiotics, NSAID(painkillers), ACE inhibitors
3. Viral Infections                                 
4. Insect Stings
5. Allergens                                          House Dust Mites, Cat/Dog/Rabbit Furs,
6. Others                                               Stress, Temperature change, Autoimmunune disease
7. Idiopathic                                         Unknown cause

What is Angioedema?

Angioedema is swelling of deeper tissues of skin - namely the subcutaneous and mucose membranes. It's easily seen where there is thick layers of subcutaneous tissue such as around eye socket (orbit) and lips. When an allergic reaction is severe it may involve the tongue and throat which may lead to breathing difficulty.

 What test can I do?

First of all, seek out a doctor who treats allergic disease. Diagnosing urticaria involves a detailed medical history taking, blood tests of the immune system and the allergy tests where appropriate.
The doctor may ask the patient to keep a medical log on timing of urticaria in relation to food, allergy exposure and frequency of episodes.
In some cases, the allergy doctor may conduct a skin prick or a patch test of different allergens to determine sensitivity.

Is there treatment available?

Urticaria may spontaneously remit after a couple of weeks in some cases. Here, the doctor's main aim is to control symptoms such as itch and redness. He may recommend antihistamines and corticosteroids to keep histamine action to a minimum. In persistent urticaria, the doctor may run deeper blood analysis on the immune system to determine if the urticaria is part of a bigger autoimmune disease.
The use of biologic agents such as xolair (omalizumab) is gaining popularity in steroid-resistant urticaria. However, high drug cost remains a challenge for mainstream usage.

Other causes of itch?

Itching (Pruritus in medical terms) can be very frustrating when it’s continuous.

Itch certainly can disrupt life. Studies have shown intense itch at night causes sleep deprivation especially in children. This can cause poor concentration in class and consequently; poor examination results.

Types of Itch

                     To many, an itch is an itch; however, it’s important to note its mechanism as not all itch responds to antihistamines. Let’s look at the itch experienced in eczema:

The intense itch of eczema is mainly due to stimulation of the tiny nerve endings on the skin. In a dry and cracked skin, these nerve endings become exposed to air thereby causing a sensation if itch. Other than itch sensation, these same nerves also carry pain and temperature signals to the brain. Scratching of an itchy skin replaces the itch sensation with pain.

On the other hand itch due to the release histamines (insect bite or contact dermatitis) responds well to antihistamine tablets such as piriton and cetirizine. Histamine is released when our body comes into contact with the virus (virus/bacteria) or allergens (dust, insect toxins). Our immune cells such as Mast cells and Basophils release histamine which is a toxic chemical; to kill virus and bacteria.

                    So we can say allergic reactions are due to a confused immune system. Whatever the allergic trigger maybe, the end result of an allergen contact will release huge amounts of histamine; resulting in itchy skin, sneezing with a runny nose and watery eyes- similar to flu symptoms except without fever. Hence, an allergic reaction mimics a virus or bacterial attack. The confused immune system releases histamine thinking its fighting off an infection.

Causes if itch

While itch is common to allergy, one must be aware that there may be other non-allergic causes of itch. The following are some non-allergic causes of itch:

                   1.    Medication that may cause itch

•         ACE inhibitors- hypertension medication.
  
•          Allopurinol for gout.
  
•          Amiodarone for heart rhythm problems.
  
•          Diuretics that relieve bloating and heart conditions.
  
•          Oestrogen- a female reproductive hormone
  
•          Hydroxyethyl cellulose (used during surgery)
  
•          Opioids- Powerful pain control medications
  
•          Simvastatin for high cholesterol.

·                 

·                                2. Liver Disease

·         Liver is the largest solid organ in the body. It does many critical functions in the body. Injury or disease of the liver may disrupt the bile production and distribution. Excess of bile in blood will settle below the skin giving the yellow jaundiced colour. The deposition of a breakdown of bile products such as bilirubin causes an intense itch on the skin.

                   3.Kidney Disease

In the same way, kidney disease results in the accumulation of urea and uric acids. These are waste products of the body which is usually excreted in urine. Accumulation of these waste products in blood cause intense itch on the whole body

                

                4.Other Skin Conditions

Not all itchy skin conditions are due to eczema. Fungal infection of the skin (commonly called Tenia) may mimic eczema especially if it’s infected. Fungal infection may also coexist with eczema and other bacterial skin infections; thereby complicating diagnosis.

Psoriasis is another scaly skin condition that has intense redness and scaly skin that flakes off when scratched. It’s a genetic autoimmune condition that requires special care for the itch.

                 5. Infestations

         Infestation such as tapeworm, pinworms, scabies and head and body louse cause intense itch due to the reaction of our immune system against these parasites

                  6. Diabetes

                    

                     Diabetic patients with uncontrolled sugar are prone to cause nerve damage. This damage is collectively called polyneuropathy. High sugar levels damage to nerve endings. This in turn release inflammatory chemicals called cytokines. The high cytokine levels cause intense itchiness, especially on the hands and feet.

                7. Cancers

                  

                     It’s rare for cancers to cause itch per se, however, itch may occur if cancer involves the liver or bile duct. Chemotherapy often causes skin dryness eczema and itch as a side effect.

Morning Sneeze- It Could Be Allergy!

Let's clarify the most common misnomer in allergy- "Doctor, I have a Sinus Problem"; when in actual fact what they suffer from is sneezing,runny nose and possibily red watery eyes.These are in actual fact is known as Allergic Rhinitis and not sinusitis (sinusitis is the inflammation of sinus- vide the different sinuses in our skull).

Sinuses are connected to the nasal cavity;hense prolonged  Allergic rhinits or nasal infection can  also  infect the sinuses. These could result in frontal headaches, constant phlegm, facial pain and foul odur among others.

To clarify, Sinuses are anatomical 'holes' or cavities in our skulls (picture 2) play important role in in sound resonance of our voice. There are 4 pairs of these sinuses in an adult. In addition, its thought that these cavities also lightens the weight of the human skull, thereby allowing swift head movements.

From the above diagram, we can see that the there are many sinuses with differing names. Sinus infection is called sinusitis while allergic rhinitis is an allergic condition of the nose. However, the sinuses my have a secondary infection from the nose; in which case it will be known as rhino-sinusitis , indicating the extensive infection of the nose and the sinuses.
I shall write only about the nose allergies and therefore rhinitis. I have to be careful in using these medical terminologies as there are many over lapping conditions that may confuse and confound. Its important to know that the term rhinitis is a generic term as it may be due to infection, allergy, drug induced and ever anatomical disease. As such I shall limit my writings to only at the atomic allergic rhinitis (AR) and not any other type of rhinitis (there are a few other non allergic rhinitis as well!)

The symptoms.
AR usually presents with sneezing,runny and blocked nose, watery eyes and sometimes throat itch and dark circles around the eyes.About 30% of AR patients have asthma while 80% of asthmatics suffer AR.
Its important not to underestimate the sufferings of these individuals as many suffer from sleep deprivation leading to poor work rate and many MC days. Studies have shown that children with AR perform rather poorly in school due to lack of concentration and motivation during school as a results of chronic sleep disturbance and snoring.

Investigation

If you suffer from one or many hese symptoms of t

Respiratory Allergies - Can it be avoided?

Our exposure to allergy is absolute. There are very few places on earth that have relatively low allergens (think the Alps and Arctic!). To develop allergy, we must be genetically predisposed and must have sufficient exposure to allergens. To date, there have been many candidate genes identified for different allergies. However, inheriting these genes alone is insufficient to trigger allergies. One needs sufficient exposure time to allergens to develop allergies.

So, can a newborn be born with allergies? It's interesting to note that amniocentesis (Amniotic fluid) studies recently have shown the presence of allergic chemokines (chemicals that mediate allergies). We are not sure how and why this happens but epidemiological studies seems to suggest a connection between allergic and smoking mothers and the birth of an allergic child (atopy).

Another interesting finding is the association between the amount or level of allergen exposure and the development of allergy. Any allergist or doctor will tell you to get rid of your pet cat if you or your family members suffer from asthma. It's interesting to note more allergic and asthmatic children are born to mothers with low or partial exposure to furry animals (like cats). In household with many cats or furry animals, the incidence of birth of an asthmatic child is lower that that of household without pets. So, experts are re-thinking on the total avoidance advice for asthma at least-maybe what they need is lots more feline friends at home!

There have been a few systematic reviews on the efficacy of allergy avoidance. One review in particular focused on all allergy avoidance studies done in the past 10 years. The conclusion-allergen avoidance does not help in reducing allergic disease.

Don't despair, all's not lost, as there are a few individual clinical trials on asthmatic and rhinitis patients that support definitive allergen avoidance measures to alleviate or improve symptoms.

By far the most common allergen to trigger respiratory allergies (allergic rhinitis , asthma, atopic cough) is the House Dust Mite (HDM). Lets be clear- it's not the dust mite one can be allergic to, rather to its droppings (poo) that are a fraction of a micron in size (a few thousandth of a millimeter). There are so minute that it takes an electron microscope to view them. HDMs live a very contended life within our mattress, pillows, duvets and indeed, in any fabric. Soft toys are another common habitat of HDM. HDM feed on our dead skin that we shed daily. A warm humid climate (as in the tropics) are a fertile ground for its propagation. Millions of HDM live and thrive in a single mattress; the HDM droppings are minute enough to pass through normal weavings of the matress and bedsheets to float freely in the air. It's not easy to dust or clean mattresses, however if you are an asthmatic with frequent symptoms, it's advisable to get anti dust mite bed and pillow covers. There are basically 2 types of these covers- acaricide (an anti-mite chemical) infused and non chemical based covers. My personal opinion is biased toward the non chemical covers as there has not been any extensive studies on the long term effects of acaricide on an asthmatic child as presumebly they would inhale these chemicals on daily basis.

There are a couple of studies on the efficacy of different vacuum cleaners on HDM population. Generally speaking , water based vacuum with HEPA filters seem to be superior in its deep vacuuming of mattresses. If you are cat allergic, its best not to allow your pet indoors as studies show they tend to sneak into your room when your back is turned. Allow me to correct another misinformation - cat allergens are found in the cat saliva and not in their fur. When a cat licks its fur as they normally do, the saliva deposited in the fur dries over time and releases very minute sized allergens in to the air. This is why a cat sensitive individual sneeze just on entering a house with cats ; even when the cats are not there. Cat allergens tend to stay for years even after the cat is gone.

Although frequent vacuuming reduces allergy symptoms, the sheer effort of daily vacuuming is only done by the most committed parent. Mopping with mild soap and water is superior to sweeping the room as this may lead to dispersion of allergens into the air. Replacing carpets with hard floor (wood or tiles) are easier to clean than frequent vacuming. While maintaining low humidity (50%) and temperatures (24C) in the room is said to decrease the HDM count, it is not always practical in the tropics. Select furniture made of leather or wood for easy cleaning and avoid soft toys on beds and cots.

And last but no least, select anti-mould paint and low VOC (Volatile Organic Compounds) to decorate the house.