Achooo

Springtime. Pollen fills the air and causes congestion, sneezing, and watery eyes. This should be a job for primary care, but no, the ER treats even seasonal allergies. I had an elderly woman arrive by ambulance because of difficulty breathing. Her only symptom was nasal congestion. Earlier this week, "Robin" my PA, examined a boy with allergies because the meds prescribed by his pediatrician 12 hours before had not cured his stuffy nose and itchy eyes.


Allergic rhinitis and allergic conjunctivitis are the medical terms for these annoying complaints. Pollen, mold spores, animal dander and other organic substances can trigger allergic symptoms. The biology is rather simple. Allergens cause the immune system to produce IgE. This is a type of immune globulin. IG's are proteins manufactured by different types of white blood cells. They enhance or modulate our immune response to foreign proteins. IgE triggers the release of histamine by immune cells. Histamine causes the swelling, itching, and general misery of seasonal allergies.

Diphenhydramine (Bendaryl and others) blocks the release of histamine. This leads to less dripping and itching but is accompanied by dry mouth, sleepiness and other annoying side effects. Newer antihistamines have less sedation. Leukotriene inhibitors (Singulair) are also effective in blocking the symptoms of seasonal allergies and asthma. Steroids are very effective in treating allergies. Usually used as a nasal inhaler, they have mild side effects and are applied at the root of the problems. There are also eye drops that can alleviate the symptoms of allergic conjunctivitis.

While we are considering the specific ER problems of spring, let's talk about rashes and bugs. The emergence of greenery inevitably leads to contact dermatitis. Poison ivy, oak and sumac are plants that contain an oil that triggers the formation of vessicles (little blisters). Urushiol is the chemical present in poison ivy that acts as a vessicant. Small blisters (vessicles) accompanied by itching and weeping result from exposure to urushiol. This is not a true allergy, but some are more sensitive than others. If someone says they are "immune" to PI, challenge them to rub their privates with poison ivy. This dare works best in the barroom setting.


Sun exposure presents an addition cause of rashes. Sunburn is obvious but the sunlight can also trigger photodermatitis. Many common medications, lotions (including sunblock, and toiletries) may be activated by ultraviolet radiation in sunlight to cause mild to severe rashes. The printed material supplied by pharmacists give some warning of potential photosensitizing medications. Avoidance of sun exposure, not simply applying sunscreen, is the only effective preventative.


Arthropods have caused disease and misery to humans and all terrestrial vertebrates since our ancestors crawled out of the sea. Mosquitoes, flies, fleas and ticks torture us like the plagues of Exodus in the bible. Black death, malaria, sleeping sickness, oriental sores, yellow fever and many other diseases are transmitted by the bite of an arthropod. The current "plague" of Lyme disease is due to Borrrelia Burgdorferi, a spirochete bacteria. The vector (carrier) is the Ixodes tick.

The mildest reaction to an arthropod bite is localized swelling and itching. This is caused by proteins in the bugs' saliva. Applying cold or topical cortisone creams quickly alleviate the problem. Ticks attach themselves to their hosts and leisurely partake of a meal of blood. While dining, they pass on the microorganisms that cause Lyme disease, Rocky Mountain spotted fever, Erlichosis and other infections. Mosquitoes transmit malaria and yellow fever while sucking our blood. A tick bite can lead to tick paralysis. This is an immune response to the tick bite that causes an ascending loss of muscle control. The only treatment necessary is to remove the tick.

Lyme disease has become common in much of the United States. The earliest cases were described and subsequently named for Old Lyme, Connecticut. The Ixodes tick can transmit the infection after 24-72 hours of being attached to a human. A transient rash, erythema migrans, may be noticed in the area of the bite. Fever, chills, and joint aches are common early in the infection. If not recognized and treated, Lyme disease can progress to inflammation and damage to the joints, especially the knees. Injury to the nerves can lead to Bell's palsy, a loss of function of the facial muscles. Meningitis and encephalitis may also be caused by the Borrelia spirochete.

Heightened awareness, early recognition and treatment with antibiotics are the keys to treating Lyme disease. There is currently no effective, safe and approved vaccine, for humans, to prevent Lyme disease. Prevention is best with regards to arthropod spread diseases. Liberal use of insect repellents, avoidance of ticks and mosquitoes and examination after being in tick prone areas are very effective. Wear light colored clothes. Tuck your trousers into your socks. Spray your clothing with DEET containing insect repellents. Remember that the Ixodes tick is the size of the period at the end of this sentence.

Enjoy the spring. Your dedicated ER staff is ready to treat the sneezes, wheezes, itches and twitches that result from the great outdoors. Gesundheit!