Dr. Monika Korff, M.D.

Dear concerned mom, 

The appearance of the rash is consistent with hives. However, your son will benefit from an evaluation by either his pediatrician or an allergist. Full history and physical exam helps to evaluate possible triggers and also can alleviate fears and assess risk. I hope he feels better soon. 

Sincerely, 

Monika Korff, MD

Dear concerned mom, 

Unfortunately, there is nothing you can do to prevent allergic sensitization to any inhalant - dust, pet dander, molds. The best you can do for your son is to have him evaluated by an allergist to determine if allergic sensitization is present and if his symptoms can be related to that. Appropriate response in terms of medications and potentially allergen immunotherapy can be addressed as well. 
I hope that helps. 

Monika Korff, MD

It seems you have experienced contact dermatitis. It is hard to know if it is allergic or irritant response. Having an evaluation by an allergist with testing to identify the trigger will be useful. Allergies to variety of pollens, dust, molds can cause contact reactions.
Hope you are felling better by now.

Sincerely,

Monika Korff, MD

Dear expecting mom,

While allergies do tend to have genetic component, the exact type of allergy is not directly passed to the offspring. Lactose intolerance is an enzyme deficiency not an allergy, but still has a genetic component. But it does not necessarily mean that your child will have the same issue as you. You should discuss your concerns with the child’s pediatrician and both of you can monitor your child’s symptoms as he or she is introduced to dairy. You can also consult with an allergist when your child is introduced to foods.
I hope that helps and I wish you a safe and healthy pregnancy and delivery.

Sincerely,

Monika Korff, MD

First and foremost - congratulations! Wish you all the best and an easy pregnancy. I am happy to alleviate your concerns. While we all want to use as few medications as possible while pregnant, I would like to reassure you that all antihistamines over-the-counter are considered safe in pregnant females. Claritin, Allegra, Zyrtec, and Xyzal along with Benadryl are all pregnancy category B. That means that you do not have to suffer with your dust allergies.
Hope that helps, and again, congratulations and all the best.

Sincerely,

Monika Korff, MD

I am sorry you are struggling with this and I can certainly understand the frustration. I wish there is an easy and straightforward explanation, but, unfortunately, cough is a complicated symptom which could arise from variety of underlying issues. Allergies (especially seasonal) can be a trigger, silent reflux disease, post nasal drip, even a type of asthma called cough variant can present that way. I would suggest seeing either your PCP or an allergist for full evaluation and proper medication suggestions.
Hope that helps.

Sincerely,

Monika Korff, MD

Yes, unfortunately, this is not an unusual situation we see - I see at least 2-3 patients/day with such symptoms. Reactions to apples are very common, but many other fresh fruits or vegetables can be involved as well. It is an extension of her pollen allergies - there are family of proteins in pollen that cross react with certain ones in fresh fruits and vegetables and trigger an oral reaction. it is called immune mimicry - the cells in the oral mucosa are confused from the structurally similar proteins in the food and become activated. The type of fruit or vegetable one would react to is dependent on the person's specific pollen sensitizations. 

The good news about those reactions is that they are usually mild and self limited - meaning than even without an antihistamine most people's symptoms would resolve on their own in 20-30min. Epinephrine device is not indicated and the person can safely consume the offending fruit or vegetable in their cooked forms - apple sauce, apple pie, etc. We generally advise avoidance of the offending food in its fresh/raw state. Speaking with an allergist and potentially doing specific and detailed testing will be able to provide you with more information and also alleviate fears of how to approach such situations in the future. 
Hope that helps. 

Sincerely, 

Monika Korff, MD

Dear sufferer,

I am sorry you are experiencing something so uncomfortable. There are plenty of possibilities and I would encourage you to see an allergist for full evaluation. The generalized itching and bumps are likely related to activation of mast cells. If the episodes are frequent we usually recommend taking the allergy tablet daily to prevent the episodes from occurring. However, it will be important to see an allergist and full evaluation with proper testing be performed.
I hope you feel better soon.

Sincerely,

Monika Korff, MD

I am sorry to hear you are struggling with this and it is disrupting your sleep. it is impossible to tell if there is an allergic trigger without proper and detailed history, exam of the skin and allergy testing. Since you are not getting better, I suggest having a formal allergy evaluation. 

Sincerely, 

Monika Korff, MD

Dear cat sufferer,

Unfortunately, you are not alone - cat allergies are very common. Not everyone has respiratory symptoms - since you did, I would suggest caution with future exposures. While the sensitization and severity of reactions may vary from pet to pet it is likely this will be a long standing issue. Allergen immunotherapy - either shots or sublingual - is a very effective way of treating this and over time will slow you the ability to be around pets with minimal or no symptoms. Until then make sure you carry allergy medication and your inhaler with you to help when symptomatic.
Good luck.

Dear mom, 

I am sorry your son is having those issues. Unfortunately lactose intolerance is quite common. In my clinical experience lactase enzyme tabs leave a lot to be desired. I have only very few patients who find them helpful enough to allow them to  continue to consume dairy products. For the majority of patients the tablets are not enough and while it may reduce the symptoms a bit they are still symptomatic at the end. They are certainly safe so feel free to try them with your son. However, the best outcome will be guaranteed by avoidance of dairy products. Good non cow's milk alternatives include coconut, pea protein (Ripple )milk, hemp milk. If your son does not have tree nut allergies then cashew and almond are also options. Lactaid milk is not tolerated by most patients. For some patients goat or sheep's milk are also acceptable - they are a bit easier to digest than cow's milk but again you will have to try them with your son to see how he responds. 
Good luck  - I hope he finds an alternative he likes and tolerates. 

Sincerely, 

Monika Korff, MD

I am sorry to hear about this experience and I am glad that your daughter didn't have a more serious issue. Since she is not having any issues currently, I suggest getting a formal allergy evaluation after you come back from your trip. It will be helpful to get the ingredients of the chocolate she had a reaction to - that will be helpful. In countries other than the US, tree nuts and other allergens are found more often in chocolates, however, there may be another ingredient that caused the issue. Regardless if you get the information about the ingredients or not, seeing an allergist will be helpful in evaluating her reaction, risk of future issues and determining how to proceed from here. For now, I would suggest sticking to chocolate or candy she has had before without a reaction. 

Sincerely, 

Monika Korff, MD

Dear concerned mom, 

Very good question. No, antibiotics are not required and most of the time not needed for seasonal colds. During the changes of the seasons in patients with inhalant allergies, the immune system is more prone/suspected to viral illnesses. So, it is not uncommon for people to "get sick" during the peak of allergy season - honestly, even for us it is hard to tell the difference between a cold and allergies - symptoms overlap a lot. Since most of those situations are viral in nature, antibiotic use should be reserved only if the patient has a high fever, on exam, there is evidence of bacterial supra infection, or the symptoms have been present or worsening after 7-10 days. I hope that helps. 

Sincerely, 

Monika Korff, MD

Yes, that is possible. Allergies can change over time - sometimes new sensitizations develop or old ones resolve. It is important to follow up with your allergist on a regular basis and update your evaluation periodically. Especially if you note any changes in your reactions. 

Hope that helps. 

Hello, allergy sufferer, 

There are several options for you, each of them has risks/benefits, pluses and minuses, so I cannot say that one is the "best" one. I hope that by going through the options and dissecting them for you, you can make the choice that is a best fit for you. 

1. Allergy medications - the one class of medications that offers most relief is nasal steroid sprays. Most of them are OTC now - Rhinocort, Nasacort, Flonase, Flonase sensimist. The work of variety of pathways and thus offer relief of most symptoms - sneezing, nasal congestion, post nasal drip, eye itching and swelling as well. However they will offer such relief only if taken consistently (daily) during the season which bothers you the most. Another advantage is that they can offer what we call pre-seasonal prophylaxis - if you start them 2-3 weeks before the peak of the season you will minimize or eliminate the breakthrough symptoms once the pollen gets very high. The most common side effects are nasal irritation and potentially nose bleeds, some people also get a sore throat. 
Antihistamines  - Claritin, Zyrtec, Allegra, Xyzal, the good old Benadryl can also help but they work on fewer symptoms compared to the nasal steroid sprays. They primarily help with itching, sneezing and runny nose. 
Oral decongestants such as Sudafed, phenylephrine can help with congestion but we do not advise using them frequently because of their stimulant effects and stress on the cardiovascular system. 

2. Immunotherapy - known commonly as "allergy shots" is a very effective way to desensitize patients and make them mostly symptom free over time. They require allergy testing to decide which allergens need to be included in the solution and should be administered by a licensed allergist or another doctor's office that is comfortable with giving allergy shots. That is necessary to minimize the risk of an allergic reaction which is the biggest risk one takes on when pursuing allergen immunotherapy. 
There are some oral tablets for oral immunotherapy which can be done at home by the patient that are less risky and while helpful in reducing symptoms, may be not as potent as the shots. However, you still need an evaluation by an allergist to see if you are a candidate. 

Hope that helps inform you of your options so you can decide what is best for you. 

Sincerely, 

Monika Korff, MD

Dear mom, 

I am sorry about the issue you are dealing with in your young child. We do know what lactose intolerance results from - a lack of enzyme that is needed to break down lactose that is a sugar found in milk. Unfortunately, we do not know why some people are lacking that enzyme. There are some hereditary patterns - some parts of the world for example have a higher prevalence of lactose intolerance. Sometimes people are born with the deficiency and their issues with dairy are noted early in life like in your child and other times people develop the deficiency over time - as they get older. At times the progression is sudden (people develop issues with dairy quickly) and other times gradual and slow - people notice the GI symptoms slowly creeping up on them. It is not clear why the enzyme's production diminishes or is completely lost in those people - at times that is a result of a GI virus, other times prolonged illness and use of antibiotics and other medications for long periods of time but the reality is each case is different. Lactaid products are rarely helpful and I generally do not recommend their use in my patients. 

I would like to reassure you though that your child will not be lacking nutritionally because of his lack fo dairy consumption and will grow and develop without any issues. Dairy by itself is not a requirement for human development. Calcium, fat, and protein, which are found in dairy products is what humans need, but the reality is they can find those nutrients in many other food groups. Fresh fruits and veggies, eggs, legumes, meats, and seafood are all good sources. There are a variety of non-dairy milks currently, which can provide your son with what he needs - combination of tree nut milks (almond, cashew, hazelnut, etc.), coconut milk as well hemp and pea protein milk are all excellent choices. 
I hope that helps and relives some of your angst. 

Sincerely, 

Monika Korff, MD

I am sorry to hear you are uncomfortable. While an allergy could be present, it is the least likely cause for the symptoms. A thorough GU evaluation and also dermatologic exam will be important and should be done first. Taking cultures and evaluation for potential bacterial or fungal overgrowth should be done as they are more common and can certainly trigger the symptoms. Allergic triggers usually cause generalized itching, so such localized symptoms while could be allergy related will require contact with the allergen only in that body area. 

Hope that helps,
 
Monika Korff, MD

Unfortunately, your daughter is not alone. Oral allergy syndrome with fresh fruits and vegetables is quite common. It results from cross reacting proteins found in certain pollens (Birch tree, ragweed, mugworth and Timothy grass being the main ones) and those fruits and vegetables. While this oral allergy carries negligent risk for systemic reactions and normally does not require Epinephrine device, the symptoms can be quite bothersome and include itching, during, mild swelling or hives. They are usually self limited and resolve without intervention though oral antihistamines may prove helpful. There is no direct treatment for this allergy - we generally recommend avoidance of the offending fruit or vegetable but those can safely be eaten in a cooked form. So fruits from cups, cans and in baked goods as well as apple sauce or juice will be tolerated. Some patients who choose to undergo immunotherapy (allergy shots) for their inhalant allergies may see an improvement or sometimes complete resolution of the oral allergy symptoms though this is not the outcome for everyone. 
So, in a few words, she can safely eat cooked forms of apples but I would advise avoiding raw/fresh apples for now and any other fresh fruits/veggies that trigger similar symptoms in the future.  
Hope that helps.
 
Monika Korff, MD

In my clinical experience not very effective. First, however, let me clarify that lactose intolerance is not an allergic issue. It is a food intolerance caused by a deficiency or a lack of enzyme needed to break down lactose. Some people are born lacking the enzyme and others may develop the deficiency later in life. There is no “cure” for the condition as we cannot replace the enzyme. The tablets may help to reduce the symptoms a bit but for most of my patients they have proven ineffective. The best approach is to avoid consuming dairy - you and may try lactose free products but even those at times may prove to be a challenge.
Hope that helps.
Sincerely,
Monika Korff, MD

Depends on how you define "really works." It is not harmful and can contribute to better functioning immune system. However, if you expect the turn off the cold symptoms in 24-48hrs just because you started to take it, you will be disappointed. Remaining on it during the cold flu season daily (similar approach with vitamin C) may prove to be more beneficial than as needed use. 

Hope that helps, 

Monika Korff, MD