Vocal Cord Dysfunction (VCD), also known as Paradoxical Vocal Fold Movement (PVFM) occurs when the vocal cords do not move or open properly. Sometimes, VCD can be confused with asthma because their symptoms and triggers are very similar. Symptoms of VCD can include shortness of breath, chronic cough, throat clearing, wheezing, loud whistling sound with breathing in, difficult getting a good breath in, frequent yawning, throat tightness, or hoarse voice. VCD can be triggered during stressful or anxious events, or with exercise. Triggers also include airborne dust, pollens and irritants, or colds and viruses. VCD can affect patients of all ages and conditioning level, and is commonly seen in elite athletes or runners. Acid reflux, seen with gastroesophageal reflux disease (GERD) and post nasal drainage seen with allergies or sinus disease, can also trigger VCD.
Diagnosing VCD can be a challenge. Often times we rely on the patient’s history, symptoms, and the timing of symptom onset. Sometimes, how a patient responds to different inhaled medications can be a clue. Spirometry, a test often used for asthma diagnosis and monitoring, can sometimes show features of vocal cord irritation. The most definitive way to diagnosis VCD is with laryngoscopy with visualization of the vocal cords.
Treatment for VCD depends on the underlying cause and is different for everyone. It involves treating the underlying cause and controlling triggers, as well as speech therapy or special breathing exercises to relax the throat muscles. The providers at AAAI can help determine if you have VCD or asthma (or both) and help find the right treatment program for you.
In eczema, or atopic dermatitis, the skin is dry, irritable, sensitive and prone to inflammation and infection. The natural course of eczema is to see periodic flares in symptoms – whether there is an identifiable trigger or not. Because of this, it can be very tricky to determine if a food is causing the eczema flares. Most of the time, the food does not cause the eczema, despite someone having a strong suspicion. People with eczema are at risk for food allergies, but when the food is ingested, there will typically be an immediate allergic reaction (with hives or wheezing, for example), rather than an eczema flare. Finally, it is not common for foods that were previously eaten without problems to become the allergic trigger. If you cannot get your eczema under control and have concerns about a food trigger, it’s important to discuss with your allergist. In the meantime, here are some tips:
1. Don’t assume the rash is result of a food allergy. Eczema is due to a barrier dysfunction and inflammation in the skin. A good skin care regimen or eczema care plan can help minimize flares and keep skin under control. The most important part of a skin care regimen is moisturizing (especially after bathing) and avoiding known triggers (chemicals, certain fabrics, etc).
2. If you see typical food allergy symptoms (such as hives, wheezing, vomiting) in addition to the eczema flare, it makes it much more likely that a food could be a trigger. Treat any reactions, take note of food ingredients, and talk to your allergist.
3. Do not remove foods from the diet on your own when a relationship is not clear. Removing foods can cause social and nutritional problems, and potentially cause more issues down the road.
4. Come to your allergist appointment ready to give details. Keep a good history about the foods eaten, how symptoms started and timing of symptoms. The history is the best “test” to determine if there is a food allergy, and way more informative than any blood or skin tests. Random testing for several foods can be inaccurate and misleading, but a good “history”, or details of what happened, is the most accurate test.
Managing food allergy and eczema is complicated. If you continue to have problems controlling your eczema, make an appointment with your allergist to discuss.
Insect activity, especially bee activity, increases during the spring and summer months in Arizona. Approximately 0.5% of children and 3% of adults will have a reaction to insect stings. It’s important to be aware of how to avoid these insects and protect yourself.
The most common symptoms with insect sting allergy are pain, redness, swelling in the area of the sting and spreading beyond the area, flushing, hives or welts, itching, and more severe symptoms of anaphylactic shock.
Many people have a small, localized area of itching, redness and swelling after a sting. A true allergic reaction involves local reactions which cause swelling and redness that extends beyond the area of the initial sting, hives, chest tightness or shortness of breath, or anaphylaxis. These symptoms warrant immediate medical attention. Anaphylaxis is the most severe type of reaction, and can be fatal if not treated with epinephrine right away.
Don’t worry – It’s important to know that severe anaphylactic reactions are rare. However, people who have experienced an allergic reaction to an insect sting have a 60% chance of similar or worse symptoms if stung again, and should be evaluated by an allergist for further evaluation and treatment.
After taking a detailed history of the sting and the symptoms and performing any necessary testing, your allergist will recommend the right treatment for you. The most important thing is to have epinephrine auto-injector available if there is a risk of another allergic reaction. There’s also the possibility of doing immunotherapy (allergy shots) for venom to help prevent future allergic reactions.
Avoiding the insect all together is the best treatment. There are many precautions that can be taken to avoid exposure, including: avoiding walking barefoot in the grass, keeping any outdoor food covered at all times, avoid sweet and citrus-scented colognes or perfumes, avoid wearing bright colored clothing, and keeping window and door screens in good repair.
If you’ve had an allergic reaction to an insect sting, it’s important to discuss with your allergist at AAAI to develop the best treatment plan for you!