Anaphylactic reactions are usually characterized by their sudden onset and dramatic presentation and can be fatal. Symptoms may associate a sudden drop in blood pressure with potential loss of consciousness or mental confusion, rapid heart rate and usually general flushing. Other systemic symptoms may also be present such as generalized hives and swelling (urticaria and angioedema), acute shortness of breath with obvious and wheezing. Systemic reactions are more common than true anaphylactic reactions with loss of consciousness. Anaphylactic reactions are mostly due to immediate reactions which can be triggered by foods, insect stings (bee, wasp, etc), drugs (penicillin and others), exercise or may occur without a known trigger. Patients must be evaluated for identification of the potential trigger and treated accordingly. They must be correctly educated and supplied with epinephrine and antihistamines to be used during potential future reactions.

About 20% of the general population in the southern United States suffer from Allergic Rhinitis, commonly called "Allergies" or hay fever. Symptoms develop upon exposure to airborne particles, called allergens, such as pollens, mold spores, dust mite particles or animal dander. Symptoms may be seasonal when due to seasonal allergens such as pollens, or be present year round when due to perennial allergens such as animal dander, dust mite, molds and cockroach. Most common symptoms include itchy and watery eyes, itchy and runny nose, nasal congestion, post nasal drainage and itchy throat. It is the recurrence of the symptoms, the lack of fever or muscle aches which distinguishes allergic rhinitis from the common cold or flu. The most frequent complication is sinus infections, otherwise known as sinusitis, which may affect the various sinus cavities. Symptoms then include purulent nasal drainage, bad breath, headaches and "head congestion". Sinusitis is frequently misdiagnosed and incorrectly treated. Incorrect treatment of chronic sinusitis may lead to more complicated situation which may require sinus surgery. It is important to recognize allergic rhinitis and sinusitis, identifie the potential offending allergens, evaluate any potential complication and apply appropriate treatment. The treatment of allergic rhinitis/sinusitis is not restricted only to symptomatic relief medications such as antihistamines, decongestants and anti-inflamatory nasal sprays. Prophylactic therapy is crucial to the successful control of this chronic condition which include allergen avoidance and potentially immunotherapy in selected patients. Desensitization immunotherapy, commonly called allergy shots is the only potentially curative treatment available in allergic respiratory illnesses.

Asthma is a highly prevalent disease with a rising morbidity and mortality worldwide. In The United States about 15 millions individuals suffer from Asthma. Asthma is a chronic inflammatory disease of the airways. A genetic predisposition to develop allergic sensitivities to common aeroallergens such as pollens, dust mite, animal dander airborne particles and others, constitute the strongest identifiable predisposing factor for developing asthma. Allergic inflammation of the airways contribute to airway hyperresponsiveness, otherwise known as twitchy airways, airflow limitation, respiratory symptoms and disease chronicity. It is the hyperresponsiveness state of the airways which is responsible for the recurrent acute exacerbation of asthma. The symptoms of asthma are frequently worse at night. Symptoms may include intermittent coughing, wheezing, episodic shortness of breath, or wheezing on exertion only. In most cases symptoms are intermittent or seasonal but at other times they may become chronic. Other exacerbating factors are various irritant aerosols (tobacco smoke, household aerosols, pollutants, chemical odors etc.), upper airway infections, exercise and others. Patients with asthma must be evaluated properly, particularly if their disease is significant enough to cause them substantial dysfunction in their daily activities. Evaluation should include spirometry (pulmonary capacity testing) and a thorough evaluation for allergic sensitivities, chronic sinusitis and other potential aggravating factors. Treatment of asthma include patient education, anti-inflammatory therapy (mostly via inhalers), bronchodilators, allergen avoidance and potentially immunotherapy in selected patients. Desensitization immunotherapy, commonly called allergy shots, is the only potentially curative treatment available in allergic respiratory illnesses.

Itchy skin rashes or hives may be caused by allergic or physical trigger. Hives, which may involve a local area of the skin or be generalized, may last for few hours or weeks to months. Allergic triggers may include food ingredients such as peanut, eggs, cow milk products and various drugs such as penicillin and codeine. Hives can also be caused by physical triggers such as pressure, persistent vibration, exposure to cold, heat, to sunlight or following exercise or hot showers. Other non allergic triggers are food additives such as food preservatives. Occasionally, hives may be associated with certain vascular diseases and require a thorough clinical evaluation. In most cases however, the exact cause is unknown, yet hives are relatively easy to control. Treatment include avoidance of the offending agent when identified, antihistamines and occasionally anti-inflammatory agents such as steroids.

Atopic dermatitis is mostly seen in young infants and children and less frequently during adult life. The disease is relatively easily diagnosed due to the type of skin lesions and their the areas they appear on the skin. While eczema can be relatively easy to control, frequently it is mistreated and hence cause much suffering and may lead to potential complications and side effects due to the misuse of steroid preparations. Eczema is frequently associated to food allergies particularly at an early age.

Contact dermatitis is inflammatory reactions of the skin following contact of the skin with certain substances. It is mostly seen in the adult and is frequently related to certain occupations (hair dresser, dry cleaning), makeup, certain hobbies, certain chemicals (such as the inflammatory reactions of the feet resembling athlete feet due to certain shoe chemicals) or the skin contact with certain metals such as gold or silver in relation to jewelry. A thorough investigation is needed to identify the offending agent including detailed history and patch skin testing.

Primary immunodeficiency Disorders are genetic disorders of children who are born with deficient immune defenses with susceptibility to develop severe recurrent infections. Primary Immunodeficiency diseases are rare yet must be considered in cases of chronic or recurrent infections which mostly affect the respiratory tract with recurrent pneumonia, chronic bronchitis, Chronic sinusitis etc. In severe cases of immunodeficiency with total absence of the immune system (termed severe combined immunodeficiency - SCID) symptoms are present early on after birth with diarrhea, failure to gain weight, skin rashes and respiratory infections such as pneumonia. In most cases however, primary immunodeficiency results from antibody deficiency disorders either global with no ability to make antibodies or more frequently, partial or selective immunodeficiency with the inability of the child to make antibodies against certain infections. In Antibody Deficiency Disorders symptoms appear either in early childhood or recognized only later on during adulthood. Due to the frequent use of antibiotics, symptoms are not as severe or life threatening as one would expect in a case of a deficient immune system. Symptoms are usually the result of recurrent respiratory infections such as chronic sinus infection, chronic purulent ear infections, chronic sputum productive cough particularly when not explained by tobacco smoking, or history of recurrent pneumonia. Occasionally, the presenting symptoms may include deep seated infections such as meningitis, deep abscesses or bone or joint infection. Many of these patients may have proven history of asthma and/or hay fever. The recognition of these conditions is crucial in trying to avoid potential life threatening infections. Once the condition is recognized treatment may include chronic prophylactic antibiotics and potentially intravenous immunoglobulin treatment as a replacement therapy. The vast majority of patients with antibody deficiency disorders will do well on such treatment.

The diagnosis of CFIDS is a clinical one. It is defined as a chronic debilitating fatigue for at least six months with a reduction of at least 50% of the patient overall activities as compared to his condition prior to his illness and that there is no evidence for known causes or diseases that may be responsible for such a chronic fatigue (i.e. cancer, TB, Connective tissue disease, psychiatric disorder etc.). The existence of other minor criteria are required to establish the diagnosis such as sleep disorder, mental depression, recurrent painful lymph nodes, low grade fever, sore throats, joint pains, headaches, various skin rashes etc. Frequently, patients give a history of recurrent respiratory infections and in about 40% of the cases an immune deficiency disorder is recognized. It is believed that this condition is associated to a chronic viral infection yet at present there is no such evidence. Most frequently treatment is symptomatic. It is important to recognize CFIDS since if an immune deficiency condition is recognized, treatment may be of a significant help to these patients with this debilitating condition.

When a person is stung by a bee, wasp, hornet, yellow jacket or fire ants, the insect injects venom into its victim. This venom can cause severe life threatening reactions in certain people who are allergic to it. In a typically normal reaction the sting site will be painful, reddened, may swell and itch, but this will last only few hours. Enlarged local reactions might be seen with a painful swelling of several inches surrounding the area of the sting. This reaction might last for days. In a severe allergic reaction the person might feel dizzy, nauseated and weak. Stomach cramps and diarrhea may occur. Generalized hives and itching, wheezing and difficulty breathing, and potentially an anaphylactic reaction with a sudden drop in blood pressure, loss of consciousness which may lead to death if no immediate medical care is provided. There is clear evidence that venom immunotherapy in the majority of patients is protective for any future life threatening reactions. Patients with known allergic sensitivities to insect venom should be evaluated by the allergist and placed on protective desensitization therapy.