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2018-10-30 18:09:58 有 2 人按讚

Came to realise that I have sensitive skin recently and redness and tenderness are just some of the symptoms I experience. Since then, I started to be more wary of what my skin comes into contact with, especially the products I choose to put on my face. One of the allergy triggers I face is dusty or unclean bedsheets which will cause my skin to become irritated or break out in hives ☹ Tried @lrpsg 's Toleriane Ultra Light for 5 days and noticed that my face has less red patches and developed a higher resistance to environmental nasties. Also, with its ultra-hermetic packaging, you'll know for sure that your product will not be contaminated thus preventing any further skin irritation! Get yours now at @watsonssg with their on-going 2 for $62 promo, plus all Toleriane products are going for 20% off :D #1MinSkinRelief #lrpsg

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คุณหมอเพจนี้ฝากแชร์ เป็นเคสที่น่าสนใจดี คือสาวคนนึง (ไม่ใช่คนในภาพอันนี้ภาพประกอบเฉยๆ) เขามีอาการแพ้รุนแรง แล้วไปหาหมอ ตอนแรกหาสาเหตุไม่เจอ แต่เขาก็สังเกตว่า มักจะมีอาการหลังกินพวกผลไม้ หรืออาหารที่มีผลไม้เป็นส่วนประกอบ เช่น ข้าวเหนียวมะม่วง กล้วยน้ำว้า กีวี่ ก็สงสัยกันว่า แพ้ผลไม้รึเปล่าหว่า แต่ระหว่างที่กำลังตรวจหาสาเหตุก็มีคนไปบอกเขาประมาณว่า เฮ้ย แพ้ผลไม้มีที่ไหน ใครๆเขาก็กินกล้วยกินมะม่วง ไม่มีอาการแพ้ เด็กๆมันยังกินกันเลย

เจ้าตัวเลยไปลองกินผลไม้อีกรอบ ปรากฏว่าแพ้หนัก เกือบตายยยยยย แล้วผลตรวจก็ออกว่า แพ้ผลไม้จริงๆว่ะครับ เป็นอาการที่ไม่ค่อยได้เจอในบ้านเราแต่ก็พบได้นะ คือเอาจริงๆเรื่องอาหาร มันแพ้ได้หมดทุกชนิดล่ะ อยู่ว่าที่จะซวยไปแพ้อาหารชนิดไหน มันไม่มีหรอก ไอ้อาหารที่กินได้ทุกคนไม่มีทางที่ใครจะแพ้เลยน่ะ

การแพ้ผลไม้ ชนิดรุนแรง (Fruit-induced anaphylaxis)
[Case scenario]

หญิงไทยอายุ 45 ปี
มีประวัติแพ้รุนแรง anaphylaxis ถึง 2 ครั้ง
ไปหาหมอก่อนหน้า ยังไม่ทราบสาเหตุว่าเกิดจากอะไร
จึงแนะนำให้ไปตรวจเพิ่มเติมที่ รร.แพทย์

ประวัติเพิ่มเติม ของการแพ้แต่ละครั้ง
ครั้งที่ 1
13.00 น. กินข้าวเหนียวมะม่วง ราดน้ำกะทิ
17.00 น. กินกล้วยน้ำว้า 1 ลูก
19.00 น. เริ่มมีปากบวม ผื่นลมพิษขึ้นทั้งตัว แน่นหน้าอก และหายใจไม่ออก
ไป รพ. ได้ยาฉีด epinephrine เข้ากล้าม อาการดีขึ้น

ครั้งที่ 2
7.30 น. กินลูกกีวี 2 ลูก, ข้าวโพด, มันม่วงญี่ปุ่น
8.00 น. เริ่มมีอาการหน้าบวม แน่นหน้าอก หายใจไม่ออก จึงไป รพ.

ประวัติเพิ่มเติม
- อาชีพพนักงานออฟฟิศ เอกชนแห่งหนึ่ง ประเทศไทย
- ปฏิเสธโรคประจำตัว รวมถึงโรคจมูกอักเสบภูมิแพ้ โรคหืด แพ้เกสร
- ก่อนหน้านี้ เคยกินกล้วยแล้วคันในลำคอ ปากบวม ปวดท้องเล็กน้อย อยู่หลายครั้ง
- กินกีวีรอบนี้เป็นครั้งแรก จากนั้นไม่ได้กินซ้ำอีก
- หลังจากเหตุการณ์ 2 ครั้งนี้ ไม่ได้กินยาแก้แพ้ใดๆต่อ
- คนไข้ลองกินข้าวเหนียวมะม่วงกะทิ, ข้าวโพด อีกรอบ อาการปกติดี
(แอดไม่แนะนำให้ลองกินเองแบบนี้นะครับ อันตราย!)
- อยู่ที่บ้าน ทำความสะอาดบ้าน สวมถุงมือยาง อาการปกติดี

เบื้องต้นแอดสงสัยว่าภาวะแพ้รุนแรงน่าจะเกิดจากผลไม้และหากคิดเป็นเรื่องเดียวกัน ผลไม้ต้องสงสัยที่สุด คือ กล้วย, กีวี เนื่องจากเป็นกลุ่มที่มีโปรตีนภูมิแพ้บางตัวที่คล้ายกัน

Provisional diagnosis : Fruit-induced anaphylaxis

การตรวจทางห้องปฏิบัติการเพิ่มเติม
การเตรียมผลไม้สดมาทดสอบ (Prick-prick test) ซึ่งเป็นการตรวจที่มีความไวสูง และไวกว่าสารสกัดในน้ำยาจากบริษัท (extract-based testing)

ผลการตรวจ skin prick-prick test ผลไม้ในรายนี้ ให้ผลบวกต่อ กล้วย และ กีวี จริง ซึ่งเข้าได้กับประวัติ แต่เนื่องจากผลไม้ทั้งสองกลุ่ม เป็นสมาชิกของผลไม้ที่มีรายงานได้บ่อยใน latex-fruit syndrome (กล้วย, กีวี, อะโวคาโด, เกาลัด etc.) จึงทำการทดสอบผลไม้ชนิดอื่นไปด้วย พบว่าผลอะโวคาโด เป็นบวกด้วยเช่นกัน ซึ่งอาจเป็นการแพ้จริง หรือ เป็นเพียงผลจากการทดสอบแต่ไม่มีอาการจริง (asymptomatic sensitization)

ในขณะนี้ผู้ป่วยยังไม่มีประวัติการแพ้ latex ชัดเจน และผู้ป่วยยังไม่เคยกินผลไม้ชนิดอื่นๆในกลุ่มนี้ จึงรอผลการทดสอบเพิ่มเติมเพื่อประเมินต่อไป

แนวทางการรักษา
- พกเข็มฉีดยาเอพิเนฟฟริน
- แนะนำเลี่ยงการกินผลไม้ในกลุ่มข้างต้นไปก่อน ระหว่างรอผลการตรวจเพิ่มเติม

สรุปแล้ว การแพ้ผลไม้แบบรุนแรง (anaphylaxis) มีอยู่จริงนาจา เพื่อนแพทย์ท่านใดที่มีประสบการณ์สงสัยภาวะดังกล่าวในผู้ป่วยของท่าน แอดคิดว่าควรแนะนำให้เลี่ยงผลไม้กลุ่มเสี่ยงไปก่อน (กล้วย-กีวี-อะโวคาโด-เกาลัด) กรณีที่อาการแพ้รุนแรง อาจเลี่ยงผลไม้(ที่ไม่แน่ใจ)ไปก่อนทั้งหมด ให้พกเข็มฉีดยาเอพิเนฟฟริน + รีบส่งมาประเมินกับแพทย์ด้านโรคภูมิแพ้ที่ รพ.ของท่านครับ

ท่านที่มีสงสัยว่าตนเองหรือคนรู้จักเป็นภาวะนี้
แนะนำมาปรึกษาแพทย์เฉพาะทางด้านภูมิแพ้ครับ

ติดต่อนัดหมาย
รพ ศิริราช line ID: allergymed

หรือ"ศูนย์ภูมิแพ้ อายุรกรรม"
รพ ศิริราชปิยมหาราชการุณห์ โทร 02-419-1474

Admin B1
Severe Fruit Allergy (Fruit-induced anaphylaxis)
[Case scenario]

Thai woman, age 45 years old.
There is a record of 2 times of losing anaphylaxis
Went to the doctor earlier. Still don't know what happened.
So I recommend you to check out more at the school. Doctor Doctor

More history of each loss
1st time
13.00 pm Eating mango sticky rice topped with coconut milk.
17.00 pm Drink 1 bananas.
19.00 pm Starting to have swollen mouth, hives, hives, chest tighten and can't breathe.
Going to hospital. Got epinephrine injection. Feeling better.

2st time
7.30 pm Eating 2 Kiwi Balls, corn, Japanese Purple.
8.00 pm Starting to have swollen face, chest can't breathe so i go to the hospital.

More history
- occupation of private office staff, Thailand.
- denial of congenital diseases, including nose, allergy, asthma, allergic to pollen
- I used to eat bananas before. Itchy in my throat, swollen mouth. I have a little
- eating kiwi for the first time, then I didn't eat again.
- after this 2 incident, I didn't take any antidote.
- patient tried to eat mango sticky rice, coconut milk, corn again. Good condition.
(admin doesn't recommend you to try it yourself like this. Dangerous! (sighs))
- at home, cleaning house, wearing rubber gloves. Normal condition.

Preliminary admin suspected that severe allergy should be caused by fruit. and if you think about the same thing, the most suspected fruit is banana, kiwi due to some allergy groups with similar allergy

Provisional diagnosis : Fruit-induced anaphylaxis

More laboratory inspection
Preparing fresh fruit to test (Prick-prick test) which is a higher and faster check than the extract from the company (Extract-based testing)

Skin Prick-prick test results in this one gives positive results for real bananas and kiwi, which are compatible with history. But since both fruits are members of the fruits frequently reported in latex-Fruit Syndrome (Banana, Kiwi, AA. Vocado, chestnut etc. ) so I did another fruit test. the avocado results are positive as well. It may be allergic or just a result of the test, but there is no real condition (asymptomatic sensitization)

Patients currently have no history of Latex Allergy, and patients haven't eaten any other fruits in this group, waiting for more test results for further evaluation.

Treatment Guidelines
- carry a syringe of ephrin
- recommended to avoid eating fruit in the above group while waiting for more results.

In conclusion, severe fruit allergy (Anaphylaxis) exists. Any medical friend who has experienced such condition in your patients, admin thinks that you should recommend avoiding fruit. (Banana-Kiwi-Avocado-Chestnut ) in case of severe allergies, you may avoid fruit (not sure) first. Bring an ephinefrin syringe + send it to evaluate with allergy doctor at the hospital. It's yours.

Those who have doubted themselves or acquaintances are this condition.
I recommend you to consult a doctor only in allergy.

Contact for appointment
Siriraj Hospital Line Id: allergymed

Or "Allergy Center for age"
Siriraj Pimharachkarunh Hospital. Call 02-419-1474

AdminTranslated

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#63. Allergens: Poison Ivy / Poison Oak / Poison Sumac - Johns ...

To be allergic to poison ivy, you must come in contact with the plant once for sensitization to ... There is no cure for the reaction once the rash starts.

#64. Hives and Rashes (Urticaria) in Dogs - Dog Owners - Merck ...

Hives are relatively uncommon in dogs. The most frequent causes are insect bites or stings, shampoos, and medications. Other causes include contact with ...

#65. The Hives (@TheHives) / Twitter

It's a pandemic-ending, life-affirming, all-out, scream-shout, The Hives European Tour ... London, Brixton Academy Yup we still call this venue just that.

#66. Hive | Call of Duty Wiki

For the Specialist Weapon, see H.I.V.E.. A Hive is an object in Extinction Mode for Call of Duty: Ghosts. There are a total of fourteen Hives to complete in ...

#67. CONTACT | Eyesonhives

Streamlining Information for Eyesonhives Users! Bee Monitoring: Bees in the Extremes. Recent Comments. Paul Cronshaw on Eyesonhives Scout B; Richard Parsons on ...

#68. Hives (Urticaria) | AAFA.org

Hives can occur during severe allergic reactions known as anaphylaxis (anna-fih-LACK-sis). Call your health care provider if: Your hives are making you ...

#69. Hives - The Center for Allergy & Immunology

Both children and adults can suffer from hives. Some people who get hives or angioedema are having a dangerous allergic reaction. Call 911 or see a doctor or ...

#70. Contact Dermatitis in Children

The substances may be: Irritants. These cause direct skin irritation and inflammation. They are the most common cause of contact dermatitis. Allergens. These ...

#71. Contact Us | Art Hives

For general questions, please fill-up the submission form below. For issues with our website, please contact [email protected].

#72. Contact dermatitis - treatments, symptoms and prevention

Inflammation of the skin is commonly termed eczema or dermatitis. It can be effectively managed with treatment – find out how.

#73. Hives (Urticaria) - Symptoms and Causes - Penn Medicine

Swelling in the throat can lead to life-threatening airway blockage. When to Contact a Medical Professional. Call 911 or your local emergency number if you have ...

#74. Eczema/Contact - Tallahassee Allergy Asthma & Immunology

Contact Dermatitis Hives & Swelling. Contact dermatitis is an inflammation of the skin caused by contact with substances. It causes an itchy, red rash and ...

#75. Contact Us - Relieve Allergy, Asthma and Hives

Patients who have an emergency should call 911 or go directly to the nearest Emergency Room. Patients may request an appointment online 24/7 ...

#76. Poison Ivy Dermatitis - American Osteopathic College of ...

A person doesn't have to come in direct contact with the leaves, roots, or branches of Rhus plants to get the rash. One can get it from contaminated ...

#77. Hives - Is Your Child Sick - Lake Forest Pediatric Associates

Most are caused by skin contact with an irritant. · Localized hives are not caused by drugs, infections or swallowed foods. · Wash the allergic substance off the ...

#78. Hives | Advocare Aroesty Ear, Nose & Throat Associates

Hives, an itchy rash made up of raised pink bumps with pale centers, that comes and goes. ... Contact Doctor During Office Hours. Hives last ...

#79. Skin Allergy, Eczema, Atopic Dermatitis, Urticaria, Hives ...

The most common skin allergies include eczema, hives/angioedema and contact dermatitis. Atopic Dermatitis (Eczema). Atopic Dermatitis Symptoms. Itchy bumps, ...

#80. Rash and Skin Disorders | Common Types and Treatments

Hives (Urticaria) · Contact Dermatitis · Eczema · Psoriasis · Lupus · Heat Rash · Rashes Caused by Infection or Disease · Rashes Caused by Medications.

#81. Hives Definition & Meaning - Merriam-Webster

The meaning of HIVES is an allergic disorder marked by raised edematous patches of skin or mucous membrane and usually intense itching and caused by contact ...

#82. Does My Child Have Hives? | Pediatric Clinic |

An itchy rash made up of raised pink bumps. Most often, rash is very itchy. Call PHA today to make an appointment.

#83. What are Hives (Urticaria)? Investigating This Bizarre Skin ...

However, if the swelling affects a person's throat and hinders their breathing or makes their voice hoarse, call 911 or go to the emergency room ...

#84. Hives - symptomviewer - HealthyChildren.org

Hives just in one spot are usually due to skin contact with an irritant. They are not an allergy. Plants. Many plants cause skin reactions. Sap from evergreens ...

#85. Rash on Face: What It Means If You Got One From Your Makeup

Contact dermatitis is zero fun. This condition can lead to a red, itchy rash on your face. Here's what to do if this happens to you.

#86. Rash, Age 12 and Older | Michigan Medicine

Contact dermatitis may cause mild redness of the skin or a rash of small red bumps. A more severe reaction may cause swelling, redness, and larger blisters. The ...

#87. Hives - Pediatric Web

Hives just in one spot are usually due to skin contact with an irritant. They are not an allergy. Plants. Many plants cause skin reactions.

#88. Rash - HSE.ie

Or it could mean your skin has come into contact with something which has caused a reaction. If you have a rash but feel well, it is probably an allergic ...

#89. Contact Dermatitis - Skin Disorders - MSD Manuals

Contact dermatitis is caused by either an irritant or an allergic reaction. · A rash develops and may be itchy or painful or both. · Doctors base the diagnosis on ...

#90. Cholinergic Urticaria: A Guide to Chronic Heat Hives - Google 圖書結果

Symptoms can include intense itching (pruritus), burning sensation, small hives or wheals, and flushing of the skin in the areas that come into contact with ...

#91. Contact Urticaria Syndrome: Diagnosis and Management

The clinical aspect can change according with the type of the contact substance. The wheals are distributed linearly arranged if these are habitually caused ...

#92. The Australasian Beekeeper - 第 13-15 卷 - 第 38 頁 - Google 圖書結果

He asked Mr. Garmade immune to bacteria and prorett , as a favour , to shift some hives ; tozoa by contact with them ? two hives were removed to two miles ...

#93. British Bee Journal - 第 23 卷 - 第 24 頁 - Google 圖書結果

Perhaps you could kindly give a disease , i.e. , communicated by contact , but I ... Eds . ) At any rate , my at the entrance of the hives ; if such was the ...

#94. American Bee Journal - 第 14-15 卷 - 第 110 頁 - Google 圖書結果

If two or three kinds of hives and boxes are used , in the same apiary ... The armature 10 is drawn back against contact - point 5 by tension of spring 6 .

#95. Hives When I Work Out: Am I Allergic to Exercise?

But to be clear: the sweat itself does not cause such hives. Ostro stresses that cholinergic urticaria is “not a form of contact dermatitis.

#96. Hives: What You Should Know - American Academy of Family ...

Hives are raised bumps caused by irritation in the upper layers of the skin. ... Contact [email protected] for copyright questions and/or ...

#97. Patient education: Hives (urticaria) (Beyond the Basics)

Hives are raised or puffy areas of the skin that itch intensely (). ... ○Physical contact – Hives can occur after you touch certain ...

#98. Contact dermatitis – Symptoms and causes - National Eczema ...

Contact dermatitis happens when the skin becomes irritated or inflamed after coming in contact with a substance that triggers an allergic reaction. It bears ...