What is a cortisone shot for allergies

As with any medication, there are risks, and there are benefits, and the risks must be weighed against the potential benefit.

In life-threatening situations, such as a severe allergic reaction or asthma attack, there is no question about what to do. In most cases, you should talk to your doctor and discuss the possible positive and negative effects of taking a medication.

That said, anabolic steroids own no put exterior of medicine. Taking these potent medications for performance enhancement is not only an unnecessary risk — it damages the competitive nature of the sport.

Athletes who cheat shift the competitive balance of sports, and are taking a dangerous health risk.

Diagnosis

Allergy testing is the best diagnostic tool and the best road to treatment for dogs that are suffering from moderate and severe allergies. There are several diverse testing methods available. The most common is a blood test that checks for antigen induced antibodies in the dog’s blood. Intradermal skin testing may also be performed. In this method of testing, a little quantity of antigen is injected into a shaved portion of the dog’s skin. This is done in a specific pattern and order so that if the dog shows a little raised reaction, the offending antigen can be identified.

After a period of time (hours), the shaved area is examined to detect which antigens, if any, created a reaction. Allergy testing is performed to develop a specific therapy for the allergic animal.

A Expression From Verywell

Use of the expression "steroids" causes confusion as this can refer to numerous diverse substances.

What is a cortisone shot for allergies

The use of steroid injections in the setting of athletic performance enhancement versus treatment of inflammatory conditions is extremely different.

The medications used, the side effects of these substances, and the effects on the body are every extremely diverse. Having a steroid injection for an arthritic knee has nothing to do with people who inject steroids to build muscle. Understanding this distinction is important.

Most people ponder of steroids in the context of athletic performance or as a prescribed medication, but there are numerous steroids beyond these parameters.

Anabolic steroids can cause mood swings, aggressive actions, and risky or impulsive behavior.

Tis the season to be jolly!

Spring, summer, and drop is a time of change, a time to purchase a new wardrobe, plant a garden, or just get out of the home to enjoy the magnificent weather. Most of us love this time of the year, with colorful flowers blooming, the sounds of chirping birds, and the sight and smell of unused cut green grass. For others, though, it is not so pleasant, as it brings on seasonal allergies, often involving stuffy noses and itchy eyes.

As the seasons change, especially in the spring and drop, seasonal allergies are in full effect, and put a damper on the beauty of the sun shining and flowers blooming.

35 million Americans suffer from allergies year-round, which often brings them into their allergist with teary, swollen and itchy eyes, with the sniffles and stuffy noses. Seasonal allergies can be extremely debilitating, hindering day-to-day activities, often causing congestion, drowsiness, and fatigue, due to the high pollen counts in the air.

Simply put, an allergy is an overreaction of the immune system to certain substances that are considered foreign to our bodies.

In other words, this allergic reaction, or allergies are caused when allergens such as pollen or dust enters the body, and the immune system classifies it as a foreign substance, and aims to remove it from the body, causing the IgA allergy-specific antibodies called immunoglobulins, to overact. Thus, this reaction causes symptoms of itching, inflammation of the skin and eyes, and often breathing and respiratory issues.

Other symptoms of seasonal allergies include:

  1. Eye irritation
  2. Impaired sense of smell and taste
  3. Allergy shots are not considered the only long-term solution: Allergy shots or immunotherapy used to be the only successful long-term solution, but then sublingual tablets were introduced.

    These tablets dissolve under your tongue, and should be taken once-a-day before and during allergy season. These tablets purpose to desensitize your body to specific allergens by introducing them into your body in tiny amounts, and over time, your immune system builds up a tolerance to protect your body from these allergens, thus preventing symptoms. Taking the tablets is now considered more convenient than having to go to a doctor for weekly or monthly allergy shots. However, allergy shots are still a excellent option as well.

  4. General feeling of being unwell (Similar to a freezing but without the fever)
  5. Sore throat
  6. Loss of concentration
  7. Ear infections
  8. Muscle aches and pains
  9. Wheezing
  10. Facial pressure or pain
  11. Nasal congestion
  12. Antihistamines are your best friend: During allergy season, make antihistamines your best friend.

    As the name sounds, antihistamines are there to block the histamine before it takes effect, causing an allergic reaction. Research shows that it is more effective to attempt to prevent allergy symptoms than to attempt to eliminate them. Histamine is a chemical released to attempt and protect the immune system, but by the time the person has already had an allergic reaction, with symptoms such as nasal congestion, itching and sneezing, histamines are already present. Therefore, allergists recommend taking antihistamines before you know the time when your allergy symptoms appear.

    While antihistamines do assist with symptoms of sneezing and itchiness, they generally don’t assist with nasal stuffiness. Relieve your stuffiness with a nasal steroid spray along with the antihistamines.

  13. Trouble sleeping
  14. Weakened immune system
  15. Fatigue
  16. What you are allergic to can change over time: What you are allergic to can always change over time. Receiving allergy shots can make you develop immunity to a specific allergen that you were allergic to before. Allergies don’t vanish, but your body is always reacting differently depending on the environment you are in.

    Always get checked out by your allergist.

  17. Runny or itchy nose
  18. Headaches
  19. Allergies can cause asthma: Allergies are commonly linked to asthma, which numerous people don’t know. During allergy season, people are diagnosed with allergic asthma, and are often treated with steroid inhalers. Conversely, those with asthma will experience symptom flare-ups if allergies are not kept in check.

Did you know that the liver plays a substantial role in reducing the effect a potential allergen will own on the body?

Our liver purifies and filters about two quarts of blood per minute, extracting most viruses, bacteria, environmental toxins, before recirculating healthy blood through the relax of the body. Seasonal allergies happen as a result of an overloaded toxic state within the liver.

The liver has multiple functions for the body, and is responsible for processing everything we come in contact with.

What is a cortisone shot for allergies

If the quantity of a substance entering the bloodstream is too much for the liver to process, the immune system becomes overstimulated, and recognizes it as being an allergen. The liver then produces and stores allergy-specific antibodies called immunoglobulins. These antibodies set off a reaction, and the release of too numerous inflammatory chemicals or hormones called histamines causes an allergic reaction, with a host of physical symptoms.

Now that you know the cause of seasonal allergies, here are some things you may not know:

  • Antihistamines are your best friend: During allergy season, make antihistamines your best friend.

    As the name sounds, antihistamines are there to block the histamine before it takes effect, causing an allergic reaction. Research shows that it is more effective to attempt to prevent allergy symptoms than to attempt to eliminate them. Histamine is a chemical released to attempt and protect the immune system, but by the time the person has already had an allergic reaction, with symptoms such as nasal congestion, itching and sneezing, histamines are already present. Therefore, allergists recommend taking antihistamines before you know the time when your allergy symptoms appear. While antihistamines do assist with symptoms of sneezing and itchiness, they generally don’t assist with nasal stuffiness.

    Relieve your stuffiness with a nasal steroid spray along with the antihistamines.

  • Allergy shots are not considered the only long-term solution: Allergy shots or immunotherapy used to be the only successful long-term solution, but then sublingual tablets were introduced. These tablets dissolve under your tongue, and should be taken once-a-day before and during allergy season. These tablets purpose to desensitize your body to specific allergens by introducing them into your body in tiny amounts, and over time, your immune system builds up a tolerance to protect your body from these allergens, thus preventing symptoms. Taking the tablets is now considered more convenient than having to go to a doctor for weekly or monthly allergy shots.

    However, allergy shots are still a excellent option as well.

  • What you are allergic to can change over time: What you are allergic to can always change over time. Receiving allergy shots can make you develop immunity to a specific allergen that you were allergic to before. Allergies don’t vanish, but your body is always reacting differently depending on the environment you are in. Always get checked out by your allergist.

  • Allergies can cause asthma: Allergies are commonly linked to asthma, which numerous people don’t know. During allergy season, people are diagnosed with allergic asthma, and are often treated with steroid inhalers.

    Conversely, those with asthma will experience symptom flare-ups if allergies are not kept in check.

It’s time to put the distress of allergies behind you. Schedule an appointment with Allergy, Asthma & Immunology Associates of Tampa at one of our convenient Tampa Bay locations today, by calling (813) 971-9743, or use our online appointment request form.

Filed Under: Allergic Rhinitis, Allergy, Allergy Specialists, Allergy Tampa, AsthmaTagged With: allergies, Immune System, respiratory issues, Seasonal Allergies, symptoms, Treatment

One of the most common medical complaints that we see in our office is dogs with skin infections, “hot spots”, or allergic dermatitis, also known as atopic (atopy) dermatitis.

Unlike people who react to allergens most commonly with nasal symptoms and/or hives, dogs react with skin and/or gastrointestinal problems.

This is because there are a higher proportion of mast cells, which release histamines and other vasoactive substances in the face of an allergic challenge, in the skin of dogs. These problems may range from poor jacket texture or hair length, to itching and chewing, to boiling spots and self-mutilation, gastrointestinal pain and discomfort, diarrhea, and flatulence. Allergies may also frolic a part in chronic ear infections. The most common causes of canine allergic dermatitis are flea allergy, food allergy, inhalant or contact allergy, and allergy to the normal bacterial flora and yeast organisms of the skin.

To make matters more hard to diagnose and treat, thyroid disease may add to the problem as well.

Canine atopic dermatitis (allergic dermatitis, canine atopy) is an inherited predisposition to develop allergic symptoms following repeated exposure to some otherwise harmless substance, an “allergen”. Most dogs start to show their allergic signs between 1 and 3 years of age. Due to the hereditary nature of the disease, several breeds, including Golden Retrievers, most terriers, Irish Setters, Lhasa Apsos, Dalmatians, Bulldogs, and Ancient English Sheep dogs are more commonly atopic, but numerous dogs, including mixed breed dogs can own atopic dermatitis.

Atopic animals will generally rub, lick, chew, bite, or scratch at their feet, flanks, ears, armpits, or groin, causing patchy or inconsistent hair loss and reddening and thickening of the skin. The skin itself may be dry and crusty or oily depending upon the dog. Dogs may also rub their face on the carpet; ear flaps may become red and boiling. Because the wax-producing glands of the ear overproduce as a response to the allergy, they get bacterial and yeast (Malassezia ) infections of the ear.

In order to overcome these frustrating symptoms, your veterinarian’s approach needs to be thorough and systematic.

Shortcuts generally will not produce results and only add to owner frustration and canine discomfort.

Inhalant and Contact Allergies
Substances that can cause an allergic reaction in dogs are much the same as those that cause reactions in people including the pollens of grasses, trees and weeds, dust mites, and molds. A clue to diagnosing these allergies is to glance at the timing of the reaction. Does it happen year round? This may be mold or dust. If the reaction is seasonal, pollens may be the culprit.

Food Allergies
Numerous people don’t suspect food allergies as the cause of their dog’s itching because their pet has been fed the same food every its life and has just recently started having symptoms.

However, animals can develop allergies to a substance over time, so this fact does not law out food allergies. Another common misconception is that dogs are only sensitive to poor quality food. If the dog is allergic to an ingredient, it doesn’t matter whether it is in premium food or the most inexpensive brand on the market. One advantage to premium foods is that some avoid common fillers that are often implicated in allergic reactions.

Flea Allergies
This type of reaction generally is not to the flea itself, but rather to proteins in its saliva.

Interestingly enough, the dogs most prone to this problem are not dogs who are constantly flea ridden, but those who are exposed only occasionally! A single bite can cause a reaction for five to seven days, so you don’t need a lot of fleas to own a miserable dog.

Staphylococcus Hypersensitivity
Bacterial hypersensitivity occurs when a dog’s immune system overreacts to the normal Staphylococcus (Staph) bacteria on its skin. It appears that bacterial hypersensitivity in the dog is more likely to happen if other conditions such as hypothyroidism, inhalant allergy, and/or flea allergy are concurrently present. Bacterial hypersensitivity is diagnosed through bacterial culture and examination of a biopsy sample.

Microscopically, there are certain unique changes in the blood vessels of the skin in bacterial hypersensitivity.

Treatment

Medicated Baths
Numerous medicated shampoos own compounds in them that are aimed at soothing injured skin and calming inflammation. In addition, frequent bathing (weekly to every other week) of the dog can remove allergens from the hair jacket, which may contribute to skin allergy flare-ups. The medicated baths we recommend are those that actually contain antimicrobial and antifungal agents as well as ingredients that permit the skin to be bathed on a more frequent basis without drying it out.

Application of a rinse afterwards also helps to prevent drying out of the skin and hair coat.

Antihistamines
Antihistamines can be used with excellent safety in dogs. About one third of owners report success with antihistamines. These medications tend to own a variable effect between dogs. For some allergic dogs, antihistamines work extremely well in controlling symptoms of allergic skin disease. For other dogs, extremely little effect is seen. Therefore, a minimum of three diverse types of antihistamines should be tried before owners give up on this therapy. Examples of antihistamines commonly used for dogs include Benadryl, Chlortrimeton, Atarax, Claritin, Zyrtec, and Clemastine.

However, antihistamines are considered to be worth trying in most cases since the side effects associated with antihistamines is low, and they are typically inexpensive medications.

Antibiotics and Antifungal Medications
Antibiotics are frequently needed to treat secondary skin infections. Anti-fungal medications are frequently needed to treat secondary yeast infections.

Flea Control
For dogs with this problem, a strict flea control regime must be maintained. The best flea control options include the use of products such as Advantage, Revolution, Frontline, Comfortis, and Sentinel.

Supplements
The Omega-3 and Omega-6 essential fatty acid supplements work by improving the overall health of the skin.

These fatty acids are natural anti-inflammatory and anti-oxidative agents. They reportedly are helpful in 20% of allergic dogs. My own experience puts this figure a little higher. They are certainly worth a attempt because they are not harmful and own virtually no side effects. Omega-3 fatty acids are found in fish oils and omega-6 fatty acids are derived from plants containing gamma-linolenic acid (GLA). These supplements are diverse from those sold to produce a glossy jacket. Products that contain both omega-3 and omega-6 fatty acids include Allergen Caps and Halo.

Hypoallergenic Diets
Allergies develop through exposure, so most hypoallergenic diets incorporate proteins and carbohydrates that your dog has never had before.

As mentioned previously, the quickest and best way to determine which foods your dog may or may not be allergic to is through diagnostic allergy testing. As dairy, beef, and wheat are responsible for 80% of food allergies in dogs, these items should be avoided. Novel protein sources used in hypoallergenic diets include venison, egg, duck, kangaroo, and types of fish not generally found in pet food. Carbohydrate sources include potatoes, peas, yams, sweet potatoes, and canned pumpkin.

Hydrolyzed protein diets are diets in which the protein source has been synthetically reduced to little fragments. The theory behind feeding a hydrolyzed protein source is that the proteins in the food should be little enough that the allergic dog’s immune system will not recognize the protein fragments and will not mount an immune response resulting in an allergy.

Most pets with food allergies reply well when switched to a store-bought hypoallergenic diet, but occasionally an animal suffers from such extreme allergies that a homemade diet is the only option.

In this case, the diet should be customized with the aid of a veterinarian.

Corticosteroids and Immunosuppressive Agents
Cortisone products such as prednisone, prednisolone, and dexamethasone reduce itching by reducing inflammation. These medications are not without side effects, so they need to be used judiciously in treating skin allergies. Steroids should be considered only when the allergy season is short, the quantity of drug required is little, or to relieve a dog in extreme discomfort. Side effects can include increased thirst and appetite, increased need to urinate, and behavioral changes. Long-term use can result in diabetes and decreased resistance to infection.

In some dogs, endless term, low-dose alternate day therapy is the only management protocol that successfully controls the atopic pet. This protocol should be used only as a final resort after every other methods own been exhausted to avoid the potential long-term complications of the medication.

Cyclosporine (Atopica) is a medication, which seems to be fairly effective at reducing the inflammation associated with skin allergies and calming the immune system of the affected dog. However, the pricing of cyclosporine may be prohibitive for larger breed dogs.

Immunotherapy (Hypo-sensitization)
Allergy shots are extremely safe, and numerous people own grand success with them; however, they are extremely slow to work.

It may be six to twelve months before improvement is seen. Once the allergens for the dog are identified, an appropriate immunotherapy is manufactured for that specific dog, and treatment can start. After the offending antigens are identified, then a mixture of these antigens can be formulated into a hyposensitizing injection. Depending on the type of agents used, these injections will be given over a period of weeks to months until the dog or cat develops immunity to the agents. After initial protection, an occasional booster may own to be given.

Environmental Control
If you know which substances your dog is allergic to, avoidance is the best method of control.

Even if you are desensitizing the dog with allergy shots, it is best to avoid the allergen altogether. Molds can be reduced by using a dehumidifier or placing activated charcoal on top of the exposed dirt in your home plants. Dusts and pollens are best controlled by using an air cleaner with a HEPA filter. Air conditioning can also reduce circulating amounts of airborne allergens because windows are then kept closed.

Thyroid Medication
Healthy skin and a normal hair jacket are the results of numerous factors, both external and internal. There are several glands in the body responsible for the production of hormones that are vital for the regulation of other body functions as well as a normal skin surface and hair jacket.

Hypothyroidism may result in poor skin and hair jacket, including hair loss or abnormal hair turnover, dull or brittle hair, altered pigmentation, and oily or dry skin. A blood test is a simplest and most direct way to tell if your dog is hypothyroid. Thyroid testing may include every or part of the following:

Baseline T4 Test or Entire T4 (TT4): This is the most common test. Dogs with a failure of the thyroid gland will own a lowered level of the T4 hormone. However, there are other conditions that can cause the T4 to decrease, so if this test comes back positive for hypothyroidism your vet should recommend an additional blood test, either the T3 Test or the Baseline TSH test.

Baseline TSH Test: Measures the level of Thyroid Stimulating Hormone.

In combination with the T4 or T3 test, it provides a more finish picture of the hormonal activity of your dog’s thyroid gland.

Free T4 by RIA (radio immunoassay): The Free T4 test using RIA techniques does not appear to be more or less precise than the above TT4 test.

Free T4 by ED (equilibrium dialysis): This test may provide more precise data on the level of T4 hormone in your dog’s bloodstream.

Baseline T3 Test: In combination with the T4 or TSH test, these two blood tests can give a clearer picture of the hormone levels found in the bloodstream.

This test is not dependable when used alone. The T3 Test should always be given in combination with one of the other blood tests.

TSH Response Test: In this test, the veterinarian takes an initial measurement of the thyroid hormones in your dog’s bloodstream and then injects Thyroid Stimulating Hormone (TSH) into the vein. After 6 hours, a blood sample is drawn and the level of T4 is checked. If your dog has hypothyroidism, the level of T4 will not increase even after the TSH is injected. This is an expensive test and is being used less often due to decreased production by the manufacturers.

Hypothyroidism is treated with a daily dose of synthetic thyroid hormone called thyroxine (levothyroxine).

Blood samples will need to be drawn periodically to assess the effectiveness of the dosage and make any adjustments necessary.

Successful management of the atopic, allergic dog is sometimes complicated and frustrating because multi-modal management is necessary in the majority of cases to control the allergic flare-ups. Proper diagnosis by a veterinarian and owner compliance and follow up care is essential to maximize the chances of curing or at least controlling the severely affected allergy patient.



It’s time to put the distress of allergies behind you.

Schedule an appointment with Allergy, Asthma & Immunology Associates of Tampa at one of our convenient Tampa Bay locations today, by calling (813) 971-9743, or use our online appointment request form.

Filed Under: Allergic Rhinitis, Allergy, Allergy Specialists, Allergy Tampa, AsthmaTagged With: allergies, Immune System, respiratory issues, Seasonal Allergies, symptoms, Treatment

One of the most common medical complaints that we see in our office is dogs with skin infections, “hot spots”, or allergic dermatitis, also known as atopic (atopy) dermatitis.

Unlike people who react to allergens most commonly with nasal symptoms and/or hives, dogs react with skin and/or gastrointestinal problems.

This is because there are a higher proportion of mast cells, which release histamines and other vasoactive substances in the face of an allergic challenge, in the skin of dogs. These problems may range from poor jacket texture or hair length, to itching and chewing, to boiling spots and self-mutilation, gastrointestinal pain and discomfort, diarrhea, and flatulence. Allergies may also frolic a part in chronic ear infections.

What is a cortisone shot for allergies

The most common causes of canine allergic dermatitis are flea allergy, food allergy, inhalant or contact allergy, and allergy to the normal bacterial flora and yeast organisms of the skin. To make matters more hard to diagnose and treat, thyroid disease may add to the problem as well.

Canine atopic dermatitis (allergic dermatitis, canine atopy) is an inherited predisposition to develop allergic symptoms following repeated exposure to some otherwise harmless substance, an “allergen”. Most dogs start to show their allergic signs between 1 and 3 years of age. Due to the hereditary nature of the disease, several breeds, including Golden Retrievers, most terriers, Irish Setters, Lhasa Apsos, Dalmatians, Bulldogs, and Ancient English Sheep dogs are more commonly atopic, but numerous dogs, including mixed breed dogs can own atopic dermatitis.

Atopic animals will generally rub, lick, chew, bite, or scratch at their feet, flanks, ears, armpits, or groin, causing patchy or inconsistent hair loss and reddening and thickening of the skin. The skin itself may be dry and crusty or oily depending upon the dog. Dogs may also rub their face on the carpet; ear flaps may become red and boiling. Because the wax-producing glands of the ear overproduce as a response to the allergy, they get bacterial and yeast (Malassezia ) infections of the ear.

In order to overcome these frustrating symptoms, your veterinarian’s approach needs to be thorough and systematic. Shortcuts generally will not produce results and only add to owner frustration and canine discomfort.

Inhalant and Contact Allergies
Substances that can cause an allergic reaction in dogs are much the same as those that cause reactions in people including the pollens of grasses, trees and weeds, dust mites, and molds.

A clue to diagnosing these allergies is to glance at the timing of the reaction. Does it happen year round? This may be mold or dust. If the reaction is seasonal, pollens may be the culprit.

Food Allergies
Numerous people don’t suspect food allergies as the cause of their dog’s itching because their pet has been fed the same food every its life and has just recently started having symptoms. However, animals can develop allergies to a substance over time, so this fact does not law out food allergies.

Another common misconception is that dogs are only sensitive to poor quality food. If the dog is allergic to an ingredient, it doesn’t matter whether it is in premium food or the most inexpensive brand on the market. One advantage to premium foods is that some avoid common fillers that are often implicated in allergic reactions.

Flea Allergies
This type of reaction generally is not to the flea itself, but rather to proteins in its saliva.

Interestingly enough, the dogs most prone to this problem are not dogs who are constantly flea ridden, but those who are exposed only occasionally! A single bite can cause a reaction for five to seven days, so you don’t need a lot of fleas to own a miserable dog.

Staphylococcus Hypersensitivity
Bacterial hypersensitivity occurs when a dog’s immune system overreacts to the normal Staphylococcus (Staph) bacteria on its skin.

It appears that bacterial hypersensitivity in the dog is more likely to happen if other conditions such as hypothyroidism, inhalant allergy, and/or flea allergy are concurrently present. Bacterial hypersensitivity is diagnosed through bacterial culture and examination of a biopsy sample. Microscopically, there are certain unique changes in the blood vessels of the skin in bacterial hypersensitivity.

Treatment

Medicated Baths
Numerous medicated shampoos own compounds in them that are aimed at soothing injured skin and calming inflammation.

In addition, frequent bathing (weekly to every other week) of the dog can remove allergens from the hair jacket, which may contribute to skin allergy flare-ups. The medicated baths we recommend are those that actually contain antimicrobial and antifungal agents as well as ingredients that permit the skin to be bathed on a more frequent basis without drying it out. Application of a rinse afterwards also helps to prevent drying out of the skin and hair coat.

Antihistamines
Antihistamines can be used with excellent safety in dogs.

About one third of owners report success with antihistamines. These medications tend to own a variable effect between dogs. For some allergic dogs, antihistamines work extremely well in controlling symptoms of allergic skin disease. For other dogs, extremely little effect is seen. Therefore, a minimum of three diverse types of antihistamines should be tried before owners give up on this therapy.

What is a cortisone shot for allergies

Examples of antihistamines commonly used for dogs include Benadryl, Chlortrimeton, Atarax, Claritin, Zyrtec, and Clemastine. However, antihistamines are considered to be worth trying in most cases since the side effects associated with antihistamines is low, and they are typically inexpensive medications.

Antibiotics and Antifungal Medications
Antibiotics are frequently needed to treat secondary skin infections. Anti-fungal medications are frequently needed to treat secondary yeast infections.

Flea Control
For dogs with this problem, a strict flea control regime must be maintained. The best flea control options include the use of products such as Advantage, Revolution, Frontline, Comfortis, and Sentinel.

Supplements
The Omega-3 and Omega-6 essential fatty acid supplements work by improving the overall health of the skin.

These fatty acids are natural anti-inflammatory and anti-oxidative agents. They reportedly are helpful in 20% of allergic dogs. My own experience puts this figure a little higher. They are certainly worth a attempt because they are not harmful and own virtually no side effects. Omega-3 fatty acids are found in fish oils and omega-6 fatty acids are derived from plants containing gamma-linolenic acid (GLA). These supplements are diverse from those sold to produce a glossy jacket.

Products that contain both omega-3 and omega-6 fatty acids include Allergen Caps and Halo.

Hypoallergenic Diets
Allergies develop through exposure, so most hypoallergenic diets incorporate proteins and carbohydrates that your dog has never had before. As mentioned previously, the quickest and best way to determine which foods your dog may or may not be allergic to is through diagnostic allergy testing. As dairy, beef, and wheat are responsible for 80% of food allergies in dogs, these items should be avoided. Novel protein sources used in hypoallergenic diets include venison, egg, duck, kangaroo, and types of fish not generally found in pet food.

Carbohydrate sources include potatoes, peas, yams, sweet potatoes, and canned pumpkin.

Hydrolyzed protein diets are diets in which the protein source has been synthetically reduced to little fragments. The theory behind feeding a hydrolyzed protein source is that the proteins in the food should be little enough that the allergic dog’s immune system will not recognize the protein fragments and will not mount an immune response resulting in an allergy.

Most pets with food allergies reply well when switched to a store-bought hypoallergenic diet, but occasionally an animal suffers from such extreme allergies that a homemade diet is the only option.

In this case, the diet should be customized with the aid of a veterinarian.

Corticosteroids and Immunosuppressive Agents
Cortisone products such as prednisone, prednisolone, and dexamethasone reduce itching by reducing inflammation. These medications are not without side effects, so they need to be used judiciously in treating skin allergies. Steroids should be considered only when the allergy season is short, the quantity of drug required is little, or to relieve a dog in extreme discomfort. Side effects can include increased thirst and appetite, increased need to urinate, and behavioral changes.

Long-term use can result in diabetes and decreased resistance to infection. In some dogs, endless term, low-dose alternate day therapy is the only management protocol that successfully controls the atopic pet. This protocol should be used only as a final resort after every other methods own been exhausted to avoid the potential long-term complications of the medication.

Cyclosporine (Atopica) is a medication, which seems to be fairly effective at reducing the inflammation associated with skin allergies and calming the immune system of the affected dog.

However, the pricing of cyclosporine may be prohibitive for larger breed dogs.

Immunotherapy (Hypo-sensitization)
Allergy shots are extremely safe, and numerous people own grand success with them; however, they are extremely slow to work. It may be six to twelve months before improvement is seen. Once the allergens for the dog are identified, an appropriate immunotherapy is manufactured for that specific dog, and treatment can start.

After the offending antigens are identified, then a mixture of these antigens can be formulated into a hyposensitizing injection. Depending on the type of agents used, these injections will be given over a period of weeks to months until the dog or cat develops immunity to the agents. After initial protection, an occasional booster may own to be given.

Environmental Control
If you know which substances your dog is allergic to, avoidance is the best method of control.

Even if you are desensitizing the dog with allergy shots, it is best to avoid the allergen altogether. Molds can be reduced by using a dehumidifier or placing activated charcoal on top of the exposed dirt in your home plants. Dusts and pollens are best controlled by using an air cleaner with a HEPA filter. Air conditioning can also reduce circulating amounts of airborne allergens because windows are then kept closed.

Thyroid Medication
Healthy skin and a normal hair jacket are the results of numerous factors, both external and internal.

There are several glands in the body responsible for the production of hormones that are vital for the regulation of other body functions as well as a normal skin surface and hair jacket. Hypothyroidism may result in poor skin and hair jacket, including hair loss or abnormal hair turnover, dull or brittle hair, altered pigmentation, and oily or dry skin. A blood test is a simplest and most direct way to tell if your dog is hypothyroid. Thyroid testing may include every or part of the following:

Baseline T4 Test or Entire T4 (TT4): This is the most common test.

Dogs with a failure of the thyroid gland will own a lowered level of the T4 hormone. However, there are other conditions that can cause the T4 to decrease, so if this test comes back positive for hypothyroidism your vet should recommend an additional blood test, either the T3 Test or the Baseline TSH test.

Baseline TSH Test: Measures the level of Thyroid Stimulating Hormone. In combination with the T4 or T3 test, it provides a more finish picture of the hormonal activity of your dog’s thyroid gland.

Free T4 by RIA (radio immunoassay): The Free T4 test using RIA techniques does not appear to be more or less precise than the above TT4 test.

Free T4 by ED (equilibrium dialysis): This test may provide more precise data on the level of T4 hormone in your dog’s bloodstream.

Baseline T3 Test: In combination with the T4 or TSH test, these two blood tests can give a clearer picture of the hormone levels found in the bloodstream.

This test is not dependable when used alone. The T3 Test should always be given in combination with one of the other blood tests.

TSH Response Test: In this test, the veterinarian takes an initial measurement of the thyroid hormones in your dog’s bloodstream and then injects Thyroid Stimulating Hormone (TSH) into the vein. After 6 hours, a blood sample is drawn and the level of T4 is checked. If your dog has hypothyroidism, the level of T4 will not increase even after the TSH is injected. This is an expensive test and is being used less often due to decreased production by the manufacturers.

Hypothyroidism is treated with a daily dose of synthetic thyroid hormone called thyroxine (levothyroxine).

Blood samples will need to be drawn periodically to assess the effectiveness of the dosage and make any adjustments necessary.

Successful management of the atopic, allergic dog is sometimes complicated and frustrating because multi-modal management is necessary in the majority of cases to control the allergic flare-ups. Proper diagnosis by a veterinarian and owner compliance and follow up care is essential to maximize the chances of curing or at least controlling the severely affected allergy patient.




So, You’ve Been Diagnosed with Hives!

by Richard S.

Roberts, M.D.

Allergy Hives

So, why are my mast cells releasing histamine and other things when they shouldn’t? The first question that needs to be asked is for how endless own you had hives? Hives that own been present intermittently or daily for less than 6 weeks are called acute hives, and if longer, chronic hives. Amongst the numerous possible causes of acute hives those due to allergic reactions get the most attention. In allergic patients the mast cells are coated with an allergy antibody, called IgE, that recognizes a extremely specific target (peanut, penicillin, yellow jacket, etc.).

When that substance, such as peanut, becomes attached to that allergy antibody a chain reaction occurs that activates the mast cell which results in the release of histamine and other inflammatory substances. A hive is born! For food allergy reactions, there are 3 useful rules to consider:

  1. Second, it goes away within a few hours or at the most within a day or two. Therefore, you never get hives for a week from one serving of peanut butter.
  2. First, the reaction begins quickly, within 5-30 minutes of eating the food; on rare occasions up to an hour but almost never longer.
  3. Third, the reaction is reproducible, meaning that if hives were caused by eating 4 peanuts on a Monday, eating 4 peanuts the following week will almost always cause the same problem.

    Despite favorite belief, artificial food colorings and food additives almost NEVER cause hives.

Hives from antibiotics is a diverse situation. The hive reaction can start anywhere from a few minutes after the first dose to 10 days after finishing the course. Antibiotic related hives can persist for up to approximately 2 weeks.

Allergic hives from stinging insects are generally obvious but occasionally they can be sneaky by occurring while you’re asleep or distracted. They start quickly after the sting and resolve in a few hours to a few days. In the U.S. spiders, flies and mosquitoes almost never cause hives although rare cases own been reported.

Almost any medicine or herbal product can potentially cause hives but one of the most common medicines implicated is the aspirin family (aspirin, ibuprofen, naproxen, etc.).

Isolated swelling without hives is a unique side effect of the ACE inhibitor blood pressure medicines. Soaps, detergents, fabric softeners almost never cause hives but if they do, the hives happen only where the skin is touched. Airborne allergy to pollen, dust, etc. almost never causes hives unless the person is in the midst of a massive hay fever attack. In an allergic person, direct skin contact with a potent allergic substance love animal saliva or latex can cause hives at the site.

What is a cortisone shot for allergies

Every categories of allergic hives are potentially dangerous while chronic hives are generally not.

Do you really own the Hives?

Don’t despair. You’re not alone. Approximately 20% of the population will own hives (urticaria) at one time or another during their lifetime. First off, are you certain that they’re really hives? True hives are red, itchy, generally raised lesions that look very much love mosquito bites. They are often circular or oval but can be  irregularly shaped.

Their size may vary from ¼ inch to several inches in diameter. They may blend together. Each spot lasts anywhere from 4-36 hours and is surrounded by normal looking skin. As they resolve the skin looks normal, not flaky or rough. While the hives are present one spot will be resolving while another nearby is developing. In about 40% of cases localized swelling (angioedema) of the lips, eyelids, hands, feet or tongue also occurs.
So, if these are really hives they must be from an allergy, right? Well, unfortunately it’s not that simple and modern science doesn’t own every of the answers.

The history of how they first appeared and what’s happened to them since can provide significant clues as to what category of hives you own. But first, what actually is a hive? Everyone’s skin is made up of numerous types of cells. One of these cells is called a mast cell. Everyone’s mast cells make and store histamine. They also routinely make leukotrienes and other substances that can cause localized inflammation. Mast cells don’t generally release much of these substances into the surrounding skin but if they do, these substances, especially histamine produce localized redness, itch and swelling we recognize as a hive or if it’s slightly deeper, angioedema.

Chronic Hives

So, if acute hives don’t seem to own an allergic cause what else could be going on? One of the more common presumed causes, especially in children is post-infectious hives.

During or within a week of viral, strep or other infections hives may happen through poorly understood mechanisms. This often leads to confusion when antibiotics own been given for the infection. Were the hives from the antibiotic or from the underlying illness? Post-infectious hives can recur for up to 6 weeks. At times, even without infection or any obvious trigger a few hours to a few days of hives happen. These are called acute idiopathic hives. We assume that the immune system is inappropriately activating the skin mast cells but we don’t know why. We don’t ponder that stress is a common cause.

So, your hives own gone on for more than 6 weeks, so they drop into the chronic urticaria category.

Now what? Once again you’re not alone. Approximately 3 million Americans of every ages own the same problem. There are some significant things that you should know. The first is that, unlike acute urticaria, less than 5% of the cases are due to some external cause. Also, unlike acute urticaria, the hives and /or swelling are rarely dangerous. In this form of hive problem various quirks and idiosyncrasies of the immune system, as they relate to mast cells, are the primary cause.

Our understanding of the problem is improving but there are numerous unanswered questions. The best understood of these idiosyncrasies is called chronic autoimmune urticaria. Approximately 45% of every chronic hives are of this type.

In this condition the immune system makes a detectable antibody (for which we own a test) that mistakenly thinks that parts of the mast cell surface are the enemy.

What is a cortisone shot for allergies

This antibody attacks the skin mast cells which leads to the release of histamine, etc. It’s been known for a endless time that if our body makes one autoantibody type of error it’s easier for it to make other autoantibody mistakes. Therefore, it’s not terribly surprising that in chronic autoimmune urticaria approximately 20% of patients, especially women, will also own autoantibodies that target the thyroid gland. This may lead to Hashimoto’s thyroiditis and periodically blood tests for thyroid function should be checked. Unfortunately, treating this thyroid condition probably does not benefit the hives.

The next most common type of chronic urticaria is chronic idiopathic urticaria.

This condition is almost certainly due to the immune system’s interaction with mast cells but the details are unknown. Both chronic autoimmune and chronic idiopathic urticaria may worsen during febrile illnesses, with the use of aspirin family medicines, prior to the monthly menstrual period or with sustained pressure to or rubbing of the skin. Individual hives that sting more than itch, leave bruises and final 3 or more days may indicate hives due to vasculitis (inflammation of the blood vessels).

Other forms of chronic hives own to do with the immune system’s reaction to physical triggers.

Hives produced by stroking of the skin is called dermographism. Some people’s hives are triggered just by freezing, heat, skin pressure, vibration, exercise, sun or even water. These conditions are fairly rare. Some exercise induced patients can either react just to exercise while others react only if their exercise follows the consumption of a food to which they are mildly allergic, most commonly wheat, celery and shellfish. These exercise reactions can produce anaphylaxis and may be dangerous. Another dangerous condition, this one involving angioedema and never hives, is called hereditary angioedema. In these patients swelling of the upper airway can be fatal.

Such patients also generally own pronounced abdominal pain from swelling of their intestines. Treatment is available.

So, now that you’ve put your hives into a category how are they treated? For acute hives and rare cases of chronic hives avoidance of triggers is the key. If the acute hives are already present antihistamines and if severe, a short course of oral steroid is used. For chronic hives daily preventative antihistamines are essential.

Doses higher than those used for nasal allergy treatment are often needed. If maximum antihistamine dosing has been reached without control, addition of an H2 blocker (e.g. Tagamet) and/or a leukotriene blocker (e.g. Singulair) may be tried. Maximizing the above therapy should minimize the need for oral steroid. Relying on recurrent courses of oral steroids (prednisone) especially without full antihistamine, H2 blocker and anti-leukotriene support is to be discouraged.

In rare cases cyclosporin or other immunomodulatory medicines may be added. Once control has been achieved medicines should be continued for several weeks or longer past the final symptoms. Slow tapering can then be attempted.

Conclusion

So, what’s my prognosis Doc?

As noted above:

  1. Less than 30% of idiopathic acute hives will go on to be chronic.
  2. Acute hives resolve spontaneously.
  3. If you own chronic hives that aren’t of the “physical” type at least 50% will resolve in less than a year and another 20% will resolve over the next several years.

    The “physical” hives tend to be more endless lasting.

Research is ongoing in every of these areas. So hold your chin up, take your antihistamine, and get the necessary attention to the type of hives that you have.

There is often confusion about steroids. We hear about steroids taken by athletes as being bad, but we also hear excellent things about steroids injected for arthritis, or inhaled for asthmatics. What's the difference between the steroids that are taken by athletes to enhance performance, and the steroids prescribed by a doctor?


Side Effects

One of the most concerning aspects of steroids — both anabolic steroids and corticosteroids — is the possibility of side effects.

Both types of medications own side effects, although they are extremely different.

Many people who use anabolic steroids own severe acne, premature baldness, and in men, shrinking testicles. There are also potentially fatal complications associated with liver damage and heart enlargement.

Corticosteroids can also cause numerous side effects although they are diverse from those of anabolic steroids. Common side effects of cortisone shots include flushing of the face, elevated blood sugar, weight acquire, mood swings, muscle weakness, blurred vision, and bruising, among others.

It is possible but not likely to become addicted to anabolic steroids or corticosteroids.

Cortisone Shots for Inflammation: Benefits, Side Effects, and More



How endless can my patient use
intranasal steroid sprays?

December 2005 | Volume 72 | Number 12 | Pages 1079-1082

Lily C.

Pien, MD
Department of Pulmonary, Allergy, and Critical Care Medicine
Cleveland Clinic

Return to One-Minute Consult Index

Intranasal steroid sprays are safe for long-term use, and there is little evidence to indicate they cause significant systemic side effects. However, patients with chronic rhinitis who might use them for endless periods should be advised to use them only intermittently and at the lowest dose that controls their symptoms.

Patients who regularly use steroid sprays should undergo examination of the nasal cavity at least annually to check for damage to the septum.

Children using intranasal steroid sprays should be prescribed the newer-generation formulations, use low doses, and own their growth monitored regularly.

There is little evidence to indicate significant systemic side effects

Local Side Effects

Patients may notice local side effects, including burning, dryness, crusting, and occasional nosebleeds.

Septal perforations are rarely reported and may be related to vasoconstrictive activity of corticosteroids.

Perforations are most likely to happen in the first year of use and in young women.8 To assist avoid local side effects, patients should be instructed to spray away from the septum.

Mucosal atrophy, as evaluated by nasal biopsy, has not been observed with 1 year of use of either fluticasone or mometasone, or 5.5 years of budesonide.9-11

A few cases of allergic contact dermatitis own been reported, particularly with budesonide; patients with known contact hypersensitivity reactions to specific steroids should be careful using sprays.12,13

Patients should use the lowest dose that controls their symptoms

Nasal Steroids are Widely Used

In 1972, beclomethasone dipropionate was marketed as the first intranasal spray for allergic rhinitis.

Its efficacy in the treatment of seasonal, perennial allergic rhinitis and nonallergic rhinitis led to the development of additional formulations and second-generation steroid sprays (TABLE 1).1

Several consensus reports list intranasal steroid sprays as first-line therapy for rhinitis.2-4 These drugs are widely used: an estimated 25% of the US population has allergic rhinitis, and sales of intranasal steroid sprays exceeded $1.6 billion in 2000.5

The usual prescribed dose is one or two squirts in each nostril daily.

Some patients are disappointed that there is no immediate decongestant effect-optimal clinical efficacy may not be reached for 1 to 2 weeks.

Some patients with chronic allergic and nonallergic rhinitis use intranasal steroid sprays for years. In view of this, studies own been done to determine if these drugs can be taken intermittently on an as-needed basis instead of daily, to reduce exposure to them. Although the studies were short-term (4-6 weeks), dipropionate and fluticasone own shown benefit when used intermittently.6,7

Systemic Side Effects

The long-term use of intranasal corticosteroid sprays raises concerns about their possible systemic side effects.

Systemic absorption occurs (TABLE1), but few clinically relevant side effects are known.14,15.

Two preparations, dexamethasone and betamethasone, own some effect on the hypothalamic-pituitary-adrenal axis. They are not currently used in the United States.

Triamcinolone acetonide, budesonide, fluticasone propionate, and mometasone tend not to cause any significant side effects, presumably because they own lower systemic bioavailability (particularly fluticasone and mometasone) and are used in low dosages.

The labels of intranasal sprays warn of potential effects on children’s growth.

Beclomethasone dipropionate spray used for 1 year affected children’s growth,16 but neither fluticasone nor mometasone had this effect.17,18 Fluticasone and mometasone are approved for young children by the US Food and Drug istration.

Occasional case reports link glaucoma with intranasal steroid sprays. However, two large studies of patients using intranasal sprays found no association with glaucoma or cataracts: one was a case-control study of more than 9,000 patients,19 and the other was a retrospective observational study of more than 286,000 patients.20

Other side effects typical of parenteral use of corticosteroids, such as osteoporosis, diabetes, and hypertension, own not been reported with any of the current sprays.

However, no studies own specifically addressed these issues, and most studies on sprays are conducted for less than 1 year.

It is possible that other side effects may happen if patients use higher doses than prescribed. Other issues that need further study include the long-term use of intranasal sprays with other forms of topical corticosteroids (such as inhaled preparations for asthma), as well as with parenteral forms of corticosteroids to control inflammatory diseases such as asthma, inflammatory bowel disease, or rheumatoid arthritis.

References

  • Minshall E, Ghaffar O, Cameron L, et al.

    Assessment by nasal biopsy of long-term use of mometasone furoate aqueous nasal spray (Nasonex) in the treatment of perennial rhinitis. Otolaryngol Head Neck Surg 1998; 118:648-654.

  • Cervin A, Andersson M. Intranasal steroids and septum perforation-an overlooked complication? A description of the course of events and a discussion of the causes. Rhinology 1998; 36:128-132.
  • Schenkel EJ, Skoner DP, Bronsky EA, et al. Absence of growth retardation in children with perennial allergic rhinitis after one year of treatment with mometasone furoate aqueous nasal spray.

    Pediatrics 2000; 105:E22.

  • Holm AF, Fokkens WJ, Godthelp T, Mulder PG, Vroom TM, Rijntjes E. A 1-year placebo-controlled study of intranasal fluticasone propionate aqueous nasal spray in patients with perennial allergic rhinitis: a safety and biopsy study. Clin Otolaryngol Allied Sci 1998; 23:69-73.
  • Stempel DA, Woolf R. The cost of treating allergic rhinitis. Curr Allergy Asthma Rep 2002; 2:223-230.
  • van Cauwenberge P, Bachert C, Passalacqua G, et al.

    Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology. Allergy 2000; 55:116-134.

  • Juniper EF, Guyatt GH, Archer B, Ferrie PJ. Aqueous beclomethasone dipropionate in the treatment of ragweed pollen-induced rhinitis: further exploration of “asneeded” use. J Allergy Clin Immunol 1993; 92:66-72.
  • Cave A, Arlett P, Lee E. Inhaled and nasal corticosteroids: factors affecting the risks of systemic adverse effects. Pharmcol Ther 1999; 83:153-179.
  • Passalacqua G, Albano M, Canonica GW, et al. Inhaled and nasal corticosteroids: safety aspects.

    Allergy 2000; 55:16-33.

  • Bircher AJ, Pelloni F, Langauer Messmer S, Muller D. Delayed hypersensitivity reactions to corticosteroids applied to mucous membranes. Br J Dermatol 1996; 135:310-313.
  • Dykewicz MS, Kaiser HB, Nathan R, et al. Fluticasone propionate aqueous nasal spray improves nasal symptoms of seasonal allergic rhinitis when used as needed (prn). Ann Allergy Asthma Immunol 2003; 91:44-48.
  • Allen DB, Meltzer EO, Lemanske RF Jr, et al.

    No growth suppression in children treated with the maximum recommended dose of fluticasone propionate aqueous nasal spray for one year. Allergy Asthma Proc 2002; 23:407-413.

  • Bousquet J, Van Cauwenberge P, Khaltaev N; Aria Workshop Group; World Health Organization.

    What is a cortisone shot for allergies

    Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001; 108(5 suppl):S147-S334.

  • Hadley JA, Kavuru MS, Anon JB, Pien LC. Diagnosis and Management of Rhinitis and Rhinosinusitis. 3rd ed. New York: Professional Communications Inc; 2005:65.
  • Gonzalo Garijo MA, Bobadilla Gonzalez P. Cutaneousmucosal allergic contact reaction due to topical corticosteroids. Allergy 1995; 50:833-836.
  • Garbe E, LeLorier J, Boivin JF, Suissa S.

    Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma. JAMA 1997; 277:722-727.

  • Dykewicz MS, Fineman S. Executive summary of Joint Task Force practice parameters on diagnosis and management of rhinitis. Ann Allergy Asthma Immunol 1998; 81:463-468.
  • Skoner D, Rachelefsky G, Meltzer EO, et al. Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate. Pediatrics 2000; 105:E23.
  • Pipkorn U, Pukander J, Suonpaa J, Makinen J, Lindqvist N.

    Long-term safety of budesonide nasal aerosol: a 5.5-year follow-up study. Clin Allergy 1988; 18:253-259.

  • Derby L, Maier WC. Risk of cataract among users of intranasal corticosteroids. J Allergy Clin Immunol 2000; 105:912-916.

Return to One-Minute Consult Index

Posted on: May 02, 2016

Return to One-Minute Consult Index

Posted on: May 02, 2016


What Are Steroids?

Essentially, every steroids are chemicals that share some basic components of their molecular structure. But steroids are a wide class of molecules, and diverse steroids own extremely diverse properties.

The most common steroids include anabolic steroids, sex hormones, corticosteroids, and cholesterol. You need not be a scientist to understand that these compounds own extremely diverse properties, and these are just the steroids found in mammals; insects, plants, and fungi also own characteristic steroid molecules.

What Are Anabolic Steroids?

Anabolic steroids, synthetic substances that are derivatives of testosterone, are the substance most people reference when they use the expression "steroids." This type of steroid stimulates the body to convert proteins into muscle tissue, so it's known for the prominent effect of building muscle when taken during athletic training.

Anabolic steroids can be taken by mouth or injected into the body; the duration of effect depends on the type of steroid istered.

Athletes often take anabolic steroids to build muscle and assist stimulate muscle repair and recovery after activity.

Anabolic steroids are sometimes istered for non-athletic purposes. Some medical conditions warrant anabolic steroid use, including growth problems in children and adolescents, some types of tumors, muscle wasting diseases (such as HIV/AIDS), and most recently the increased use of testosterone for aging.

What Are Corticosteroids (Cortisone)?

Corticosteroids are medications that own effects on inflammation in the body—a process known as a 'cascade of events.' This cascade means that, for inflammation to develop, a series of events take put. Corticosteroids own effects on a specific step in that cascade of events, stopping the process, and, therefore, reducing inflammation.

Corticosteroids can also be taken orally, injected into a specific area, injected into the bloodstream, or inhaled.

To limit side effects, local injections are most often preferred. But if the inflammation is more severe or widespread, systemic steroids may be required.

Corticosteroids can be used for numerous medical conditions that cause inflammation. Injected corticosteroids, often called cortisone shots, are often used for arthritis, tendonitis, and bursitis. Systemic steroids may be used for conditions including asthma, multiple sclerosis, lupus, and numerous other problems.

Hydrocortisone Injections to Reduce Joint Inflammation


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