Allergic Skin Reactions and Rashes

An allergic reaction is not the same as an irritation

Got a rash? Have you worn a new cosmetic, or perfume, or piece of jewelry? You may be having an allergic reaction, which is very different from an occasional skin irritation — and skin allergies carry the risk of future and more severe reactions.

They produce itchy, red, painful, bumpy, scaly or rashy skin, and the knock-on effects are the part people usually come in about: disrupted sleep, embarrassment, and the fog that comes from months of over-the-counter symptom treatments.

Skin allergies are often associated with asthma and nasal allergy (allergic rhinitis, or hay fever), which is why a skin visit here frequently turns into a conversation about breathing as well.

What we diagnose and treat

• Hives (Urticaria)
• Eczema (Atopic Dermatitis)
• Contact Dermatitis
• Swelling (Angioedema)
• Itchy skin (Pruritus)
• Metal Allergy
• Fragrance Allergy
• Cosmetic Allergy
• Latex Allergy
• Rash
• Mastocytosis

Eczema (Atopic Dermatitis)

Eczema produces red and itchy skin, commonly in children but also in adults. It is often accompanied by asthma or hay fever (allergic rhinitis). Eczema triggers include airborne, contact and food allergy. There is no cure yet, and a full range of treatment options is offered to manage symptoms.

Allergy skin tests give the maximum information needed to rule an allergic condition in or out, with minimum discomfort and risk, and can usually be completed during the initial visit. The optimal number of tests is applied for effective diagnosis and treatment decisions. The testing is essentially painless and patients remain comfortable throughout. We are happy to demonstrate testing on parents whose young children are being tested.

Dr. Johana Castro Wagner has a special interest in eczema and hives, alongside food allergies and pediatric allergy and asthma.

Biologics for eczema (atopic dermatitis)

Biologic therapies target the underlying pathways that drive allergic and inflammatory disease, with the potential for deeper control, fewer exacerbations, and in some conditions they may actually modify the disease itself.

For moderate to severe atopic dermatitis that topical prescription treatments have not controlled, these are the biologics approved for it. Which one suits you is decided in the office.

Hives (Urticaria)

Chronic hives, or chronic urticaria, is now generally referred to as chronic spontaneous urticaria (CSU) or chronic inducible urticaria (CIndU), particularly when physical factors such as pressure, heat, cold, exercise, or other stimuli bring on the hive rash. Although this is considered a chronic condition, the individual hives characteristically come and go, usually disappearing within 24 to 36 hours while new hives may develop elsewhere. The rash can consist of raised, red or skin-colored welts and may also be accompanied by deeper swelling, known as angioedema. Significant itching is extremely common and, for some patients, can be debilitating and interfere with sleep and normal daily activities. An important part of evaluating chronic urticaria is determining whether there is an identifiable trigger, including a physical stimulus, an allergic cause, a medication, or an underlying systemic illness. However, in many patients with chronic spontaneous urticaria, no specific outside trigger can be identified. Fortunately, chronic hives can usually be very effectively controlled with individualized, expert medical management, including nonsedating antihistamines, sometimes at higher doses, other medications when appropriate, and biologic therapies such as omalizumab for patients whose symptoms are not adequately controlled with antihistamines. Our goal is to understand the nature of each patient’s urticaria and develop a treatment approach that provides effective control of the hives, swelling, and itching and allows the patient to return to normal daily life.

Biologics for chronic hives

Where chronic spontaneous hives keep going despite antihistamines, these are the options that work at the immune system level rather than on the itch.

Contact dermatitis and patch testing

Contact dermatitis is the rash that shows up where something touched the skin — a new cosmetic, a perfume, a piece of jewelry. The difficulty is that the culprit is rarely the most recent thing you used, and the rash can appear a day or two after contact, so working backwards from memory usually fails.

At Sher Allergy Specialists, we offer comprehensive contact patch testing for up to 70 of the most common contact allergens. These include substances found in cosmetics and personal-care products, fragrances, preservatives, metals, cleaning products, hair products, rubber, adhesives, and topical medications. Small patches containing these allergens are placed on the back and left in place for 48 hours. The patches are then removed, and the skin is examined over several visits for delayed allergic reactions that can help identify what may be causing your dermatitis or eczema.

Other skin conditions seen here

Beyond eczema, hives and contact dermatitis, the practice diagnoses and treats itching (pruritus), swelling (angioedema), rash and mastocytosis.

What the first visit looks like

• We listen to your food allergy story and review your history in detail before testing anything
• A physical exam and that history decide which tests are worth doing
• Testing and preliminary results happen during the initial evaluation visit when possible
• Allergy skin tests are personally measured and read by a physician or physician assistant, with physician oversight and interpretation
• You leave with a diagnosis and treatment steps, not a general recommendation to avoid things
• An Allergist leads the care team and is on-site for every clinic visit
• An Allergist is available 24/7 every day in case of emergency
• Your allergist communicates with your other doctors

Common questions about skin allergy