Disinfecting Your Face Mask

As a result of the Covid-19 pandemic, the use of face masks are recommended to prevent spread of the virus. On top of this, one should also practice hand washing, personal hygiene and social distancing.

Due to increased demand for face masks, sometimes it is difficult to buy new ones. So the question is if you can reuse the face mask after disinfection. The table below highlights the methods that you can use without destroying the integrity of the filter system.

The most important point is to not use alcohol or chlorine methods of disinfection.

Disinfecting Face Mask

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Filed under General Allergy and Medicine

Unusual Treatment for Autoimmune induced Chronic Urticaria/Hives

Urticaria 4

A major trigger of chronic urticaria/hives is due to autoimmune cause. Currently there are thought to be 2 types of autoimmune triggers.

  • The IgE antibody on the skin mast cells that senses and reacts to an antigen created by your own body and that triggers release of histamine leading to urticaria.


  • An antibody created by your own body stimulates the skin mast cells to release histamine leading to urticaria.

There have been a few studies of using the serum of these patients suffering from chronic urticaria and then performing a self skin test by injecting a small amount the person’s serum under the skin. Lo and behold! the serum will produce the same urticaria/hive reaction at the area of injection.

Other studies have looked at using an unusual method of self injecting a larger amount of the serum into the individual. Sort of “fighting fire with fire”, a form of “self immunotherapy” towards these autoimmune triggers.


The data has been quite promising in that the patients that were resistant to antihistamine treatment showed response with some achieving complete remission. The study indicated that you will only see results beginning at the 8th treatment. This treatment can be considered in patients that see no improvement on antihistamines and does not want to be on immune modulation medications and/or unable to be on Biologic medications.

It is important to see a qualified Allergist for treatment for your chronic urticaria. At the AI Clinic, we have a protocol for using self injection of serum for patients with uncontrolled urticaria with good success rates.


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Filed under Hives/Urticaria

Chronic Urticaria/Hives

Urticaria 4

Urticaria or Hives is an itchy rash caused by release of histamine from mast cells from the skin. The release of histamine will lead to itchy raised bumps that looks like wheals “mosquito bites” pictured above. This rash can involve every part of the body and when severe, lead to swelling of the underneath tissues called angioedema. The definition of chronic urticaria is when this rash has been going on for 6 weeks or more.

Patients suffering from chronic urticaria are very distressed as the itch severely interferes with sleep, work and quality of life. Based on medical studies, the majority of patients with chronic urticaria have no external cause or underlying disease process that can be identified.  However, that DOES NOT mean that you should ignore it! You should see a qualified Allergist so that your condition can be properly evaluated.

Sometimes, patients come to us with different test results that cannot be interpreted or utilized. Here at the AI Clinic, we have helped many patients with chronic urticaria by doing proper evaluation followed by comprehensive treatment of their condition. By undergoing proper evaluation, we have identified underlying triggers such as autoimmune conditions, infections and allergic triggers without using a shotgun approach!

After proper evaluation, we will begin a treatment protocol that will give you the best chance of success in controlling your urticaria and to induce remission. We will first start from the basic treatment process and then escalate to the next level if you do not achieve control of your condition.

Why do we emphasize urticaria control? This is because medical data is now showing that complete control leads to higher chance of success in inducing remission/resolution of your chronic urticaria. Let us help you in finding a solution to your condition.




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Filed under Hives/Urticaria

Irritated Skin from Washing and Sanitizer use

During the current Covid-19, hand washing or use of hand sanitizers are recommended to prevent infection. However some of our patients have reported skin issues from this current practice. Here are some FAQs and answers from the AI Clinic which may help your condition.

Sanitizer Hand Eczema

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Filed under Skin

Apple Cider Vinegar unhelpful for Atopic Dermatitis

Apple cider vinegar

There has been social media postings of people applying apple cider vinegar to help their eczema rash.  It is an emerging popular option that patients think is safer or more natural than prescriptions like topical steroids. However, this is not recommended as it can cause irritation to the skin.

A study was done in 2019 at the University of Virginia and published in Pediatric Dermatology where they did an investigation on the use of apple cider vinegar on subjects with atopic dermatitis. Researchers found that transepidermal water loss increased right after apple cider vinegar treatment which only recovered 60 minutes post treatment (increased transepidermal water loss is a marker of skin barrier disruption). More than 70% of subjects reported mild side effects from apple cider vinegar soaks. The side effects, including forearm skin discomfort and, in one patient, severe itching, only improved after they discontinued the apple cider vinegar application.

At this time, we do not recommend the use of apple cider vinegar to treat atopic dermatitis. Please come for a consult at the AI Clinic where the Allergist can perform proper evaluation and diagnosis followed by recommendations for appropriate skin care for your atopic dermatitis.

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Filed under Allergy Treatment, Skin

Inducing Tolerance to Cows Milk or Egg

Cows milk and Egg are the two most common food allergies encountered in children. Reactions can range from eczema flare to hives/urticaria and anaphylaxis.

It is very important to see a qualified Allergist for proper evaluation of food allergies. During the consultation, a detailed history is obtained followed by confirmatory allergy testing to determine allergic sensitization. This is then followed by dietary advice on avoidance. There will be a detailed discussion on the use of Epipen for instances of severe allergic reaction.

In general, cow milk and egg allergy can be outgrown by children. The rates of resolution of these food allergies varies by country as well as the individual. From what we can gather from medical literature, the more severe the food allergic reaction, the less the chance to outgrow. Other factors responsible include presence of other allergic diseases such as the severity of eczema, presence of allergic rhinitis or asthma. Studies show that children with cows milk or egg allergy can tolerate these food allergens in a baked form such as cakes or muffins. If these children ingests the baked form of cow milk or egg regularly, they can gain tolerance and outgrow the allergy compared to those children that do not eat.


At the AI Clinic, we have developed a treatment protocol to help children with cow milk or egg allergy. We perform allergy skin prick test to a specific baked cow milk or egg muffin (recipe and instructions given to the patient to prepare). Based on the reaction of the skin prick test, the patient is then given the food challenge in the AI Clinic under proper observation. This must be done carefully as there has been reported severe reaction.

If the patient passes the challenge, instructions on regular ingestion is given. The patient is then monitored regularly for side effects or problems. If everything goes well, the patient will gradually begin to develop tolerance to the cow milk or egg allergen and outgrow the allergy. Confirmation on outgrowing the food allergy to cow milk or egg is done with an Oral Food Challenge procedure in the AI Clinic.

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Filed under Allergy Treatment, Food Allergy

Ask A Doctor: Allergies

Allergic appearance

In this BFM radio interview I discuss about allergies and answer some questions from listeners. Please click on the link below to listen to the interview:

BFM Ask A Doctor – Allergy Interview

Some important points that I highlight in the radio interview:

  1. Hygiene hypothesis as one of the factors for development of allergy.
  2. Allergic rhinitis is the most common form of allergic disease affecting 15-20% of people in Malaysia.
  3. The bacterial microbiome has an important influence on our immune system’s development.
  4. Premastication-the process of chewing food and feeding the food to the baby is one form of allergy prevention.
  5. Allergen specific immunotherapy is available to treat allergic rhinitis.
  6. Urticaria or hives, can be an early marker of an autoimmune condition.

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Filed under General Allergy and Medicine