An abdominal aortic aneurysm (AAA) is a swelling (aneurysm) of the aorta – the main blood vessel that leads away from the heart, down through the abdomen to the rest of the body. The abdominal aorta is the largest blood vessel in the body and is usually around 2cm wide – roughly the width of a garden hose. However, it can swell to over 5.5cm – what doctors class as a large AAA. Large aneurysms are rare, but can be very serious. If a large aneurysm bursts, it causes huge internal bleeding and is usually fatal. The bulging occurs when the wall of the aorta weakens. Although what causes this weakness is unclear, smoking and high blood pressure are thought to increase the risk of an aneurysm. AAAs are most common in men aged over 65. A rupture accounts for more than 1 in 50 of all deaths in this group. This is why all men are invited for a screening test when they turn 65. The test involves a simple ultrasound scan, which takes around 10-15 minutes. Symptoms of an AAA In most cases, an AAA causes no noticeable symptoms. However, if it becomes large, some people may develop a pain or a pulsating feeling in their abdomen (tummy) or persistent back pain. An AAA doesn’t usually pose a serious threat to health, but there’s a risk that a larger aneurysm could burst (rupture). A ruptured aneurysm can cause massive internal bleeding, which is usually fatal. Around 8 out of 10 people with a rupture either die before they reach hospital or don’t survive surgery. The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the abdomen. If you suspect that you or someone else has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Read more about the symptoms of an AAA. Causes of an AAA It's not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. There are other risk factors you can do something about, including smoking and having high blood pressure and cholesterol level. Having a family history of aortic aneurysms also means that you have an increased risk of developing one yourself. Read more about the causes of an AAA. Diagnosing an AAA Because AAAs usually cause no symptoms, they tend to be diagnosed either as a result of screening or during a routine examination – for example, if a GP notices a pulsating sensation in your abdomen. The screening test is an ultrasound scan, which allows the size of your abdominal aorta to be measured on a monitor. This is also how an aneurysm will be diagnosed if your doctor suspects you have one. Read more about diagnosing an AAA. Treating an AAA If a large AAA is detected before it ruptures, most people will be advised to have treatment, to prevent it rupturing. This is usually done with surgery to replace the weakened section of the blood vessel with a piece of synthetic tubing. If surgery is not advisable – or if you decide not to have it – there are a number of non-surgical treatments that can reduce the risk of an aneurysm rupturing. They include medications to lower your cholesterol and blood pressure, and quitting smoking. You will also have the size of your aneurysm checked regularly with ultrasound scanning. Read more about treating AAAs. Prevention The best way to prevent getting an aneurysm – or reduce the risk of an aneurysm growing bigger and possibly rupturing – is to avoid anything that could damage your blood vessels, such as: smoking eating a high-fat diet not exercising regularly being overweight or obese Read more about preventing aneurysms. Screening Read more about screening for an AAA. Symptoms In most cases, an unruptured abdominal aortic aneurysm (AAA) will cause no symptoms, unless it becomes particularly large. Symptoms of an unruptured AAA may include: a pulsating feeling in your stomach (abdomen), usually near your belly button, that's usually only noticeable when you touch it persistent back pain persistent abdominal pain If you have any of the symptoms above, you should see your GP as soon as possible. Ruptured AAA If your aortic aneurysm ruptures, you will feel a sudden and severe pain in the middle or side of your abdomen. In men, the pain can also radiate down into the scrotum. Other symptoms include: dizziness sweaty and clammy skin rapid heartbeat (tachycardia) shortness of breath feeling faint loss of consciousness Medical emergency A ruptured aortic aneurysm is a medical emergency, and it’s important to get to hospital as soon as possible. Around 80% of people with a rupture die before they reach hospital or don’t survive emergency surgery. This is why the NHS AAA Screening Programme was introduced, so dangerously large aneurysms can be treated before they burst. If you suspect that you or someone in your care has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Causes The aorta is the largest blood vessel in the body. It transports oxygen-rich blood away from the heart to the rest of the body. An abdominal aortic aneurysm (AAA) occurs when part of the aorta wall becomes weakened and the large amount of blood that passes through it puts pressure on the weak spot, causing it to bulge outwards to form an aneurysm. The abdominal aorta is usually around 2cm wide – about the width of a garden hosepipe  – but can swell to over 5.5cm, which is what doctors classify as a large aneurysm. Risk factors for an AAA It's not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. One study found that people aged over 75 are seven times more likely to be diagnosed with an AAA than people under 55 years old. Men are around six times more likely to be diagnosed with an AAA than women. However, there are other risk factors that you can do something about – described below – the most important of which is smoking. Smoking Research has found that smokers are seven times more likely to develop an AAA than people who have never smoked. The more you smoke, the greater your risk of developing an AAA. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. The risk may increase because tobacco smoke contains harmful substances that can damage and weaken the wall of the aorta. Atherosclerosis Atherosclerosis is a potentially serious condition where arteries become clogged up by fatty deposits, such as cholesterol. An AAA is thought to develop because these deposits (called plaques) cause the aorta to widen in an attempt to keep blood flowing through it. As it widens, it also gets weaker. Smoking, eating a high-fat diet and high blood pressure all increase your risk of developing atherosclerosis. High blood pressure As well as contributing to atherosclerosis, high blood pressure (hypertension) can place increased pressure on the aorta's wall. Family history Having a family history of AAAs means that you have an increased risk of developing one. One study found that people who had a brother or sister with an AAA were eight times more likely to develop one than people whose siblings were unaffected. This suggests that certain genes you inherit from your parents may make you more vulnerable to developing an AAA. However, no specific genes have yet been identified. Read about how to reduce your risk of developing an AAA. Diagnosis An abdominal aortic aneurysm (AAA) usually causes no symptoms. Therefore, they tend to be diagnosed as a result of screening, or during a routine physical examination when a GP notices a distinctive pulsating sensation in your abdomen. A diagnosis can be confirmed using an ultrasound scan. Ultrasound can also determine the size of the aneurysm, which is an important factor in deciding on a course of treatment. Screening All men in the UK who are 65 or over are offered an ultrasound scan to check for AAAs. All men should receive an invitation in the year they turn 65 years old. Men who are older than 65 can refer themselves for screening by contacting their local NHS AAA screening service. For more information, visit our page on AAA screening. Treatment Treatment for an abdominal aortic aneurysm (AAA) depends on several factors, including the aneurysm's size, your age and general health. In general, if you have a large aneurysm (5.5cm or larger) you will be advised to have surgery, either to strengthen the swollen section of the aorta or to replace it with a piece of synthetic tubing. This is because the risk of the aneurysm rupturing is usually greater than the risk of having it repaired.  If you have a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you will be offered regular scans to check its size. You will also be given advice on how to slow its growth and reduce the risk of it rupturing – for example, stopping smoking – and perhaps medications to reduce your blood pressure and cholesterol level. If you have a large AAA If you are diagnosed with an AAA that is 5.5cm or larger, you will be referred to a vascular surgeon (a surgeon who specialises in diseases of the blood vessels), who may recommend an operation. The surgeon will discuss treatment options with you, taking into account your general health and fitness, as well as the size of your aneurysm. If it's decided that surgery isn’t suitable for you, it’s still possible to reduce the risk of the aneurysm bursting, and you will have regular scans to check its size – in the same way people with small or medium aneurysms are treated. See below for more information on treating small and medium aneurysms. There are two surgical techniques used to treat a large aneurysm: endovascular surgery open surgery Although both techniques are equally effective at reducing the risk of the aneurysm bursting, each has its own advantages and disadvantages. The surgeon will discuss with you which is most suitable. Endovascular surgery Endovascular surgery is a type of "keyhole" surgery where the surgeon makes small cuts in your groin. A small piece of tubing called a graft– made of metal mesh lined with fabric – is then guided up through the leg artery, into the swollen section of aorta, and sealed to the wall of the aorta at both ends. This reinforces the aorta, reducing the risk of it bursting. This is the safest of the two types of surgery available. Around 98-99% of patients make a full recovery, and recovery time from the operation is shorter than if you have open surgery. There are also fewer major complications, such as wound infection or deep vein thrombosis (DVT).  However, the way the graft is attached is not as secure as open surgery. You’ll need regular scans to make sure the graft hasn’t slipped, and in some patients, the seal at each end of the graft starts to leak and will need to be resealed. You will need to have surgery again if either of these occurs. Open surgery In open surgery, the surgeon cuts into your stomach (abdomen) to reach the abdominal aorta and replaces the enlarged section with a graft. This type of graft is a tube made of a synthetic material. Because the graft is stitched (sutured) into place by the surgeon, it’s more likely to stay in place, and will usually work well for the rest of your life. The risk of complications linked to the graft after surgery is lower than in people who have endovascular surgery. Open surgery isn’t usually recommended for people who are in poor health as it is a major operation. It is slightly more risky than endovascular surgery, with 93-97% of patients making a full recovery. The main risk of open surgery is death or heart attack, and recovery time is longer than with endovascular surgery. There is also a greater risk of complications, such as wound infection, chest infection and DVT. Making a decision about treatment for a large aneurysm If you or a relative is faced with making a decision about treatment for a large AAA, the AAA repair decision aid may help you weigh up the pros and cons of each option. If you have a small or medium AAA If you are diagnosed with a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you won’t be referred to see a vascular surgeon, as it’s unlikely you’d benefit from surgery. You’ll be invited back for regular scans to check the size of the aneurysm, in case it gets bigger – every year if you have a small aneurysm and every three months if you have a medium aneurysm. You will also be given advice on how to prevent the aneurysm from getting bigger, including: stopping smoking eating a balanced diet ensuring you maintain a healthy weight taking regular exercise If you smoke, the most important change you can make is to quit. Aneurysms have been shown to grow faster in smokers than in non-smokers. Read more about stopping smoking and nicotine replacement therapies (NRTs) that can make it easier to stop smoking. Your GP will be sent your test result and may decide to change your current medication or start you on a new one, especially if you have: high blood pressure – which you will probably be treated for with a medication called an angiotensin-converting enzyme (ACE) inhibitor high cholesterol – which you will probably be treated for with a medication called a statin Treating a ruptured AAA Emergency treatment for a ruptured AAA is based on the same principle as preventative treatment. Grafts are used to repair the ruptured aneurysm. The decision on whether to perform open or endovascular surgery is made on a case-by-case basis by the surgeon carrying out the operation. Prevention The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger and possibly rupturing, is to avoid anything that could damage your blood vessels. This includes: smoking eating a high-fat diet not exercising regularly being overweight or obese If your GP finds out you have high blood pressure or a high cholesterol level, you may be prescribed medication for both. This will reduce the risk of developing an abdominal aortic aneurysm (AAA). Smoking Smoking is a major risk factor for aneurysms because it causes atherosclerosis (hardening of the arteries) and raises your blood pressure. Tobacco smoke contains substances that can damage the walls of the arteries. It is known that smokers are seven times more likely than non-smokers to develop an AAA.  The more you smoke, the greater your risk. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. If you want to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will give you dedicated help and advice about the best ways to quit. You can also call or chat online with Quit Your Way Scotland. The specially trained helpline staff can offer you free expert advice and encouragement. Read more about stopping smoking and nicotine replacement therapies (NRTs), which can make it easier to quit. Diet Eating a high-fat diet increases your risk of atherosclerosis. It’s especially important to limit the amount of foods you eat that are high in saturated fat, such as biscuits, cakes, butter, sausages and bacon. This is because eating too much saturated fat can lead to high cholesterol, which can build up in the artery walls. Read more about high cholesterol. Find out more about healthy eating and how to reduce the amount of saturated fat you eat. Exercise Being active and doing regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Regular exercise can also help you lose weight, which will also help lower your blood pressure. Adults should do at least 150 minutes (two hours and 30 minutes) of moderate-intensity aerobic activity every week. Examples of moderate intensity activity include cycling or fast walking. For it to count, the activity should make you feel warm and slightly out of breath. Someone who is overweight may only have to walk up a slope to get this feeling. Physical activity can include anything from sport to walking and gardening. Get more ideas on being active. Weight Being overweight forces your heart to work harder to pump blood around your body. This can raise your blood pressure, which in turn puts pressure on your arteries. Use a BMI healthy weight calculator to find out if you need to lose weight. If you need to shed some weight, it's worth remembering that losing just a few pounds will make a big difference to your blood pressure and overall health. Get tips on losing weight safely and read more about preventing high blood pressure.

Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital. The main symptom of acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder. The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse. Unlike some others types of abdominal pain, the pain associated with acute cholecystitis is usually persistent, and doesn't go away within a few hours. Some people may additional symptoms, such as: a high temperature (fever) nausea and vomiting sweating loss of appetite yellowing of the skin and the whites of the eyes (jaundice) a bulge in the abdomen When to seek medical advice You should see your GP as soon as possible if you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or is accompanied by other symptoms, such as jaundice and a fever. If it's not possible to contact your GP immediately, phone your local out-of-hours service or call the NHS 24 111 service for advice. It's important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly (see below).   What causes acute cholecystitis? The causes of acute cholecystitis can be grouped into 2 main categories: calculous cholecystitis and acalculous cholecystitis. Calculous cholecystitis Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases. Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge. Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt. The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around 1 in every 5 cases, the inflamed gallbladder also becomes infected by bacteria. Acalculous cholecystitis Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder. Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS. Who is affected Acute cholecystitis is a relatively common complication of gallstones. It is estimated that around 10-15% of adults in the UK have gallstones. These don't usually cause any symptoms, but in a small proportion of people they can cause infrequent episodes of pain (known as biliary colic) or acute cholecystitis. Diagnosing cholecystitis To diagnose acute cholecystitis, your GP will examine your abdomen. They will probably carry out a simple test called Murphy’s sign. You will be asked to breathe in deeply with your GP's hand pressed on your tummy, just below your rib cage. Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctor’s hand. If your symptoms suggest you have acute cholecystitis, your GP will refer you to hospital immediately for further tests and treatment. Tests you may have in hospital include: blood tests to check for signs of inflammation in your body an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder Other scans – such as an X-ray, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan – may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis. Treating acute cholecystitis If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment. Initial treatment Initial treatment will usually involve: fasting (not eating or drinking) to take the strain off your gallbladder receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration taking medication to relieve your pain If you have a suspected infection, you will also be given antibiotics. These often need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home. With this initial treatment, any gallstones that may have caused the condition usually fall back into the gallbladder and the inflammation often settles down. Surgery In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some point after the initial treatment. This type of surgery is known as a cholecystectomy. Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder. If you are fit enough to have surgery, your doctors will need to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised to wait for the inflammation to fully resolve over the next few weeks. Surgery can be carried out in two main ways: laparoscopic cholecystectomy – a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen open cholecystectomy – where the gallbladder is removed through a single, larger incision in your abdomen Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, you can lead a perfectly normal life without a gallbladder. The organ can be useful but it's not essential, as your liver will still produce bile to digest food. Possible complications Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications. The main complications of acute cholecystitis are: the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess) In about 1 in every 5 cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications. Preventing acute cholecystitis It's not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones. One of the main steps you can take to help lower your chances of developing gallstones is adopting a healthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones. Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly. However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best.  Read more about preventing gallstones.

Acute lymphoblastic leukaemia (ALL) is a type of blood cancer. One-third of all childhood cancers are leukaemia, with approximately 400 new cases in the UK each year. Approximately, three out of four of these cases are acute lymphoblastic (ALL). ALL can affect children of any age but is more common in children aged 1-4 years old. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. It is devastating to hear that your child has cancer, and at times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. We hope you find the information here helpful. Your child’s specialist will give you more detailed information, and if you have any questions it is important to ask the specialist doctor or nurse who knows your child’s individual situation. Leukaemia Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, the spongy substance at the core of some bones in the body. Bone marrow contains: red blood cells, which carry oxygen around the body platelets, which help the blood to clot and control bleeding white blood cells, which help fight infection There are two different types of white blood cells; lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are four main types of leukaemia: acute lymphoblastic (ALL) acute myeloid (AML)  chronic lymphocyte (CLL) chronic myeloid (CML) Chronic leukaemias usually affect adults and each type of leukaemia has its own characteristics and treatment. ALL is a cancer of immature lymphocytes, called lymphoblasts or blast cells. There are two different types of lymphocytes; T-cells and B-cells. Often, leukaemia occurs at a very early stage in the immature lymphocytes, before they have developed into either T-cells or B-cells. However, if the cells have developed this far before becoming leukaemic, the type of leukaemia may be known as T-cell or B-cell leukaemia. This is about acute lymphoblastic leukemia (ALL). Causes The exact cause of ALL is unknown. Research is going on all the time into possible causes of this disease. Children with certain genetic disorders, such as Down’s syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with ALL (particularly identical twins) have a slightly increased risk of developing ALL themselves, although this risk is still small. Like all cancers, ALL is not infectious and cannot be passed on to other people. Signs and symptoms As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells. Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood (which help blood to clot). Sometimes, children suffer from infections because of low numbers of normal white blood cells. A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands. At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear. How ALL is diagnosed A blood test usually shows low numbers of normal white blood cells and the presence of the abnormal leukaemia cells. A sample of bone marrow is usually needed to confirm the diagnosis. A sample is also sent to the genetics department to look for any abnormal chromosomes, and for a test called MRD (minimal residual disease) analysis. A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest x-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your child’s symptoms. These tests will help to identify the precise type of leukaemia and help doctors decide on the best treatment. Treatment The aim of treatment for ALL is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for ALL and is given according to a treatment plan (often called a protocol or regimen). The treatment is given in several phases, or ‘blocks’, which are explained below. Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible and is usually started within days of being diagnosed. The induction phase lasts 4-6 weeks. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. The sample that is taken is looked at under a microscope and when there is no evidence of leukaemia, the child’s condition is referred to as being in ‘remission’. Consolidation and central nervous system (CNS) treatment The next phase of treatment is aimed at maintaining the remission and preventing the spread of leukaemia cells into the brain and spinal cord (the central nervous system, or CNS). CNS treatment involves injecting a drug, usually methotrexate lumbar puncture. After this consolidation treatment there is a recovery period which is called interim maintenance. This is when more drugs will be given to try to keep the leukaemia in remission. The exact details will depend on which arm of treatment your child follows and will be discussed in detail by your child’s doctor as it depends on your child’s response to treatment so far. Further doses of chemotherapy treatment, called ‘delayed intensification’, are given to kill off any remaining leukaemia cells. Maintenance treatment This phase of treatment lasts for two years from the start of interim maintenance for girls and three years from the start of interim maintenance for boys. It involves the child taking daily and weekly tablets, some children also have monthly injections of chemotherapy and oral pulses of steroids and three-monthly intrathecal treatment. Children will be able to take part in their normal daily activities as soon as they feel able to. Most children return to school before beginning maintenance treatment. Bone marrow transplantation Bone marrow treatment is only needed by a minority of patients and is used for children with ALL that is likely to come back following standard chemotherapy. Testicular radiotherapy In some situations it may be necessary for boys to have radiotherapy to their testicles. This is because leukaemia cells can survive in the testicles despite chemotherapy. Central nervous system (CNS) radiotherapy Children who have leukaemia cells in their CNS when they are first diagnosed with ALL need more frequent lumbar punctures with intrathecal chemotherapy. Your child’s specialist will discuss with you which treatment and how much of it your child needs, and will answer any questions you have. Side effects of treatment Many cancer treatments will cause side effects. This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects of chemotherapy are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (an increased risk of bruising, bleeding and infection loss of appetite feeling sick (nausea) and being sick (vomiting) Steroid medicines can also cause side effects such as: increased appetite mood changes and irritability weight gain muscle weakness (especially in the legs) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your child’s doctor or nurse will talk to you about any possible side effects. It is important to discuss any side effects your child is having with the team treating them, so that they know how your child is feeling. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way their heart works and a small increase in the risk of developing another cancer later in life. Your child’s doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for ALL. If appropriate, your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and you’ll be given enough time to decide if it is right for your child. Treatment guidelines Sometimes, clinical trials are not available for your child. This may be because a recent trial has just finished, or because the condition is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the UK. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Most children with ALL are cured. If the leukaemia recurs after initial treatment, it usually does so within the first three years. Further treatment can then be given. Long-term side effects (late side effects) are rare, and most children with ALL grow and develop normally. If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. It’s not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young People’s Cancer; A Parent’s Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parent’s Guide discusses these further and talks about how you can support your child.

Leukaemia is cancer of the white blood cells. Acute leukaemia means it progresses rapidly and aggressively, and usually requires immediate treatment. Acute leukaemia is classified according to the type of white blood cells affected. The two main types of white blood cells are: lymphocytes – mostly used to fight viral infections myeloid cells – which perform a number of different functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage  This topic focuses on acute myeloid leukaemia (AML), which is an aggressive cancer of the myeloid cells. The following types of leukaemia are covered separately: acute lymphoblastic leukaemia chronic myeloid leukaemia chronic lymphocytic leukaemia Signs and symptoms of AML The symptoms of AML usually develop over a few weeks and become increasingly more severe. Symptoms can include: pale skin tiredness breathlessness frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds In more advanced cases, AML can make you extremely vulnerable to life-threatening infections or serious internal bleeding. Read more about the complications of AML Seeking medical advice You should see your GP if you or your child have possible symptoms of AML. Although it's highly unlikely that leukaemia is the cause, these symptoms should be investigated. If your GP thinks you may have leukaemia, they'll arrange blood tests to check your blood cell production. If the tests suggest there's a problem, you'll be urgently referred to a haematologist (a specialist in treating blood conditions) for further tests and any necessary treatment. Read more about diagnosing AML What causes AML? AML occurs when specialised cells called stem cells, which are found in the bone marrow (a spongy material inside the bones), produce too many immature white blood cells. These immature cells are known as blast cells. Blast cells don't have the infection-fighting properties of healthy white blood cells, and producing too many can lead to a decrease in the number of red blood cells (which carry oxygen in the blood) and platelets (cells that help the blood to clot). It's not clear exactly why this happens and, in most cases, there's no identifiable cause. However, a number of factors that can increase your risk of developing AML have been identified. These include: previous chemotherapy or radiotherapy exposure to very high levels of radiation (including previous  radiotherapy treatment) exposure to benzene – a chemical used in manufacturing that's also found in cigarette smoke having an underlying blood disorder or genetic disorder, such as Down's syndrome Read more about the causes of AML Who's affected AML is a rare type of cancer, with around 2,600 people diagnosed with it each year in the UK. The risk of developing AML increases with age. It's most common in people over 65. How AML is treated AML is an aggressive type of cancer that can develop rapidly, so treatment usually needs to begin soon after a diagnosis is confirmed. Chemotherapy is the main treatment for AML. It's used to kill as many leukaemia cells in your body as possible and reduce the risk of the condition coming back (relapsing). In some cases, intensive chemotherapy and radiotherapy may be needed, in combination with a bone marrow or stem cell transplant, to achieve a cure. Read more about treating AML Outlook The outlook for AML largely depends on the specific type of AML you have, as well as your age and general health. There are many subtypes of AML, which are classified according to various features – such as the specific genetic changes in the leukaemia cells. Some types of AML are more challenging to treat than others. Even if treatment is initially successful, there's still a significant risk that the condition will return at some point during the next few years. If this happens, treatment may need to be repeated. A number of medical trials have suggested that almost half of those aged under 60 diagnosed with AML will live for at least five years, and in some types of AML, such as acute promyeloid leukaemia (APML), around 85% will live for at least five years. In general, the outlook for children with AML tends to be better than that of adults diagnosed with the condition. Symptoms The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells (blast cells) in your blood increases. Symptoms of AML can include: pale skin tiredness breathlessness a high temperature (fever) excessive sweating weight loss frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds easily bruised skin flat red or purple spots on the skin (petechiae) bone and joint pain a feeling of fullness or discomfort in your tummy (abdomen), caused by swelling of the liver or spleen In rare cases of AML, the affected cells can spread into the central nervous system. This can cause symptoms such as headaches, fits (seizures), vomiting, blurred vision and dizziness. When to seek medical advice See your GP if you or your child have the symptoms listed above. Although it's highly unlikely that AML is the cause, these symptoms need to be investigated and treated promptly. Causes Acute myeloid leukaemia (AML) is caused by a DNA mutation in the stem cells in your bone marrow that produce red blood cells, platelets and infection-fighting white blood cells. The mutation causes the stem cells to produce many more white blood cells than are needed. The white blood cells produced are still immature, so they don't have the infection-fighting properties of fully developed white blood cells. These immature cells are known as "blast cells". As the number of immature cells increases, the amount of healthy red blood cells and platelets decrease, and it's this fall that causes many of the symptoms of leukaemia. Increased risk It's not known what triggers the genetic mutation in AML, although a number of different factors that can increase your risk of developing the condition have been identified. The main risk factors for AML are outlined below. Radiation exposure Being exposed to a significant level of radiation can increase your chances of developing AML, although this usually requires exposure at very high levels. For example, rates of AML are higher in people who survived the atomic bomb explosions in Japan in 1945. In the UK, most people are unlikely to be exposed to levels of radiation high enough to cause AML. However, some people who have had radiotherapy as part of their treatment for previous cancer (see below) can be the exception. Benzene and smoking Exposure to the chemical benzene is a known risk factor for AML in adults. Benzene is found in petrol, and it's also used in the rubber industry, although there are strict controls to protect people from prolonged exposure. Benzene is also found in cigarette smoke, which could explain why people who smoke have an increased risk of developing AML. Previous cancer treatment Treatment with radiotherapy and certain chemotherapy medications for an earlier, unrelated cancer can increase your risk of developing AML many years later. Leukaemia that develops as a result of previous cancer treatment is called "secondary leukaemia" or "treatment-related leukaemia". Blood disorders People with certain blood disorders – such as myelodysplasia, myelofibrosis or polycythaemia vera (PCV) – have an increased risk of developing AML. Genetic disorders People with certain genetic disorders, including Down’s syndrome and Fanconi’s anaemia, have an increased risk of developing leukaemia. Other suggested triggers A number of other environmental factors that could trigger AML have also been suggested, including childhood vaccinations and living near a nuclear power station or a high-voltage power line. However, there's no clear evidence to suggest that these can increase your risk of developing AML. Diagnosis In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests. A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate the presence of leukaemia. If this is the case, you'll be urgently referred to a haematologist (a specialist in treating blood conditions). A haematologist may carry out further blood tests, in addition to some of the tests outlined below. Bone marrow biopsy To confirm a diagnosis of AML, the haematologist will take a small sample of your bone marrow to examine under a microscope. This procedure is known as a bone marrow biopsy, which is usually carried out under a local anaesthetic. The haematologist will numb an area of skin at the back of your hip bone, before using a thin needle to remove a sample of liquid bone marrow. In some cases, a larger needle may also be used to remove a small amount of bone and bone marrow together. You won't feel any pain during the procedure, but you may experience some bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete, and you shouldn't have to stay in hospital overnight. The bone marrow sample will be checked for cancerous cells. If cancerous cells are present, the biopsy can also be used to determine the type of leukaemia you have. Further tests Additional tests can be used to reveal more information about the progress and extent of your AML. They can also provide an insight into how the condition should be treated. These tests are described below. Genetic testing Genetic tests can be carried out on blood and bone marrow samples to identify the genetic makeup of the cancerous cells. There are many specific genetic variations that can occur in AML, and knowing the exact type of AML you have can help doctors make decisions about the most appropriate treatment. For example, people who have a type of AML known as acute promyelocytic leukaemia (APML) are known to respond well to a medicine called All Trans-Retinoic Acid (ATRA). Scans If you have AML, a computerised tomography (CT) scan, X-ray or echocardiogram (an ultrasound scan of the heart) may be used to check that your organs, such as your heart and lungs, are healthy. These tests are carried out because it's important for doctors to assess your general health before they can decide on the most appropriate treatment for you. Lumbar puncture In rare situations where it's thought there's a risk that AML has spread to your nervous system, a lumbar puncture may be carried out. In this procedure, a needle is used to extract a sample of cerebrospinal fluid (which surrounds and protects your spine) from your back, so it can be checked for cancerous cells. If cancerous cells are found in your nervous system, you may need to have injections of chemotherapy medication directly into your cerebrospinal fluid as part of your treatment. Treatment Acute myeloid leukaemia (AML) is an aggressive condition that develops rapidly, so treatment will usually begin a few days after a diagnosis has been confirmed. As AML is a complex condition, it's usually treated by a multidisciplinary team (MDT) – a group of different specialists working together (see below). Your treatment plan Treatment for AML is often carried out in two stages: Induction – the aim of this initial stage of treatment is to kill as many leukaemia cells in your blood and bone marrow as possible, restore your blood to proper working order and treat any symptoms you may have. Consolidation – this stage aims to prevent the cancer returning (relapsing), by killing any remaining leukaemia cells that may be present in your body. The induction stage of treatment isn't always successful and sometimes needs to be repeated before consolidation can begin. If you have a relapse after treatment, both re-induction and consolidation may need to be carried out. This may be the same as your first treatment, although it's likely to involve different medications or a stem cell transplant (see below). If you're thought to have a high risk of experiencing complications of AML treatment – for example, if you're over 75 years of age or have another underlying health condition – less intensive chemotherapy treatment may be carried out. This is less likely to successfully kill all of the cancerous cells in your body, but it can help control your condition.  Induction The initial treatment you have for AML will largely depend on whether you're fit enough to have intensive chemotherapy, or whether treatment at a lower dosage is recommended. Intensive chemotherapy If you can have intensive induction chemotherapy, you'll usually be given a combination of chemotherapy medication at a high dose to kill the cancerous cells in your blood and bone marrow. This stage of treatment will be carried out in hospital or in a specialist centre, as you'll need very close medical and nursing supervision. You'll have regular blood transfusions because your blood won't contain enough healthy blood cells. You'll also be vulnerable to infection, so it's important that you're in a clean and stable environment where your health can be carefully monitored and any infection you have can be promptly treated. You may also be prescribed antibiotics to help prevent further infection. Depending on how well you respond to treatment, the induction phase can last from four weeks to a couple of months. You may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve. For intensive treatment, the chemotherapy medications will be injected into a thin tube that's inserted either into a blood vessel near your heart (central line) or into your arm (a peripherally inserted central catheter, or PICC). In very rare cases, chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. This is done using a needle that's placed into your spine, in a similar way to a lumbar puncture. Side effects of intensive chemotherapy for AML are common. They can include:  nausea vomiting diarrhoea loss of appetite sore mouth and mouth ulcers (mucositis) tiredness skin rashes hair loss infertility – which may be temporary or permanent (see complications of AML for more information) Most side effects should resolve once treatment has finished. Tell a member of your care team if side effects become particularly troublesome, as there are medicines that can help you cope better with certain side effects. Read more about the side effects of chemotherapy Non-intensive chemotherapy If your doctors don’t think you're fit enough to withstand the effects of intensive chemotherapy, they may recommend non-intensive treatment. This involves using an alternative type of chemotherapy to the standard intensive therapy, which is designed more to control leukaemia rather than cure it. The main aim of this treatment is to control the level of cancerous cells in your body and limit any symptoms you have, while reducing your risk of experiencing significant side effects of treatment. The medications used during non-intensive chemotherapy may be given through a drip into a vein, by mouth or by injection under the skin, and can often be given on an outpatient basis. All Trans-Retinoic Acid (ATRA) If you have the sub-type of AML known as acute promyelocytic leukaemia, you'll usually be given capsules of a medicine called ATRA, in addition to chemotherapy. ATRA works by changing the immature white blood cells (blast cells) into mature healthy cells, and can reduce symptoms very quickly. Side effects of ATRA can include headaches, nausea, bone pain, and dry mouth, skin and eyes. Consolidation If induction is successful, the next stage of treatment will be consolidation. This often involves receiving regular injections of chemotherapy medication that are usually given on an outpatient basis, which means that you won't have to stay in hospital overnight. However, you may need some short stays in hospital if your symptoms suddenly get worse or if you develop an infection. The consolidation phase of treatment lasts several months. Other treatments Many other treatments are used for AML, as described below.  Radiotherapy Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat AML: to prepare the body for a bone marrow or stem cell transplant (see below) to treat advanced cases that have spread to the nervous system and/or brain, although this is uncommon Side effects of radiotherapy can include hair loss, nausea and fatigue. The side effects should pass once your course of radiotherapy has been completed. Bone marrow and stem cell transplants If chemotherapy doesn't work, a possible alternative treatment option is a bone marrow or stem cell transplant. Before transplantation can take place, the person receiving the transplant will need to have intensive high-dose chemotherapy and possibly radiotherapy to destroy the cells in their bone marrow. The donated stem cells are given through a tube into a blood vessel, in a similar way to chemotherapy medication. This process can put an enormous amount of strain on the body and cause significant side effects and potential complications, so you'll usually need to stay in hospital for a few weeks. Transplantations have better outcomes if the donor has the same tissue type as the person receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type. Transplantations are most successful when they're carried out on children and young people, or older people who are otherwise in good health, and when there's a suitable donor, such as a brother or sister. Read about bone marrow donation Azacitidine Azacitidine is a possible alternative treatment for adults with AML who can't have a stem cell transplant. It's recommended by the National Institute for Health and Care Excellence (NICE) for use in certain circumstances – for example, depending on the characteristics of the person's blood and bone marrow. Azacitidine is a chemotherapy medication that's given by injection under the skin. It interferes with the growth of cancer cells and destroys them, and also helps bone marrow to produce normal blood cells. NICE has more information about azacitidine for the treatment of AML Clinical trials and newer unlicensed treatments In the UK, a number of clinical trials are currently underway that aim to find the best way of treating AML. Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and possibly curing, AML. As part of your treatment, your care team may suggest taking part in a clinical trial to help researchers learn more about the best way to treat your AML, and AML in general. Search for clinical trials for AML. If you take part in a clinical trial, you may be offered medication that isn't licensed for use in the UK and isn't normally available. However, there's no guarantee that the techniques being studied in the clinical trial will work better than current treatments. Your care team can tell you whether there are any clinical trials available in your area, and can explain the benefits and risks involved. Macmillan has more information about unlicensed treatments for AML Complications If you have acute myeloid leukaemia (AML), you may experience a number of complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment. Some of the main complications associated with AML are outlined below. Weakened immune system Having a weakened immune system – being immunocompromised – is a common complication of AML. Even if your blood is restored to normal working order with treatment, many of the medications that are used to treat AML can temporarily weaken your immune system. This means you're more vulnerable to developing an infection, and any infection you develop could be more serious than usual. Complications arising from infection are the leading cause of death in people with AML. However, if treated early, nearly all infections respond to appropriate treatment. Therefore, you may be advised to: take regular doses of antibiotics to prevent bacterial infections maintain good personal and dental hygiene avoid contact with anyone who's known to have an infection – even if it's a type of infection that you were previously immune to, such as chickenpox or measles check with your GP to ensure that all of your vaccinations are up to date, although you won't be able to have any vaccine that contains "live" viruses or bacteria, such as the shingles vaccine and MMR vaccine (against measles, mumps and rubella) Report any possible symptoms of an infection to your treatment unit immediately because prompt treatment may be needed to prevent complications. Symptoms of an infection can include: a high temperature (fever) a headache aching muscles diarrhoea tiredness Bleeding If you have AML, you'll bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive. People with advanced AML are more vulnerable to excessive bleeding inside their body, which is the second most common cause of death in people with the condition. Serious bleeding can occur: inside the skull (intracranial haemorrhage) – causing symptoms such as a severe headache, stiff neck, vomiting and confusion inside the lungs (pulmonary haemorrhage) – causing symptoms such as coughing up blood, breathing difficulties and a bluish skin tone (cyanosis) inside the stomach (gastrointestinal haemorrhage) – causing symptoms such as vomiting blood and passing stools (faeces) that are very dark or tar-like in colour All these types of haemorrhage should be regarded as medical emergencies. Dial 999 immediately and ask for an ambulance if you think a haemorrhage is occurring. Infertility Many of the treatments that are used to treat AML can cause infertility. This is often temporary, but in some cases can be permanent. People particularly at risk of permanent infertility are those who have received high doses of chemotherapy and radiotherapy in preparation for a bone marrow or stem cell transplant. Your treatment team can give a good estimation of the risk of infertility in your specific circumstances. It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have their sperm samples stored. Similarly, women can have eggs or fertilised embryos stored, which can then be placed back into their womb, following treatment. However, as AML is an aggressive condition that develops rapidly, there may not always be time to do this before treatment needs to start.

This section is for teenagers and young adults and is about a type of cancer called acute myeloid leukaemia (AML). The other main type of leukaemia that can affect teenagers and young adults is acute lymphoblastic leukaemia. For information about AML in people of all ages, please see our general AML section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isn’t enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help us fight infection (white cells) carry oxygen from the lungs around our body (red blood cells) stop us bleeding when we cut ourselves by clotting our blood (platelets). Symptoms Many of the symptoms of AML are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired - because of too few red blood cells (anaemia) bruises or bleeding - you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections - because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats - you may have a high temperature without any obvious cause, such as an infection headaches and blurred vision - because of too many white blood cells breathlessness - because of too many white blood cells. Causes We don't know exactly what causes AML, but research is going on to try to find out. We do know some things might increase the risk of AML: Some genetic conditions, like Down's Syndrome. A genetic condition is something you are born with. Some non-cancerous conditions of the bone marrow, such as aplastic anaemia or myelodysplastic syndromes. If you're worried about AML If you think you might have any of the symptoms of AML, you should go to your GP. They'll talk to you about your symptoms, examine you and can arrange tests or refer you to see a specialist. Remember that the symptoms can be caused by other things, but it’s important to go and get checked if you are worried.  Leukaemia, blood tests and bone marrow To help you understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. Knowing a bit about how blood cells are made in the body can help you to understand leukaemia and how it’s treated. All blood cells are made in the bone marrow, which is like a blood cell factory inside our bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are three main types of blood cells: white blood cells – which help us fight infection red blood cells – which carry oxygen from the lungs around our body platelets – which clot our blood to stop us bleeding when we cut ourselves The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (they’re immature). The main job of blast cells is to make more blood cells like themselves. They can’t do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until they’ve matured into fully-developed blood cells. Once blood cells are mature, they’re ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever they’re needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isn’t enough room for the bone maow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from two types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils. Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: leukaemia that starts from abnormal myeloid cells is called acute myeloid leukaemia - or AML for short. leukaemia that starts from abnormal lymphoblasts is called acute lymphoblastic leukaemia (ALL). There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more, contact Macmillan. We also have more info about: symptoms and causes of AML  having tests for AML  being treated for AML  If you're looking for information about ALL in people of all ages, please see our general AML section. Tests for AML You should see your GP as soon as possible if you think you have some of the symptoms of AML. But remember that the symptoms of AML can be caused by other things. Visiting your GP Your GP (family doctor) will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so you’ll need to have a blood test to help diagnose acute myeloid leukaemia (AML). If you have AML, a blood test will usually find leukaemia cells and you'll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood disorders. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests - you’ll need more blood tests even if you’ve had some already. These tests look at the changes in the leukaemia cells. This helps the doctors decide on the best treatment for you. You might hear the doctors calling these tests cytogenetics and immunophenotyping. bone marrow test - you’ll have samples taken from your bone marrow. The doctors will count the numbers of leukaemia cells in the bone marrow. They will also send samples for cytogenetic and immunophenotyping testing. lumbar puncture - a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells. chest X-ray – this may also be done to see if there are any swollen lymph nodes (glands) in your chest. Macmillan has more information on these and other tests. If you have AML, you might need a few more tests to check how your body is working in general. These could be blood tests, an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, or an echocardiogram (which is an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them - what will happen, how you'll feel and when you'll get the results - can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a cancer support specialist on Macmillan's free helpline. We also have more info about: symptoms and causes of AML  being treated for AML leukaemia, blood cells and bone marrow   If you're looking for information about AML in people of all ages, please see our general AML section. Treating AML The main treatment for acute myeloid leukaemia (AML) is chemotherapy (chemo). This means having anti-cancer drugs to destroy the leukaemia cells. You’ll also have drugs called steroids, which help the chemo to work. The treatment for AML is pretty intensive at times and can cause unpleasant side effects. But you'll be in hospital when you’re most likely to feel unwell, and the staff can help if things get tough. Don’t feel you have to be brave. Be honest about how you're feeling with your doctors and nurses, and they can give you medicines to help you feel better. There are different phases of treatment for AML: getting rid of the leukaemia - remission induction keeping the leukaemia away - consolidation and delayed intensification therapy central nervous system (CNS) therapy (mainly for teenagers under 16) Very often, treatment is given as part of a clinical trial or research study, but it will be your decision whether to take part in the trial or not. Clinical trials help doctors to keep improving treatment for leukaemia.   You usually start chemo pretty quickly after finding out that you have AML. You'll be in hospital for your treatment to begin with. If you're 18 or younger, you'll be treated in a specialist Principal Treatment Centre (PTC) for teenage and young adults (TYA). If you're 19 or older, you'll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Most chemo for AML is given into the bloodstream (intravenously). So you’ll have a ‘line’ put into one of your main veins to make it easier for you to have intravenous chemo. There are different kinds of lines. You might have a central line (Hickman® or Groshong®), an implantable port (portacath), or a PICC line. You’ll also be given chemo into the fluid around your spinal cord and brain. This is to get rid of any leukaemia cells that might be hiding there. This type of treatment is called central nervous system (CNS) therapy. Having chemo can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And you’ll be given medicines to help you feel less sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when you’ll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. You’ll be given chemo to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. You have chemo over a few days, then you have a few weeks off so that your body can recover from any side effects. The days you have the chemo and the rest period afterwards is called a cycle. You’ll usually have four cycles of chemotherapy overall with two courses in the induction phase. Some people might also need to have a bone marrow transplant. This normally happens after 2 cycles of chemotherapy. You'll probably need to stay in hospital most of the time that you’re having remission induction. This is so that the doctors can check how things are going. Chemo drugs Drugs you may have include: cytarabine (Ara-C) daunorubicin, doxorubicin or idarubicin etoposide thioguanine Side effects Different chemo can cause different side effects. There is information about the specific ones in Macmillan's chemotherapy section. As well as the chemo drugs, you’ll be given other drugs to: Help prevent you from feeling sick or being sick. Help prevent infections. Protect your kidneys. Sometimes, when lots of leukaemia cells are destroyed at once, it can cause kidney problems. You may have a drug called allopurinol or one called rasburicase. You’ll probably also need blood and platelet transfusions to top up the numbers of red cells and platelets in your blood. Chemo can cause side effects. Most of them are short-term (temporary) and gradually disappear once treatment stops. The most common side effects are: being more at risk of infections feeling sick hair loss a sore mouth Sometimes side effects can be long-term. For example, some chemo treatments can affect fertility (your ability to have a baby). If you are a young man, you will be offered the chance to store sperm before chemotherapy is started. There may be other late effects of treatment and your specialist can talk to you about this. Remission induction is pretty intense treatment and you’ll probably feel a bit wiped out sometimes. You’ll need to stay in hospital for most of the time and you might not have the energy to do much. You might feel fed up, tearful or irritable. It’s normal to feel like this. It's hard to be in hospital and you might worry about losing touch with your friends or falling behind at school or college. It can help to talk about this with a friend, doctor, nurse or counsellor. Keeping the leukaemia away (post-remission treatment) This phase of treatment is sometimes also called consolidation or intensification treatment. It’s given to prevent the leukaemia from returning (known as a relapse). When you’re in remission, it means the doctors can’t see any leukaemia cells in your blood or bone marrow samples under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells. You start post-remission treatment soon after you complete remission induction. You’ll usually have two courses of treatment. You might be given the same chemo drugs you’ve had before (perhaps at similar or higher doses) or you might be given different chemo drugs. When your doctors decide what chemotherapy treatment plan to give you, they will take into account: how well your leukaemia responded to the first lot of treatment (remission induction) the results of the tests that were done when you were diagnosed The following drugs may be used to treat you: cytarabine (ara-C) methotrexate Central nervous system therapy (CNS) You usually won’t need this treatment if you’re 16 or over. But if you’re under 16, you’ll probably have it. CNS therapy is given to get rid of any leukaemia cells that might be in the brain or spinal cord. (The CNS or central nervous system is the name for the brain and spinal cord.) CNS therapy involves giving chemotherapy into the fluid, called cerebrospinal fluid or CSF, around the spinal cord and brain. It’s a bit like having a lumbar puncture but with chemo added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemo into the CSF. The CSF will carry the chemo around your CNS so it can reach any leukaemia cells that might be there. You’ll have a lumbar puncture before you start treatment to check for leukaemia cells in the CSF. If there is no sign of leukaemia cells, you’ll have two lots of CNS therapy, one after each cycle of remission induction therapy. If there are leukaemia cells in the CSF, you’ll have CNS therapy twice a week until all traces of leukaemia cells in your CSF have gone. You’ll then have two more lots of CNS therapy just to make sure. For CNS therapy for AML, you’ll have chemo drugs called methotrexate and cytarabine and a steroid called hydrocortisone. Side effects The most common side effect is feeling sick but you can be given anti-sickness treatment to help this. Rarer side effects include a headache, dizziness, tiredness or blurry vision for a few hours afterwards. We also have more info about: symptoms and causes of AML  having tests for AML  leukaemia, blood cells and bone marrow  If you're looking for information about AML in people of all ages, please see our general AML section.

Addison’s disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder of the adrenal glands. The adrenal glands are two small glands that sit on top of the kidneys. They produce two essential hormones: cortisol and aldosterone. In Addison's disease, the adrenal gland is damaged, and not enough cortisol and aldosterone are produced. About 8,400 people in the UK have Addison's disease. It can affect people of any age, although it's most common between the ages of 30 and 50. It's also more common in women than men. Early-stage symptoms of Addison’s disease are similar to other more common health conditions, such as depression or flu. You may experience: fatigue (lack of energy or motivation) muscle weakness low mood loss of appetite and unintentional weight loss increased thirst Over time, these problems may become more severe and you may experience further symptoms, such as dizziness, fainting, cramps and exhaustion. You may also develop small areas of darkened skin, or darkened lips or gums. Although these symptoms aren’t always caused by Addison’s disease, you should see your GP, so they can be investigated. Read more about the symptoms of Addison’s disease and diagnosing Addison’s disease Why it happens The condition is usually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production of steroid hormones aldosterone and cortisol. It's not clear why this happens, but it's responsible for 70-90% of cases in the UK. Other potential causes include conditions that can damage the adrenal glands, such as tuberculosis (TB), although this is uncommon in the UK. Read more about the causes of Addison’s disease Treating Addison's disease Addison’s disease is treated with medication to replace the missing hormones. You'll need to take the medication for the rest of your life. With treatment, symptoms of Addison's disease can largely be controlled. Most people with the condition live a normal lifespan and are able to live an active life, with few limitations. However, many people with Addison's disease also find they must learn to manage bouts of fatigue and there may be associated health conditions, such as diabetes or an underactive thyroid. People with Addison's disease must be constantly aware of the risk of a sudden worsening of symptoms, called an adrenal crisis. This can happen when the levels of cortisol in your body fall significantly. An adrenal crisis is a medical emergency. If left untreated, it can be fatal. If you or someone you know has Addison’s disease and is experiencing severe symptoms, dial 999 for an ambulance. Read more about treating Addison's disease Information about you If you have Addison's disease, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Symptoms Addison's disease can be difficult to detect at first, because early symptoms are similar to symptoms of many other health conditions. Initial symptoms of Addison's disease can include: fatigue (lack of energy or motivation) lethargy (abnormal drowsiness or tiredness) muscle weakness low mood (mild depression) or irritability loss of appetite and unintentional weight loss the need to urinate frequently increased thirst craving for salty foods Dehydration can also be an early sign of Addison’s disease. It's caused by lack of the hormone aldosterone in your body, which is used to regulate the balance of salt and water. Later symptoms Further symptoms of Addison’s disease tend to develop gradually over months or years. However, additional strees, caused by another illness or an accident, for example, may cause your symptoms to suddenly get worse. You may go on to develop: low blood pressure when you stand up, which can cause dizziness and fainting  feeling sick (nausea) vomiting diarrhoea abdominal, joint or back pain muscle cramps  chronic exhaustion, which may cause depression brownish discolouration of the skin, lips and gums (hyperpigmentation), particularly in the creases on your palms, on scars or on pressure points, such as your knuckles or knees a reduced libido (lack of interest in sex), particularly in women Some women may also have irregular periods or miss some periods completely. Children with Addison's disease may experience puberty later than usual. Some people with Addison's disease also develop low blood sugar (hypoglycaemia). This can cause symptoms such as difficulty concentrating, confusion, anxiety and even unconsciousness (particularly in children). If you're experiencing symptoms of Addison's disease, see your GP so they can diagnose or rule out the condition. These symptoms will usually improve with appropriate treatment. Read more about diagnosing Addison's disease and treating Addison's disease Adrenal crisis If Addison’s disease is left untreated, the levels of hormones produced by the adrenal gland gradually decrease in the body. This causes your symptoms to get progressively worse and eventually lead to a life-threatening situation called an adrenal or Addisonian crisis. During an adrenal crisis, the symptoms of Addison’s disease appear quickly and severely. This could happen when you're already experiencing initial symptoms or without any symptoms at all. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness An adrenal crisis is a medical emergency. If left untreated, it can be fatal. If you think you or someone you know with Addison’s disease is having an adrenal crisis, dial 999 for an ambulance. If an adrenal crisis isn't treated, it can lead to a coma and death. There's also a risk your brain won't get enough oxygen if treatment is delayed, which can cause permanent disability. Causes Addison's disease develops when the outer layer of your adrenal glands (your adrenal cortex) is damaged, reducing the levels of hormones it produces. Problems with the immune system In the UK, a problem with the immune system is the most common cause of Addison's disease, accounting for 70-90% of cases. The immune system is your body’s defence against infection and disease. If you're ill, your immune system produces antibodies (a special type of protein that destroys disease-carrying organisms and toxins). These antibodies attack the cause of the illness. However, if you develop a problem with your immune system, it can start to attack your own healthy tissues and organs. This is known as an autoimmune disorder. Addison’s disease can develop if your immune system attacks your adrenal glands and severely damages your adrenal cortex. When 90% of the adrenal cortex is destroyed, your adrenal glands won't be able to produce enough of the steroid hormones cortisol and aldosterone. Once levels of these start decreasing, you'll experience symptoms of Addison’s disease. It's not clear why some people develop this problem with their immune system, although it can run in families (see below). Genetics Research has shown that some people with certain genes are more likely to develop autoimmune disorders. It's not clear how these genes lead to Addison's disease and similar conditions, but it does mean your risk of developing Addison's disease is increased if you or a close family member have another autoimmune condition, such as: vitiligo– a chronic (long-term) condition that causes pale, white patches to develop on the skin type 1 diabetes – a chronic condition caused by too much glucose in the blood   underactive thyroid gland (hypothyroidism)  Other causes Tuberculosis (TB) is the most common cause of Addison's disease worldwide, but is rare in the UK. TB is a bacterial infection that mostly affects the lungs, but can also spread to other parts of your body. It can cause Addison’s disease if it damages your adrenal glands. Other possible causes of Addison’s disease include: infections – such as those linked to AIDS, or fungal infections a haemorrhage – very heavy bleeding into the adrenal glands, sometimes associated with meningitis or other types of severe sepsis cancer – if cancer cells from elsewhere in your body spread to your adrenal glands amyloidosis – a disease where amyloid, a protein produced by your bone marrow cells, builds up in your adrenal glands and damages them surgical removal of both adrenal glands (adrenalectomy) – for example, to remove a tumour adrenoleukodystrophy (ALD) – a rare, life-limiting, inherited condition affecting the adrenal glands and nerve cells in the brain that most often affects young boys certain treatments needed for Cushing's syndrome – a collection of symptoms caused by very high levels of cortisol in the body Diagnosis To help diagnose Addison’s disease, your GP will first ask about your symptoms and review your medical history. They're also likely to ask if anyone in your family has an autoimmune disorder (a condition caused by a problem with their immune system). Your GP will examine your skin for any evidence of brownish discolouration (hyperpigmentation), particularly in certain areas, such as: where skin creases on your palm in your elbow crease on any scars your lips and gums However, hyperpigmentation doesn't occur in all cases of Addison’s disease. You'll also be tested for low blood pressure (hypotension) while you're lying down and again shortly after you stand up. This is to see whether you have postural or orthostatic hypotension (low blood pressure when you change position). Blood tests If Addison’s disease is suspected, blood tests will be carried out to measure the levels of sodium, potassium and cortisol in your body. A low sodium, high potassium or low cortisol level may indicate Addison’s disease. You may need to see a hospital hormone specialist (endocrinologist) for your blood to be tested for the following: a low level of the hormone aldosterone a high level of adrenocorticotrophic hormone (ACTH) a low level of glucose (sugar used for energy) positive adrenal antibodies (antibodies designed to attack the adrenal gland) Any of the above could be a sign of Addison’s disease. Synacthen stimulation test If cortisol in your blood is low, or your symptoms strongly suggest Addison’s disease, you'll need to have a synacthen stimulation test to confirm the diagnosis. Your GP may refer you to an endocrinology unit (a unit that specialises in the study of hormones) for the test. How urgently you're referred depends on how severe your symptoms are. Synacthen is a man-made (synthetic) copy of the adrenocorticotrophic hormone (ACTH). ACTH is naturally produced by the pituitary gland (a pea-sized gland below the brain) to encourage the adrenal glands to release the hormones cortisol and aldosterone. When synacthen is administered, the adrenal glands should respond in the same way as they would to ACTH, and release cortisol and other steroid hormones into the blood. A blood sample will be taken and tested for cortisol, before an injection of synacthen is given into your arm. After 30 and 60 minutes, a further blood sample will be taken for cortisol measurement. If the ACTH level is high, but the cortisol and aldosterone levels are low, it's usually confirmation of Addison’s disease. Thyroid function test As well as a synacthen stimulation test, your thyroid gland may also be tested to see if it's working properly. Your thyroid gland is found in your neck. It produces hormones that control your body's growth and metabolism. People with Addison’s disease often have an underactive thyroid gland (hypothyroidism), where the thyroid gland does not produce enough hormones. By testing the levels of certain hormones in your blood, your endocrinologist (a specialist in hormone conditions) can determine whether you have hypothyroidism. Scans In some cases, your specialist may refer you for a scan of your adrenal glands – this could be a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan. Diagnosis during an adrenal crisis If Addison’s disease is left untreated, it eventually leads to an adrenal crisis. This is where the symptoms of Addison’s disease appear quickly and severely. During an adrenal crisis, there's not enough time to perform a synacthen stimulation test to confirm Addison’s disease. If possible, blood will be taken and tested for any of the abnormalities listed above. While you're waiting for the results, treatment may be started with steroid injections, and fluids containing salt and glucose. Read more about treating Addison’s disease Driving If you're diagnosed with Addison's disease and have a bus, coach or lorry licence, it's your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA). Read about driving and Addison's disease on the GOV.UK website. Treatment If you have Addison’s disease, you'll need to take daily medication to replace the lost hormones. This should help you to live an active life, although many people find they still need to manage their fatigue. In some cases, the underlying causes of Addison’s disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least six months. However, most cases are caused by a problem with the immune system that can't be cured. Medication for Addison’s disease Treatment usually involves corticosteroid (steroid) replacement therapy for life. Corticosteroid medication is used to replace the hormones cortisol and aldosterone that your body no longer produces. It's usually taken in tablet form two or three times a day. In most cases, a medication called hydrocortisone is used to replace the cortisol. Other possible medicines are prednisolone or dexamethasone, though these are less commonly used.  Aldosterone is replaced with a medication called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet, although if you're taking enough fludrocortisone medicine this may not be necessary. Unlike most people, if you feel the urge to eat something salty, then you should eat it. In general, the medications used for Addison's disease don't have side effects, unless your dose is too high. If you take a higher dose than necessary for a long time, there's a risk of problems such as weakened bones (osteoporosis), mood swings and difficulty sleeping (insomnia). Living with Addison’s disease Many people with Addison’s disease find that taking their medication enables them to continue with their normal diet and exercise routines. However, bouts of fatigue are also common, and it can take some time to learn how to manage these periods of low energy. Some people find that needing to take regular doses of medication is restrictive and affects their daily life or emotional health. Missing a dose of medication, or taking it late, can also lead to exhaustion or insomnia. Some people can develop associated health conditions, such as diabetes or an underactive thyroid, which require extra treatment and management. You'll usually need to have appointments with an endocrinologist every 6-12 months, so they can review your progress and adjust your medication dose, if necessary. Your GP can provide support and repeat prescriptions in between these visits. Failing to take your medication could lead to a serious condition called an adrenal crisis, so you must: remember to collect your repeat prescriptions keep spare medication as necessary – for example, in the car or at work, and always carry some spare medication with you take your medication every day at the right time pack extra medication if you are going away – usually double what you would normally need, plus your injection kit (see below) carry your medication in your hand luggage if you are travelling by plane, with a note from your doctor explaining why it is necessary You could also inform close friends or colleagues of your condition. Tell them about the signs of adrenal crisis and what they should do if you experience one. Medical alert bracelets It's also a good idea to wear a medical alert bracelet or necklace that informs people you have Addison’s disease. After a serious accident, such as a car crash, a healthy person produces more cortisol. This helps you cope with the stressful situation and additional strain on your body that results from serious injury. As your body cannot produce cortisol, you'll need a hydrocortisone injection to replace it and prevent an adrenal crisis. Wearing a medical alert bracelet will inform any medical staff treating you about your condition, and what medication you require. Medical alert bracelets or necklaces are pieces of jewellery engraved with your medical condition and an emergency contact number. They are available from a number of retailers. Ask your GP if there's one they recommend, or go to the MedicAlert website.  If you need to stay in hospital, the healthcare professionals responsible for your care will also need to know you need steroid replacement medication throughout your stay. It's important to note that this advice still applies if you're not supposed to eat or drink (nil by mouth) for any reason. Adjusting your medication At certain times, your medication may need to be adjusted to take into account any additional strain on your body. For example, you may need to increase the dosage of your medication if you experience any of the following: an illness or infection – particularly if you have a high temperature of 37.5C (99.5F) an accident, such as a car crash an operation, dental or medical procedure (such as a tooth filling or endoscopy) you're taking part in strenuous exercise not usually part of your daily life This will help your body cope with the additional stress. Your endocrinologist will monitor your dosage and advise about any changes. Over time, as you get used to the condition and learn what can trigger your symptoms, you may learn how to adjust your medication yourself. However, always consult your GP or specialist if you're unsure. Emergency treatment You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency. This could be necessary if you go into shock after an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medication. This may occur if you're pregnant and have morning sickness. Your endocrinologist will discuss with you when an injection might be necessary. If you need to administer emergency hydrocortisone, always call your GP immediately afterwards. Check what out-of-hours services are available in your local area, in case the emergency is outside normal working hours. You can also register yourself with your local ambulance service, so they have a record of your requirement for a steroid injection or tablets, if you need their assistance. Treating adrenal crisis Adrenal crisis, or Addisonian crisis, needs urgent medical attention. Dial 999 for an ambulance if you or someone you know are experiencing adrenal crisis. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness In hospital, you'll be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose) to replace those that your body is lacking. You'll also be injected with hydrocortisone to replace the missing cortisol hormone. Any underlying causes of the adrenal crisis, such as an infection, will also be treated.

Alcohol poisoning occurs when a person drinks a toxic amount of alcohol, usually over a short period of time (binge drinking). Being poisoned by alcohol can damage your health or even put your life in danger. It's important to avoid misusing alcohol and to be aware of how much you're drinking and the effect this could have on your body. This topic covers: Signs and symptoms When to seek medical help Treatment in hospital Dangers of alcohol poisoning How alcohol poisoning occurs The effects of alcohol Recommended alcohol limits Signs and symptoms of alcohol poisoning The signs and symptoms of alcohol poisoning include: confusion severely slurred speech loss of co-ordination vomiting irregular or slow breathing hypothermia (pale or blue-tinged skin caused by low body temperature) stupor (being conscious but unresponsive) passing out and being unconscious In the most severe cases, alcohol poisoning can lead to coma, brain damage and death. When to seek medical help If you suspect alcohol poisoning, dial 999 immediately to request an ambulance. While you're waiting: try to keep them sitting up and awake give them water if they can drink it if they've passed out, lie them on their side in the recovery position and check they're breathing properly keep them warm stay with them and monitor their symptoms Never leave a person alone to 'sleep it off'. The level of alcohol in a person's blood can continue to rise for up to 30-40 minutes after their last drink. This can cause their symptoms to suddenly become much more severe. You also shouldn't give them coffee or any more alcohol, put them under a cold shower or walk them around. These won't help someone 'sober up' and may even be dangerous. How alcohol poisoning is treated in hospital In hospital, the person will be carefully monitored until the alcohol has left their system. If treatment is required, this may include: inserting a tube into their mouth and windpipe (intubation) – to open the airway, remove any blockages and help with breathing fitting an intravenous drip, which goes directly into a vein – to top up their water, blood sugar and vitamin levels fitting a catheter (thin tube) to their bladder – to drain urine straight into a bag so they don't wet themselves Dangers of alcohol poisoning If a person is poisoned by alcohol they could: choke on their vomit stop breathing have a heart attack inhale vomit, leading to fatal lung damage become severely dehydrated, which can cause permanent brain damage in extreme cases develop more severe hypothermia have seizures (fits) as a result of lowered blood sugar levels Repeated vomiting and retching can lead to the vomiting of blood as a result of a torn blood vessel (Mallory-Weiss tear) at the junction of the stomach and gullet. Other related risks Drinking too much alcohol can affect a person's judgement and put them in situations where their health and safety are at risk. For example, they may: have an accident or get injured become involved in violent or antisocial behaviour have unsafe sex, which can lead to an unplanned pregnancy or a sexually transmitted infection (STI) lose personal possessions How alcohol poisoning occurs Every time you drink alcohol, your liver has to filter it out of your blood. Alcohol is absorbed quickly into your body (much quicker than food), but the body can only process around one unit of alcohol an hour. If you drink a lot of alcohol over a short space of time, such as on a night out, your body won't have time to process it all. Alcohol poisoning can also occur if a person drinks household products that contain alcohol – children sometimes drink these by accident. The amount of alcohol in your bloodstream – known as your blood alcohol concentration (BAC) – will rise. The effects of alcohol Around 1-2 units your heart rate will speed up and your blood vessels will expand you get the warm, sociable feeling associated with moderate drinking Around 4-6 units your decision making and judgement will start to be affected, making you lose your inhibitions and become more reckless the cells in your nervous system will start to be affected, making you feel lightheaded your co-ordination will be affected and your reaction time may be slower Around 8-9 units your reaction times will be much slower your speech will be slurred your vision will begin to lose focus your liver won't be able to remove all of the alcohol overnight, so it's likely you'll wake up with a hangover At this stage you should seriously consider not drinking any more alcohol. If you do: Around 10-12 units your co-ordination will be seriously impaired, placing you at high risk of having an accident you may stagger around or feel unstable on your feet you'll feel drowsy or dizzy the amount of alcohol in your body will begin to reach toxic (poisonous) levels you may need to go to the toilet more often as your body attempts to quickly pass the alcohol out of your body in your urine you'll be dehydrated in the morning, and probably have a severe headache the excess alcohol in your system may upset your digestive system, leading to nausea, vomiting, diarrhoea or indigestion More than 12 units you're at high risk of developing alcohol poisoning, particularly if you're drinking lots of units in a short space of time the alcohol can begin to interfere with the automatic functions of your body, such as your breathing, heart rate and gag reflex you're at risk of losing consciousness Recommended alcohol limits If you drink most weeks, to reduce your risk of harming your health: men and women are advised not to regularly drink more than 14 units a week spread your drinking over three days or more if you drink as much as 14 units a week One unit of alcohol is equivalent to: half a pint of lower-strength lager, beer or cider (ABV 3.6%) a single small shot of spirits (25ml, ABV 40%) You should also avoid binge drinking as it's dangerous and puts you at risk of alcohol poisoning. Read more about alcohol units and drinking and alcohol including tips on cutting down on your drinking

Allergic rhinitis is inflammation of the inside of the nose caused by an allergen, such as pollen, dust, mould, or flakes of skin from certain animals. It's a very common condition, estimated to affect around one in every five people in the UK. Signs and symptoms Allergic rhinitis typically causes cold-like symptoms, such as sneezing, itchiness and a blocked or runny nose. These symptoms usually start soon after being exposed to an allergen. Some people only get allergic rhinitis for a few months at a time because they're sensitive to seasonal allergens, such as tree or grass pollen. Other people get allergic rhinitis all year round. Most people with allergic rhinitis have mild symptoms that can be easily and effectively treated. But for some symptoms can be severe and persistent, causing sleep problems and interfering with everyday life. The symptoms of allergic rhinitis occasionally improve with time, but this can take many years and it's unlikely that the condition will disappear completely. When to see your GP Visit your GP if the symptoms of allergic rhinitis are disrupting your sleep, preventing you carrying out everyday activities, or adversely affecting your performance at work or school. A diagnosis of allergic rhinitis will usually be based on your symptoms and any possible triggers you may have noticed. If the cause of your condition is uncertain, you may be referred for allergy testing. Read more about diagnosing allergic rhinitis What causes allergic rhinitis? Allergic rhinitis is caused by the immune system reacting to an allergen as if it were harmful. This results in cells releasing a number of chemicals that cause the inside layer of your nose (the mucous membrane) to become swollen and excessive levels of mucus to be produced. Common allergens that cause allergic rhinitis include pollen – this type of allergic rhinitis is known as hay fever – as well as mould spores, house dust mites, and flakes of skin or droplets of urine or saliva from certain animals. Read more about the causes of allergic rhinitis Treating and preventing allergic rhinitis It's difficult to completely avoid potential allergens, but you can take steps to reduce exposure to a particular allergen you know or suspect is triggering your allergic rhinitis. This will help improve your symptoms. If your condition is mild, you can also help reduce the symptoms by taking over-the-counter medications, such as non-sedating antihistamines, and by regularly rinsing your nasal passages with a salt water solution to keep your nose free of irritants. See your GP for advice if you've tried taking these steps and they haven't helped. They may prescribe a stronger medication, such as a nasal spray containing corticosteroids. Read more about treating allergic rhinitis and preventing allergic rhinitis Further problems Allergic rhinitis can lead to complications in some cases. These include: nasal polyps – abnormal but non-cancerous (benign) sacs of fluid that grow inside the nasal passages and sinuses sinusitis – an infection caused by nasal inflammation and swelling that prevents mucus draining from the sinuses middle ear infections – infection of part of the ear located directly behind the eardrum These problems can often be treated with medication, although surgery is sometimes needed in severe or long-term cases. Read more about the complications of allergic rhinitis Causes Allergic rhinitis is caused by an allergic reaction to an allergen, such as pollen, dust and certain animals. Oversensitive immune system If you have allergic rhinitis, your immune system – your natural defence against infection and illness – will react to an allergen as if it were harmful. If your immune system is oversensitive, it will react to allergens by producing antibodies to fight them off. Antibodies are special proteins in the blood that are usually produced to fight viruses and infections. Allergic reactions don't occur the first time you come into contact with an allergen. The immune system has to recognise and "memorise" it before producing antibodies to fight it. This process is known as sensitisation. After you develop sensitivity to an allergen, it will be detected by antibodies called immunoglobulin E (IgE) whenever it comes into contact with the inside of your nose and throat. These antibodies cause cells to release a number of chemicals, including histamine, which can cause the inside layer of your nose (the mucous membrane) to become inflamed and produce excess mucus. This is what causes the typical symptoms of sneezing and a blocked or runny nose. Common allergens Allergic rhinitis is triggered by breathing in tiny particles of allergens. The most common airborne allergens that cause rhinitis are described below. House dust mites House dust mites are tiny insects that feed on the dead flakes of human skin. They can be found in mattresses, carpets, soft furniture, pillows and beds. Rhinitis isn't caused by the dust mites themselves, but by a chemical found in their excrement. Dust mites are present all year round, although their numbers tend to peak during the winter. Pollen and spores Tiny particles of pollen produced by trees and grasses can sometimes cause allergic rhinitis. Most trees pollinate from early to mid-spring, whereas grasses pollinate at the end of spring and beginning of summer. Rhinitis can also be caused by spores produced by mould and fungi. Animals Many people are allergic to animals, such as cats and dogs. The allergic reaction isn't caused by animal fur, but flakes of dead animal skin and their urine and saliva. Dogs and cats are the most common culprits, although some people are affected by horses, cattle, rabbits and rodents, such as guinea pigs and hamsters. However, being around dogs from an early age can help protect against allergies, and there's some evidence to suggest that this might also be the case with cats. Work-related allergens Some people are affected by allergens found in their work environment, such as wood dust, flour dust or latex. Who's most at risk? It isn't fully understood why some people become oversensitive to allergens, although you're more likely to develop an allergy if there's a history of allergies in your family. If this is the case, you're said to be "atopic", or to have "atopy". People who are atopic have a genetic tendency to develop allergic conditions. Their increased immune response to allergens results in increased production of IgE antibodies.  Environmental factors may also play a part. Studies have shown certain things may increase the chance of a child developing allergies, such as growing up in a house where people smoke and being exposed to dust mites at a young age. Diagnosis Your GP will often be able to diagnose allergic rhinitis from your symptoms and your personal and family medical history. They'll ask you whether you've noticed any triggers that seem to cause a reaction, and whether it happens at a particular place or time. Your GP may examine the inside of your nose to check for nasal polyps. Nasal polyps are fleshy swellings that grow from the lining of your nose or your sinuses, the small cavities inside your nose. They can be caused by the inflammation that occurs as a result of allergic rhinitis. Allergic rhinitis is usually confirmed when medical treatment starts. If you respond well to antihistamines, it's almost certain that your symptoms are caused by an allergy. Allergy testing If the exact cause of allergic rhinitis is uncertain, your GP may refer you to a hospital allergy clinic for allergy testing. The two main allergy tests are: skin prick test – where the allergen is placed on your arm and the surface of the skin is pricked with a needle to introduce the allergen to your immune system; if you're allergic to the substance, a small itchy spot (welt) will appear blood test – to check for the immunoglobulin E (IgE) antibody in your blood; your immune system produces this antibody in response to a suspected allergen Commercial allergy testing kits aren't recommended because the testing is often of a lower standard than that provided by the NHS or an accredited private clinic. It's also important that the test results are interpreted by a qualified healthcare professional with detailed knowledge of your symptoms and medical history. Further tests In some cases further hospital tests may be needed to check for complications, such as nasal polyps or sinusitis. For example, you may need: a nasal endoscopy – where a thin tube with a light source and video camera at one end (endoscope) is inserted up your nose so your doctor can see inside your nose a nasal inspiratory flow test – where a small device is placed over your mouth and nose to measure the air flow when you inhale through your nose a computerised tomography (CT) scan – a scan that uses X-rays and a computer to create detailed images of the inside of the body Treatment Treatment for allergic rhinitis depends on how severe your symptoms are and how much they're affecting your everyday activities. In most cases treatment aims to relieve symptoms such as sneezing and a blocked or runny nose. If you have mild allergic rhinitis, you can often treat the symptoms yourself.  You should visit your GP if your symptoms are more severe and affecting your quality of life, or if self-help measures haven't been effective. Self-help It's possible to treat the symptoms of mild allergic rhinitis with over-the-counter medications, such as long-acting, non-sedating antihistamines. If possible, try to reduce exposure to the allergen that triggers the condition. See preventing allergic rhinitis for more information and advice about this. Cleaning your nasal passages Regularly cleaning your nasal passages with a salt water solution – known as nasal douching or irrigation – can also help by keeping your nose free of irritants. You can do this either by using a homemade solution or a solution made with sachets of ingredients bought from a pharmacy. Small syringes or pots that often look like small horns or teapots are also available to help flush the solution around the inside of your nose. To make the solution at home, mix half a teaspoon of salt and half a teaspoon of bicarbonate of soda (baking powder) into a pint (568ml) of boiled water that's been left to cool to around body temperature – do not attempt to rinse your nose while the water is still hot. To rinse your nose: stand over a sink, cup the palm of one hand and pour a small amount of the solution into it sniff the water into one nostril at a time repeat this until your nose feels comfortable – you may not need to use all of the solution While you do this, some solution may pass into your throat through the back of your nose. The solution is harmless if swallowed, but try to spit out as much of it as possible. Nasal irrigation can be carried out as often as necessary, but a fresh solution should be made each time. Medication Medication won't cure your allergy, but it can be used to treat the common symptoms. If your symptoms are caused by seasonal allergens, such as pollen, you should be able to stop taking your medication after the risk of exposure has passed. Visit your GP if your symptoms don't respond to medication after two weeks. Antihistamines Antihistamines relieve symptoms of allergic rhinitis by blocking the action of a chemical called histamine, which the body releases when it thinks it's under attack from an allergen. You can buy antihistamine tablets over the counter from your pharmacist without a prescription, but antihistamine nasal sprays are only available with a prescription. Antihistamines can sometimes cause drowsiness. If you're taking them for the first time, see how you react to them before driving or operating heavy machinery. In particular, antihistamines can cause drowsiness if you drink alcohol while taking them. Corticosteroids If you have frequent or persistent symptoms and you have a nasal blockage or nasal polyps, your GP may recommend a nasal spray or drops containing corticosteroids. Corticosteroids help reduce inflammation and swelling. They take longer to work than antihistamines, but their effects last longer. Side effects from inhaled corticosteroids are rare, but can include nasal dryness, irritation and nosebleeds. If you have a particularly severe bout of symptoms and need rapid relief, your GP may prescribe a short course of corticosteroid tablets lasting 5 to 10 days. Add-on treatments If allergic rhinitis doesn't respond to treatment, your GP may choose to add to your original treatment.  They may suggest: increasing the dose of your corticosteroid nasal spray using a short-term course of a decongestant nasal spray to take with your other medication combining antihistamine tablets with corticosteroid nasal sprays, and possibly decongestants using a nasal spray that contains a medicine called ipratropium, which will help reduce excessive nasal discharge using a leukotriene receptor antagonist medication – medication that blocks the effects of chemicals called leukotrienes, which are released during an allergic reaction If you don't respond to the add-on treatments, you may be referred to a specialist for further assessment and treatment. Immunotherapy Immunotherapy, also known as hyposensitisation or desensitisation, is another type of treatment used for some allergies. It's only suitable for people with certain types of allergies, such as hay fever, and is usually only considered if your symptoms are severe. Immunotherapy involves gradually introducing more and more of the allergen into your body to make your immune system less sensitive to it. The allergen is often injected under the skin of your upper arm. Injections are given at weekly intervals, with a slightly increased dose each time. Immunotherapy can also be carried out using tablets that contain an allergen, such as grass pollen, which are placed under your tongue. When a dose is reached that's effective in reducing your allergic reaction (the maintenance dose), you'll need to continue with the injections or tablets for up to three years. Immunotherapy should only be carried out under the close supervision of a specially trained doctor as there's a risk it may cause a serious allergic reaction. Complications If you have allergic rhinitis, there's a risk you could develop further problems. A blocked or runny nose can result in difficulty sleeping, drowsiness during the daytime, irritability and problems concentrating. Allergic rhinitis can also make symptoms of asthma worse. The inflammation associated with allergic rhinitis can also sometimes lead to other conditions, such as nasal polyps, sinusitis and middle ear infections. These are described below. Nasal polyps Nasal polyps are swellings that grow in the lining inside your nose or sinuses, the small cavities above and behind your nose. They're caused by inflammation of the membranes of the nose and sometimes develop as a result of rhinitis. Nasal polyps are shaped like teardrops when they're growing and look like a grape on a stem when fully grown. They vary in size and can be yellow, grey or pink. They can grow on their own or in clusters, and usually affect both nostrils. If nasal polyps grow large enough, or in clusters, they can interfere with your breathing, reduce your sense of smell and block your sinuses, which can lead to sinusitis. Small nasal polyps can be shrunk using steroid nasal sprays so they don't cause an obstruction in your nose. Large polyps may need to be surgically removed. Sinusitis Sinusitis is a common complication of rhinitis. It's where the sinuses become inflamed or infected. The sinuses naturally produce mucus, which usually drains into your nose through small channels. However, if the drainage channels are inflamed or blocked – for example, because of rhinitis or nasal polyps – the mucus can't drain away and it may become infected. Common symptoms of sinusitis include: a blocked nose, making it difficult to breathe through your nose a runny nose mucus that drips from the back of your nose down your throat (post-nasal drip) a reduced sense of smell or taste a feeling of fullness, pressure or pain in the face  snoring obstructive sleep apnoea (OSA) – your airways become temporarily blocked while you're asleep, which can disturb your sleep Over-the-counter painkillers, such as paracetamol, ibuprofen or aspirin, can be used to help reduce any pain and discomfort in your face. However, these medications aren't suitable for everyone, so check the leaflet that comes with them before using them. For example, children under the age of 16 shouldn't take aspirin, and ibuprofen isn't recommended for people with asthma or a history of stomach ulcers. Speak to your GP or pharmacist if you're unsure. Antibiotics may also be recommended if your sinuses become infected with bacteria. If you have long-term (chronic) sinusitis, surgery may be needed to improve the drainage of your sinuses. Read more about treating sinusitis Middle ear infections Middle ear infections (otitis media) can also develop as a complication of nasal problems, including allergic rhinitis. These infections can occur if rhinitis causes a problem with the Eustachian tube, which connects the back of the nose and middle ear, at the back of the nose. If this tube doesn't function properly, fluid can build up in the middle ear behind the ear drum and can become infected. There's also the possibility of infection at the back of the nose spreading to the ear through the Eustachian tube. The main symptoms of a middle ear infection include: earache a high temperature (fever) being sick a lack of energy slight hearing loss Ear infections often clear up within a couple of days, but paracetamol or ibuprofen can be used to help relieve fever and pain. Antibiotics may also be prescribed if the symptoms persist or are particularly severe. Read more about treating middle ear infections Prevention The best way to prevent allergic rhinitis is to avoid the allergen that causes it. But this isn't always easy. Allergens, such as dust mites, aren't always easy to spot and can breed in even the cleanest house. It can also be difficult to avoid coming into contact with pets, particularly if they belong to friends and family. Below is some advice to help you avoid the most common allergens. House dust mites Dust mites are one of the biggest causes of allergies. They're microscopic insects that breed in household dust. To help limit the number of mites in your house, you should: consider buying an air-permeable occlusive mattress and bedding covers – this type of bedding acts as a barrier to dust mites and their droppings choose wood or hard vinyl floor coverings instead of carpet fit roller blinds that can be easily wiped clean regularly clean cushions, soft toys, curtains and upholstered furniture, either by washing or vacuuming them use synthetic pillows and acrylic duvets instead of woollen blankets or feather bedding use a vacuum cleaner fitted with a high efficiency particulate air (HEPA) filter – it can remove more dust than ordinary vacuum cleaners use a clean damp cloth to wipe surfaces – dry dusting can spread allergens further Concentrate your efforts on controlling dust mites in the areas of your home where you spend most time, such as the bedroom and living room. Pets It isn't pet fur that causes an allergic reaction, but exposure to flakes of their dead skin, saliva and dried urine. If you can't permanently remove a pet from the house, you may find the following tips useful: keep pets outside as much as possible or limit them to one room, preferably one without carpet don't allow pets in bedrooms wash pets at least once a fortnight groom dogs regularly outside regularly wash bedding and soft furnishings your pet has been on If you're visiting a friend or relative with a pet, ask them not to dust or vacuum on the day you're visiting because it will disturb allergens into the air. Taking an antihistamine medicine one hour before you enter a house with a pet can help reduce your symptoms. Pollen Different plants and trees pollinate at different times of the year, so when you get allergic rhinitis will depend on what sort of pollen(s) you're allergic to. Most people are affected during the spring and summer months because this is when most trees and plants pollinate. To avoid exposure to pollen, you may find the following tips useful: check weather reports for the pollen count and stay indoors when it's high avoid line-drying clothes and bedding when the pollen count is high wear wraparound sunglasses to protect your eyes from pollen keep doors and windows shut during mid-morning and early evening, when there's most pollen in the air shower, wash your hair and change your clothes after being outside avoid grassy areas, such as parks and fields, when possible  if you have a lawn, consider asking someone else to cut the grass for you  Mould spores Moulds can grow on any decaying matter, both in and outside the house. The moulds themselves aren't allergens, but the spores they release are. Spores are released when there's a sudden rise in temperature in a moist environment, such as when central heating is turned on in a damp house or wet clothes are dried next to a fireplace. To help prevent mould spores, you should: keep your home dry and well ventilated when showering or cooking, open windows but keep internal doors closed to prevent damp air spreading through the house, and use extractor fans avoid drying clothes indoors, storing clothes in damp cupboards and packing clothes too tightly in wardrobes deal with any damp and condensation in your home

Alzheimer's disease is the most common type of dementia, affecting an estimated 850,000 people in the UK. Dementia is a progressive neurological disease which affects multiple brain functions, including memory. The exact cause of Alzheimer's disease is unknown, although a number of things are thought to increase your risk of developing the condition. These include: increasing age a family history of the condition previous severe head injuries lifestyle factors and conditions associated with cardiovascular disease It's becoming increasingly understood that it's very common to have both changes of Alzheimer's and vascular dementia together (mixed dementia). Read more about the causes of Alzheimer's disease Signs and symptoms of Alzheimer's disease Alzheimer's disease is a progressive condition, which means the symptoms develop gradually and become more severe over the course of several years. It affects multiple brain functions. The first sign of Alzheimer's disease is usually minor memory problems. For example, this could be forgetting about recent conversations or events, and forgetting the names of places and objects. As the condition develops, memory problems become more severe and further symptoms can develop, such as: confusion, disorientation and getting lost in familiar places difficulty planning or making decisions problems with speech and language problems moving around without assistance or performing self-care tasks personality changes, such as becoming aggressive, demanding and suspicious of others hallucinations (seeing or hearing things that aren't there) and delusions (believing things that are untrue) low mood or anxiety Read more about the symptoms of Alzheimer's disease Who is affected? Alzheimer's disease is most common in people over the age of 65, and affects slightly more women than men. The risk of Alzheimer's disease and other types of dementia increases with age, affecting an estimated 1 in 14 people over the age of 65 and 1 in every 6 people over the age of 80. However, around 1 in every 20 cases of Alzheimer's disease affects people aged 40 to 65. Receiving a diagnosis As the symptoms of Alzheimer's disease progress slowly, it can be difficult to recognise that there's a problem. Many people feel that memory problems are simply a part of getting older. However, a timely diagnosis of Alzheimer's disease can give you the best chance to prepare and plan for the future, as well as receive any treatment or support that may help. If you're worried about your memory or think you may have dementia, it's a good idea to see your GP. If you're worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. There's no single test that can be used to diagnose Alzheimer's disease. Your GP will ask questions about any problems you are experiencing and may do some tests to rule out other conditions. If Alzheimer's disease is suspected, you may be referred to a specialist memory service to: discuss the process of making the diagnosis organise testing  create a treatment plan Read more about diagnosing Alzheimer's disease How Alzheimer's disease is treated There's no cure for Alzheimer's disease, but medication is available that can help relieve some of the symptoms and slow down the progression of the condition in some people. Various other types of support are also available to help people with Alzheimer's live as independently as possible, such as making changes to your home environment so it's easier to move around and remember daily tasks. Psychological treatments such as cognitive stimulation therapy may also be offered to help support your memory, problem solving skills and language ability. Read more about treating Alzheimer's disease Outlook On average, people with Alzheimer's disease live for around 8 to 10 years after they start to develop symptoms. However, this can vary considerably from person to person. Some people with the condition will live longer than this, but others will not. Alzheimer's disease is a life-limiting illness, although many people diagnosed with the condition will die from another cause. As Alzheimer’s disease is a progressive neurological condition, it can cause problems with swallowing. This can lead to aspiration (food being inhaled into the lungs) which can cause frequent chest infections. It's also common for people with Alzheimer’s disease to eventually have difficulty eating and to have a reduced appetite.  There's increasing awareness that people with Alzheimer’s disease need palliative care. This includes support for families, as well as the person with Alzheimer's. Can Alzheimer's disease be prevented? As the exact cause of Alzheimer's disease isn't clear, there's no known way to prevent the condition. However, there are things you can do that may reduce your risk or delay the onset of dementia, such as: stopping smoking and cutting down on alcohol eating a healthy, balanced diet and maintaining a healthy weight staying physically fit and mentally active These measures have other health benefits, such as lowering your risk of cardiovascular disease and improving your overall mental health. Read more about preventing Alzheimer's disease Symptoms The symptoms of Alzheimer's disease progress slowly over several years. Sometimes these symptoms are confused with other conditions and may initially be put down to old age. The rate at which the symptoms progress is different for each individual and it's not possible to predict exactly how quickly it will get worse. In some cases, infections, medications, strokes or delirium can be responsible for symptoms getting worse. Anyone with Alzheimer's disease whose symptoms are rapidly getting worse should be seen by a doctor, so these can be managed. Stages of Alzheimer's disease Generally, the symptoms of Alzheimer's disease are divided into three main stages. Early symptoms In the early stages, the main symptom of Alzheimer's disease is memory lapses. For example, someone with early Alzheimer's disease may: forget about recent conversations or events, or misplace items forget the names of places and objects, or have trouble thinking of the right word repeat themselves regularly, such as asking the same question several times show poor judgement or find it harder to make decisions become less flexible and more hesitant to try new things There are often signs of mood changes, such as increasing anxiety or agitation, or periods of confusion. Middle-stage symptoms As Alzheimer's disease develops, memory problems will get worse. Someone with the condition may find it increasingly difficult to remember the names of people they know and may struggle to recognise their family and friends. Other symptoms may also develop, such as: increasing confusion and disorientation – for example, getting lost, or wandering and not knowing what time of day it is obsessive, repetitive or impulsive behaviour delusions (believing things that are untrue) or feeling paranoid and suspicious about carers or family members problems with speech or language (aphasia) disturbed sleep changes in mood, such as frequent mood swings, depression and feeling increasingly anxious, frustrated or agitated difficulty performing spatial tasks, such as judging distances hallucinations By this stage, someone with Alzheimer's disease usually needs support to help them with their everyday living. For example, they may need help eating, washing, getting dressed and using the toilet. Later symptoms In the later stages of Alzheimer's disease, the symptoms become increasingly severe and distressing for the person with the condition, as well as their carers, friends and family. Hallucinations and delusions may come and go over the course of the illness, but can get worse as the condition progresses. Sometimes people with Alzheimer's disease can be violent, demanding and suspicious of those around them. A number of other symptoms may also develop as Alzheimer's disease progresses, such as: difficulty eating and swallowing (dysphagia) difficulty changing position or moving around without assistance considerable weight loss – although some people eat too much and put on weight unintentional passing of urine (urinary incontinence) or stools (bowel incontinence) gradual loss of speech significant problems with short- and long-term memory In the severe stages of Alzheimer's disease, people may need full-time care and assistance with eating, moving and using the toilet. Read more about how Alzheimer's disease is treated Seeking medical advice If you're worried about your memory or think you may have dementia, it's a good idea to see your GP. If you're worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them. Memory problems are not just caused by dementia – they can also be caused by depression, stress, medications or other health problems. Your GP can carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for more tests, if necessary. Read more about diagnosing Alzheimer's disease Causes Alzheimer's disease is caused by parts of the brain shrinking (atrophy), which affects the structure and function of particular brain areas. It's not known exactly what causes this process to begin. However, in the brains of people with Alzheimer's disease, scientists have found amyloid plaques (abnormal deposits of protein), neurofibrillary tangles (containing tau) and imbalances in a chemical called acetylcholine. It's also common to have a degree of vascular damage in the brain. These reduce the effectiveness of healthy neurons (nerve cells that carry messages to and from the brain), gradually destroying them. Over time, this damage spreads to several areas of the brain. The first areas affected are responsible for memories. Increased risk Although it's still unknown what triggers Alzheimer's disease, several factors are known to increase your risk of developing the condition. Age Age is the single most significant factor in the development of Alzheimer's disease. The likelihood of developing the condition doubles every five years after you reach 65 years of age. However, it's not just older people who are at risk of developing Alzheimer's disease. Around 1 in 20 people with the condition are under 65. This is called early onset Alzheimer's disease and it can affect people from around the age of 40. Family history The genes you inherit from your parents can contribute to your risk of developing Alzheimer's disease, although the actual increase in risk is small if you have a close family member with the condition. However, in a few families, Alzheimer's disease is caused by the inheritance of a single gene, and the risks of the condition being passed on are much higher. If several of your family members have developed dementia over the generations, it may be appropriate to seek genetic counselling for information and advice about your chances of developing Alzheimer's disease when you are older. The Alzheimer's Society website has more information about the genetics of dementia. Down's syndrome People with Down's syndrome are at a higher risk of developing Alzheimer's disease. This is because the genetic fault that causes Down's syndrome can also cause amyloid plaques to build up in the brain over time, which can lead to Alzheimer's disease in some people. Head injuries People who have had a severe head injury have been found to be at higher risk of developing Alzheimer's disease. Cardiovascular disease Research shows that several lifestyle factors and conditions associated with cardiovascular disease can increase the risk of Alzheimer's disease. These include: smoking obesity  diabetes  high blood pressure high cholesterol You can help reduce your risk by: stopping smoking eating a healthy, balanced diet leading an active life, both physically and mentally losing weight if you need to drinking less alcohol having regular health checks as you get older Read more about reducing your risk of Alzheimer's disease Diagnosis It's best to see your GP if you're worried about your memory or think you may have dementia. If you're worried about someone else, encourage them to make an appointment and perhaps suggest going with them. It's often very helpful having a friend or family member there. A timely diagnosis gives you the best chance to adjust, prepare and plan for the future, as well as accessing treatments and support that may help. Seeing your GP Memory problems aren't just caused by dementia – they can also be caused by: depression or anxiety stress medications alcohol or drugs other health problems – such as hormonal disturbances or nutritional deficiencies Your GP can carry out some simple checks to try to find out what the cause may be. They can then refer you to a specialist for assessment, if necessary. Your GP will ask about your concerns and what you or your family have noticed. They'll also check other aspects of your health, and carry out a physical examination. They may also organise some blood tests and ask about any medication you're taking to rule out other possible causes of your symptoms. You'll usually be asked some questions and carry out some memory, thinking, and pen and paper tasks to check how different areas of your brain are functioning. This can help your GP decide if you need to be referred to a specialist for more assessments. Referral to a specialist Your GP may refer you to a specialist memory assessment service to help with your diagnosis. Memory clinics are staffed by professionals from multiple disciplines who are experts in diagnosing, caring for and advising people with dementia and their families. Memory clinic staff can include the following, depending on your local area: a nurse – usually a trained mental health nurse who specialises in diagnosing and caring for people with dementia a psychologist – a healthcare professional who specialises in the assessment and treatment of mental health conditions a psychiatrist – a qualified medical doctor who has training in treating mental health conditions a neurologist – a specialist in treating conditions that affect the nervous system (the brain and spinal cord) a geriatrician – a physician with specialist training in the care of older people a social worker – a trained member of staff able to advise and assist with accessing social services within the local area an occupational therapist – a member of staff with specialist skills in assessing and supporting people with dementia and their families with adjusting to disabilities There's no simple and reliable test for diagnosing Alzheimer's disease, but the staff will listen to the concerns of both you and your family about your memory or thinking. They will assess your skills and arrange more tests to rule out other conditions. Assessing your mental abilities  A specialist will usually assess your mental abilities using a special series of questions. One widely used test is the mini mental state examination (MMSE). This involves being asked to carry out activities such as memorising a short list of objects correctly and identifying the current day of the week, month and year. Different memory clinics may also use other, longer tests.  The MMSE isn't used to diagnose Alzheimer's disease, but it's useful to initially assess areas of difficulty that a person with the condition may have. This helps specialists to make decisions about treatment and whether more tests are necessary. Tests To rule out other possible causes of your symptoms and look for possible signs of damage caused by Alzheimer's disease, your specialist may recommend having a brain scan. This could be a: computerised tomography (CT) scan – where several X-rays of your brain are taken at slightly different angles and a computer is used to put the images together magnetic resonance imaging (MRI) scan – where a strong magnetic field and radio waves are used to produce detailed images of the inside of your brain  Some specialist centres offer scans which look at brain function and particular protein deposits. However, at the moment, these are mostly experimental and only used if the diagnosis is unclear.  After diagnosis It may take several appointments and tests over months, or even years, before a diagnosis of Alzheimer's disease can be confirmed. For some people, a diagnosis of Alzheimer's disease is a huge shock, especially as it's not unusual for people with dementia to have less awareness of their difficulties. For others, the diagnosis can be very important in helping them and their families to make sense of symptoms they've been concerned about for a long time. If you've just been given a diagnosis of dementia, you may be feeling numb, scared and unable to take everything in. It may be helpful to have the diagnosis explained again to help make sense of the idea over time. It might help to talk things through with family and friends. It takes time to adapt to a diagnosis of dementia, for both you and your family. Some people find it helpful to seek information and plan for the future, but others may need a longer period to process the news. However, as dementia is a progressive illness, the weeks to months after a diagnosis is often a good time to think about legal, financial and healthcare matters for the future. Read more about what to do if you've just been diagnosed with dementia Treatment There's currently no cure for Alzheimer's disease, although medication is available that can temporarily reduce some symptoms or slow down the progression of the condition in some people. Support is also available to help someone with the condition cope with everyday life. Care plan If you're diagnosed with Alzheimer's disease, it's helpful if your health and social care needs are assessed and plans made for the future. A care plan is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as: what support you or your carer need for you to remain as independent as possible whether there are any changes that need to be made to your home to make it easier to live in whether you need any financial assistance Healthcare professionals (such as your GP or psychiatrist) and social care services (which is normally your local council working with the NHS), will usually both be involved in helping draw up and carry out care plans. Medication A number of medications may be prescribed for Alzheimer's disease to help temporarily improve some symptoms and slow down the progression of the condition. Donepezil, galantamine and rivastigmine (known as AChE inhibitors) can be prescribed for people with early to mid-stage Alzheimer's disease. Memantine may be prescribed for people with mid-stage disease who cannot take AChE inhibitors, or for those with late-stage disease. There's no difference in how well each of the three different AChE inhibitors work, although some people respond better to certain types or have fewer side effects. All of these medications can only be prescribed by specialists such as psychiatrists, neurologists and geriatricians. They may be prescribed by your GP on the advice of a specialist. If you're caring for someone with Alzheimer's disease, your views should be taken into account when prescribing medication, as well as at regular assessments. These assessments take place to ensure the medication is having a worthwhile effect and to identify and monitor side effects. Read guidance from the National Institute for Health and Care Excellence (NICE) on donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease. Side effects Donepezil, galantamine and rivastigmine can cause side effects such as: feeling and being sick dizziness diarrhoea  headache  agitation insomnia muscle cramps more rarely, slowing of the heartbeat – which can cause issues if you already have problems with your heart rhythm. These side effects are more likely to occur at the beginning of therapy or when the dose is increased. Your doctor should review your medical history and your other medications to check the suitability and risk of interactions. Common side effects of memantine include: dizziness headaches high blood pressure tiredness constipation shortness of breath more rarely, problems with walking or increased confusion very rarely, seizures For more information about the possible side effects of your specific medication, refer to the patient information leaflet that comes with it or speak to your doctor. Supportive measures and treatments In addition to medication, treatment for Alzheimer's disease involves a wide range of other measures and treatments to help people with dementia live as independently as possible. For example, an occupational therapist can identify problems or unsafe areas in your everyday life and help you to develop strategies or use alternative tools to manage these. They may suggest: ways of prompting and reminding yourself of important tasks – such as using diaries or calendars assistive technology – devices or systems to help maintain the independence and safety of people living with dementia adding grab bars and handrails to your home to help you move around safely other professionals visiting you at home and assisting with daily tasks to maintain your independence in the community Psychological treatments, such as cognitive stimulation, may be offered to help improve your memory, problem solving skills and language ability. Medication, other psychological therapies, such as cognitive behavioural therapy (CBT), music and art therapy, reminiscence and relaxation therapies may also be offered. These may help with managing depression, anxiety, agitation, hallucinations, delusions and challenging behaviour that can occur with Alzheimer's disease. Read more about how dementia is treated Practical tips for people with Alzheimer's If you have Alzheimer's disease, you may find it useful to: keep a diary and write down things you want to remember pin a weekly timetable to the wall put your keys in an obvious place, such as in a large bowl in your living room have a daily newspaper delivered to remind you of the day and date put labels on cupboards and drawers keep useful telephone numbers by the phone write yourself reminders – for example, put a note on the front door to remind you to take your keys with you if you go out programme people's names and numbers into your telephone set the alarm on your watch to act as a reminder install safety devices such as gas detectors and smoke alarms throughout your home It may also be helpful to get in touch with a local or national Alzheimer's or dementia support group, such as the Alzheimer's Society, for more information and advice about living with Alzheimer's disease. Read more about living well with dementia Advance care planning People with dementia often live for many years after their diagnosis. However, as it's a progressive condition, it can be helpful and reassuring for both you and your family if you make plans for the future. Advance care planning means considering, discussing and possibly recording your wishes and decisions for future care. It's about planning for a time when you may not be able to make some decisions for yourself. In the earlier stages of the disease, you should have the opportunity to discuss with health professionals and your family about the future. This may involve the use of: advance statements  advance decisions to refuse treatment lasting power of attorney preferred priorities for care Palliative care Although the outlook is variable, dementia is a life-limiting illness and can begin to affect multiple body systems in the later stages. End of life care, or palliative care, provides support for people with an incurable illness, so they're able to live as well and as comfortably as possible until their death. It also involves support for family members. Care may be provided at home, a hospice, a care home or hospital. For people nearing the end of life, their care team should assess their needs, make them feel comfortable and allow them to die with dignity in a place of their choosing. Read more about palliative care Telecare Self-Check online tool Visit the Telecare Self-Check online tool to find the right support for you in your area. This easy to use online tool allows you to find helpful information on telecare services that could help you live independently at home for longer. Prevention As the exact cause of Alzheimer's disease is still unknown, there's no way to prevent the condition. However, there are steps you can take that may help to delay the onset of dementia. Reducing your risk of cardiovascular disease Cardiovascular disease has been linked with an increased risk of Alzheimer's disease and vascular dementia. You may be able to reduce your risk of developing these conditions – as well as other serious problems, such as strokes and heart attacks – by taking steps to improve your cardiovascular health, including:  stopping smoking not drinking large amounts of alcohol eating a healthy, balanced diet, including at least five portions of fruit and vegetables every day exercising for at least 150 minutes (2 hours and 30 minutes) every week by doing moderate-intensity aerobic activity (such as cycling or fast walking) – this will improve both your physical and mental health make sure your blood pressure is checked and controlled through regular health tests if you have diabetes, make sure you keep to the diet and take your medication Read more about preventing dementia Staying mentally active There's some evidence to suggest that rates of dementia are lower in people who remain as mentally, physically and socially active as possible throughout their lives, as well as among those who enjoy a wide range of different activities and hobbies. It may be possible to reduce your risk of Alzheimer's disease and other types of dementia by: reading writing for pleasure learning foreign languages playing musical instruments taking part in adult education courses playing tennis playing golf swimming group sports, such as bowling walking Interventions such as "brain training" computer games have been shown to improve cognition over a short period, but research hasn't yet demonstrated whether this can prevent dementia. Future research Research into Alzheimer's disease is continuing. As more is revealed about the condition, other ways to treat or prevent it may be found. Participation in research is important and helps to improve dementia care and support for people with dementia, plus their carers and families. You can read about ongoing dementia research on the Alzheimer's Research UK website. You can also ask your local memory clinic about projects taking place. The National Institute for Health and Care Excellence (NICE) has advised that there isn't evidence to support the use of the following to prevent dementia: statins hormone replacement therapy – when chemicals are taken to replace those that your body no longer produces vitamin E – found in a variety of foods, such as olive oil, nuts and seeds non-steroidal anti-inflammatory drugs (NSAIDs)

Anaphylaxis is a severe, potentially life-threatening allergic reaction that can develop rapidly. It is also known as anaphylactic shock. Signs of anaphylaxis include: itchy skin or a raised, red skin rash swollen eyes, lips, hands and feet feeling lightheaded or faint swelling of the mouth, throat or tongue, which can cause breathing and swallowing difficulties wheezing abdominal pain, nausea and vomiting collapse and unconsciousness What to do Anaphylaxis should always be treated as a medical emergency. If available, an injection of a medicine called adrenaline should be given as soon as possible. Some people with a previous history of anaphylaxis will have an auto-injector of adrenaline. This should be injected into their outer thigh muscle and held in place for 5 to 10 seconds. Instructions for how to use these auto-injectors can be found on the side of each device. You should call 999 for an ambulance whether adrenaline has been given or not. If after 5 to 10 minutes the person still feels unwell, a second injection should be given. This should be given in the opposite thigh. A second dose may also be needed if the person improves and then becomes unwell again. The person should lie flat, with their legs raised on a chair or a low table. If they are having difficulty breathing, they should sit up to make breathing easier. If the person is unconscious, you should move them to the recovery position – on their side, supported by one leg and one arm, with the head tilted back and the chin lifted. If the person's breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed. Further treatment will be carried out in hospital. Read more about treating anaphylaxis. Causes and triggers Anaphylaxis is the result of your body's immune system overreacting to a harmless substance, such as food. Substances that trigger allergic reactions are known as allergens. Anaphylaxis usually develops within minutes of contact with an allergen, but sometimes the reaction can happen up to 4 hours later. The most widely reported triggers of anaphylaxis are: insect stings – particularly wasp and bee stings peanuts and tree nuts other types of foods – such as milk and seafood certain medicines – such as antibiotics Read more about the causes of anaphylaxis. Preventing further episodes If you know what has triggered anaphylaxis, it's important to take steps to avoid exposure to similar triggers. You should be referred to a specialist allergy clinic to either find out your allergy triggers or, if you already know what causes it, for further assessment and advice about how to avoid allergens in the future. You may be given two adrenaline auto-injectors to use during any future episodes of anaphylaxis. Read more about preventing anaphylaxis. Who is affected? Anaphylaxis is not common, but people of all ages can be affected. People with other allergic conditions, such as asthma or the allergic skin condition atopic eczema, are most at risk of developing anaphylaxis. Although the condition is life threatening, deaths are rare. There are around 20 deaths in the UK each year. With prompt and proper treatment, most people make a full recovery.  Causes Anaphylaxis is caused by a problem with the immune system, which is the body's natural defence against illness and infection. In the case of anaphylaxis, your immune system overreacts to a harmless substance and releases a number of different chemicals, such as histamine, to deal with the mistaken threat. Triggers Some of the more common triggers for anaphylaxis are shown below. Insect stings Most cases of anaphylaxis are caused by wasp and bee stings, although potentially any insect bite or sting can cause anaphylaxis. It's estimated around 1 in 100 people will experience an allergic reaction after a wasp or bee sting, but only a small number of these people will go on to develop severe anaphylaxis. Foods More than half of all cases of food-related anaphylaxis are caused by peanuts. Other foods known to trigger anaphylaxis include: nuts – such as walnuts, cashew nuts, almonds, brazil nuts and hazelnuts milk fish and shellfish eggs some types of fruit – such as bananas, kiwi fruit, grapes and strawberries Medicines Medicines known to trigger anaphylaxis in a small amount of people include: antibiotics – particularly penicillin-like antibiotics general anaesthetic – muscle-relaxant medicines used during surgery  non-steroidal anti-inflammatory drugs (NSAIDs) – a type of painkiller that includes ibuprofen and aspirin People sensitive to these types of medicines will usually develop anaphylaxis as soon as they begin a course of treatment, although they may have safely received them in the past. The risk of anaphylaxis using these types of medicines is very small, so in most cases the benefits of treatment outweigh the potential risk. For example, the risk of developing anaphylaxis is around: 1 in 1,480 after taking a NSAID-type painkiller  1 in 5,000 after taking penicillin 1 in 10,000 after being given a general anaesthetic Contrast agents Contrast agents are a group of special dyes used in some medical tests to help certain areas of your body show up better on scans such as X-rays. For example, a contrast agent injected into a blood vessel will help show up any problems in the vessel, such as a blockage, on the X-ray. This is known as angiography. The risk of developing anaphylaxis after being injected with a contrast agent is thought to be less than 1 in 10,000. Rubber latex Less than 1 in 100 people in the population has a natural rubber latex allergy. Healthcare, hair, beauty, catering and motor industry workers are more likely to have a latex allergy. Those with a history of hayfever, asthma, eczema, and certain medical conditions, like spina bifida, are more likely to be affected. Idiopathic anaphylaxis Sometimes, despite extensive testing, no trigger can be found for anaphylaxis, and the cause remains unknown. This is known as idiopathic anaphylaxis. Treatment If you think somebody is experiencing symptoms of anaphylaxis, you should use an adrenaline injector if one is available. Dial 999 immediately afterwards. Call 999 straight away if an adrenaline injector is not available. If you can see a potential trigger, such as a wasp or bee sting stuck in their skin, carefully remove it. Adrenaline injections Adrenaline causes the blood vessels to become narrower, which raises your blood pressure and reduces swelling. It also causes the airways to open, relieving breathing difficulties. An adrenaline injection should be given as soon as a serious reaction is suspected. The signs of suspected anaphylaxis are: problems breathing feeling faint or dizzy loss of consciousness The injection can be done by the person with anaphylaxis, but sometimes – if it's a young child or someone who is unconscious, for example – another person may need to do it. Before attempting the injection, make sure you know what to do. You should read all of the instructions carefully when you, or the person you are responsible for, are first prescribed the injector. After injecting, the syringe should be held in place for 5 to 10 seconds. Injections can be given through clothing. After injecting the adrenaline, you should immediately dial 999 for an ambulance, even if the person is starting to feel better. Most people should experience a rapid improvement in symptoms once the adrenaline has been used. If there's no improvement after 5 to 10 minutes, you should inject a second dose of adrenaline, if one is available. This should be injected into the opposite thigh. Read Medicines and Healthcare products Regulatory Agency (MHRA) 2014 guidelines on how to use an adrenaline auto-injector (PDF, 188kb). Positioning and resuscitation In most cases, the person should lie flat, with their legs raised on a chair or a low table, to help maintain bloodflow to the head and heart. Pregnant women should lie down on their left side to avoid putting too much pressure on the large vein that leads to the heart. If the person is conscious but having trouble breathing, they should sit up to make breathing easier. If the person is unconscious, check that their airways are open and clear, and also check their breathing. Then put them in the recovery position to make sure they don't choke on their vomit. Place the person on their side, making sure they are supported by one leg and one arm. Open the airway by tilting the head and lifting the chin. If the person's breathing or heart stops, cardiopulmonary resuscitation (CPR) should be performed. Admission to hospital Even if adrenaline is given, the person will need to go to hospital for observation – usually for 6 to 12 hours – as symptoms can occasionally return during this period. While in hospital, an oxygen mask can be used to help breathing, and fluids given by an intravenous drip directly into a vein can help increase blood pressure. As well as adrenaline, additional medications such as antihistamines and corticosteroids can be used to help relieve symptoms. Blood tests may also be carried out while you're in hospital to confirm anaphylaxis. You should be able to leave hospital when the symptoms are under control and it's thought they will not return quickly. This may be after a few hours, but you may have to stay in hospital for a few days if the symptoms were severe. You may be asked to take antihistamines and corticosteroid tablets 2 to 3 days after leaving hospital to help stop your symptoms returning. You will probably be asked to attend a follow-up appointment so you can be given advice about how you can avoid further episodes of anaphylaxis. An adrenaline auto-injector may be given to you for emergency use between leaving hospital and attending the follow-up appointment. Read more about preventing anaphylaxis. Prevention If you have anaphylaxis, you should be offered advice and medication to help prevent further episodes. Allergy clinic You should be referred to a specialist allergy clinic for tests to find out what caused the anaphylaxis. Knowing what allergen triggered the allergic reaction can help you avoid further episodes of anaphylaxis. Some of the tests commonly used to determine allergies include: a skin prick test – your skin is pricked with a tiny amount of a suspected allergen to see if it reacts by becoming red, raised and itchy a blood test – a sample of your blood is taken to test its reaction to a suspected allergen Read more about diagnosing allergies. Adrenaline auto-injectors You may be prescribed an adrenaline auto-injector if you've had a previous episode of anaphylaxis and there's a risk of you having another episode in the future. There are 3 types of auto-injector: EpiPen Jext  Emerade Each type is slightly different, and you should make sure you know how to use your auto-injector correctly. You can also ask for a "trainer" kit so you can practise giving yourself or your child injections. The following points are important: Carry your auto-injector(s) at all times – there should be no exceptions. It may also be recommended that you get an emergency card or bracelet with full details of your allergy and doctor's contact details to alert others. Extremes of heat can make adrenaline less effective, so don't leave your auto-injector in the fridge or your car's glove compartment. Check the expiry date regularly. An out-of-date injector will offer limited protection. The manufacturers offer a reminder service, where you can be contacted near the expiry date. Check the information leaflet that comes with your medicine for more information. If your child has an auto-injector, they will need to change over to an adult dose once they reach 30kg (approximately 4.5 stone). Don't delay injecting yourself if you think you may be experiencing the beginning of anaphylaxis, even if your initial symptoms are mild. It's better to use adrenaline early and then find out it was a false alarm than delay treatment until you're sure you are experiencing severe anaphylaxis. Avoid triggers If a trigger has been identified as causing your episode of anaphylaxis, you will need to take steps to avoid it in the future. Food You can reduce the chances of being exposed to a food allergen by: checking food labels letting staff at a restaurant know what you're allergic to, so it's not included in your meal remembering that some types of food may contain small traces of potential allergens – for example, some sauces contain wheat and peanuts See our page on living with a food allergy for more information. Insect stings You can reduce your risk of being stung by an insect by taking basic precautions, such as: moving away from wasps, hornets or bees slowly without panicking – don't wave your arms around or swat at them using an insect repellent if you spend time outdoors, particularly in the summer Some specialist allergy centres also offer special treatment to help desensitise you to insect stings if you are at a particularly high risk of a further sting – for example, if you are a beekeeper or gardener. Read more about preventing insect stings. Medicines If you're allergic to certain types of medicines, there are normally alternatives that can be safely used. For example, if you're allergic to: penicillin – you can normally safely take a different group of antibiotics known as macrolides non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin – you can normally safely take paracetamol, but read the ingredients of things like colds medicines carefully to make sure they don't contain NSAIDs one type of general anaesthetic – others are available, or it may be possible to perform surgery using a local anaesthetic or an epidural injection angiotensin-converting enzyme (ACE) inhibitors – alternative blood pressure medications, such as calcium channel blockers, can be used Always tell any healthcare professional about medicine allergies you have, as they may not be aware of them. Contrast agents There may be times when it's necessary to use contrast agents – for example, if you had bleeding inside your brain – even if this places you at risk of anaphylaxis. In such circumstances, you can be given injections of antihistamines and corticosteroids before the contrast agents, which may help prevent symptoms occurring or at least make them less severe.