All You Have to Know About Insomnia

What is insomnia?

Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Insomnia may be due to poor quality or quantity of sleep.
Insomnia is very common and occurs in 30% to 50% of the general population. Approximately 10% of the population may suffer from chronic (long-standing) insomnia.
Insomnia affects people of all ages including children, although it is more common in adults and its frequency increases with age. In general, women are affected more frequently than men.
Insomnia may be divided into three classes based on the duration of symptoms.

• Insomnia lasting one week or less may be termed transient insomnia;
  
• short-term insomnia lasts more than one week but resolves in less than three weeks; and
  
• long-term or chronic insomnia lasts more than three weeks.

Insomnia can also be classified based on the underlying reasons for insomnia such as sleep hygiene, medical conditions, sleep disorders, stress factors, and so on.
It is important to make a distinction between insomnia and other similar terminology; short duration sleep and sleep deprivation.

• Short duration sleep may be normal in some individuals who may require less time for sleep without feeling daytime impairment, the central symptom in the definition of insomnia.
  
• In insomnia, adequate time and opportunity for sleep is available, whereas in sleep deprivation, lack of sleep is due to lack of opportunity or time to sleep because of voluntary or intentional avoidance of sleep.

What causes insomnia?

Insomnia may have many causes and, as described earlier, it can be classified based upon the underlying cause.
Situational and stress factors leading to insomnia may include:

• jet lag,
  
• physical discomfort (hot, cold, lighting, noise, unfamiliar surroundings),
  
• working different shifts,
  
• stressful life situations (divorce or separation, death of a loved one, losing a job, preparing for an examination),
  
• illicit drug use,
  
• cigarette smoking,
  
• caffeine intake prior to going to bed,
  
• alcohol intoxication or withdrawal, or
  
• certain medications.

Most of these factors may be short-term and transient, and therefore insomnia may resolve when the underlying factor is removed or corrected.
Sleep hygiene
Sleep hygiene can play an important role in insomnia. Poor sleep hygiene includes physical factors such as:

• using the bedroom for things other than sleeping,
  
• eating or exercising prior to sleep,
  
• going to bed hungry,
  
• sleeping in a room with too much noise or lighting, or
  
• doing work in bed.

Medical and psychiatric conditions
Medical and psychiatric conditions may also contribute to insomnia.
Some of these common medical conditions may include:

• breathing problems from chronic heart or lung disease (asthma, chronic obstructive pulmonary disease (COPD),
  
• congestive heart failure,
  
• obstructive sleep apnea),
  
• obesity,
  
• acid reflux,
  
• hyperthyroidism,
  
• urinary problems (frequent urination, urinary incontinence),
  
• chronic pain,
  
• fibromyalgia,
  
• Parkinson's disease, or
  
• dementia.

Common psychiatric problems can be responsible for insomnia including:

• depression,
  
• psychosis,
  
• mania,
  
• anxiety, or
  
• posttraumatic stress disorder (PTSD).

Some common physiologic conditions can lead to insomnia such as:

• menopause,
  
• menstrual cycle,
  
• pregnancy,
  
• fever, or
  
• pain.

Other causes of insomnia may be related to sleep disorders including:

• sleep walking,
  
• sleep apnea,
  
• restless leg syndrome (creeping sensations in the leg during sleep, relieved by leg movement),
  
• periodic limb movement disorder (involuntary repeated leg movement during sleep), or
  
• circadian sleep disturbance (unusual sleep time due to disturbed biological clock).

 

What are other causes of insomnia?

Besides the conditions listed previously, there are other types of insomnia that are not necessarily linked to an underlying condition. Some of the common types of insomnia are listed in this section.
Psychophysiological insomnia
Psychophysiological insomnia or primary insomnia is a type of insomnia in which learned behaviors prevent sleep. Individuals with this condition are unable to relax their minds (racing thoughts) and have an increased mental function when they try to fall sleep. This may become a long-term issue, and going to bed becomes associated with an increased level of anxiety and mental arousal, leading to chronic insomnia. This condition may be present in about 15% of people who undergo formal sleep studies for evaluation of chronic insomnia.
Idiopathic insomnia
Idiopathic insomnia (without an obvious cause) (childhood onset insomnia or life-long insomnia) is a less common condition (1% of young adults or adolescents) that starts in childhood and may continue into adulthood. These individuals have difficulty initiating and maintaining sleep and have chronic daytime fatigue. Other more common conditions need to be evaluated and ruled out before this diagnosis is made. This condition may run in families.
Paradoxical insomnia
Paradoxical insomnia is also called subjective insomnia or sleep state misconception. In this condition, individuals may report and complain of insomnia;, however, they would have a normal pattern of sleep if they were to have a formal overnight sleep study done.

What are the risk factors for insomnia?

There are no specific risk factors for insomnia because of the variety of underlying causes that may lead to insomnia. The medical and psychiatric conditions listed earlier may be considered risk factors for insomnia if untreated or difficult to treat. Some of the emotional and environmental situations that were also mentioned above may act as risk factor for insomnia.

What are the symptoms of insomnia?

Impairment of daytime functioning is the defining and the most common symptom of insomnia.
Other common symptoms include:

• daytime fatigue,
  
• daytime sleepiness,
  
• mood changes,
  
• poor attention and concentration,
  
• lack of energy,
  
• anxiety,
  
• poor social function,
  
• headaches, and
  
• increased errors and mistakes. 

 

When should I call the doctor about insomnia?

In general, insomnia related to transient situational factors resolves spontaneously when the provoking factor is removed or corrected. However, medical evaluation by a doctor may be necessary if the insomnia persists or it is thought to be related to a medical or a psychiatric condition.
There are also specialized doctors who evaluate and treat insomnia and other sleep disorders. Sleep apnea may be evaluated and treated by pulmonologists (lung doctors) who have specialized in sleep disorders. Other doctors who evaluate and treat sleep disorders are neurologists with a specialty in sleep disorders.

How is insomnia diagnosed?

Evaluation and diagnosis of insomnia may start with a thorough medical and psychiatric patient history taken by the physician. As mentioned above, many medical and psychiatric conditions can be responsible for insomnia.
A general physical examination to assess for any abnormal findings is also important, including assessment of mental status and neurological function; heart, lung and abdominal exam; ear, nose and throat exam; and measurement of the neck circumference and waist size. Assessment of routine medications and use of any illegal drugs, alcohol, tobacco, or caffeine is also an important part of the medical history. Any laboratory or blood work pertinent to these conditions can also be a part of the assessment.
The patient's family members and bed partners also need to be interviewed to ask about the patient's sleep patterns, snoring, or movements during sleep.
Specific questions regarding sleep habits and patterns are also a vital part of the assessment. A sleep history focuses on:

• duration of sleep,
  
• time of sleep,
  
• time to fall sleep,
  
• number and duration of awakenings,
  
• time of final awakening in the morning, and
  
• time and length of any daytime naps.

Sleep logs or diaries may be used for this purpose to record these parameters on a daily basis for more accurate assessment of sleep patterns.
Sleep history also typically includes questions about possible symptoms associated with insomnia. The physician may ask about daytime functioning, fatigue, concentration and attention problems, naps, and other common symptoms of insomnia.
Other diagnostic tests may be done as part of the evaluation for insomnia, although they may not be necessary in all patients with insomnia.
Polysomnography is a test that is done in sleep centers if conditions such as sleep apnea are suspected. In this test, the person will be required to spend a full night at the sleep center while being monitored for heart rate, brain waves, respirations, movements, oxygen levels, and other parameters while they are sleeping. The data is then analyzed by a specially trained physician to diagnose or rule out sleep apnea.
Actigraphy is another more objective test that may be performed in certain situations but is not routinely a part of the evaluation for insomnia. An actigraph is a motion detector that senses the person's movements during sleep and wakefulness. It is worn similar to a wrist watch for days to weeks, and the movement data are recorded and analyzed to determine sleep patterns and movements. This test may be useful in cases of primary insomnia disorder, circadian rhythm disorder, or sleep state misconception.

How is insomnia treated?

The treatment of insomnia depends largely on the cause of the problem. In cases where an obvious situational factor is responsible for the insomnia, correcting or removing the cause generally cures the insomnia. For example, if insomnia is related to a transient stressful situation, such as jet lag or an upcoming examination, then insomnia will be cured when the situation resolves.
Generally speaking, the treatment of insomnia can be divided into non-medical or behavioral approaches and medical therapy. Both approaches are necessary to successfully treat insomnia, and combinations of these approaches may be more effective than either approach alone.
When insomnia is related to a known medical or psychiatric condition, then appropriate treatment of that condition is in the forefront of therapy for insomnia in addition to the specific therapy for insomnia itself. Without adequately addressing the underlying cause, insomnia will likely go on despite taking aggressive measures to treat it with both medical and non-medical therapies.

What are non-medical treatments for insomnia?

There are several recommended techniques used in treating people with insomnia. These are non-medical strategies and are generally advised to be practiced at home in combination with other remedies for insomnia, such as medical treatments for insomnia and treatment for any underlying medical or psychiatric disorders.
Some of the most important of these behavioral techniques are sleep hygiene, stimulus control, relaxation techniques, and sleep restriction.

What is sleep hygiene?

Sleep hygiene is one of the components of non-medical treatments for insomnia and includes simple steps that may improve initiation and maintenance of sleep. Sleep hygiene consists of the following strategies:

• Sleep as much as possible to feel rested, then get out of bed (do not over-sleep).
  
• Maintain a regular sleep schedule.
  
• Do not force yourself to sleep.
  
• Do not drink caffeinated beverages in the afternoon or evening.
  
• Do not drink alcohol prior to going to bed.
  
• Do not smoke, especially in the evening.
  
• Adjust the bedroom environment to induce sleep.
  
• Do not go to bed hungry.
  
• Resolve stress and anxiety before going to bed.
  
• Exercise regularly, but not 4-5 hours prior to bed time.

 

How can stimulus control help with insomnia?

Stimulus control refers to techniques used to help with initiating sleep. These techniques are used to induce an environment in the bedroom that promotes sleep. Some simple steps include:

• Use the bed only for having sex and sleeping, not working, reading, watching TV, eating, or other mentally stimulating activities.
  
• Go to bed only when you feel ready to sleep.
  
• Turn off the lights and all the noise in and around the bedroom.
  
• Get up at the same time every morning to avoid over-sleeping.
  
• If you do not fall asleep longer than 20 minutes after going to bed, get up and try some relaxation techniques until you are ready to sleep again.

Relaxation techniques, which are also a part of non-medical therapy for insomnia, involve sitting or lying comfortably and relaxing muscles of the body in one area at time. This may be combined with deep, relaxed breathing to promote further body relaxation.

What is sleep restriction?

Sleep restriction refers another non-medical behavioral therapy for insomnia which involves limiting the time spent in bed for sleeping only. Many people with insomnia may stay in bed for a long time after they wake up in the morning. This over-sleeping may disrupt the circadian rhythm and make sleep initiation more difficult the following night.
Sleep logs are used to record the actual time spent sleeping each night, and the time spent in bed is gradually reduced to the exact time spent sleeping by shortening the total time in bed. This method gradually reduces and eliminates over-sleeping over a period of time. It also increases the drive to sleep and makes sleep more efficient, as the time spent in bed approximates the duration of sleep.

What medications are used to treat insomnia?

The main classes of medications used to treat insomnia are the sedatives and hypnotics, such as the benzodiazepines and the non-benzodiazepine sedatives.
Several medications in the benzodiazepine class have been used successfully for the treatment of insomnia, and the most common ones include:

• quazepam (Doral),
  
• triazolam (Halcion),
  
• estazolam (ProSom),
  
• temazepam (Restoril),
  
• flurazepam (Dalmane), and
  
• lorazepam (Ativan).

Another common benzodiazepine, diazepam (Valium), is typically not used to treat insomnia due to its longer sedative effects.
Non-benzodiazepine sedatives are also used commonly for the treatment of insomnia and include most of the newer drugs. Some of the most common ones are:

• zaleplon (Sonata),
  
• zolpidem (Ambien or Ambien CR, Zolpimist), and
  
• eszopiclone (Lunesta).

Melatonin, a chemical released from the brain which induces sleep, has been tried in supplement form for treatment of insomnia as well. It has been generally ineffective in treating common types of insomnia, except in specific situations in patients with known low levels of melatonin. Melatonin may be purchased over-the-counter (without a prescription).
Ramelteon (Rozerem), which is an insomnia drug that acts by mimicking the action of melatonin, is a newer drug. It has been used effectively in certain group of patients with insomnia.
There are also other medications that are not in the sedative or hypnotic classes, which have been used in the treatment of insomnia. Sedative antihistamines, diphenhydramine (Benadryl) have been used as sleep aids because of their sedative effects; however, this is not a recommended use of these or other similar drugs due to many side effects and long-term drowsiness the following day.
Some anti-depressants [for example, trazodone (Desyrel), amitriptyline (Elavil, Endep), doxepin (Sinequan, Adapin)] can be used effectively to treat insomnia in patients who also may suffer from depression. Some anti-psychotics have been used to treat insomnia, although their routine use for this purpose is generally not recommended.
A doctor or sleep specialist is the best person to discuss these different medications, and to decide which one may be the best for each specific individual. Many of these drugs have a potential for abuse and addiction and need to be used with caution. None of these medications may be taken without the supervision of the prescribing physician.

What is the outlook for insomnia?

Insomnia overall has a favorable outlook. Many cases of insomnia are related to transient situational stresses and are easily reversed when the situation is resolved. In cases of long-standing (chronic) insomnia, any medical or psychiatric cause needs to be assessed and treated. Medical and non-medical home remedies are available for treating insomnia and are generally successful.

Insomnia At A Glance

• Insomnia is a condition characterized by poor quality or quantity of sleep, despite adequate opportunity to sleep, which could lead to daytime functional impairment.
  
• Many medical and psychiatric conditions may be responsible for causing insomnia.
  
• Insomnia may, at times, be unrelated to any underlying condition.
  
• There are several useful non-medical behavioral techniques available for treating insomnia.
  
• Medications are widely used to treat insomnia in conjunction with non-medical strategies.
  
• Sleep specialists are medical doctors who can play an important role in evaluating and treating long-standing (chronic) insomnia. 

http://www.medicinenet.com/ 

ALLERGY

What does an allergy mean?

An allergy refers to an exaggerated reaction by our immune system in response to bodily contact with certain foreign substances. It is exaggerated because these foreign substances are usually seen by the body as harmless and no response occurs in non- allergic people. Allergic people's bodies recognize the foreign substance and one part of the immune system is turned on. Allergy-producing substances are called "allergens." Examples of allergens include pollens, dust mite, molds, danders, and foods. To understand the language of allergy it is important to remember that allergens are substances that are foreign to the body and can cause an allergic reaction in certain people.
When an allergen comes in contact with the body, it causes the immune system to develop an allergic reaction in persons who are allergic to it. When you inappropriately react to allergens that are normally harmless to other people, you are having an allergic reaction and can be referred to as allergic or atopic. Therefore, people who are prone to allergies are said to be allergic or "atopic."
Austrian pediatrician Clemens Pirquet (1874-1929) first used the term allergy. He referred to both immunity that was beneficial and to the harmful hypersensitivity as "allergy." The word allergy is derived from the Greek words "allos," meaning different or changed and "ergos," meaning work or action. Allergy roughly refers to an "altered reaction." The word allergy was first used in 1905 to describe the adverse reactions of children who were given repeated shots of horse serum to fight infection. The following year, the term allergy was proposed to explain this unexpected "changed reactivity."

Allergy Fact

• It is estimated that 50 million North Americans are affected by allergic conditions.
• The cost of allergies in the United States is more than $10 billion dollars yearly.
• Allergic rhinitis (nasal allergies) affects about 35 million Americans, 6 million of whom are children.
• Asthma affects 15 million Americans, 5 million of whom are children.
• The number of cases of asthma has doubled over the last 20 years.

What causes allergies?

To help answer this question, let's look at a common household example. A few months after the new cat arrives in the house, dad begins to have itchy eyes and episodes of sneezing. One of the three children develops coughing and wheezing, especially when the cat comes into her bedroom. The mom and the other two children experience no reaction whatsoever to the presence of the cat. How can we explain this?
The immune system is the body's organized defense mechanism against foreign invaders, particularly infections. Its job is to recognize and react to these foreign substances, which are called antigens. Antigens are substances that are capable of causing the production of antibodies. Antigens may or may not lead to an allergic reaction. Allergens are certain antigens that cause an allergic reaction and the production of IgE.
The aim of the immune system is to mobilize its forces at the site of invasion and destroy the enemy. One of the ways it does this is to create protective proteins called antibodies that are specifically targeted against particular foreign substances. These antibodies, or immunoglobulins (IgG, IgM, IgA, IgD), are protective and help destroy a foreign particle by attaching to its surface, thereby making it easier for other immune cells to destroy it. The allergic person however, develops a specific type of antibody called immunoglobulin E, or IgE, in response to certain normally harmless foreign substances, such as cat dander. To summarize, immunoglobulins are a group of protein molecules that act as antibodies. There are five different types; IgA, IgM, IgG, IgD, and IgE. IgE is the allergy antibody.
(In 1967, the husband and wife team of Kimishige and Teriko Ishizaka detected a previously unrecognized type of immunoglobulin in allergic people. They called it gamma E globulin or IgE.)
In the pet cat example, the dad and the youngest daughter developed IgE antibodies in large amounts that were targeted against the cat allergen, the cat dander. The dad and daughter are now sensitized or prone to develop allergic reactions on subsequent and repeated exposures to cat allergen. Typically, there is a period of "sensitization" ranging from months to years prior to an allergic reaction. Although it might occasionally appear that an allergic reaction has occurred on the first exposure to the allergen, there must have been a prior contact in order for the immune system to be poised to react in this way.
IgE is an antibody that all of us have in small amounts. Allergic persons, however, produce IgE in large quantities. Normally, this antibody is important in protecting us from parasites, but not from cat dander or other allergens. During the sensitization period, cat dander IgE is being overproduced and coats certain potentially explosive cells that contain chemicals. These cells are capable of causing an allergic reaction on subsequent exposures to the dander. This is because the reaction of the cat dander with the dander IgE irritates the cells and leads to the release of various chemicals, including histamine. These chemicals, in turn, cause inflammation and the typical allergic symptoms. This is how the immune system becomes exaggerated and primed to cause an allergic reaction when stimulated by an allergen.
On exposure to cat dander, the mom and the other two children produce other classes of antibodies, none of which cause allergic reactions. In these non-allergic members of the family, the dander particles are eliminated uneventfully by the immune system and the cat has no effect on them.
Figure 1

The Immune System Foreign Substance alt="-" (cat dander, pollen, virus, bacteria)
Normal Immune Response IgM, IgG, IgA, IgD and various immune cells respond to attack.		Exaggerated Immune Response IgE is overproduced in response to cat dander, pollens, and other harmless allergens.
Foreign substance is eliminated.		Subsequent exposure results in an allergic reaction.
Non-Allergic Individual		Allergic Individual

Who is at risk and why?

Allergies can develop at any age, possibly even in the womb. They commonly occur in children but may give rise to symptoms for the first time in adulthood. Asthma may persist in adults while nasal allergies tend to decline in old age.
Why, you may ask, are some people "sensitive" to certain allergens while most are not? Why do allergic persons produce more IgE than those who are non-allergic? The major distinguishing factor appears to be heredity. For some time, it has been known that allergic conditions tend to cluster in families. Your own risk of developing allergies is related to your parents' allergy history. If neither parent is allergic, the chance that you will have allergies is about 15%. If one parent is allergic, your risk increases to 30% and if both are allergic, your risk is greater than 60%.
Although you may inherit the tendency to develop allergies, you may never actually have symptoms. You also do not necessarily inherit the same allergies or the same diseases as your parents. It is unclear what determines which substances will trigger a reaction in an allergic person. Additionally, which diseases might develop or how severe the symptoms might be is unknown.
Another major piece of the allergy puzzle is the environment. It is clear that you must have a genetic tendency and be exposed to an allergen in order to develop an allergy. Additionally, the more intense and repetitive the exposure to an allergen and the earlier in life it occurs, the more likely it is that an allergy will develop.
There are other important influences that may conspire to cause allergic conditions. Some of these include smoking, pollution, infection, and hormones.

What are common allergic conditions, and what are allergy symptoms and signs?

The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Although the various allergic diseases may appear different, they all result from an exaggerated immune response to foreign substances in sensitive people. The following brief descriptions will serve as an overview of common allergic disorders.

Allergic Rhinitis

Allergic rhinitis ("hay fever") is the most common of the allergic diseases and refers to seasonal nasal symptoms that are due to pollens. Year round or perennial allergic rhinitis is usually due to indoor allergens, such as dust mites, animal dander, or molds. It can also be caused by pollens. Symptoms result from the inflammation of the tissues that line the inside of the nose (mucus lining or membranes) after allergens are inhaled. Adjacent areas, such as the ears, sinuses, and throat can also be involved. The most common symptoms include:

• Runny nose
• Stuffy nose
• Sneezing
• Nasal itching (rubbing)
• Itchy ears and throat
• Post nasal drip (throat clearing)

In 1819, an English physician, John Bostock, first described hay fever by detailing his own seasonal nasal symptoms, which he called "summer catarrh." The condition was called hay fever because it was thought to be caused by "new hay."

Asthma

Asthma is a breathing problem that results from the inflammation and spasm of the lung's air passages (bronchial tubes). The inflammation causes a narrowing of the air passages, which limits the flow of air into and out of the lungs. Asthma is most often, but not always, related to allergies. Common symptoms include:

• Shortness of breath
• Wheezing
• Coughing
• Chest tightness

Allergic Eyes

Allergic eyes (allergic conjunctivitis) is inflammation of the tissue layers (membranes) that cover the surface of the eyeball and the undersurface of the eyelid. The inflammation occurs as a result of an allergic reaction and may produce the following symptoms:

• Redness under the lids and of the eye overall
• Watery, itchy eyes
• Swelling of the membranes

 

Allergic Eczema

Allergic eczema (atopic dermatitis) is an allergic rash that is usually not caused by skin contact with an allergen. This condition is commonly associated with allergic rhinitis or asthma and features the following symptoms:

• Itching, redness, and or dryness of the skin
• Rash on the face, especially children
• Rash around the eyes, in the elbow creases, and behind the knees, especially in older children and adults (rash can be on the trunk of the body)

Hives

Hives (urticaria) are skin reactions that appear as itchy swellings and can occur on any part of the body. Hives can be caused by an allergic reaction, such as to a food or medication, but they also may occur in non-allergic people. Typical hive symptoms are:

• Raised red welts
• Intense itching

Allergic Shock

Allergic shock (anaphylaxis or anaphylactic shock) is a life-threatening allergic reaction that can affect a number of organs at the same time. This response typically occurs when the allergen is eaten (for example, foods) or injected (for example, a bee sting). Some or all of the following symptoms may occur:

• Hives or reddish discoloration of the skin
• Nasal congestion
• Swelling of the throat
• Stomach pain, nausea, vomiting
• Shortness of breath, wheezing
• Low blood pressure or shock

Shock refers to the insufficient circulation of blood to the body's tissues. Shock is most commonly caused by blood loss or an infection. Allergic shock is caused by dilated and "leaky" blood vessels, which result in a drop in blood pressure.

Where are allergens?

Everywhere...
We have seen that allergens are special types of antigens that cause allergic reactions. The symptoms and diseases that result depend largely on the route of entry and level of exposure to the allergens. The chemical structure of allergens affects the route of exposure. Airborne pollens, for example, will have little effect on the skin. They are easily inhaled and will thus cause more nasal and lung symptoms and limited skin symptoms. When allergens are swallowed or injected they may travel to other parts of the body and provoke symptoms that are remote from their point of entry. For example, allergens in foods may prompt the release of mediators in the skin and cause hives.
We will assume that allergens are defined as: the source of the allergy producing substance (for example, cat), the substance itself (cat dander), or the specific proteins that provoke the immune response (for example, Feld1). Feld1, from the Felis domesticus (the domesticated cat), is the most important chemical allergen in cat dander.
Allergens may be inhaled, ingested (eaten or swallowed), applied to the skin, or injected into the body either as a medication or inadvertently by an insect sting.

In the Air We Breathe

Breathing can be hazardous if you are allergic. Aside from oxygen, the air contains a wide variety of particles; some toxic, some infectious, and some "innocuous," including allergens. The usual diseases that result from airborne allergens are hay fever, asthma, and conjunctivitis. The following allergens are usually harmless, but can trigger allergic reactions when inhaled by sensitized individuals.

• Pollens: trees, grasses, and/or weeds
• Dust mites
• Animal proteins: dander, skin, and/or urine
• Mold spores
• Insect parts: cockroaches

 

In What We Ingest

When foods or medications are ingested, allergens may gain access to the blood stream and become attached to specific IgE on cells in remote sites such as the skin or nasal membranes. The ability of allergens to travel explains how symptoms can occur in areas other than the gastrointestinal tract. Food allergy reactions may begin with tongue or throat swelling and may be followed by tingling, nausea, diarrhea, or stomach cramps. Nasal breathing difficulties or skin reactions may also be seen. The two main allergen groups that are ingested are:

• Foods
• Drugs (when taken by mouth): for example, antibiotics and aspirin

Allergy Assist The most common foods that cause allergic reactions are cow's milk, fish, shellfish, eggs, peanuts, tree nuts, soy, and wheat.

Touching Our Skin

Allergic contact dermatitis is an inflammation of the skin that is caused by a local allergic reaction. The majority of these localized skin reactions do not involve IgE, but are caused by cells of inflammation. The rash produced is similar to that of a poison ivy rash. It should be noted that when some allergens (for example, latex) come into contact with the skin, they are absorbed by the skin and can also potentially cause reactions throughout the body, not just the skin. For most people, however, the skin is a formidable barrier that can be only locally affected. Examples of allergic contact dermatitis include:

• Latex (causes IgE and non-IgE reactions)
• Plants (poison ivy and oak)
• Dyes
• Chemicals
• Metals (nickel)
• Cosmetics

Allergic contact dermatitis does not involve IgE antibody, but involves cells of the immune system which are programmed to react when triggered by a sensitizing allergen. Touching or rubbing a substance to which you were previously sensitized can trigger a skin rash.

Injected into Our Body

The most severe reactions can occur when allergens are injected into the body and gain direct access to the blood stream. This access carries the risk of a generalized reaction, such as anaphylaxis, which can be life-threatening. The following are commonly injected allergens that can cause severe allergic reactions:

• Insect venom
• Medications
• Vaccines (including allergy shots)
• Hormones (for example, insulin)

Allergy At A Glance

• Allergy involves an exaggerated response of the immune system.
• The immune system is the body's organized defense mechanism against foreign invaders, particularly infections.
• Allergens are substances that are foreign to the body and can cause an allergic reaction.
• IgE is the allergy antibody.
• Allergies can develop at any age.
• Your risk of developing allergies is related to your parents' allergy history.
•  

REFERENCES: Fiocchi A, Assa'ad A, Bahna S; Adverse Reactions to Foods Committee; American College of Allergy, Asthma and Immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Adverse Reactions to Foods Committee, American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 2006 Jul;97(1):10-20; quiz 21, 77.

Price D, Bond C, Bouchard J, Costa R, Keenan J, Levy ML, Orru M, Ryan D, Walker S, Watson M. International Primary Care Respiratory Group (IPCRG) Guidelines: management of allergic rhinitis. Prim Care Respir J. 2006 Feb;15(1):58-70. Epub 2005 Dec 27.

American College of Allergy, Asthma, & Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol. 2006 Mar;96(3 Suppl 2):S1-68. No abstract available.

Flinterman AE, Pasmans SG, Hoekstra MO, Meijer Y, van Hoffen E, Knol EF, Hefle SL, Bruijnzeel-Koomen CA, Knulst AC. Determination of no-observed-adverse-effect levels and eliciting doses in a representative group of peanut-sensitized children. J Allergy Clin Immunol. 2006 Feb;117(2):448-54.

Scibilia J, Pastorello EA, Zisa G, Ottolenghi A, Bindslev-Jensen C, Pravettoni V, Scovena E, Robino A, Ortolani C. Wheat allergy: a double-blind, placebo-controlled study in adults. J Allergy Clin Immunol. 2006 Feb;117(2):433-9.

Medically Reviewed By: Ellen Reich, MD, Board Certified in Allergy and Immunology, Board Certified in Pediatrics

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Rasulullah shallallahu'alaihi wasallam Berlindung dari Lima Perkara

Saudariku muslimah yang dimuliakan Allah..
Sesungguhnya Rasul kita yang mulia Muhammad shalallahu ‘alaihi wasallam adalah merupakan uswah, teladan kita dalam kehidupan kita.

لَقَدْ كَانَ لَكُمْ فِي رَسُولِ اللَّهِ أُسْوَةٌ حَسَنَةٌ لِّمَن كَانَ يَرْجُو اللَّهَ وَالْيَوْمَ الْآخِرَ وَذَكَرَ اللَّهَ كَثِير

“Sesungguhnya telah ada pada diri Rasulullah itu suatu tauladan yang baik bagimu (yaitu) bagi orang-orang yang mengharapkan rahmat Allah dan keselamatan dihari kiamat dan banyak mengingat Allah.” (Qs. Al-Ahzab : 21)
Rasulullah shalallahu ‘alaihi wasallam mengajarkan kepada umatnya perkara-perkara yang diperintahkan oleh Allah dan mempraktekkannya agar umatnya dapat mengamalkannya. Diantaranya adalah do’a setelah tasyahud akhir sebelum salam. Do’a itu senantiasa Rasulullah ajarkan kepada umatnya agar senantiasa dibaca setiap sebelum salam. Begitu pentingnya hal ini sehingga disunnahkan setiap kali shalat untuk berdo’a memohon perlindungan kepada Allah dari empat perkara, yaitu :

اَللَّهُمَّ إِنِّيْ أَعُوْذُ بِكَ مِنْ عَذَابِ الْقَبْرِ ، وَمِنْ عَذَابِ جَهَنَّمَ  ، وَمِنْ فِتْنَةِ الْمَحْيَا وَالْمَمَاتِ، وَمِنْ شَرِّ فِتْنَةِ الْمَسِيْحِ الدَّجَّالِ

“Ya Allah, Sesungguhnya aku berlindung kepadaMu dari siksaan kubur, siksa neraka Jahanam, fitnah kehidupan dan setelah mati, serta dari kejahatan fitnah Almasih Dajjal.” (HR. Bukhari-Muslim)
Dalam riwayat yang lain,

اَللَّهُمَّ إِنِّيْ أَعُوْذُ بِكَ مِنْ عَذَابِ الْقَبْرِ، وَأَعُوْذُ بِكَ مِنْ فِتْنَةِ الْمَسِيْحِ الدَّجَّالِ، وَأَعُوْذُ بِكَ مِنْ فِتْنَةِ الْمَحْيَا وَالْمَمَاتِ . اَللَّهُمَّ إِنِّيْ أَعُوْذُ بِكَ مِنْ الْمَأْثَمِ وَالْمَغْرَمِ

“Ya Allah! Sesungguhnya aku berlindung kepadaMu dari siksa kubur. Aku berlindung kepadaMu dari fitnah Almasih Dajjal. Aku berlindung kepadaMu dari fitnah kehidupan dan sesudah mati. Ya Allah, Sesungguhnya aku berlindung kepadaMu dari perbuatan dosa dan hutang.” (HR. Bukhari-Muslim)
Saudariku muslimah ..
Rasulullah shalallahu ‘alaihi wasallam menganjurkan kepada umat beliau untuk memohon perlindung dari empat perkara ini disetiap kali kita sholat dan diulang-ulang setiap harinya. Hal ini menunjukkan betapa penting dan agungnya do’a ini.

Yang pertama, Rasulullah shalallahu ‘alaihi wasallam berlindung dari azab Jahannam.

اَللَّهُمَّ إِنِّيْ أَعُوْذُ بِكَ مِنْ عَذَابِ جَهَنَّمَ

Jahannam, ia adalah merupakan tempat kembali seburuk-buruknya tempat kembali. Neraka Jahannam yang disebutkan oleh Rasulullah shalallahu ‘alaihi wasallam memiliki panas 70 kali lipat dari api dunia. Hal itu telah digambarkan oleh Rasulullah shalallahu ‘alaihi wasallam dalam sebuah hadist yang diriwayatkan oleh shahabat Abu Hurairah radhiyallahu ‘anhu, “(Panasnya) api yang kalian (Bani Adam) nyalakan di dunia ini merupakan sebagian dari tujuh puluh bagian panasnya api neraka Jahannam.” Para sahabat bertanya, “Demi Allah, api dunia itu sudah cukup wahai Rasulullah!” Beliau shalallahu ‘alaihi wasallam bersabda, “sesungguhnya panasnya api neraka melebihi panas api dunia sebanyak enam puluh kali lipat.” (HR. Muslim no. 2843)
Rasulullah shalallahu ‘alaihi wasallam kemudian menyebutkan betapa seramnya azab neraka. Penduduknya dijadikan berbadan sebesar-besarnya sampai-sampai Rasulullah shalallahu ‘alaihi wasallam mengabarkan bahwasanya gigi penduduk neraka sebesar Gunung Uhud. Yang demikian itu agar penduduk neraka lebih merasakan azab.
Dari Abu Hurairah radhiyallahu ‘anhu berkata, “Dari Nabi shallallahu ‘alaihi wasallam bersabda, ‘Jarak antara kedua pundak orang kafir (di neraka) seperti jarak orang yang menaiki kendaraan dengan cepat selama tiga hari.‘ (HR. Bukhori : 5661, Muslim : 2582).
Dari Abu Hurairah radhiyallahu ‘anhu dari Nabi shallallahu alaihi wasallam bersabda, “(Besar) gigi geraham orang kafir atau gigi taringnya (di neraka) seperti gunung uhud, dan tebal kulitnya sejarak perjalanan tiga hari.” (HR. Muslim : 2851).
Kulit mereka yang begitu tebal dibakar dengan api yang menyala-nyala hingga kulit itupun hangus. Dan apabila kulit itu hangus lalu Allah akan menggantinya dengan kulit yang lain.
Allah Ta’ala berfirman,

إِنَّ الَّذِينَ كَفَرُواْ بِآيَاتِنَا سَوْفَ نُصْلِيهِمْ نَاراً كُلَّمَا نَضِجَتْ جُلُودُهُمْ بَدَّلْنَاهُمْ جُلُوداً غَيْرَهَا لِيَذُوقُواْ الْعَذَابَ إِنَّ اللّهَ كَانَ عَزِيزاً حَكِيماً

“Sesungguhnya orang-orang yang kafir kepada ayat-ayat Kami, kelak akan Kami masukkan kedalam neraka. Setiap kulit tubuh mereka hangus, Kami ganti kulit mereka dengan kulit yang lain, agar mereka merasakan adzab. Sesungguhnya Allah Maha Perkasa lagi Maha Bijaksana.” (Qs. An-Nisa : 56)
Saudariku Muslimah.. Maka dari itu, sudah selayaknya kita berlindung kepada Allah dari  keburukan azab neraka jahanam.

Yang kedua, Rasulullah shalallahu ‘alaihi wasallam berlindung dari azab kubur.

وَمِنْ عَذَابِ الْقَبْرِ

Azab kubur merupakan kehidupan akhirat yang pertama kali. Azab kubur adalah penentuan bagi seorang hamba. Jika ia selamat di dalam kuburnya, maka ia akan lebih selamat lagi di hari akhirat kelak. Dan sebaliknya, apabila ia tidak selamat didalam kuburnya, lebih-lebih dia tidak akan selamat di dalam kehidupan akhirat kelak.
Pada saat Utsman bin Affan radhiyallahu ‘anhu melihat kuburan ketika berziarah, beliaupun menangis. Lalu ditanya oleh sahabatnya,”Wahai Utsman, dituturkan surga neraka engkau tidak menangis, sekarang melihat kuburan engkau menangis!” Utsman menjawab, Rasulullah shalallahu ‘alaihi wasallam pernah berkata,
“Kuburan adalah rintangan pertama kali akhirat, siapa yang sekarang berhasil di situ setelahnya lebih mudah, siapa yang celaka di situ, maka setelahnya akan lebih susah. Tidaklah aku melihat suatu pandangan yang lebih mengerikan dibandingkan kuburan” (HR. Ahmad-Tirmidzi)
Maka sudah sepatutnya kita berlindung dari adzab kubur. Dan sudah sepatutnya pula kita berlindung kepada Allah Subhanahu wa Ta’ala sambil kita menjauhi perkara-perkara yang dapat menyebabkan kita diazab didalam kubur. Tahukah engkau wahai saudariku, apa yang meyebabkan seorang hamba diazab didalam kuburnya? Ada dua sebab, sebab yang umum dan sebab yang khusus. Diantara sebab yang umum wahai saudariku, adalah setiap kemaksiatan kepada Allah. Itulah penyebab seorang hamba di azab di dalam kubur. Adapun sebab yang khusus wahai saudariku, maka yang ditunjukkan oleh dalil-dalil syariat. Disebutkan didalam hadits, Rasulullah shallallahu ‘alaihi wasallam berkata kepada Jibril dan Mikail ‘alaihissalam sebagaimana disebutkan dalam hadits yang panjang,

فَأَخْبِرَانِي عَمَّا رَأَيْتُ. قَالَا: نَعَمْ، أَمَّا الَّذِي رَأَيْتَهُ يُشَقُّ شِدْقُهُ فَكَذَّابٌ يُحَدِّثُ بِالْكَذْبَةِ فَتُحْمَلُ عَنْهُ حَتَّى تَبْلُغَ الْآفَاقَ فَيُصْنَعُ بِهِ إِلَى يَوْمِ الْقِيَامَةِ، وَالَّذِي رَأَيْتَهُ يُشْدَخُ رَأْسُهُ فَرَجُلٌ عَلَّمَهُ اللهُ الْقُرْآنَ فَنَامَ عَنْهُ بِاللَّيْلِ وَلَمْ يَعْمَلْ فِيهِ بِالنَّهَارِ يُفْعَلُ بِهِ إِلَى يَوْمِ الْقِيَامَةِ، وَالَّذِي رَأَيْتَهُ فِي الثَّقْبِ فَهُمُ الزُّنَاةُ، وَالَّذِي رَأَيْتَهُ فِي النَّهْرِ آكِلُوا الرِّبَا

“Beritahukanlah kepadaku tentang apa yang aku lihat.” Keduanya menjawab,”Ya. Adapun orang yang engkau lihat dirobek mulutnya, dia adalah pendusta. Dia berbicara dengan kedustaan lalu kedustaan itu dinukil darinya sampai tersebar luas. Maka dia disiksa dengan siksaan tersebut hingga hari kiamat. Adapun orang yang engkau lihat dipecah kepalanya, dia adalah orang yang telah Allah ajari Al-Qur’an, namun dia tidur malam (dan tidak bangun untuk shalat malam). Pada siang hari pun dia tidak mengamalkannya. Maka dia disiksa dengan siksaan itu hingga hari kiamat. Adapun yang engkau lihat orang yang disiksa dalam tungku, mereka adalah pezina. Adapun orang yang engkau lihat di sungai darah, dia adalah orang yang makan harta dari hasil riba.” (HR. Al-Bukhari no. 1386 dari Jundub bin Samurah radhiyallahu ‘anhu)
Itulah sebagian adzab kubur yang diperlihatkan kepada Rasulullah shalallahu ‘alaihi wasallam. Maka dari itu wahai saudariku, mohonlah perlindungan kepada Allah dari siksa kubur, karena ia merupakan siksa pedih sebelum kita melanjutkan perjalanan menuju akhirat.

Yang ketiga, Rasulullah shallallahu’alaihi wa sallam berlindung dari fitnah kehidupan dan sesudah kematian.

وَأَعُوْذُ بِكَ مِنْ فِتْنَةِ الْمَحْيَا وَالْمَمَاتِ

“Aku berlindung kepadaMu dari fitnah kehidupan dan sesudah mati”
Fitnah hidup berupa syubhat dan syahwat. Seorang hamba diuji oleh Allah dengan syubhat(kesesatan pemahaman) dan syahwatnya. Ujian berupa fitnah syubhat merupakan seberat beratnya ujian bagi seorang hamba karena hal itu bisa merusak agamanya. Rasulullah shalallaahu ‘alaihi wasallam saja berlindung dari fitnah-fitnah tersebut duhai saudariku. Beliau berlindung kepada Allah agar tidak dijadikan musibah dalam agamanya. Beliau shalallahu ‘alaihi wasallam pun berdo’a,

وَلاَ تَجْعَلْ مُصِيْبَتَنَا فِى دِيْنِنَا

“(Wahai Allah) ,dan janganlah engkau jadikan musibah menimpa agama kami.” (HR. at-Tirmidzi)
Karena sessungguhnya ini adalah seburuk-buruk musibah. Seorang hamba yang berbuat maksiat, merupakan musibah dalam agamanya. Seorang hamba yang berbuat bid’ah, merupakan musibah dalam agamanya. Seorang hamba yang melanggar larangan-larangan Allah, ia pun merupakan musibah di dalam agamanya. Musibah yang menimpa seorang hamba dalam perkara dunia itu lebih ringan wahai saudariku. Seseorang diberi kefakiran, seseorang diberikan penyakit, seseorang diberikan kelaparan, barangkali itu tidak merubah agamanya. Akan tetapi, ketika seseorang diberi ujian syubhat dan syahwat lalu ia ikuti hal tersebut, ketahuilah hal ini bisa menghancurkan agamanya. Itulah musibah yang paling besar. Wal iyyadzubillah.

Yang keempat Rasulullah shalallahu ‘alaihi wasallam berlindung dari keburukan fitnah masihud Dajjal.
Dajjal, makhluk yang akan datang di akhir zaman yang diberikan oleh Allah sebagai fitnah yang besar kepada manusia. Sampai-sampai kata Rasulullah shalallahu ‘alaihi wasallam, tidak ada seorang pun nabi, kecuali memperingatkan umatnya dari bahaya Dajjal.

Dari Ibnu ‘Umar radhiyallahu ‘anhuma,

قَامَ النَّبِيُّ صَلَّى اللهُ عَلَيْهِ وَسَلَّمَ فِي النَّاسِ فَأَثْنَى عَلَى اللهِ بِمَا هُوَ أَهْلُهُ ثُمَّ ذَكَرَ الدَّجَّالَ فَقَالَ: إِنِّي أُنْذِرُكُمُوْهُ وَمَا مِنْ نَبِيٍّ إِلاَّ قَدْ أَنْذَرَهُ قَوْمَهُ، لَقَدْ أَنْذَرَهُ نُوْحٌ قَوْمَهُ وَلَكِنْ سَأَقُوْلُ لَكُمْ فِيْهِ قَوْلاً لَمْ يَقُلْهُ نَبِيٌّ لِقَوْمِهِ، تَعْلَمُوْنَ أَنَّهُ أَعْوَرُ وَأَنَّ اللهَ لَيْسَ بِأَعْوَرَ

“Rasulullah shalallahu ‘alaihi wasallam berdiri di hadapan manusia, menyanjung Allah Subhanahu wa Ta’ala dengan sanjungan yang merupakan hak-Nya, kemudian menyebut Dajjal dan berkata, ‘Aku memperingatkan kalian darinya, tidaklah ada seorang nabi kecuali pasti akan memperingatkan kaumnya tentang Dajjal. Nuh ‘alaihissalam telah memperingatkan kaumnya. Akan tetapi aku akan sampaikan kepada kalian satu ucapan yang belum disampaikan para nabi kepada kaumnya. Ketahuilah dia itu buta sebelah, adapun Allah Subhanahu wa Ta’ala tidaklah demikian.” (HR. Ahmad, Al-Bukhari dan Muslim no. 2930)
Dajjal adalah fitnah yang sangat besar. Bagaimana tidak wahai saudariku, Dajjal mengaku sebagai rabb, memerintahkan hujan untuk turun, lalu turunlah hujan (dengan ijin Allah-ed), memerintahkan bumi untuk menumbuhkan tanaman, lalu tumbuh tanaman, menghidupkan orang mati dan yang lainnya sebagai fitnah bagi kaum muslimin (dengan ijin Allah-ed). Bayangkan wahai saudariku?
Maka dari itu Rasulullah shalallahu ‘alaihi wasallam mengabarkan, bahwasanya yang menjadi pengikut dajjal adalah orang-orang yang bodoh terhadap agama mereka. Betapa tidak, orang-orang awam banyak yang tertipu dan terfitnah oleh para dukun. Orang-orang awam banyak yg terfitnah oleh kuburan-kuburan yang dianggap “kuburan wali”. Orang-orang awam banyak terfitnah dengan keris-keris pusaka dan yang lainnya. Apabila dengan dajjal kecil saja tertipu, bagaimana dengan Dajjal yang sangat besar fitnahnya.
Rasulullah shalallahu ‘alaihi wasallam menyebutkan tentang kisah seorang pemuda yang dibunuh oleh Dajjal. Dalam riwayat Imam Muslim (2938) dari hadits Abu Sai’id al-Khudri terdapat kisah menarik tentang pertarungan antara Dajjal dengan seorang mukmin, ringkasnya:

Ada seorang pemuda beriman datang kepada Dajjal seraya berkata padanya, “Wahai manusia, ini adalah Dajjal yang telah diceritakan Rasulullah dalam haditsnya!”
Dajjal berkata, ” Apakah kamu beriman padaku?”
Jawab pemuda itu, “Kamu adalah pendusta”.
Pemuda itu kemudian digergaji sehingga terbelah menjadi dua, lalu Dajjal melewati dua potongan badannya kemudian menyuruhnya berdiri.
Pemuda itupun berdiri lagi seraya berkata, “Saya malah bertambah mantap tentang dirimu bahwa engkau adalah Dajjal yang dikabarkan oleh Rasulullah shalallahu ‘alaihi wasallam!”.
Setelah itu, Dajjal ingin membunuhnya tetapi tidak bisa”.
Bayangkan wahai saudariku, si pemuda tersebut telah memiliki pengentahuan bahwasanya Dajjal akan datang. Ini menunjukkan bahwa orang yang memahami ilmu agama, insyaa Allaah dia akan diselamatkan dari fitnah Dajjal. Maka dari itu wahai saudariku, kita berkewajiban untuk berlindung dari fitnah dajjal. Ia adalah fitnah yang sangat besar.

Dan terakhir Rasulullah shalallahu ‘alaihi wasallam berdo’a memohon perlindungan dari perbuatan dosa dan hutang.

اَللَّهُمَّ إِنِّيْ أَعُوْذُ بِكَ مِنْ الْمَأْثَمِ وَالْمَغْرَمِ

Dosa dan hutang, terkadang seorang hamba menganggapnya kecil dan remeh, padahal itu akan dibayar dengan amalan di akhirat kelak. Ketika Rasulullah shalallahu ‘alaihi wasallam mengabarkan bahwasanya orang yang mati syahid diampuni semua dosa-dosanya, kemudian Rasulullah shalallahu ‘alaihi wasallam pun memberikan pengecualian, yakni kecuali hutang. Dari ‘Abdillah bin ‘Amr bin Al ‘Ash, Rasulullah shallallahu ‘alaihi wa sallam bersabda,

يُغْفَرُ لِلشَّهِيدِ كُلُّ ذَنْبٍ إِلاَّ الدَّيْنَ

“Semua dosa orang yang mati syahid akan diampuni kecuali hutang.” (HR. Muslim no. 1886)
Dari Ibnu ‘Umar, Rasulullah shallallahu ‘alaihi wa sallam bersabda,

مَنْ مَاتَ وَعَلَيْهِ دِينَارٌ أَوْ دِرْهَمٌ قُضِىَ مِنْ حَسَنَاتِهِ لَيْسَ ثَمَّ دِينَارٌ وَلاَ دِرْهَمٌ

“Barangsiapa yang mati dalam keadaan masih memiliki hutang satu dinar atau satu dirham, maka hutang tersebut akan dilunasi dengan kebaikannya (di hari kiamat nanti) karena di sana (di akhirat) tidak ada lagi dinar dan dirham.” (HR. Ibnu Majah no. 2414. Syaikh Al Albani mengatakan bahwa hadits ini shohih. Ibnu Majah juga membawakan hadits ini pada Bab “Peringatan Keras Mengenai Hutang.”)
Demikianlah keadaan orang yang mati dalam kondisi masih membawa hutang dan belum juga dilunasi, maka untuk membayarnya akan diambil pahala kebaikannya. Itulah yang terjadi ketika hari kiamat karena di sana tidak ada lagi dinar dan dirham untuk melunasi hutang. Kenapa Nabi shalallahu ‘alaihi wa sallam sering berlindung dari hutang ketika shalat?
Ibnul Qoyyim dalam Al Fawa’id (hal. 57, Darul Aqidah) mengatakan,
“Nabi shallallahu ‘alaihi wa sallam meminta perlindungan kepada Allah dari berbuat dosa dan banyak hutang karena banyak dosa akan mendatangkan kerugian di akhirat, sedangkan banyak utang akan mendatangkan kerugian di dunia.” Inilah do’a yang seharusnya kita amalkan agar terlindung dari hutang:
ALLAHUMMA INNI A’UDZU BIKA MINAL MA’TSAMI WAL MAGHROM
(Ya Allah, aku berlindung kepadamu dari berbuat dosa dan banyak utang).
Maka dari itu wahai saudariku, janganlah seorang hamba bermudah-mudah untuk berhutang. Dan jangan pula seorang hamba berbuat zhalim dengan tidak membayar hutang. Sesungguhnya hutang itu akan dibayar di akhirat, bukan dibayar dengan dinar, bukan dibayar dengan rupiah, bukan dibayar dengan dirham, akan tetapi akan dibayar dengan amalan kita. Padahal amalan kita adalah modal utama menuju surga.

Wa shollallahu ‘ala nabiyyiina Muhammad wa ‘ala alihi wa shohbihi wa sallam.

Penulis: Ummu Izzah Hilda
Muraja’ah: Ust. Aris Munandar hafidzahullah
Maraji’:

• Qur’anul karim
• Rekaman kajian Ustadz Abu Yahya Badrusalam, Lc Hafizhahullahu Ta’ala
• http://abiubaidah.com/
• http://rumaysho.com/
• http://www.indoquran.com
• Syarah ‘Aqidah Ahlus Sunnah wal Jama’ah, Yazid bin Abdul Qadir Jawas,Imam Asy-Syafi’i, Jakarta.
• Syarah Do’a dan Dzikir Hishnul Muslim, Dr, Sa’id bin Ali Wahf Al-Qahthani, Darul Falah, Jakarta.
• Sudah Benarkah Aqidah Kita, Syaikh DR. Shalih bin Fauzan Al-Fauzan, Ash-Shahihah, Jakarta.
• Surga Neraka dan Calon Penghuninya menurut al-Quran dan as-Sunnah, Syaikh ‘Ali Hasan bin ‘Ali al-Halabi al-Atsari, Imam Asy-Syafi’i, Jakarta.