The Allergy and Asthma Clinic Monthly Newsletters Continued
December Newsletter 2013
Interesting Updates from the Annual Meeting of the American College of Allergy, Asthma and Immunology (ACAAI)
Defining Allergy Fact from Fiction
From gluten allergy and hypoallergenic pets, to avoiding the flu shot because of an egg allergy, there are a lot of common myths and misconceptions about allergies. Many might be shocking due to a great deal of false information in the media and on the internet. And some of the misconceptions can be damaging to your health if vaccinations are skipped and extreme dietary restrictions are taken which are not medically necessary.
But where did all of these misconceptions come from? According to a presentation that was given at the Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology (ACAAI), previously held beliefs from medical experts and public perception are partially to blame.
According to the presenter, David Sukus, MD, many previously held beliefs have been proven to be incorrect as research has advanced. Unfortunately, some of these “facts” are still on the internet, where an astonishing 72 percent of users turn to for health information. In his presentation, he outlined some of the greatest allergy myths and explained why they were false.
“I’m Allergic to Artificial Dyes” – There is no scientific evidence to support a link between exposure to artificial coloring and allergies. Controversy exists regarding evidence for artificial coloring and behavioral changes in children, as well as whether dyes cause chronic urticaria and asthma.
“I cannot have vaccines due to an egg allergy” - Egg embryos are used to grow viruses for vaccines such as the flu, yellow fever and rabies shots. However, it’s now safe for almost everyone to get the flu shot, which can help prevent serious illness.
“At-home blood tests reveal all you’re allergic to” – These tests might be able to reveal sensitization, but being sensitized to a certain allergen, like milk, doesn’t mean you can’t eat it. These sort of at-home screening tests are not reliable and can often lead to misinterpretation, diagnostic confusion and unnecessary dietary elimination.
“Highly allergenic foods shouldn’t be given to children until 12 months of age” – For most children, there is no evidence to support avoidance of highly allergenic foods past six months of age. This is a big change from the thinking on introducing foods to children which was widely promoted 10 year ago.
“I’m allergic to cats and dogs, but can have a hypoallergenic breed” - Unfortunately, there is no such thing as a truly hypoallergenic dog or cat. Allergens are released in saliva, sebaceous glands and perianal glands. It’s not the fur that most people are allergic to. It is true that some breeds are more bothersome for allergy sufferers than others.
“I’m allergic to shellfish and cannot have iodine imaging” – Radiologists and cardiologists often use iodinated contrast during CT scans and other procedures for better imaging. Since shellfish contain iodine, many physicians have linked a contrast reaction to shellfish allergy. However, this is false, and a shellfish allergy has nothing to do with the reaction. In fact, iodine is not and cannot be an allergen as it is found in the human body.
“I can’t have bread, I’m allergic to gluten” – You can have a gluten intolerance, but it’s extremely rare to have a true gluten allergy. Most allergic reactions to these foods stem from wheat. Many people self-label themselves as having gluten allergy and avoid gluten without any medical indication.
With information being widespread online via social media portals, how do you know what to believe and what not to believe? If you think you may have an allergy, you should see an allergist for proper evaluation, testing, diagnosis and treatment. Misdiagnosis and inappropriate treatment can be dangerous. If you or a love one is having symptoms and you are unsure of the cause, please contact us so we can help you identify the cause of the problem and then develop and discuss treatment options in order to resolve it.
Allergy Shots during Pregnancy may Decrease Allergies in Children
Another interesting presentation revealed promising research in the prevention of allergies that was presented by Jay Lieberman, MD.
According to ACAAI, allergies tend to run in families. If both parents have allergies, their children have a 75% chance of being allergic. If only one parent is allergic, or if a relative has allergies, the child has a 30-40% chance of having an allergy. If neither parent has allergy, the chance of a child developing an allergy is only 10-20%. However, a study that was presented found pregnant women who receive allergy shots, also known as immunotherapy, during pregnancy may decrease their baby’s chance of developing allergies.
Dr. Lieberman stated that his research found trends suggesting women receiving allergy shots either before or during pregnancy reduced their child’s chances of having asthma, food allergies, or eczema. Studies have suggested that mothers can pass protective factors to their fetus that may decrease their child’s chance of developing allergic disease and these protective factors are increased with allergy immunotherapy. Although more research is needed to understand if mothers can truly prevent allergies in their children by receiving allergy shots during or before pregnancy, these study results show there is a strong association which is very encouraging.
While there is no cure for the more than 50 million Americans suffering from allergies, immunotherapy is known to modify and prevent disease progression. Allergy shots and drops are not only very effective but cost efficient as well; typically they result in very significant health care savings by reducing the cost of medication, sick visits, missed work and school. Let us help you and your family stay well with treatment plans that are custom designed to fit your personal health needs.
Our Holiday Schedule will be as follows:
Closed December 24th and 25th
Open December 31st 9am-12pm
Closed January 1st
November Newsletter 2013
Do newborns have more complications when mom has asthma?
Asthma is fairly common in women of reproductive age and complicates about 7-10% of pregnancies in the US. Mothers with asthma are known to have increased risk of pregnancy related complications including preterm labor and growth problems in their newborns. However, other serious newborn complications have not been as well studied in relation to maternal asthma.
In an original research article published in The Journal of Allergy and Clinical Immunology (JACI), Mendola et al looked at whether the newborns of asthmatic mothers would experience more complications compared to newborns whose mothers did not have asthma. The study team analyzed data from a large group of patients. They compared newborns of mothers with asthma to newborns of non-asthmatic mothers and looked for potential differences in gestational week at delivery, birth weight, and a number of newborn complications.
As expected, the study found an increased risk for preterm labor and babies that were born smaller for their gestational age in those with maternal asthma. With data from such a large number of deliveries, the authors were able to examine the risk for early delivery at each week of gestation – a novel aspect of the study. They found that preterm delivery was associated with maternal asthma for each week after 33 completed weeks of gestation, but not earlier. Maternal asthma also increased the risk for neonatal intensive care unit (NICU) admissions, jaundice and breathing complications including respiratory distress syndrome, transient tachypnea of the newborn, and asphyxia. These findings were present even if babies were born at full term. Infants also had additional increased risk for intracerebral hemorrhage and anemia. However, maternal asthma did not increase the risk of perinatal death, infections such as sepsis or pneumonia, or other uncommon complications.
In summary, this study highlights a connection between maternal asthma and neonatal health, showing that maternal asthma is associated with higher risk of neonatal complications than previously thought.
So what is a mother to do? First of all, don’t panic! While these study findings are of concern, keeping your allergies and asthma under optimum control dramatically reduces the risk of any adverse consequences to your baby. There are different types, causes and treatments of asthma. It is important for expectant mothers to discuss individual circumstances to reduce their asthma risk with either their obstetrician or an allergist. Make sure you avoid known asthma triggers, take prescribed medications which have been approved by your obstetrician, eat a healthy well balanced diet and get appropriate rest. If your asthma is well managed, this reduces risk to your baby. Therefore it is important to emphasize the importance of regular follow-up care for women with asthma and visit your obstetrician and/or allergist on a regular basis during pregnancy.
We have helped hundreds of women keep their allergies and asthma under excellent control during their pregnancy with safe effective treatments that have stood the test of time and are also approved by their obstretricians. If you, a loved one or a friend are pregnant and suffer from allergies or asthma, please contact us so we can help keep you healthy while you are pregnant as well as after you deliver your baby.
Unavailable Meds alert for 2014
We recently received a formulary bulletin from Express Scripts that the medications Advair, Alvesco, AuviQ, Flovent, MaxAir, Omnaris, Proventil HFA, Rhinocort AQ, Veramyst, Xopenex and Zetonna will no longer be covered on most patients’ Express Scripts national plans after January 1, 2-14. While Express Scripts has provided us with a “covered alternative” for these medication(s) we should see you in the office to review your allergy and asthma medication regimen before considering a trial of one of these medications. If the covered alternative has been tried in the past and was not effective or was associated with side effects, we can then discuss other treatment options. Please call our office to schedule a follow-up appointment so you are prepared in 2014.
In observance of Thanksgiving Day the office will be closed
Thursday & Friday,
November 28th and 29th.
We will be open Saturday, November 30, 9am-noon.
October Newsletter 2013
Will consuming local honey improve your allergies?
Unfortunately, the majority of available medical evidence shows that ingestion of honey has no reliable beneficial effects on the symptoms of allergy. It has been a popular notion that eating honey is a natural remedy for symptoms of allergies and asthma. In fact, bee pollen is commonly marketed as a natural allergy remedy and an anti-inflammatory agent and quite a number of patients have asked us whether they should try it.
Other names for commercially available bee pollen include royal jelly or propolis. Whatever the name, the theory that taking in small amounts of pollen by eating local honey to build up immunity is tempting. While consuming local honey for your allergies may sound like a good idea, and many would argue that it can't hurt, most well designed scientific studies show that it doesn’t actually work. In addition, it should be noted that there have been cases where very sensitive people have experienced life threatening allergic reactions as a result of eating locally produced honey due to its pollen and venom protein content which suggests that honey does contain a certain amount of pollen and/or other antigen particles. However, for most people, ingesting local honey has probably no more than a placebo effect.
It is certainly true that bees don't just bring flower pollen back to their honeycomb but also minor amounts of tree and grass pollen. They also bring mold spores, diesel particles, and other contaminants. However, the bulk of what they bring to the honeycomb is from the pollen in flowers and not the pollen blowing in the wind released by the non-flowering trees, weeds, and grasses which are among the most common sources of the average person’s allergy symptoms.
There is only one well-designed study comparing two different types of honey against a placebo in people with pollen allergy. Unfortunately, there was no difference in allergy symptoms among the three groups of study participants. However, more studies are needed to further investigate the possible benefits of honey for the treatment of allergies.
In conclusion, unlike the scientifically proven regimens that are specifically tailored and meticulously measured and prepared for individual patients who are on immunotherapy treatments, it's difficult to make honey from the particular pollen(s) that the patient may be allergic to. (Keep in mind the bees have their own reason for making honey and it has nothing to do with treating your allergies.) Therefore, for relief of your allergy symptoms, immunotherapy continues to be the gold standard for allergy treatment and care and the closest thing we have to a cure. So, our advice is to enjoy some delicious honey with your tea and toast, but keep it out of your allergy medicine cabinet.
Other remedies to relieve allergy symptoms that are just myths!
Quail eggs? Eating quail eggs to relieve allergy symptoms is probably one of the most far-fetched remedies. This treatment leaves most allergists scratching their heads about any possible connection. There are plenty of sites online selling the tiny eggs with the promise that their "natural antihistamines" will help with allergy symptoms. But without any science to back up their claims, there's no evidence quail eggs will cure anything more than hunger. There are much more effective, easier, less-expensive treatments available.
Salt Mine? According to the local lore of Krakow, Poland, if you are an allergy sufferer in search of a cure, you can take sanctuary in the city's famed salt mines. The expansive network of mines are said to be safe haven for allergy sufferers because of the mine's "micro-climate" that is "free of pollution and allergens". For approximately $650 per week visitors can stay at the underground health resort located within the mine to let their lungs heal. While visiting the UNESCO World Heritage Site might be an interesting field trip, there is no proof that escaping to a salt mine will alleviate or "cure" hay fever symptoms.
Onion Poultice? The stinky remedy, which is made from a cut onion, has been used to help ear infections and alleviate cold symptoms. Unfortunately, there is no proof that the old wives’ cure works or that any cut root vegetable can help ease sneezing and wheezing. With plenty of other options available, allergists say there's no reason to ruin good produce with this home remedy.
Congratulations to our patients who are making efforts to kick the habit!
Electronic cigarettes are becoming more and more popular to assist people who want to stop smoking and we encourage all our patients to continue to seek the best alternatives to help them quit. However, while most available medical evidence suggests that vaping on e-cigarettes is vastly preferable to smoking the old fashioned kind, we would like to make our patients aware that there have been numerous side effects, as well as allergic reactions, linked with e-cigarette use—both for those using them and those exposed to the second hand vapors. We therefore ask that if you are using e-cigarettes as a tool to help you quit smoking, please be sensitive to individuals around you and avoid using e-cigarettes around others who may be adversely impacted, particularly when you are in healthcare facilities and medical offices. This is the reason we have asked our patients not to use e-cigarettes in our office. We thank you in advance for your kind consideration.
September 2013 Newsletter
Time to take charge of your home before your allergies take charge of you!
As we head into the fall and winter season, we tend to spend more time indoors. Unfortunately, our homes are the place that frequently contain many of the peskiest allergy and asthma triggers. Your environment may contain a variety of animal and plant life, many of which can become a source for allergens, which are the triggers of allergic reactions. Pollens are the main cause of seasonal allergies. However, if your nasal stuffiness, sneezing, watery eyes, and constant sniffling bother you year-round, then you most likely have non-seasonal allergies that are often referred to as perennial allergic rhinitis. This condition is typically caused by indoor allergens such as dust mites, cockroach parts, molds, and animal dander.
People are rarely allergic to the things that make up a house such as; paint, wood, steel, plastic, etc. Instead, it is the microscopic things growing and accumulating in the house that usually cause allergies. People with allergies need a plan that will help identify hot spots and get them under control. Understanding the nature and location of common and indoor sources of allergy is fundamental. The key to managing allergies that are caused by indoor allergens involves reducing your level of exposure to them or avoiding them entirely, if possible.
The indoor problems:
House dust is a mixture of several components that can cause allergies.
Dust mites thrive in warm, humid places, including our mattresses and pillows.
Cockroach allergy can be a major factor for many patients with asthma and nasal allergies.
Allergy symptoms and asthma can be caused by the inhalation of mold spores. Indoor plants, especially those that are kept in damp wicker baskets, are a common source of molds. Avoid overwatering the plants.
Dander and skin shedding of an animal is more potent in causing allergic reactions than the animal’s fur or hair.
About 6% of the population is allergic to cats.
At the front of your house
Use a doormat made of synthetic material. Natural materials such as rope and other fibers can break down and become a good environment for mites, mold and fungus that can be tracked into the house. Wash your mats weekly.
Clean dead insects from the porch and other outdoor lights. As they decompose, they can become an allergen source.
Put a shoe rack at the front door and encourage your family and friends to remove their shoes when they enter.
In your livingroom
Replace your cloth furniture with leather or vinyl, which will not be as hospitable to dust mites and other allergens.
Consider replacing your carpets with solid flooring such as laminate, vinyl or wood.
Consider swapping cloth curtains with simple shades, which can be cleaned regularly.
Put pebbles on top of any dirt near the home to prevent mold spores from getting into the air too easily.
In your kitchen
Put open boxes of food in airtight containers to discourage insects.
Clean the tray under the refrigerator with a bleach solution and add salt to the drip tray to help reduce the growth of mold and bacteria.
Check under your sink, quite often there will be leaks which create a perfect environment for mold.
Use an exhaust fan while cooking.
In your bedroom
Tackle dust with a wet cloth or a “swiffer”. Clean behind dressers, under beds, ceiling fans, etc.
Make your bedroom a pet-free zone.
Eliminate common dust magnets such as stuffed animals, items containing feathers, upholstered headboards, down comforters, carpeting and drapes.
Use allergy proof dustproof covers for your mattress and pillows.
In your bathroom
Check under sinks and behind toilets for leaks and make sure fixtures are properly installed to avoid water leaks in the wall which could encourage mold growth.
Wash bathmats in hot water weekly.
Run the exhaust fan and open your window when showering.
In your closet
Keep clothing in zippered plastic bags and shoes in boxes off the floor.
Don’t use mothballs but rather use cedar chips or store clean woolens in sealed plastic or airtight containers. You can also place garments in the freezer for several days to kill moths and larvae.
Check corners and walls for mold. You may have a leak you’ve never noticed because it’s in back of a dark crowded closet.
In your basement
Inspect every inch of your basement, including crawlspaces, for signs of dampness and mold. Clean these areas with bleach solution. If there is a water intrusion problem, fix it asap.
Check stored belongings. Anything stored directly on a concrete floor such as boxes, newspapers, clothing or wood is vulnerable to mold.
Purchase a hygrometer and measure the humidity to ensure the reading is below 50 in your home.
You don’t have to let allergies control your life. Different allergies call for different tactics, but there is no reason you can’t live a good life without constantly worrying about allergens in your home. Improving air quality can go a long way in controlling your allergies. Air purifiers and using vacuums with HEPA filters can also help improve air quality.
Fortunately, with proper allergy testing and treatment, we can usually reduce, if not eliminate, many of your symptoms to help give you a better quality of life. One very effective treatment, immunotherapy through allergy shots or drops, makes most patients much less sensitive to the harmful effects of various allergens. With immunotherapy, most patients experience a significant decrease in their allergy symptoms along with a marked decrease in their need for allergy and asthma medications. If you or a loved one are suffering needlessly, please contact us to discuss what treatment options will best fit into your lifestyle, help you fight back and regain control of your symptoms, improve your breathing and help keep you healthy.
August 2013 Newsletter
Is Asthma in adults different than in children?
Asthma is a common disease that affects the lungs. About 15 million Americans have asthma. People who have asthma often experience wheezing, coughing, increased mucous production and difficulty breathing. These symptoms are caused by inflammation and/or obstruction of the bronchial airways, which transport air from the nose and mouth to the lungs. Many people with asthma have allergies “triggered” by various allergens. Allergens are substances found in our everyday environment, such as dust, pollen and mold, which can cause the tissue that lines the bronchial airways to become inflamed.
Although asthma is more common in children, adults and older people also frequently develop asthma. Asthma in adults can be a recurrence of childhood asthma. But adult onset asthma generally refers to the onset of asthma for the first time in someone of middle age or older. There are some features that make adult onset asthma different from that seen in a younger age.
There is evidence that asthma and allergy have a strong genetic factor but as outlined in the following, several factors may make a person more likely to get adult onset asthma:
Different illnesses, viruses or infections can be a factor in adult onset asthma. Many adults first experience asthma symptoms after a bad cold, a case of bronchitis or a bout of the flu.
Adult onset asthma is not caused by smoking; however, if you smoke or are exposed to cigarette smoke (secondhand smoke), it may provoke asthma symptoms.
For others, obesity appears to significantly increase the risk of developing asthma as an adult.
Adult asthma cases are frequently triggered by allergies. People allergic to cats have an increased risk for developing adult onset asthma. Exposure to cigarette smoke, mold, dust, feather bedding, perfume or other substances commonly found in the person’s environment may trigger the first asthma symptoms. Prolonged exposure to certain workplace materials can also set off asthma symptoms in adults.
Women are more likely to develop asthma after age 20. Hormonal fluctuations and changes in women may play a role in adult onset asthma. Some women first develop asthma symptoms during or after a pregnancy. Women going through menopause can also develop asthma symptoms for the first time. An ongoing Harvard Nurses Health Study found that women who take estrogen supplements after menopause for ten years or more are 50 percent more likely to develop asthma than women who never used estrogen. However, as with any medical treatment option, it is important to always weigh the risks and benefits of every medication.
It is increasingly recognized that asthma is not one single disease, but has several subtypes. The most common type of asthma occurs in children and is associated with allergies, whereas asthma that starts in adulthood is less common, but may show a severe progressive course in some patients. To identify these patients with severe, adult-onset asthma at an early stage, and to better understand the underlying mechanisms, it is important to determine whether an underlying allergy is contributing to the problem and take appropriate steps to deal with this condition.
In a research study published in The Journal of Allergy & Clinical Immunology examining patients with adult-onset asthma with respect to clinical, functional and inflammatory markers, the researchers found that patients with severe adult-onset asthma had more nasal symptoms and higher incidence of sinus disease including nasal polyps. Most had increased exhaled nitric oxide levels and these findings persisted despite treatment and were not correlated with age, sex, or how long they have had asthma. Further analyses showed that some other markers of allergic inflammation were independently associated with having severe disease. The authors’ findings suggest that severe adult-onset asthma is a distinct asthma subtype that has different underlying mechanisms as compared to milder forms of adult-onset asthma but also as compared to severe asthma in general.
In some cases, asthma simply persists into adulthood and in others, childhood asthma clears up for a number of years only to reappear later in life. The way that adult onset asthma compares to childhood asthma is that unlike children who often experience intermittent asthma symptoms in response to allergy triggers or respiratory infections, adults with newly diagnosed asthma generally have persistent symptoms.
After middle age, most adults experience a decrease in their lung capacity. These changes in lung function may lead some physicians to overlook asthma as a possible diagnosis. Asthma can mimic other illnesses or diseases, especially in older adults, and untreated asthma can contribute to even greater loss of lung function. Diseases that have similar asthma-like symptoms can include: hiatal hernia, reflux or other stomach problems; rheumatoid arthritis; chronic obstructive pulmonary disease (COPD); emphysema or chronic bronchitis.
If you or a loved one are experiencing symptoms that haven’t been experienced before or at least not for a long while-- symptoms such as a dry cough (especially at night or in response to specific “triggers”); tightness or pressure in the chest; difficulty breathing; wheezing or a whistling sound when exhaling; shortness of breath after exercise; or colds that go to the chest and “hang on” for 10 days or more, you could be experiencing adult onset asthma. If you have any of these symptoms, don’t ignore them or try to treat them yourself. Get a definitive diagnosis from an allergy & asthma specialist who can understand your symptoms, conduct appropriate lung function testing and test for allergies. This will provide the necessary clinical information to make a correct diagnosis and come up with appropriate treatment options to control and reduce your symptoms and help you feel better.
In observance of Labor Day we will be closed
Newsletter July 2013
Ah, Summer … Beaches, baseball, barbecues and unfortunately, bee stings.
No one likes getting a bee sting but when most people are stung by an insect, the site develops redness, swelling and itching, which is uncomfortable but goes away within a few hours. However, some people are actually allergic to insect stings , which means that their immune system overreacts to the venom. For these people, insect stings are much more than a nuisance, they can be life threatening.
If you are allergic to insect stings, your immune system produces antibodies called Immunoglobulin E (IgE). When you are stung by the insect to which you are allergic, the venom interacts with this specific IgE antibody, triggering the release of substances that cause an allergic reaction. For people with a significant venom allergy, insect stings can cause life threatening reactions called anaphylaxis. Symptoms may include: itching and hives, swelling in the throat and tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea. In severe cases, a rapid fall in blood pressure may result in shock and loss of consciousness.
Anaphylaxis is a medical emergency and can be fatal. If you have any of these symptoms after an insect sting, get emergency medical treatment. After this treatment, you should also ask for a referral to an allergist to learn how to stay safe in the future.
It is important to identify the most common stinging insects that may cause a reaction.
Their nests are made of a paper-mache material and are usually located underground but sometimes they can be found in the walls of frame buildings, cracks in masonry or woodpiles.
Honeybees and bumble bees:
These bees are usually non-aggressive and will typically only sting when provoked. However African honeybees (AKA "killer bees") found in the Southwestern US are much more aggressive and may sting in swarms. Domesticated honeybees live in man-made hives, while wild honeybees live in colonies or "honeycombs" found in trees or cavities of buildings.
These insects' nests are usually made of paper-like material that forms in a circular comb of cells which opens downward. The nests are often located under eaves, behind shutters, or in shrubs or woodpiles. It should be noted that the vast majority of patients will be wasp allergic instead of allergic to bees. When an allergic patient says they got stung by a bee, most likely it was from a wasp.
These insects are usually larger than yellow jackets. Their nests are gray or brown, football shaped and made of a paper material similar to that of yellow jackets' nests. Hornets' nests are usually found high above the ground on branches of trees, in shrubbery, on gables or in tree hollows.
These insects build a nest of dirt in the ground that may be quite tall (18 inches) in the right kinds of soil.
The best way to prevent stings is to simply stay away from these insects. Insects are most likely to sting if their homes are disturbed, so it is important to have nests around your home destroyed, preferably by an exterminator.
If flying stinging insects are close by, remain calm and move slowly away. Avoid brightly colored clothing and perfume when outdoors. Because the smell of food attracts insects, be careful outdoors when cooking, eating or drinking sweet drinks like soda or juice. Beware of insects inside straws or canned drinks. Keep food covered until eaten. Wear closed-toe shoes outdoors and avoid going barefoot. Also, avoid loose-fitting garments that can trap insects between material and skin.
If you are stung and if the insect left its stinger in your skin, remove the stinger within 30 seconds to avoid receiving more venom. A quick scrape or flick of your fingernail removes the stinger and sac. Avoid squeezing the sac because this forces more venom through the stinger and into your skin. For all stinging insects, try to remain calm, brush these insects from the skin and immediately leave the area.
The following are some suggestions to treat local reactions to stings that can help to minimize the reaction:
Raise the affected limb and apply a cold compress to reduce swelling and pain.
Gently clean area with soap and water to prevent secondary infections
Do not break blisters
Use a topical steroid ointment or oral antihistamines to relieve itching.
Avoid scratching the sting area. Scratching will worsen itching and swelling and increase your risk of infection
See your physician if swelling progresses or if the sting site seems infected.
If you are severely insect-allergic, carry auto-injectable epinephrine. Learn how and when to self-administer the epinephrine, and replace the device before the labeled expiration date. Remember that epinephrine is a rescue medication only, and you must still have someone take you to an emergency room immediately if you are having a severe reaction after being stung. Those with severe allergies may want to consider wearing a bracelet or necklace that identifies the wearer as having severe insect sting allergies.
We are often asked whether a patient should pursue allergy shots for bee venom if they have had a reaction in the past. The appropriate treatment for reactions can be complex and it really depends on the individual and the details of their reaction. There are generally two important factors to consider: the age of the patient and the type of reaction that occurred after being stung. For children, allergy shots or venom immunotherapy should be considered if the child has a respiratory reaction, such as an asthma attack or a serious systemic reaction like anaphylactic shock. For adults, it should be considered if they have a respiratory reaction, serious anaphylactic shock, or if they have diffuse hives and breaking out in a rash immediately after the sting. Those who experience large, local reactions which are confined to the area where they are stung are usually not a candidate to undergo venom allergy testing or immunotherapy.
Medical studies show that using venom immunotherapy in the appropriate circumstances will greatly reduce the rate of future reactions. In those who were untreated, there's an up to 70% chance that they will have a serious reaction the next time they are stung. Successful treatment with venom allergy shots reduces that risk to less than 2%!
It is important to see an allergist and review your medical history and get appropriate testing done to determine whether you'll benefit from venom immunotherapy. In cases where allergy shots are used appropriately, they are very, very effective.
If you or a loved one have had a reaction to an insect sting or know of someone who has, we encourage you or them to contact us to discuss this matter further. This treatment can literally be lifesaving.
Newsletter June 2013
Oral Allergy Syndrome
If you suffer from pollen allergies and you’ve experienced an itchy mouth or scratchy throat after eating certain raw fruits or vegetables and some tree nuts, you may have oral allergy syndrome symptoms.
Symptoms of oral allergy syndrome include itchy mouth, scratchy throat, or swelling of the lips, mouth, tongue, and throat. The symptoms are usually confined to one area and do not normally progress beyond the mouth. Because the symptoms usually subside quickly once the fresh fruit or raw vegetable is swallowed or removed from the mouth, treatment is not usually necessary.
Oral allergy syndrome does not typically appear in young children; the onset is more common in older children, teens, and young adults who have been eating the fruits or vegetables in question for years without any problems. Those with oral allergy syndrome typically have allergy to birch tree, ragweed or grass pollens.
Oral allergy syndrome occurs because the proteins in some fruits and vegetables are similar to proteins in some pollens and there is a cross-reacting allergen found in both. They are not identical proteins, but they are similar enough to confuse the immune system into having these reactions. That’s not to say that everyone with pollen allergies has oral allergy syndrome. A person may sneeze all spring long and not have any obvious food sensitivities.
Oral allergy syndrome may help explain , though, why some people have seemingly mysterious reactions to certain foods-- for example, someone who is allergic to birch may have a reaction when eating apples. That’s because there are proteins in raw apples that are very similar to the proteins in birch pollen. However, the individual may only have this reaction with raw apples and not cooked apples and the reason is that cooking the offending fruits and vegetables will change the shapes of these proteins, usually enabling people with oral allergy syndrome to eat them cooked without a problem. In addition to cooking the offending fruit, peeling the fruit first may help, since the peel of the fruit usually has more allergens than the meat. Many people who undergo allergy shots for pollen allergies will also experience relief from the oral allergy syndrome and can then eat the fruit without any obvious symptoms.
Although not everyone with a pollen allergy experiences oral allergy syndrome, for those whom are affected, the most common foods associated with this syndrome are with these following allergens:
apple, almond, carrot, celery, cherry, hazelnut, kiwi, peach, pear, plum & other “stone” fruits
celery, melons, oranges, peaches, tomato
banana, cucumber, melons, sunflower seeds, zucchini.
Because the reaction is usually localized to the mouth area, including lips, tongue, and throat, some people will choose to ignore the symptoms and continue to eat the offending foods. For people with reactions confined to itching of the mouth, this is a reasonable choice they could make. Patients can typically decide on their own, without any discussion with a doctor, whether they enjoy the apple enough to put up with an itchy mouth, or whether they hate the itchy mouth enough to avoid the apple. But in rare cases, people with oral allergy syndrome can experience anaphylaxis, a life-threatening reaction that may include blocked airways, low blood pressure, anxiety, vomiting and diarrhea or even death. If a person experiences a reaction beyond the mouth area after eating fresh fruit or raw vegetable, that food should be considered a risk for anaphylaxis, a very serious reaction that is rapid in onset and may require the use of an injection of epinephrine to subside. This is why many people with food allergies carry auto-injectors containing adrenaline for emergencies.
Diagnosis of oral allergy syndrome is reached after taking a patient’s clinical history and conducting allergy skin tests and/or oral food challenges with the appropriate food. Combining the results of both skin testing and oral food challenges is the best way to provide patients an understanding of why symptoms are occurring and the best actions to take to prevent them from continuing to occur. Undergoing comprehensive allergy evaluation and testing can identify your allergic triggers and help you avoid the substance(s) you should stay away from as much as possible. By doing so, you will be less likely to experience a flare up of your allergies.
We have often been asked by parents if skin testing or oral food challenge testing would hurt or harm their child. We would like to take this opportunity to relieve your concerns.
Skin Testing: To do a skin test, a drop of sterile extract containing a potential allergen is loaded onto the skin testing applicator, which is then placed on the child’s back. The applicator is designed to gently place the allergy extract under the skin with little to no pain in a safe, effective manner. Because our nurses are so skilled, the process goes quickly and most patients find it much more comfortable than a blood test. However, if your child is allergic to one or more of the allergens applied, the area which reacts can be itchy. After the test is completed and the allergy is diagnosed, our nurses will apply a soothing anti-itch cream which typically calms down any itching very quickly.
Oral Food Challenge: Patients first undergo a series of simple screenings to make sure the patient can safely undergo the food challenge test. Then in a controlled clinical environment, while being carefully monitored, patients are given a sample of the offending food in incrementally increased doses over a period of time to determine if an allergy is causing any symptoms and what level of tolerance the patient has for the food in question. If the patient experiences symptoms at any point during the challenge, the challenge is halted.
What is Meaningful Use?
Meaningful use is a set of standards defined by the Centers for Medicare & Medicaid Services (CMS) that governs the use of newly mandated electronic health records and that requires health care providers to meet specific criteria. The statistical health information physicians are now mandated to provide to the Health Information Technology for Economic and Clinical Health (HITECH) is supposed to be used to assist in establishing programs to improve health care quality, safety, and efficiency. In order for us to be compliant, we are required to ask patients various questions about social behaviors, ethnicity, smoking history, etc and this statistical information is securely transmitted by us to HITECH and is combined with other national averages. We ask for your patience and understanding since we must comply with these federal regulations. Thank you.
In observance of Independence Day we will be closed Thursday, July 4th
Newsletter May 2013
Common Sinusitis Symptoms
- Postnasal drip
- Discolored nasal discharge (greenish in color)
- Nasal stuffiness or congestion
- Tenderness of the face (particularly under the eyes or at the bridge of the nose)
- Frontal (forehead) headaches
- Pain in the teeth
- Bad Breath
Sinus disease is a major health problem. It afflicts over 30 million people in the United States. Americans spend more than $1 billion each year on over-the-counter medications to treat it. Sinus disease is responsible for 16 million doctor visits and $150 million spent on prescription medications. People who have allergies, asthma, structural blockages in the nose or sinuses, or people with weak immune systems are at greater risk of developing this condition.
A bad cold is often mistaken for sinusitis
because many symptoms are the same. However, sinusitis is an inflammation of the sinuses which is often caused by bacterial infection and sometimes, viruses and fungi (molds) cause it. People with weak or compromised immune systems are more likely to develop bacterial or fungal sinusitis. Acute sinus disease can last for up to eight weeks. Sinus disease lasting longer than eight weeks is considered chronic. In rare cases, it can spread to the brain which can be life threatening. Fortunately, these cases are very uncommon.
Normal sinuses are lined with a thin layer of mucus that traps dust, germs and other particles in the air. Tiny hair-like projections in the sinuses (called cilia) sweep the mucus (and whatever is trapped in it) toward openings that lead to the back of the nose and throat. From there, it slides down to the stomach. This process is a normal bodily function. When someone suffers from sinus disease, the normal flow of mucus out of the sinuses is disrupted. Viral infections and allergies cause the tiny nasal tissues to swell, which traps mucus in the sinuses and frequently leads to sinusitis.
Allergies frequently play an important role in chronic or recurrent sinus disease. Many people with allergies suffer from frequent bouts of sinusitis. Sinus disease is sometimes confused with rhinitis. Rhinitis is a medical term used to describe the symptoms that accompany nasal inflammation and irritation and is often caused by allergies. Nasal and sinus passages become swollen, congested, and inflamed when they come in contact with the offending inhaled particles that trigger allergies. Pollens are seasonal allergens. Molds, dust mites and pet dander can cause symptoms year round. If you have allergies and suffer from sinus disease, we can prescribe appropriate treatment options to help bring your allergies under better control and reduce your risk of developing an infection.
Asthma also has been linked to chronic sinus disease. Many people with chronic nasal inflammation and irritation and/or asthma develop a type of chronic sinus disease that is not caused by infection. In these patients, treating the underlying inflammation usually improves the sinus disease which, in turn, often improves asthma symptoms.
Some people have bodily defects that contribute to sinus disease. The most common of these defects are: deformity of the bony partition between the two nasal passages (the nasal septum); nasal polyps (benign growths that contain mucus); and a narrowing of the sinus openings. People with these abnormalities often suffer from chronic sinus disease. If there are problems with the structure of the nose or sinuses, surgery is sometimes needed to correct these problems. So an accurate diagnosis is essential.
To diagnose sinusitis, we will take a detailed medical history, perform a physical exam and may order appropriate testing. These tests can include allergy testing and CT scans, which take precise images of the sinus cavities. Knowing what kind of bacteria is causing the infection can lead to more effective antibiotic therapy and in some cases, we may refer you to an ENT specialist for other studies. A fungus could also cause your sinus disease. Confirming the presence of fungus is important. Fungal sinusitis often needs to be treated with antifungal agents or other medications, rather than standard antibiotics.
Sinus infections generally require a mix of therapies. Several non-drug treatments can be helpful, including breathing in hot, moist air and irrigating the sinus cavities with salt water. However, if these conservative treatment options fail, medications may be prescribed to reduce blockage or control allergies and help keep the sinus passages open. Choices include a decongestant, a mucus-thinning medicine and/or an anti-inflammatory nasal spray. If bacterial sinusitis is present, you may be prescribed an antibiotic. For people with allergies, long-term treatment to control and reduce allergic symptoms can also help prevent sinusitis. Immunotherapy is the gold standard treatment to help control allergies because it treats the underlying cause. Even if more aggressive treatment is recommended, such as surgery, having the allergies under control can help improve the outcome of the surgery.
Getting the right care can make the difference between being healthy and chronically suffering with breathing problems. The first step is to consult with a specialist to determine the cause of your sinus condition so we can make the right recommendations and give you the treatment you need and deserve.
In observance of Memorial Day we will be closed on Monday, May 27th
Newsletter April 2013
Gardening with Allergies
For many of those who love being outside, gardening is one of their favorite pastimes. But, spring is also a peak time for allergies.
For people with seasonal allergic rhinitis (hay fever), getting your hands dirty in the garden can have many unpleasant consequences. Sneezing, itchy eyes, congestion and other reactions can turn gardening into an unpleasant chore. Though it is not the only potential culprit, spring pollen is a very important cause of allergic misery. In fact, pollen from trees, plants and weeds can cause problems in all seasons. However, there is hope for the millions of Americans who suffer from allergy symptoms but also love to dig in the dirt. With a few simple precautions, allergies don't have to stand between you and your garden.
Say yes to plants with pretty brightly colored flowers.
Generally, roses and other attractive flowering shrubs have waxy pollens carried from plant to plant by bees and other insects and do not usually trigger allergy symptoms. Some other plants with low pollen triggers include: cactus, cherry trees, dahlias, daisies, geraniums, hibiscus, iris, magnolias, snapdragons and tulips.
Say no to highly-allergenic trees such as:
Ash, birch, cedar, cottonwood, cypress, elm, maple, oak, poplar, and walnut. Also, be wary of common grasses such as Johnson grass, rye grass, Bermuda, orchard, sweet vernal, red top and some blue grasses. The low-growing weeds should also be avoided such as sagebrush, pigweed, tumbleweed, Russian thistle and cocklebur which have small, light, dry pollens easily disseminated by the wind.
But don’t go overboard
By ripping out your landscaping in hopes of an allergy cure. Studies have shown that pollen from certain trees in Texas have been measured all the way into Canada so there is absolutely no sense in chopping down trees or tearing up grass all over the neighborhood, in hopes of eliminating your allergies.
Keep away from common garden chemicals
Including fungicides, herbicides, and insecticides as much as possible. These classes of chemicals can be very irritating to the nose, throat and lungs, so it is a good idea to avoid of them even if you are not allergic to these chemicals.
If you see any unusual insect activity
Such as a wasp nest or a bee hive, contact a professional. Stinging insects can potentially cause a severe allergic reaction and it's better to be safe than sorry.
Learn allergy hot spots
And beware of mold on plants, moist soil, drainage areas, compost piles and rotting wood. If possible, have someone else rake leaves and mow the lawn to avoid leaf piles and compost areas, which can trigger allergy symptoms.
Time your work carefully.
Pollen counts are usually highest between 5am and 10am, so garden later in the day if possible. Rainy, cloudy, or windless days will have fewer allergens in the air whereas hot, dry and windy conditions can trigger more allergic reactions.
Check pollen counts.
You can find these on the National Allergy Bureau web site or at www.pollen.com. Avoid working outside when counts are especially high.
Wear gloves, a long-sleeved shirt, a hat, and sunglasses or goggles and severe allergy sufferers might add a mask as well. Be sure to shower, thoroughly wash your hair, and change clothes when work is complete so you don't bring allergens into the house.
Some people think that moving to another area of the country may help their allergy symptoms but many pollens and molds are common to a large part of the United States. Not only that, but many kinds of related trees, shrubs, and weeds can trigger symptoms, and allergies to new plants can evolve within one to two years.
The best way to determine which plants trigger your allergic reactions is through skin testing performed by an allergist. We can help you find out what is causing your allergy problems, develop strategies to avoid troublesome plants and pollens, and can prescribe medication to help alleviate your symptoms.
Often the best solution to pollen allergies is allergy shots or drops (Immunotherapy) which can provide more permanent relief from allergy symptoms. If you have taken leave from your allergy treatment or had been intending to start allergy shots or drops but never got around to doing so, now is the time to start (or re-start) your immunotherapy so your body can better defend itself against another unpleasant allergy season. Don’t wait! Spring is here! And the sooner you start your allergy treatment, the sooner we can help you feel better.
Time for Spring Cleaning
If you experience indoor allergies, you know how important it is to keep your home clean to minimize the impact of allergens like dust mites, pet dander and mold. But an unfortunate allergy catch-22 is that by using the wrong cleaning products, you can actually make allergy symptoms even worse.
Fortunately there are several things you can do to minimize exposure to harmful chemicals and still end up with a sparkling clean home.
While care should be used with any cleaning product, avoid anything that has strong noxious odors, such as ammonia and products that produce particulates, including air fresheners and ozone generators.
Aerosol spray cleaners are another item to scratch off your shopping list. Not only can they trigger allergy symptoms, but a recent study also found that weekly use of cleaning sprays was linked with increases in asthma, asthma-medication use and wheezing. More frequent use of these cleaners was associated with even greater risk.
On smooth surfaces, use products that have minimal odors. Use dust cloths and mops that pick up and retain the dust rather than those that stir it into the air. Vacuuming is another potential source of trouble. Using a vacuum with HEPA filters is a good choice for removing allergens. Wearing a dust mask while working can also help keep allergy symptoms at bay.
Use natural remedies as cleaners such as a tablespoon of vinegar or lemon juice in a quart of water, used as glass cleaner. Furniture polish can be made by combining a teaspoon of lemon juice with a pint of mineral or vegetable oil. Deodorize carpets by sprinkling baking soda liberally, waiting 15 minutes and then vacuuming. Instead of mothballs, consider cedar chips, lavender flowers, rosemary, mint or white peppercorns.
Use your washing machine to your advantage. Everything from bedding (including mattress pads) to your kids' stuffed animals should be washed regularly in hot water to keep allergen accumulation low. And while using a detergent labeled "hypoallergenic" is a good idea, keep in mind that even some of these might cause an allergy flare-up. Through trial and error, you can find gentle yet effective brands that don't bother you or your loved ones.
If you need assistance to determine your allergies to soaps, detergents, and other chemicals, please contact us to determine if you are a candidate for patch testing.
Newsletter March 2013
Nighttime Breathing Problems
The symptoms of Nocturnal Asthma or Nighttime Asthma include chest tightness, shortness of breath, coughing, and wheezing at night. It can make sleep impossible and leave you feeling tired and irritable during the day. These problems may affect your overall quality of life and make it more difficult to control your daytime asthma as well.
The chances of experiencing asthma symptoms are higher during sleep. Nocturnal wheezing, coughing, and trouble breathing are common yet potentially dangerous. Doctors often underestimate the severity of nocturnal asthma, even though studies show that most deaths related to asthma occur at night.
Although asthma affects people of all ages, it often starts in childhood and it is extremely important for children with asthma to get adequate sleep. In a study published in Archives of Diseases in Children, sleep disturbance was studied in children with nocturnal asthma. Researchers found that children whose sleep was disturbed by nocturnal asthma also exhibited signs of psychological problems and impaired performance in school. Fortunately, they found that when proper treatment was given to improve the nocturnal symptoms and reduce sleep disturbance, improvement in mental function and school performance followed.
There is no one single reason why asthma is worse during sleep. Rather, there are several underlying mechanisms that occur while we are sleeping which medical research has demonstrated play a significant role in our body’s physiology. Understanding these will shed light on why asthma is more likely to flare up at night and help guide us on how to prevent this from occurring.
Airway Resistance - During sleep, the airways tend to narrow, which may cause increased airflow resistance. This may trigger nighttime coughing, which can cause more tightening of the airways. In addition, any mucus which drips down into your bronchial airways will have a greater effect since there is less room for the airway to handle it.
Internal Triggers – Asthma problems frequently occur during sleep, whenever the sleep period is taking place. People with asthma who work on the night shift and sleep during the day after have breathing attacks during the daytime, when they are sleeping.
Most research suggests that lung function worsens about four to six hours after you fall asleep, no matter whether you sleep during the day or the night.
Reclining Position - Lying in a reclining position may also predispose you to nighttime breathing problems. Many factors may cause this, such as accumulation of secretions in the airways, (drainage from sinuses or postnasal drip), increased blood volume in the lungs, decreased lung volumes, and increased airway resistance.
Air conditioning - Breathing colder air at night or sleeping in an air-conditioned bedroom may also cause loss of heat from the airways. Airway cooling and moisture loss are also important triggers of exercise-induced asthma.
GERD - If you are frequently bothered with heartburn, the reflux of stomach acid up through the esophagus to the larynx may stimulate a bronchial spasm. It's worse when lying down or if you take medications for asthma that relax the valve between the stomach and esophagus. Sometimes acid from the stomach will irritate the lower esophagus and lead to constriction of your airways. If stomach acid backs up to your throat, it may drip down to the trachea, airways and lungs, leading to a severe reaction. This can involve airway irritation, increased mucus production, and airway tightening. Taking care of GERD and asthma with appropriate medications can often reduce the episodes of nighttime asthma.
Late phase response -- If you are exposed to an allergen or asthma trigger, the chances are great that airway obstruction or allergic asthma will occur shortly afterward. This acute asthma attack typically happens quite quickly and then gradually wears off. However, about 50% of those who experience an immediate reaction also have a second phase of airway obstruction within three to eight hours of exposure to the allergen. This phase is called the late phase response and it is characterized by an increase in airway sensitivity, development of bronchial inflammation, and a more prolonged period of airway obstruction. Many studies report that when allergen exposure occurs in the evening instead of the morning, you are more susceptible to having a late phase response and are more likely to have one of greater severity.
Hormones - Hormones that circulate in the blood have well-characterized biological rhythms that are seen in everybody. Cortisol is one such hormone, which exerts important influences on the bronchial tubes. This hormone helps keep the muscles which
surround our bronchial airways relaxed so the airway can remain more open. Cortisol also suppresses the release of other substances, such as histamines, which cause mucus secretion and bronchospasm. Your blood levels of cortisol and peak flow rates (which measure the maximum speed you can blow air out of your lungs) are lowest at about 4am, while histamine levels tend to peak at this same time. These fluctuations in specific hormones levels may predispose you to nocturnal asthma during sleep.
Sleep Apnea-It should be pointed out that nocturnal asthma and obstructive sleep apnea have similar symptoms and can be mistaken for each other since both involve repetitive arousals associated with changes in airflow through the breathing passages and increased respiratory effort and both can decrease your oxygen levels during sleep. Studies suggest that people with asthma may be at increased risk for sleep apnea and that sleep apnea can worsen asthma. Sleep apnea worsens asthma in a number of ways, including increasing acid reflux, contributing to weight gain and obesity (which pushes up on your stomach and makes it difficult to fully expand your lungs) and decreasing the flow of air in and out of your lungs when you stop breathing entirely (during your periods of apnea).
There is no cure for asthma, but there are many effective treatment options to help control it both during the day and at night. If you find that you or a loved one are having trouble sleeping, it may not be just sleep apnea but ,instead, you may be suffering from allergies or an onset of asthma which would require different treatment options than the use of a CPAP machine (which is commonly prescribed for sleep apnea sufferers). Testing your lung function with spirometry and evaluation of your eNO to assess the level of inflammation in your breathing passages gives important data to help find out the cause of your problem and the proper treatment. Identifying and treating your underlying allergies can help reduce your exposure to those substances which make your breathing worse. And, fortunately, there are a number of excellent medications available which can help reduce airway inflammation and improve your breathing significantly.
To determine what your best course of action is, please discuss this with one of our health care providers or your family physician. We are here to help you breathe easier throughout the day and night. Getting adequate sleep is vital for your health and well being!
Newsletter February 2013
Allergies, Asthma and the Pregnant Patient
Pregnancy is a wonderful experience and it is our goal to keep you feeling well during this important time in your life. The following are answers to some commonly asked questions.
Will being pregnant affect my asthma and allergies?
Asthma and allergies may affect the severity of asthma and allergic conditions. Statistics show that when women with allergies and/or asthma become pregnant, a third of the patients improve, a third of the patients worsen and the last third are unchanged. The change in symptoms may be dependent on a number of factors, including the presence of seasonal and perennial allergens, as well the rise in pregnancy related hormones.
Hormonal changes may affect the nose and the sinuses, as well as the lungs. An increase in estrogen causes congestion of the capillaries in the lining of the nose, which in turn can cause a stuffy nose. A rise in progesterone can cause a feeling of shortness of breath. These events contribute to your underlying allergic or asthmatic conditions.
What should I avoid if I have allergies or asthma?
The connection between asthma and allergies is very common and about 75-85% of women with asthma are allergic to pollen, mold, animal dander and/or dust mite. Other irritating substances such as tobacco smoke, chemicals, strong odors and fumes can also cause allergic conditions and asthma to flare. Whenever possible, try to avoid contact with known allergic sensitivities. This is the time to be stringent about keeping up with dust, mold and pollen avoidance measures. Make sure that all bedding is washed in hot water and that there are allergy covers in place. Vacuum and dust frequently and if possible, keep the pets out of the bedroom. Although you may not be allergic to the pet, keep in mind that pets frequently "track in" dirt and pollen.
How does uncontrolled asthma affect my baby?
In the event of a significant asthma flare-up, there is a risk that the baby may not get enough oxygen. The baby needs a constant supply of oxygen for normal growth and development and it is therefore crucial to keep your asthma under optimum control. Anyone requiring the use of medications such as Albuterol more than 2 times a week, should speak with their allergist or obstetrician regarding the pros and cons of using a preventative, pulmonary product.
What medications are safe to take while I'm pregnant?
If avoidance measures alone are inadequate in managing your symptoms, there are safe medications that you and your obstetrician can consider. It is important to note that no medication has been proven entirely safe for use by every single person during pregnancy but in many cases, the potential benefits of these products outweigh the potential side effects. Inhaled respiratory medications (often used to treat asthma) are generally preferable because they have a more localized effect, with only small amounts entering the bloodstream. "Time-tested" medications are also preferred. Ideally, the use of medications should be kept to a minimum during the first trimester.
The Food and Drug Administration has assigned "risk categories" to medications for use during pregnancy.
CATEGORY A: Medications in this category have shown that well controlled studies in pregnant women have not shown any increased risk of fetal abnormalities. Unfortunately, very few medications are in this category, and no asthma medications are in it.
CATEGORY B: Animal studies have revealed no evidence of harm to the fetus but there are no adequate and well-controlled studies in pregnant women. Or, animal studies have shown an adverse effect but adequate, well-controlled studies in pregnant women failed to demonstrate a risk to the fetus. Some antihistamines commonly used for the treatment of allergies that are in this category include Claritin, Zyrtec and Xyzal. Cromolyn (sold under the OTC name of Nasalcrom), an anti-inflammatory nasal spray, is also Pregnancy Category B. Of the steroid-based nasal sprays available, Rhinocort AQ has a pregnancy Category B rating and, if indicated, this product should be the first to be considered for the treatment of rhinitis. Pulmicort, a preventative pulmonary product, is also rated Pregnancy category B.
CATEGORY C: Animal studies have shown an adverse effect but there were no adequate and well-controlled studies on pregnant women. However, the benefits of these drugs may outweigh the potential risks in the mother and the fetus. Although Sudafed is the "preferred" decongestant to take during pregnancy, Sudafed should be avoided during the first trimester because it has been associated with infant gastroschisis. Sudafed also has the potential to raise the mother's blood pressure, which can lead to complications during the latter trimesters.
CATEGORY D: These medications show a clear risk to the fetus but in certain select cases the benefits may outweigh potential risks. These medications require careful consideration before being used. CATEGORY X: These medications show clear evidence of birth defects in animal and/or human studies and should not be used in pregnancy.
Is it safe to continue my allergy shots or drops during pregnancy?
Allergy immunotherapy is very effective in helping patients become less allergic. These patients typically note a significant decrease in their symptoms and therefore a decrease in their need for medication which is desirable, especially during pregnancy. Immunotherapy can be safely continued during pregnancy but it is not recommended that immunotherapy be initiated during pregnancy. Pregnant patients on immunotherapy should be closely monitored and, typically, their immunotherapy doses are not increased during their pregnancy.
Pregnancy is a joyous and an overwhelming time in a woman's life. Our goal is to maximize allergy and asthma control and to promote a safe pregnancy and a healthy baby.
Remember these tips:
Eat a well-balanced diet. Avoid processed foods. Whenever possible, gear toward organic food products.
Stop smoking and avoid being around people who smoke.
Avoid cleaning litter boxes.
Avoid raw or undercooked meats and seafood.
Speak with your OB about an exercise regimen, one that does not have an increased risk of injury or one that does not increase your body temperature excessively.
In observance of President's Day we will be closed on Monday, February 18th.
Newsletter January 2013
Are your allergies or asthma keeping you from achieving your New Year's Resolutions?
In January, most of us make New Year's resolutions for self improvement. Many of us will vow to lose weight, exercise more often, or get our finances under control. But why not also use this as an opportunity to take charge of your allergies so they do not prevent you from achieving your goals?
One of the most popular New Year's resolutions is to eat healthier and lose weight. But as these resolutions and health regimens are about to come into full swing, many might find that instead of feeling well, they are feeling worse. And the reason might be due to one thing that should be helping--exercise. Not only can new workout routines be difficult for those with allergies and asthma, but several allergens can be found lurking in health clubs, making this normally healthy activity bothersome. By understanding what triggers your symptoms, those with allergies and asthma will be able to feel better and remain active. Gym & health club facilities can also harbor viruses & bacteria. It is important to make sure that you maintain safety practices, including washing your hands after your workout or showering right after.
To help you make your New Year's resolutions succeed, here are some helpful tips recommended by the American College of Allergy, Asthma and Immunology (ACAAI):
Improve your breathing
If you are experiencing shortness of breath, wheezing, coughing, chest tightness and/or unusual fatigue when you exercise, you might have exercise-induced bronchoconstriction. This condition affects about 10 percent of Americans. Many find relief by using their prescribed inhaler before they begin their workout routine. Breathing through your nose, rather than your mouth, can also help.
Look before you eat
Whether you have signed up for a dieting meal plan or are opting for foods with less calories, be sure to always read nutrition labels before you consume new items. Many products contain hidden food allergens, such as milk, wheat and egg. Energy bars can also be loaded with allergens, including soy and nuts, that affect certain people with food allergies.
Choose equipment wisely
While most exercise machines won't cause you to sneeze or wheeze, rubber mats, medicine balls and some rubber coated free weights might. Latex can often be found in these items, causing those with latex allergies to develop a rash or hives. Also beware of disinfectant wipes and sprays used to clean gym equipment. They can contain volatile organic compounds (VOC’s) which can spur an asthma attack or cause skin irritation.
Beware of outdoor triggers
If you are allergic to pollen, grass and other environmental factors, hit the ground running indoors. Not a fan of treadmills and indoor tracks? Take your allergy medication and avoid running outdoors during mid-day and afternoon hours when pollen counts tend to be highest. Be sure to change your clothes and shower immediately after finishing your workout to remove any particles that might have gotten onto your clothes and hair.
Opt for comfort over fashion
If your workout leaves you itchy and you have ruled out other gym culprits, your clothing might be the problem. Synthetic materials used in everything from shirts to socks could be irritating your skin. ACAAI recommends checking clothing labels and opting for Lycra (spandex) which is higher quality and less likely to irritate your skin than many other materials. Garments made of natural products can also help. If you have latex allergy, be wary of athletic shoes and elastic waistbands.
Make time for an activity that you truly enjoy
Bring some happiness into your life in the new year. Whether that is painting, walking, volunteering or just playing with your kids; happy people live longer.
Resolve to be a good example to your children or grandchildren - Instead of preaching about eating those fruits and veggies, do it. They watch your every move.
Try not to be so hard on yourself
In the continuous attempt to balance it all, there is a lot of opportunity for guilt and you often question if some of your choices were right.
It is important to create a balance between your work & family commitments & at the same time, maintain a healthy, active lifestyle.
Pace yourself and find at least five to ten minutes a day to meditate, pray, reflect or just have quietness. The calming and reflection
can boost your spirit and emotional health and reduce your stress.
Most people underestimate the severity of their asthma, and therefore most asthmatics are under-treated. Sub-optimal treatment of asthma can lead to severe complications, including reduced lung function, emergency room visits/hospitalizations for asthma, and potentially asthma-related deaths. The first step is to meet with a specialist and review your symptoms, undergo appropriate allergy testing, learn how to avoid your allergic triggers and initiate appropriate therapy, which for many includes allergy drops or shots--the therapy closest to a "cure". Learning the causes of your allergies and asthma will help you better understand your condition, including how to help prevent it and knowing when you need to seek medical advice.
The new year is a good time to take charge of your health, including assessing your current allergy situation and if needed, make changes. If you are feeling well and your allergies are under good control, then you can keep doing what you are doing, stay on track with your prescribed treatments and know that the efforts you are putting into your health are all worth it. However, if your allergies or asthma are not under optimal control and are interfering with the quality of your life, now’s the time to contact us and let us help you by giving you the treatment you need and the care you deserve.
Now is also the time to complete a thorough review of your health insurance coverage and benefits. You will need to make informed decisions about your benefits as 2013 begins. Make certain that your plan allows you access to our clinic and that we have accurate updated information. Your plan may require a referral. And remember -- most insurance plans have a time limit for filing claims after which they may not cover your medical expenses. So make sure we have your new insurance information if you have any changes taking place in 2013. Ongoing access to the allergy and asthma care you require should be a critical factor in selecting your health plan for the new year. If you have any questions with regard to your insurance coverage, our insurance specialists are ready to assist you in getting the full benefit out of your 2013 health plan to which you are entitled. Give us a call today! We’re here to help.
Happy New Year to everyone! Wishing you less sneezing and wheezing and better breathing!
Newsletter December 2012
Is the cold weather wreaking havoc on your health?
We all know individuals who blame the weather for their achy joints, migraines and many other health woes. Do you, too, wonder why your allergies feel worse after you have been outside in chilly weather? Most medical experts agree that weather can have profound affects on asthma and allergies.
Many of us feel sniffly after being outside in the cold for too long. But for allergy sufferers, the combination of the cold air and their underlying allergies can be a double whammy. The cold weather doesn’t actually cause respiratory allergies, but by triggering common allergy symptoms of congestion and runny nose, it can make your allergies feel worse.
Breathing cold air causes nasal congestion in two ways. First of all, the cold air affects an important body defense mechanism called the mucus transport, which stimulates an increase in mucus production causing a runny nose. This is your body’s way to fend off any nasal intruders which might try to venture in. Secondly, cold air affects the tissue in your nose because it is your nose’s job to warm the air you breathe to your body temperature. When you are breathing cold air, the capillaries in your nose tissue dilate, bringing warm blood to heat the cold air. Dilated capillaries mean swollen tissue and more nasal congestion and stuffiness.
Cold air can also set off asthma attacks. Cold air alone often triggers asthma symptoms, but upper respiratory infections that are common in the wintertime can also cause asthma attacks. Although cold air by itself does not cause infections, cold air does affect the respiratory system. Despite the protection of the mucus blanket in the nose, cold air can still reach the lungs. When this happens, the lungs react by releasing histamine, which causes bronchial congestion and wheezing.
In addition to the above, winter time is peak cold and flu season and these infections can cause severe flare-ups,
which can lead to potential complications including pneumonia and even hospitalization. The flu is a respiratory viral infection and spreads through the air and through direct physical contact.
Not only can the flu live on many surfaces for up to two hours, sneezing and coughing by infected individuals spews germ-laced airborne particles into the air where they are often inhaled by nearby individuals.
Another obstacle winter provides is poorer indoor air quality due to closed doors and windows that are sealed tightly against the cold; this prevents fresh air circulation and leads to higher concentrations of indoor allergens. So for indoor allergy sufferers, winter can be the toughest season of the year. Trying to stay out of the cold means cozying up with indoor offenders such as: dust mites, mold and pet dander. Snuggling up by the fireplace where the smoke irritates the nose and lungs and turning on the central heating system can also trigger symptoms.
It is even possible to have a true allergic response to cold temperatures, although this condition is very rare. The condition is called cold induced urticaria. However cold urticaria generally causes a reaction in the form of hives or welts, not a respiratory condition.
Keeping winter allergies and asthma at bay:
It is a good idea to wear a warm scarf or mask during cold and/or damp weather.
Wash your bed sheets weekly in hot water and invest in allergy proof covers for the bedding.
Ban pets from your bedroom
Minimize the use of a fireplace throughout the season and ensure you have adequate ventilation. The person with allergies should not be in the room when the fire is being built.
Keep an eye on mold producing items in your home and regularly clean damp rooms such as bathrooms, kitchens and laundry areas. Scrub refrigerators, sinks, tubs, floors and garbage cans to help prevent mold build up.
Always have your rescue medications handy to help control symptoms and keep your airways open and relaxed.
HEPA air purifiers can help remove airborne
mold spores before they lead to new mold growth or are inhaled.
Pre-treat areas that are susceptible to mold growth, such as shower curtains, bathroom tiles, basements, or closets. Vital
Oxide is a safe and effective mold and mildew remover that also inhibits the growth of new mold for up to seven months. M-1 Sure Cote also acts as a sealant to prevent mold re-growth.
As much as possible, allow moisture to escape from the home. If possible, open windows to allow shower or cooking steam to escape and/or turn on air vents.
Bathe pets regularly with dust mite and pet dander neutralizing shampoo.
Clean furniture and surfaces frequently using electrostatic dust cloths that trap dust rather than sweeping it up into the air or into carpets.
When vacuuming, use a HEPA filter-equipped vacuum. Consider using dust mite-killing carpet treatment such as Allersearch X-Mite Powder or Anti-Allergen ADMS spray.
Wash throw rugs, blankets and stuffed toys frequently. Consider using laundry additives such as De-mite Laundry Additive or Allergen Wash.
Change the filters on the heating system, especially at the onset of the winter season.
Get a flu shot
Wash hands frequently and avoid touching mucus membranes, i.e. eyes, nose and mouth.
Beware of flu-harboring surfaces such as grocery cart handles, elevator buttons, escalator handrails, office desks and phones.
Avoid close contact with others such as in subways and busses during flu season.
Boost your immune system by eating well, getting adequate sleep, exercising, and reducing stress.
Winter is not the time to become lax about controlling the factors that could lead to an increase in your allergy or asthma symptoms. With all of the hoopla that goes on this time of the year, it’s easy to become distracted and forget to take your preventative allergy and asthma treatment, such as your prescriptions and/or your allergy immunotherapy.
One of the most important steps to treating winter allergies is identifying your allergy triggers. Know your allergy profile and what steps you should take to control them. The most accurate way to do this is through allergy testing. If you are not feeling your best during the winter months, please contact our office and let us help you find the source of your allergy discomfort and help you feel better.
Holiday Safety Tips
For some helpful hints on how to avoid allergy and asthma triggers that may interfere with your holiday spirit go to our website at www.theallergyclinic.com and read our December 2011 newsletter in the archived newsletter section.
Our Holiday Schedule will be as follows:
Closed December 24 and 25th
Open December 31st 9am-12pm
Closed January 1st