Allergy & Asthma Center, PC

Topic of the Month

November 2011 Topic of the Month

Egg Allergy and the Flu Vaccine

Flu season is here, and so is the need to get protected by getting vaccinated. This vaccine contains a very small amount of egg protein; so before giving it, health providers ask if you are allergic to eggs. But do you really know if you are allergic to egg? Could you have egg intolerance?

Food allergies affect millions of adults and children. On the flip side, many people think they are allergic and unnecessarily avoid certain products.

The big difference between a food intolerance and allergy is an allergy can cause a serious or even life-threatening reaction. This is why it is important to know if you have an allergy or intolerance to egg when you receive a flu vaccination. An allergist/immunologist has specialized training to properly diagnose your reaction to eggs or other foods. Food intolerance happens in the digestive system and occurs when you are unable to properly breakdown food. This could be due to enzyme deficiencies, sensitivity to food additives, or reactions to naturally occurring chemicals in foods.

An allergic reaction involves the immune system or defense system. If you have an allergy to eggs, your immune system identifies eggs as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction.

Recent studies have shown that most egg-allergic individuals can receive the flu vaccine safely under the care of their allergist.

There are two ways people with confirmed egg allergy can receive the flu vaccine without being skin tested for the vaccine first.

Both should be used under the direction of an allergist skilled in administering the vaccine to people with food allergies.

DID YOU KNOW?

To the Point

Recent studies show that, depending on the severity of an egg allergy, flu vaccines are safe for most egg-allergic individuals.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

October 2011 Topic of the Month

Avoid the Danger of Anaphylaxis this Halloween

A Safe Halloween

Having food allergies doesn’t mean having to skip all Halloween fun. Follow these tips for a safe holiday:

Ghosts and goblins aren’t the only scary things your children might encounter this Halloween. For parents of kids with food allergies, Halloween treats – from candy to cookies – can be frightening too.

Common allergens, such as peanuts, tree nuts, milk, and egg, are often ingredients in Halloween treats. Some kids may experience a rash or red, itchy skin; vomiting; a stuffy, itchy nose; diarrhea or stomach cramps if they eat a food to which they are allergic. For children who are severely allergic, a single bite of these foods may cause a life-threatening reaction called anaphylaxis.

An anaphylactic reaction typically affects more than one part of the body and can happen very quickly. Signs of anaphylaxis include:

Other symptoms of anaphylaxis include dizziness, confusion, and shock. If you or your child experiences any of these symptoms, use your autoinjectable epinephrine and call 911 immediately.

DID YOU KNOW?

To the Point

Be cautious of “fun-size” candy, which may contain different ingredients than regular-size packages.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

September 2011 Topic of the Month

Outpatient open oral food challenges – feasible and “feed-able”

Inappropriate diagnosis of food allergy can lead to life-threatening reactions or unnecessary avoidance of foods and psychological distress. Screening tests, such as skin tests and serum IgE levels, can help predict reactions; but ultimately, feeding patients the suspected allergic food is the only way of confirming or ruling out a food allergy. The double-blind oral food challenge (OFC) is the accepted best method for doing this, but this procedure can take upwards of eight hours and requires dedicated facilities to perform appropriately. Therefore, many physicians simply feed the suspected allergen to patients in an open, un-blinded challenge as a surrogate test; yet very few studies have examined this type of open challenge.

In a Letter to the Editor in The Journal of Allergy & Clinical Immunology(JACI), Lieberman et al, reported results from the largest series of open OFCs to date. They reviewed 22 months’ worth of successive open OFCs performed at a university-based pediatric allergy outpatient clinic (Mount Sinai School of Medicine, New York, NY). All patients were suspected of possible food allergy due to evidence of reaction history and/or positive allergy testing. Decisions to proceed with OFCs were made by the allergists in the clinic in conjunction with families’ interests on an individual basis; however, patients were rarely challenged if the risk of reaction was deemed to be greater than 50%.

The authors reported results of 70 challenges over the 22-month period; 18.8% of the challenges were positive, i.e., elicited a reaction. The challenged foods were common food allergens (in descending order of frequency: peanut, tree nuts, egg, milk, soy, fish, sesame, shellfish, wheat, and others). Milk, peanut, wheat, and soy most commonly elicited a reaction. Factors associated with positive challenges included larger skin tests, higher food-specific serum IgE levels, and history of past reaction to the food (as compared to those patients who were avoiding a food due to previous test results and had never eaten the food). The majority (87.9%) of reactions were treated with an antihistamine alone, while 12 reactions, or 1.7% of all challenges, required epinephrine.

The authors showed that the open OFC can be done in high volume and can be very effective in adding foods back to the diets of the majority of patients, if selected when the testing and history are favorable (estimated less than 50% chance of reaction). This likely represents a majority of patients encountered in most pediatric allergy outpatient clinics. It is a relatively safe procedure as well, with systemic reactions occurring at a rate that is equivalent to or lower than most published studies on systemic reactions to allergy shots.

August 2011 Topic of the Month

Tips to Remember: Asthma Triggers and management

If you have asthma, you can minimize your symptoms and improve your quality of life by avoiding your asthma triggers and working with your allergist/immunologist, often referred to as an allergist, to develop a treatment plan.

Triggers

People with asthma have recurrent episodes of airflow limitation, often from inflamed airways that become narrowed, making it more difficult to move air in and out of their lungs. This can cause wheezing, coughing, chest tightness, and shortness of breath.

It is important to understand what triggers your symptoms and what makes them go away. Common asthma triggers include:

Treatment and Management

Asthma has different causes in different people; and therefore, individualized therapy is wise. Personalized plans for treatment may include:

You and your allergist can work together to ensure that your asthma is well managed so that you can participate in your normal activities.

Since asthma is a chronic disease, it requires ongoing management. This includes using proper medications to prevent and control your asthma symptoms and to reduce airway inflammation. There are two general classes of asthma medications, quick-relief and long-term controller medications. Your allergist may recommend one or a combination of two or more of these medications.

Rescue Medications

Quick-relief medications are used to provide temporary relief of symptoms. They include bronchodilators and oral corticosteroids.

Bronchodilators, generally called “rescue medications,” open up the airways so that more air can flow through. Bronchodilators include beta-agonists and anticholinergics and come in inhaled, tablet, liquid, or injectable forms.

There are some corticosteroids designed for short-term use that are swallowed or given by injection; they work a bit more slowly to help treat particularly bad inflammation in your airways.

Long-Term Control Measures

Long-term controller medications are important for many people with asthma and are taken on a regular basis (often daily) to control airway inflammation and treat symptoms in people who have frequent asthma symptoms.

Inhaled corticosteroids (there are many different ones), cromolyn or nedocromil and leukotriene modifiers can help control the inflammation that occurs in the airways of most people who have asthma. One medication may work better for you than another; your allergist can help guide you.

Inhaled long-acting beta 2-agonists are symptom-controllers that open your airways and may have other beneficial effects; but in certain people, they have some risks. Current recommendations are for them to be used only along with inhaled corticosteroids.

Leukotriene modifiers are typically used to open airways. Methylxanthines provide modest opening of the airways and may have a mild anti-inflammatory effect. Theophylline is the most frequently used methylxanthine.

Omalizumab is an injectable antibody that helps block allergic inflammation. It is used in patient with persistent allergic asthma.

Your asthma medications may need to be adjusted as you and your asthma change, so stay in close touch with your allergist. The better informed you are about your asthma triggers and management, the better your asthma symptoms will be. Together, you and your allergist can work to ensure that asthma interferes with your daily life as little as possible.

Healthy Tips

Feel Better. Live Better.

An allergist/immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of problems such as allergies, asthma, autoimmune diseases, and the evaluation and treatment of patients with recurrent infections, such as immunodeficiency diseases.

The right care can make the difference between suffering with an allergic disease and feeling better. By visiting the office of an allergist, you can expect an accurate diagnosis, a treatment plan that works, and educational information to help you manage your disease.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology


July 2011 Topic of the Month

Common Eye Symptoms Could be an Allergy

Eye allergies occur when the conjunctiva becomes inflamed. This is the mucous membrane covering the white of the eye and the inner side of the eyelid.

Physicians use the terms "ocular allergy" or "allergic conjunctivitis" to describe this allergic reaction.

Like all allergies, allergic conjunctivitis starts when the immune system identifies an otherwise harmless substance as an allergen. When the immune system senses this allergen, it overreacts. Chemicals are produced, which cause an allergic reaction. In this case, allergic reactions include eyes that water, itch, hurt, or become red or swollen.

Typical allergens affecting the eyes include pollen and mold spores, animal dander, and house dust mites. So if you have been diagnosed with any of these allergies, then symptoms may develop in your eyes.

Most people suffering from eye allergies have problems in both eyes. Symptoms usually appear quickly, soon after the eyes come in contact with the allergen.

The most common symptom occurs when the small blood vessels widen and the eyes become pink or red. Some people experience pain in one or both eyes. Other symptoms include swollen eyelids, a burning sensation, and sore or tender eyes.

The first approach to managing your eye allergy symptoms is to avoid the allergens that trigger your symptoms. However, this isn't always possible. That is when medications might be helpful.

Over-the-counter eye drops or oral antihistamines are commonly used for short-term relief. If these are not effective, your allergist may prescribe long-term, targeted medications. Also, immunotherapy (allergy shots) is a proven treatment approach to managing many allergies, including ocular.

DID YOU KNOW?

To the Point

Eye allergies are caused by seasonal or year-long allergies and may be treated with eye drops, oral medications, or allergy shots.


Reprinted with permission from the American Academy of Allergy Asthma & Immunology

June 2011 Topic of the Month

Summer Travel With Allergies And Asthma

The summer travel season shifts into gear Memorial Day weekend, and American families will make more than 650 million long distance trips throughout the season. Whether headed to the beach, big city, or backwoods, careful preparations are in order for asthma and allergy patients. Start by visiting an allergist/immunologist one month before the vacation to discuss any health concerns or treatment questions.

Traveling by Car
Avoid driving with the windows down if someone in the vehicle suffers from pollen or mold allergies. Use the air conditioner instead.

Travel during low traffic periods, such as early morning or late evening. You'll spend less time on the road and avoid higher levels of air pollution from idling vehicles.

Traveling by Air
Carry all medications with you onto the aircraft. The Transportation Security Administration (TSA) allows all types of medication through security checkpoints, but requires they be screened. Liquid and gel medications in three-ounce containers or less must be inside a clear quart-size bag and separated from other carry-on items through screening. Liquid and gel medications in larger quantities should be in a separate bag and declared to the security checkpoint operator. Make sure all medications are properly labeled.

Include saline nasal spray in your carry-on bag to relieve sensitive noses from the airplane's dry air. Use once an hour to keep nasal passages moist.

Beware of airline food, which rarely has ingredients listed. Visit convenience stores inside the airport to stock up on safe snacks for the flight. Take an epinephrine injector on board in case of a severe allergic reaction.

More Tips
It is always best to be prepared. Take all medications needed on the trip, as well as a day's worth of extra doses in case of travel delays.

When reserving a hotel, ask for allergy-free accommodations, which could include special rooms, pillows, and bed linens. If you are sensitive to molds, request a sunny, dry room away from indoor swimming pools.

When camping, be aware of asthma and allergy triggers surrounding the campsite. Since medical help may not be readily available, prepare an emergency plan in case of an asthma attack or severe allergic reaction.

Contact an allergist/immunologist for information on diagnosing allergies and asthma or questions about treatment. An allergist/immunologist is the best-qualified medical professional to manage the prevention, diagnosis, and treatment of allergies and asthma.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

May 2011 Topic of the Month

Tipsto Remember: Outdoor Allergens

Seasonal allergic rhinitis, or "hay fever," affects more than 35 million Americans. If you suffer from it, you may experience sneezing, stuffiness, a runny nose, and itchiness in your nose, the roof of your mouth, throat, eyes, or ears. These allergic reactions are most commonly caused by pollen and mold spores in the air, which start a chain reaction in your immune system.

Your immune system controls how your body defends itself. For instance, if you have an allergy to pollen, the immune system identifies pollen as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction.

Pollen
Pollens are tiny cells needed to fertilize plants. Pollens from plants with colorful flowers, like roses, usually do not cause allergies. These plants rely on insects to transport the pollen for fertilization. On the other hand, many plants have flowers that product light, dry pollen that is easily spread by wind. These culprits cause allergy symptoms.

Each plant has a period of pollination that does not vary much from year to year. However, the weather can affect the amount of pollen in the air at anytime. The pollinating season starts later in the spring the further north one goes. Generally, the entire pollen season lasts from February or March through October. In warmer places, pollination can occur year-around

Seasonal allergic rhinitis is often caused by tree pollen in the early spring. During the late spring and early summer, grasses often cause symptoms. Hay fever in late summer and fall is caused by weeds.

Molds
Molds are tiny fungi related to mushrooms but without stems, roots, or leaves. Their spores float in the air like pollen. Outdoor mold spores begin to increase as temperatures rise in the spring and reach their peak in July in warmer states and October in the colder states. They can be found year-around in the South and on the West Coast.

Molds can be found almost anywhere, including soil, plants, and rotting wood.

Pollen and Mold Levels
Pollen and mold counts measure the amount of allergens present in the air.

The National Allergy BureauTM (NABTM) is the nation's only pollen and mold counting network certified by the American Academy of Allergy, Asthma & Immunology (AAAAI). As a free service to thepublic, the NAB compiles pollen and mold levels from certified stations across the nation. You can find these levels onthe NAB page of the AAAAI's Website at www.aaaai.org/nab.

Effects of Weather and Location
The relationship between pollen and mold levels and your symptoms can be complex. Your symptoms may be affected by recent contact with other allergens, the amount of pollen exposure, and your sensitivity to pollen mold.

Allergy symptoms are often less prominent on rainy, cloudy, or windless days because pollen does not move around during these conditions. Pollen tends to travel more with hot, dry, and windy weather, which can increase your allergy symptoms.

Some people think that moving to another area of the country may help lessen their symptoms. However, many pollens (especially grasses) and molds are common to most plant zones in the United States; so moving to escape your allergies is not recommended. Also, because your allergy problem begins in your genes, you are likely to find new allergens to react to in new environments.

Treatment
Finding the right treatment is the best method for managing your allergies. If your seasonal allergy symptoms are making you miserable, an allergist/immunologist, often referred to as an allergist, can help. Your allergist has the background and experience to test which pollens or molds are causing your symptoms and prescribe a treatment plan to help you feel better. This plan may include avoiding outdoor exposure, along with medications.

If your symptoms continue or if you have them for many months of the year, your allergist may recommend allergy shots or immunotherapy. This involves receiving regular injections, which help your immune system become more and more resistant to the specific allergen and lessen your symptoms as well as the need for medications.

There are also simple steps you can take to limit your exposure to the pollens or molds that cause your symptoms.

Keep your windows closed at night and, if possible, use air conditioning, which cleans, cools, and dries the air.

Try to stay indoors when the pollen or mold levels are reported to be high. Wear a pollen mask if long periods of exposure are unavoidable.

Don't mow lawns or rake leaves because it stirs up pollen and molds. Also avoid hanging sheets or clothes outside to dry.

During the height of the pollen season, consider taking a vacation to a more pollen-free area, such as the beach or sea. When traveling by car, keep your windows closed.

Most important, be sure to regularly take any medications prescribed by your allergist, in the recommended dosage.

Healthy Tips

Feel Better. Live Better.
An allergists/immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of problems such as allergies, asthma, autoimmune diseases, and the evaluation and treatment of patients with recurrent infections, such as immunodeficiency diseases.

The right care can make the difference between suffering with an allergic disease and feeling better. By visiting the office of an allergist, you can expect an accurate diagnosis, a treatment plan that works, and educational information to help you manage your disease.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

April 2011 Topic of the Month

New research suggests link between climate change
and outdoor allergies

The environment is an ongoing concern in today's world; but "Going Green" is becoming even more of a factor for people with respiratory allergic diseases, such as allergic rhinitis or hay fever.

Pollen counts, seasons' duration, and prevalence of sensitizations for five types of pollen in the Bordighera region of Italy were recorded from 1981 to 2007 by the Allergy and Respiratory Diseases Clinic, DIMI, Genoa University in Genoa, Italy. Over time, there was a progressive increase in the duration of some pollen seasons. Additionally, the total pollen load was progressively increased for some species.

"Climate changes are a reality, and they can be documented if long enough periods of time are considered," according to Renato Ariano, M.D., lead author of the study.

"By studying a well-defined geographical region, we observed that the progressive increase of the average temperature has prolonged the duration of the pollen seasons of some plants and consequently, the overall pollen load," added World Allergy Organization Past President G. Walter Canonica, M.D.

Results showed that the percentage of patients sensitized to these allergens increased throughout the years of the study; however, the jury is still out as to whether longer pollen seasons actually put more people at risk for developing allergies.

"Longer pollen seasons and high levels of pollen certainly can exacerbate symptoms for people with allergic rhinitis and for those who previously had minimal symptoms. This may cause more people to seek medical attention," explained Professor Estelle Levetin, member of the National Allergy Bureau Task Force of the AAAAI.

The National Allergy Bureau (NAB) provides the most accurate and reliable pollen and mold levels from approximately 78 counting stations throughout the United States, two counting stations in Canada, and two counting stations in Argentina. The stations use air sampling equipment to collect airborne pollen and spores, which are then examined microscopically. This information is also used for research to aid in the diagnosis, treatment, and management of allergic diseases.

If you suffer through pollen seasons, or wonder if your symptoms could be allergies, consult with an allergist/immunologist. To find one in your area, visit www.aaaai.org. Additionally, you can sign up for personalized pollen count e-mail alerts in the NAB portion of the Web site.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

 

March 2011 Topic of the Month
Tips to Remember: Indoor Allergens

Millions of people suffer from allergy symptoms caused by indoor allergens, such as house dust mite droppings, animal dander, cockroach droppings, and molds. The symptoms are the result of a chain reaction that starts in the genes and is expressed in the immune system.

Your immune system controls how your body defends itself. For instance, if you have an allergy to dust mites, your immune system identifies dust mites as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction. This reaction usually causes symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach, or on the skin.

With the help of an allergist/immunologist, often referred to as an allergist, you can learn what indoor allergens are causing your symptoms and make environmental changes to avoid them.

Controlling Dust Mites

Dust mite allergens – the most common trigger of allergy and asthma symptoms – are found throughout the house; but they thrive in bedding and soft furnishings. Because so much time is spent in the bedroom, it is essential to reduce mite levels there.

Encase mattresses, box springs, and pillows in special allergen-proof fabric covers of airtight, zippered plastic covers. Bedding should be washed weekly in hot water (130° F) and dried in a hot dryer. Cover comforters and pillows that can't be regularly washed with allergen-proof covers.

Keep humidity low by using a dehumidifier or air conditioning. Wall-to-wall carpeting should be removed as much as possible. Instead, throw rugs may be used if they are regularly washed or dry cleaned.

People with allergies should use a vacuum with a HEPA (high-efficiency particulate) filter or a double-layered bag and wear a dust mask – or ask someone else to vacuum.

Controlling Pet Allergens

People are not allergic to an animal's hair, but to an allergen found in the saliva, dander (dead skin flakes), or urine of an animal with fur. Usually, symptoms occur within minutes.

For some people, symptoms build and become most severe eight to 12 hours after contact with the animal. People with severe allergies can experience reactions in public places if dander has been transported on a pet owner's clothing.

There are no "hypoallergenic" breeds of cats or dogs. The same is true for any animal with fur, so it is best to remove the pet from the home and avoid contact if you are highly allergic. Keeping an animal outdoors is only a partial solution, since homes with pets in the yard still have higher concentrations of animal allergens. Before getting a pet, ask your allergist to determine if you are allergic to animals.

If you cannot avoid exposure, try to minimize contact and keep the pet out of the bedroom and other rooms where you spend a great deal of time. While dander and saliva are the source of cat and dog allergens, urine is the source of allergens from rabbits, hamsters, mice, and guinea pigs; ask a non-allergic family member to clean the animal's cage.

As with dust mites, vacuum carpets often or replace carpet with a hardwood floor, tile, or linoleum. Some studies have found that using a HEPA air cleaner may reduce animal allergen exposure.

Controlling Cockroaches

An allergen in cockroach droppings is a main trigger of asthma symptoms, especially for children living in densely populated, urban neighborhoods.

Block all areas where cockroaches could enter the home, including crevices, wall cracks, and windows. Cockroaches need water to survive, so fix and seal all leaky faucets and pipes. When your family and pets are gone, have an exterminator go through the house to eliminate any remaining roaches.

Keep food in lidded containers and put pet food dishes away after your pets are finished eating. Vacuum and sweep the floor after meals, and take out garbage and recyclables. Use lidded garbage containers in the kitchen. Wash dishes immediately after use and clean under stoves, refrigerators, or toasters where crumbs can accumulate. Regularly wipe off the stove and other kitchen surfaces and cupboards.

Controlling Indoor Molds

Indoor molds and mildew need dampness, such as found in basements, bathrooms, or anywhere with leaks. Clean up mold growth on hard surfaces with water, detergent, and, if necessary, 5% bleach (do not mix with other cleaners). Then dry the areas completely. If mold covers an area more than ten square feet, consider hiring an indoor environmental professional. For clothing, washing with soap and water is best. If moldy items cannot be cleaned and dried, throw them away.

Promptly repair and seal leaking roofs or pipes. Using dehumidifiers in damp basements may be helpful, but empty the water and clean units regularly to prevent mildew from forming. All rooms, especially basements, bathrooms, and kitchens, require ventilation and cleaning to deter mold and mildew growth. Avoid storing items in damp areas, as well as carpeting on concrete or damp floors.

See your allergist for more suggestions.

Healthy Tips

Feel better, Live Better

An allergist/immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of problems such as allergies, asthma, autoimmune diseases, and the evaluation and treatment of patients with recurrent infections, such as immunodeficiency diseases.

The right care can make the difference between suffering with an allergic disease and feeling better. By visiting the office of an allergist, you can expect an accurate diagnosis, a treatment plan that works, and educational information to help you manage your disease.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

February 2011 Topic of the Month
Immunotherapy Can Provide Lasting Relief

Immunotherapy treatment(allergy shots) is based on a century-old concept that the immune system can bedesensitized to specific allergens that trigger allergy symptoms.  These symptoms may be caused by allergic respiratoryconditions, such as allergic rhinitis (hay fever) and asthma.

Whilecommon allergy medications often control symptoms, if you stop taking themedication(s), your allergy symptoms return shortly afterward.

Allergyshots can potentially lead to lasting remission of allergy symptoms, and theymay play a preventive role in terms of development of asthma and new allergies.

The Process

Treatment involves injecting the allergens(s) causing theallergy symptoms.  These allergens areidentified by a combination of a medical evaluation performed by a trainedallergist/immunologist  and allergy skinor allergy blood tests.

Thetreatment begins with a build-up phase. Injections containing increasing amounts of the allergens are given 1-2times a week until the target dose is reached. This target dose varies from person to person.  The target dose may be reached in 3-6 monthswith a conventional schedule (one dose increase per visit); but it may beachieved in a shorter period of time with fewer visits with an acceleratedschedule such as a cluster that administers 2-3 dose increases per visit.

Themaintenance phase begins when the target dose is reached.  Once the maintenance dose is reached, thetime between the allergy injections can be increased and generally ranges fromevery two to every four weeks. Maintenance immunotherapy treatment is generally continued for 3-5years.

Somepeople have lasting remission of their allergy symptoms, but others may relapseafter discontinuing immunotherapy; so the duration of allergen immunotherapyvaries from person to person.

Risksinvolved with the immunotherapy approach are rare, but they may include seriouslife-threatening anaphylaxis.  For thatreason, immunotherapy should be given only under the supervision of a physicianor a qualified physician extender (nurse practitioner or physician assistant)in a facility equipped with proper staff and equipment to identify and treatadverse reactions to allergy injections. The decision to begin immunotherapy will be based on several factors:

Reprinted with permission from the AmericanAcademy of Allergy Asthma & Immunology

January 2011 Topic of the Month

Egg Allergy Versus Egg Intolerance

It makes a difference when getting the flu vaccine

Did you know?

Flu season is here, and so is the need to be protected by getting vaccinated.  This vaccine contains a very small amount of egg protein; so before giving it, health providers ask if you are allergic to eggs. But do you really know if you are allergic to egg?  Could you have egg intolerance?

Food allergies affect millions of adults and children.  On the flip side, many people think they are allergic and unnecessarily avoid certain products. 

The big difference between a food intolerance and an allergy is that an allergy can cause a serious or even life-threatening reaction.  This is why it is important to know if you have an allergy or an intolerance to egg when you receive a flu vaccination.  An allergist/immunologist has specialized training to properly diagnose your reaction to eggs or other foods

Food intolerance happens in the digestive system and occurs when you are unable to properly break down food.  This could be due to enzyme deficiencies, sensitivity to food additives, or reactions to naturally occurring chemicals in foods.

An allergic reaction involves the immune system or defense system.  If you have an allergy to eggs, your immune system identifies eggs as an invader or allergen.  Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reactions.

Recent studies show that depending on the severity of an egg allergy, most egg-allergic individuals can receive the flu vaccine safely under the care of their allergist.

There are two ways people with confirmed egg allergy can receive the flu vaccine without being skin tested for the vaccine first:

One way is to receive the vaccine in two parts.  You receive ten percent of the full dose and wait 30 minutes to see if allergic symptoms develop.  If symptoms do not develop, the remainder of the dosage is given and another 30-minute observation period is held.

Another way is to give the entire vaccine followed by a 30-minute observation period.

Both methods should be used under the direction of an allergist skilled in administering the vaccine to people with food allergies.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

December 2010 Topic of the Month

Get The Facts On Food Allergy Testing

Eight Kinds Of Food Cause Most Food Allergies:

If you have experienced red and itchy skin, swelling,vomiting, or trouble breathing after eating or coming into contact with acertain food, you may wonder if you have a food allergy.

Whilediagnosing food allergies can be tricky, an allergist has the training andexpertise to know which tests to give you and how to accurately interpret them.

Yourallergist will take a thorough medical history, followed by a physicalexam.  You may be asked about contents ofthe foods, the frequency, seasonality, severity, and nature of your symptoms,and the amount of time between eating a food and any reaction.

Anallergy skin test may determine which foods, if any, trigger your allergicsymptoms.  In skin testing, a smallamount of extract made from the food is placed on your back or arm. If a raised bump or small hive developswithin 20 minutes, it indicates a possible allergy.

Incertain cases, such as in patients with severe eczema, an allergy skin testcannot be done.  Your doctor may thenrecommend a blood test.  False positiveresults can occur with both skin and blood testing; but there is another typeof test that an allergist can perform if there is any doubt.

Toconfirm your diagnosis, an allergist may perform a food challenge.  Food challenges are done by consuming thefood in a medical setting to determine if that food causes a reaction.  Do not try this test at home.  Anaphylaxis (pronounced an-a-fi-LAK-sis) is aserious allergic reaction that happens very quickly.  Without immediate treatment, it can be fatal.

Ifa reaction should occur during a food challenge, your allergist can spot thesymptoms and provide a shot of epinephrine (adrenalin) and expert care.

Onceyou know which foods you are allergic to, your allergist can help you develop atreatment plan so you can be healthy and safe.

To the Point

November 2010 Topic of the Month

Food Supplements and Medications During Pregnancy

It has long been known that the choices you make during pregnancy can have a lasting impact, but new research shows folate levels and food allergen intake during pregnancy could influence whether your child will develop food allergies or asthma.

Folate Levels

An adequate folate level is recommended for women during pregnancy because it is essential in fetal development and lowers the risk of neural tube defects like spina bifida.

Yet, results from a recent study presented at the 2010 Annual Meeting of the AAAAI indicate that too much of a good thing may produce negative consequences.

Children born to mothers who had plasma folate levels in the top 20% had an increased risk of asthma at age three in comparison to those mothers who had the lowest levels. The researchers also found that as the mother's plasma folate level increased, so did the risk of asthma in the child.

Getting enough folate is important, but too much may cause risks. That is why it is important for pregnant women to follow the advice of their physicians.

Food Allergens

We all laugh at strange pregnancy craving stories; but if you have a child with a food allergy, does avoiding food allergens during a subsequent pregnancy make a difference in a possible allergy or asthma diagnosis for the baby?

Another study presented at the AAAAI Annual Meeting focused on pregnant women who have food-allergic children. This group avoided food allergens in the third trimester of pregnancy, during breast feeding, and into the second year of life. Emphasis was placed on avoiding nuts, but egg and milk intake were also monitored.

As a result, the babies had significantly lower rates of peanut and egg sensitivity at both 18 and 36 months; and these babies were less likely to develop symptoms of asthma at both ages.

Program Focuses on the Respiratory Health of Pregnant Women

The Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) is a new effort led by the AAAAI and includes the Organization of Teratology Information Specialists (OTIS) and the Slone Epidemiology Center(SEC) at Boston University.

Given that asthma is one of the most commonly treated chronic diseases of pregnant women, the initial focus of VAMPSS will be respiratory health. This includes surveillance of asthma medications, seasonal and H1N1 vaccines, and antiviral medications used to treat influenza.

Pregnant women who take asthma medications and/or have received the seasonal influenza vaccine, the H1N1 vaccine, or any antiviral medications to prevent or treat the flu can call OTIS at (877) 311-8972 to access safety information and enroll in a study.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

 

October 2010 Topic of the Month

Scratching the Surface on Skin Allergies

Do you often suffer from red, bumpy, scaly, itchy,inflamed/blistered or swollen skin? Dryskin, sunburn, or an insect bite may be the cause. Or you may have a skin allergy. The most common skin allergies includeeczema, hives/angioedema, and contact dermatitis.

Eczema

Eczema usually affects the face, elbows, and knees. The red, scaly, itchy rash is more common ininfants and those who have a history of allergies or asthma. Older children and adults with eczema oftenexperience rashes on the knees or elbows (often in the folds of the joints), onthe backs of hands or on the scalp.

Triggersinclude allergens, overheating or sweating, emotional stress, food, and contactwith irritants such as wool, pets, or soaps.

Preventingthe itch is the main treatment goal. Applying cold compresses and topical steroid and calcineurin inhibitorcreams are the most effective. Antihistamines are often recommended to help relieve the itchiness. In severe cases, oral steroids areprescribed.

Hives and Angioedema

Hives are red, itchy, raised areas which may be triggeredby food, latex, or drug allergies. Hivescan also result from non-allergic sources like rubbing of the skin, cold, heat,physical exertion or exercise, pressure, and sunlight. Hives usually go away within a few days. Chronic hives can linger for months to years.

Angioedemais a swelling of the deeper skin layers that sometimes occurs with hives. Angioedema appears on the eyelids, lips,tongue, hands, and feet and is typically not red or itchy – just swollen.

Theallergens that trigger hives may take days to leave the body, so anallergist/immunologist may prescribe antihistamines or in severe cases,steroids. Other tips for symptoms reliefare cool showers, applying a cool compress, or wearing loose/light clothing.

Contact Dermatitis

Contactdermatitis is often more painful than itchy. It is characterized by an itchy, red, blistered reaction from poisonivy, nickel, perfumes, dyes, latex products, or cosmetics. Some ingredients in medications can cause areaction, most commonly neomycin, an ingredient in antibiotic creams.

Allergiccontact dermatitis reactions can happen 24 to 48 hours after contact. Once a reaction starts, it takes 14 to 28days to go away, even with treatment.

Contactdermatitis can be treated by scrubbing the skin with soap and water afterexposure and using prescribed antihistamine and cortisone medications. Calamine lotion, oatmeal baths/milk soaks,and cool compresses can offer relief.

DID YOU KNOW?

Reprinted with permission from the AmericanAcademy of Allergy Asthma & Immunology

September 2010 Topic of the Month

Confused about Your Asthma Medications?
Take the "Stepwise" Approach

For many asthma sufferers, recent safety issues raised by the U.S. Food and Drug Administration (FDA) have generated confusion and concern. 

In February 2010, the FDA announced that based on their analyses of clinical trials, the use of long-acting beta agonists (LABAs) is associated with an increased risk of severe worsening of asthma symptoms, leading to hospitalizations in both children and adults and death in some patients with asthma. The AAAAI agrees with the FDA recommendation that LABAs never be used as sole therapy for asthma. The FDA has also urged patients to "step down" from LABAs once symptoms are under control. This statement may not be consistent with your physician's approach to treatment managing your asthma. 

The Facts
LABAs are long-term controller medications, typically taken on a daily basis. When prescribed in conjunction with inhaled corticosteroids (ICS), these medications can be very effective in controlling airway inflammation and treating frequent asthma symptoms. 

In treating your condition, your allergist/immunologist is most likely following the 2007 National Asthma Education and Prevention Program's (NAEPP) EPR-3 guidelines. Achieving and maintaining control of your symptoms is at the core of these guidelines. 

When asthma is diagnosed, the recommended course of action is to use a stepwise approach to treatment. This calls for "stepping up" the use of long-term controller medications until your symptoms are controlled. Once this is achieved, your physician should monitor your symptoms and medication to assure control remains stable. 

Step down therapy identifies the minimum amount of medication necessary to maintain control of symptoms. Unlike the FDA's recent recommendation that all patients should step down from the LABA upon achieving control, the EPR-3 guidelines outline a set of parameters for physicians to use when considering "stepping down" a patient's medication, and does not advocate discontinuing LABA as the first step. 

The Question
When is the right time to begin "stepping down" your medications? That depends on each individual case. Prescribing the minimum amount of medication necessary should be a goal in treating any chronic disease. Yet this must be balanced against the risks of potential adverse consequences, such as severe or life-threatening asthma exacerbations. 

Our Advice
If you are concerned about your medications, talk to your allergist/immunologist about your treatment plan. By closely monitoring your condition, you and your physician can ensure that your asthma does not interfere with your daily life. 

DID YOU KNOW?

 

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

August 2010 Topic of the Month

Don't Let Allergies Crash Your Party

The bride walked down the aisle in a beautiful white lace gown—carrying a box of tissues. This is not the picture-perfect description you want to see; but weddings, receptions, and graduation parties can attract allergens—uninvited guests that cause allergic reactions for many people.

These party planning tips can help avoid putting a damper on celebrations for people with allergies.

Food Allergies
Celebrations typically involve food, but this pleasure can cause anxiety for people with food allergies. For some, symptoms may occur after consuming even a tiny amount of the food allergen.

The most common food allergens are the proteins in cow's milk, eggs, peanuts, wheat, soy, fish, shellfish, and tree nuts. When planning gift favors, remember that many contain tree nuts, so consider a nut-free alternative.

Allergic reactions include hives, itchiness, swelling of the skin, vomiting, and diarrhea.

In severe cases, an allergic reaction called anaphylaxis can happen very quickly. Without immediate treatment—an injection of epinephrine (adrenalin) and expert care—anaphylaxis can be fatal. Symptoms may include difficulty breathing, dizziness, or loss of consciousness.

TIP: If the group is small, consider planning your menu with your guests' food allergies in mind. For larger groups, make sure the food preparer is available to answer guests' questions about ingredients.

Flowers and Pollen Counts
Bouquets, corsages, boutonnieres, centerpieces, and venue decorations are other staples for weddings or graduations. For those who suffer from outdoor allergies, the pollen in flowers can cause sneezing, stuffiness, runny noses, and itchy roof of the mouth, throat, eyes, or ears.

TIP: If silk flowers are not an option, these flowers are less likely to cause an allergic reactions:

Azalea Dahlia Iris Narcissus Snapdragon
Begonia Daisy Irish moss Orchid Sunflower
Bougainvillea Geranium Lily Pansy Tulip
Cacti Gladiola Magnolia Petunia Violet
Cherry Hibiscus Marigold Roses Zinnia

Outdoor Celebrations
One detail you cannot plan is the weather. An outdoor event, especially one on a windy day, increases exposure to pollen.

TIP: To keep seasonal allergy symptoms at bay, avoid early morning outdoor gatherings when pollen levels are highest. If your celebration falls on a high ozone day, be aware this can cause respiratory distress for people with allergies and asthma.

TIP: Also be aware that stinging insects can crash your party. Some people are allergic to the venom from insect stings. For those people, a sting can be life-threatening.  Symptoms may include: itching and hives, swelling of the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea, or diarrhea. In severe cases, a rapid fall in blood pressure may result in shock and a loss of consciousness.

For more information on these allergy topics, see our Tips to Remember brochures

Food allergies:  http://www.aaaai.org/patients/publicedmat/tips/foodallergy.stm

Outdoor allergies:  http://www.aaaai.org/patients/publicedmat/tips/outdoorallergens.stm

Stinging insect allergies:  http://www.aaaai.org/patients/publicedmat/tips/stinginginsect.stm

 

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

 

July 2010 Topic of the Month

Treatment for Allergic Rhinitis Nothing to Sneeze About

By Kim Mudd, RN, MSN, CCRP

Reviewed by Linda Cox, MD, FAAAAI

Allergic rhinitis, sometimes referred to as hay fever, is an inflammatory disease that causes sneezing, itchy/watery eyes, itchy/runny nose, and congestion. For millions of suffers, antihistamines and nasal corticosteroid medications provide temporary relief of symptoms. For others, allergy shots (subcutaneous immunotherapy or SCIT) are a long-term alternative.

SCIT (SHOTS)

Allergy shots are administered in a medically supervised facility and involve frequent injections of increasing amounts of allergen extract during a build-up phase. They can be effective at controlling symptoms of allergic rhinitis, but the injection schedule can be difficult to maintain. In the end, allergy shots may provide long-lasting relief after they are discontinued.

SLIT (SUBLINGUAL)

Another form of therapy is currently being investigated in clinical research settings for use in the United Stated.

Sublingual Immunotherapy (SLIT) involves a dosing schedule of increasing amounts of allergen, much like the shots. These allergens are administered in a liquid form under the tongue.

SLIT is currently being used in Europe and in some countries in South America.

SLIT appears to have a favorable safety profile. In one review of the literature, the authors estimated that in approximately 1.2 million doses administered to 4,400 patients, there were no serious, "life-threatening reactions." There are reports of anaphylaxis with SLIT, but the incidence is rare. The primary symptoms reported by patients were oral itching, itchy skin, abdominal pain, nausea, and vomiting.

The effectiveness of SLIT has been studied in both adults and children. Some studies report that SLIT takes at least two years of treatment before subjects see improvement in symptoms. Other studies show improvement within a single year of therapy.

One large review of over 100 SLIT research studies demonstrated that about 1/3 of studies showed significant improvement in symptoms while 1/3 showed no significant improvement. The variation in effectiveness had been attributed to the differences in the dose of allergen used for the various studies. In general, the higher doses of allergen appeared to have the largest impact on symptoms improvement.

SLIT has potential to become a useful treatment of allergic rhinitis; yet several questions need to be answered before SLIT can be used outside of the research domain in the United States. The optimal starting dose and dosing frequency for maintenance have not been established. It is not clear if the starting/maintenance doses will be the same for all of the various allergens. Once the dosing questions have been addressed, the cost-effectiveness of SLIT needs to be established.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

June 2010 Topic of the Month  

"SPRING FEVER" AND ALLERGIES

For many people, the cure for spring fever is planning the perfect summer garden. However, outdoor bliss can quickly turn into sneezing, itching eyes, and congestion for people who suffer from outdoor allergies.

Before you start planting, an allergist/immunologist can determine which plants will trigger your allergic reactions so you can avoid including them in your plan.

If your allergist/immunologist concludes you have pollen allergies, there are certain flowers, trees, and grasses that are less likely to produce irritating pollen but can still add color and variety to your garden.

Be Selective in Your Garden Choices

Plants that tend to minimize allergy symptoms include:

Azalea Magnolia
Begonia Marigold
Bougainvillea Narcissus
Cacti Orchid
Cherry Pansy
Dahlia Petunia
Daisy Roses
Geranium Snapdragon
Gladiola Sunflower
Hibiscus Tulip
Iris Violet
Irish moss Zinnia
Lily

These plants produce high pollen levels and should be avoided:

Amaranthus Oak
Ash Peony
Cedar Pine
Coneflower Poppy
Cottonwood Privet
Crocus Saltgrass
Elderberry Timothy
Juniper Willow
Maple

Helpful Strategies for Outdoor Allergy Sufferers

In addition to careful plant selection, there are other ways to make gardening more enjoyable. For instance, the time of day and weather can play roles in pollen counts and in your symptoms. For some, outdoor allergy symptoms are worse in the morning; whereas for others, the afternoon and evening hours can be worse. Windy, dry, sunny, and clear days may have greater pollen counts where rainy, cloudy, and windless days often have lower pollen counts. The National Allergy Bureau (http://www.aaaai.org/nab) can help you monitor pollen counts in your area.

While it is impossible to avoid pollen, following these strategies can put the fun back into gardening:

For more tips on outdoor allergies visit:
http://www.aaaai.org/patients/publicedmat/tips/outdoor allergens.stm.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

May 2010 Topic of the Month  

Affording Medications in a Tough Economy

Health care is a hot topic in today's economy.  Whether you are in Congress debating the bill or a family forced to make health care decisions based on your financial factors, you have probably been touched by the crisis.  One way families are saving money is by eliminating prescriptions.

Forgoing asthma and allergy medications could result in a devastating and very expensive outcome.  Asthma and allergies are chronic conditions that require ongoing management.  Your allergist prescribed your medications based upon your specific needs and to keep symptoms under control.  Straying from the plan could lead to severe asthma symptoms and the need for costly emergency room treatment.

Your asthma action plan may include long-term and quick-relief medications.  Both are important in symptom control.  Long-term controller medications are taken on a regular basis (typically daily) to control airway inflammation and treat symptoms.  Quick-relief medications are used to provide temporary relief of symptoms.  Uncontrolled asthma can lead to missed work or school, emergency room visits, hospitalizations, or even death.

Many people with allergies take allergy shots (immunotherapy) to relieve symptoms.  There are two phases to immunotherapy:  build-up and maintenance.  The build-up phase, generally ranging three to six months, involves receiving injections with increasing amounts of the allergens.  The maintenance phase begins when the most effective dose is reacted.

Because immunotherapy is successful by steadily increasing doses of allergens in your body, discontinuing treatment will send you back to square one in getting relief and cost you more over time.  Ongoing allergy symptoms could result in sinus infections or worsening asthma.

Do not be afraid to talk to your allergist about prescription costs.  Your allergist may be able to recommend generics, offer samples, or know of assistance programs so you can stay on track with your treatment plan.  

If you need additional assistance, here are some tips:

DID YOU KNOW?

Reprinted with permission from the American Academy of Allergy Asthma & Immunology 
 

April 2010 Topic of the Month  

Select Your Seed to Avoid the Sneeze


For those with seasonal allergies, lawns and gardens in spring can bring endless sneezing, itchy eyes, congestion, scratchy throat, and sometimes even an asthma attack.  However, if you're an avid gardener with allergies, you can select certain plants that don't have as large an impact on the quality of your outdoor experiences.

To avoid symptoms, allergy sufferers should first identify which plants cause their allergic reactions.  Skin testing by an allergist/immunologist can determine which allergens trigger reactions.  An allergist/immunologist will also help you develop strategies to help avoid plants and pollen that trigger your allergies and can prescribe medications to alleviate your symptoms.

Allergy experts have found that some plants cause fewer reactions than others.  For example, maple trees can cause problems for those allergic to its pollen; but trees such as apple trees cause very few allergic reactions.  Weeds, such as ragweed, pigweed, and Russian thistle, are common in the United States; they are usually unavoidable and are highly allergenic.  Other highly allergenic trees and plants include:

  • Ash
  • Cedar
  • Cottonwood
  • Oak
  • Pine
  • Saltgrass
  • Timothy

Some trees, plants, and grasses that have been found to be better for allergy sufferers include:

  • Cacti
  • Cherry
  • Dahlia
  • Daisy
  • Geranium
  • Hibiscus
  • Iris
  • Snapdragon
  • Tulip

Other Tips:
Always wear a mask when gardening if you have seasonal allergies, and avoid touching your eyes and nose.  Leave all gardening tools, including your clothing, outdoors and be sure to shower immediately after working outdoors.  This will help control allergic reactions.  Taking steps to avoid planting allergy-inducing plants near your home will help make it possible to garden, even if you do suffer from spring allergies.

Please contact an allergist/immunologist for information on treatment options and tips on reducing allergen exposure.  It is important to learn what causes your indoor allergies so that you can take steps to make them easier to live with.  An allergist/immunologist is the best-qualified medical professional to manage the prevention, diagnosis, and treatment of allergies and asthma.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

 

March 2010 Topic of the Month  

Take Control of Peak Allergy Season


The peak of spring allergy season has either hit or is about tohit your area of the country.  Trees are budding, flowers are blooming,and while most people are grabbing their ball and bat to head outside,allergy sufferers are grabbing a box of tissues.

Allergy sufferers are all too familiar with peak allergy season asa time when they can be forced indoors, missing out on a fun soccergame and strolls in the park due to their allergy symptoms.

When to Seek Help
Pollen, trees, and ragweed areallergens that could cause an allergic outbreak.  If an allergicoutbreak occurs, it is best to consult an allergist/immunologist.  Anallergist/immunologist is the best qualified specialist to helppatients who suffer from allergies.  Symptoms of an allergic reaction:

Dos and Don'ts
The following dos and don'ts aresuggested by the American Academy of Allergy, Asthma & Immunology(AAAAI) to help lessen exposure to pollens and molds that could triggerallergy symptoms.

DO a thorough spring cleaning.  Windows, book shelves, andair conditioning vents collected dust and mold throughout the winterthat can provoke allergy symptoms.

DO keep windows closed at night to prevent pollens or moldsfrom drifting into your home.  Instead, if needed, use airconditioning, which cleans, cools, and dries the air.

DO  minimize early morning activity.  Pollen is usually emitted between 5 a.m. and 10 a.m.

DO keep your car windows closed when traveling.  

DO shower and wash your hair every night before going to bed.

DO  try to stay indoors when the pollen count or humidity isreported to be high and on windy days when dust and pollen are blowingabout.

DO  view the pollen count in your area.  Visit the National Allergy Bureau (NAB) Web site at www.aaaai.org/nab/.

DO take a vacation during the height of the pollen season to a more pollen-free area, such as the beach or sea.

DO take medications prescribed by your allergist/immunologist regularly, in the recommended dosage.

DON'T take more medication than recommended in an attempt to lessen your symptoms.

DON'T mow lawns or be around freshly cut grass.  Mowing stirs up pollens and molds.

DON'T rake leaves, as this also stirs up molds.

DON'T hang sheets or clothing outside to dry.  Pollens and molds may collect in them.

DON'T over water or grow too many indoor plants if you are allergic to mold.  Wet soil encourages mold growth.

 

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

 

 

February 2010 Topic of the Month  

Identifying Your Itch

During the colder months of the year, skin can appear dry, itchy, and red.  This might not be just the weather.  Red, bumpy, scaly, and itchy skin can be a sign of an allergic skin condition.

Two common allergic skin conditions are eczema and urticaria (hives).  Knowing what they are and what signs to look for are important in the treatment of any skin condition.

What is eczema?
Eczema is an allergic skin condition.  It is hereditary and is often associated with food allergies, asthma, and/or allergic rhinitis.  All age groups are affected by eczema, and it most often affects the face, wrists, inside of the elbows, and backs of the knees.

What signs should I look for?

What is the most effective treatment for eczema?

What is urticaria?
Urticaria (hives) is red, itchy, and raised areas of the skin varying in shapes and sizes.  Hives are the result of histamine and other compounds that are released from mast cells.  Hives tend to break out in clusters.  Clusters of hives typically fade away and clear up within two to 48 hours as new clusters appear on other areas of the skin.

What signs should I look for?

What is the most effective treatment for hives?

Many people suffer from allergic skin conditions year around; but if proper treatments are taken, you can help reduce or prevent future outbreaks.

Whenever you have an unusual rash, make sure to contact an allergist/immunologist, who will work with you to determine whether it is caused by an allergy, irritant, or other trigger.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology

 

 

 

January 2010 Topic of the Month

Food Allergies and College Students

By Matthew Greenhawt, M.D.

Given the increase in the diagnosis of food allergy in young children, it is expected that larger numbers of college students may have a food allergy in the future. But can campuses meet the needs of a college student with food allergies?

At the University of Michigan, we attempted to categorize the scope of the food allergy problem within our large undergraduate student population.

Based on pilot data from 2001, we had some indication that students were not only dealing with food allergy on a daily basis, they were also coping with dangerous risk-taking behaviors. These risks included not having emergency medication with them and eating food that may contain their particular food allergen.

From spring through fall of 2007, we updated the pilot study questionnaire and adapted it for distribution as an electronic survey to the undergraduate population. Our aims were to define the scope of food allergy on our campus and to assess the knowledge of students with food allergies, as well as their attitudes about their allergies. Specifically, we were most interested in the food allergy preparedness of both the student and the university.

Approximately 15,000 questionnaires were distributed, and 513 students responded. Our questions asked about the types of food allergy a student may have, the types of medications prescribed for emergency treatment, notification to others on campus about special needs or the presence of a food allergy, the involvement of the university health services and dining services, and questions about avoidance of food allergens and the student's overall self-perception of risk-taking with eating.

Of the 513 students who responded, 293 reported they had a known food allergy or likely have had a reaction to a food. Of this food-allergic population, 36% had suffered symptoms of a reaction that were consistent with clinical criteria for anaphylaxis. Milk, tree nut, shellfish, peanut, and fish were the most prevalent food allergies reported.

Almost 48% of students with food allergies reported they have emergency medication for treatment. Antihistamines, such as Benadryl®, were the most common medication (nearly 41%). Just 21% reported always carrying self-injectable epinephrine.

Students with food allergies who had not yet experienced a reaction while at college were significantly less likely to carry emergency medication. Among students with food allergies who had a past history of anaphylaxis, about 40% reported always carrying their epinephrine device. Approximately 24% of students with a prior history of anaphylaxis reported they were never prescribed epinephrine.

Nearly 60% of the food-allergic population had not experienced a reaction while at school; but among the remaining 40% who did, 62% of the reactions occurred on campus.

Though a majority of students with food allergies notified their friends (65.5%) about having a food allergy, just under half (nearly 49%) notified their roommate. Few (nearly 13%) notified dining services, and even fewer (3.5%) notified campus health services. However, notification of close campus contacts (friends, roommate) was significantly higher among those who had experienced a reaction while at college.

There were 124 students with food allergies who did not prepare their own food. Among these students, approximately 24% reported their food preparer was aware of their food allergy. Only 11.5% of the 293 respondents reported that foods were always labeled for allergen content in the dining halls.

In examining the risk-taking behavior among the students, nearly 40% reported always avoiding their particular food allergen.

Strict avoidance was significantly less likely among students who had never experienced anaphylaxis; and in a specific question examining why a student would take risks with eating foods that could cause an allergic reaction, the most common response was "lack of history of a severe reaction."

This same group of students was also significantly less likely to maintain medication, to carry epinephrine, and to notify close campus contacts about their food allergy.

Similarly, our results highlighted deficits on our campus in terms of the involvement of health services and dining services. Labeling of food allergens in the dining halls needs to be improved upon so that students are more aware of what they may be eating.

Health services needs to become more proactive in tracking students with food allergies during registration so that support can be offered to them for both medical as well as psychological needs.

This study was not designed as a prevalence study, but rather as a study to examine the social issues surrounding food allergy at college. Therefore, while not without technical flaws and bias, this study offers preliminary evidence that neither the student with food allergies nor the college campus is ready to handle the growing problem of food allergy.

Students and parents alike should work closely with campus administrators, food services, and health center personnel. Before arrival at campus, students should notify dining services or prepare their own food when possible.

Parents should talk to their college-bound children about risk-taking behaviors to ensure these students understand the consequences of such risks.

Reprinted with permission from The Food Allergy & Anaphylaxis Network

 

 

December 2009 Topic of the Month

Flu Vaccine Guidance for Patients with Immune Deficiency

While vaccinations for both the seasonal flu and H1N1 are among the best prevention tools available to prevent complications from the flu, should patients with immune deficiency be given the vaccines?

Immune deficient patients have a decreased resistance to infections and often have repeated or more severe infections that cause unexpected complications.

In general, there are two different types of vaccines.  One is a live vaccine, the other is a killed vaccine.  Live vaccines contain live bacteria or a virus that has been modified.  This means they have lost their disease-causing ability or are administered by a route that prevents them from causing clinical disease.  Killed vaccines are just what the name says â€" the bacteria or virus in the vaccine is dead.

The difference between the live and killed vaccines is important for those with immune disorders.  The live viral vaccines should not be given to patients with immunodeficiencies.  This includes FluMist®, a live viral intranasal vaccine.

Also, family members or household contacts should not receive a live viral vaccine, as they may transmit the live virus to the immune deficient family member.  On the other hand, most people in these categories should get the killed vaccines for seasonal influenza and H1N1 because there is no risk of disease from killed or microbial subunit vaccines in patients with immune deficiency.  Patients with severe T-cell deficiency should not receive the H1N1 vaccine.

Patients with primary immune deficiency, but not patients with severe T-cell deficiency, should receive the H1N1 vaccine.  Although the antibody response may be poor or low, the cell-mediated immune response may be a helpful immune response to the virus.

In addition to the immune deficient patient and his or her household members receiving vaccinations with the killed influenza virus, preventative measures such as hand washing should be practiced.  If a family member or household contact begins to have flu symptoms, anti-viral influenza drugs should be made available and taken at the first sign of the symptoms.

Reprinted with permission from the American Academy of Allergy Asthma & Immunology