Allergy & Asthma Center, PC

Topic of the Month

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

 

 

November 2009 Topic of the Month

Is There a Link Between Childhood Obesity and Allergies?

 

Obese children and adolescents are at greater risk of developing some kind of allergy, especially to a food, according to a study published earlier this year in the Journal of Allergy and Clinical Immunology.

The study is the first to be published using new data from the National Health and Nutrition Examination Survey (NHANES). NHANES is a survey to assess the health and nutritional status of adults and children in the U.S.; and since an allergy/asthma component was added to the 2005-2006 NHANES, it is now the largest nationally representative dataset of allergy and asthma information.

The study authors found allergies to be more common among obese and overweight children than in normal-weight children. Milk allergy (more common in younger children) and shrimp allergy (only tested in those older than six years) were both strongly associated with being overweight or obese.

Analyzing data from 4,111 children aged 2-19, the researchers looked at total and allergen-specific Immunoglobulin E (IgE), or antibody levels, to a wide variety of environmental food allergens. Body weight and responses to a questionnaire about diagnoses of allergies, eczema, and hay fever were also reviewed.

Obesity was defined as being in the 95th percentile of the body mass index for the child’s age. The researchers found that the IgE levels were higher among children who were obese or overweight. Obese children were about 26% more likely to have allergies than children of normal weight and 59% more likely to have an allergy to egg, milk, peanut, or shrimp (the four foods tested).

Because the study collected the information on weight and allergies at the same time, the findings do not prove that the obesity was the cause of the increase in allergy, only that obesity and allergy were related to each other. Other explanations for the relationship are possible.

For example, children with food allergies may develop eating patterns that predispose them to obesity (e.g., children who have milk allergy might drink more juice or sweetened beverages). It is also possible that some other factor, not measured in this study, could be the cause of both the obesity and the allergies.

The authors also examined C-reactive protein, which is a marker of systemic inflammation. Obesity is associated with chronic inflammation, and it may be that such inflammation also plays a role in the development of allergic disease. C-reactive protein was found to be associated with both obesity and IgE levels in this study, and the analysis showed that an inflammatory pathway was one possible explanation for the relationship between obesity and allergic disease.

In conclusion, childhood obesity might be the most important health issue facing U.S. children today; and the data shows that more than 30% of U.S. children between the ages of 2 and 19 were classified as either overweight or obese in 2005 and 2006. Obese children face other serious challenges in addition to allergy, such as heart disease and diabetes.

If you are concerned or have questions about your child’s weight, speak to your doctor. A registered dietitian can also offer guidance for caloric intake within the parameters of your child’s dietary allowances.

Reprinted with permission from The Food Allergy & Anaphylaxis Network

 

 

 

October 2009 Topic of the Month

OFF TO COLLEGE WITH ALLERGIES AND ASTHMA

 

For many students, starting college marks the beginning of adulthood and it may be the first time they’ll be living independently. This exciting (and sometimes scary) transition poses special challenges for those with allergies and asthma, and it often raises concerns for parents.

 

A new environment exposes students to different allergy and asthma triggers. The challenges of college life may add additional stress that can aggravate asthma. And, for those with food allergies, dining on campus can seem like a minefield.

 

These may seem like daunting hurdles to overcome. Yet, with a little planning, teens can successfully transition from high school to college and at the same time take a more active role in managing their health.

 

Steps to Take

If they aren’t already doing so, now is the time for teens to begin to take responsibility for managing their conditions. Here are some timely tips for the college-bound student:

 

Taking control of your health and being prepared for emergencies will help you manage your asthma and allergies and give your parents some peace of mind.

 

Did You Know?

 

 

To the Point

Studies have shown that young people are more likely than others to take risks with their health. For example, one study found that many young people with food allergies have eaten a food even though they know that it contains an allergen.

 

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

 

 

September 2009 Topic of the Month

Anaphylaxis: Your Questions Answered

By Robert A. Wood, M.D.

Once again, it’s time to tackle this year’s top ten questions about anaphylaxis.  As usual, each of these excellent questions was posed by one of you, the readers.

Q: Are there medical concerns if epinephrine is given multiple times in a week?
A: Epinephrine is a very safe medication, so there would not be concerns about using it several times in a week, or even in a day.  The real medical concern, however, would be why so many reactions have occurred, and what can be done to change that.

Q: What are the risks of giving epinephrine if you’re not really sure it’s anaphylaxis?
A: Thankfully, unless you have a serious heart condition, the answer is that there are mild side effects, but not significant risks.

Q: Can you build up immunity to epinephrine?
A: This has never been described, even when we used to use epinephrine on a regular basis for the treatment of asthma in the emergency room.  Believe it or not, this was the usual treatment for asthma before we had inhalers and nebulizers.

Q: Should we always go to the emergency room after giving epinephrine?
A: The simple answer is yes, absolutely.  However, there may be situations when there are absolutely no symptoms and the epinephrine was given as a precaution, and your doctor might decide a trip to the hospital is not needed.  One common misconception is that you are going to the emergency room because of the epinephrine; the real reason is that the allergic reaction may progress or recur.

Q: Does it take epinephrine long to reduce hives:
A: In most instances, hives will begin to fade within minutes of using epinephrine.

Q: Can you give epinephrine in the arm if the child is kicking?
A: You can, although in a small child, the muscle may not be large enough to use for an injection.  The leg is, therefore, always preferred.

Q: How can you tell the difference between an asthma attack  and an anaphylactic episode?  Which should you treat first?
A: Asthma and anaphylaxis can look very similar, especially if there are only respiratory symptoms with anaphylaxis.  This occurs about 20% of the time when there are no skin or gastrointestinal symptoms to suggest allergy versus asthma.  My usual answer is to interpret symptoms in the context of the overall situation.  For example, if you are at home and know only safe food has been eaten, an allergic reaction is unlikely, compared to symptoms that begin when you are at a party or eating out.

With regard to what to treat first, the beauty of epinephrine is that it is a great drug for asthma as well as anaphylaxis, so you can never go wrong using epinephrine when there is any doubt.

 

 

Q: Is  there really a "click†with a real auto-injector device, as there is with a trainer?
A: The trainers for the epinephrine auto-injectors are very helpful, but they do not mimic the real devices exactly.  I always recommend that you use an expired device on an orange to know what the real thing feels like.  This is especially useful in training your child to self-administer, something I think you should be teaching by the time your child is 11 or 12.

Q: Sometimes my epinephrine gets too cold or hot.  How can I tell if the epinephrine has gone bad?
A: Epinephrine should be completely clear and colorless; and if the color has changed or if there are any crystals or solids, you can assume the medication has gone bad.  However, the medicine can be completely bad and still look clear, so you can by no means use this as a rule to assure the medicine is still good.  Do not use your epinephrine auto-injector if it is discolored or has any crystals or solids.

Q: Are expiration dates accurate?  Or is epinephrine still good for, say, six months after expiration?
A: In the one study that was done on this topic, they found that epinephrine did clearly weaken after the expiration date.  The conclusion of the study, written by Dr. Estelle Simons of FAAN’s (Food Allergy & Anaphylaxis Network) Medical Advisory Board, was as follows:  "For pre-hospital treatment of anaphylaxis, we recommend the use of auto-injectors that are not outdated.  If, however, the only auto-injector available is an outdated one, it could be used as long as no discoloration or precipitates [solids] are apparent because the potential benefit of using it is greater than the potential risk of a suboptimal epinephrine dose or of no epinephrine treatment at all.

 

 

August 2009 Topic of the Month

PACKING AN ALLERGY-SAFE PICNIC BASKET

Whether it's a romantic outing or family trip to the beach, the summer months are the perfect time for dining outdoors. Like all food-focused events, picnics pose special challenges for people with food allergies; but with careful planning, it's easy to put together an allergy-friendly picnic basket that everyone can enjoy.

 

More Picnic Tips:

Take a clean tablecloth to cover the picnic table. This will prevent contact with germs and any allergens left over from previous picnics.

Potluck-style picnics and barbecues can be a minefield for those with food allergies. Always take allergy-safe options for yourself or your child, and have whoever is doing the grilling cook your food first to avoid cross-contamination.

Take hand wipes or sanitizer in case there is no water at the picnic site. If you are camping, remember that cleaning pots, pans, and plates may be more difficult than at home, increasing risks for cross-contamination.

Check cell phone coverage at your picnic or camp site, especially if you are headed to a more remote area. Have a plan if you or someone you are with should have a severe allergic reaction.

Clean up when you are done eating. Leaving food out in the open can attract bugs, such as wasps and honeybees, to which many people are allergic.

For allergy-safe recipes, visit www.aaaai.org/patients.stm

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

 

 

July 2009 Topic of the Month

PREPARE FOR SUMMER SKIN FLARE-UPS

Summer is finally here! It is time for your camping trip, family vacation, day at an amusement park, or visit to Grandma's house.

It may also be time for your child's skin allergy flare-ups. Symptoms often include hives (raised, itchy bumps). Some people get dry, itchy patches. Sometimes the rash can even have fluid-filled blisters. These rashes don't have to spoil the fun. Knowing the causes and being prepared can help make your summer outings enjoyable for everyone.

According to Dr. Julie McNairn, a member of the American Academy of Allergy, Asthma & Immunology, there are several tips for taking the heat out of summer skin allergies.

  1. Beware of the sun. Hives can be triggered by heat or sweat, so make sure your kids drink plenty of fluids, avoid becoming too hot, and wear sunscreen.

     

  2. Be prepared. Eczema can worsen in the summer, especially if there is excess sweating. Have a skin care treatment plan. This may include having on hand mild bathing products. Check with your allergist to see if an antihistamine or steroid might help.

     

  3. Beware of contact with certain plants. Poison oak, sumac, or ivy can all lead to skin rashes. There is a saying you can teach your children: "Leaves of three, let them be.†Some people are sensitive to the point that their conditions can flare up when in contact with grass or other plants. For protection, your children can wear long pants and long sleeves if outdoor plants cause a reaction.

     

  4. The eyes have it. High pollen levels can cause itchy, runny eyes. Other contacts can also cause symptoms around the eyes. Be sure to tell your doctor if the skin allergies also involve the eyes.

     

  5. Bug bites. Can cause a severe local reaction in some people insect repellant can help. Ticks can also be a cause. If a tick is discovered, remove the whole body and save it to show to your doctor.

     

  6. Insect stings. It is normal for bee and wasp stings to cause a minor rash. However, for people with actual stinging insect allergies, these stings can cause a severe reaction â€" in some cases anaphylaxis â€" and require emergency treatment. Always report the reaction to your doctor in case testing is needed.

     

  7. Allergens climb. Summertime is the time for high mold counts, poor air quality with smog, and ragweed, depending on where you live. Worsening nasal allergies or asthma can cause skin flare ups.

     

  8. Year¬-around rashes. Certain foods, medications, environmental allergens, and even sunscreen, fragrances, and nickel can cause rashes any time of the year. A diary of what has been eaten or touched may help you and your doctor determine what might be causing the rash.

     

  9. It is not an allergy at all! Infections are common in the summer and can cause hives or rashes. Not to worry â€" these usually respond to antihistamine and time, though they might need other treatment. Prickly heat or heat stroke can look like an allergy.

"If any of these rashes are severe, involve breathing troubles, confusion, nausea, or circulation problems, get medical help right away," warns McNairn.

If your child has already been diagnosed with skin allergies, a visit to your allergist can help you prepare for summer. Allergists/immunolgists are specially trained doctors who can help your regular doctor take care of summer skin rashes. Prepare for your allergies ahead of time with antihistamines, creams, and any regular allergy (or asthma) medications. Treatment depends on the cause.

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

 

 

June 2009

 

"SUMMER BREAK" DOESN'T APPLY TO ASTHMA MEDICATIONS

It's summertime, and the living is easy. But it can be dangerous to apply that laidback attitude toward asthma treatment.

The American Academy of Allergy, Asthma & Immunology urges patients to continue to take all asthma drugs as prescribed over the summer, even if you don't have symptoms. It is the best way to avoid an asthma flare-up.

Studies have shown that patients who reduce or stop taking their asthma medications during the summer months are at greater risk of serious asthma symptoms in the fall. This so-called "drug holiday" leads to a spike in hospitalizations and emergency department visits due to asthma, especially among children and young adults.

Managing your asthma
Long-acting medications (such as inhaled corticosteroids) are taken daily to reduce inflammation in the lungs, preventing asthma flare-ups. Even though you may feel fine, your lungs depend on the medication to control inflammation.

Short-acting medications (such as albuterol) should be used as prescribed only when immediate relief is needed. If you are using your rescue medication often, talk with your allergist to discuss other treatment options to help control your symptoms.

There are many triggers for asthma, and each patient is different. Your allergist can help you develop a plan for avoiding asthma symptoms from triggers such as:

Remember that asthma is a constant companion â€" don't use a family vacation or summer camp as an excuse to stop taking medications.

Find additional information on asthma, including a medication guide, at www.aaaai.org.

Did You Know?
Doctors aren't sure why some asthma patients stop using their medications during the summer. There is no evidence that supports taking a break. In fact, stopping medications can put you at higher risk for an asthma attack.

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

 

 

May 2009

 

POLLEN: LITTLE CELLS THAT CAUSE BIG PROBLEMS
By David Shulan, MD, FAAAAI

For people with seasonal allergies, pollen levels can be a useful tool. Yet many don't fully understand what they are and how monitoring pollen levels can help to reduce their symptoms.

WHAT IS POLLEN?:
Pollenâ€"the tiny, male cells of flowering plantsâ€"can cause itchy or watery eyes, a stuffy and runny nose, allergic eczema, and asthma. The pollens that cause the most problems are those that are spread by wind, such as ones from trees, grasses, and weeds. These are very light pollens and can blow hundreds of miles from their origin. As a result, you can suffer symptoms caused by pollens that were released hundreds of miles away.

Pollen levels often include these problematic pollens, some of which are from species not found in the local area. Plants with large flowers usually do not cause major allergy symptoms as they have heavy pollens that drop out of the air quickly.

WHAT DO POLLEN LEVELS MEASURE?
Pollen levels measure airborne allergens. For sensitive individuals, monitoring pollen levels can help limit outdoor exposure at peak pollen times and in turn reduce their allergy symptoms.

Various concentration levels are associated with the amount of pollen recorded. In general, "absent" means no measurable pollen is recorded. "Low†means that only very sensitive individuals will experience symptoms. "Moderate" means that many more individuals will suffer symptoms. "High" means that most sensitive individuals will suffer some symptoms. "Very high" indicates that all sensitive individuals will suffer symptoms and most will have more severe symptoms.

WHAT AFFECTS POLLEN LEVELS?
Location is one of several factors that can influence pollen levels. A ragweed count of 100 grains/cubic meter would be considered very high in Albany, NY, but only counts in the thousands will raise eyebrows in Iowa City, IA, where they can reach 5,000. Generally, the number of ragweed plants in the Midwest is much higher than in the eastern United States; but ragweed in smaller numbers can be found pollinating in Florida during the spring.

Weather conditions also play a role in pollen levels. Moderate temperatures with low humidity and a gentle breeze keep pollen in the air, whereas rain washes the pollen out. A windless day will result in low levels since pollen needs wind to disperse. High levels of humidity will make the pollen grains heavier, meaning they will drop out of the air more quickly.

CAN ALLERGY SYMPTOMS VARY THROUGHOUT THE SEASON?
Throughout the season, individuals can vary in their level of sensitivity. Many become more sensitive as the season progresses. This process, called allergic priming, means that you may not have problems with low pollen levels at the beginning of the season; but towards the end of the season, low levels may start to cause symptoms.

WHERE CAN I FIND POLLEN LEVELS?
The National Allergy Bureau (NAB) is the section of the AAAAI’s Aeroallergen Network responsible for reporting current pollen and mold spore levels to the public.

The NAB provides the most accurate and reliable pollen and mold levels from approximately 78 counting stations throughout the United States, as well as several counting stations in Canada and Argentina. To view the pollen levels for your area, visit www.aaaai.org.

If seasonal allergy symptoms are making you miserable, see an allergist/immunologist. Knowing when you are having symptoms, along with when exposure occurs, can help your allergist/immunologist to use the most effective therapies.

David Shulan, MD, FAAAAI, is an allergist/immunologist based in the Albany, NY, area for nearly 24 years. He is currently in practice with six other board-certified allergists at Certified Allergy and Asthma Consultants and is the director of its NAB-certified pollen counting station.

TIPS TO REMEMBER DURING POLLEN SEASON

Following these tips can reduce exposure to pollen:

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 out to dry. Pollens and molds may collect in them.

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

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

 

 

April 2009

Spring is the busiest time of the year at your allergist's office as patients begin experiencing the first symptoms of seasonal allergies or "hay fever."

An estimated 35 million Americans suffer from allergies to pollen and mold, according to the American Academy of Allergy, Asthma & Immunology. Symptoms include sneezing, a stuffy or runny nose, and itchy, watery eyes.

If you are planning to see an allergist/immunologist this spring, make sure you get the most from your appointment by writing down your questions and concerns ahead of time. Let your allergist know if:

You might also want to ask these questions:

DID YOU KNOW?

In most parts of the country, trees are the first plants to pollinate, beginning in early spring. Grass pollen is present in the early summer months, and weed pollen (such as ragweed) arrives in the late summer and fall. Allergy sufferers in many areas get relief in winter months when pollen levels are extremely low. Not so in Texas, where highly-allergenic cedar trees peak in January.

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

 

 

March 2009

Questions and Answers about Complementary and Alternative Medicine

Pharmacy shelves stocked with supplements â€" some even promising to treat allergies and asthma. Techniques such as yoga, massage, biofeedback, or acupuncture.

What do these have in common? They are all considered complementary and alternative medicines (CAM) and are used in one form or another by nearly four in ten people. What is the difference between them? Alternative medicine is often used instead of conventional medical techniques, and complementary medicine is used along with more traditional approaches.

Do they work? Scientific evidence supports use of some treatments or practices when used along with or in place of traditional medicine. But many others are not effective therapies and may even be dangerous, especially those that ask you to forgo treatment from your doctor. In addition, CAM can interfere with conventional medicines prescribed by your doctor â€" reducing benefits or increasing risks.

Allergic Risks
If you have allergies or asthma, it is best to speak with your allergist before using CAM. Unlike conventional medicines, CAM products are considered "supplements†and are not tested for safety and efficacy by the U.S. Food and Drug Administration (FDA). Neither are they subject to quality controls or ingredient labeling laws. In addition, some manufacturers may not test their products; and there is no guarantee that you are purchasing a safe and effective form of the supplement. It can be extremely difficult to know what ingredients these supplements contain, potentially creating risk for people with food or medication allergies.

Herbal formulas can cause side effects and have been connected with severe reactions. Several cases of anaphylaxis, a life-threatening allergic reaction, have been reported with the use of some herbal supplements. Some food supplements may also cause an allergic reaction. For example, people with a ragweed pollen allergy may also have an allergic reaction to chamomile tea.

As physicians learn more about CAM, there is agreement that some treatments can be very helpful when integrated into practices for health and well-being.

Check with your allergist first to see if you should include CAM as part of your healthcare. Visit www.aaaai.org to locate an allergist near you or to find additional information about allergy and asthma treatments.

Did You Know?
Researchers are currently studying the effects of herbal medicines on food allergies. Early results suggest that some formulas may prevent severe allergic reactions to peanuts.

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

 

 

February 2009

Two cents about nickel allergy. . . .

Nickel is a leading cause of allergic contact dermatitis â€" an itchy rash that develops when a person's skin touches a normally harmless material.

Nickel is a silver-colored metal that is mixed with other metals to make coins, jewelry, eyeglass frames, home fixtures, keys, and other common items. In people allergic to it, nickel causes an itchy red rash, similar to a reaction from poison ivy.

More women than men are allergic to nickel. This is probably because women are more likely to have pierced ears. Studies show that body piercing is the single most common cause of nickel allergy.

While there is no cure for nickel allergy, allergic reactions can be prevented by avoiding products that contain it. Home testing kits are available to check metal items for nickel.

Wear only nickel-free jewelry, including earrings, necklaces, and watches. Keep a barrier, such as an undershirt, between your skin and metal snaps and zippers on clothing.

If you are having your ears pierced, choosing the right pair of earrings can prevent nickel allergy from developing. Wear only stainless steel or solid gold earrings until the piercing has completely healed â€" about three weeks.

While most reactions are uncomfortable and unattractive, they are usually easily treated. Your allergist/immunologist can recommend the best treatment for an allergic reaction.

If the rash is small, a doctor may prescribe medicated creams (topical corticosteroids) to rub on the irritated skin. For larger or more serious outbreaks, pills may be required.

Talk to your allergist/immunologist if you think you have a nickel allergy. An allergist/immunologist is the best doctor to diagnose nickel allergy and prescribe treatments.

DID YOU KNOW?

Nickel can be found in braces, crowns, and dentures. Be sure to tell your dentist or orthodontist if you have a nickel allergy. Orthopedic surgeons may also use hardware that contains nickel.

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

 

 

January 2009

More Than a Cold?

If your stuffy nose and cough last longer than one or two weeks, you may have more than a cold. Sinusitis, an inflammation of the nasal sinuses, has many of the same symptoms as a cold but can be much more serious.

Often called a "sinus infection," up to 16% of American adults will develop sinusitis each year, leading to $5.8 billion in healthcare costs and millions of days of missed work, according to the American Academy of Allergy, Asthma & Immunology (AAAAI).

Sinusitis occurs when the sinuses â€" hollow areas behind the forehead, cheeks and nose â€" become swollen, which blocks mucous from draining and leads to painful pressure and infection.

Symptoms of sinusitis include:

People with allergies or asthma are more likely to develop sinusitis because their nasal and sinus tissues can become swollen when they breathe in triggers like dust, pollen, or smoke.

Treatment provides relief

When sinusitis is caused by an infection, antibiotics are used to kill the bacteria. Other treatments can include medications like decongestants or home remedies, such as heat pads. These treatments reduce swelling to relieve the pain.

For people with allergies, there are steps that can taken to reduce the risk of sinusitis. Your allergist/immunologist may recommend long-term treatments, such as allergy shots, medication to control inflammation, and avoidance of allergy triggers.

Some people get sinusitis because of problems with the structure of their nose â€" such as tumors or narrow nasal passages. In this case, an operation may be needed.

Your allergist/immunologist can diagnose sinusitis and help you choose the best treatment, as well as offer methods to avoid future infections.

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

 

 

December 2008

Handling the Holidays

Do asthma and allergies threaten to be the Grinch in your holidays? The American Academy of Allergy, Asthma & Immunology (AAAAI) offers these tips to help keep your season merry:

 

Visit the AAAAI Web site, www.aaaai.org, for additional patient resources on allergies and asthma, including allergy-friendly holiday recipes.

Did you know . . . .

Some individuals think they are allergic to Christmas trees, but it is actually mold growing on the evergreens that causes sneezing. Reduce your reaction by shaking your tree thoroughly â€" many vendors have a machine that can do this â€" and allowing it to dry for a few days in a covered area before bringing it indoors.

To the Point . . . .

 

 

November 2008

Prepare for battle: How to fight indoor allergens

With colder months approaching quickly you will probably be spending more time indoors. Unfortunately, many people don't realize that allergy and asthma triggers may be lurking inside their homes. Spending time indoors increases your exposure to indoor allergens, such as dust mites, mold spores, pet dander, and even cockroaches.

More than 40 million people in the United States suffer from indoor allergies year-around. Perennial allergy sufferers experience symptoms such as a stuffy or runny nose, itchy eyes, sneezing, and wheezing. These symptoms are triggered by airborne particles, or allergens. Allergies can lead to other chronic conditions, such as asthma or perennial allergic rhinitis. Therefore, it is important to learn what provokes your indoor allergies and what steps you can take to avoid triggers.

Below are tips to learn about common indoor allergens and ways to minimize your exposure to them

Dust Mites

 

Mold

 

Pets

 

Cockroaches

 

Making changes to you indoor environment can take time and commitment, but it is necessary if you want to reduce your allergy symptoms. To begin, you may want to create a priority list and consider a "fall cleaning" as colder months approach. Progressive changes and a deep cleaning will produce an indoor environment that is less allergenic and healthier for the whole family.

Contact an allergist/immunologist for more information on treatment options and tips on reducing your allergen exposure. An allergist/immunologist is the best qualified medical professional trained to manage the prevention, diagnosis, and treatment of allergies and asthma.

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

 

 

 

October 2008

Food Allergies 101: Back-to-School Safety

Did you know?
Children frequently outgrow allergies to egg, milk, and soy. However, peanut, tree nut, fish, and shellfish allergies are usually life-long.

The first day of school is an exciting time for most students and parents. But for families of children with food allergies, it can also be a time of anxiety and fear. For students with food allergies, potential dangers lurk throughout the school environment. Risks in the cafeteria are often obvious to parents, but students must also be careful when art projects, fieldtrips, and class parties involve food.

The American Academy of Allergy, Asthma & Immunology (AAAAI) estimates that approximately 2.2 million school-age children suffer from food allergies. Yet school districts have differing policies on how to provide a safe environment for these children.

Cooperation is key
Parents, school officials, and teachers need to work together to create a safe environment for students with food allergies. Make sure that school staff knows what foods are unsafe for your child. If necessary, give cafeteria workers a picture of your child and require that they prepare allergy-free lunches for him or her. Your doctor can provide you with information on preventing, recognizing, and treating an allergic reaction. Pass these tips on to all school staff that interact with your child.

Keeping healthy. Staying safe.

The AAAAI offers these tips for parents:

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

 

 

No topic of the month for September.

 

 

August 2008

Staying Fit with Exercise-Induced Asthma

Summer is a popular time to get outside and exercise. However, for people with asthma, this can be difficult. Asthma is triggered or worsened by a number of factors, but exercise is one of the most common. In fact, an estimated 80% of people with asthma have increased symptoms when they exercise. This is called exercise-induced asthma (EIA).

In normal circumstances, airways open with exercise. With EIA, the airways close after about 5-8 minutes of near-maximum physical activity. This can cause symptoms such as coughing, wheezing, shortness of breath, and chest tightness.

Exercise-induced asthma tends to occur in sports such as track, basketball, tennis, and soccer. Symptoms are less likely to happen in sports such as swimming, baseball, football, and volleyball. Once exercise stops, most people with EIA recover (even without treatment) after 20-60 minutes.

Studies indicate that as many as 15% of athletes suffer from EIA. Studies evaluating elite athletes, such as Olympians, show that up to 40% have symptoms of EIA.

There are people who have asthma associated only with exercise, but the majority of people have underlying asthma that worsens with exercise.

If you experience symptoms of EIA, you should have an evaluation, including pulmonary-function testing, to confirm the diagnosis, develop a plan, and rule out the need to look for other causes of symptoms. Allergy skin testing may also be done.

The first and best treatment for EIA is making sure that your asthma is well controlled. The primary medications used for EIA are bronchodilators, such as albuterol or pirbuterol. These should be used at least 15-30 minutes before exercising and may last up to four hours. Cromolyn sodium has also been effective when used pre-exercise, and montelukast has been approved in preventing EIA in patients aged 15 years or older.

In addition to taking medications, there are other ways to reduce EIA. Avoiding exercise in conditions where air is cold and dry can help, as well as doing warm-up exercises. Appropriate training and condition, in addition to breathing through the nose (as opposed to the mouth), may also help reduce EIA.

If asthma symptoms are interfering with your ability to exercise, consult an allergist/immunologist to get back on track.

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