Allergy & Asthma Center, PC

Topic of the Quarter

Topic of the Quarter
March 2017

If you suffer from allergy symptoms, you may wonder if allergy immunotherapy (allergy shots or allergy tablets) is the best treatment for you. While it requires time and patience, the payback can be long-term relief.

Allergies are the result of a hyperreactive immune system. Your immune system serves to protect your body against injections and other conditions. Allergies are caused by an abnormal immune response to substances that are not harmful. For instance, if you have an allergy to grass pollen, your immune system identifies pollen as an invader or allergen and produces antibodies against grass pollen called Immunoglobulin E (IgE.)

Allergy immunotherapy is a treatment that aims to correct or “cure” this abnormal immune response. It involves regular administration of the allergenic substance by injecting it subcutaneously into the arm, which is also known as ‘shots’ or subcutaneous immunotherapy (SCIT), or as a solution or tablet underneath the tongue. Sublingual immunotherapy (SLIT) is the medical term for delivering the allergic substance underneath the tongue. In the United States, the only FDA-approved forms of sublingual immunotherapy are allergy tablets.

Both forms of allergy immunotherapy–the shots and the tablets– are prescribed by allergist/immunologists. An allergist/immunologist, often referred to as an allergist, has specialized training and experience to determine which allergens are causing your symptoms and can discuss if allergy immunotherapy is right for you.

How Do Allergy Tablets Work?

Allergy immunotherapy, whether it’s the shots or the tablets, works much like a vaccine. Your body responds to the added amounts of a particular allergen given, eventually developing a resistance and immune tolerance to it. Allergy tablets can lead to decreased, minimal or no allergy symptoms with symptom relief for years after treatment is completed.

Allergy tablets administer the allergen in a tablet form under the tongue, generally on a daily basis. They are currently available in the United States for grass pollen and/or short ragweed pollen induced allergies. Allergy tablets are also available for dust mite allergies in many European countries and Japan and may soon be available in the United States.

Will I Feel Better?

In clinical studies, during treatment for one ragweed or grass pollen season, patients who received allergy tablets experienced significant improvement in their allergy symptoms, required less allergy medications and in general reported a better quality of life in the first treatment season. These improvements were even better in the second and third treatment year.

If you aren’t responding to allergy immunotherapy, it may be because you have other allergies in addition to grass and ragweed. Other reasons could be that there are high levels of the allergen in your environment or major exposures to non-allergic triggers like tobacco smoke are present.

What is the Length of Treatment?

The tablets are typically started four months before the start of the featured pollen season and continued throughout the season. Tablets are similar to allergy shots in terms of the effectiveness of controlling allergy symptoms, and both have been shown to provide long term improvement even after the treatment has ended.

The first dose is taken at the healthcare provider’s office, where the patient is to be observed for at least 30 minutes for potential adverse reactions. Future dosages can be administered at home, making the dosage schedule more convenient than allergy shots.

Who Can Be Treated with Allergy Tablets?

Grass allergy tablets are currently approved for ages 10 through 65. Ragweed tablets are currently approved for ages 18 to 65.

Allergy immunotherapy is not started on patients who are pregnant but can be continued on patients who become pregnant while receiving it. In some patients with other medical conditions or who take certain common medications, allergy tablets may be more risky. It is important to mention other medications you take to your allergist.

What Are the Possible Reactions?

Allergy tablets have a more favorable safety profile than allergy shots, which is why it does not need to be given in a medical setting after the first dose. However, FDA-approved product information for the three tablets available in the United States include a warning about the possibility of severe allergic reactions, including anaphylaxis, from the tablets.

That is why the preferred location for receiving your first dose is your prescribing allergist’s office. Initial treatments may also be given at another facility where the physician and staff are trained to recognize and treat reactions or have received instructions by your prescribing allergist.

The primary side effects of allergy tablets are local reactions such as itching or burning of the mouth or lips and less commonly, gastrointestinal symptoms. These reactions usually stop after a few days or a week. An epinephrine autoinjector should also be prescribed to patients receiving allergy tablets in the event that a severe allergic reaction should occur at home.

Healthy Tips

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



Topic of the Quarter
December 2016

As people age, the number of medications they take often increases significantly. It is essential that older patients have an awareness of what medications they are taking, how to take them and what the potential side effects can be. This is especially true for older adults with allergies or asthma.

It is important not to let your treatments become asthma triggers. The best way to avoid medication-induced asthma is to talk with your physician about what medications are best for you.

Asthma Medications

There are times when a medication can be very beneficial for one ailment, but has the potential to cause concern for another condition. Such is the case with a particular class of asthma medications: inhaled corticosteroids (ICS). On the other hand, corticosteroids are known to contribute to the development of osteoporosis (a condition leading to brittle bones), which is a common problem for older patients, especially women. On the other hand, ICS is the most effective class of drugs in the treatment of asthma. There is concern that ICS may lead to osteoporosis because oral and injected steroids are well known to contribute to this process.

Apart from being a potentially life-threatening disease, uncontrolled asthma puts you at a high risk for other complications. If your asthma is uncontrolled, you may not be sleeping well, it could become difficult to maintain an active lifestyle and you may require hospitalization. Reduced levels of activity, in turn, can also cause osteoporosis.

An allergist/immunologist, often referred to as an allergist, has extensive training in the management of asthma and in minimizing the side effects of medications such as inhaled corticosteroids.

Allergy Medications

Allergies such as allergic rhinitis (hay fever), allergic conjunctivitis (eye allergy) and urticaria (hives) are common problems for older adults and often require the use of antihistamines. Antihistamines are divided into two classes: first generation antihistamines and second generation antihistamines.

First generation antihistamines, while very effective at controlling symptoms, are often associated with symptoms in older adults such as anxiety, confusion, sedation, blurred vision, reduced mental alertness, urinary retention and constipation. These side effects are even more common if you are being treated with certain antidepressant medications.

The second and third generation antihistamines do not cross the blood-brain barrier as readily and, therefore, cause fewer side effects. If you have allergies that require an antihistamine, discuss with your physician the use of second generation antihistamines in place of a first generation antihistamine. Physician and allergist prescribed antihistamines currently in use are generally second or third generation drugs that have an extremely favorable safety profile for users.

Drugs That Can Trigger Asthma

Beta-Blockers
These drugs are often used for problems such as high blood pressure, heart disease, and migraine headache. They may also be used in an eye drop form for treating the eye disease glaucoma. They are classified in one of two groups: non-specific and specific.

Non-specific beta-blockers, such as propanalol, are the most important ones to avoid. Ideally, a person with asthma would avoid all beta-blockers, but these types of drugs may be quite important for certain patients’ health and may not substantially worsen their asthma. Your physician may conduct a trial using a “specific” beta-blocker. Remember that even beta-blockers in eye drops may make asthma worse, so be sure to tell your ophthalmologist that you have asthma.

Aspirin and Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
This group of medications include some common over-the-counter pain relievers, such as ibuprofen and naproxen. Approximately 10 to 20% of people with asthma may notice that one or more of these drugs trigger their asthma. These asthma attacks may be severe and even fatal, so patients with known aspirin sensitivity must be very careful to avoid these drugs. Medications that usually don’t cause increased asthma in aspirin-sensitive patients include acetaminophen (low to moderate dose), propoxyphene and prescribed narcotics such as codeine.

ACE Inhibitors
These drugs, which may be used for hypertension or heart disease, include Lisinopril and enalapril. Although they usually don’t cause asthma, approximately 10% of patients who receive one of these drugs develop a cough. This cough may be confused with asthma in some patients and possibly trigger increased wheezing in others. In addition, any cough can be associated with reflux (acid coming up from the stomach into the esophagus) which can cause more coughing and worsen asthma.

Healthy Tips

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



Topic of the Quarter
August 2016

Myth 1: Vaccines contain many harmful ingredients.

Fact: Vaccines contain ingredients that allow the product to be safely administered. Any substance can be harmful in significantly high doses, even water. Vaccines contain ingredients at a dose that is even lower than the dose we are naturally exposed to in our environment. Thimerosal, a mercury containingcompound, is a widely-used preservative for vaccines that are manufactured in multi-dose vials. We are naturally exposed to mercury in milk, seafood, and contact lens solutions. There is no evidence to suggest that the amount of thimerosal used in vaccines poses a health risk. Many vaccines now produce single-dose vials, which has greatly decreased the use of thimerosal in vaccines. Formaldehyde, another vaccine ingredient, is an automobile exhaust, household products and furnishings such as carpets, upholstery, cosmetics, paint and felt-tip markers, and in health products such as antihistamines, cough drops, and mouthwash. The dose in vaccines is much lower than the amount we are exposed to in our daily life. Not all vaccines contain aluminum, but those that do typically contain about .125mg to .625 mg per dose. This, too, is much less than what the average person consumes in a day. An estimated 30 to 59 mg of aluminum is consumed by the average person daily, mainly from foods, drinking water and medicines.

Myth 2: Vaccines cause autism and sudden infant death syndrome (SIDS).

Fact: Vaccines are very safe. Most vaccine reactions are usually temporary and minor, such as fever or sore arm. It is rare to experience a very serious health event following a vaccination, but these events are carefully monitored and investigated. You are far more likely to be seriously injured by a vaccine-preventable disease than by a vaccine. For example, polio can cause paralysis, measles can cause encephalitis (inflammation of the brain) and blindness, and some vaccine-preventable diseases can even result in death. The benefits of vaccination greatly outweigh the risk, and without vaccines many more injuries and deaths would occur. Science has not yet determined the cause of autism and SIDS. These diagnoses are made, though, during the same age range that children are receiving their routine immunizations. The 1998 study that raised concerns about a possible link between measles-mumps-rubella (MMR) vaccine and autism was retracted by the journal that published it because it was significantly flawed by bad science. There is no evidence to link vaccines as the cause of autism or SIDS.

Myth 3: Vaccine-preventable diseases are just part of childhood. It is better to have the disease than become immune through vaccines.

Fact: Vaccine-preventable diseases have many serious complications that can be avoided through immunization. For example, more than 226,000 people are hospitalized from influenza complications including 20,000 children. About 36,000 people die from influenza each year. Vaccines stimulate the immune system to produce an immune response similar to natural infection, but they do not cause the disease or put the immunized person at risk of its potential complications.

Myth 4: I don’t need to vaccinate my child because all the other children around him are already immune.

Fact: Herd immunity occurs when a large population of a community is immunized against a contagious disease, reducing the change of an outbreak. Infants, pregnant women and immunocompromised people who cannot receive vaccines depend on this type of protection. However, if enough people rely on herd immunity as the method of preventing infection from vaccine-preventable diseases, herd immunity will soon disappear.

Myth 5: A child can actually get the disease from a vaccine.

Fact: A vaccine causing complete disease would be extremely unlikely. Most vaccines are inactivated (killed) vaccines and it isn’t possible to contract the disease from the vaccine. A few vaccines contain live organisms, and when vaccinated lead to a mild case of the disease. Chickenpox vaccine, for example, can cause a child to develop a rash, but only with a few spots. This isn’t harmful, and can actually show that the vaccine is working. One exception was the live oral polio vaccine, which could very rarely mutate and actually cause a case of polio. However, oral polio vaccine is no longer administered in the United States.

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



Topic of the Quarter
May 2016

If you have asthma, the airways in your lungs are usually inflamed. During an asthma flare-up these airways get even more swollen, and the muscles around the airways can tighten. This can trigger wheezing, coughing, chest tightness, and shortness of breath.

An allergist/immunologist, often referred to as an allergist, has specialized expertise to clearly identify your asthma triggers and to develop a treatment plan that can minimize flare-ups and improve your quality of life.

Common Asthma Triggers

Asthma Medications

Asthma is a chronic disease, so it requires ongoing management. This includes using proper medications to prevent and control 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.

Quick-relief medications are used to provide temporary relief of symptoms and, at times, used before exercise. These rescue medicines are bronchodilators, which help to open up the airways so that more air can flow through. Bronchodilators are primarily short-acting beta-agonists administered by an inhaler or a nebulizer machine. Another type of medicine called an anticholinergic may be used at times.

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

Inhaled corticosteroids 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-agonists are symptom controllers that open your airways.

Current recommendations are for them to be used only along with inhaled corticosteroids.

Leukotriene modifiers are typically used to open airways.

Methylxanthines can help open the airways and may have a mild anti-inflammatory effect. Theophylline is the most frequently used methylxanthine. Blood levels of theophylline need to be monitored.

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

Asthma Management Plan

The better informed you are about your condition, the better control you will have over your asthma symptoms. To assist, you and your allergist will develop a personalized management plan. This plan includes:

Together, you and your allergist can work to ensure that asthma interferes with your daily life as little as possible.

Health Tips

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



Topic of the Quarter
January 2016

Allergen immunotherapy, also known as allergy shots, is a form of long-term treatment that decreases symptoms for many people with allergic rhinitis, allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy.

Allergy shots decrease sensitivity to allergens and often leads to lasting relief of allergy symptoms even after treatment is stopped. This makes it a cost-effective, beneficial treatment approach for many people.

Who Can Benefit From Allergy Shots?

Both children and adults can receive allergy shots, although it is not typically recommended for children under the age of five. This is because of the difficulties younger children may have in cooperating with the program and in articulating any adverse symptoms they may be experiencing. When considering allergy shots for an older adult, medical conditions such as cardiac disease should be taken into consideration and discussed with your allergist/immunologist first.

You and your allergist/immunologist should base your decision regarding allergy shots on:

Allergy shots are not used to treat food allergies. The best option for people with food allergies is to strictly avoid that food.

How Do Allergy Shots Work?

Allergy shots work like a vaccine. Your body responds to injected amounts of a particular allergen, given in gradually increasing doses, by developing immunity or tolerance to the allergen.There are two phases:

You may notice a decrease in symptoms during the build-up phase, but it may take as long as 12 months on the maintenance dose to notice an improvement. If allergy shots are successful, maintenance treatment is generally continued for three to five years. Any decision to stop allergy shots should be discussed with your allergist/immunologist.

How Effective Are Allergy Shots?

Allergy shots have shown to decrease symptoms of many allergies. It can prevent the development of new allergies, and in children it can prevent the progression of allergic disease from allergic rhinitis to allergic asthma. The effectiveness of allergy shots appears to be related to the length of the treatment program as well as the dose of the allergen. Some people experience lasting relief from allergy symptoms, while others may relapse after discontinuing allergy shots. If you have not seen improvement after a year of maintenance therapy, your allergist/immunologist will work with you to discuss treatment options.

Failure to respond to allergy shots may be due to several factors:

Where Should Allergy Shots Be Given?

This type of treatment should be supervised by a specialized physician in a facility equipped with proper staff and equipment to identify and treat adverse reactions to allergy injections. Ideally, immunotherapy should be given in your allergist/immunologist’s office. If this is not possible, your allergist/immunologist should provide the supervising physician with comprehensive instructions about your allergy shot treatments.

Are There Risks?

A typical reaction is redness and swelling at the injection site. This can happen immediately or several hours after the treatment. In some instances, symptoms can include increased allergy symptoms such as sneezing, nasal congestion or hives.

Serious reactions to allergy shots are rare. When they do occur, they require immediate medical attention. Symptoms of an anaphylactic reaction can include swelling in the throat, wheezing or tightness in the chest, nausea and dizziness. Most serious reactions develop within 30 minutes of the allergy injections. This is why it is recommended you wait in your doctor’s office for at least 30 minutes after your receive allergy shots.

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



Topic of the Quarter
October 2015

Cold weather is a prime time for stuffy noses, sore throats, and watery, itchy eyes. But if your symptoms last more than a week or if they seem to turn off and on based on your surroundings, you may be battling allergies or sinusitis. Proper diagnosis and treatment can lead to quicker recovery and less misery.

Colds are caused by a virus, whereas allergies are caused by exposure to allergens. Colds and allergies can both lead to sinusitis, which occurs when the sinuses become swollen and block mucous from draining, leading to painful pressure and infection.

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.

Most cases of sinusitis resolve without antibiotics in about two weeks. Decongestants, nasal sprays, hot packs, humidifiers, or salt water rinses may ease symptoms.

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

COLDS ALLERGIES SINUSITIS
Symptoms Similar to allergies, but may also include sore throat, fever, and body aches Runny or stuffy nose, sneezing, wheezing, watery or itchy eyes Swollen, painful feeling around forehead, eyes, and cheeks; stuffy nose with thick, colored mucus; bad tasting post nasal drip; bad breath; sore throat; cough; tiredness and occasional light fever
Warning Time Develops over several days Begins shortly after exposure to an allergen Stuffy nose and cough lasting longer than one or two weeks
Duration Should clear up within several days Lasts as long as exposure Acute sinusitis refers to symptoms that last less than four weeks. Chronic sinusitis is when symptoms last three months or longer.

DID YOU KNOW?

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



Topic of the Quarter
August 2015

Overview

Vocal Cord Dysfunction (VCD) occurs when the vocal cords (voice box) do not open correctly. This disorder is also referred to as paradoxical vocal fold movement.

VCD is sometimes confused with asthma because some of the symptoms are similar.

In asthma, the airways (bronchial tubes) tighten, making breathing difficulty. With VCD, the vocal cord muscles tighten, which also makes breathing difficult. Unlike asthma, VCD is not an allergic response starting in the immune system.

To add to the confusion, may people with asthma also have VCD.

Although the two may have similar triggers and symptoms, the treatment approach for VCD is very different than treatments used to manage and control asthma. This makes proper diagnosis essential.

An allergist/immunologist has specialized training and experience in the diagnosis, treatment and management of complex conditions such as asthma and VCD.

Symptoms & Diagnosis

Symptoms

Symptoms of VCD can include:

Much like with asthma, breathing in lung irritants, exercise, a cold or viral infection, or Gastroesophageal Reflux Disease (GERD) may trigger symptoms of VCD.

Unlike asthma, VCD causes more difficulty breathing in than breathing out. The reverse is true for symptoms of asthma.

Diagnosis

Diagnosing VCD can be challenging. The history of breathing difficulties when taking in a breath, having a hoarse voice, or experiencing voice changes may be very helpful to discuss with your allergist/immunologist. This may lead to further tests, such as spirometry or laryngoscopy.

Spirometry is a breathing test that measures airflow. A laryngoscopy involves looking at the vocal cords through a camera attached to a flexible tube. Vocal cords should be open when taking in a breath. In some people with VCD, the vocal cords actually close instead of opening.

Treatment & Management

Many people have both VCD and asthma. Yet, the treatment approach for each is different.

Treatment for VCD typically involves activities that relax the throat muscles, including:

If you suffer from asthma, allergies or GERD, managing these conditions will help in treating VCD.

Keep pace with the latest information and connect with others. Join us on Facebook and Twitter.

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



Topic of the Quarter
May 2015

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

While common allergy medications often control symptoms, if you stop taking the medication(s), your allergy symptoms return shortly afterward. Allergy shots can potentially lead to lasting remission of allergy symptoms, and it may play a preventive role in terms of development of asthma and new allergies.

The Process

Treatment involves injecting the allergen(s) causing the allergy symptoms. These allergens are identified by a combination of a medical evaluation performed by a trained allergist/immunologist and allergy skin or allergy blood tests.

The treatment begins with a build-up phase. Injections containing increasing amounts of the allergens are given one to two times a week until the target dose is reached. This dose may be reached in three to six months with a conventional schedule (one dose increase per visit) but may be achieved in a shorter period of time with fewer visits with accelerated schedules, such as clusters that administer two to three dose increases per visit.

The maintenance phase begins when the target dose is reached. Once the maintenance dose is reached, the time between the allergy injections can be increased and generally range from every two to every four weeks. Maintenance immunotherapy treatment is generally continued for three to five years.

Some people have lasting remission of their allergy symptoms, but others may relapse after discontinuing immunotherapy; therefore, the duration of allergen immunotherapy varies from person to person.

Risks involved with the immunotherapy approach are rare, but they may include serious life threatening anaphylaxis. For that reason, immunotherapy should be given only under the supervision of a physician or qualified physician extender (nurse practitioner or physician assistant) in a facility equipped with proper staff and equipment to identify and treat adverse reactions to allergy injections.

The decision to begin immunotherapy will be based on several factors:

Another form of allergy immunotherapy was recently approved in the United States called sublingual immunotherapy (SLIT) allergy tablets. Rather than shots, allergy tablets involve administering the allergens under the tongue, generally on a daily basis.

Allergen Immunotherapy: still working after 100 Years

In 1911, both allergen immunotherapy and the electrical ignition system for cars were introduced. Although unrelated, these events share a common outcome. One paved the way for advances in transportation; the other led to advances in the treatment of allergies.

The earliest published successes for allergen immunotherapy were based on the work of two English scientists, Leonard Noon and John Freeman. Recognizing that pollen was the cause of hay fever, these scientists thought that they could induce immunity and tolerance by injecting hay fever patients with the pollen to which they were allergic.

This idea was based on the positive results of vaccine that produced protection against infectious diseases, such as smallpox.

Over the years, we’ve learned much more about allergen immunotherapy, including long-term benefits and what protocols are needed to make it very beneficial. Among the most important findings are that immunotherapy can provide long-term symptom relief for years after treatment is discontinued and that it is a cost-effective approach to treating many allergies.

Research has demonstrated that allergy immunotherapy can be effective in treating:

New Frontier

Currently, immunotherapy for food allergies is not recommended and strict avoidance of the food is advised; however, investigations with oral desensitization for food allergies are in progress in the United States.

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



Topic of the Quarter
February 2015

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 sufferers, antihistamine and nasal corticosteroid medications provide temporary relief of symptoms. For others, allergy shots (subcutaneous immunotherapy or SCIT) are a treatment option that can provide long-term relief.

Allergy shot treatment involves two phases. The first phase involves frequent injections of increasing amounts of allergen extract. This is followed by a maintenance phase, during which the injections are given about once a month. Although allergy shots can be very effective at controlling symptoms of allergic rhinitis, the schedule can be difficult to maintain. Local reactions, for example swelling and itchiness at the injection site, are also common allergy shot side effects. In addition, severe allergic reactions can occur but are relatively uncommon; deaths have even been reported.

Another form of allergy immunotherapy called sublingual immunotherapy (SLIT) allergy tablets was recently approved in the United States. Rather than shots, allergy tablets involve administering the allergens in a liquid or tablet form under the tongue, generally on a daily basis.

What Are the Treatments the FDA Approved?

The U.S. Food and Drug Administration (FDA) recently approved three allergy tablet products. Two are directed at different kinds of grass pollen, and one is for short ragweed. The two grass pollen allergy tablets are Oralair® (Stallergenes), which has five kinds of northern grass pollen, and Grastek® (Merck), which has timothy grass pollen. The short ragweed allergy tablet is called Ragwitek® (Merck).

These three allergy tablets provide an additional option for the treatment of allergic rhinitis/rhinoconjunctivitis triggered by ragweed or timothy/northern grasses.

Effectiveness

SLIT (allergy tablets) is similar to SCIT (injections) in terms of the effectiveness of controlling allergy symptoms; and both have been shown to provide long-term improvement, even after the treatment has ended. However, the treatment is effective only for the allergen contained in SCIT or allergy tablets. If someone is allergic to ragweed and trees, the ragweed tablets/shots would help control only ragweed symptoms during the ragweed season.

Safety

Allergy tablets have a more favorable safety profile than SCIT, which is why it does not need to be given in a medical setting after the first dose. However, the FDA-approved product information of the three SLIT tablets includes a warning about the possibility of severe allergic reactions from SLIT and a recommendation that an epinephrine autoinjector be prescribed to patients receiving allergy tablets in the event a severe allergic reaction should occur.

Side Effects

The primary side effects of allergy tablets are local reactions, such as itching or burning of the mouth or lips, and less commonly, gastrointestinal symptoms. These reactions usually stop after a few days or a week.

SLIT Liquid Drops

There are currently no FDA-approved SLIT liquid (drops) formulations. The effectiveness of SLIT with U.S. allergen extract drops is still under investigation, and the effectiveness of mixtures of allergens is not known. There is a wide range of effective and ineffective doses of SLIT liquid formulations across the published literature and expert opinion has been that each formulation needs to prove its safe and effective dosing regimen.

Another important question is optimal starting time and schedule, i.e., is it best to start some time before the season (e.g., two or four months), or can it be started just as the season begins? Does it have to be administered all year long, or can it be given just before and during the season? The allergy tablets dosing regimen will clearly impact treatment costs, which will be greater than SCIT due to higher extract costs associated with daily dosing.

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




January 2015 Topic of the Month

About 70-80% of the North American population has headaches, with 50% experiencing at least one headache per month, 15% experiencing at least one weekly, and 5% daily. The occurrence of headaches rises sharply during the second decade of life. Then it levels off until the age of 40-50 years, after which it decreases.

While the majority of headaches are not a sign of a serious or life-threatening illness, they often affect quality of life. There are occasions where allergies or sinus problems can lead to a person having headaches.

Headaches with rhinitis (hay fever) are common and may be due to sinus disease in and around the nasal passages. A sinus headache is hard to identify since headache specialists consider true sinus headache to be fairly rare. Recent studies suggest that patients who appear to have sinus headaches frequently have migraines.

People who have headaches that seem like they’re originating in the sinus should be carefully evaluated by a physician. Making the right diagnosis is important because primary headache disorders like migraines need a very different treatment compared with rhinosinusitis.

Acute sinusitis occurs when there is a bacterial infection in one or more of the sinuses in your head. Sinusitis is often over diagnosed as a cause of headaches because of the belief that pain over the sinuses must be related to the sinuses. In reality, pain in the front of the head is more often caused by migraines. Migraines are confused with true sinus headaches because of their similar locations. Headaches attributed to acute bacterial rhinosinusitis are a specific, rare diagnosis. Antibiotics are often used for treatment. Other options include steam, corticosteroids, and decongestants. If sinusitis does not respond to medical treatment, surgery may need to be considered.

Chronic rhinosinusitis is one of the most common problems experienced with allergic rhinitis and can occasionally lead to headaches. Patients may also describe experiencing “sinus headaches.” However, it is controversial whether constant blockage of the nasal passages caused by allergic inflammation can lead to chronic headaches. Patients who experience blocked nasal passages should visit an allergist for testing. An allergist can find out what you are allergic to and help you manage your symptoms. Treatment strategies could include steps to avoid specific allergens, medications, or allergy immunotherapy (allergy shots).

The criteria below are used by physicians to diagnose rhinosinusitis headaches:

  1. A headache in the front of your head with pain in one or more areas of the face, ears, or teeth, and clinical or laboratory evidence of acute or chronic rhinosinusitis. For example, your doctor might do a nasal endoscopy, which lets him or her see what is happening in your nasal and sinus passages.
  2. Headache and rhinosinusitis symptoms that occur at the same time.
  3. Headache and/or facial pain that goes away within seven days after decreased symptoms or successful treatment of acute or chronic rhinosinusitis.

The majority of people with self-diagnosed sinus headaches are really suffering from migraines, which is why it is important to see a doctor to get a correct diagnosis. Research also supports a link between migraine and allergy, so your physician will consider both migraine headache and sinus headache if you are experiencing headaches and allergic rhinitis.

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




December 2014 Topic of the Month

Overview

Systemic mastocytosis is a disorder where mast cells are abnormally increased in multiple organs, including the bone marrow. Mast cells are immune cells that produce a variety of mediators, such as histamine, that are important in the body’s allergic responses.

When mast cells are present in greatly increased numbers, the amount of released mediators can be very high and thereby cause multiple symptoms. The disease can occur in both children and adults.

Symptoms & Diagnosis

Initial signs of this disease may include “spots” that look like freckles on the skin of a person’s inner thighs or stomach. These spots are called urticaria pigmentosa and can transform into hives and itch if stroked or irritated or if the skin is exposed to sudden changes in temperature, such as a hot shower.

Other common symptoms include the following:

Diagnosis can include the following studies and should be conducted by a physician with special knowledge of this disorder:

Treatment & Management

The objective of treatment is to control the effects of mast cell-released mediators by avoidance of dietary and environmental triggers, as well as the use of various medications. Antihistamines are commonly used. Cromolyn sodium, ketotifen, and leukotriene-modifying agents are additional medications that may provide benefit. Epinephrine may be required to treat episodes of low blood pressure. More aggressive forms of Systemic Mastocytosis may require interferon or chemotherapeutic agents.

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




November 2014 Topic of the Month

Eosinophilic (ee-uh-sin-uh-fil-ik) esophagitis (EoE) is a recently recognized allergic/immune condition. A person with EoE will have inflammation or swelling of the esophagus. The esophagus is the tube that sends food from the mouth to the stomach.

In EoE, large numbers of white blood cells called eosinophils are found in the tissue of the esophagus. Normally, there are no eosinophils in the esophagus. EoE can occur at any age and most commonly occurs in Caucasian males. The symptoms of EoE vary with age. In infants and toddlers, you may notice that they refuse their food or are not growing properly. School-age children often have recurring abdominal pain, trouble swallowing, or vomiting. Teenagers and adults most often have difficulty swallowing. The esophagus can narrow to the point that food gets stuck. This is called food impaction and is a medial emergency.

Allergists and gastroenterologists are seeing many more patients with EoE. This is due to an increase in the frequency of EoE and greater physician awareness. EoE is considered to be a chronic condition.

Other diseases can also result in eosinophils in the esophagus. One example is acid reflux.

Diagnosing Eosinophilic Esophagitis

Currently, the only way to diagnose EoE is with an endoscopy and biopsy of the esophagus. An endoscopy is a medical procedure that lets your doctor see what is happening in your esophagus. During a biopsy, tissue samples will be taken and analyzed.

The EoE diagnosis is made by both a gastroenterologist and pathologist. There are certain criteria for diagnosis EoE that are followed by gastroenterologists, pathologists, and allergists. These include a history consistent with EoE, a visual look at the esophagus during the endoscopy procedure, and a careful evaluation of tissues taken from the esophagus by a pathologist.

Eosinophilic Esophagitis and Allergies

The majority of patients with EoE are atopic. An atopic person is someone who has a family history of allergies or asthma and symptoms of one or more allergic disorders. These include asthma, allergic rhinitis, atopic dermatitis, and food allergy. EoE has also been shown to occur in other family members. After the diagnosis of EoE has been made by a gastroenterologist, it is important to have allergy testing. It will provide you, your family, and the gastroenterologist with information so that any allergic aspects of EoE can be properly treated. It will also help plan diet therapy and eventual reintroduction of foods to your diet.

Eosinophilic Esophagitis: Environmental Allergies

Environmental allergies to substances, such as dust mites, animals, pollen and molds, can play a role in EoE. For some patients, it may seem like their EoE is worse during pollen seasons. Allergy testing for these common environmental allergies is often part of the EoE evaluation.

Eosinophilic Esophagitis: Food Allergies

Adverse immune responses to food are the main cause of EoE in a large number of patients. Allergists are experts in evaluating and treating EoE related to food allergies. However, the relationship between food allergy and EoE is complex. In many types of food allergy, the triggers are easily diagnosed by a history of a severe allergic reaction like hives after ingestion of the food. In EoE, it is more difficult to establish the role of foods since the reactions are slower; therefore, a single food is hard to pinpoint as the trigger. Allergists may do a series of different allergy tests to identify the foods causing EoE. Foods, such as dairy products, egg, soy, and wheat, are main causes of EoE. However, allergies to these foods often cannot be easily proven by conventional allergy tests (skin tests, patch tests, or blood tests ). Once a food has been removed from a person’s diet, symptoms generally improve in a few weeks.

Eosinophilic Esophagitis: Prick Skin Testing

People who have allergies react to a particular substance in the environment or their diet. Any substance that can trigger an allergic reaction is called an allergen.

Prick skin getting introduces a small amount of allergen into the skin by making a small puncture with a prick device that has a drop of allergen. Foods used in allergy testing sometimes come from commercial companies. Occasionally, foods for skin prick testing are prepared fresh in the allergist’s office or supplied by the family.

Allergy skin testing provides the allergist with specific information on what you are and are not allergic to. Patients with allergies have an allergic antibody called Immunoglobulin E (IgE). Patients with IgE for the particular allergen put in their skin will have an area of swelling and redness where the skin prick test was done. It takes about 15 minutes for you to see what happens from the test.

Eosinophilic Esophagitis: Blood Tests

Sometimes an allergist may do a blood test (called a serum specific immune assay) to see if you have allergies. This test can be helpful in certain conditions linked to food allergies. The results of blood tests are not considered as helpful as skin prick testing in EoE and are not recommended for the routine evaluation of food allergy in EoE.

Eosinophilic Esophagitis: Food Patch Tests

Eliminating foods based on prick skin testing alone does not always control EoE. Food patch testing is another type of allergy test that can be useful in diagnosing EoE. This test is used to determine if the patient has delayed reactions to a food. The patch test is done by placing a small amount of a fresh food in a small aluminum chamber called a Finn chamber. The Finn chamber is then taped on the person’s back. The food in the chamber stays in contact with the skin for 48 hours. It is then removed, and the allergist reads the results at 72 hours. Areas of skin that came in contact with the food have become inflamed point to a positive delayed reaction to the food. The results from the food patch test will help your doctor see if there are foods you should avoid.

Eosinophilic Esophagitis: Treatment

Food Testing Directed Diets

If you are diagnosed with specific food allergies after prick skin testing and patch testing, your doctor may remove specific foods from your diet. In some individuals, this helps control their EoE.

Empiric Elimination Diets

Eliminating major food allergens from the diet before any food allergy testing is also an accepted treatment of EoE. The foods excluded usually include dairy, egg, wheat, soy, peanut, tree nuts, and fish. These diets have been shown to be very helpful in treating EoE, although they can be very difficult to follow. Foods are typically added back one at a time with follow-up endoscopies to make sure that EoE remains in Control

Elemental Diets

In this diet, all sources of protein are removed from the diet. The patient receives their nutrition from an amino acid formula, a well as simple sugars and oils. All other food is removed from the diet. A feeding tube may be needed since many people do not like the taste of this formula. This approach is generally reserved for children with multiple food allergies who have not responded to other forms of treatment.

Medical Therapy

No medications are currently approved to treat EoE. However, medications have been shown to reduce the number of eosinophils in the esophagus and improve symptoms. Glucocorticosteroids, which control inflammation, are the most helpful medications for treatment EoE. Swallowing small doses of corticosteroids is the most common treatment. Different forms of swallowed corticosteroids are available. At first, higher doses may be needed to control the inflammation, but they are linked with a greater risk of side effects.

Proton pump inhibitors, which control the amount of acid produced, have also been used to help diagnose and treat EoE. Some patients respond well to proton pump inhibitors and have a large decrease in the number of eosinophils and inflammation when follow-up endoscopy and biopsy are done. However, proton pump inhibitors can also improve EoE symptoms without making the inflammation any better. Researchers are now looking into using them to manage EoE. Careful monitoring by a physician knowledgeable in treating EoE is very important.

New types of treatment that could greatly help patients are being studied.

Working with Your Doctors

EoE is a complex disorder. It’s important for patients to listen to their gastroenterologist for advice on managing EoE and figuring out when endoscopies are needed to check to see if the condition is getting better or worse. Patients also need to work closely with their allergist/immunologist to find out if allergies are playing a role. An allergist/immunologist will also be able to tell if you need to avoid any foods and can help you manage related problems like asthma and allergic rhinitis. If you are following a diet to treat your EoE, it’s often recommended to visit a dietitian.

It’s important to have cooperation among physicians and families. When you first find out you have EoE, it can be overwhelming. Families often benefit from participating in support groups and organizations. Visit APFED and CURED. These are two lay organizations that have ongoing relationships with the AAAAI.

Your allergist/immunologist can give you more information on EoE, allergy testing, and treatment.

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




October 2014 Topic of the Month

Overview

Vocal Cord Dysfunction (VCD) occurs when the vocal cords (voice box) do not open correctly. This disorder is also referred to as paradoxical vocal fold movement.

VCD is sometimes confused with asthma because some of the symptoms are similar.

In asthma, the airways (bronchial tubes) tighten, making breathing difficult. With VCD, the vocal cord muscles tighten, which also makes breathing difficult. Unlike asthma, VCD is not an allergic response starting in the immune system.

To add to the confusion, many people with asthma also have VCD.

Although the two may have similar triggers and symptoms, the treatment approach for VCD is very different than treatments used to manage and control asthma. This makes proper diagnosis essential.

An allergist/immunologist has specialized training and experience in the diagnosis, treatment, and management of complex conditions such as asthma and VCD.

Symptoms and Diagnosis

Symptoms

Symptoms of VCD can include:

Much like with asthma, breathing in lung irritants, exercising, a cold or viral infection, or Gastroesophageal Reflux Disease (GERD) may trigger symptoms of VCD.

Unlike asthma, VCD causes more difficulty breathing in than breathing out. The reverse is true for symptoms of asthma.

Diagnosis

Diagnosing VCD can be challenging. The history of breathing difficulties when taking in a breath, having a hoarse voice, or experiencing voice changes may be very helpful to discuss with your allergist/immunologist. This may lead to further tests such as spirometry or laryngoscopy.

Spirometry is a breathing test that measures airflow. A laryngoscopy involves looking at the vocal cords through a camera attached to a flexible tube. Vocal cords should be open when taking in a breath. In some people with FCD, the vocal cords actually close instead of opening.

Treatment & Management

Many people have both VCD and asthma. Yet, the treatment approach for each is different.

Treatment for VCD typically involves activities that relax the throat muscles, including:

If you suffer from asthma, allergies, or GERD, managing these conditions will help treating VCD.

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




September 2014 Topic of the Month

Overview

Chronic Obstructive Pulmonary Disease (COPD) is a group of lung diseases (including emphysema and chronic bronchitis) that block airflow in the lungs. This makes it increasingly difficult to breathe. Many of the symptoms of COPD are similar to asthma symptoms.

Although COPD is the leading cause of death and illness worldwide, it is often preventable. That is because long-term cigarette smoking is the primary cause of this life-threatening disease. Additionally, smokers are particularly likely to suffer from a combination of both asthma and COPD.

It is important to distinguish between asthma, COPD, or a combination of the two, as the treatment approach will differ. An allergist/immunologist has specialized training and experience to accurately diagnose these conditions.

Symptoms and Diagnosis

Symptoms

Both asthma and COPD may cause shortness of breath and a cough. A daily morning cough that produces a yellowish phlegm is characteristic of COPD. Episodes of wheezing and coughing at night are more common with asthma. Other symptoms of COPD include fatigue and frequent respiratory infections.

Diagnosis

To make an accurate diagnosis of COPD, your doctor should spend time with you discussing your medical history and perform a physical examination. Chest x-rays, spirometry, CT scans, or blood work may also help in diagnosing your condition.

Treatment & Management

There is no cure for COPD, but proper medications and lifestyle changes can control symptoms and reduce the progression of damage to the lungs.

If you smoke, stop. It is the only way to prevent COPD from getting worse. Quitting isn’t easy, so talk to your doctor about medications that might help.

Medications are used to treat symptoms of COPD. These include:

People with COPD are susceptible to getting lung infections, so get flu and pneumonia shots every year.

Avoid things that can irritate your lungs, such as smoke, pollution, and air that is cold and dry.

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




August 2014 Topic of the Month

Many of the symptoms of allergic and nonallergic rhinitis are the same, but the triggers may be different.

Allergic Asthma Triggers

Allergic asthma, or allergy-induced asthma, is the most common form of asthma. If your asthma is allergic, your symptoms are most often triggered by inhaling allergens. An allergen is a typically harmless substance, such as house dust mites, pet dander, pollen, or mold.

If you are allergic to a substance, this allergen triggers a response starting in the immune system. Through a complex reaction, these allergens then cause the passages in the airways of the lungs to become inflamed and swollen. This results in coughing, wheezing, and other asthma symptoms.

Exposure to allergens may trigger the symptoms, but the real culprit in allergic asthma is the IgE antibody. The IgE antibody is produced by the body in response to allergen exposure. The combination of the antibody with allergens results in the release of potent chemicals called mediators. The mediators cause inflammation and swelling of the airways, resulting in symptoms of asthma.

Other Asthma Triggers

Some people with asthma do not have allergies. Asthma symptoms may also be triggered by exercise, viral or bacterial infections, cold air, or by related conditions, such as gastroesophageal reflux disease (GERD).

Knowing if your asthma is allergic is essential for taking control of your condition. Given the relationship between allergies and asthma, an allergist/immunologist is the best qualified physician to diagnose your symptoms and help you manage your asthma.

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




July 2014 Topics of the Month

Allergen immunotherapy, also known as allergy shots, is a form of long-term treatment that decreases symptoms for many people with allergic rhinitis, allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy.

Allergy shots decrease sensitivity to allergens and often lead to lasting relief of allergy symptoms even after treatment is stopped. This makes it a cost-effective, beneficial treatment approach for many people.

Who Can Benefit From Allergy Shots?

Both children and adults can receive allergy shots, although it is not typically recommended for children under age five. This is because of the difficulty younger children may have in cooperating with the program and in articulating any adverse symptoms they may be experiencing. When considering allergy shots for an older adult, medical conditions, such as cardiac disease, should be taken into consideration and discussed with your allergist/immunologist first.

You and your allergist/immunologist should base your decision regarding allergy shots on:

Allergy shots are not used to treat food allergies. The best option for people with food allergies is to strictly avoid that food.

How Do Allergy Shots Work:

Allergy shots work like a vaccine. Your body responds to injected amounts of a particular allergen, given in gradually increases doses, by developing immunity or tolerance to the allergen.

There are two phases:

You may notice a decrease in symptoms during the build-up phase, but it may take as long as 12 months on the maintenance dose to notice an improvement. If allergy shots are successful, maintenance treatment is generally continued for three to five years. Any decision to stop allergy shots should be discussed with your allergist/immunologist.

How Effective Are Allergy Shots?

Allergy shots have been shown to decrease symptoms of many allergies. They can prevent the development of new allergies and in children can prevent the progression of allergic disease from allergic rhinitis to asthma. The effectiveness of allergy shots appears to be related to the length of the treatment program, as well as the dose of the allergen. Some people experience lasting relief from allergy symptoms, while others may relapse after discontinuing allergy shots. If you have not seen improvement after a year of maintenance therapy, your allergist/immunologist will work with you to discuss treatment options.

Failure to respond to allergy shots may be due to several factors:

Where Should Allergy Shots Be Given?

This type of treatment should be supervised by a specialized physician in a facility equipped with proper staff and equipment to identify and treat adverse reactions to allergy injections. Ideally, immunotherapy should be given in your allergist's/immunologist’s office. If this is not possible, your allergist/immunologist should provide the supervising physician with comprehensive instructions about your allergy shot treatments.

Are There Risks?

A typical reaction is redness and swelling at the injection site. This can happen immediately or several hours after the treatment. In some instances, symptoms can include increased allergy symptoms, such as sneezing, nasal congestion, or hives. Serious reactions to allergy shots are rare. When they do occur, they require immediate medical attention. Symptoms of an anaphylactic reaction can include swelling in the throat, wheezing, or tightness in the chest, nausea, and dizziness. Most serious reactions developing within 30 minutes of the allergy injections. This is why it is recommend that you wait in your doctor’s office for at least 30 minutes after you receive allergy shots.

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




June 2014 Topics of the Month

Controlling Hay Fever Symptoms With Accurate Pollen Counts
Allergy Tablet Approval Warrants Caution for Some

Seasonal allergic rhinitis, known as hay fever, is caused by pollen carried in the air during different times of the year in different parts of the world. If you are allergic to pollen, this allergen triggers symptoms such as sneezing, stuffiness, a runny nose, and itchiness in your nose, the roof of your mouth, throat, eyes, or ears.

To control hay fever symptoms, it is important to monitor pollen counts so you can limit your exposure on days the counts are high. Also, hay fever medications work best if started before allergy symptoms develop. So, if you start taking allergy medications before you first come into contact with spring allergens, the medication can prevent the release of histamine and other chemicals. As a result, allergy symptoms are prevented from developing or are much less severe.

Pollen counts are different than pollen forecasts. Forecasts are predicted based on the previous year’s counts and current weather conditions. The counts are reported for specific plants, such as trees, grasses, and weeds, and mold spores.

Pollen counts are measured with an instrument that is usually situated on a rooftop where it collects spores for a 24-hour period. The instrument is then taken to a lab where the collected material is analyzed for pollen types and concentration.

Humidifiers and Indoor Allergies

During the winter, dry indoor air is often the cause of chapped lips, dry skin, and irritated sinus passages. The moisture from a humidifier can soothe dry sinus passages. However, if you have indoor allergies, dust and mold from the humidifier may cause more harm than good.

The number one indoor allergen is the dust mite. Dust mites grow best where there is moisture. Moisturizing the air with a humidifier creates the perfect home for dust mites to live and prosper. Keep the humidity level in your house between 30-45%. You can monitor the levels with a hygrometer.

Mold spores can also be an issue for people with mold allergies. It is important to clean and change the filter in the humidifier on a regular basis so mold does not grow in the unit and blow into the home. Read the manufacturer’s instructions for tips on cleaning your humidifier.

If possible, use distilled or demineralized water in your humidifier. The higher level of minerals in tap water can increase bacteria growth, resulting in a white dust and additional irritation to your sinuses.

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




A pill a day keeps spring allergies away. In a perfect world, it would be that easy. And for those suffering from an allergy to some grasses, the Food and Drug Administration’s (FDA) approval of the oral dissolvable tablets designed to help treat symptoms may be beneficial. But for the majority of seasonal sufferers allergic to pollens from the more than 30 other pollinating species, relief isn’t that easy.

“The approval of oral immunotherapy tablets is advancement in the right direction,” said allergist Michael Foggs, M.D., president of the American College of Allergy, Asthma and Immunology (ACAAI). “It’s an additional treatment option for those who are allergic to some types of grasses, but not those allergic to other varieties of grass, trees, and weeds.”

According to ACAAI, those with seasonal allergies can be affected by the pollen of 11 different types of weeds and trees and eight varieties of grass. Mold is also problematic in the spring, summer, and fall months.

Fortunately, there is a longstanding solution for those suffering from multiple allergies. Immunotherapy, also known, as allergy shots, as been used for 100 years and is a natural treatment. Each injection can be customized to an individual’s allergic needs. Allergy shots can modify and prevent allergy progression while also relieving symptoms. They are also fast acting and cost efficient.

“It would be ideal if tablets could be customized like allergy shots, but that’s not on the horizon yet,” said Dr. Foggs. “Since allergy treatment is not a one-size-fits-all approach, treatment needs to be tailored to an individual’s needs.”

Although the approved tablets are beneficial only for those suffering from some form of grass allergy, the FDA’s approval will help open the door for others getting approved, such as tablets for ragweed and dust mite allergy.

The best way to conquer allergy symptoms is to avoid allergens, according to the ACAAI. During the spring sneezing season, suffers should:

Allergy sufferers should talk with their board-certified allergist to learn which treatment is best suited for their needs. To locate an allergist and learn more about allergy treatment, visit AllergyAndAsthmaRelief.org

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




May 2014 Topic of the Month

If you have a food allergy, your immune system overreacts to a food. This is caused by an antibody called Immunoglobulin E (IgE), which is found in people with allergies. Food allergy is more likely to develop in a person who has family members with allergies. Symptoms may occur after you consume even a tiny amount of the food allergen.

Most food allergens can cause reactions even after they are cooked or have undergone digestion. There are some exceptions. For example, some allergens (usually fruits and vegetables) cause allergic reactions only if eaten in their raw form. Symptoms are usually limited to the mouth and throat.

The most common food allergens are the proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish, and nuts.

In some food groups, especially tree nuts and seafood, an allergy to one member of a food family may result in a person being allergic to other members of the same group. This is known as cross-reactivity.

Cross-reactivity is not as common with foods from animal groups. For example, people allergic to cow’s milk can usually eat beef, and patients allergic to eggs can usually eat chicken.

With shellfish, crustaceans (shrimp, crab, and lobster) are most likely to cause an allergic reaction. Mollusk shellfish (clams, oysters, scallops, mussels, abalone, etc.) can also cause allergic reactions. Occasionally, people are allergic to both types of shellfish.

Symptoms of Allergic Reactions to Foods

Symptoms of allergic reactions are generally seen on the skin (hives, itchiness, swelling of the skin). Gastrointestinal symptoms may include vomiting and diarrhea. Respiratory symptoms may accompany gastrointestinal symptoms but don’t usually occur alone.

Severe Allergic Reactions

Anaphylaxis (an-a-fi-LAK-sis) is a serious allergic reaction that happens very quickly. Without immediate treatment – an injection of epinephrine (adrenaline) and expert care – anaphylaxis can be fatal. Follow-up care with an allergist/immunologist, often referred to as an allergist, is essential.

Symptoms of anaphylaxis may include difficulty in breathing, dizziness, or loss of consciousness. If you have these symptoms, particularly after eating, seek medical care immediately (call 911). Don’t wait to see if the symptoms go away or get better on their own.

Diagnosis

An allergist is the best qualified professional to diagnose food allergy. Your allergist will take a thorough medical history, followed by a physical examination. You may be asked about contents of the foods, the frequency, seasonality, severity, and nature of your symptoms, and the amount of time between eating a food and any reaction.

Allergy skin tests may determine which foods, if any, trigger your allergic symptoms. In skin testing, a small amount of extract made from the food is placed on the back or arm. If a raised bump or small hive develops within 20 minutes, it indicates a possible allergy. If a hive does not develop, the test is negative. It is uncommon for someone with a negative skin test to have an IgE-mediated food allergy.

In certain cases, such as in patients with severe eczema, an allergy skin test cannot be done. Your doctor may recommend a blood test. False positive results may occur with both skin and blood testing. Food challenges are often required to confirm the diagnosis. Food challenges are done by consuming the food in a medical setting to determine if that food causes a reaction.

Outgrowing Food Allergies

Most children outgrow cow’s milk, egg, soy, and wheat allergies, even if they have a history of a severe reaction. About 20% of children with peanut allergy will outgrow it. About 9% of children with tree nut allergy will outgrow it. Your allergist can help you lean when your child might outgrow a food allergy.

Treatment

The best way to treat food allergy is to avoid the foods that trigger your allergy. Although it has been shown that just smelling peanut butter will not cause a reaction, sometimes food allergens can be airborne, especially in steam, and can cause reactions. Boiling or simmering seafood is a particular offender.

Always ask abut ingredients when eating at restaurants or when you are eating foods prepared by family or friends.

Carefully read food labels. The United States and some other countries require that eight major food allergens are to be listed in common language, for example, “milk” rather than a scientific or technical term like “casein.”

Carry and know how to use injectable epinephrine and antihistamines to treat emergency reactions. Teach family members and other people close to you how to use epinephrine, and wear an ID bracelet that describes your allergy. If a reaction occurs, have someone take you to the emergency room, even if symptoms subside. Afterwards, get follow-up care from an allergist.

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




April 2014 Topic of the Month

If you have red, bumpy, scaly, itchy, or swollen skin, is it because of a skin allergy?

There are several types of allergic skin conditions. They are often itchy and red and may appear scaly or swollen. An allergist/immunologist, often referred to as an allergist, is the most qualified physician to diagnose allergic diseases. An allergist can determine which condition you have and develop a treatment plan to help control your symptoms.

While skin allergies are unpleasant and troublesome, there are steps you can take to treat them.

Hives and Angioedema

Urticaria (hives) are red, itchy, raised areas of the skin that can range in size and appear anywhere on the body. Most cases of hives are known as acute and go away within a few days or weeks, but some people suffer from chronic hives with symptoms that come and go for several months or years. cases where food or drug allergies are triggers. These hives usually go away in a few days. In cases of chronic hives, people may suffer for many months to years.

Angioedema is a swelling of the deeper layers of the skin that sometimes occurs with hives. Angioedema usually is not red or itchy. The areas often involved are the eyelids, lips, tongue, hands, and feet.

Food or drug reactions are a common cause of acute hives and/or angioedema. Viral or bacterial infections can trigger hives in both adults and children. Hives can also be triggered by physical factors, such as cold, heat, exercise, pressure, and exposure to sunlight.

If the cause of your hives can be identified, you should avoid that trigger. With acute hives, your allergist may prescribe antihistamines to relieve your symptoms. It may take some time for that to happen.

Contact Dermatitis

When certain substances come into contact with your skin, they may cause a rash called contact dermatitis. Irritant contact dermatitis is often more painful than itchy and is caused by a substance damaging the part of your skin it comes into contact with. The longer your skin is in contact with the substance or the stronger the substance is, the more severe your reaction will be. These reactions appear most often on the hands and are frequently work related.

Allergic contact dermatitis is best known by the itchy, red, blistered reaction experienced after you touch poison ivy. This allergic reaction is caused by a chemical in the plant called urushiol. You can have the reaction from touching other items the plant has come into contact with. However, once your skin has been washed, you cannot get another reaction from touching the rash or blisters. Allergic contact dermatitis reactions can happen 24 to 48 hours after the contact. Once a reaction starts, it takes 14 to 28 days to go away, even with treatment.

Nickel, perfumes, dyes, rubber (latex) products, and cosmetics also frequently cause allergic contact dermatitis. Some ingredients in medications applied to the skin can cause a reaction, most commonly neomycin, an ingredient in antibiotic creams. For irritant contact dermatitis, you should avoid the substance causing the reaction. You should also avoid spilling chemicals on your skin. Gloves can sometimes be helpful. Since these reactions are nonallergic, avoiding the substance will relieve your symptoms and prevent lasting damage to your skin.

Treatment for allergic contact dermatitis depends on the severity of symptoms. Cold soaks and compresses can offer relief for the acute, early, itchy blistered stage of your rash. Topical corticosteroid creams may also be prescribed. To prevent the reaction from returning, avoid contact with the offending substance. If you and your allergist cannot determine which substance caused the reaction, your allergist may conduct a series of patch tests to help identify it.

Eczema

A common allergic reaction often affecting the face, elbows, and knees is atopic dermatitis (eczema). This red, scaly, itchy rash is more common in young infants and those who have a personal or family history of allergy.

Common triggers include aeroallergens like cat dander or house dust, overheating or sweating, and contact with irritants like wool or soaps. In older individuals, emotional stress can cause a flare-up. For some patients, usually children, certain foods can also trigger eczema. Skin staph infections can cause a flare-up in children as well. Eczema patients usually have very dry skin and allergic shiners (an extra crease, called a Dennie’s line) across their lower eyelids. They are also more at risk for other skin infections.

Preventing the eczema itch is the main goal of treatment. Do not scratch or rub your rash. Applying cold compresses and creams or ointments is helpful. Also remove from your environment all irritants that aggravate your condition. If a food is identified as the cause, it must be eliminated from your diet.

Topical corticosteroid cream medications and topical calcineurin inhibitors are most effective in treatment the rash. Antihistamines are often recommended to help relieve the itchiness. In severe cases, oral corticosteroids are also prescribed. If a skin staph infection is suspected to be a trigger for your eczema flare-up, antibiotics are often recommended.

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




March 2014 Topic of the Month

Selective IgA Deficiency Overview

Selective IgA Deficiency is the most common primary immunodeficiency disease (PIDD). People with this disorder have absent levels of a blood protein called immunoglobulin A (IgA). IgA protects against infections of the mucous membranes lining the mouth, airways, and digestive tract.

Although individuals with Selective IgA Deficiency do not produce IgA, they do produce all the other kinds of immunoglobulin. This is why many people with IgA deficiency appear healthy or only have mild recurring illnesses, such as gastrointestinal infections.

A common problem in IgA deficiency is susceptibility to infections. A second major problem in IgA deficiency is increased occurrence of autoimmune diseases. Also, many people with Selective IgA Deficiency also have allergies or asthma.

Selective IgA Deficiency Symptoms and Diagnosis

The most common symptom of Selective IgA Deficiency is susceptibility to infections including:

IgA deficiency may also cause autoimmune disease, in which the immune system attacks itself. Common examples of these diseases are rheumatoid arthritis and lupus.

Diagnosis requires blood screening to show an IgA deficiency but normal levels of other immunoglobulins.

Selective IgA Deficiency Treatment and Management

The underlying cause for Selective IgA Deficiency is unknown, and there is currently no way to replace IgA in the body.

Unlike many other immunoglobulin deficiencies, the condition is not treated with immunoglobulin replacement therapy.

In cases where recurrent infections are a problem, preventative antibiotics may be used to help diminish the frequency of infections. Individuals with IgA deficiency often require a longer course of antibiotics for infections to clear up.

To learn more bout PIDDs, visit the Immune Deficiency Foundation website.

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




February 2014 Topic of the Month

CVID OVERVIEW

Common variable Immunodeficiency (CVID) is an antibody deficiency that leaves the immune system unable to defend against bacteria and viruses, resulting in recurrent and often severe infections.

The exact cause and genetic inheritance pattern of CVID is unknown in most cases. Both males and females are affected. It is one of the most common forms of primary immunodeficiency disease (PIDD), and the severity of symptoms varies from one person with the disease to another.

CVID can be associated with autoimmune disorders that affect other blood cells causing low numbers of white cells or platelets, anemia, arthritis, and other conditions.

People with CVID are also at an increased risk for certain cancers.

Keep pace with the latest information and connect with others. Join us on Facebook

CVID Symptoms and Diagnosis

Symptoms

CVID can be diagnosed anytime from childhood through adulthood.

As with other antibody deficiencies, the most common types of recurrent infections involve the ears, sinuses, nose, bronchi, and lungs. These include:

Recurrent pneumonia and chronic infections in the lungs can lead to lung damage called bronchiectasis, which can complicate treatment.

Diagnosis

CVID may be suspected in children or adults with a history of recurrent infections involving the lungs or sinuses.

An accurate diagnosis can be made through screening tests that measure immunoglobulin levels or the number of B cells in the blood.

CVID Treatment and Management

CVID is treated with immunoglobulin replacement therapy 9IRT), which most often relieves symptoms. IRT treatments must be given regularly and are life-long.

Antibiotics are used to treat most infections that results from CVID, though patients may need treatment for a longer duration than a healthy individual.

To learn more about PIDDs, visit the Immune Deficiency Foundation website.

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




January 2014 Topic of the Month

Itching can be caused by many different things, including allergies, insect bites, dry skin or illness.

While most itches are merely bothersome or uncomfortable, excessive scratching can damage your skin’s protective barrier and expose your body to germs and infection.

Itch and pain are closely linked in the brain. The reflex to pain is to withdraw. The reflex to itching is to scratch. This reflex is a protective response developed to help animals remove parasites from their skin. That’s why even a slight movement of hairs is enough to make you want to scratch.

Itching is often triggered by histamine, a chemical in the body associated with immune response. It causes the itch and redness you see with insect bites, rashes, and skin dryness or damage.

Histamine is released by the body during allergic reactions, such as those to pollen, food, latex, and medications.

Types of Itch

Pruriceptive itch is due to an allergic reaction, inflammation, dryness, or other skin damage. It is seen in atopic dermatitis (eczema), urticaria (hives), psoriasis, drug reactions, mites, and dry skin. This type of itch is often treated with antihistamines and other drugs that alter the immune reaction.

Neuropathic itch is caused by damage to the nervous system. It is usually accompanied by sensations of numbness and tingling. This type of itch is seen after shingles, after stroke or burn injury, and in notalgia parasthetica (an area of itchy skin, usually on the back). It is treated with non-narcotic analgesics and capsaicin.

Neurogenic itch is seen in chronic liver and kidney disease in response to opioid neuropeptides. It is treated with narcotic and non-narcotic analgesics.

Psychogenic itch is induced in response to the chemicals serotonin and norepinephrine. These chemicals influence stress, depression, and delusional parasitosis (as false belief of parasite infestation). Psychogenic itch is treated with antidepressants and antipsychotic medications.

An allergic/immunologist has advanced training and experience to identify what is triggering a persistent or recurring itch and to prescribe treatment.

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




December 2013 Topic of the Month

Hereditary angioedema (HAE) is a rare genetic condition. People with HAE either have a low level of an important protein (C1-INH) in their blood, or the C1-INH protein does not function appropriately. These forms of hereditary angioedema are different than allergic angioedema. Allergic angioedema is a skin reaction commonly associated with urticaria (hives). Hereditary angioedema is a potentially life-threatening disorder caused by a genetic defect.

HAE Symptoms and Diagnosis

The term “edema” means swelling. Hereditary angioedema causes painful episodes of swelling, typically in the face, hands, feet, or genitals. Dangerous swelling can also occur in the airways of the lungs or the intestinal walls. These symptoms can move from one place to another during the same episode.

Most episodes or attacks are difficult to predict, and triggers vary from person to person. These triggers may include anxiety, surgery, dental procedures, medications, and illnesses, such as colds and flu.

Many people have early warning signs of an HAE attack. For instance, extreme fatigue, a tingling of the skin, a hoarse voice, or sudden mood changes may signal an oncoming episode.

Accurately diagnosing HAE can be difficult. Because the disease is rare, physicians often first rule out more common conditions with similar symptoms. In addition to a physical examination and medical history, HAE is diagnosed by measuring the level and function of C1-INH in the blood.

Living with HAE

Great strides have been made within the last decade to help manage this life-long condition. Your doctor may prescribe a medication to prevent attacks. There are also medications for treatment HAE attacks. In addition to medications, the best approach to managing the disease is to be aware of your early warning signs and triggers that can provoke an attack. Recording information in a diary or journal will help you and your doctor develop a personalized management plan to empower you to lead a full life

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




November 2013 Topic of the Month

Overview

Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids, back up from the stomach into the esophagus. GERD affects people of all ages – from infants to older adults.

People with asthma are at higher risk of developing GERD. Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back, or reflux, into the esophagus. Some asthma medications (especially theophylline) may worsen reflux symptoms.

On the other hand, acid reflux can make asthma symptoms worse by irritating the airways and lungs. This in turn can lead to progressively more serious asthma. Also, this irritation can trigger allergic reactions and make the airways more sensitive to environmental conditions such as smoke or cold air.

Symptoms and Diagnosis

Symptoms

Everyone has experienced gastroesophageal reflux. It happens when you burp, have an acid taste in your mouth, or have heartburn. However, if these symptoms interfere with your daily life, it is time to see your physician.

Other symptoms that occur less frequently but can indicate that you could have GERD are:

Diagnosis

Several tests may be used to diagnose GERD, including:

Treatment and Management

If you have both GERD and asthma, managing your GERD will help control your asthma symptoms.

Studies have shown that people with asthma and GERD saw a decrease in asthma symptoms (and asthma medication use) after treating their reflux disease.

Lifestyle changes to treat GERD include:

Your physician may also recommend medications to treat reflux or relieve symptoms. Over-the-counter antacids and H2 blockers may help decrease the effects of stomach acid. Proton pump inhibitors block acid production and also may be effective.

In severe and medication intolerant cases, surgery may be recommended

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




October 2013 Topic of the Month

Overview

Eosinophilic (ee-us-sin-uh-fil-ik) Esophagitis (EoE) is an allergic condition causing inflammation of the esophagus. The esophagus is the tube that sends food from the throat to the stomach.

People with EoE have a larger than normal number of eosinophils in their esophagus. Eosinophils are a type of white blood cell that may cause inflammation in the esophagus and other parts of the gastrointestinal tract.

Most research suggests that the leading cause of EoE is an allergy or a sensitivity to particular proteins found in foods. Many people with EoE have a family history of allergic disorders, such as asthma, rhinitis, dermatitis, or food allergy.

Symptoms and Diagnosis

Symptoms

The most common symptom of EoE in adults is difficulty and sometimes pain in swallowing solid foods. This is due to inflammation of the esophagus.

Other symptoms include:

  • Heartburn
  • Vomiting (often during meals
  • Abdominal pain
  • Chest pain
  • In children, EoE symptoms can include poor growth, weight loss, a poor appetite, or even refusal to eat.

    Diagnosis

    In order to diagnose EoE, a doctor will perform an endoscopy and a biopsy of the esophagus. This is usually done after medications to control acid reflux have failed to improve symptoms.

    Diagnosing the condition is often a coordinated effort between a gastroenterologist and an allergist/immunologist. An allergist will determine the role that allergies may play in EoE by performing allergy testing to diagnose which specific allergens may be involved with your EoE.

    Treatment and Management

    If tests performed by an allergist/immunologist indicate that an allergy is involved with your EoE condition, then your allergist will work with you to develop a plan to avoid allergens that trigger your symptoms.

    In the case of food allergies, this means eliminating the food protein from your diet.

    No medications are currently FDA approved for specifically treating EoE. New forms of therapy are being investigated and may provide significant relief in the future. Under the care of a physician, some individuals with EoE are currently being treated with swallowed steroid from an asthma inhaler or nebulizer.

    The American Partnership for Eosinophilic Disorders (APFED) helps patients and their families cope with eosinophilic gastrointestinal disorders.

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




    September 2013 Topic of the Month

    Overview

    Chronic Obstructive Pulmonary Disease (COPD) is a group of lung diseases (including emphysema and chronic bronchitis) that block airflow in the lungs, which makes it increasingly difficult to breathe. Many of the symptoms of COPD are similar to asthma symptoms.

    Although COPD is the leading cause of death and illness worldwide, it is often preventable. That is because long-term cigarette smoking is the primary cause of this life-threatening disease. Additionally, smokers are particularly likely to suffer from a combination of both asthma and COPD.

    It is important to distinguish between asthma, COPD, or a combination of the two as the treatment approach will differ. An allergist/immunologist has specialized training and experience to accurately diagnose these conditions.

    Symptoms & Diagnosis

    Symptoms

    Both asthma and COPD may cause shortness of breath and a cough. A daily morning cough that produces yellowish phlegm is characteristic of COPD. Episodes of wheezing and cough at night are more common with asthma. Other symptoms of COPD include fatigue and frequent respiratory infections.

    Diagnosis

    To make an accurate diagnosis of COPD, your doctor should spend time with you discussing your medical history and perform a physical examination. Chest x-rays, spirometry, CT scans, or blood work may also help in diagnosing your condition.

    Treatment & Management

    There is no cure for COPD, but proper medication and lifestyle changes can control symptoms and reduce the progression of damage to the lungs.

    If you smoke, stop. It is the only way to prevent COPD from getting worse. Quitting isn’t easy, so talk to your doctor about medications that might help.

    Medications are used to treat symptoms of COPD. These include:

    People with COPD are susceptible to getting lung infections, so get flu and pneumonia shots every year.

    Avoid things that can irritate your lungs, such a smoke, pollution, and air that is cold and dry.

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




    August 2013 Topic of the Month

    Overview

    Vocal Cord Dysfunction (VCD) occurs when the vocal cords (voice box) do not open correctly. This disorder is also referred to as paradoxical vocal fold movement.

    VCD is sometimes confused with asthma because some of the symptoms are similar.

    In asthma, the airways (bronchial tubes) tighten, making breathing difficult. With VCD, the vocal cord muscles tighten, which also makes breathing difficult. Unlike asthma, VCD is not an allergic response starting in the immune system.

    To add to the confusion, many people with asthma also have VCD.

    Although the two may have similar triggers and symptoms, the treatment approach for VCD is very different than treatments used to manage and control asthma. This makes proper diagnosis essential.

    An allergist/immunologist has specialized training and experience in the diagnosis, treatment, and management of complex conditions, such as asthma and VCD.

    Symptoms & Diagnosis

    Symptoms

    Symptoms of VCD can include:

    Much like with asthma, breathing in lung irritants, exercise, a cold or viral infection, or Gastroesophageal Reflux disease (GERD) may trigger symptoms of VCD.

    Unlike asthma, VCD causes more difficulty breathing in than in breathing out. The reverse is true for symptoms of asthma.

    Diagnosis

    Diagnosing VCD can be challenging. The history of breathing difficulties when taking in a breath, having a hoarse voice, or experiencing voice changes may be very helpful to discuss with your allergist/immunologist. This may lead to further tests, such as spirometry or laryngoscopy.

    Spirometry is a breathing test that measures airflow. A laryngoscopy involves looking at the vocal cords through a camera attached to a flexible tube. Vocal cords should be open when taking in a breath. In some people with VCD, the vocal cords actually close instead of opening.

    Treatment & Management

    Many people have both VCD and asthma. Yet, the treatment approach for each is different.

    Treatment for VCD typically involves activities that relax the throat muscles including:

    If you suffer from asthma, allergies or GERD, managing these conditions will help in treating VCD.

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




    July 2013 Topic of the Month

    When most people are stung by an insect, the site develops redness, swelling, and itching. However, some people are actually allergic to insect stings. This means that their immune systems overreact to the venom.

    If you are insect-allergic, after the first sting your body produces antibodies called Immunoglobulin E (IgE). If stung again by the same kind of insect, the venom interacts with this specific IgE antibody and triggers the release of substances that cause an allergic reaction.

    Symptoms of a Severe Reaction

    For a small number of people with venom allergy, stings may be life-threatening. This reaction is called anaphylaxis (an-a-fi-LAK-sis). Symptoms may include two or more of the following: itching and hives, swelling in the throat or tongue, difficulty in breathing, dizziness, stomach cramps, nausea or diarrhea. In severe cases, a rapid fall in blood pressure may result in shock and loss of consciousness.

    Anaphylaxis is a medical emergency and may be fatal. If you have these symptoms after an insect sting, get emergency medical treatment. After this treatment, you should also ask for a referral to an allergist/immunologist, often referred to as an allergist, to learn how to stay safe in the future.

    Identifying Stinging Insects

    To avoid stinging insects, it is important to identify them.

    Yellow jacket’s nests are made of a paper-mache’ material and are usually located underground, but they can sometimes be found in the walls of frame buildings, cracks in masonry, or woodpiles.

    Honeybees and bumblebees are non-aggressive and will sting only when provoked. However, Africanized honeybees (AKA “killer bees”) found in the Southwestern U.S. are more aggressive and may sting in swarms. Domesticated honeybees live in manmade hives, while wild honeybees live in colonies or “honeycombs” in hollow trees or cavities of building.

    Paper wasps’ nests are usually made of a paper-like material that forms a circular comb of cells, which opens downward. The nests are often located under eaves, behind shutters, or in shrubs or woodpiles.

    Fire ants build nests of dirt in the ground and may be quite tall (18 inches) in the right kinds of soil.

    Preventing Stings

    Stay away! These insects are most likely to sting if their homes are disturbed, so it is important to have nests around your home destroyed.

    If flying stinging insects are close by, remain calm and move away slowly. Avoid brightly-colored clothing and perfumes when outdoors. Because the smell of food attracts insects, be careful outdoors when cooking, eating, or drinking sweet drinks like soda or juice. Beware of insects inside straws or canned drinks. Keep food covered until eaten. Wear closed-toe shoes outdoors and avoid going barefoot. Also, avoid loose-fitting garments that can trap insects between material and skin.

    Treating Stings

    If the insect left its stinger in your skin, remove the stinger within 30 seconds to avoid receiving more venom. A quick scrape of your fingernail removes the stinger and sac. Avoid squeezing the sac – this forces more venom through the stinger and into your skin. For all stinging insects, try to remain calm and brush the insects from the skin, then immediately leave the area.

    These steps can help in treating local reactions to insect stings:

    If you are severely insect-allergic, carry auto-injectable epinephrine. Learn how and when to self-administer the epinephrine, and replace the device before the labeled expiration date. Remember that epinephrine is a rescue medication only; you must still have someone take you to an emergency room immediately if you are stung. Those with severe allergies may want to consider wearing a bracelet or necklace that identifies the wearer as having severe allergies.

    Consult Your Allergist

    If you have had a serious reaction to an insect sting, make an appointment with an allergist. With proper testing, your allergist can diagnose your allergy and determine the best form of treatment. In many cases, insect venom allergy shots (immunotherapy) are very effective.

    With proper diagnosis, treatment plan, and careful avoidance, people with an insect allergy can feel more confident and enjoy being outdoors.

    Health Tips

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




    June 2013 Topic of the Month

    Nonallergic Rhinitis

    Some people with rhinitis symptoms do not have allergies. Nonallergic rhinitis usually beings in adults and causes year-around symptoms, especially a runny nose and nasal stuffiness.

    Strong odors, pollution, smoke, and other irritants may cause symptoms of nonallergic rhinitis. Nonallergic rhinitis symptoms can also develop as side effects of medications, including some blood pressure medicines, oral contraceptives, or medications used for erectile dysfunction. The most common form of this type of nonallergic rhinitis is caused by nasal decongestant sprays, such as oxymetazoline, when used for long periods of time. This type of medication-induced rhinitis is also called rhinitis medicamentosa.

    Treatment of Nonallergic Rhinitis

    If there is inflammation in the nose, the treatment of choice is nasal corticosteroid sprays. Ipratropium nasal spray can relieve a runny nose. Decongestant pills can be used as needed to relieve nasal stuffiness.

    Other forms of treatment may be considered if you have problems with the structure of your nose, such as narrow drainage passages, tumors, or a shifted nasal septum (the bone and cartilage that separate the right from the left nostril). In these cases, an operation may be needed.

    Healthy Tips

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




    May 2013 Topic of the Month

    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; 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 medication 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 Medication

    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 and work a bit more slowly to help treatment 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 may 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 patients 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

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




    April 2013 Topic of the Month

    Seasonal allergic rhinitis (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

    Pollen are tiny cells needed to fertilize plants. Pollen 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, which produce light, dry pollen that are 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 any time. 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 be year around.

    Seasonal allergic rhinitis is often caused by tree pollen in the early spring. During the late and early summer, grasses often cause symptoms. Late summer and fall hay fever 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. Molds can be found almost anywhere, including soil, plants, and rotting wood. 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 and year-around in the South and on the West Coast.

    Pollen and Mold Levels

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

    The National Allergy Bureau™ (NAB™) 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 the public, the NAB compiles pollen and mold levels from certified stations across the nation.

    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 and 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 to 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. You allergist has the background and experience to test which pollen 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 immunotherapy treatment (allergy shots). This treatment approach 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 medication.

    There are also simple steps you can take to limit your exposure to the pollen 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.

    Consider taking a vacation during the height of the pollen season 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 take any medications prescribed by your allergist and in the recommended dosage.

    Healthy Tips

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




    March 2013 Topic of the Month

    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 results 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 house dust mites, your immune system identifies house dust mites as invaders. Your immune system overreacts by producing antibodies called Immunoglobulin (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 cause your symptoms and make environmental changes to avoid them.

    Controlling House Dust Mites

    Dust mite allergens are the most common trigger of allergy and asthma symptoms. They can be found throughout the house, but 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 or airtight, zippered plastic covers. Bedding should be washed weekly in hot water (130°) 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 Air) 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's best to remove the pet from the home and avoid contact if you're 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 - so ask a non-allergic family member to clean the animals' cage.

    As for house 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 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 the roaches could enter the home, including crevices, wall cracks, and windows. Cockroaches need water to survive, so fix and seal all leaky faucets and pipes. Have an exterminator go through the house when your family and pets are gone 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 stove, refrigerators, or toasters where crumbs can accumulate. Wipe off the stove and other kitchen surfaces and cupboards regularly.

    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 area 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 placing carpeting on concrete or damp floors and storing items in damp areas.

    Healthy Tips

    • Keep your home clean and dry.
    • Focus on sites where allergens accumulate -- bedding, carpet, and upholstered furniture.
    • Weekly vacuuming can help. Use a vacuum with a HEPA filter or double bags.
    • Keep humidity low by using an air conditioner or dehumidifier.
    • Fix leaks to avoid mold, and clean or remove moldy materials promptly.
    • Avoid pests by keeping food in sealed containers and using covered garbage cans.
    Reprinted with permission from the American Academy of Allergy Asthma & Immunology




    February 2013 Topic of the Month

    If you have a food allergy, your immune system overreacts to a food. This is caused by an antibody called Immunoglobulin E (IgE), which is found in people with allergies. Food allergy is more likely to develop in someone who has family members with allergies. Symptoms may occur after you consume even a tiny amount of the food.

    Most food allergens can cause reactions even after they are cooked or have undergone digestion in the intestines. There are some exceptions; for example, some allergens (usually fruits and vegetables) cause allergic reactions only if eaten in their raw form. Symptoms are usually limited to the mouth and throat.

    The most common food allergens are the proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish, and tree nuts.

    In some food groups, especially tree nuts and seafood, an allergy to one member of a food family may result in the person being allergic to other members of the same group. This is know as cross-reactivity.

    Cross-reactivity is not as common with foods from animal groups; for example, people allergic to cow’s milk can usually eat beef, and patients allergic to eggs can usually eat chicken.

    With shellfish, crustaceans (shrimp, crab, and lobster) most are likely to cause an allergic reaction. Molluscan shellfish (clams, oysters, scallops, mussels, abalone, etc.,) can cause allergic reactions, but reactions to these are less common. Occasionally, people are allergic to both types of shellfish.

    Symptoms of Allergic Reactions to Food

    Symptoms of allergic reactions are generally seen on the skin (hives, itchiness, swelling of the skin). Gastrointestinal symptoms may include vomiting and diarrhea. Respiratory symptoms may accompany skin and gastrointestinal symptoms, but don’t usually occur alone.

    Severe Allergic Reactions

    Anaphylaxis (an-a-fi-LAK-sis) is a serious allergic reaction that happens very quickly. Without immediate treatment – an injection of epinephrine (adrenaline) and expert care – anaphylaxis can be fatal. Follow-up care by an allergist/immunologist, often referred to as an allergist, is essential.

    Symptoms of anaphylaxis may include difficulty breathing, dizziness, or loss of consciousness. If you have any of these symptoms, particularly after eating, seek medical care immediately (call 911). Don’t wait to see if your symptoms go away or get better on their own.

    Diagnosis

    An allergist is the best qualified professional to diagnose food allergy. Your allergist will take a thorough medical history, followed by a physical examination. You may be asked about contents of the foods, the frequency, seasonality, severity and nature of your symptoms, and the amount of time between eating a food and any reaction.

    Allergy skin tests may determine which foods, if any, trigger your allergic symptoms. In skin testing, a small amount of extract made from the food is placed on the back or arm. If a raised bump or small hive develops with in 20 minutes, it indicates a possible allergy. If it does not develop, the test is negative. It is uncommon for someone with a negative skin test to have an IgE-mediated food allergy.

    In certain cases, such as in patients with severe eczema, an allergy skin test cannot be done. Your doctor may recommend a blood test. False positive results may occur with both skin and blood testing. Food challenges are often required to confirm the diagnosis. Food challenges are done by consuming the food in a medical setting to determine if that food causes a reaction.

    Outgrowing Food Allergies

    Most children outgrow cow’s milk, egg, soy, and wheat allergy, even if they have a history of a severe reaction. About 20% of children with peanut allergy will outgrow it. About 9% of children with tree nut allergy will outgrow it. Your allergist can help you learn when your child might outgrow a food allergy.

    Treatment

    The best way to treat food allergy is to avoid the foods that trigger your allergy. Although it has been shown that just smelling peanut butter will not cause a reaction, sometimes food allergens can be airborne, especially in steam, and can cause reactions. Boiling or simmering seafood is a particular offender.

    Always ask about ingredients when eating at restaurants or when you are eating foods prepared by family or friends.

    Carefully read food labels. The United States and some other countries require that eight major food allergens are to be listed in common language, for example, 'milk' rather than a scientific or technical term, like 'casein.'

    Carry and know how to use injectable epinephrine and antihistamines to treat emergency reactions. Teach family members and other people close to you how to use epinephrine, and wear an ID bracelet that describes your allergy. If a reaction occurs, have someone take you to the emergency room, even if symptoms subside. Afterwards, get follow-up care from an allergist.

    Healthy Tips

    • The most common food allergens are the proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish, and tree nuts.

    • An allergist is the best qualified professional to diagnose a food allergy. Testing performed by an allergist often helps determine if foods are causing your symptoms.

    • Some food allergies can be outgrown.

    • The best treatment is to avoid the foods that cause your reaction.

    • Read food labels carefully and ask about ingredients at restaurants or when eating food prepared by another person.
    Reprinted with permission from the American Academy of Allergy Asthma & Immunology




    January 2013 Topic of the Month

    Everyone reacts to medications differently. One person may develop a rash while taking a certain medication, while another person on the same drug may have no adverse reaction. Does that mean the person with the rash has an allergy to that drug?

    All medications have the potential to cause side effects, but only about 5-10% of adverse reactions to drugs are allergic. Whether allergic or not, reactions to medications can range from mild to life-threatening.

    It is important to take all medication exactly as your physician prescribes. Call your doctor if you have side effects that concern you or you suspect a drug allergy has occurred. If you symptoms are severe, seek medical help immediately.

    Allergic Reactions

    Allergy symptoms are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to a particular medication, your immune system identifies that drug as an invader or allergen. Your immune system reacts by producing antibodies called Immunoglobulin E (IgE) to the drug. These antibodies travel to cells that release chemicals, triggering an allergic reaction. This reaction causes symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach, or on the skin.

    Most allergic reactions occur within hours to two weeks after taking the medication, and most people react to medications to which they have been exposed in the past. This process is called sensitization. However, rashes may develop up to six weeks after starting certain medications. One of the most severe allergic reactions is anaphylaxis. Symptoms of anaphylaxis include hives, facial or throat swelling, wheezing, lightheadedness, vomiting, and shock.

    Most anaphylactic reactions occur within one hour of taking a medication or receiving an injection of the medication. But sometimes the reaction may start several hours later. Anaphylaxis can result in death, so it is important to seek immediate medical attention if you experience these symptoms.

    Antibiotics are the most common culprit of anaphylaxis; but more recently, chemotherapy drugs and monoclonal antibodies have also been shown to induce anaphylaxis.

    Rarely, blisters develop as a result of a drug rash. Blisters may be a sign of a serious complication called Stevens-Johnson syndrome where the surfaces of your eyes, lips, mouth, and genital region may be eroded.

    Topical epidermal necrolysis (TEN), where the upper surface of your skin detaches as in a patient who has suffered burns, is another type of severe cutaneous adverse reaction. You should seek medical help immediately if you experience any of these. Certain medications for epilepsy (seizures) and gout are often associated with these severe skin reactions.

    A number of factors influence your chances of having an adverse reaction to a medication. These include: body size, genetics, body chemistry, or the presence of an underlying disease. Also, having an allergy to one drug predisposes an individual to having an allergy to another unrelated drug. Contrary to popular myth, a family history of a reaction to a specific drug does not increase your chance of reacting to the same drug.

    Non-Allergic Reactions

    Symptoms of non-allergic drug reactions vary, depending on the type of medication. People being treated with chemotherapy often suffer from vomiting and hair loss. Other people experience flushing, itching, or a drop in blood pressure from IV dyes used in x-rays or CT scans. Certain antibiotics irritate the intestines, which can cause stomach cramps and diarrhea. If you take ACE (angiotensin converting enzyme) inhibitors for high blood pressure, you may develop a cough or facial and tongue swelling.

    Some people are sensitive to aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs NSAIDs). If you have aspirin or NSAID sensitivity, certain medications may cause a stuffy nose, itchy or swollen eyes, coughing, wheezing, or hives. In rare instances, severe reactions can result in shock. This is more common in adults with asthma and in people with nasal polyps (benign growths).

    Taking Precautions

    It is important to tell your physician about any adverse reaction you experience while taking a medication. Be sure to keep a list of any drugs you are currently taking and make special note if you have had past reactions to specific medications. Share this list with your physician and discuss whether you should be avoiding any particular drugs or if you should be wearing a special bracelet that alerts people to your allergy.

    When to See an Allergist/Immunologist

    If you have a history of reactions to different medications, or if you have a serious reaction to a drug, an allergist/immunologist, often referred to as an allergist, has specialized training to diagnose the problem and help you develop a plan to protect you in the future.

    Healthy Tips

    • Allergic drug reactions account for 5-10% of all adverse drug reactions. Any drug has the potential to cause an allergic reaction.
    • Symptoms of adverse drug reactions include cough, nausea, vomiting, diarrhea, high blood pressure, and facial swelling.
    • Skin reactions (i.e., rashes, itching) are the most common form of allergic drug reaction.
    • Non-steroidal anti-inflammatory drugs, antibiotics, chemotherapy drugs, monoclonal antibodies, anti-seizure drugs, and ACE inhibitors cause most allergic drug reactions.
    • If you have a serious adverse reaction, it is important to contact your physician immediately.
    Reprinted with permission from the American Academy of Allergy Asthma & Immunology




    December 2012 Topic of the Month

    Anaphylaxis (an-a-fi-LAK-sis) is a serious allergic reaction that typically comes on quickly and may cause death. This medical emergency requires immediate treatment and then follow-up care by an allergist/immunologist, often referred to as an allergist.

    Many people may not realize they have an allergy until they experience anaphylaxis. An allergist can examine you and make a proper diagnosis. If warranted, your doctor will prescribe injectable epinephrine to use in an emergency.

    Anaphylaxis is triggered when the immune system overreacts to a usually harmless substance (an allergen such as peanut or penicillin) causing mild-to-severe symptoms that affect various parts of the body. Symptoms usually appear within minutes to a few hours after eating a food, swallowing medication, or being stung by an insect.

    Anaphylaxis requires immediate medical treatment, including an injection of epinephrine and a trip to a hospital emergency room. If it isn't treated properly, anaphylaxis can be fatal. Sometimes symptoms go away and then return a few hours later, so it is important to take these steps as soon as an anaphylactic reaction begins and to remain under medical observation for as long as the reaction and symptoms continue.

    Symptoms of Anaphylaxis

    Symptoms of anaphylaxis may include:

    • Breathing: wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, trouble swallowing, itchy mouth/throat, nasal stuffiness/congestion
    • Circulation: pale/blue color, low pulse, dizziness, lightheadedness/passing out, low blood pressure, shock, loss of consciousness
    • Skin: hives, swelling, itching, warmth, redness, rash
    • Stomach: nausea, pain/cramps, vomiting, diarrhea
    • Others: anxiety; feeling of impending doom; itchy, red, watery eyes; headaches; cramping of the uterus.

    The most dangerous symptoms are low blood pressure, breathing difficulty, and loss of consciousness, all of which can be fatal. If you have any of these symptoms, particularly after eating, taking medication, or being stung by an insect, seek medical care immediately (call 911). Don't wait to see if symptoms go away or get better on their own.

    Common Causes

    Foods: Any food can cause an allergic reaction, but foods that cause the majority of anaphylaxis are peanuts, tree nuts (such as walnut, cashew, Brazil nut), shellfish, fish, milk, eggs, and preservatives.

    Stinging insects: Insect sting venom from yellow jackets, honeybees, paper wasps, hornets, and fire ants can cause severe and even deadly reactions in some people.

    Medications: Almost any medication can cause an allergic reaction. Common medications that cause anaphylaxis are antibiotics and anti-seizure medicines. Certain post-surgery fluids, vaccines, blood and blood products, radiocontrast dyes, pain medications, and other drugs may also cause severe reactions.

    Latex: Some products made from natural latex contain allergens that can cause reactions in sensitive individuals. The greatest danger of severe reactions occurs when latex comes into contact with moist areas of the body or internal surfaces during surgery.

    Exercise: Although rare, exercise can cause anaphylaxis. Oddly enough, it does not occur after every exercise session and in some cases occurs only after eating certain foods before exercise.

    Treatment and Prevention

    If you (or anyone you are with) begin to have an allergic reaction, use your autoinjectable epinephrine and get to the closest emergency room. The sooner the reaction is treated, the less severe it is likely to become. If you have taken medications and are feeling better, go to the hospital anyway to be sure your reaction is under control.

    Once you've had an anaphylactic reaction, visit an allergist to get a proper diagnosis. The allergist will take your medical history and conduct other tests, if needed, to determine the exact cause of your reaction. Your allergist can provide information about avoiding the allergen, as well as a treatment plan. Avoiding the allergen(s) is the main way to remain safe, but it requires a great deal of education. Specific advice may include:

    • Food: how to interpret ingredient labels, manage restaurant dining, avoid hidden food allergens
    • Insects: not wearing perfumes, avoiding brightly colored clothing and high risk activities; wearing long sleeves/pants when outdoors
    • Medications: which drugs/treatments to avoid, a list of alternative medications

    In some cases, your allergist may suggest specific treatments, such as immunotherapy (allergy shots) to virtually eliminate the risk of anaphylaxis from insect stings, or procedures that make it possible to be treated with certain medications to which you are allergic.

    Your allergist may also prescribed autoinjectable epinephrine. If so, be sure you understand how and when to use it. Always refill the prescription upon expiration. This medication should be carried with you at all times.

    Your allergist may also want you to wear special jewelry that identifies you as having a severe allergy. This ID can provide physicians and others with important information about your medical condition.

    If you have had an anaphylactic reaction, inform family, healthcare workers, employers, and school staff about your allergy.

    Healthy Tips

    • Anaphylaxis is a serious allergic reaction that comes on quickly, causing at times severe symptoms that affect various parts of the body.
    • The most dangerous symptoms are low blood pressure, breathing difficulty, and loss of consciousness, all of which can be fatal.
    • The most common causes of anaphylaxis are foods, medications, and insect stings.
    • If you (or anyone you are with) being to have an allergic reaction, call for medical help to get to the closest emergency room.
    • See an allergist for follow-up care and developing a treatment plan.
    Reprinted with permission from the American Academy of Allergy Asthma & Immunology




    November 2012 Topic of the Month

    Symptoms, Diagnosis, Treatment, & Management

    According to the leading experts in immunology, when part of the immune system is either absent or not functioning properly, it can result in an immune deficiency disease. When the cause of this deficiency is hereditary or genetic, it is called a primary immunodeficiency disease (PIDD). Researches have identified more than 150 different kids of PPD.

    The immune system is composed of white blood cells. These cells are made in the bone marrow and travel through the bloodstream and lymph nodes. They protect and defend against attacks by “foreign” invaders, such as germs, bacteria, and fungi.

    In the most common PIDDs, different forms of these cells are missing. This creates a pattern of repeated infections, severe infections, and/or infections that are unusually hard to cure. These infections may attack the skin, respiratory system, the ears, the brain or spinal cord, or the urinary or gastrointestinal tracts.

    In some instances, PIDD targets specific and/or multiple organs, glands, cells, and tissues. For example, heart defects are present in some PIDDs. Other PIDDs alter facial features, some stunt normal growth, and still other are connected to autoimmune disorders such as rheumatoid arthritis.

    Primary Immunodeficiency Disease Symptoms & Diagnosis:

    Serious PIDDs typically become apparent in infancy. In milder forms, it often takes a pattern of recurrent infections before PIDD is suspected. In some cases, a PIDD is not diagnosed until people reach their 20s and 30s.

    Important signs that may indicate a PIDD include:

    • Recurrent, unusual, or difficult to treat infections
    • Poor growth or loss of weight
    • Recurrent pneumonia, ear infections, or sinusitis
    • Multiple courses of antibiotics or IV antibiotics necessary to clear infections.
    • Recurrent deep abscesses of the organs or skin
    • A family history of PIDD
    • Swollen lymph glands or an enlarged spleen
    • Autoimmune disease

    Some immunodeficiency disorders are not primary (hereditary or genetic). A secondary immune deficiency disease occurs when the immune system is compromised due to an environmental factor. Examples of these external causes include: HIV, chemotherapy, severe burns, and malnutrition.

    Primary Immunodeficiency Disease Treatment & Management

    Research in primary immunodeficiency is making great strides, improving treatment options, and enhancing the quality of life for most people with these complex conditions.

    If you or your child have symptoms of these sometimes crucial conditions, you want the best care available. An allergist/immunologist or a clinical immunologist has specialized training and expertise to accurately diagnose and coordinate a treatment plan for PIDD.

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




    October 2012 Topic of the Month

    Sinuses are empty cavities within your cheek bones, around your eyes, and behind your nose. Their main job is to warm, moisten, and filter air in your nasal cavity.

    If your stuffy nose and cough last longer than one or two weeks, you may have more than a cold. Rhinosinusitis is a swelling of one or more of your nasal sinuses and nasal passages. It is often called sinusitis or a sinus infection.

    You may experience pressure around your nose, eyes, or forehead; a stuffy nose; thick, discolored nasal drainage; bad-tasting post nasal drip; cough; head congestion; ear fullness; or headache. Symptoms may also include a toothache, tiredness, and, occasionally a fever.

    Types and Causes of Sinusitis

    Acute sinusitis refers to sinusitis symptoms that last less than four weeks. Most acute sinusitis starts as a regular cold from the common cold viruses and then becomes a bacterial infection. Chronic sinusitis is when symptoms last three months or longer. The cause of chronic sinusitis is believed to be a combination of swelling and infection. Recurrent sinusitis occurs when three or more acute episodes happen in a year.

    Allergic rhinitis puts you at risk for developing sinusitis because allergies can cause swelling of the sinuses and nasal mucous linings. This swelling prevents the sinus cavities from draining and increases your chances of developing secondary bacterial sinusitis.

    If you test positive for allergies, your allergist can prescribe appropriate medications to control your allergies, possibly reducing your risk of developing an infection. In rare cases, immune problems that harm your ability to fight common infections may present with chronic or recurrent sinusitis. Problems with the structure of your nose, such as narrow drainage passages, tumors, or a shifted nasal septum (the bone and cartilage that separate the right from the left nostrils) can also cause sinusitis. Surgery is sometimes needed to correct these problems. Many patients with recurring or chronic sinusitis have more than one factor that puts them at risk of infection. So, an accurate diagnosis is

    Diagnosis

    To diagnose sinusitis, an allergist will take a detailed history and perform a physical examination. He or she may also order tests. These tests can include allergy testing, sinus CT scans (which take exact images of the sinus cavities), or a sample of your nasal secretions or lining.

    Your physician may also perform an endoscopic examination. This involves inserting a narrow, flexible endoscope (a device with a light attached) into the nasal cavity through the nostrils after local anesthesia. This allows your physician to view the area where your sinuses drain into your nose in an easy, painless manner.

    Treatment

    Sinus infections generally require a mix of therapies. Your physician may prescribe a medication to reduce blockage or control allergies, which helps keep the sinus passages open. This medicine may be a decongestant, a mucus-thinning medicine, or a steroid nasal spray. If bacterial sinusitis is present, your physician may prescribe an antibiotic. For people with allergies, long-term treatment to control and reduce allergic symptoms can also help in preventing sinusitis.

    Several non-drug treatments can also be helpful. These include breathing in hot, moist air and washing the nasal cavities with salt water. If you need surgery to fix the structure of your nose, your allergist may refer you to an otorhinolaryngologist, or an ear-nose-throat physician (ENT).

    Sinusitis Versus Rhinitis

    Symptoms of sinusitis and rhinitis are very similar. Rhinitis is a swelling of the mucous membranes of the nose, while sinusitis includes swelling of the sinuses in addition to the nasal passages. For this reason, sinusitis is often called rhinosinusitis.

    Rhinitis may be allergic or non-allergic. Allergic rhinitis is caused by allergens in the air, which are usually harmless but can cause problems in allergic people. Symptoms of allergic rhinitis often are a runny nose, sneezing nasal congestion, and itchy eyes, nose, throat, and ears. People with nonallergic rhinitis usually just have a stuffy nose. It may be caused by irritants, such as smoke, change sin barometric pressure, or temperature or overuse of over-the-counter decongestant nasal sprays.

    Healthy Tips