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Every food allergic child needs a food allergy action plan!

Published on Jan 30, 2013 with 37 comments

It is imperative that parents of food allergic children take extra precautions in preventing the accidental exposure or ingestion of allergenic foods while at school. While most exposures are accidental, they do happen with some frequency, so teachers and schools administrators need to have specific instruction and the tools ( antihistamines and Epipens) to treat an allergic reaction.

Kudos to the the Food Allergy & Anaphylaxis Network for providing, free of charge, a critical document called a Food Allergy (Anaphylaxis) Action Plan. This document should be filled out by the parents and physician of every severely food allergic child and presented to the child’s teacher one the first day of school.

Every child’s allergies are different and there will be variations in the aggressiveness of the action plan should a reaction occur. This form allow one’s physician to design a plan based on the child’s previous reactions, degree of allergy, and the potential for a subsequent reaction.

The form is available by clicking this link: https://www.foodallergy.org/files/FAAP.pdf

Check out TheOnlineAllergist.com for more information and tools from board certified allergists.


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The Genetics of Allergic Disease: a moving target

Published on Jan 28, 2013 with 0 comment

All practicing allergists are frequently asked by parents the chance or likelihood of a child being born with allergies or asthma if one or both parents are allergic. At best, the genetics of allergic disease is an inexact science, and the predictions vary widely. I have always given the standard answer: If one parent is allergic or asthmatic, each child has approximately a 25% chance of having allergies or asthma, and if both parents are allergic or asthmatic, the chance increases to approximately 50%, or slightly higher.


Until new data emerged recently from The Journal of Allergy and Clinical Immunology, I thought my response was adequate. But, recent data suggests a very strong “parent-of-origin effect” as an important variable. A total of 1456 children were retrospectively examined for the presence of asthma and eczema and were followed until age 18. Without getting into the complicated statistics involved, the researchers came to the following startling conclusions: Maternal asthma was associated with asthma in girls, but not in boys. Conversely, paternal asthma was associated with asthma in their sons, but not in their daughters. Maternal eczema increased the risk of eczema in girls, and paternal eczema increased the risk for eczema only in their boys. Who ever would have guessed it?


In my opinion, a much larger study needs to be done to confirm these finding and better clarify the genetics of allergic disease. Until then, it is certainly going to make for some interesting discussions.


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Is there an association between beef (red meat) allergy and a previous snake bite?

Published on Jan 27, 2013 with 0 comment

  As a practicing allergist, I was fascinated to read the report several months ago linking the development of red meat allergy to a previous tick bite. The reason that this caught my attention is that over the years, I observed the onset of allergy to beef after a snake bite. I observed this possible relationship in two or three patients who, several months after being bitten by a poisonous snake, developed anaphylaxis to all types of red meat. They were all skin test positive to beef. At the time I could find no such association described in the medical literature. But, since both allergy to red meat and a snake bites are such rare and infrequent events, in retrospect, I regret that I did not write my observations and publish them in the medical literature, especially in light of these recent findings.

My hypothesis regarding the possible connection between snake bite and red meat allergy was that the patient likely developed auto-antibodies to the necrotic muscle protein at the site of the bite. This is akin to the researchers findings that patients who were bitten by the tick developed antibodies to the protein alpha-gel, which is also present in red meat. It would then follow that these antibodies, now present in the previously bitten and sensitized subject would react upon the ingestion of red meat. The researchers described a delayed reaction, including swelling, hives, and difficulty breathing, occurring three to six hours after the ingestion of red meat.

The cases recently described by allergists at Virginia Commonwealth University identified the Lone Star Tick as the likely culprit. This tick is widely found in the southeast United States. And, so are venomous snakes!


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Opening an asthmatic’s pandora’s box: How much is true?

Published on Sep 04, 2012 with 0 comment

Yes. This allergist is a skeptic.

Like many of you, I subscribe to Google Alerts. This is a wonderful tool provided by Google where by their mighty search engine forwards to one’s inbox a brief synopsis of media reports on given subjects which one chooses. I have chosen allergies and asthma, so everyday I receive dozens of references to these subjects. The problem is that the overwhelming majority of the articles that Google picks up are not reputable sources. Therefore, anyone can write anything about any subject in a blog or article and the Google search engine may find it and send it to me and thousands of others. Fortunately, being an allergist with 30 years of experience, I can sort out the nonsense, and there is plenty of it!

I am constantly amazed at the myriad of posts which try to explain the factors which cause or exacerbate allergies or asthma. Some are reputable, but some are so bizarre that they are laughable. I probably know the real causes and worsening factors as well as anyone, and they are numerous and well documented. So, what arrived recently from Google Alerts caught my eye.

A “leading global interdisciplinary design firm” ( I don’t really know what that means) is about to publish a list of 374 substances found the the built environment which are potentially hazardous materials to an asthmatic individual. These include personal care products, household building products, byproducts of central heating/ AC systems and humidification systems, building materials and household furnishings. Yes, you read it correctly: 374! I can’t wait to see their sources. Maybe they too subscribe to Google Alerts.

So, this is a call to all asthmatics to build a bubble to live in while we digest the list and sort out fact from fiction. Will the “public service” provided by this company cause all asthmatics to read the labels on the furniture they might buy or have to read the fine print on the central air conditioner that might need to replaced? Only time will tell. But, as I opened this blog, I am a skeptic.

 


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Allergy Quiz Question: Which physical signs best predict nasal allergies?

Published on Aug 26, 2012 with 0 comment

Sneezing and watery eyes would be a good guess, but I suggest that allergists would give another answer. Of all of the signs of symptoms suggesting allergy, including sneezing, runny nose, red and watery eyes, I would suggest that the allergic salute and the presence of a transverse nasal crease would best predict allergies in a given individual.

The allergic salute is the name given to the repetitive upward trust of the palm of the hand on the nose in response to nasal itching. We have all seen children actively engaging in this exercise to the point of nose abuse! This activity is very commonly seen in allergic children, especially during the spring and fall when exposed to pollens, or when a cat allergic child is exposed to cat allergen.

A transverse nasal crease is a visible line across the nose which becomes evident after years of allergy saluting. When one sees the presence of the crease, the likelihood of allergies approaches 100%. The line is sometimes subtle and only recognizable when looking for it, although it can be quite noticeable, especially in dark complexioned individuals.
So, the next time you see someone with a transverse nasal crease, tell them you hope their allergies are under good control.

To learn more about common allergy symptoms , click here.


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Sunscreen Allergy

Published on Aug 22, 2012 with 0 comment

The use of sunscreens has become a routine part of our daily lives due to our recognition of the dangers associated with prolonged sun exposure. These dangers include the cosmetic disfigurement associated with sun-damaged skin and the obvious risk of skin cancers.Years ago, sunscreens were used only when there was anticipated exposure to direct sunlight over long periods of time, such as going to the beach. Today, sunscreens are used daily by some and are often found in combination with cosmetics and other skin products.This exposure to the chemicals in sunscreens has led to an increasing frequency of allergic skin reactions. Most of these allergic reactions result in the skin inflammation of contact dermatitis.
   
Contact dermatitis is a red, itchy, and sometimes blistering skin rash typically caused by the direct contact to the skin by a sensitizing chemical present in the sunscreen preparation. There are two types of contact dermatitis, irritant and allergic. This difference is often difficult to tell apart, but it is irrelevant, as the treatment is often the same.

Contact dermatitis results in 5.7 million doctor visits each year in the United States, and all ages are affected. Females are slightly more commonly affected than males, and teenagers and middle-aged adults seems to be the most commonly affected age groups.Many of these physician visits are the result of the use of sunscreens.
   
Sunscreens work in one of two ways. Firstly, they act as chemical absorbers. Most sunscreens absorb ultraviolvet (UV) radiation (the energy from the rays of the sun) and turn this energy into a less dangerous form of radiation that causes less damage to the skin. There are sunscreens that absorb different types of UV radiation, such as UVA and UVB. Chemical absorbers include most of the available sunscreens that can be rubbed completely into the skin.

Secondly, sunscreens can act as physical blockers. These sunscreens reflect the sun’s radiation away from the skin, so that the radiation is not absorbed. Physical blockers include zinc oxide, the brightly colored sunscreens frequently used on the nose and lips of beach goers.

While contact dermatitis to sunscreens is not as common as skin allergy caused by cosmetics, it is not a rare condition. The reaction to sunscreens can occur anywhere the substance is applied on the body, although it tends to be more common on the areas of the body with the most exposure to the sun. This is called “photo-contact dermatitis”. Photo-contact dermatitis usually occurs in a sun-exposed pattern on the body. These areas would include the face (but not the eyelids), the “V” area of the upper chest and lower neck, and the backs of the hands and the forearms.

Those most at-risk for developing sunscreen allergy include the following groups: women, possibly as a result of higher use of cosmetics containing sunscreens; those with chronic sun-related skin conditions, such as sun-damaged skin; individuals with eczema or atopic dermatitis; people who have applied sunscreens to damaged skin; and those with outdoor occupations.

There are many active ingredients are present in sunscreens that cause contact dermatitis. Some of these chemicals cause more problems than the others. Many sunscreens have multiple active ingredients, so it may be difficult to determine the exact cause without testing for the individual chemicals. Common active ingredients in sunscreens reported to cause contact dermatitis include Para-Aminobenzoic Acid, Benzophenones, and Cinnamates, among others.
     
Para-Aminobenzoic Acid (PABA) was one of the earliest ingredients used in sunscreens. It is used less frequently now due to the many side effects of this chemical including contact dermatitis, and its tendency to stain clothing. A number of chemicals related to PABA still used today, including padimate A and O. Many sunscreens are falsely labeled “hypo-allergenic” since they do not contain PABA, but can still cause contact dermatitis from other active ingredients.  Those with PABA allergy may be allergic to other similar chemicals, including para-phenylenediamine (found in hair dye) and sulfonamide (sulfa) medications.

Benzophenones have been used in sunscreens for 50 years and are one of the most common causes of sunscreen-induced contact dermatitis in the United States. Other names for benzophenones include oxybenzone, Eusolex 4360, methanone, Uvinal M40, diphenylketone and any other chemical name ending with “-benzophenone”.

Cinnamates are less commonly found in sunscreens but are a common ingredient used as flavorings and fragrances in everything from toothpaste to perfumes. These chemicals are related to Balsam of Peru, cinnamon oils and cinnamic acid and aldehyde, so people allergic to cinnamates may also be allergic to these other chemicals. Other names of cinnamate containing chemicals include Parsol MCX and any chemical ending with “–cinnamate.”
     
Patch testing is the best way of identifying the cause of contact dermatitis. This test is commonly performed by allergists and dermatologists.

Click here for more information on Contact Dermatitis.


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Does the presence of allergies lower the incidence of brain tumors?

Published on Aug 21, 2012 with 1 comment

Researchers at The National Cancer Institute have made an interesting observation. When studying patients with Glioma, a serious form of brain tumor, they noticed that those patients with the presence of allergy antibodies in their blood had approximately 1/2 the incidence of brain tumor two decades later, versus those who did not have allergy markers in their blood. This observation could suggest that the presence of allergies, meaning the over-stimulation of the immune response to ordinary things we are exposed to, could also stimulate that component of the immune system that protects us from other diseases; in this case, brain tumors. The reduced risk was found to be greater in women than men. Fascinating, indeed!
It is difficult to make sweeping epidemiological conclusions based on this study alone, but this observation is important in unraveling the intricate workings of the immune system.


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Prevent a Poison Ivy rash before it happens!

Published on Aug 20, 2012 with 0 comment

Except for the chance of contacting poison ivy, the summer is an excellent time for enjoying the great outdoors and getting close to nature. So learn to identify this leafy bush or vine in order to avoid contact. It may save you a lot of misery.
Poison ivy is a common plant that contains oil called urushiol in the leaves, stems, and roots. The poison ivy rash, called contact dermatitis, is caused by an immune response to urushiol. Poison ivy has three leaves and typically grows as a shrub in the northern US and a vine in southern US. It tends grow on the edges of fields, forests, or roads as well as in areas where the ground has been disturbed (new construction, etc.). Poison oak and poison sumac also can cause contact dermatitis. Poison oak also has leaves of three and grows as a shrub. Poison sumac has rows of paired leaflets and grows and a shrub or small tree.

Most people (about 85%) have been previously sensitized to urushiol and will develop the typical poison ivy rash on subsequent exposure.  The rash is typically delayed and generally appears 24-48 hours after contact with the plant. The rash of poison ivy presents with redness and itching, followed by small or large blisters, typically in a linear pattern.  Swelling of the affected area is also common. The rash is not contagious but you the rash can spread by by accidentally spreading the oil to other parts of the body.

There are several ways of contracting the poison ivy rash. The most common way is through direct contact; by touching the leaves of poison ivy, poison oak, or poison sumac. A person can also get the rash through indirect exposure. Urushiol is very sticky and can stick to just about anything including a pet’s fur, clothing, and tools.  One can then get the rash by touching objects that are contaminated with the urushiol oil and transferring it to their skin. The third way to get the rash is through airborne exposure. If poison ivy is burned, small particles of urushiol are released into the air. These airborne particles can subsequently land on the skin, beginning the process leading to contact dermatitis.

Most poison ivy rashes are minor and go away in 1-3 weeks. Treatment of poison ivy includes oral antihistamines, calamine lotion, steroid creams, and cool compresses. If a large area of skin is involved, especially if it involves the face or the eyes, a physician should be consulted for more aggressive treatment. Your physician may prescribe oral steroids to reduce swelling and inflammation. You should also monitor the rash for signs of skin infection which include pain, fever, worsening of the redness and swelling, and the presence of pus. But, the best treatment is always avoidance.

If one has come in contact with poison ivy, the skin should be washed immediately with soap and water. If the urushiol oil is washed off before it absorbs, the rash can be prevented. Also, any clothing that may have come in contact with poison ivy should be removed.

If you are going into an area where poison ivy may be growing, protect yourself. Wear long pants, long sleeves, boots, and gloves. You can also buy over the counter product called Ivy Block ® which can prevent your skin from absorbing the urushiol oil. Have a fun and poison ivy free summer!

Click here for more information on Contact Dermatitis.

 


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Every food allergic child needs a food allergy action plan!  Do you have one?

Published on Aug 19, 2012 with 0 comment

Does your child suffer from food allergies?  The first day of school is just around the corner, so parents of children with food allergies must take extra precautions in preventing the accidental exposure or ingestion of foods that can cause allergic reactions while at school. While most food allergy exposures are accidental, they do happen with some frequency, so teachers and schools administrators need to have specific instruction and the tools (antihistamines and epipens) to treat an allergic reaction.

Kudos to the the Food Allergy & Anaphylaxis Network for providing, free of charge, a critical document called a Food Allergy (Anaphylaxis) Action Plan. This document should be filled out by the parents and physician of every child that has severe food allergies, and presented to the child’s teacher on the first day of school.

Every child’s allergies are different and there will be variations in the aggressiveness of the action plan should a reaction occur. This form allows one’s physician to design a plan based on the child’s previous reactions, degree of allergy, and the potential for a subsequent allergic reaction.

Please click the Allergy Action Plan in order to prepare for the first day of school.

Check out our Food Allergy section for more information regarding food allergies and their treatment.


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Are allergy shots safe long-term?

Published on May 03, 2012 with 2 comments

Much is known about the immediate and short-term side effects of allergy shots, or subcutaneous immunotherapy. However, little is known about the long-term effects of allergy shot immunotherapy. Because allergy shots modify the immune response, questions have lingered as to whether long term immunotherapy could affect other immune-related inflammatory diseases, for better or for worse,

In the February, 2012 edition of The Journal of Allergy and Clinical Immunology this issue was addressed by epidemiological researchers in Denmark. They studied the incidence of autoimmune disease, ischemic heart disease (heart attacks), and mortality rates in 18,841 patients on allergy shots, compared to 428,484 persons whose allergies were treated without allergy shots.

The conclusion is very encouraging, indeed. Overall, the allergy shot group had a lower risk of autoimmune disease and fewer heart attacks, as well as a decreased all-cause mortality as compared to the conventional treatment group.

We are a long way from your rheumatologist or cardiologist recommending allergy shots as a preventive for immune-mediated and inflammatory diseases.  But, this study does add credible evidence to the safety of immunotherapy and its long-term effects.


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This Video is Worth Watching - Dr. Mike Evans

Published on May 01, 2012 with 0 comment

Even though my expertise is allergies and asthma, every once in a while I will see a health related new item or report that I deem to be so important that I want to share it with everyone. Such is the case with this 9 minute video by Dr. Mike Evans.

The information provided and recommendations made in this clip are compelling to me both as a physician and as an adult who is getting older….one day at a time. We are all vulnerable to all of the maladies and conditions mentioned, and unfortunately our behaviors greatly contribute. But, the weather is beautiful and spring is the optimal time to do a reality check and begin a new initiative toward preventive care and excellent health.

The Online Allergist strongly recommends that you watch this and let it serve as a call to action. It will likely help your allergies and/or asthma as well.


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Allergies in Babies

Published on Dec 05, 2011 with 0 comment

Baby allergies are a fear of any new parent.  Allergies in babies are relatively common, and, because of their age, newborns and infants can be especially sensitive to food allergies. Symptoms of allergies in babies and infants may include colic, irritability, excessive spitting and vomiting, rashes (including eczema or hives), nasal symptoms (such as congestion and runny nose), coughing or wheezing, and other gastrointestinal symptoms (diarrhea, bloody stools, or constipation). There can also be poor weight gain.

Allergies in babies up to age one are almost always caused by food, the most common being cow’s milk.  Yet, a baby does not have to drink milk for symptoms to occur. The offending milk proteins in milk can enter the baby’s system through milk-based commercial formulas, as well as by passing through the mother’s milk during nursing.  A small percentage of milk-allergic babies are also allergic to soy formula.

In recent years, researchers have devoted themselves to understanding the disturbing rise of food allergies, especially in infants and young children. What they have discovered is leading allergists and pediatricians to consider revising the current recommendations on how and when to introduce foods to infants.

For many decades, the time-honored and well-established approach was to delay the introduction of highly allergenic foods into the infant’s diet to prevent the emergence of food allergies.  For example, solid foods are generally not recommended until six months of age; cow’s milk until one year; eggs until two years; and peanuts, tree nuts, and fish until three years. And, there is also a widely accepted notion that breastfeeding alone for the first six months of life will minimize or delay the onset of food allergies and other allergic diseases (including asthma), as well as atopic dermatitis or eczema.

The latest medical evidence however, is debunking these age-old theories.  New research is suggesting that the recommendation to delay the introduction of foods to infants as a means of preventing food allergies may be the wrong approach altogether. Recent studies have revealed very credible scientific evidence to suggest that the common practice of delaying the introduction of cow’s milk, eggs, peanuts, and other foods may actually increase the child’s risk of developing food allergies.  And, even more importantly, there is evidence to suggest that the early introduction of allergenic foods may actually prevent the development of the allergy to that food.  As an example, a recent study demonstrated that children in England were ten times more likely to be allergic to peanuts than children in Israel.  One very strong hypothesis to explain this finding is the fact that Israeli infants are introduced to peanuts, generally through an Israeli product called “Bamba” (an ideal teething food in terms of consistency), at about six months of age.  On the other hand, children in England are generally not introduced to peanuts in any form until approximately three years of age.  This study is just one of many that strongly suggest that an early introduction to certain foods can help babies build desensitization, thereby decreasing the risk of developing a food allergy.

The jury is still out with regard to many questions concerning allergies in babies and infants, but there is excitement in the field of allergy about the possibility of new breakthroughs in the near future, both in prevention and treatment.  One has good reason to be optimistic that safe and effective treatments for food allergies are close at hand.


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Are there any side effects to allergy shots?

Published on Nov 30, 2011 with 0 comment

Allergy shots have been given for many decades, and they have provided allergy relief to probably millions of allergy sufferers, both young and old.  Allergy shots are an important component to a comprehensive allergy treatment plan.  It is a long term treatment lasting several years, but the potential allergy relief they give can last many years, and sometimes for a lifetime.

Allergy shots, when given under the supervision of a board certified allergist are, for the most part, very safe.  However, there are two potential side effects to an allergy injection.

The most common allergy reaction to an allergy shot is a local reaction.  A local reaction will result in an area of redness, swelling, and heat at and around the injection site.  These reactions can vary in size from a very small area of swelling the size of a quarter, to the size of a baseball.  This reaction may occur within a few minutes or may be delayed for several hours.  These reactions, although sometimes uncomfortable, are generally not dangerous.  Local reactions are generally treated with a cold pack and sometimes antihistamines.  Most require no treatment and are usually self-limited, resolving over several hours.  If a large local reaction does occur, it is very important that one tell the allergy nurse prior to receiving another injection as the dose of the next shot may need to be modified.

Albeit rare, an allergy injection can precipitate a serious systemic allergic reaction resulting in nasal and eye symptoms, itching, hives, and difficulty breathing.  A severe reaction can progress into anaphylaxis.  The onset of symptoms in this type of allergy reaction is likely to occur within just a few minutes of the injection.  Generally, the sooner the onset of symptoms, the more severe the reaction is likely to be.  If one feels the onset of any of these symptoms, he or she should notify the nurse or doctor immediately.  It is because of this unlikely event that all patients must wait in a medical facility for at least 20-30 minutes after receiving an allergy shot.  Allergy shots should never be given at home and one should never give themselves an allergy injection!

In order to minimize the likelihood of an allergy reaction to an allergy shot, one should not take an injection if they are presently having significant allergy symptoms or asthma symptoms. One should inform the allergy nurse of all existing symptoms prior to an injection.  Although allergy shots can sometimes be prone to side effects, they have proven themselves to be a source of relief to millions of allergy sufferers.


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How young is too young for allergy testing?

Published on Nov 28, 2011 with 0 comment

Allergy testing is a procedure that is performed by allergists to diagnose allergies.  How young can a child be to take an allergy test?

Strictly speaking, there is no such thing as too young for allergy testing.  And, contrary to popular belief, allergy testing can even be done at less than a year of age, either by a skin allergy test or through a blood allergy test.  Both methods of allergy testing are quite accurate, but there is no perfect test.  Each has advantages and disadvantages.  The key is for your allergist to correlate the allergy test results with the clinical presentation.  Your allergist will recommend which method would be preferable for you or your child.

Most board certified allergists prefer skin allergy testing by the prick method.  This procedure takes only moments to apply and the results are available in about 20 minutes.  Multiple allergens can be tested at one time.  Children generally tolerate this simple procedure quite well, as it is only minimally uncomfortable.  The most difficult part of skin testing can be the itchiness that occurs locally on the histamine (positive control) prick, or from any positive reactions.  If local itchiness does occur, it lasts for only a few minutes.  It is necessary that the patient be off of all antihistamines for at least 3 days prior to skin testing.

When skin testing is not an option, an allergy blood test can be done. This requires several milliliters of blood being drawn from the child’s arm.  The blood is sent to a qualified lab and results are generally available within several days.  Multiple allergens can be tested, but the cost can get quite prohibitive.  Fortunately, antihistamines do not influence the results of the blood test.

Although allergy testing can be done at a young age, keep in mind that most allergies which present in the first year or two of life are usually caused by a food.  After two, the incidence of allergies to inhalants, such as dust mites, molds, pets, and pollens increases dramatically.  Your allergist may try to delay allergy testing as long as possible as a child’s allergy profile can change dramatically in the first few years of age.  Either way, given proper care and treatment, most allergy sufferers can get their allergy symptoms under control, and can live comfortable, allergy-free lives.


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How Do I Find Out if I am Allergic to My Cat?

Published on Nov 22, 2011 with 0 comment

Do I have a cat allergy?

The allergens that cause cat allergies are among the strongest allergens on the face of the earth. This fact, combined with the fact that so many children and adults who have cat allergies have cats in their homes, makes for a most challenging situation.  It is very important that cat allergies be diagnosed and that maximum effort is exerted to minimize exposure in the home.  In addition to environmental control measures, some cat allergic symptoms can improve with medications.  Others respond extremely well to cat allergen immunotherapy, a process which desensitizes one to this very bothersome allergen.

Many people know that they have a cat allergy by the fact that their symptoms are precipitated or made worse when exposed to cats. This exposure can occur by breathing cat allergens or having direct contact.  But, for those individuals who cannot correlate their symptoms with exposure, allergy testing to cats is quite easy.  It can be diagnosed by a simple skin test or a blood test.

If someone in your family is allergic to your cat, do not sit idly by.  Be proactive and follow your allergist’s recommendations to totally eliminate exposure to your cat, especially in the bedroom.  If that is not possible, do all you can to reduce exposure to highly allergenic cat allergen in your home.  You can do this by making sure that you have pet allergy control products such as a pet vacuum, pet air purifier, and pet allergy shampoos. By using these products and following the steps outlined in our cat allergy article,  you can create a healthier and allergen-free environment for you and your entire family.

Read More about pet allergies here.


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Snoring…can it be caused by allergies?

Published on Nov 21, 2011 with 35 comments

Snoring is caused by the turbulence of inspired air as it moves through a partially obstructed airway.  Snoring is so common that we generally dismiss its potential harmful effects or its significant causes.  Even though many adults snore, it should not be viewed as a minor noise issue disturbing only to one’s sleep partner.  In some cases, it may be a symptom of a more serious problem.

Snoring is extremely common in both men and women, especially those who are obese and those with large necks.  In these individuals, snoring is generally caused by a narrowed breathing passage as their thick soft palate relaxes, approaching or meeting the back of the tongue during sleep.  Nasal congestion is also a common contributor to snoring.

As snoring is caused by a partially obstructed airway, snoring in children is never a normal condition.  And, noisy breathing or snoring in babies and toddlers is always abnormal and should be evaluated to ascertain the area of obstruction.  In children, snoring is commonly caused by enlarged adenoids and/or tonsils in combination with nasal congestion.

A serious complication of snoring is obstructive sleep apnea.  Sleep apnea can occur in children, although it is much more common in adults.  Sleep apnea occurs when the airway becomes totally obstructed, albeit temporarily.  A sleep study is necessary to diagnose sleep apnea, and to ascertain its cause and level of severity.  But, sleep apnea is generally suspected even before formal diagnostic testing in individuals who snore loudly and whose snoring abruptly stops for several seconds.  This period of quiet, which can last as long as 15-20 seconds, is generally interrupted abruptly by a strong snore, sometimes awakening the patient in a startle.  This pattern of interrupted breathing (snoring then quiet, snoring then quiet, etc) can literally occur hundreds of times through the night.  Patients with obstructive sleep apnea are generally very tired during the day and easily fall asleep when not engaged in physical activity.  They are chronically sleep deprived and can exhibit symptoms such as irritability and headaches.

Snoring results from a combination of many factors.  It therefore needs to be evaluated by a board certified ENT physician or a Sleep Specialist.  Even though allergies may be the cause of the nasal congestion, allergies must be considered only a contributory factor, and not the primary cause of snoring.


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Allergy Shots or Allergy Drops?

Published on Nov 02, 2011 with 0 comment

Immunotherapy, or desensitization, is the cornerstone in the treatment of allergies in both children and adults.  Popularly known as “allergy shots”, this treatment modality works by exposing an allergic individual to minute amounts of the substance(s) to which he or she is allergic and increasing the dose over months to years in order to induce an increased state of tolerance to the allergen(s).  This form of treatment is most commonly used to desensitize one to inhaled allergens such as dust mites, animal dander, mold spores, and pollen, but it is now being used very successfully to desensitize highly allergic individuals to peanuts, tree nuts, milk, and other foods.

Immunotherapy has been in clinical practice for over one hundred years. In the U.S., it is most commonly administered by injection.  It is estimated that 2.5-3.0 million children and adults are receiving injection therapy and that 40-60 million allergy shots are given annually in the U.S. alone.

In Europe and other parts of the world, immunotherapy is commonly administered sublingually, or as drops under the tongue.  The safety and efficacy of the sublingual route of administration is presently being researched in the U.S., but the data so far has been very positive and encouraging.  As a result, more and more allergists are now offering sublingual immunotherapy, or SLIT, to their allergic patients as an alternative to allergy shots.  For further information on sublingual immunotherapy, TheOnlineAllergist recommends http://www.theonlineallergist.com/article/sublingual-immunotherapy-has-its-time-come.

Allergy shots or allergy drops are an important treatment option in the treatment of allergies, and sometimes allergy induced asthma.  Consultation with a board certified allergist is in order for those seeking long term or permanent relief from their allergy symptoms.


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5 Tips to help your Dog and Cat Allergies

Published on Oct 28, 2011 with 1 comment

Pet allergies are extremely common. At least 30% of the people who have allergies will find that they are allergic to dogs and cats. One needs to be aware that the pet dander from their own pet could be causing some serious allergy symptoms.  Although the most effective treatment for dog allergies and cat allergies is removing the pet from the home, many people love their pets and they wouldn’t dream of giving them up just because they have allergies. Since your pet is a part of the family and you don’t want to give him or her away, you need to know best ways to prevent pet allergies. It’s a good thing there are some great products that will help you with your pet dander allergies!

Environmentally Controlling the Pet Allergy

Cat allergies and dog allergies are the result of an allergic reaction to the dander and fur that the pet sheds. You may also have allergies to their saliva. Because your pets are going to have dander, hair and saliva their entire lives, you have to make sure that you take a proactive approach to controlling the presence of these allergens in your home. The allergens, particularly the dander and the fur, can be found all around your home, in your bedroom, on the furniture, and potentially in every nook and cranny. Controlling your pet allergy symptoms is possible, but it is going to require some work on your part.

Tip #1: Clean your Home with a HEPA vacuum cleaner

Cleaning your home thoroughly is a good way to eliminate some of these very powerful allergens. Use of a high quality HEPA filter vacuum cleaner on your floors and upholstery is great way to remove much of the fur and dander that are causing your allergies to cats and allergies to dogs. There are many quality HEPA vacuums available. One excellent model, designed specifically for pet dander, is the Miele Cat and Dog Vacuum. You can also compare features and shop for HEPA vacuums with this HEPA Vacuum Cleaner Buying Guide from achooallergy.com.

Tip #2: Use a steam cleaner for deep cleaning

You should also invest in a steam cleaner that will be able to get down deeper into the carpet and upholstery and remove even more of the allergens. Steam cleaners are extremely effective in removing not only pet dander, but dust mites as well. The high temperature of the steam can kill dust mites and dust mite eggs. Using a steam cleaner, combined with regular dusting and cleaning, will help to remove some of the allergens from your home, and that should help you breathe easier, quite literally.

Tip #3: Invest in an Air Purifier for Pet Allergy Relief

Another item that will help you with your pet allergy symptoms is an air purifier. You want to make sure that you get one that has a HEPA filter on it so it will be able to eliminate the largest amount of particulates in the air, including dander. The Austin Air Pet Machine is specifically for this purpose.

These, along with the above methods, will be able to help make the pet allergy more bearable. You might find that it’s a good idea to keep more than one purifier in the house. Make sure you have one in any area of the home that the pet frequents, including your bedroom – even if you don’t allow your animals in the bedroom.

Tip #4 - Make sure that you keep your animal clean!

You can find some great shampoos for your pets that can help to keep their coats clean and shiny and their skin healthy so they have less dander. Brushing your pets outdoors and brushing them frequently will help to keep some of the fur and dander out of your home too.

Tip #5 - Keep your pet out of the bedroom

By limiting the number of locations you allow your pet to go in your home, you can reduce some of the problems too. Keeping them out of your bedroom, the room where you spend about a third of your life, will lower the amount of allergens there and make sleeping easier.

Using all of the tips above will make a significant difference to your allergy symptoms from dog and cat allergies.


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Is one Epipen enough? Be prepared!

Published on Oct 27, 2011 with 0 comment

imageA recent study assessing emergency room records confirms the fact that a significant number of patients with anaphylactic reactions to food needed more than one injection of epinephrine. The data from this study revealed that 16% of patients presenting with food induced anaphylaxis required two injections.  Previous data showed that as many as 25% of reactions required multiple doses.  Multiple doses of epinephrine appeared to be more likely in those with reactions to peanuts and tree nuts and those presenting with hypotension (low blood pressure).

Additionally, many patients, even after observing a demonstration on the proper use of an auto-injector, are not able to use it properly, especially in an emergency situation. Please watch The Online Allergist’s video presentations on How to use an Epipen and insist that all members of the family watch the video and know how to use this device as well.

The message is clear: Those with a history of anaphylaxis and those highly allergic to foods, medicines, or insect stings should be prepared to treat anaphylaxis with multiple injections of epinephrine until medical assistance arrives. One injection may not be enough!


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Four Myths About Dust Mites

Published on Oct 26, 2011 with 0 comment

imageMyth # 1: Air purifiers can trap and kill dust mites - A number of air purifier companies have gone on record saying that HEPA room air cleaners are effective at catching and trapping dust mites. The truth is that dust mites do not fly and are unlikely to even come into contact with a HEPA air cleaner. Even their allergenic waste particles are largely unaffected by HEPA air cleaners, because even when they become temporarily airborne, they settle back down quickly. Although these air cleaners are minimally effective against dust mites, they can play a very important role in eliminating other allergens like mold, pollen and animal dander from our homes. On the other hand, mattress encasings and pillow encasings can create an important barrier between you or your child and dust mite allergens, thereby removing a major source of exposure.

Myth # 2: Dust mites live in air ducts - This untruth is sometimes perpetuated by companies that want to sell you their duct cleaning service. A small amount of dust mite allergen that becomes airborne could settle in your ductwork, but ducts are far from the humid, fibrous environments where the dust mites live and produce their allergenic waste.

Myth # 3: Dust mites bite - Dust mites are far too small to bite humans, but skin reactions to dust mite allergen may be the cause of this myth. Dust mite waste and other allergens can trigger a skin reaction known as eczema or atopic dermatitis.

Myth # 4: Dust mites live in all dust - You will not find live dust mites living in the dust on your bookshelf or in that dust “bunny” that skitters across your hard surface floor. Nor will you find dust mites in outdoor dust. They just cannot survive on the surface of things; they need to burrow deep into bedding, carpeting and upholstery, making these environments the perfect homes for dust mites.


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Oral Allergy Syndrome

Published on Oct 25, 2011 with 35 comments

Does your throat itch when eating certain raw fruits?  If so, you probably can be diagnosed as having the Oral Allergy Syndrome.

Although generally not classified as a serious food allergy, the oral allergy syndrome is the most common food related allergy in adults. In actuality, the oral allergy syndrome is not a direct food allergy, but rather it represents cross-reactivity between tree or weed pollens and corresponding foods which share a common allergen.  Because of this relationship, the oral allergy syndrome is seen only in tree and weed allergic patients.

Fortunately, symptoms of the oral allergies are generally mild and transitory. Oral allergy syndrome symptoms are classically itching of the throat, mouth, and tongue. The itchiness of the throat commonly results in the patient trying to relieve this symptom by rubbing the tongue against the soft palate, making a characteristic “clucking” sound.  The vast majority of patients experience symptoms within five minutes of ingestion.  Depending on the time of year, the presentation can be affected by the particular pollen season.

Many fruits and vegetables can elicit symptoms in tree or weed allergic individuals. For example, because ragweed pollen and foods in the gourd family share a common allergen, persons allergic to ragweed may have oral symptoms upon ingestion of foods such as melons (watermelon, cantaloupe, and honeydew), zucchini, cucumber, and bananas.  Birch tree pollen individuals may develop an itchy throat upon eating apples, pears, and apricots. Ingestion of celery may cause oral symptoms in those allergic to mugwort pollen.

It is important to note that symptoms are caused by the ingestion of only raw or uncooked fruits or vegetables. The heating process that occurs during cooking breaks down the allergic protein and, as a result, even patients with the oral allergy syndrome can usually tolerate these cooked foods without having symptoms.


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An Allergist Reflects:  Primatine Mist and the FDA Ban of Asthma Inhalers Containing CFC

Published on Oct 24, 2011 with 3 comments

As a practicing allergist and asthma specialist, I have been privy to watch the repercussions of the FDA’s ruling banning of the use of chlorofluorocarbons (CFCs) in asthma inhalers during the years leading up to 2005 when the ban became law, and up until the present.

Over the past few years, this issue was all but forgotten until the recent flurry of new articles reminding the public that Primatine Mist, the only OTC, non-prescription asthma inhaler and the only remaining CFC containing asthma inhaler, will no longer be available on pharmacy shelves after December 31st.

Primatine is probably the last survivor of the ban which was mandated by the FDA as the result of environmental concerns articulated in the mid-1970’s that chlorofluorocarbons released into the atmosphere would deplete the earth’s ozone layer, increasing the risk of skin cancer, cataracts, and no doubt global warming.  CFCs, organic compounds that contain carbon atoms, chlorine atoms, and fluorine atoms, are relatively stable here on earth, but scientists and environmental advocates have expressed concerns that these inhaler releasing CFCs could deplete the ozone in the stratosphere, the zone about 15 to 40 km (10 to 25 miles) above the earth’s surface in which ozone is relatively highly concentrated.

From the outset, this asthma specialist could not understand the logic of removing CFCs from asthma inhalers. True, chlorofluorocarbons can have a deleterious effect on the environment, but, in my opinion, the ban should have been imposed on large sources of CFCs, such as refrigerants and air conditioning systems, insulation materials, solvents and cleaning agents, as well as aerosols which are sprayed into the environment.  As a prescriber of asthma inhalers for over 30 years, I never witnessed any of my patients going around discharging their inhalers into the atmosphere.  One could argue that the amount of CFCs released into the environment by asthma inhalers was miniscule and irrelevant.  Asthma patients sprayed their inhalers, chlorofluorocarbons and all, into their mouths and inhaled it into their lungs, not into the environment.

As a result of this ban, I have watched as pharmaceutical companies transition from using chlorofluorocarbons in the propellant of their asthma inhalers to using a more environmentally safe chemical called hydrofluoroalkane, or HFA.  But this transition has not been without great costs.  In order to transition, the FDA mandated to pharmaceutical companies that all asthma inhalers containing the new propellant containing hydrofluoroalkane, or HFA, must undergo rigorous clinical trials to prove its safety and efficacy.  I participated in those trials as a clinical investigator and can attest to the fact that pharmaceutical companies spent tens, perhaps hundreds of millions of dollars to transition from Proventil to Proventil HFA and from Ventolin to Ventolin HFA, just to name a few.  There is no doubt that these costs were passed on to the consumers, as the “environmentally safe” HFA containing inhalers cost at least three times that of the old CFC containing inhalers.

Something to think about.


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Primatine Mist Inhaler to no longer be available after December 31st

Published on Oct 03, 2011 with 34 comments

Primatine Mist is presently the only asthma inhaler available over-the-counter (OTC) and without a prescription. Primatine, a potent bronchodilator whose active ingredient is epinephrine, has been available for decades, but its days are clearly numbered. The FDA has announced that the product will be discontinued and removed from pharmacy shelves after December 31, 2011.

Since the advent of albuterol many years ago, Primatine Mist has fallen out of favor with physicians and patients due to concern about the cardiac side effects of Primatine and the potential for abuse and overuse.  Albuterol and other bronchodilating inhalers, available as Proventil HFA, Ventolin HFA, Proair HFA, and others are presumably safer than Primatine due to the fact that they have less excitatory effects on the heart and their availability is regulated due to the fact that they can be purchased only with a prescription.

But, it is not for safety reasons that the FDA is requiring that the inhaler is being discontinued. Rather, it is for environmental reasons! The FDA has banned all inhalers that contain chlorofluorocarbons due to the concern that when exposed to the environment, chlorofluorocarbons deplete the ozone layer of the atmosphere. Chlorofluorocarbons which are used as propellants in asthma inhalers, have now been replaced by hydrofluoroalkane, or HFA, hence Proventil HFA and Ventolin HFA.

The OnlineAllergist, for one, will be sad to see Primatine Mist removed from the list of available medications to treat bronchoconstriction. While albuterol is clearly preferable in treating asthma symptoms that result from the constriction of small and medium sized bronchial tubes, epinephrine in the form of Primatine is most effective in treating airway constriction which occurs high in the airway, specifically in the larynx and in the large bronchial tubes. The classic clinical presentation of large airway constriction which is helped by an epinephrine inhaler such as Primatine Mist is croup, a very common respiratory illness in young children.


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Vitamin D is proving to be very important in asthma and allergies!

Published on Sep 18, 2011 with 0 comment

It has been recognized for some time that Vitamin D is critical for the maintenance of good health. Deficiency of vitamin D has been associated with many illnesses, and there is now good evidence to suggest that low levels of Vitamin D have a deleterious effect on asthma and allergies.

Research has indicated that Vitamin D levels play a regulatory effect on the production of cytokines, substances that are secreted by specific cells of the immune system which carry signals locally between cells. This effect, called immunomodulation, is a very sensitive and critical component in the immune response, and any change in the quantity of cytokines produced can cause specific cellular changes which can lead to disease.

In a recent paper published in the Journal of Allergy & Clinical Immunology, researchers at the National Jewish Medical and Research Center in Denver found that 47 percent of their asthma patients have vitamin D levels that are considered insufficient, and only 17 percent have deficient levels. They also found that asthmatic children with low vitamin D levels have higher levels of IgE, a nonspecific marker of allergy.

Asthmatics with low levels of Vitamin D are found to have poorer lung function, have higher levels of immunoglobulin E (IgE), an immune system protein the body makes in response to allergies, be more likely to need inhaled and oral steroids to reduce airway inflammation, and be more likely to need long-acting beta-agonist drugs to relax muscles in the lung’s airways. 

Overall, Vitamin D deficiency is more prevalent in the general population than previously recognized. Because of this, efforts should be made to increase one’s level of Vitamin D. The sunshine’s ultraviolet rays are the primary source of Vitamin D and exposure to the sun for 15 minutes two to three times a week has been recommended. Foods that are naturally high in Vitamin D, including cod liver oil and oily fish such as herring, mackerel, and salmon, are encouraged. Also recommended are milk, cereal, other dairy products, and fruit juices fortified with Vitamin D.

In 2008, the American Academy of Pediatrics (AAP) doubled their recommended intakes for vitamin D from 200 IU daily to 400 IU daily. The AAP recommends that exclusively and partially breastfed infants receive supplements of 400 IU/day of vitamin D shortly after birth and continue to receive these supplements until they are weaned and are consuming adequate amounts of vitamin D-fortified formula or whole milk. Similarly, all non-breastfed infants should receive a vitamin D supplement of 400 IU/day. AAP also recommends that older children and adolescents who do not obtain 400 IU/day through vitamin D-fortified milk and foods should take a 400 IU vitamin D supplement daily. Because Vitamin D is not a water soluble vitamin and can be stored in the body, care must be taken not to exceed recommended doses.

Allergists and other physicians are recognizing the importance of Vitamin D.  Many are routinely recommending vitamin D supplementation in their patients with allergies and asthma.


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Food or drug allergy: identify yourself with a medical ID alert bracelet or necklace

Published on Sep 14, 2011 with 41 comments

Allergists strongly recommend that both children and adults who have a severe food allergy or drug allergy wear medical alert ID bracelets, necklace, or any other type of medical alert jewelry.  And, for those who have had an episode of anaphylaxis or are at risk for experiencing anaphylactic shock symptoms, wearing a medical ID bracelet is crucial.

Why do allergists feel so strongly about this recommendation?  Firstly, young children are extremely vulnerable due to the fact that they are not able to communicate their allergies. They are subsequently at risk in day care, school, and at friends’ homes if the care taker or teacher does not have an intimate understanding of the child’s food allergy or drug allergy.  However, this potential lack of communication does not apply exclusively to young children.  It also applies to allergic individuals of all ages, both children and adults, during severe allergic reactions.  During anaphylaxis or when suffering from anaphylactic shock symptoms, and other medical emergencies, patients often cannot communicate vital information, resulting in a situation which can be life threatening.  This is especially true if the individual is having throat swelling, difficulty breathing, other anaphylactic shock symptoms, and certainly if they lose consciousness.

If the individual and their food allergy or drug allergy are properly identified, emergency medical personnel can rapidly assess the situation and initiate appropriate treatment without delay.  Delay in identifying allergic reactions can be catastrophic.  Emergency medical personnel are trained and instructed to look for the presence of medical ID alert bracelets or other medical alert jewelry in all acutely ill patients and during any medical emergency.

Medical alert jewelry has evolved over the years, especially in terms of fashion. There are now many types and styles available, so wearing one if these life saving devices does mean that fashion needs to be sacrificed.  In fact there, there are stylish medical bracelets for women, and sporty and “cool” versions of medical alert bracelets for kids. You can shop for medical ID bracelets and necklaces by clicking here.

Medical ID alert bracelets and necklaces save lives.  So, if you or your child have a serious food allergy or drug allergy, please take our advice and identify yourselves.


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Food induced allergic reactions can be expensive

Published on Aug 03, 2011 with 2 comments

In this month’s issue of The Journal of Allergy and Clinical Immunology, researchers studied the economic impact of food induced allergic reactions in the United States over a one year duration. Their results were extrapolated from 35,000 patients who received medical attention resulting from an allergic reaction to food, including anaphylaxis, in 2007.

The study included patients of all ages, but 10% of all costs were generated by children four years of age or younger. The study calculated direct costs, such as physician office visits and hospital visits during or as a result of a food induced allergic reaction, as well as the estimated indirect costs including wages lost by adult patients and the parents of children treated and admitted to the hospital.

Direct costs were estimated to be $225 million. Doctor’s visits accounted for 52.5% of costs.  Emergency room visits accounted for 20%, inpatient hospitalizations approximately 12%, outpatient visits 4.0%, ambulance costs 3%. Epipen or other epinephrine devices made up almost 9% of the direct costs. Indirect costs were approximately $115 million. In total, it is likely that the economic impact of food induced allergic reactions is approaching one half billion dollars a year. That’s nothing to sneeze at!


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Cold Induced Urticaria: Be careful where you swim!

Published on Jul 25, 2011 with 2 comments

I was recently approached by a friend who related to me the fact that his daughter went swimming in a cold stream and almost immediately developed hives over her entire body. “Does that mean she is allergic to water?” he asked.  Much to his surprise, I answered “No, but I suspect she is allergic to the cold.”

While not technically correct (it is not really an allergy), this young lady was likely exhibiting the symptoms of cold induced urticaria or cold induced hives, a rare form of physical urticaria.  Physical urticarias are those cases of hives which occur upon exposure to cold, sunlight, heat, water, and pressure, or as the result of exercise.

Recurrent urticaria or chronic urticaria is one of the most frustrating conditions for both patients and allergists. Part of the frustration is the fact that in most cases, the cause for the chronic urticaria cannot be ascertained. Equally frustrating is the unpredictability of symptoms in terms of their timing, their distribution on the body, and their severity. The symptoms of recurrent or chronic urticaria can also be extremely difficult to treat. To the dismay of many hives sufferers, hives are generally extremely itching and can be disfiguring. They may be transient, but unfortunately, in some cases they can last for years.

Approximately 30% of those with recurrent or chronic urticaria have one of the above mentioned physical triggers. Cold induced urticaria is hives which are brought on upon exposure to cold weather, cold water, drinking cold liquids, or eating cold foods. The symptoms are caused by the release of histamine under the skin. The resultant hives are usually mild and transitory once the cold stimulus is removed. However, cold induced urticaria can be dangerous if excessive amounts of histamine is release at one time, as this can result in anaphylaxis and shock. It is for this reason that those with this condition should be cautioned to never swim in cold water and never to swim alone.

The diagnosis of cold induced urticaria is generally quite easy to make. Firstly, the presenting history is quite classic in suggesting a cause and effect relationship between the expose to the cold and the development of the hives. To confirm the diagnosis, an allergist will like perform an ice cube test. This is a simple procedure whereby an ice cube is placed on the forearm for five minutes. If, after being removed, a hive is present on the area exposed to the ice cube, or develops during the re-warming period, the diagnosis has been confirmed.

The cornerstone of the treatment of cold induced urticaria or cold induced hives is the avoidance of exposure to cold environments. This would include covering as much exposed skin as possible in cold weather conditions and avoiding exposure to cold water during swimming. Some susceptible individuals also need to avoid cold drinks and foods such as ice cream and popsicles. Antihistamines, especially some of the older antihistamines can be very helpful.  Injectable epinephrine, such as an Epipen, should be available to those with potential systemic symptoms. A medic alert bracelet or necklace can also help to identify this condition in the event that the individual is not able to communicate.  American Medical ID is a great source for medic alert bracelets and necklaces.


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The Danger of Food Allergies: A Letter from an allergist to his family

Published on Jul 24, 2011 with 0 comment

The following is a letter I wrote to members of our extended family and close friends upon learning about my grandson’s allergic reaction to tree nuts.

Dear Family and Friends,

Even though all of you are probably aware of Jacob’s recent severe allergic reaction to a cashew, I feel compelled to follow with my own letter in order to emphasize the severity of this condition.

Jacob was tested last week by an allergist and was found to be highly allergic to:  ALL TREE NUTS:  cashews, pistachios, almonds, Brazil nuts, hazelnuts, macadamia nuts, pecans, walnuts.

What this means is the following:

Jacob can NEVER be exposed to any of the above nuts!

Exposure means:
  a)  when he is in your house, you should have NO NUTS in candy dishes, in food that you’ve prepared, on counter tops—basically anywhere.
  b)  if you have touched a nut, WASH YOUR HANDS.  Touching Jacob with nut protein on your hands can trigger an allergic reaction.
  c) it is imperative that you CHECK LABELS on all processed foods for the presence of tree nuts. And certainly, do not cook with tree nuts as an ingredient if Jacob will be there.
  d) if you have eaten tree nuts, RINSE YOUR MOUTH AND LIPS before kissing him.

Fortunately, Jacob was tested and is not allergic to peanuts which is another category of food altogether, unrelated to tree nuts.  However, because he is a child and will not be able to differentiate between “good nuts” and “bad nuts”, I ask you to also NEVER have peanuts around when he’s visiting.  It’s a small sacrifice when one considers the great danger he faces. [Author’s Note: This paragraph is relevant ONLY if a child has been tested and is NOT allergic to peanuts!]

In light of the above, it is imperative that you learn how to use an Epipen Jr. I recommend the following short video: How to Use and Epipen  He will have to have one with him wherever he goes.  Jacob’s parents have been instructed in its use, and they will demonstrate how to use it to those of you who regularly take care of him.  Sometimes, in spite of all the precautions we try to institute, accidents happen, and we need to be prepared for that.

I would also recommend that you have liquid Benadryl available. If there is a question as to whether he is having an allergic reaction with symptoms such as mild itching, or sneezing, then administer 1 tsp of Benadryl immediately. If, on the other hand, he is breaking out with hives, having swelling of his face, coughing, wheezing, or having difficulty breathing, the Epipen should be given immediately in his thigh, and 911 should be called. If there is ever a doubt whether to give the Epipen or not, give it!  It cannot hurt him.

I am sorry if I’ve alarmed you, but quite frankly, that was my intention.  All too often, people don’t fully realize the seriousness of food allergies, and I felt that I had a responsibility certainly to let our family know the necessary steps to keep our precious little Jacob safe and healthy.

If any of you have any questions, please write me or call me—I’m always available to you.

Love,

Me
(Robert M. Cohen, MD)


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Proper inhaler technique: It is critical to effective asthma treatment

Published on Jun 19, 2011 with 0 comment

Is your asthma inhaler or your child’s inhaler seemingly not working?

If you or your child are not getting the desired results from an asthma inhaler, chances are that the inhaler is not being used correctly and efficiently. As a matter of fact, the proper inhaler use could be the most important factor in the success or failure in the treatment of asthma in children and adults.

The ability to use inhaled medications for the control and treatment of asthma is a major breakthrough. Metered dose inhalers, diskus inhalers, twist inhalers, and flexhalers are the most effective delivery systems for both preventative medications such as inhaled steroids, and for the fast acting bronchodilators such as albuterol, taken for immediate relief of asthma symptoms. But, for these medications to be helpful, one must know how to use an inhaler. If proper inhaler technique is not used, the medication will not be delivered to the lower airways - resulting in minimal or no improvement in symptoms. Unfortunately, every allergist and asthma specialist deals with the issue of improper inhaler technique every day.

If an asthma patient is not responding to a medication delivered by a metered dose inhaler, a diskus inhaler, or a flexhaler, the most likely explanation is that the patient is taking the medication less frequently than prescribed, or that they simply don’t know how to use an inhaler.  Proper inhaler technique is very simple, but it does require demonstration, coaching, and constant reinforcement.  The Online Allergist is a big proponent of inhaler “show and tell”.  It is incumbent upon every physician or nurse to demonstrate proper inhaler technique and a review of how to use an asthma inhaler should be an integral part of every visit. Pharmacists should also demonstrate proper inhaler technique when the medication is dispensed.

As a practicing allergist, I have seen adult patients who have been using inhalers for many years - and even decades - all the while using the inhaler incorrectly, and therefore receiving no benefit. Mistakes include spraying into the mouth but not inhaling, actuating multiple sprays at one time, and even holding the inhaler upside down. It is not a laughing matter, but had I taken videos over the years of adults and children using inhalers, I would have collected an endless chronicle of misuse and I could have sent them to a medical edition of World’s Funniest Videos. While being amused however, such inhaler techniques are inefficient and even dangerous.

The Online Allergist recommends that the following videos be watched to learn how to use an inhaler:

How to use an inhaler
How to use a Discus inhaler
How to use a Twisthaler

It is important to note that children less than 6 years of age generally cannot use an inhaler correctly, as it does require a certain amount of coordination. For young children, devices such as spacers, aero-chambers, and aero-chambers with mask are available and are widely prescribed.  However, these devices are not always efficient in delivering the appropriate dose of inhaled medication to the lower airways, and many allergists will recommend the use of a nebulizer, depending on the asthma medication that is prescribed.  Since little coordination is necessary, a nebulizer is often the delivery system of choice for infants and young children.  The PARI Vios Nebulizer and the PARI TRK S Nebulizer are very good nebulizers for both adults and children.

Proper inhaler technique is critical and potentially life-saving for both adults and children with asthma.  Make it a point to learn how to use an inhaler and make sure to practice frequently.


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Nose Spray Addiction is common, but curable

Published on Jun 14, 2011 with 0 comment

Decongestant nasal sprays or decongestant nose drops, like Afrin, Neosynephrine, Vicks, Sinex, Duration, and 4-Way, offer wonderful short term relief of nasal congestion. These brand names and their generic equivalent over-the-counter nasal sprays provide almost immediate relief of congested noses associated with colds, allergies, or other sinus conditions. Most are designed to provide 12 hour relief of nasal congestion, but they do nothing for the runny nose, sneezing, itching, or post nasal drip associated with these conditions.

Decongestant nose sprays and decongestant nose drops are generally very safe and effective if used as recommended, but the problem comes when they are taken too frequently or for longer than 5-7 days consecutively. Overuse results in a rebound phenomenon, whereby the medication lasts for shorter and shorter periods of time, resulting in the need to be taken more frequently to provide relief. The first sign of a problem may be the need to use a nasal spray several times in the middle of the night in order to breathe through the nose. Such patients become increasingly dependent and think they have a nasal spray addiction. This overuse leads to a condition called Rhinitis Medicamentosa.

During my career as a physician, I can recall two very memorable cases of Rhinitis Medicamentosa. The first occurred when I was consulted to see a newborn baby who was in respiratory distress. It was determined that the baby’s obstruction to airflow was occurring in the nose and not the lungs. Unfortunately for this baby, newborns can only breathe through their noses and they do not mouth breathe. Since this was a very unusual presentation, I spoke to the mother and a careful history revealed that she had a nasal spray addiction and was using decongestant nasal sprays frequently throughout her pregnancy, labor and delivery. It was presumed that the baby had Rhinitis Medicamentosa secondary to the mother’s overuse. Tubes were placed in the baby’s nostrils to create an airway and fortunately the swelling in the baby’s nose resolved over several days.

The other was a case of an elderly gentleman who had been using decongestant nose spray every 2-4 hours for over 25 years! He was indeed addicted to nose spray. Fortunately, he responded well to treatment and he was off of spray within two weeks.

Treatment of decongestant nose spray addiction is generally very successful. It commonly requires a short course of oral or injectable corticosteroids in order to break the cycle of overuse, and a short weaning period from the nasal spray. But, the best treatment is to avoid overuse. Long acting decongestant nose sprays and decongestant nose drops are recommended either once or twice a day, and for no longer than five to seven days consecutively.

The issue of nasal spray addiction applies only to decongestant nose sprays and not to nasal corticosteroid sprays. Because the steroid sprays do not give immediate relief, there is rarely a problem of overuse. Steroid nose sprays can be safely used over long periods of time, while under the supervision of a physician. Even if steroid nose sprays are taken more than prescribed, Rhinitis Medicamentosa will not result.

Becoming “hooked on” or addicted to decongestant nose spray or decongestant nose drops is preventable. The bottom line is that all medicines, both prescription and over-the-counter, should be taken only as prescribed or recommended!


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A peanut patch? Now that’s very interesting.

Published on May 30, 2011 with 0 comment

Just today, the Daily Mail reported that two French pediatricians have developed a peanut patch that has the potential to “cure” thousands of individuals who have severe peanut allergies. Today’s report comes several months after researchers at the National Jewish Hospital in Denver disclosed that they are studying the effectiveness of a peanut patch as a means to desensitize peanut allergic patients. This exciting research comes on the heels of several years of progress in the treatment of peanut allergy and other food allergies. The availability of a patch would be an excellent therapeutic option for many patients.

Similar to oral desensitization, or oral induction of tolerance, small amounts of peanut protein would be placed on the skin under a patch. Over time, the dose of exposure would increase to a level equivalent to the amount of protein eaten during an accidental ingestion. If this amount of tolerance is reached, then the fear of an accidental ingestion of peanut would be greatly reduced. This process is similar to nicotine patches used to eliminate the addition to nicotine and smoking.

Research is in its early stages, but it is quite promising. We are not likely to have the opportunity to treat patients with the peanut patch for years to come, but it does offer great hope for those who live in fear of a serious allergic reaction to foods.


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Beware of Poison Ivy, Poison Oak, and Poison Sumac!

Published on May 16, 2011 with 4 comments

For those who love to be outdoors in the warm spring weather, be aware that poison ivy, poison oak, and poison sumac are growing everywhere.

For those unfortunate individuals who are allergic to these plants, even the slightest contact to urushiol, the oil present on the leaves of poison ivy, poison oak, and poison sumac, will likely cause a red, raised, and extremely itchy rash called allergic contact dermatitis. Almost immediately upon contact with the skin (within 5-30 minutes), the urushiol oil penetrates the outer layer of skin. Once it has progressed to the deeper skin, the inflammatory process will begin. In most cases, the poison ivy rash (and likewise, the poison oak rash and sumac rash) usually appears 8 to 48 hours after exposure but can be delayed by up to 14 days! While still on the surface of the skin, the oil can be spread from the area of direct contact to other areas of the body. However, once the rash appears, it is not contagious to oneself or to others, even if fluid is oozing from the blisters.

The poison Ivy rash can be quite mild and localized, but severe cases can occur. The poison ivy rash will typically present as red, raised streaks on the arms or other areas of contact, and will often blister. Systemic involvement can be quite severe and result in widespread rash, eyes swollen closed, facial swelling, genital swelling, intense generalized itching, and overall discomfort.

One should learn to identify these poisonous plants of poison Ivy, poison oak, and poison sumac in order to avoid contact and prevent allergic contact dermatitis.  Poison ivy, the most common offender, grows on a vine and its leaves are usually present from May to July. Poison ivy leaves are green in the spring and reddish-orange in the fall. They are broad and spoon shaped leaves, and they cluster in groups of three. Poison ivy vines contain abundant amounts of urushiol oil and contact should be avoided, even if there are no poison ivy leaves present. The vines themselves, which can measure several inches in diameter, can be found running up pine trees and other trees and have a hairy appearance. The Urushiol oil can remain active for years so one must be careful around piles of cut wood or leaves. One must also be aware that a poison ivy rash or allergic contact dermatitis can occur after touching a dog or other pet that has been playing and running in the woods and whose hair has come in contact with the oil from poison ivy leaves.

Obviously, the best treatment for poison Ivy, poison oak, and poison sumac is to prevent exposure. When in the woods, or other areas where these poisonous plants grow, keep all skin covered. But, if contact has occurred, the skin should be washed immediately with soap or a solvent to prevent allergic contact dermatitis. A delay in washing off the oil as short as 5 or 10 minutes may be too late, as absorption into the deeper layer of skin occurs very quickly.

Regardless of whether the offending plant is poison ivy, poison oak, or poison sumac, contact dermatitis treatment is the same. Mild itching and discomfort of a poison ivy rash can be treated with cool compresses, calamine lotion, or 1% over-the-counter hydrocortisone cream or ointment. Mild cases generally run their course over several days. More severe cases, especially if there is allergic contact dermatitis with systemic involvement, may need to be treated with oral or injectable steroids. In severe cases of allergic contact dermatitis the rash may last from days to weeks.

Before heading out to the woods this spring and summer, The Online Allergist suggests that you look online for poison ivy pictures and poison oak pictures.  It would also be prudent to study poison sumac pictures, even though Poison Sumac is much less common.

The image below is one of the more illustrative poison ivy pictures.  It can help you identify what to avoid.

 

 

 

 


Studying poison oak pictures, like the one below, will help you prepare as well. 

 

 

 

 

 


The best poison ivy treatment is avoidance. So remember, “Leaves of three, let it be”.


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Cockroach allergy is a very common cause of allergy and asthma symptoms, especially in children

Published on Apr 18, 2011 with 1 comment

Cockroach allergy?  Believe it or not, allergy symptoms and asthma symptoms due to exposure to cockroaches have been recognized since the 1940s. And, scientific studies over the years have linked this allergen to the increasing frequency and severity of childhood allergies and asthma. This is a very common and significant health issues in urban, inner city environments, especially in the south where it is relatively warm and humid.

Cockroach allergy symptoms are caused from the inhalation of tiny particles produced from the feces, saliva, and body parts of cockroaches. When inhaled, the cockroach allergen sets in motion a sequence of events that result in the release of histamine and subsequent sneezing, runny nose, congestion, itchy eyes and nose, and symptoms of asthma such as coughing, wheezing, and difficulty breathing.

It is not a pleasant thought, but 78 percent to 98 percent of urban homes have cockroaches. According to the Asthma and Allergy Foundation of America, the spotting of just one cockroach in the house would make it is safe to assume that at least 800 roaches are hiding under the kitchen sink, in closets, and other dark places. And, if that is not frightening enough, each home a can have as many as 300,000 cockroaches!

Cockroach allergy is present in 23 to 60 percent of inner-city asthmatics. In one of many studies, 37 percent of inner-city children were allergic to cockroaches, 35 percent to dust mites, and 23 percent to cats. Cockroach allergen is such a potent allergen that children who live in homes with cockroaches are 3.3 times more likely to be hospitalized for asthma.
Fortunately, cockroach allergy can be easily diagnosed. It is most effectively treated by a comprehensive approach similar to other nasal allergy treatment, which would include environmental control to eliminate these pests from the house, medication to control symptoms, and desensitization to build up a tolerance to the allergen.

Not only are cockroaches ugly, filthy, and nasty, they pose a clear health danger to susceptible individuals, especially children.


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How to use an asthma inhaler correctly: It is critical to effective asthma treatment

Published on Apr 15, 2011 with 0 comment

Is your inhaler not helping your asthma symptoms?

If you are not getting the desired results from your inhaler, and are still having difficulty breathing, tightness in your chest, and other asthma symptoms even after using it, chances are it is not being used correctly and efficiently. As a matter of fact, the proper use of an inhaler could be the most important factor in the success or failure in the asthma treatment of adult and childhood asthma.

The ability to use inhaled medications for asthma control and asthma treatment is a major breakthrough. Metered dose inhalers, diskus inhalers, and twist inhalers are now the most effective delivery systems for both preventative asthma medications such as inhaled steroids and for the fast acting bronchodilators, taken for immediate relief of asthma symptoms. But, for these medications to be helpful, one has to use the inhaler correctly. If not used correctly, the medicine will not be delivered to the lower airways resulting in minimal or no improvement in asthma symptoms. Unfortunately, every allergist and asthma specialist deals with this issue every day.

Proper inhaler technique is very simple, but it does require demonstration, coaching, and constant reinforcement. It is important to note that asthma in children less than 6 years of age cannot be treated with an inhaler, as they generally cannot use an inhaler correctly.  Devices such as spacers, aero-chambers, and aero-chambers with mask are available and are widely prescribed, but they are not very efficient in delivering the appropriate dose of inhaled medication to the lower airways. Fortunately, many asthma medications can be aerosolized through a nebulizer. Since little coordination is necessary, a nebulizer is often the delivery system of choice for infants and young children.  Click here to find a recommended nebulizer.

To see proper inhaler technique, please watch the following how-to videos:

How to use an inhaler
How to use a diskus inhaler
How to use a twisthaler
How to use a Flexhaler
How to use an AeroChamber
How to use an AeroChamber with mask

Using these inhaler techniques, an asthma sufferer will be much more likely to have control of his or her asthma symptoms, and use an asthma treatment that actually works.


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Dust Mite Allergy Facts and Figures

Published on Apr 11, 2011 with 8 comments

Dust mite allergy is the most common cause of year-round allergy symptoms in both children and adults. It is estimated that as many as 1.2 billion people have a dust mite allergy. This extremely high degree of allergic sensitization results from the fact that we are all exposed to dust mites and the allergens they produce on a daily basis. Virtually all homes have dust mites, so even though you may not have pets, you have pests! And, if you live in a relatively warm and humid home environment, or in such a climate, then the following information is highly relevant to you. You could have a dust must allergy and not even know it.

If you do have a dust mite allergy (and even if you don’t) you may be interested in knowing some scary facts and figures about the mighty dust mite. For starters, it takes only about a month for a dust mite to grow from egg to adulthood, and an adult dust mite will live another one to three months. An adult female dust mite will lay up to 80 eggs. After all is said and done, with this rate of reproduction, a non-encased mattress may be the home to more than 10 million dust mites and may contain over 2 ½ billion dust mite fecal pellets, the most allergenic component of the dust mite and a main concern for some looking for allergy relief. It is staggering, but an average dust mite produces up to 200 times its body weight in highly allergenic excrement during its short lifetime. And, it is also estimated that the weight of a two year old pillow will be comprised of 90% pillow stuffing and 10% living and dead dust mites!

Dust mites thrive in warm, humid environments. The ideal surroundings for dust mites are temperatures between 65-76 F (19-30 C) and 70-80 % humidity. And, a plentiful diet for a hungry, growing dust mite is not a problem, since dust mites eat the skin scales that we humans shed every day. The average person sheds the outer layer of skin every two weeks and estimates range from 50,000 to millions of skin scales shed each day.

The Online Allergist cannot corroborate the accuracy of all of the often quoted numbers cited above, but one thing is crystal clear: Dust mites and their allergenic by-products are abundant in the home environment and consequently, dust mite allergies are a huge problem. Therefore, the individual with a dust mite allergy must do whatever he or she can to minimize exposure to dust mites and their allergens. As daunting as this task seems, there are some effective allergy control products as well as three simple suggestions which can make a big difference in reducing allergy symptoms and bring some allergy relief.

1) All mattresses and pillows in the bedroom should be covered with dust mite covers specially designed and manufactured as allergy bedding (or as an allergy pillow), creating an allergy-proof barrier between the allergic child or adult and the dust mites.

2) The humidity of the bedroom should be lowered to less than 55%. This can be accomplished with a room dehumidifier. A dehumidifier is not specifically one of the many allergy control products sold on the market,  but they can be effective in bringing allergy relief to sufferers of a dust mite allergy.  For this reason, you may notice them sold along with other allergy products. 

3)  All carpeting should be removed from the bedroom as dust mites live and thrive there as well. (A square meter of carpeting can contain over 100,000 mites.) A HEPA vacuum should then be used to keep all of the surfaces in the bedroom clean, including floors, shelves, and walls.  A HEPA vacuum will help keep allergens out of the air.   

We hope that this presentation of dust mite allergy numbers, and the accompanying suggestions for allergy relief and allergy control products will result in a better set of numbers: less runny noses, less sneezing, less itchy eyes and noses, less allergy treatments needed, fewer boxes of Kleenex purchased…the list of reduced allergy symptoms goes on and on.


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Not All Allergy Information is the Same, or Sane

Published on Apr 10, 2011 with 0 comment

Perhaps it’s because allergies are so common, but there is a lot of allergy information out there.  And not all allergy information is created equal.

Nonsense, ridiculous, rubbish, and just plain absurd are just a few of the descriptive terms that go through my mind and flow from my lips when I read about unproven allergy testing techniques or about the latest bazaar asthma and allergy treatment in many blogs and articles written by non-physicians. I ask myself: Where are they getting their asthma and allergy information and what are their sources?  According to these articles, allergy symptoms cause everything from grey hair to hemorrhoids.  And, an allergy treatment can include drinking one’s urine or the use of ozone enemas!

At best, the allergy information presented is many times comical, but, at worst, it can be dangerous. Those seeking medical information about asthma or allergy relief must be very careful. The Online Allergist strongly recommends that one consult a board certified primary care physician or an allergist for the most effective and up to date asthma and allergy information, testing, or treatments available.  This will help you to achieve your goal of finding medically sound asthma or allergy relief. 

For the basic, down to earth, nuts and bolts of allergies check out Allergies 101 - a crash course of allergy symptoms, diagnosis, and treatment.


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EpiPen and Twinject: Don’t Leave Home Without Them

Published on Mar 28, 2011 with 1 comment

It is a sad fact, but most fatal allergic reactions could be prevented by the early recognition of allergic symptoms and the rapid self administration of epinephrine, in the form of an Epipen or Twinject auto-injector.

Most life threatening reactions are caused by food allergies, medication allergies, and stinging insect allergies. Essentially any food can trigger an allergic reaction, but the most common ones that cause severe anaphylaxis are: peanuts, tree nuts (e.g., walnut, pecan, almonds, cashew, Brazil nut), shellfish, fish, milk, and eggs.

The venom of stinging insects such as yellow jackets, honeybees, wasps, hornets are common causes of anaphylaxis, as is the biting fire ant in certain geographical areas of the U.S.

Virtually any medication can trigger an allergic reaction. Common categories of drugs that cause anaphylaxis are aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS), antibiotics, and anti-seizure medicines.

Upon exposure in the allergic individual, these allergens can initiate a severe, total body allergic reaction called anaphylaxis, whose symptoms may include urticaria (hives), a generalized sensation of warmth, vomiting, abdominal cramping, difficulty breathing, and circulatory collapse resulting in a rapid decrease in blood pressure and shock. The rapid injection of an Epipen or Twinject can slow down or eliminate the allergic reaction, but it must be injected as quickly as possible. The earlier the injection in the course of a reaction, the more likely the epinephrine is to control and stop the serious effects of anaphylaxis. Approximately 20-30% of all reactions require a second or third dose of epinephrine.

For anyone who has experienced a systemic allergic reaction or who is recognized as being at high risk, it is imperative that they or their caregivers have at least two auto-injectors of epinephrine with them at all times. They should be at home, in the workplace, school, daycare, homes of relatives, or any environment where an allergic individual frequents. One should avoid exposure of these devices to extremes in temperatures, such as in automobile glove compartments, as they are temperature sensitive and can lose their potency. They also lose their potency with the passage of time and, therefore, should be constantly monitored for expiration dates.

It is also imperative that patients or caregivers understand both the indications for and the proper techniques for the administration of an Epipen or Twinject. Demonstration devices are available and health care professional should demonstrate technique when prescribing these auto-injectors. You can also watch how to use an Epipen or how to use a Twinject auto injector.

Prevention of anaphylaxis is a public health responsibility which is shared by health care providers, patients, and care-givers, especially parents of young children. Education must be made available with regard to avoiding exposure to the allergic agent, recognition of an allergic reaction, and rapid treatment including the immediate administration of the Epipen or Twinject.


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Seasonal Allergies Are Here!

Published on Mar 28, 2011 with 1 comment

Seasonal allergies are back!  With the arrival of spring, many children and adults have already had the onset of allergy symptoms due to exposure to seasonal pollens. You can spot them from across the room- tissue in hand, sneezing, sniffling, blowing their nose, tearing, and rubbing their eyes and nose. If fortunate, these allergy symptoms are but a minor inconvenience, but, if severe, they can significantly affect one’s quality of life.

Seasonal allergies, also known as seasonal allergic rhinitis, as its name implies, manifests itself during the pollen seasons, most typically in the spring and fall. Exposure to tree pollens is generally responsible for late winter and springtime symptoms, while grass pollens are generally the cause of late springtime and early summer symptoms. Flare ups in the fall are typically due to weed pollens and high mold spore exposure.  Symptoms of seasonal allergic rhinitis and allergic conjunctivitis can be quite intense and can last for weeks to months, if not treated.

Allergic rhinitis is actually one of the easiest allergy diagnoses for an allergist to make. If the medical history suggests allergic rhinitis, an allergist will likely perform allergy testing in order to confirm the diagnosis, identify the offending allergen(s), and ascertain the severity of the allergy. The preferable and simplest testing method of testing is skin testing. This method allows the testing of multiple allergens at one time with the results being available immediately. Contrary to popular belief, the most recent skin testing techniques are painless and well tolerated, even in young children. (See allergy diagnosis for more information on skin testing)

Once the relevant allergens have been identified, an allergist will recommend a comprehensive treatment plan to eliminate the existing symptoms and hopefully reduce or prevent symptoms in the future. Treatment options fall into three categories: environmental control, pharmacotherapy, and immunotherapy. One, two, or all three of these options may be recommended, depending on multiple factors such as the severity and chronicity of allergy symptoms, results of past treatment, and the effect that the symptoms have on one’s quality of life.

Theoretically, environmental control is quite simple: one needs to minimize exposure to all relevant allergens.  As simple as this is conceptually, it may be quite difficult, if not impossible, to implement in many cases. This is especially true when one is exposed to pollen, as these pollens are light and microscopic, traveling for tens to hundreds of miles in a gentle breeze. Once the pollinating season starts, it is virtually impossible to avoid exposure to airborne pollen while outdoors. If possible, one should stay indoors with air conditioning on high pollen days and the windows should remain closed. It may also be helpful to wear an allergy mask when outdoors for long periods of time.

In the arena of pharmacotherapy, there are many medicines available which are quite safe and effective in minimizing or eliminating the symptoms of seasonal allergic rhinitis. These generally fall into the categories of antihistamines, steroid nasal sprays, and other non-steroidal blockers of inflammation.

As important as environmental control and pharmacotherapy are, the third treatment option, immunotherapy or desensitization, is the only treatment option that addresses the actual cause of the immune system’s abnormal over-response.  Historically, the gold standard of treatment has been allergy injections. However, an exciting advance in the area of immunotherapy is the ability to desensitize pollen allergic individuals by using oral or sublingual immunotherapy (SLIT), as opposed to allergy injections. This procedure has been used for decades in Europe and has gained acceptance among a growing number of American board certified allergists over the last few years.

The good news for those who suffer from seasonal allergies is that help is available, and in most cases, allergy symptoms due to pollen and other inhaled allergens can be significantly diminished or eliminated, greatly improving one’s quality of life.


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Swimming Pool Allergy

Published on Mar 09, 2011 with 2 comments

imageEvery allergist has heard patients say that their allergies become worse at the swimming pool.  We usually respond that one cannot be allergic to the environs of the swimming pool, but not so fast.  Recent evidence has shown that chlorinated pool exposure interacts with one’s allergic predisposition to potentially increase the nasal congestion, runny nose and sneezing of allergic rhinitis, and the coughing and wheezing of asthma.

Swimming pools are commonly disinfected through chlorination of the water. Chlorine, when added to the water, releases hypochlorous acid, the active ingredient which oxidizes and inactivates a wide variety of waterborne pathogens. While advantageous in eliminated bacteria in the water, this chemical, especially in high concentrations, can at the same time be an irritant to the skin, eyes, nose, throat, and lungs.

It has been observed that swimmers have a higher prevalence of respiratory symptoms than other athletes. Researchers suggest that these respiratory issues may, in part, be the result of the repeated and frequent exposure to the chlorine used to disinfect the pool water. Recent studies have also documented a higher incidence of respiratory symptoms including allergic rhinitis and asthma in allergic children, suggesting an exacerbating or additive effect. So, the evidence is mounting that chlorine exposure in and around the pool can indeed make susceptible individuals more symptomatic.

Swimming is a wonderful activity, especially during these very hot summer days. TheOnlineAllergist recommends that those with allergies and asthma swim in outdoor pools and in pools where the chlorine levels are continuously monitored. Have fun, but be careful out there.


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Sesame Allergy: This seed packs a powerful punch!

Published on Mar 03, 2011 with 0 comment

imageThe sesame seed, tiny in size, represents a growing danger as a food that can cause severe allergic reactions.  Sesame is in a family of seeds that also includes poppy seed, flax seed, sunflower seed, buckwheat, mustard, and pine nut. In the entire family of seeds however, sesame causes majority of allergic reactions. And, the incidence of sesame allergy is on the rise.  This is likely due to the increase in popularity in the use of seeds, especially sesame, in the Mediterranean diet.

Sesame allergy shares many similar properties to peanuts and tree nuts in terms of its clinical allergy symptoms, severity, and persistence in symptoms.  Despite these similar characteristics, sesame is not considered one of the “big 8” food allergens, although it is now the second most common food allergen in Israel. Sesame allergy often presents by age two, but this is highly variable and is influenced by countries that feed their young a sesame rich diet.

Sesame is associated with life-threatening anaphylaxis in susceptible individuals.  Again, this is very similar to tree nut and peanut allergy, and sesame sensitive individuals are recommended to avoid any amount of contact, even one tiny seed.


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Milk and Phlegm: A Relationship?

Published on Mar 01, 2011 with 47 comments

imageThere is a wide-spread and accepted notion that there is a cause and effect relationship between the ingestion of milk and increased phlegm production.  But, the truth is that there is absolutely no scientific evidence to support such a claim.  And, there is no truth to the notion that milk makes asthma worse, unless one is truly allergic to milk protein.

Yet, despite the lack of evidence, many people claim such a relationship, especially during an upper respiratory virus or when they are having allergy symptoms.  This claim is so pervasive that many physicians recommend stopping milk during these episodes.  Even though such anecdotal evidence does not stand up to the scrutiny of scientific trials, The Online Allergist does not rule out the possibility that there is a subset of susceptible individuals who may indeed have increased mucus production when exposed to milk.  This is clearly not an allergic reaction, but other immunologic or contact responses may be operative.  There is even a recent article that suggests that some milk from certain breeds of cows contains a protein that causes the mucus glands of the gastrointestinal tract to over-react on contact.

Fact or old wives’ tale?  It is difficult to say.  Regardless, if you are one who believes that milk increases the amount or thickness of phlegm during an upper respiratory infection or allergies, there is certainly no harm in stopping milk during that episode.


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Parents: Stop poisoning your children!

Published on Feb 27, 2011 with 0 comment

imageExposure to tobacco smoke has long been known to cause illness in children.  Widespread educational programs and public awareness campaigns have identified passive exposure to second-hand cigarette smoke as a major health risk.  Yet, despite this, children unfortunately continue to be exposed in great numbers, and the greatest source of exposure is in the home.  Alarmingly, one quarter of all children in the U.S. live in a home with at least one smoker.

Exposure levels are not theoretical, as exposure and its degree can now be objectively measured. One can detect the presence of cotinine, a nicotine metabolite, in the blood, urine, saliva, and hair of those individuals exposed to passive smoke. In a recent study of children 3-10 years of age in Rochester, N.Y., mean cotinine levels were significantly higher in children whose parents smoked (2.82 ng/ml) compared with those children who live with non-smoking parents (0.72 ng/ml).  And interestingly, measured exposure to cigarette smoke was higher in children whose mother smoked, compared to other members of the family.

The medical community is very aware of the harmful effects of passive exposure to cigarette smoke. Allergists and pediatric pulmonologists can attest to the deleterious effects of exposure in young children. They clearly recognize the increased frequency and severity of respiratory illnesses. Children with asthma or reactive airways are especially susceptible. There is evidence that smoke exposure can temporarily paralyze the hair-like structures called cilia which line the respiratory tract.  Well functioning cilia are a critical defense mechanism in promoting the movement of mucous and ridding the body of foreign respiratory pathogens, allergens and irritants. Dysfunctional or paralyzed cilia can lead to respiratory infections including pneumonia, bronchitis, sinusitis, and recurrent ear infections in children.

We must all do more to discourage cigarette smoking in teenagers and adults, and we must do a better job in educating the public about this preventable health crisis. Parents must stop turning a blind eye to the fact that they are poisoning their children.


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Be careful with antihistamines!

Published on Feb 23, 2011 with 0 comment

imageFor many years, physicians have recommended first generation H1-antihistamines to patients suffering from allergic reactions and itching.  These antihistamines, long recognized for their effectiveness in treating allergies, and available over-the-counter, include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton, Piriton, Chlor-Tripolon, HISTA-12), clemastine (Allerhist-1, Contac 12-Hour Allergy, Dailyhist-1, Tavist, Vistamine), hydroxyzine (Vistaril, Atarax), or triprolidine (Actidil, Myidil, Actifed).

Despite their effectiveness, there has always been a drawback.  First generation H1-antihistamines are well known to cause drowsiness and sedation.  Studies have shown them to be associated with impaired learning, reduced work efficiency, and they have been implicated in car, boat, and aircraft accidents. They have also been responsible for deaths due to intentional as well as accidental overdosing.

A Global Allergy and Asthma European Network (GA2LEN) task force recently performed a large scale review of accidents and fatal adverse events which occurred in the United States from 1996-2008 in which these first generation H1-antihistamines were implicated. Their goal was to enhance consumer protection by highlighting the potential dangers of the indiscriminate use of first-generation H1-antihistamines purchased over-the counter in the absence of appropriate medical supervision. The task force recommended that older first-generation H1-antihistamines no longer be available over-the-counter for self-medication of allergies and other diseases.

Newer and safer antihistamines including Claritin, Clarinex, Zyrtec, and Xyzal (click for coupons) are now available at competitive prices.  These new antihistamines are just as effective in treating allergy symptoms as their predecessors, without the harmful and dangerous side effects, at least at normal dosage levels.  Some are available over-the-counter, while others are available only with a prescription.  The Online Allergist recommends that one consult their primary care physician or allergist about which antihistamine would be optimal, especially now at the onset to the spring allergy season.


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MSG: It is not an Allergy!

Published on Feb 22, 2011 with 3 comments

imageMonosodium Glutamate, or MSG, is a white crystalline powder commonly used as a food additive for its unique flavor enhancing qualities. MSG is the sodium salt of the natural occurring non-essential amino acid called glutamic acid. It is manufactured through the fermentation of starch, sugar cane, sugar beets, or molasses.

Although once associated only with Chinese food, MSG is now widely used by fast food establishments and it is present in many foods such as soup bouillon cubes, barbecue sauces, salad dressings, flavored chips, canned, frozen, and dry prepared foods, processed meats, as well as seasoning mixes. Fermented products such as soy sauce, steak sauce, and Worcestershire sauce contain high levels of glutamate similar to foods with added MSG.  It is available commercially under the trade names Accent, Ajinomoto, and Vetsin.

MSG has been reported to be responsible for a variety of symptoms including headaches, flushing, sweating, facial pressure or tightness, numbness, heart palpitations, chest pain, nausea, and weakness. These symptoms were initially characterized as the “Chinese Restaurant Syndrome”, but have subsequently been described as the “monosodium glutamate symptom complex”. Despite reports suggesting a cause and effect relationship, decades of research have failed to demonstrate a clear and consistent relationship between the ingestion of MSG and these symptoms. In addition, symptom characteristics do not support an IgE mediated or allergic mechanism. In short, we are not exactly sure how, why or when MSG may cause symptoms in certain people, and MSG is certainly not an allergy.  However, anecdotal reports continue to suggest that MSG can produce symptoms in susceptible individuals, especially headaches, muscle tightness, numbness and tingling.

Because of anecdotal reports of MSG related symptoms, the FDA requires that it be listed on processed food labels and has classified MSG as a food which is “generally recognized as safe”.

For more information about MSG, allergies to spices and other food additives, read our article Food Additives and Spice Allergy.


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Food Allergies: Prevention and Treatment - Fascinating New Research

Published on Feb 21, 2011 with 0 comment

imageAsk anyone who was raising children 25 years ago if they ever heard of food allergies. The likely answer would be no. Yet today, who doesn’t know someone, if not several people, with severe food allergies? Allergists and pediatricians are observing first hand that the incidence of food allergies in infants and children has increased to “epidemic” proportions over the last few decades. 

The good news is that we are now beginning to understand how food allergies are developed.  But more importantly, new strategies are being recommended for food allergy prevention in the newborn and infant, and in the treatment of the severely food allergic individual.

Many theories have been presented to explain this disturbing trend. However, most research in the past has focused on breast feeding and its affect on the development of allergy. A close examination of the medical literature reveals that true scientific evidence about the timing of cows’ milk and solid food introduction into a child’s diet is scarce at best, and conflicting at worst. The time-honored and well established approach has been to delay the introduction of highly allergenic foods into the infant’s diet; solid foods until six months of age, cow’s milk until one year, eggs until two years, and peanuts, tree nuts and fish until three years. It is a generally accepted notion, although not necessarily valid, that breast feeding alone is the ideal diet for the first six months of life and that it can minimize or delay the onset of atopic dermatitis (eczema) and other allergic diseases, including asthma.

But, new medical evidence has shown that the recommendations to delay the introduction of foods to infants as a means of preventing food allergies may be the wrong approach altogether!

Recent studies have revealed very credible scientific evidence to suggest that the common practice of delaying the introduction of cow’s milk, eggs, peanuts, and other foods may actually increase the child’s risk for developing food allergies. And, even more importantly, there is evidence to suggest that the early introduction of allergenic foods may actually prevent the development of the allergy to that food.

A landmark study published within the last year demonstrated that children in England were ten times more likely to be allergic to peanuts than children in Israel. One very strong hypothesis to explain this finding is the fact that most Israeli infants have been exposed to soft peanut snacks by six months of age. On the other hand, children in England are not introduced to peanuts in any form until approximately three years of age. This study is just one of many which strongly suggested that the decreased risk for the development of allergy by the early introduction of food is due to the induction of “oral tolerance”, i.e., the induction of a systemic immunologic hypo-responsiveness to a dietary protein.

Our entire approach to feeding newborns and infants may be “turned on its head” in the coming months to years. It is difficult to change one’s opinion and behavior about well accepted dogma; however, very exciting medical research may cause us to rethink the current approach which has resulted in an 18% increase in food allergies over the last 10 years.

There is also good reason to be very optimistic about the treatment of severe food allergies. Historically, the treatment of food allergies has consisted of avoiding exposure and ingestion of the allergenic food, and the immediate availability of antihistamines and epinephrine for the treatment of an allergic reaction. Avoidance of exposure is indeed difficult, as evidenced by the large number of accidental ingestions and allergic reactions with resulting emergency room visits. But even with strict avoidance measures, the potential for sudden and life-threatening reactions leads to extreme anxiety in both the allergic individual and his or her family. Fortunately, medical research has now proven that orally administered immunotherapy can result in a significant degree of desensitization, or tolerance, to a given food in most allergic patients.

Food Oral Immunotherapy is a process whereby a food allergic individual is given small amounts of the allergenic food daily and for long periods of time in order to induce a state of oral “tolerance”. It is often possible to increase the dose tolerated over time, leading to even greater protection. In the classic sense, this is not a cure. Rather, it is a method to desensitize the highly allergic individual to a given food in order to decrease, and sometimes eliminate, the likelihood of a severe allergic reaction upon ingestion. This method has been proven successful with milk, eggs, peanuts, and some tree nuts. But, do not try this at home! The desensitization process is associated with a small degree of risk and therefore should be performed only by an experienced allergist and in a controlled setting.

We are on the brink of some very exciting breakthroughs in both the prevention and treatment of food allergies. We are hopeful that one day soon, such treatment will significantly improve the quality of life for those individuals in whom avoidance of food either limits or controls their daily activities.


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Can bleach remove mold and mildew?

Published on Feb 18, 2011 with 15 comments

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There is now additional scientific evidence that the allergenic potential of environmental mold and mildew can be effectively eliminated by the use of common household bleach.

Investigators have found that the allergen epitopes (the part of the molecule that is recognized by the immune system, specifically allergy antibodies) that are present in the common outdoor and indoor mold spores Alternaria and Cladosporium are denatured when treated with sodium hypochlorite, the active ingredient in bleach. They also showed that treatment with hypochlorite was effective at concentrations commonly used for household cleaning.

Sodium hypochlorite solution is frequently used as a bleaching agent or disinfectant. Household bleach used in laundering clothes is sold as a 3-6 % solution of sodium hypochlorite. A 1 to 5 dilution of household bleach with water (1 part bleach and 4 parts water) is effective against many bacteria and some viruses, and is frequently used in hospitals as the disinfectant of choice, due to its effectiveness and relative low cost.

The Online Allergist recommends aggressive environmental control to minimize the exposure to allergenic mold spores. If mold and mildew can be seen in the home, particularly in damp, moist areas such as bathrooms, it should be treated aggressively with diluted bleach. Such treatment should also be done periodically to prevent the reemergence of the mold and mildew.


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Preventing food allergies in babies and infants: Do we have it all wrong?

Published on Feb 17, 2011 with 0 comment

imageAllergists and primary care physicians, especially pediatricians, have observed first hand that the incidence of food allergies in infants and children has increased dramatically over the last few decades to “epidemic” proportions. Many theories have been presented to explain this disturbing trend; however most research in the past has focused on breast feeding and its affect on the development of allergy. A close examination of the medical literature reveals that true scientific evidence about the timing of solid food introduction is scarce at best, and conflicting at worst. The time-honored and well established approach has been to delay the introduction of highly allergenic foods into the infant’s diet; solid foods until six months of age, milk until 12 months, eggs until 2 years, and peanuts, tree nuts and fish until 3 years. It is a generally accepted notion, although not necessarily valid, that breast feeding alone is the ideal diet for the first six months of life and that it can minimize or delay the onset of atopic dermatitis (eczema) and other allergic diseases, including asthma.

But, new medical evidence has shown that the recommendations to delay the introduction of foods to infants as a means of preventing food allergies may the wrong approach altogether!

Recent studies have revealed very credible scientific evidence (and more is on the way) to suggest that the common practice of delaying the introduction of cow’s milk, eggs, peanuts, and other foods may actually increase the child’s risk for developing food allergies. And, even more importantly, there is evidence to suggest that the early introduction of allergenic foods may actually prevent the development of the allergy to that food. It is thought that the decreased risk for the development of allergy by the early introduction of food is due to the induction of “oral tolerance”, i.e., the induction of a systemic immunologic hypo-responsiveness to a dietary protein.

Our entire approach to feeding newborns and infants may be “turned on its head” in the coming months to years. It is difficult to change one’s opinion and behavior about well accepted dogma; however, very exciting medical research may cause us to rethink the current approach which has resulted in an 18% increase in food allergies over the last 10 years.

In the opinion of TheOnlineAllergist, we are on the brink of some very exciting breakthroughs in both the prevention and treatment of food allergies. Stay tuned for more encouraging news soon.


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Health food junkie?  Watch out for lupine allergy

Published on Feb 15, 2011 with 0 comment

imageLupines, or lupins, are common garden plants found commonly in South America, western North America, in the Mediterranean area, and in Africa. The seeds produced on the lupine plant are members of the legume family and therefore related to peanuts, soy, and peas.

In the last few years, lupine ingestion has been recognized as a cause of allergic reactions, including anaphylaxis. In the occupational setting, inhalation of lupine flour may also produce rhinitis and asthma symptoms. Cross-reactivity between foods in the legume family is rare, but several studies have demonstrated significant cross-reactivity between peanut and lupine.

Lupinus albus is the species most widely cultivated for food. In some Mediterranean countries, dried lupine is a traditional snack. In Europe, lupine is manufactured as a flour and bran, or is used as an additive to wheat flour. It is commonly used in the preparation breads, pasta, and other bakery products. Lupine is also used as an alternative to soy flour. It is said to boost protein and fiber in food. Lupine can be found in health food stores.

Although not a frequent cause of severe allergic reactions in the U.S., lupine does have the potential for mild or severe allergic reactions in susceptible individuals.


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Help Prevent Allergy Attacks Using Your Iphone

Published on Feb 14, 2011 with 1 comment

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With all of the technology at the grasp of your hands today, why not use it to help prevent allergic reactions?  Our friends over at the Pollen Blog have done just that.

The name of the Iphone App. is “Allergy Alert” by SDI Health LLC, and it’s a 4-in-one tool for those who suffer from Allergies.  Using you zip code information, this App. can be used to set up alerts, pull forecast information (pertaining to allergies, asthma, coughing, and ultraviolet rays), and give you allergy index levels.  Best of all it’s free!

To download this Iphone App. for free, either search for “Allergy Alert” on Itunes, or in the App. store on your Iphone.


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Are you allergic to your cell phone?

Published on Feb 10, 2011 with 47 comments

There have been a “rash” of reports linking allergic contact dermatitis to the use of cell phones, especially among teenagers.

Allergy to the nickel alloy found in most metals is the most common cause of contact allergy. Nickel allergy has been estimated to occur in 18.8% of all individuals, and 17-33% in the pediatric population. Nickel alloy can be found many metal objects in which we come in contact with on a daily basis, including metal jewelry, zippers, belt buckles, musical instruments and, yes,  cell phones. Cell phones with fashionable designs are commonly manufactured with metallic accents containing nickel.

Contact of the metal to the skin can cause allergic sensitization and the development of a rash which is typically red and very itchy. The resultant facial or auricular dermatitis most commonly presents on one side of the face, typically on the cheek or ear. Treatment includes covering the cell phone to prevent direct content of the metal to the skin and the use of hydrocortisone cream.


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Dust Mites for Breakfast?

Published on Feb 08, 2011 with 0 comment

Dust mites are one of the most common allergens known to be responsible for upper and lower respiratory symptoms such as nasal congestion,  runny nose, sneezing, coughing, and wheezing.  House dust mites are found in highest concentrations in our bedding (mattresses and pillows) and carpets, and allergists are constantly working with patients on ways to minimize or avoid exposure to this very problematic allergen.

But interestingly, over the past few years, house dust mites and their cousin, the storage mite, have been recognized to be the cause of severe allergic reactions when eaten in foods contaminated with high concentrations of mites.  Dust mites have been found to contaminate pancake and flour mixes and when ingested, can cause severe allergic reactions, including anaphylaxis,  in sensitized individuals.  This has most commonly been reported with pancake mixes but has also been seen with cake mixes, and in beignet mixes from New Orleans. This allergy to ingested mites has been appropriately named Oral Mite Anaphylaxis or “Pancake Syndrome”.

Interestingly, cooking these foods at high temperatures did not get rid of the allergen. This is not surprising as mite allergen tends to be quite heat resistant. To eliminate mite allergen from your bedding you must wash the sheets in 120 degree water!

The risk of finding mites in flour increases in tropical and humid climates.  To decrease the chances of having mites contaminate foods, it is recommended that flour be stored in an airtight containers in the refrigerator or freezer.
 


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Foods can make you sick!

Published on Feb 04, 2011 with 1 comment

Even though food allergies seem to be constantly in the news, there are actually more common and preventable food related illnesses. These illnesses are caused by eating unwashed and/or poorly cooked common foods contaminated with dangerous bacteria and other pathogens. According to a recently released study from The Center for Science in the Public Interest, “millions of consumers are being made ill, hundreds of thousands hospitalized and thousands are dying each year from preventable foodborne illnesses.” The top ten riskiest foods in terms of outbreaks were identified as leafy greens, eggs, tuna, oysters, potatoes, cheese, ice cream, tomatoes, sprouts and berries.

The top cause of illness in leafy greens such as lettuce are pathogens like E. coli, Norovirus and Salmonella. Salmonella was also a chief culprit in egg, cheese and tomato-related illnesses, the study said, in cases when eggs are undercooked and when cheese is not processed properly. The study also associated Salmonella and E. coli with potatoes. Proper washing and cooking are essential in reducing the risks of eating contaminated foods, in many cases.

The top 10 affected foods resulted in more than 1,500 outbreaks, totaling nearly 50,000 reported illnesses, according to the center, which added that most food-related illnesses don’t get treated or reported, so the real total is likely much larger.


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The Flu Vaccine and Egg Allergy

Published on Feb 02, 2011 with 2 comments

Egg allergy is one of the most common food allergies in children, affecting an estimated 1.5% of the pediatric population.  A diagnosis of egg allergy is based on a combination of clinical history and a positive allergy test .  It is important to know that egg allergens do not cross-react with chicken allergens, and therefore chicken does not need to be avoided if one is allergic to eggs.

If you or your child is allergic to eggs, you have probably wondered which vaccines contain egg protein. 

Injectable influenza vaccines are grown in chicken egg cultures and do contain measurable quantities of egg protein.  The intranasal influenza vaccine, FluMist, also contains egg protein and is currently not recommended in patients with severe egg allergy.

A common misconception is that the measles, mumps and rubella (MMR) vaccine should be avoided in those who are egg allergic.  However, doctors now know it is safe for patients with egg allergy to receive the MMR vaccine without any prior testing.  This is because the measles and mumps vaccines are not grown in egg cultures, but in chick embryo fibroblast cultures which contain negligible or no egg protein.

It is important to know that, in most cases, egg-allergic patients can safely receive the injectable influenza vaccine. Allergy skin testing to egg and the flu vaccine by a board certified allergist should be performed if one is highly allergic to eggs, and especially if one has had a previous anaphylactic reaction upon ingestion of eggs. Based on these results, the vaccine may be administered by a graded-dose or split-dose protocol.

Allergists specialize in making sure the influenza vaccine may be administered safely to both children and adults with egg allergy.  Receiving the flu vaccine decreases your or your child’s risk of serious illness or hospitalization due to influenza, allowing you to remain healthy and active. 


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Alternative to Allergy Shots for Some Patients

Published on Jan 26, 2011 with 37 comments

Sublingual immunotherapy (SLIT), or allergy drops under the tongue,  may now be an alternative to allergy shots for some patients.This form of desensitization has been used successfully in Europe for decades and has proven to be safe and effective. Pending FDA approval, this form of treatment is considered “off label”, but ongoing clinical trials in the U.S. will likely remove the off-label indication. SLIT could become the immunotherapy of choice for many allergists and patients in the next few years as the results of the clinical trials become available.


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10 Helpful Hints For Coping With Food Allergies

Published on Jan 21, 2011 with 0 comment

Living with food allergies is a challenging reality for many individuals.  However, do not despair! As you navigate the sometimes stormy waters of food allergies, it is important to know that you are not alone.  And, more importantly, food allergies are manageable. Knowing this, the following are some tips and recommendations that will help you meet the challenges of living healthily with food allergies.

1)  You are not alone.

Although having a food allergy can be a challenge, it should not be perceived as a stigma. While only 4-8% of the population have proven food allergies, up to 25% of the population perceive that they are allergic to at least one food item.  As a result, it is likely that you already know someone who is dealing with similar issues and challenges.

Recommendations: Visit other websites of organizations that offer a wide variety of food allergy resources. Start with the following: The Food Allergy & Anaphylaxis Network, The Food Allergy Initiative, Kids With Food Allergies, Anaphylaxis Canada, and The Allergy & Asthma Network Mothers of Asthmatics.

Additionally, there may be food allergy support groups in your neighborhood or city. There are also support groups that can be found on the internet where you can discuss your food allergy with others who face similar challenges. Such online support groups can be found through internet providers such as Yahoo, AOL, and Google.

2)  Avoidance is the only treatment.

Simply put, if you do not eat or come into contact with the particular food(s) to which you are allergic, you will not have a reaction.

While it is possible that many individuals will “outgrow” their food allergy, it is very dangerous to experiment in order to see if one can eat a food to which they previously reacted.  Remember, in some circumstances, even the smallest amount of exposure can lead to a serious, life-threatening reaction. Your allergy specialist is the only person who should determine when it is safe to introduce such items in to one’s diet, and food challenges should only be done under the supervision of your allergist.

Recommendation: Never dabble or cheat with a food that your physician recommended that you avoid. Additionally, an individual should never try to “detoxify” , “desensitize”, or challenge oneself.

3)  Do not assume that a food item is safe.

Always check all ingredients to verify that a food product does not contain your particular allergen. In fact, one should approach all food items with some suspicion that there could be a hidden ingredient.  In particular,  be especially suspicious of pastries, sauces. Such foods commonly have multiple ingredients and the ingredients can change during the cooking, preparation, or manufacturing process. Additionally, it is important to remember that one can never assume that a restaurant or food service establishment properly labeled the ingredients on their menu.

Recommendation:  When possible, always ask how an item is prepared, and try to ascertain if there has been any contact with other items that may cause cross-contamination.  Be proactive when dining at a restaurant or food establishment by bringing cards that clearly list your particular food allergen and ask the wait staff to clarify the ingredients of each dish.  If you are served an item that you suspect contains your food allergen, do not eat it. If you cannot confirm that the food item is safe to eat, it is best to avoid eating it altogether.

4) Read Labels Carefully.

Starting in 2006, the Federal Government mandated that all packaged goods containing milk, egg, wheat, soy, fish, shellfish, peanut or tree nut be labeled in plain English in order to alert potentially allergic consumers of their contents.

Recommendation: Make sure you read the labels of all packaged goods, even those very familiar to you, because manufacturers do change ingredients from time to time. Despite the 2006 labeling laws, it is still important to learn about the alternative ways that the food industry labels food products. This is a potentially life-saving skill to have. The Food Allergy & Anaphylaxis Network’s website provides a quick tutorial on the details of food labeling (Click here to download the PDF).

5) Always carry with you your emergency medications, especially self-injectable epinephrine (EpiPen or Twinject).

It is surprising that in nearly every study of known food allergic individuals, many allergic individuals simply do not comply with the recommendation to have epinephrine with them at all times.  Epinephrine is a drug that can rapidly reverse skin, cardiac, respiratory and gastrointestinal symptoms in an acute allergic reaction. As a result, Epinephrine is potentially lifesaving.  In fact, in studies of food allergy related fatalities, lack of available epinephrine was almost always associated with the fatality.  Moreover, lack of receiving any emergency medication has been associated with an increased severity of reaction.

Recommendation: Always have emergency medication, especially epinephrine, available in the event of a reaction.

6) Learn to use your Epinephrine device, use the device promptly after a reaction occurs, and teach others to use it.

Quite surprisingly, it is not uncommon for individuals to be given these devices without a demonstration of how to use them. It is important not only that the food allergic individual know how to use the device, but that the people who are in close daily contact with the food allergic individual be trained and comfortable with the use of the device as well.  This includes teachers, school administration, co-workers, and family members.

Knowing how to use the device, however, does not guarantee that the device is used in appropriate situations.  Unfortunately, there is much data that suggests that even when an auto-injecting epinephrine device is available, it is under-utilized.  Delay in receiving epinephrine has been shown to increase the potential for a life-threatening reaction, and has been associated with food allergy related fatalities.  Parents or other care providers of food allergic children should not be afraid of using the epinephrine device out of fear of having to give their child an injection. The risk of not administering epinephrine is much greater than the risk of giving it unnecessarily.

Recommendation: First, make sure you and those who are in close daily contact with the food allergic individual know how to use the Epinephrine device. Click on this link  to view a video demonstration of how to use both devices sold in the US, EpiPen and Twinject. Additionally, both companies provide free how-to-use DVD’s which are available from both the company and your allergist. Trainer devices, available from your allergy provider or in twin-pack devices of EpiPen and Twinject, closely mimic the actual devices and are a wonderful tool to practice with.

Finally, written “Food Allergy Action Plans” are highly recommended for school aged children, including those in child care, to clearly detail how a particular reaction should be treated. Such plans should be kept on file with the child’s particular institution as they will help ensure that your child receives proper treatment in the event of a reaction. Please remember, there is never a wrong time to use one’s epinephrine device to treat an allergic reaction, but there are, however, times when it is wrong to avoid using it.

7)  Be wary of cross-contamination.

Allergen-free food can be very easily contaminated accidentally. Utensils, pots, and pans that were used to prepared allergenic foods need to be thoroughly cleaned. In addition, preparation surfaces, such as tables and chairs, must be cleaned thoroughly with hot, soapy water after use.  Foods can spill, splatter, or rub against one another as an additional means of accidental contamination.

Recommendation: Call restaurants in advance to determine if one’s food allergy needs can be met.  Request that appropriate cleaning procedures be taken, and, if possible, attempt to arrange for the meal to be prepared with cooking items and surfaces that have not come into contact with the particular allergen.  If these requests cannot be met, it would be advisable not to risk potential exposure and to eat at an establishment that can provide such requests.  Bring clearly written instruction cards detailing one’s food allergies and the special preparation instructions required to help avoid potential inadvertent or unintentional contamination. A sample card is available at The Food Allergy & Anaphylaxis Network (Click here to begin PDF download).

8)  Learn to recognize and take appropriate precautions in situations that are likely to increase one’s risk for potential exposure.

Because it can be difficult to ascertain whether food being served in certain situations contains any allergens, a food allergic individual must take extra care at events such as birthday parties, company events, or even while attending a ballgame at a stadium. Bakeries, ethnic restaurants, and snack bars may be sources of potential exposure and cross-contamination.  Attending such locations can be dangerous because exposure is possible though direct ingestion, skin contact of a contaminated surface, and even through inhalation of allergen particles.

Recommendation: Whatever the situation, it is important to have a plan in place to avoid a potential reaction. Prior to eating anything, make an attempt to verify the ingredients and the potential for cross contamination in the food preparation.  If this cannot be done, avoid eating the food altogether, or avoid eating at the particular location if special requests cannot be met. Additionally, it is advisable to wash your hands several times a day to limit the potential for contact exposure. Be extra cautious when ordering food in situations where there is a language barrier between oneself and the person taking the order, or ordering from a menu not written in one’s primary language. Use of written cards again is highly advisable.

9) Never share food and encourage others to wash their hands after food contact.

Sharing of food is a very easy way to increase the likelihood of an accidental reaction, especially in younger food allergic individuals who may not be capable of distinguishing safe from non-safe foods.  Additionally, the person sharing the food may not have gone to the necessary lengths to ensure the food has not been contaminated.

Recommendation: Make sure everyone washes their hands after food contact as this is important to cut down on potential routes of cross-contamination.  This critical measure is also particularly recommended to be implemented in classrooms of food allergic children, especially those in schools where there is presence of the particular allergen in the classroom/eating area or where children with food allergies are not afforded a designated “safe” eating area.

10)  Feel empowered and be proactive—be your own advocate!

Having a food allergy may require a little more diligence in terms of awareness and recognition of certain situations, but it is entirely manageable and reactions are preventable.  At present, awareness of food allergy in the general community is increasing, but there is still much work to do.

Recommendation: Join a food allergy advocacy organization such as the The Food Allergy & Anaphylaxis Network, The Food Allergy Initiative, Kids With Food Allergies or other similar groups.  Contact your allergy provider for other recommendations.  Help bring food allergy awareness to the community by talking to local officials about how they can help advocate for healthy, safe eating.  Teach others how to maintain a safe environment for you or your child.  Our goal is for you to feel safe and be safe, both inside and outside the home.


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5 Ways to Save on Allergy and Asthma Medication

Published on Jan 19, 2011 with 0 comment

Treating your allergies or asthma properly can be expensive.  Statistics from the American Academy of Allergy have estimated the cost of treating allergic rhinitis (seasonal allergies or hayfever) and asthma is on the order of many billions of dollars per year in the U.S.  The costs that patients face are both direct (medications, doctor visits, hospital stays etc) and indirect (missed work or school, decreased productivity on the job etc).

Both add up rapidly to become a big part of health care costs for patients and insurance companies.  The following are suggestions for patients who are interested in saving money on their prescription medications.  Working with your doctor is the best way to find ways to control spiraling prescription medication costs.

1.  Take the medications as directed by your doctor.

This may seem obvious, but it is probably the best long term way to save money.  Many medications such as nasal steroid sprays (Flonase, Nasonex, Veramyst, Rhinocort AQ, Nasacort AQ) and inhaled steroids (Flovent, Asmanex, Qvar, Azmacort, Advair, Symbicort) and Leukotriene blockers (Singulair or Accolate) work best as “Controller Medications”. 

Controller means that taking the medicine daily prevents symptoms and illness. If you can prevent allergy symptoms, or a flare of asthma, you save health care dollars and money out of your pocket by not needing additional medications such as antibiotics, or incurring co-pays for sick visits.  You and your kids will also miss less work and school, which makes you more productive in the long run.

2.  Check with your insurance plan to see if ordering medication in bulk will be cheaper.

Many insurance plans come with pharmacy benefits that offer discounts if you order ninety day supplies of medications.  Since many allergy and asthma medications need to be taken on a preventative basis (“controller”), having several months supply of medication on hand makes sense, may allow for discounts, and will save you several trips to the pharmacy.

3.  Research which medications are covered best by your insurance plan.

Physicians have a difficult time keeping up with which medications are covered best by your insurance plan.  Do your homework to see if your insurance plan has a list of medications, or formulary, which outlines which medications they cover at lower, or generic, co-pays and discuss this with your physician during a visit.  Often times, physicians are happy to switch a patient to a medication that is covered well by their plan as long as it is safe and provides equal benefits.

4.  Don’t just ask for samples. Ask your doctor if his office has any coupons for you medications.

There is a trend now for pharmaceutical companies to provide fewer samples and more coupons or discount cards for their medications.  Often these coupons will lower or totally eliminate the entire co-pay.  Many coupon offers provide you a month’s free supply of medications and enroll you in future discount programs.

5.  Research on the internet discount offers for medications.

TheOnlineAllergist.com compiles many allergy and asthma medication coupon offers to help patients.  You can also Google coupons or discount offers for your allergy or asthma medications.  Another good resource is the website of the pharmaceutical company that makes your medication.  Often these coupons are not quite as good as what you can find at your doctor’s office, but they can save you a great deal of money and are easy to use.


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Inhaler Technique is Critical

Published on Jan 16, 2011 with 0 comment

Most asthma patients are not using their inhalers and/or spacers correctly, and, therefore, are not getting the maximum benefit from these devices. All physicians caring for asthma patients will attest to the fact that even after demonstrating the proper technique for using a metered dose inhaler or spacer, “show and tell” on subsequent office visits proves that excellent technique is rarely observed, especially in children.

A recent study revealed that only 50% of those using an inhaler alone had good technique and only 29% of those using an inhaler with a spacer were using it adequately. For both groups and devices, breathing out before inhalation and breath holding was problematic. This study reinforces the need to demonstrate and observe the correct use of inhalation devices at each clinic visit.

Excellent technique is critical to good asthma control. Consult the “How to videos” page on this website for step by step instructions for inhalers, spacers, and other devices.


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Beware of Peanut Allergies in Infants and Toddlers

Published on Jan 14, 2011 with 41 comments

Most allergists practicing for more than a decade have observed that the age of presentation of peanut allergy in infants is getting earlier and earlier. A recent article published in Pediatrics has proven that this is the case.

In 1995, the median ages of first peanut reaction was 24 months. Of those infants born after July, 2000 presenting to a major university allergy department, the median age of first peanut reaction was 14 months! The decline in the age of first peanut reaction seems to be attributable to earlier exposure. It is interesting to note that this study found that most patients (68%) who were peanut allergic demonstrated sensitization or clinical allergy to other foods (53% to eggs, 26% to cow’s milk, 20% to tree nuts, 11% to fish, 9% to shellfish, 7% to soy, 6% to wheat, and 6% to sesame seeds).

Peanut allergy represents one of the most potentially serious allergies in childhood. Do not introduce peanuts prior to three years of age. And, consult an allergist if you suspect a peanut allergy in your child.
Source:  PEDIATRICS Vol. 120 No. 6 December 2007, pp. 1304-1310(doi:10.1542/peds.2007-0350)


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Are Creams and Moisturizers Containing Oats Safe For Children With Atopic Dermatitis?

Published on Jan 11, 2011 with 0 comment

It is interesting to note that some cream emollients and moisturizers that contain oats may actually be doing more harm than good in patients with atopic dermatitis (eczema). A recent study from France found an alarming rate of sensitization to oat protein among children using oat containing topical products. Sensitization rates were particularly high in children two years old and younger.

Oatmeal baths and oat creams have a reputation for soothing the angry, inflamed skin of those with atopic dermatitis or eczema. The evidence presented in this study raises questions about this claim, and caution is therefore warranted when using these products, especially if used regularly.


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One EpiPen May Not Be Enough.  Be Prepared.

Published on Jan 09, 2011 with 1 comment

A recent study assessing emergency room records confirms the fact that a significant number of patients with anaphylactic reactions to food needed more than one injection of epinephrine. The data from this study revealed that 16% of patients presenting with food induced anaphylaxis required two injections. Previous data showed that as many as 25% of reactions required multiple doses. Multiple doses of epinephrine appeared to be more likely in those with reactions to peanuts and tree nuts and those presenting with hypotension.

The message is clear: Those with a history of anaphylaxis and those highly allergic to foods, medicines, or insect stings should be prepared to treat anaphylaxis with multiple injections of epinephrine until medical assistance arrives. One may not be enough!


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There is no Relationship Between Seafood Allergy and Radiocontrast Media

Published on Jan 05, 2011 with 4 comments

How often do allergists hear: “I am allergic to fish and therefore I am allergic to the iodine in radiocontrast dye”?

The long-standing misconception that there is a higher incidence of allergic reactions to radiocontrast media (IVP dye) in those with seafood allergy is alive and well. And, this misunderstanding is pervasive among both physicians and patients.

In a survey of 231 faculty radiologist and interventional cardiologists at 6 midwest academic medical centers, sixty-nine percent of responders indicated that they inquire about a history of seafood allergy before radiocontrast media administration. Some 37.2% of responders replied that they would withhold radiocontrast media or recommend premedication on the basis of a history of seafood allergy.

Medical research has proven time and time again that there is no cross-reactivity between these substances. Physician education with respect to seafood allergy and radiocontrast media administration is vital to halting the persistence of this misconception.

Source:  The American Journal of Medicine
Volume 121, Issue 2, February 2008, Pages 158.e1-158.e4


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New Breakthrough for Severe Asthma: But, Don’t Get Too Excited

Published on Jan 03, 2011 with 0 comment

imageThe FDA has approved the first medical device that uses radio-frequency energy for the treatment of severe persistent asthma in 18-year-olds and older.

All patients with severe persistent asthma share one thing:  the common finding of inflammation and swelling of the lining of the bronchial tubes. The subsequent reduction in the diameter of the breathing tubes leads to difficulty breathing and shortness of breath that is experienced with asthma.

This new device, called the Alair Bronchial Thermoplasty System, treats asthma symptoms by using radio-frequency energy to heat the lung tissue in a controlled manner.This attempts to reduce the thickness of the airway mucosa and the surrounding smooth muscle. To benefit from this treatment, patients require multiple sessions targeting different areas in the lungs. The device is composed of a catheter with an electrode tip that delivers a controlled amount of radiofrequency energy, directly to the airways. A controller unit, operated by the physician, generates and controls the energy.

The FDA based its approval on data from a clinical trial of 297 patients with severe and persistent asthma. The trial showed a reduction of severe asthma attacks in those treated with the device. The FDA is requiring a five-year post-approval study of the device to study its long-term safety and effectiveness.

It should be noted that this procedure, like all medical procedures, is not without risks. And, it will not be appropriate therapy for all severe asthmatics. This is a very exciting breakthrough in the treatment of refractory and severe asthma, but much more study and research is needed before allergists and pulmonologists will be referring their patients for this procedure.


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Thanksgiving - The “Perfect (Asthma) Storm” is here!

Published on Nov 18, 2010 with 0 comment

Ask any allergist or pediatrician.  Or, hang around the emergency room of any pediatric hospital. From Halloween until Thanksgiving, you can bet that many asthmatics, especially children, will begin to exhibit asthma symptoms or will become more symptomatic. And, many young people who have never been diagnosed with asthma will begin to cough, wheeze, or develop difficulty breathing for the first time during this time of year.

The autumn season constitutes the “perfect storm” for asthmatic individuals. Both allergenic and non-allergenic factors converge this time of year to tickle the airway. As far as allergies are concerned, fall is the time for ragweed and other weed pollens, and in some parts of the country, mold spores are abundant. A seasonal activity which is classic for eliciting asthmatic symptoms is the hay ride. Hay, itself a grass and highly allergenic, is often loaded with mold and mildew. For some children, the final destination for this exciting adventure is a visit to the doctor or the emergency room that night or the next day.

Potent non-allergic triggers also contribute to asthma flare ups in the fall. The cool, moist air can excite an already sensitive airway.  Another potential trigger is vigorous physical activity. What child does not want to spend time outdoors riding bikes or playing football during the glorious days of autumn? And, don’t forget respiratory viruses which abound this time of year. Colds and flu are among the most common triggers for asthma symptoms in children.

Being aware of asthma exposure risks this time of year may result in one’s pediatrician or allergist prescribing preventative asthma medication during, and preferably, prior to the arrival of fall. These medications are highly effective, but they must be taken daily throughout the season. All in all, seasonal asthma can be prevented in most cases and even children with known asthma can enjoy a symptom-free fall holiday season.


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Volcanic Ash and Asthma - 10 Steps To Protect Yourself

Published on May 10, 2010 with 3 comments

It is hard to believe, but the Eyjafjallajokull Volcano in Iceland is still erupting. Tons and tons of volcanic ash are being released daily into the atmosphere and it is being carried by the wind across the Atlantic, threatening not only air travel for Europeans, but posing potential health hazard for those with respiratory diseases including asthma, emphysema or bronchitis.

Even though the majority of ash is at least 10,000 feet high in the atmosphere, significant quantities of ash and dust eventually falls to earth. This volcanic ash is composed of fine particles of fragmented volcanic rock. According to the World Health Organization (WHO), it is the ‘fine particulate matter’ measuring less than 10 microns that has the potential to create respiratory symptoms. The WHO estimates that about 25% of the particles are less than 10 microns in size, which would mean that people with asthma, emphysema or bronchitis may be susceptible to irritation if and when these minute ash particles are inhaled.

The WHO says in a statement that the plume itself does not pose a health threat as long as the ash particles remain in the upper atmosphere. “However, when it reaches ground level, and if it is in high concentration, the ash may cause health effects - but these are likely to be minimal.” it adds.

Respiratory symptoms from the inhalation of volcanic ash depend on a number of factors. These include airborne concentration of total suspended particles, proportion of small, breathable particles in the ash, frequency and duration of exposure, presence of free crystalline silica and volcanic gases or aerosols mixed with the ash, meteorological conditions, preexisting health conditions, and the use of respiratory protective equipment.

Acute respiratory symptoms upon inhalation of volcanic ash may include:

  -  nasal irritation and discharge

  -  throat irritation and sore throat

  -  dry coughing

  -  bronchitis symptoms, including cough, increased sputum production, wheezing, or shortness of breath

  -  airway irritation of people with asthma or bronchitis with subsequent shortness of breath, wheezing, and coughing

  -  difficulty breathing

These short-term effects are not considered harmful for people without existing respiratory conditions, however these symptoms can be quite severe in those with asthma, chronic bronchitis, emphysema, or other preexisting lung conditions.

The American Lung Association has published the following guidelines for those potentially exposed to volcanic ash or dust:

  1.  Stay indoors.

  2.  Do not smoke and avoid secondhand smoke.

  3.  Drink plenty of fluids to loosen mucus and help you cough.

  4.  Refrain from all outdoor exercise if particle pollution is visible. Reduce or eliminate indoor activity.

  5.  Use a High Efficiency Particle (HEPA) filter in your forced air furnace. Using a HEPA air purifier may also prove beneficial.

  6.  If you take medications, put them in a convenient place. It is important to continue taking your medicines. Medications you need for an acute episode should be readily available. If you do not have any medications, but feel that you might need them, call your physician. Make sure you have clear instructions from your physician as to what to do if your lung condition suddenly worsens.

  7.  Assume that your lung condition may deteriorate and contact your physician as soon as any problem develops. Do not allow a respiratory condition to linger, especially if there is a high concentration of ash particles.

  8.  Utilize air quality monitoring systems to determine the safety of the air quality in your area each day.

  9.  A paper, gauze surgical, or non-toxic dust mask may be helpful. Moistening the mask with a solution of baking soda and water may improve the filtration of irritating particles. ***If you find it difficult to breathe with the mask on, remove it immediately. A dust mask with an N-95 rating is most highly recommended for ash protection. If you don’t have a mask available, use a damp handkerchief.

  10.  Close doors, windows and dampers. Place damp towels at door thresholds and other draft sources; tape drafty windows.

While these suggestions are intended especially for persons suffering from respiratory conditions (asthma, emphysema, bronchitis), they are also useful for normally healthy people during episodes of volcanic haze.


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Swine Flu (H1N1) Vaccine and Egg Allergy

Published on Jul 15, 2009 with 2 comments

It appears that the Swine Flu (H1N1) vaccine will be made by some manufacturers using a cell-based system which would be safe for egg allergic individuals. However, indications are that some will be manufactured in egg cultures. Therefore, if one is not certain as to the manufacturing process,  it is strongly recommended that they be allergy tested to the vaccine by a board certified allergist prior to its administration.


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