The Allergy Clock is Ticking: Spring Ahead, Don’t Fall Behind in Treatment

Spring usually brings beautiful weather — and lots of allergies.

It’s been a brutal winter throughout most of the country. Once we get even a few consecutive days with weather in the 60’s and sunshine, everyone will rush outside for extra-long lunch breaks. My New York City office is right around the corner from Central Park, which is flooded with fresh-air-seekers of all ages as soon as spring emerges. For individuals who suffer with allergies, excitement for Spring is tempered with the weary anticipation of inevitable symptoms. However, with the right strategy and treatment all of your patients can be enjoying the blossoming of flowers and the sweet smell of Spring.

The first step in helping your Spring allergy patients is identifying them! The best strategy is identifying them before the pollen starts to skyrocket. How can you do this? Run a report of your billing codes for April, May, and June, filtering for the diagnosis of sinusitis, asthma, otitis, dermatitis, bronchitis, conjunctivitis, and, yes, allergic rhinitis. This list will provide you with a valuable group of patients who notoriously wait until their allergy symptoms are severe to seek treatment from your office. Remember, most allergy medications are over-the-counter and patients are taught by their pharmacies and big pharma marketing to take treatment into their own hands. The problem is, most of these medications are not nearly effective enough to provide true relief when the pollen counts are high and patients’ symptoms are at their worst. My recommendation is that you contact these patients – as you would your flu patients before the season – and inspire them to come and get evaluated for a pre-treatment program before it’s too late.

The typical early Spring pollen culprits are the trees. The initial pollen in March comes from the Maple and Elm trees, soon followed in April by Birch and Oak. (The AllerVision Facebook page has featured a full-scale “Field Guide” of allergenic trees. Check it out at facebook.com/allervisionllc.) If your patients suffer with Spring allergies, they need to know these pollens can start early in the season if the weather warms up. The AllerVision screening and skin testing program will help uncover the connection between pollens symptoms, and encourage your patients to prepare.  The worst parts of this allergy season are typically the beginning of Spring and the time between Mother’s Day and Memorial Day. Why does it worsen in the later period? This is usually double-whammy time: tree pollens still float around as grass pollen starts its surge. Again, using the allergy skin test, the gold standard, enables you to set out a plan for your patient to beat the perceived enemy at it’s own game.

Once you identify your tree and grass pollen patients, it’s time to take action; get them started on Nasalcrom immediately. It’s an effective, safe, cromolyn sodium nasal spray designed to stabilize mast cells. The caveat is that it works best if started a few weeks before the pollen counts are high. The other great option, that is now over-the-counter but it is rarely recommended by doctors, is Nasacort.

Of course, there is only ONE disease-modifying treatment for allergic disease: immunotherapy. Your allergy sufferers deserve the option of definitive resolution. And they especially love the fact that immunotherapy, unlike the other options, is not a drug. Your patients will appreciate the natural option that fixes the problem with almost no side effects — who wouldn’t?! Allergy drops or shots are the solution to Spring and your patients’ ticket to the great outdoors!

The clock is ticking: Find those patients before they find your office in a miserable state yet again!

– Dr. Dean Mitchell

Peanut Allergy Treatment: Close to Reality!

Allergy treatment has crossed another major barrier as reported in the January/February edition of The Journal of Allergy and Clinical Immunology: In Practice. The lead authors in this multi-center research led by Drs. Wasserman, Factor and Baker demonstrated that IgE mediated peanut allergy can be effectively treated with oral immunotherapy!

This study was designed to administer small doses of peanut flour to peanut-allergic children and young adults, followed by incrementally increasing the doses up to the equivalent of eating eight peanuts. At conclusion, 91% of the study patients were able to tolerate 800mg of peanut protein daily. This is quite an achievement!

While studies have been published regarding a number of different foods, peanut has been the main target as it’s the most frequent cause of allergy-related fatalities. Until now, most researchers were understandably afraid to conduct trials on peanut-allergic children because of the risk of an anaphylactic reaction or death. It’s important to note that the study was not without risk: many of the participants experienced side-effects related to the peanuts, including skin, respiratory and gastrointestinal symptoms. However, the good news is that 85% of the participants reached the maintenance dose to achieve peanut tolerance. This is a tremendous accomplishment and one that parents of children with peanut allergy will tell you can bring a lot of peace of mind. In response to the study, select private practices around the country have begun to add oral peanut immunotherapy to their list of services. A discussion with Dr. Factor at The New England Food Allergy Center confirmed that his practice has been successful in treating these patients, but he cautioned that it must be undertaken carefully and with a tremendous commitment on the part of the patients.

In the meantime, it’s critical that all of your patients with a history of a systemic reaction to any food be prescribed an epinephrine injector. The established standard on the market has long been Epipen. Today, the new AuviQ injector is a voice activated model that takes the patient or a person assisting who has never used the device through the simple steps of administering it. Until food allergy treatment is more widespread, be ready to lend a helping hand — or shot in this case. At the same time, stay tuned for more exciting developments on the horizon in the realm of food allergy treatment!

– Dr. Dean Mitchell