Are You Driving Everyone Crazy at Work?

Constant sneezing and throat-clearing, both symptoms of allergies, can irritate co-workers. There is a solution that will make everyone happy — immunotherapy.

Is there someone in your office who always sneezes, coughs and/or continuously clears their throat? That person may be suffering from allergy symptoms that include post-nasal drip. Co-workers offer a “bless you” once or twice, but the well wishes gradually taper off as thoroughly annoyed office mates secretly wish that person would get their allergies under control and put everyone out of their misery. It’s certainly not your fault but if you’ve been noticing dirty looks, you might be that person.

Similarly, is there a student at your child’s school who just looks miserable — suffering daily with watery eyes, runny nose, lack of energy and fleeting attention? The teacher and fellow students undoubtedly feel bad for that child — at least at first. But when symptoms continue day after day, sympathy turns to frustration and friends find excuses to slink away. That child’s grades are likely to suffer as a result of inattention and/or missed days. For this great, smart kid who isn’t achieving their deserved social or intellectual status, top notch performance seems an impossible dream. Is that your child?

Whether it’s you, your child, or someone who shares your air, there IS a solution that can clear symptoms and restore good relations — immunotherapy. Here are three need-to-know points about it … First, it can resolve reactions to multiple allergens like ragweed, mold and cat dander. Second, it lasts for years. Third, it’s entirely natural — it’s not medication. Immunotherapy exposes your immune system to very small quantities of the allergens, effectively teaching it “see, they’re really not so bad.” Since your system stops trying to fight off these harmless particles, your symptoms subside greatly or disappear altogether.

Allergy drops and shots are both forms of immunotherapy and they’re both effective. One of the major benefits of drops is you can take them at home — or on the road — so there’s no need to miss work or school for weekly doctor appointments, which are required with shots. (Missing work or school may be another strain on relationships with co-workers, friends and teachers.) Drops are affordable and are ideal for everyone from children to seniors. The upside of shots is that, currently, more insurance companies pay for them (co-pay and deductible may apply.)  In the long run, both shots and drops will likely be less expensive than medications — and will almost certainly be more effective.

If you or your child are the ones getting on everyone’s nerves, through no fault of your own, it’s time to put your allergies behind you and patch up those strained relationships. Talk to your doctor about immunotherapy. If it’s someone else, don’t bludgeon them to death — point them to https://www.allervision.com/allergies.

Spring – A Time for Love … and Pollen

A pine tree releases up to five lbs. of pollen, which will be distributed for miles by the wind. February is the start of pollen season. (Image source:Wikipedia)

Whether you’re eagerly anticipating the end of the freeze and the arrival of spring, or dreading it, depends almost entirely on whether you have allergies. If you’re an allergy sufferer, you may already be experiencing those dreaded symptoms; February is the official kickoff of pollen season for trees in many parts of the country.

So what is pollen anyway, and why does it make you feel so miserable? If it didn’t make you feel like sticking your head in the sand until the scorching summer months, the answer would be, if not romantic then at least a little racy. Pollen is a collection of powdery grains made up of microscopic proteins that male tree parts release into their air with the hope of pollinating female tree parts … ideally of a different tree. The wind carries these grains for miles, dispersing them over the terrain to find the perfect mate(s) and increase the chance of successful reproduction. Since this is a very hit or miss delivery technique (slightly more so than an internet dating service), trees — and other plants — release millions of grains of pollen. Put enough pollen out there and, like with internet dating, eventually something good will happen.

With all that pollen circulating in the air looking for companionship, it’s inevitable that sooner or later some will come in contact with your respiratory system. Since the pollen is a normal part of the environment, your body should just be able to ignore it and carry on with little more than an occasional sneeze. However, a pollen-allergic immune system mistakes pollen as a serious invader and immediately summons defenses to fight it off. The result is a wall of mucous and swelling designed to keep the invaders out and a barrage of symptoms that may include runny nose, congestion, sinus headaches, conjunctivitis, skin rashes, coughing, and asthma flare ups; they’re often worse than the symptoms of an internet match gone wrong!

There are a variety of treatment options to quell these symptoms. You can find more details about them in our Which Allergy Treatment is Right For You post. But seeing as it is virtually impossible to avoid these mate-seeking airborne grains, allergic patients should strongly consider the only solution that is actually a “cure” because it teaches your body to ignore pollen season after season: immunotherapy. That’s important considering that at this very moment, pollen from Ash, Alder and Juniper trees, among others, may be swirling around your home. Too bad we can’t offer immunity to bad matches on the internet scene. Welcome to spring!

Make “Get Rid of My Allergies” Your New Year’s Resolution

Don’t let pollen keep you from enjoying the great outdoors. You can overcome your tree, grass and weed allergies with immunotherapy.

Some people resolve to diet. Others commit to exercise more. Whatever you promised yourself for this year, we suggest the additional new year’s resolution (it’s not too late to make one!) of improving your health and wellness by overcoming your allergies. It’s possible, and we’ll tell you how below. But first, in case you need a little extra motivation, here are a few activities that you should be able to enjoy, but which often provoke allergy symptoms: strolling in the park; playing soccer; watching a little league game; exploring a forest; hugging your dog; rolling in the grass; visiting friends; petting a cat; walking outside in spring; cleaning your home; sleeping; breathing.

When we say “get rid of allergies” we’re not talking about covering up your symptoms with medications or temporary treatments. We’re talking about using immunotherapy to teach your immune system not to react to the harmless allergens that it mistakes for enemies. When you do this with allergy drops or shots, your body stops creating allergy symptoms each time it encounters the allergens; in other words, you become healthier!

The first step is visiting your healthcare provider for a pain-free allergy skin test to determine what allergen(s) causes your symptoms. If your doctor doesn’t offer the skin tests, click here to find one who does. Then talk to your provider about whether immunotherapy is right for you. If you are a good candidate for the treatment, your doctor will recommend either drops or shots. Within two months of starting immunotherapy, you may leave your allergies in the dust – not just for this year, but for many years to come! And next year, your resolution can be based on using your good health to reach new goals!

Does Your Child Have Allergies?… Are You Sure?

Allergies can cause a wide variety of symptoms, many of which you might not expect.

Viruses, bacteria, allergens — there’s any number of small organisms that can make children feel bad. Often the hardest part of treatment is determining the true cause of your child’s illness. For instance, is the latest ear infections the result of a “bug” going around day care or is grass pollen triggering an allergy?

Compounding the situation, allergies manifest themselves in many different ways. Of course, everyone knows that allergies can cause sniffles, watery eyes and sneezing. But here’s a list of other common, though often undiagnosed allergy symptoms in kids:

• Asthma
• Frequent ear infections
• Sinus headaches
• Nasal polyps
• Conjunctivitis (eye irritation)
• Skin rashes and eczema
• Mental problems such as confusion, slow thinking, depression and forgetfulness
• Respiratory effects including endless colds, chronic cough, recurrent bronchitis
• ADHD (Attention Deficit / Hyperactive Disorder)

That’s right,  allergies can even trigger ADHD. So, what do you do? The first step is a full allergy evaluation by a qualified medical provider. An allergy test alone — even a skin test, the gold standard — is not enough; it can show that your child is sensitive to an allergen but not determine if that is causing symptoms. Your provider should conduct a full health history. The results, in conjunction with your answers to when and where your child exhibits symptoms, can help determine if his or her maladies are allergies or something else.

One key to remember is that if your child’s ailments come and go regularly, or if they stay around constantly, there’s a good chance allergies are to blame. If they’re “one and done,” it may be just the cold going around. When in doubt, ask your provider for a full allergy evaluation. To find an AllerVision-affiliated doctor who is qualified to do this, click here.

Do You Have Allergies? Here’s a Quick Test

Allergies cause a wide range of maladies. Have you had an allergy test?

This time of year, allergies can cause all kinds of problems. More than 25% of Americans suffer from allergies to environmental factors from pollen to dust to mold to pet dander. Allergies are to blame for all kinds of symptoms including headaches, sinus infections, rashes, chronic cough, wheezing, eye problems and MANY more.

So how do you know if you have allergies? Discovery starts with this simple score sheet. For each item below, answer 0 for no symptoms to 5 for severe symptoms. If you score a 2 or higher on any question, we recommend you visit your healthcare provider and ask about an allergy evaluation, including a quick, painless skin test. (If your doctor doesn’t offer the skin test, click here. If you’re a doctor and want to offer the test for your patients, click here.) The test will tell you within just 15 minutes if you have allergies, and will reveal the triggers that cause your symptoms.

Nasal Discharge or sneezing         0 1 2 3 4 5

Watery or itchy eyes         0 1 2 3 4 5

Frequent sinus or ear infection         0 1 2 3 4 5

Frequent colds or sore throats         0 1 2 3 4 5

Wheezing or asthma         0 1 2 3 4 5

Cough         0 1 2 3 4 5

Poor memory or concentration         0 1 2 3 4 5

Hyperactivity         0 1 2 3 4 5

Itching, hives, eczema or skin irritations         0 1 2 3 4 5

Abdominal gas or cramping         0 1 2 3 4 5

Arthritis or muscle aching         0 1 2 3 4 5

Headache         0 1 2 3 4 5

The good news is that if you have allergies, there is an excellent treatment option — immunotherapy — because it doesn’t just cover up symptoms, it teaches your body to ignore the allergy triggers so the symptoms stop occurring. And immunotherapy in the form of allergy drops is appropriate for allergy sufferers of all ages, from children to seniors. So contact your provider or allervision.com today.

Top 7 Questions (and Answers) About Allergy Skin Testing

After antigens are applied to a patient’s back, her skin reacts with bumps and/or wheals — and, possibly, itchiness. After about 15 minutes, the provider wipes away the antigens are the reaction(s) fade away.

In our last post, we explained why nearly every doctor should offer allergy skin testing. (If you missed it, click here.) Here are patients’ top seven questions about the test.

1) Should I have an allergy skin test? Allergies cause many more symptoms than the average person realizes, including rashes (dermatitis), sinus infections, migraine headaches, dizziness, conjunctivitis, respiratory problems, fatigue, muscle and joint pain, and the list goes on. If you get any of these symptoms regularly, you should discuss the possibility of allergies with your doctor, who will likely suggest the test and a review of your health history.

2) Can my child have the test? The test is safe for children as well as seniors. In fact, it is appropriate for virtually everyone, with the exception of pregnant women, patients with unexplained episodes of anaphylaxis, patients with active hives or active severe asthma symptoms, and people with significantly suppressed immune systems.

3) What does it test for? AllerVision-affiliated providers test for a wide variety of airborne antigens common to your region of the country — such as pollen from local trees, grasses and molds — as well as molds, dust, animal dander, cockroaches and certain foods. If you suspect allergies to specific foods, your provider may test you separately for those individual items.

4) What happens during the test?  Your provider presses several plastic applicators coated with antigens onto your back. As your skin reacts to certain antigens, you may feel itchiness. After 15 minutes, the provider measures any bumps (or “wheals”) that develop — indicating positive results — and record them. Then he or she cleans your back to relieve any discomfort.

5) Does it hurt? No. You’ll temporarily feel minor pressure from the tines of the testing devices as they’re applied, but they don’t penetrate your skin and they’re specially-designed to prevent pain. Even young children rarely complain. Itching caused by positive results begins to resolve as soon as the antigens are wiped away.

6) Is there anything I need to do to prepare? The most important thing to remember is that you shouldn’t take antihistamines for three days before testing because they can prevent the very reactions your provider needs to see. Also, be sure to inform your provider if you’re pregnant, have asthma, are suffering from severe illness, or have experienced a strong allergic reaction.

7) How long does it take to get results? In just 15 minutes, your doctor will have a clear picture of your allergic reactions so you can plan and begin a treatment program immediately.

 

Top 7 Reasons Nearly Every Doctor Should Test for Allergies

The allergy skin test is painless, quick and accurate.

Family practitioners, internists, pediatricians, dermatologists, ENTs, neurologists, pulmonologists, ophthalmologists and nearly all other types of physicians and health care providers come in contact with patients who suffer from allergies virtually every day. That’s because allergies cause symptoms in every organ system. In fact, they cause many more symptoms than the average person realizes, including rashes (dermatitis), sinus infections, migraine headaches, dizziness, conjunctivitis, respiratory problems, fatigue, muscle and joint pain, and the list goes on. So here are our top seven reasons your healthcare provider should offer allergy testing — and treatment — in his or her office.

1) Since nearly every type of doctor comes in contact with patients suffering from allergies, it’s important that they are trained and have the tools to properly diagnose those patients’ allergies, suggest appropriate treatment, and know when to refer to an allergy specialist.

2) Allergies affect A LOT of people. The World Allergy Organization estimates that “30-40% of the world’s population is now affected by one or more allergic conditions.” And those numbers are growing; allergies have reached epidemic status.

3) There aren’t enough allergists to go around. Allergists make up a very small percentage of doctors. Even if there were enough, people often don’t know that their illness/ailment/discomfort is caused by allergies. Their primary care doctors should be able to make that diagnosis and offer first line definitive treatment as they do with most other chronic conditions (like hypertension and diabetes).

4) It’s impossible to be sure exactly what’s causing the allergic symptoms without a proper test. Pollens ride on the wind and cause discomfort for people up to hundreds of miles away from their source. Pet hair gets stuck in furniture and carpeting, causing allergic reactions even if the animal has been away for months. Dust mites float through the air and hide in bedsheets. Cockroaches leave hidden “presents” that trigger allergies. Which of these items cause your symptoms? The only way to find out is to test. AllerVision provides doctors with a program that allows them to test for reactions to a wide range of regional allergens and a variety of foods.

5) The allergy skin test is painless, easy to administer in the doctor’s office, and produces results in just 15 minutes. This convenient test, which is the diagnostic gold standard, helps doctors quickly determine the problem and the select the right course of treatment immediately.

6) Allergies can lead to asthma attacks. Asthma is a serious chronic airway disease that causes coughing, wheezing, and difficulty breathing. It often interferes with quality of life, preventing sufferers from participating in sports and outdoor activities. Severe asthma attacks in a patient without adequate disease control can be fatal.

7) Allergies can cause anaphylaxis, an extreme, life-threatening reaction. Anaphylaxis is usually associated with insect stings and food allergies but other allergens can cause it as well. Simply put, knowing what you’re allergic to can save your life.

Healthcare providers who don’t offer allergy testing should consider taking the time to learn and add the service to their practice. For more information, click here.

If you think that you may suffer from allergies, get an allergy test and evaluation. (Hint: if you’re feeling bad and don’t know why, it could be allergies.) AllerVision can help you find a local doctor who performs the test, or we can contact your provider to help him or her launch an allergy testing and treatment program. Click here to learn more.

The Allergy Family History: A Key Component to Diagnosing an Allergic Condition

Family history plays a large role in diagnosing allergies.

Many chronic medical conditions may stem from underlying allergic process: rhinitis, asthma, bronchitis, sinusitis, atopic dermatitis, otitis, conjunctivitis, headache, GI problems and, of course, drug allergies and anaphylaxis. Your physical exam— along with allergy testing — can often help make a specific diagnosis. However the diagnosis begins before you get there. The History is always a key element in the diagnostic process. I have found that, in regards to allergy, the Family History may be the most important component of all.

Allergic diseases have a clear genetic link. While the exact transmission of allergies has not been precisely defined, medical research has demonstrated a strong familial relationship. Allergic parents tend to have allergic children. It makes sense that allergic asthma follows the same pattern. In fact the greatest predictor of childhood asthma is not IgE levels or any other specific allergy skin or blood test; it’s maternal asthma.

IgE-mediated allergic disease can manifest with a variety of presentations. I always ask my patients if anyone in their immediate family — parents, sisters, brothers, aunts, uncles, grandparents, and don’t forget the patient’s own children — has allergies. You sometimes have to give them a nudge by specifically mentioning sinus disease, skin rashes, asthma or allergy to Penicillin. Each of these are indicators of IgE-mediated disease in the family.

I have found the link to be so strong, in fact, that when a patient presents to me with asthma and no family history of allergy, I have doubts. If they had no immediate relatives with allergy, I perform an extra careful search for a non-allergic source for their respiratory symptoms. Of course, I still investigate the allergy angle for the sake of completeness and the possibility that their family members have not been properly diagnosed. But if the family history is truly allergy-free, there is generally another source for the patient’s symptoms, such as Alpha 1 antitrypsin deficiency — an enzyme deficiency that can mimic asthma and bronchitis.

Patients often ask, “My mother (or father) has a specific food or drug allergy, do I need to avoid that product?” The patient has no symptoms but the parent has a terrible reaction to a food or medicine. This is tricky. My advice is to be vigilant! We are not identical replicas of either of our parents but it is wise to be on the alert for any symptoms of allergy to parents’ severe triggers and to avoid the offender at the first hint of a symptom. This recommendation is consistent with my frequently-lectured theme to medical students and patients alike: allergic sensitization occurs after repeated exposure. Sometimes it takes several exposures before the body’s IgE response erupts in a clinical reaction.

We can’t escape our genetics, but we can limit or avoid potential allergen exposures. This holiday season of Christmas, Hanukah and Kwanzaa, when surrounded by family, it might be a good idea to ask around and complete your own Allergy Family History!

Dr. Dean Mitchell

Acute vs. Chronic Urticaria: What You Need to Know

Urticaria can be both painful and unsightly.

Urticaria can be a debilitating condition. Patients suffer with a sometimes diffuse rash along with pruritus that can drive a person crazy. Dermatology offices are often the first referral destination for urticarial patients, but the complex issues surrounding these patients extend beneath the skin. The latest research brings insight to the underlying cause of urticarial lesions.

Getting to the bottom of acute urticaria usually involves basic medical detective work. A good history will usually lead you to the diagnosis. The most common culprits are foods (especially in children), medications and even infections. The patient usually identifies the source with a recounting of occurrences over the several hours or even days prior to the onset of the hives.

Among medications, common triggers include antibiotics like Penicillins, Cephalosporins and Sulfa-based drugs as well as over-the-counter NSAIDS or antipyretics like Advil, Alleve and aspirin. With that in mind, I check carefully in the patient’s history for meds first. Patients sometimes don’t realize that a simple antibiotic or OTC medication can cause a reaction so it’s important to ask specific questions. An infection can trigger an urticarial outbreak in highly allergic patients since they have an excess of histamine and infection facilitates the release of that histamine from skin mast cells. The treatment for acute urticaria is often simple: antihistamines for a week and avoidance of the allergic trigger.

Chronic urticaria is another story. These patients have hives that never seem to go away no matter which combination of antihistamines you throw at them. For many years, doctors tended to blame stress and psychological problems for the condition but the latest research points to an autoimmune disorder as the culprit. The mechanism of disease appears to be based in the production of autoantibody to the patient’s own IgE molecules. Just this year, the FDA approved the use of Xolair — the monoclonal antibody injection that was previously approved only for allergic asthma — for chronic urticaria. The new indication for Xolair is an exciting breakthrough for chronic urticaria as long-time sufferers may be symptom-free with just a few injections… and the results last for months!

In summary, urticaria has been a vexing condition that requires some patience on the part of both the sufferer and the physician. With good diagnostic evaluation along with advances in treatment options, the future may be looking much brighter.

Dr. Dean Mitchell

Anaphylaxis, The True Allergic Emergency – What You Need to Know

Anaphylaxis, which comes from the Greek term “reverse protection,” is the most

There are many possible signs of anaphylaxis…

dangerous type of allergic reaction. It is described as a type 1 Hypersensitivity reaction that involves release of IgE triggered, most often, by a food, medication or insect sting. Anaphylaxis is a frightening reaction where a patient, who moments before appeared fine and healthy, almost within seconds can be wheezing, hypotensive, and covered with hives.

The foods most commonly associated with anaphylaxis in children are peanuts and tree nuts; in their adult counterparts it’s usually shellfish. The confusing part for patients and clinicians is that a food allergy can develop after eating a particular food on many occasions. However, once that threshold has been crossed, even a minute amount of that food can cause an explosive reaction. If a food is the suspected cause of anaphylaxis, but the specific food unclear, it’s wise to evaluate the patient through several steps.

Initially, I would recommend a panel of food allergy blood tests. ImmunoCap is a common one used by most labs to evaluate IgE reactions to specific foods. The results range from zero to six, with a score of at least two indicating a positive reaction. If there is a positive reaction to peanut, the allergy should be further explored by ordering a UKnow Peanut test which analyzes the proteins Ara h1,2&3, as well as Ara h8. My article in Consultant for Pediatricians, “Pinpointing the Proteins in Peanut Allergy,” explains why these proteins are important to predict the severity of peanut allergy. If, for some reason, the blood test is negative, I would recommend referral to an allergist for skin testing and/or oral challenge in case there is a hidden allergen that requires more extensive testing.

Any medication can cause an anaphylactic reaction however the common culprits are antibiotics and non-steroidal anti-inflammatory drugs. Many antibiotics are mold-based, which may be part of the reason for their allergenicity. In the past, beta-lactam antibiotics such as penicillin and related cephalosporins were the most likely offenders but today we also see anaphylaxis to the widely used category of quinolone antibiotics. To complicate matters, it is not unusual for a patient to have multiple antibiotic sensitivities; there is a genetic component to this reaction. While Pre Pen can be used to diagnose penicillin allergy (talk to your AllerVision representative for more information), there is no such test for most antibiotics, and a drug challenge may be required for conclusive diagnosis.

Non-steroidal medications, such as Advil, Motrin and Alleve, work by blocking the cyclo-oxygenase pathway and trigger release of leukotrienes which are potent mediators of anaphylaxis. In my experience, patients allergic to NSAIDS are usually unaware of the source of reaction until they suffer several episodes of anaphylaxis. Be on high alert for NSAID hypersensitivity when evaluating a patient for anaphylaxis or urticaria. Unfortunately, a drug challenge is the only conclusive test NSAID hypersensitivity.

The clinical diagnosis of anaphylaxis can be complicated. The World Allergy Organization recently came out with new criteria. Essentially, it includes exposure to a possible or known allergen and the finding of two or more clinical signs: urticarial, bronchospasm, gastrointestinal distress and cardiovascular collapse. In case of cardiovascular collapse, no additional signs are needed — call 911 and immediately transport the patient to the hospital.

While anaphylaxis is fairly rare with allergy injections, and exceedingly rare with allergy skin testing, it is important that you and your staff be prepared just in case. When a patient is in your office, the question of whether or not to treat a potential reaction is simplified, and doesn’t include an extensive review of the clinical findings nor consideration about number of signs. If you place an allergenic substance on the patient’s skin, or inject them with a substance you know they are allergic to, and they have a reaction anywhere other than the local site of exposure, TREAT THEM! Common signs to look out for are itching of hands and feet, or clearing of throat that wasn’t happening when the patient came in to the office. If you apply antigen to one area of the body, and the patient has symptoms somewhere else, you have to assume that the reaction has gone systemic and you should treat accordingly.

The initial treatment of anaphylaxis is unambiguous: epinephrine intramuscularly into the lateral thigh. Don’t play around with Benedryl! Don’t give a cortisone shot! Anaphylaxis progresses immediately, and neither antihistamine nor steroid drugs act on the spot to reverse the severe pathophysiological reaction. Deaths resulting from anaphylaxis happen when epinephrine is not administered in under 3o minutes from the onset of symptoms. If you are giving allergy injections in your office, you MUST have the patient wait 20 minutes in the office to make sure they don’t have an immediate allergic reaction. If they develop ANY sign or symptom within that time, administer epinephrine. The EpiPen is convenient for an office because it contains the 0.3 ml of epinephrine with the needle size for an intramuscular injection. It also comes as the EpiPen Jr. for children or infants less than 66 lbs. Once epinephrine has been given, the patient must be monitored for several hours to make sure there isn’t a biphasic reaction; this usually takes place in a hospital.

Anaphylaxis can be the most frightening of clinical reactions. The good news is with quick recognition and prompt treatment with epinephrine, you can be a real hero!

– Dr. Dean Mitchell