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.

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!

Do You Know What You’re REALLY Allergic To?

Flowering trees do not usually trigger allergies. If you start sneezing when you encounter one, chances are that other trees — or other allergens altogether — are to blame.

Consider this: you walk down the street and see a beautiful tree with blooming purple flowers. As you get closer, you start to sneeze uncontrollably. It’s obvious you’re allergic to the tree, right? Probably not…

First, trees with flowers are usually insect pollinated, not wind pollinated. Pollen carried by insects rarely ever makes it into your system. So if it is pollen that’s causing your reaction, it’s probably not the flowering tree that’s to blame. Then why does it always seem to work that way — you see the flowers, the tree is clearly in bloom, and you start sneezing — if flowering trees are not allergy-inducing? Because they blossom at the same time as wind-pollinated trees. There may be a grove of Juniper trees two miles away and a gust of wind picked up its pollen and delivered it right into your path. Maybe you didn’t even see the Juniper pollen, which makes it an even more likely culprit; the smaller the pollen size, the farther travels and the more easily it sneaks into your nose and lungs. Then again, your allergy trigger could be pollen from recently mown grass or the patch of weeds growing in a nearby field.

Now imagine stepping into the home of a friend. Within minutes, a sinus headache comes on strong. Although there’s no pet present, cat hair covers the couch and a shaft of sunlight reveals dust wafting through the air. Either of those could be a source of your allergy symptoms. In fact, cat protein lives in a home for many months after its furry owner has vacated the scene. Or, cockroaches — completely hidden from view — could be to blame. The roaches may be long gone too, but it’s what they leave behind that gets your histamine flowing.

Last scenario… You take a bite out of an apple and your mouth tingles and your lips feel slightly swollen. Are you allergic to the apple? Hard to believe, since you just had a slice of apple pie and didn’t have any problems. You might be experiencing Oral Allergy Syndrome (OAS). Simply put, the apple is related to certain kinds of pollen to which you are sensitized and, in its raw form, the apple triggers allergy symptoms.

So, how do you tell what you’re really allergic to? There’s only one reliable way — an allergy test. First, when you visit an AllerVision-affiliated provider, your doctor will ask questions to get clues to what allergens MIGHT be to blame. Then you’ll most likely receive a pain-free skin test that will reveal your allergy sensitivities in just 15 minutes. Combined with the questions you answered, your doctor should be able to identify your allergy triggers on the spot so you can discuss treatments. That, of course, is the bottom line — we want you to enjoy the great outdoors — or whatever’s really causing your allergies.

To find an AllerVision-affiliated doctor — who’s qualified to offer allergy examinations — please click here.

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.

When Pollen Strikes!

When the wind blows, the pollen inside these sacks will be released, filling the air for miles.

One of the major causes of allergic disease, such as allergic rhinitis (also known as hay fever), is airborne pollen. All plants produce some pollen as part of their reproductive cycle. There are thousands of plant species that grow in the United States but only a small number of those are significant sources of allergenic pollen. Plants that DO produce important allergens have several characteristics in common: First, they are wind pollinated rather than insect pollinated. Next, they produce pollen that is buoyant and is spread readily by the wind. Because wind pollination is relatively inefficient, these types of plants have to produce huge quantities of pollen to keep their species alive.

To be clinically important, allergenic plants must be abundant in an area. Trees such as oak and maple grow over hundreds of acres with pollen traveling up to 200 miles; ragweed can colonize large fields and affect patients for many miles around; and grass allergens can cover hundreds of acres. Despite what your nose and eyes may suggest, brightly colored flowers are rarely allergenic. Often they are insect pollinated, and they typically don’t produce pollen that can be spread by the wind. However, the pollen from allergenically important plants lands all over their beautiful flowers, and THAT pollen is what your body rejects when you stop to smell the roses. Those pollens are also often at least part of the cause of your allergic symptoms when you snuggle up to your favorite pet. Fur is a great landing spot for all kinds of pollen!

Tree pollen allergy affects millions of people. Many allergenic trees are abundant and large, shedding and spreading huge quantities of pollen. Typically, trees shed their pollen in the spring and are the first species each year to affect patients. In warmer climates, like California and Florida, pollen season often begins in February. With the late winter on the east coast this year, pollen season there is just reaching full swing.

Because pollen can travel so far, it can be difficult to determine the exact cause of your allergies. That’s where an allergy test and evaluation comes in. We encourage you to ask your doctor about an allergy skin test — a painless procedure than can tell you in just 15 minutes specifically what you are allergic to. If your doctor doesn’t offer this test in his or her office, AllerVision can help you find one who does — or can talk to your doctor on your behalf.

If pollen is the cause of your allergies, it’s virtually impossible to avoid. You can take medication to temporarily alleviate symptoms. But with medication you’re only covering the symptoms up, and next time you encounter the pollen you’ll have the same reaction. Immunotherapy, on the other hand, teaches your immune system to ignore the pollen and thereby puts your allergies into remission — usually for years or decades. You can learn more about immunotherapy here.

Pollen from trees, grasses and weeds are likely to keep your immune system busy until the fall or winter, and then return again next year. Now that you know what you’re up against, you may want to ask your provider about immunotherapy — so you can enjoy the great outdoors instead of suffering from it.

This blog includes information from ALK-Abelló “Virtual Pollen Guide” DVD, used with permission. The company offers a helpful patient education website at fightthecauseofallergy.org

 

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

The Keys to Successful Allergy Treatment in ’14: Compliance, Compliance, Compliance

A provider explains the benefits of allergy drops to to a patient and demonstrates their use.

The new year is beginning and with it comes resolutions. I want to put this challenge out there — 2014 will be the year that doctors who treat allergies make a promise of clinical improvement for their patients… and inspire patients to do their own part in fulfilling that promise! The common ground required for this achievement: compliance.

Compliance is an important building block in the success of almost any endeavor. In medicine, it’s the key to reaching maximum therapeutic results. With allergy treatment specifically, patients must be disciplined because their symptoms are sometimes periodic, but to attain the highest level of success possible, allergy immunotherapy requires year ’round application. The struggles here are similar to those with hypertension meds where the overall wellness of the patient depends on their adherence to medication protocols even in the absence of symptoms. Studies show that compliance for allergy injection therapy is in the low 30% in most situations. Allergy drops compliance has been reported to be as high as 90% or as low as 20%. II have been fortunate in my medical practice to attain closer to 90% compliance with my immunotherapy programs and I’ll share what I’ve learned to make this possible for your clinic.

The key to compliance with allergy immunotherapy is motivation. Of course it may be easier to motivate patients at the beginning of treatment if they are diagnosed when the misery of allergies is clear in their mind. The hard part is inspiring them when they are asymptomatic, and then maintaining the course when they are feeling good. I’ve found that there are two important “up-front” times to motivate a patient: 1) At the visit when test results show their specific allergies, whether they be to pollen, dust mites, mold or animal dander. 2) At the point of informed consent. You will clearly have the patient’s attention when they are able to visually confront the allergens that have been causing them to sneeze, wheeze and itch. But to parlay that into successful treatment takes effort by both the patient and your practice. If the patient has positive allergy tests that correlate with clinical symptoms and immunotherapy is being discussed, the informed consent process is a vital opportunity to discuss the keys to successful outcome and motivate my patients to invest their time for long-term success.

Informed consent can be accomplished many ways in medicine. It is possible to unknowingly scare a patient out of a treatment with extensive lists of possible adverse events, but if you emphasize the positives in comparison to the potential negatives then you have an interested patient. Fortunately with allergy drops, the advantages far outweigh the few negatives. As always, the goal is to make the patient an equal partner in the decision-making process.

In discussing informed consent for immunotherapy, I start off with the many advantages. First, immunotherapy is a program that’s directed at the patient’s specific allergens (not a generic mix that all patients get). Second, the goal is to not only decrease their allergy symptoms, but to reverse the disease. Third, I explain that the allergens used are not drugs but elements from the environment (such as pollens) designed to train their bodies to accept their normal surroundings. Fourth, I let my patients know that studies indicate that immunotherapy is safe and effective. I also explain that the process of desensitization to allergies is similar to working out with weights: “in your workouts, it’s best to start at a low weight and gradually build up. Of course, everyone wants to see immediate results, but with time you will — you just have to visualize yourself on the road to getting there.” The final clincher with the allergy drops is convenience. When the patient realizes what they are taking is good for them and easy to use, they feel the responsibility to be an active participant.

I always ask  patients, “Do you brush your teeth everyday?” They look at me like I’m crazy; they swear they wouldn’t leave the house or go to sleep without brushing their teeth. Well, I tell them, leave your allergy drops by your toothbrush and you’ll never forget to take them either! My patients who regularly take their allergy drops see significant improvement when pollen seasons hit or when they visit a friend’s home with cats and dogs that they couldn’t tolerate in the past.

In the long term, the true key to successful compliance is the relationship between doctor and patient. Studies show that physicians can significantly increase adherence to treatment protocols through consistent follow-up visits. As much as patients know in the back of their minds that they should stay the course, nothing replaces the impact of checking in with their providers for a reminder that they have a partner in their quest for wellness.

Remember, in Latin, doctor stands for teacher. I take it another step further: as doctors we are our patient’s coaches and need to encourage them in the right direction. My best days in practice are when I see my patient at a follow-up visit during a high pollen day and I ask them what’s bothering them and they answer “Nothing!” We both celebrate!

-Dr. Dean Mitchell

Treating Allergies With Tablets or Drops: What Every Allergy Patient and Doctor Should Know

Sublingual allergy drops have been available for a while. New sublingual tablets by pharmaceutical companies are poised to bring FDA approval to sublingual treatment. There are important differences between drops and tablets.

Last week, the FDA advisory committee reviewed two sublingual allergy tablets. Both tablets gained acceptance by the advisory committee, meaning that they will be recommended for approval by the FDA. While the tablets will be new to the U.S. market, they have been available in Europe and Canada for some time. The Sublingual method is an exciting alternative for allergy sufferers who have been waiting for decades for a definitive but shot-free solution to their allergies. Though the tablets present a new answer to that dilemma, physicians in the United States have long been successful in utilizing sublingual immunotherapy drops to help reverse their patients’ allergies. The drops are generally composed of FDA approved antigen in an “off label” route of administration.

While most physicians prescribe “off label” many times per day as part of their regular practice (such as offering a Beta Blocker for performance anxiety, or prescribing Albuterol for young children), FDA approval of the new tablets will provide physicians and patients an added level of comfort with sublingual route. Like many ENTs and several other allergists, I have been prescribing sublingual immunotherapy to treat my patients’ allergic disease for 15 years. In my book, Dr. Dean Mitchell’s Allergy and Asthma Solution, I dedicate a full chapter to discussing numerous medical studies which show that sublingual allergy drops reverse allergies and asthma and prevent future allergies from developing. Most of those studies are available for your review on the AllerVision website http://www.AllerVision.com.

There’s a Big Difference Between Tablets and Drops

The question patients and their doctors will be asking is “What’s the difference between these new sublingual tablets made by the pharmaceutical companies, and the liquid drops I get from my physician?” The answer: there is a big difference. The new sublingual tablets developed my Merck and Stallergenes are high dose allergy tablets covering only a single allergen or allergen category—grass. And, in fact, they only cover the grass(es) for a specific region of the country. The new tablets are clearly effective for patients in those regions who are allergic to only grasses. I have a concern, however, about side-effects with such a concentrated tablet which is taken at full dose from day 1 as opposed to utilizing the build-up phase that defines true immunotherapy. There will be many patients who are highly sensitive to grass pollen and the tablet may cause itching in the throat, rashes or difficulty breathing. In contrast, the sublingual drops available through AllerVision-affiliated providers, are custom-made for each patient to cover the categories affecting that specific patient. The treatment program includes a progressive ramp-up phase. This is important for several reasons…

First, the customized liquid drops enable you to treat multiple allergens simultaneously; most allergy patients suffer from several airborne allergens in multiple categories (most are poly-sensitized.) Interestingly, the cost might be more favorable with the drops compared to the pharmaceutical tablets, which will likely command a third-tier copay when they arrive on the market. Second, proper allergy desensitization protocol dictates starting with a low dose of allergen and carefully building the strength up over time while monitoring patient response. This is the way allergy desensitization has been practiced for decades, and the process accomplishes the goal of modulating the immune system by easing the body into acceptance.

Allergy treatment with the sublingual method may never have been as easy or as effective as it is today; and certainly it is fast becoming more widely available. Remember, not all sublingual options are equal. As always, it is important to do your research and educate yourself so you can rest assured that you are making the right choice.

– Dr. Dean Mitchell

Why are Allergies More Common Today?

“Protecting” ourselves from germs and microbes, such as those among animals, by using vaccinations, disinfectants and sanitizers, could actually prevent the immune system from building up natural tolerance. This, in turn, could contribute to the growing allergy epidemic.

I have so many patients ask me, “Why are allergies more common today than before?” I mention in my book, Dr. Dean Mitchell’s Allergy and Asthma Solution, that there is supportive research for The Hygiene Hypothesis — the argument that Western civilizations, with their “cleaner” environments, have actually brought about the increase in allergies. Due to the more common use of antibiotics, the widespread use of vaccinations to eradicate infectious diseases, the prevalence of disinfectants and sanitizing products, and urban life in general, people are less exposed to microbes.

The Sunday New York Times published an article on Nov. 11, 2013: “A Cure For the Allergy Epidemic?” The article essentially points out that the Amish people of Indiana have a much lower rate of allergic diseases than the rest of the population in the United States. They live on farms and their children begin farming chores at a very young age. This seems to be important; because the children are exposed to microbes from the farm animals at an early age,  their immune system builds a response to counter these microbes. This shifts the immune system away from allergic inflammation.

The research on The Hygiene Hypothesis is interesting, but for now it’s not very practical for those of us who don’t live on a farm. The other impractical option — not vaccinating your children against potentially dangerous infections — also doesn’t make sense. The best option for your patients who suffer from allergic diseases, such as allergic rhinitis or allergic asthma, is allergen immunotherapy. Numerous studies show that allergen immunotherapy shifts the immune response to a non-allergic pathway through changes in T-cells, and produces IgG blocking antibodies. In contrast, medications such as antihistamines or asthma inhalers don’t change the immune system response. Medications only treat the symptoms.

To help your allergy patients, you need to first do some simple detective work — talk to them and give them an allergy skin test — to determine their specific allergies. Once you have secured a definitive diagnosis, you can offer appropriate treatment options: subcutaneous (SCIT – allergy shots) or sublingual (SLIT – allergy drops)  immunotherapy to reverse the root cause of their symptoms for the long-term.

In the future, prebiotics or probiotics may be an option for preventing the development of allergic diseases, but for now immunotherapy is the most practical and effective treatment available. It can make a real difference in your patients’ lives.

– Dr. Dean Mitchell