Are You Driving Everyone Crazy at Work?

Sick in office

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

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When Pollen Strikes!

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

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.

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


Groundhog Day is Excellent Time to Start Allergy Immunotherapy

Whether Groundhog Day reveals that spring is here or not, there's not a moment to lose in preparing to fight spring allergies.

Whether Groundhog Day reveals that spring is here or not, there’s not a moment to lose in preparing to fight spring allergies.

By the time you read this, Punxsutawney Phil will be out of the hole and we’ll know what’s in store for the next six weeks. Whether he saw his shadow and scampered back to take cover for more Winter or stayed above ground to enjoy the start of Spring, there is no time like NOW to start sublingual immunotherapy! If spring starts in six weeks, you have time to build up your immunity to pollens that get in the way of enjoying beautiful spring days. If it starts today, you’ll still feel better before the season hits full stride. How and why Phil makes his prediction is one of the mysteries of the universe but how and why immunotherapy treats allergies so effectively is no mystery at all…

If you have allergies, your immune system misinterprets something that’s normal in the environment as an enemy. As a result of this misunderstanding, it builds up a defense network to respond every time it sees that element (also called an antigen or allergen). That internal process is called sensitization, and the most common culprits are pollens from grasses, trees and weeds; pet dander; molds; and insect/inhalants like cockroach and dust mites. The next time your body sees that antigen, let’s use olive tree pollen as an example, it calls in the defense force for protection. All of the mucous, swelling and tearing you experience is your immune system doing a superb job of building a wall to keep the olive pollen out of your body. Scientifically speaking, your body is releasing histamine. Unfortunately, it’s not only unnecessary, since olive pollen isn’t actually an enemy, it’s extremely unpleasant! Fortunately there are solutions.

One solution is to use medications — typically antihistamines — that block your body’s misguided immune response. They create a constant battle within your body, wherein the allergen stimulates a response and tries to release histamine and the drug basically performs a block and tackle on your natural response. The result is that you usually feel better than the allergy but you often experience side effects. There are several other drugs that help with the symptoms but, in general, there is always at least a little downside to taking medication.

Luckily, there’s an alternative. We can teach the immune system that allergens aren’t enemies – this is the purpose of immunotherapy. It’s accomplished by gently and carefully introducing small amounts of the antigens to which your body is sensitized. Your immune system gets re-familiarized with these little particles. Little by little, we build up the levels of the antigen until your immune system is so used to it that it tolerates the normal amounts of environmental exposure. It takes a few months to get to that highest concentration – AllerVision calls it the maintenance level – which is why Punxsutawney Phil’s prediction is important to you.

Once you reach the maintenance dose, your tolerance will be greatly improved and your symptoms will hopefully disappear. Studies tell us that the body needs about four years of the constant exposure provided by immunotherapy for the so-called-enemy to be consistently ignored.

Immunotherapy can be delivered in shots – usually administered weekly in the doctor’s office – or sublingual (under the tongue) drops – at home on a daily basis. Many AllerVision providers offer both options, though most prefer the drops because they have very little risk for severe allergic reaction and they are so much more convenient for patients.

Whether Phil says yay or nay to an early Spring, get to your provider as soon as possible for an allergy test so he/she can find your allergic triggers and order an immunotherapy set designed specifically for you. There is plenty of stuff out there that your immune system SHOULD fight; take away the distraction of battling the normal environment and your system can focus all of its resources on keeping you healthy! (Click here to find a doctor who offers allergy testing and immunotherapy if your doctor does not.)

Happy Groundhog Day!

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Allergy Drops Erase 30 Years of Suffering for MD

Dr. Leiken, who has suffered from allergies for over 30 years, stands in front of an Olive tree in his backyard. Since he's been taking allergy drops, the Olive tree no longer triggers allergy symptoms.

Dr. Leiken, who has suffered from allergies for over 30 years, stands in front of an Olive tree in his backyard. Since he’s been taking allergy drops, the Olive tree no longer triggers his symptoms.

In the past, AllerVision’s blog has featured Dr. Dean Mitchell sharing his wisdom from many years of running an allergy practice. In this and future posts, we’ll be looking at allergies from the patients’ and other providers’ points of view.  

I am a physician who has been suffering from allergies for over 30 years. Five years ago, I started to give AllerVision’s allergy drops a try and have had excellent results.

Before I started using the drops, I had severe hay fever symptoms sporadically throughout the year but much more intensely between November and May. I often had sinus infections and my nose was stopped up a good deal of that time. Often I would sneeze many times in a row. Over the past 25-30 years, I tried various methods to deal with my allergies. I received shots from an allergist; it seemed to help for a time but after a couple of years I received less and less benefit. That treatment was costly and time consuming. In later years, I tried acupuncture. That also helped for a time and then lost its effectiveness. 

I suffered without any sort of treatment for quite a while until I began taking the drops. Within about three months I noticed a remarkable change in my hay fever symptoms. The most obvious improvement was that I was able to go into my backyard where there is an olive tree that never failed to cause an allergic reaction. I was even able to sit under the tree with no symptoms! Over these five past years that I’ve been taking the drops, there has been just one occasion where I experienced severe allergic symptoms; a nasal cortisone inhaler solved the problem in that situation. 

Unlike the other treatments, I have not found any noticeable diminishing effect of the AllerVision drops.They have been a major help to me over these years. I also appreciate the fact that I don’t have to go to an allergist each week for shots and I don’t have to wait in his office for a half hour to see if I develop an anaphylactic reaction. And I don’t have to make a weekly co-payment.

In short, as a long-time allergy sufferer, I can very highly recommend AllerVision drops.

Dr. Stanley Leiken, MD

(Disclosure: Dr. Leiken is the father of AllerVision co-founder Jennifer Robb and an investor in the company. His comments above, and his investment, are based on his success with the treatment.) 

Thanksgiving Advice for Your Allergy Patients

Both pets and foods can cause problems for allergy sufferers at Thanksgiving.

Both pets and foods can cause problems for allergy sufferers at Thanksgiving.

Thanksgiving is a wonderful holiday for most Americans. Families get together to celebrate each other’s company, watch football, and enjoy some delicious turkey, stuffing and a smorgasboard of trimmings. Sadly, I’ve noticed that the holiday raises several concerns for patients in my allergy practice.

For one thing, patients who are highly sensitive to cats or dogs are usually apprehensive of spending Thanksgiving at the homes of their pet-owning relatives. This makes for an uncomfortable situation: do they suffer through the dinner sneezing and wheezing, do they insult the host by declining the invitation, or do they ask that the pet — often considered a family member in it’s own right — be put away during the visit? None of these options are ideal. 

I have found that the best chance of a successful holidy for pet-allergic patients lies in having a solid plan. I strongly recommend that plan begin with the use of over-the-counter Nasalcrom twice per day for at least a week before the pet exposure. Nasalcrom is a mast cell stabilizer and it must be initiated in advance for optimal results. For Thanksgiving Day, I recommend they take a long-acting antihistamine such as Fenofexitidine for acute protection. Additional recommendations for asthmatics include preparing ahead with maximum doses of steroid inhalers leading up to the day, and use of their rescue inhaler, if separate, an hour prior to entering the home. I prefer to maintain asthmatics on an inhaler with a combined corticosteroid and beta-agonist, such as Dulera or  Advair.

Of course, planning far ahead provides the very best chance for a happy holiday for pet-allergic patients. The most effective strategy includes treatment with sublingual allergy drops, which build up their immunity to the pet allergens and significantly minimizes symptoms. I once had a patient who refused to visit her mother-in-law’s home for years because the mother-in-law had three cats and the patient became ill upon entering the home. As you can imagine, this led to a lot of family tension at holiday time. I treated the patient with sublingual drops for cat dander and her symptoms, and the family tensions along with them, completely abated. The patient was extremely happy but her husband was even happier!

Drops can take up to 12 weeks to begin taking effect — though usually much less — so it’s probably too late for them this Thanksgiving. However, Christmas, Hanukah and Kwanza are right around the corner so starting patients on an allergy drop treatment now is quite appropriate. 

Food allergies represent another potential point of holiday anxiety. The elaborate Thanksgiving dinner, with all kinds of stuffings and side dishes, may look like a veritable mine field for a patient with significant food allergies. Patients need to be proactive about contacting the host regarding specific food allergies and requesting appropriate exclusions and/or, at the very least, labeling of dishes. A severe food allergic reaction can put a real damper on the holiday spirit for everyone! Of course it is always important to remind your severely food-allergic patients to carry their epinephrine injector with them everywhere in case of emergency. This is especially critical in the midst of festive gatherings where there is likely to be a plethora of offerings.

While many food allergies are clear-cut, making avoidance do-able if not exactly easy, you must always be prepared to play detective — especially during the holiday season when special situations are the norm. My most interesting Thanksgiving allergy story was that of a patient who developed hives and swelling two Thankgivings in a row. I was intrigued because she had no known food allergies and she said she ate turkey the rest of the year without reaction. I performed extensive food allergy testing and all results came back negative. Upon review of her chart, I noticed that she had a history of allergic reaction to Cephalosporins. After some research, I discovered that turkeys are often fed antibiotics on the farm. Obviously, this supersensitive patient was triggered by exposure to the antibiotics consumed by the fresh turkey. The deli turkey she ate during the year was so processed that any antibiotic proteins it contained were likely rendered into a form no longer recognizable to the body as the original antigen.

There you have a few of my own experiences in treating allergy patients during the Thanksgiving holiday. I would love to hear any unusual cases you’ve encountered or answer any questions you have. If there’s a chance that I can help make other allergy patients’ Thanksgivings more comfortable, I am up to the challenge!

Dr. Dean Mitchell

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Chart Your Patients’ Asthma Visits Like an Expert

Asthma is often triggered by allergies. Determining the allergy source, with a skin test, can help patients avoid extensive treatment.

Asthma is often triggered by allergies. Determining the allergy source, with a skin test, can help patients avoid extensive treatment.

This time of year brings changing weather and an uptick of respiratory viruses. For most physician offices, asthma visits rise with these trends. The diagnosis of asthma is often not the hard part; patients short of breath with coughing and wheezing make for a simple diagnosis. Other patients come in with the elusive and often undiagnosed cough, and a quick run of the spirometry can provide the answer. But navigating the art of managing and charting your asthmatic patients requires some skill.

The experts agree on the need to document two key points: severity and control. The components of severity are: intermittent, mild, moderate and severe. Begin the differentiation by stratifying the patient by the Rule of Twos using the key asthma indicators: nocturnal awakenings, use of short-acting beta-agonists inhalers, and interference in daily activities. If these indicators occur less than twice a week, then the patient is considered to have intermittent asthma; if the patient has these symptoms more than twice a week but not daily, then he/she falls into the mild persistent category. Moderate persistent is used for patients who experience the indicator symptoms daily, and severe persistent asthmatics suffer with symptoms throughout the day. It is critically important to follow and document pulmonary function tests and home peak flow levels in your moderate and severe patients. The moderate persistent asthmatic will demonstrate FEV1 values between 60-80% predicted, while more severe persistent patient values fall consistently under 60%.

The ACT (Asthma Control Test) is a standardized validated questionnaire that serves as another key component to the management process. The questionnaire provides a quick assessment of both severity and control. This form should be downloaded and printed from the back end of the AllerVision website — you will use it often! A score of less than 20 on the ACT signifies poor control, indicating that intervention or change in therapy is in order.

Always keep in mind that asthma is multi-factorial and heterogenetic; meaning there are lots of components at play. The detective work of good medicine means finding that trigger of your patient’s asthma, so the plan can center on avoiding those triggers whenever possible. Respiratory infections, especially viral, are common culprits that prove difficult to avoid. Stress and emotions also affect asthma, leading to exacerbations. However, a main trigger in most asthmatic exacerbations is allergic response. This fact is the impetus behind the NIH guideline stating that all persistent asthmatics be tested to identify their allergic triggers. The AllerVision testing program offers a comprehensive and regionally appropriate assessment. Perform the test, carefully document positive results along with correlation to the careful and detailed history, and take action to help the patient learn how to remove the offending allergen(s) from his or her environment. Because avoidance can be near-impossible, give serious consideration to allergen immunotherapy for your asthmatic patients. SLIT (sublingual immunotherapy) is a fantastic option in this case because it offers the benefits with significantly less risk than SCIT (subcutaneous immunotherapy, aka allergy shots).

Our next blog post will comment on making adjustments to asthma control through medications.

Dr. Dean Mitchell

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The Late Summer Breezes Send Ragweed Pollen Flying

Western Ragweed

Ragweed spreads widespread misery in late Summer.

We’re approaching summer’s finish line and we all want to soak up as much sun and fun as possible before the weather turns chilly. Unfortunately, in addition to marking the end of summer, August hails the beginning of the ragweed pollen season. Ragweed allergy, classically known as Hay Fever, is recognized by allergy suffers far and wide as the “summer cold” that lasts through Labor Day — and sometimes beyond.

I have vivid memories of my father suffering from Hay Fever. I was 10 years old and hopeful that my dad would play catch with me when he got home from work. But one look at his red nose and watery eyes and I knew I’d have to wait for another day… or another season. My father would head straight to his bedroom where he would turn on the air-conditioner and close the door. When my dad stayed outside for an extended period, he had to “pop” Spantial, an ornate combination of sedating antihistamine and decongestant. That helped the symptoms but he struggled to stay awake with the old-fashioned antihistamine, and fought agitation from the decongestant. We’ve come a long way since my childhood in the 70s.

Today, state-of the-art symptom control treatment is available to provide relief for ragweed allergy sufferers but a well-planned approach to treatment is necessary. That means starting a program several weeks before ragweed season peaks. For appropriate candidates, I recommend Nasalcrom spray twice daily starting in early August. This allows time to build up the necessary protection. Nasalcrom is composed of cromolyn sodium, a mast cell inhibitor, and it is extremely safe with virtually no side effects. However, early prophylactic use is the key to success since it takes several weeks to reach effective levels. This is in contrast to steroid nasal sprays which work immediately but, if used for long periods, can have adverse effects.

The new exciting breakthrough in treating Hay Fever is sublingual immunotherapy. The FDA has recently approved Ragwitek, the  pharmaceutical-grade sublingual tablet to treat ragweed allergy. The medical studies have shown the efficacy of this product and validated the benefit of sublingual immunotherapy. My concern is that this product is only available as a high dose tablet without the build-up recommended for desensitizing patients to allergens. 50% of patients had adverse reactions to Ragwitek — such as sublingual irritation from the tablet, itchy throat, sneezing and nasal congestion. Also, Ragwitek is approved only for adults 18 years and older. Since the tablet treats only ragweed allergy, it’s usefulness does not extend to patients with allergy to other weeds or to allergens in the other antigen categories.

Based on my clinical experience, I believe that a better option is the use of sublingual immunotherapy drops, also known as allergy drops. These liquid drops are made from the same allergen extracts used for injections. They can be used to treat multiple allergens at the same time, so they are not limited to ragweed, they are easy to use at home, and they actually taste good. The AllerVision program promotes the safe buildup of allergen doses to achieve tolerance to the allergen for safe, successful treatment. The AllerVision program uses FDA-approved allergens in an off-label method, which is a common practice in medicine.

I’m sure many of your patients have their final summer vacation days planned. Make sure that your ragweed sensitive patients are protected so they can create summer memories that DON’T revolve around allergic disease!

Dr. Dean Mitchell

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Humidity and Mold: A Potent Combination to Set off Allergies

Mold growing in a shower. Mold is especially common in perpetually damp areas..

Mold i is common in perpetually damp areas, such as this shower stall.

It’s been hot and humid this summer, especially along the east coast. This is the time of year that most allergists take their vacations because it is the dormant season for so many trees, grasses, and weeds. This SHOULD be a good period for allergy sufferers as well. But there is a segment of patients who still battle symptoms: mold allergy sufferers.

Mold allergens are abundant in the autumn when leaves on the ground spew off the decaying mold (as I mentioned in a previous post which you can read here.) Mold doesn’t mind the summer either, especially in humid environments. In fact, mold can be a real problem indoors during this time. If your home smells damp inside, you may be at risk for mold exposure. A recent article published in The Journal of Allergy and Clinical Immunology (2013;132:1099-1110) titled “Association of Indoor Dampness and Molds with Rhinitis Risk: A Systemic Review and Meta-Analysis,” supports the theory that that mold inside the home strongly influences allergic rhinitis flare-ups. Interestingly, the strongest predictor of mold exposure was the smell of mold in the home!

A few months ago I had lunch with Bill Sothern, a true mold sleuth. Bill’s company, Microecologies, visited New Orleans just after Hurricane Katrina to help home-owners deal with the mold catastrophe resulting from the hurricane. More recently he was involved in helping victims of Hurricane Sandy in the New York, New Jersey and Connecticut area. I learned from Bill that you can’t ignore the seriousness repercussions of a mold problem. The insidious symptoms can range from classic allergy symptoms of nasal congestion, eye irritation, and asthma, to headaches, fatigue and more serious neurological complications. If you suspect mold in your apartment or home, you should contact a reputable company to investigate. At a basic level mold is differentiated by color: Green mold is highly allergenic, while black mold is highly toxic.

A few key tips for management of potentially moldy situations:

  • Keep the humidity down by using air-conditioning when possible; mold hates dry and cold environments
  • Crack open a window for a few hours to bring in some outside air; indoor air is 10x more contaminated than outdoor air
  • Sanitize bathrooms frequently as they can be prone to mold growth

If you think you’re allergic to molds, ask your doctor to perform environmental allergy test that includes specific mold allergens. The good news is that, in conjunction with mold eradication efforts, allergy immunotherapy can be very effective at keeping symptoms at bay.

– Dr. Dean Mitchell

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Antibiotics and Asthma: A Surprising Relationship

Crying Tears

The longer I practice medicine, the more amazed I am at the reversal of long held medical dogmas. Since the common use of antibiotics began around World War II, the medical profession has seen the effectiveness of antibiotics as evidence that science can prevail over infections. However, we didn’t foresee the downside of that success — the current rise of antibiotic resistance by common bacterial organisms. A similar arena of surprise in the medical field has taken place in the realm of allergy and asthma. We have observed an alarming rise in allergic diseases in Western countries over the past few decades. There are different hypotheses as to the cause of this allergy epidemic, but an article in the May issue of Annals of Allergy Asthma and Immunology seems to shed new light on one potential root of the problem: antibiotics.

Consider this common scenario: A six-month-old infant with a high fever and extreme irritability is brought to the pediatrician. The doctor examines her and sees a red tympanic membrane with fluid. The mother is desperate to relieve her child’s pain and suffering. The pediatrician wants to help and doesn’t want to miss a possible bacterial infection, despite the likelihood that the infection is viral. More often than not, the parent leaves with an antibiotic prescription. In medical practice, we are constantly faced with balancing risks and benefits, as well as attempting to perfect the art of doing good while upholding the oath to “do no harm.”  As we all know, this is a delicate balance. In order to maintain it, we have to keep ourselves constantly informed. The article cited above provides new and valuable information about the risks inherent in the above scenario. Here is the basic rundown …

Drs. Ong and Umetsu conducted a study on infants receiving antibiotics in the first year of life. The result: the antibiotic-receiving infants had double the incidence of asthma before three years of age. In addition, there appeared to be a dose-dependent relationship: the more antibiotic given, the more likely the child would develop asthma. Clearly, antibiotic usage in early infancy comes with risks. The explanation for the results lies in the alteration of the child’s microbiome. Antibiotic-induced biome alteration poses a concern for the development of atopy.

Where does this leave us in terms of treating infants with infections? As is so often the case, the key to the answer is patient/parent education. While effective for bacterial infections, antibiotics have no place in treating a child with viral infections — or allergic asthma. Doctors and parents need to be on the same page realizing that the best therapy for these young patients in the absence of definitive diagnosis of bacterial infection is close observation and supportive care. So many viral illnesses are self-limiting; a few days of rest and fluids go a long way. Powerful, broad-spectrum antibiotics are definitely not the answer to viral infection or allergic disease. Sometimes the parents just need an answer. While the febrile patient is clearly suffering from more than allergic disease, allergic inflammation sets up the ideal environment for infectious proliferation. The best thing you can do is definitively identify allergic children when they are not suffering from an acute infection.

Proper management of allergic disease, including avoidance where possible, appropriate medication use, and immunotherapy when indicated, can keep them well. A patient’s medical history is tremendously important in making the diagnosis of allergy, but a definitive IgE test is an equally important piece of the puzzle. If he or she has allergies or has asthma, if a parents smokes in the home, or if a pet lives in the house, allergies should be considered as the cause of the child’s problems. NIH guidelines indicate that all persistent asthmatics should be tested for allergic triggers and offered immunotherapy if indicated.

A new era in medicine is being ushered in, and the finding that antibiotic use in infancy increases the risk of asthma may be only the tip of the iceberg. Modern doctors must choose our treatments with care.

– Dr. Dean Mitchell

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Is the Pollen Count Helpful in Medical Practice? Yes and No.

Millions of grains of pollen, in this case from a cottonwood tree, can easily fill the air and travel great distances when picked up by the wind.

Now that the weather has turned warmer and more pleasant, TV news anchors and meteorologists need something other than the weekly snow fall and deep freeze to grab your attention. Enter the pollen count. During the spring months, when trees and grasses release their pollen, official pollen counts get a lot of attention. This isn’t news to you. What you may not know is that in most areas of the country, the publicized pollen counts may be at least partially inaccurate.

In fact, the graphs and numbers reported on television, radio and the internet might actually be yesterday’s news. That’s because, in many cases, the pollen stations report collections from the previous 24-72 hours. You might then ask yourself “why would I read yesterday’s news?” The answer is two-fold. (1) As with weather forecasts, history is used to forecast changes in pollen concentration.(2) Yesterday’s pollen may be at the root of today’s sick visits. That said, you should always remember that a forecast is nothing more than an educated guess. That guess is not only as variable as the weather forecast, but it is highly affected by frequent and unexpected fluctuations in weather. allows you to type in your zip code and retrieve just such a forecast. Whether or not the forecast is completely accurate, the site does do a nice job of revealing individual pollens that are prevalent in your area. It also provides excellent graphics that reveal pollen sources. Both are valuable features. Reviewing the individual tree pollens is particularly interesting, as the data indicates that while many trees cause allergic symptoms, not all achieve high pollen counts.

For even more specific — and potentially more accurate — data, find out if hospitals in your community have a certified pollen and mold counting station. In my area — New York/New Jersey — we have an excellent one,, which reports daily on weekdays. Like, they provide ranges of pollen units classified as low, medium or high to make it easy for patients to understand the basic pollen outlook for the day.

So what is the best way for you to use the pollen count in your office? It is a good idea to print pollen counts from reliable sources and post them in your office each day where they are easily viewed by both patients and staff. This “in-your-face” technique can often help everyone connect the dots. Once the patients understand the connection between their symptoms and the pollen counts, they are less likely to come to you with the complaint of “sinus infection” in search of an antibiotic, and more likely to come with the expectation of a diagnosis and treatment plan for their allergic disease.

I’m sure you have some of those super-sensitive allergic patients whose nose and eyes seem like radar detectors for increased pollen levels. The moment the levels rise, these patients are at your doorstep with their rhinorrhea, conjunctivitis, sinusitis and tight chests. In my practice, these canary-in-the-coal-mine patients serve as my own reminder to begin collecting information from my local pollen count stations to see if they match up with each patients’ specific allergy test results. If a patient’s tests results indicate allergy to Birch, Oak, Maple and Elm trees, for example, and the pollen count is high for one or more of these trees, then I know targeting her treatment will be relatively easy. However, it is important to figure in the potential combination of that tree allergy with grass allergy, along with the other allergenic elements affecting the patient. The person who has been suffering with tree pollen allergy in April and then gets hit with the double whammy of grass pollen on top of that in May is one you know you will see repeatedly with multiple allergy-related issues…. until you get her or him on immunotherapy.

Pollen is not just pollen — it’s important to identify the real culprit. Targeted allergen immunotherapy, with either shots or drops, can prevent future seasons of suffering. The AllerVision program is designed to help you test for all of the relevant pollens in your area of the country and then to order a treatment set that provides relief and protection.

Again, an accurate pollen report posted daily in clear view can serve as a valuable resource in your practice. For most patients, it’s an education tool. But some patients tend to go into a panic immediately upon report of high pollen counts. I hear them cry, “I’m moving to another state to get away from this pollen.” Unfortunately, as we have all learned, there is almost nowhere left to run. Even Arizona, once a haven for allergy sufferers, has become a massive pollen breeding ground. Sufferers migrating from the southern and eastern states brought their allergenic plants with them and turned wide open spaces into golf courses. Therefore, a more sound recommendation for these patients is to plant only female trees around their home because they do not produce pollen. Of course, allergy sufferers have no control over the neighbors’ yards. The best advice: give serious thought to allergy immunotherapy for a lifetime of protection.

– Dr. Dean Mitchell

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