| Exercise-Induced Asthma
Do you have problems with coughing, wheezing, or chest tightness when you exercise? Do you feel very tired and short of breath when you exert yourself? Some people wrongly believe that they are just out of shape when, in fact, they may have exercise-induced asthma. About 18 million Americans have asthma and, of those, 80% will have increased symptoms with exercise. In non-asthmatics, up to 15% experience asthma symptoms with exercise and 40% of people with nasal allergies may experience exercise-induced asthma symptoms.
What is Exercise-Induced Asthma?
Exercise-induced asthma (EIA) is a reaction of the lungs caused by exercise. The bronchial tubes become irritated and constrict, also known as bronchospasm. Excess mucus is also formed contributing to the blockage of the airway and congestion. It is thought that when you exercise the airway is cooled and dried rapidly which sets off the reaction in some people. Although chronic asthma sufferers are more likely to have EIA, the presence of EIA does not lead to chronic asthma.
Symptoms and Triggers
Symptoms of EIA include shortness of breath during or after exercise, coughing, wheezing, chest tightness or pain, and extreme fatigue. Symptoms usually start within 5-20 minutes after starting exercise and may last for 30-60 minutes. Sometimes symptoms start only after activity has stopped however. “Locker room cough”, or a cough that occurs after exercise, is a common form of exercise induced asthma. Shortness of breath, from poor conditioning, usually resolve within a few minutes of rest. People with EIA are overly sensitive to sudden changes in temperature and humidity. Colder, drier air is usually more of a problem. Nasal breathing helps warm and humidify the air you breathe so mouth-breathing with exercise reduces the moisture and humidity of the air that reaches your lungs. Air pollution, high pollen counts, and viral upper respiratory infections can also worsen wheezing with exercise.
Diagnosis
You should talk to your doctor if you think you may have EIA. You will need a good history and physical which often leads to the diagnosis. You may have a resting lung function test to make sure you have no chronic asthma. You may also have a breathing test after exercise, although this test may not be positive in everyone with EIA. A trial of bronchodilator therapy prior to exercise may be used to help determine whether you have EIA. Chest pain may be a symptom of EIA, but it is important for your doctor to rule out cardiovascular disease as well.
Treatment and Practical Tips
There are things that you can do to reduce the chance of having symptoms. Staying out of cold, dry air is a big factor so train indoors if possible. If you do exercise in the cold, try to breathe through the nose as much as possible, wear a mask or scarf, and avoid exercise in the cold if you have a respiratory infection. Warming up 45-60 minutes before training or playing may help. Taking frequent, short breaks can help. Avoid training or playing outside on days with high pollution or pollen counts. Certain sports are tolerated more than others. Swimming is usually tolerated well due to the humidity of a pool. Lower intensity sports like golf, baseball, and weight lifting are better tolerated. Sports with short bursts of energy such as baseball, football, wrestling, gymnastics, and short-term tack events are better tolerated than soccer, basketball, hockey, skiing, and long-distance running. Always have your asthma medications with you!
The first step of treatment is the use of an inhaled short-acting bronchodilator medicine 15-20 minutes before exercise. These include albuterol, pirbuterol, and levalbuterol and are effective in 80-90% of patients, have a rapid onset of action, and last for 4-6 hours. If symptoms are not controlled by these short-acting medications, a daily medication may have to be used to prevent inflammation and responsiveness of the airway.
Most importantly, you should be evaluated and continue to exercise. Exercise and training will improve fitness, reduce the amount of breathing needed with exercise, and allow you to exert yourself at a higher intensity before symptoms begin.
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| Well, our new PA, Charity Turner has been with us almost a month now, and is quickly become a member of the AP Blueridge family.
With another provider here we are able to get patients seen more quickly even in this busy time of year for us. We are also extending our shot clinic hours beginning the week of May 20th. Below are the shot clinic hours:
Monday 8:30-11:30 and 1:00-4:30 pm
Wed 11-5:30pm
Friday 8:30-11:30 and 1:00-4:00 pm
We will also be extending our office hours. We will now be seeing patients on Tuesday afternoons and Charity will see patients in the Morganton office on Thursdays 8-5 and Fridays 8-5.
~Be Happy, Be Healthy, Breath Easy~ |
| Allergy Partners of the Blueridge is excited to welcome our new provider, Charity Turner, PA. Charity comes to us from Greenville, SC where she has been working at an Urgent Care there. She will be starting with us on April 17th. Feel free to read a little bit more about her on our website under Meet our Providers.
Having another provider in our office is going to allow us to extend our hours, including our shot hours. Beginning mid-May, our shot clinic will be open on Fridays now as well from 8:30-4:00. We will be taking an hour lunch mid day so that our staff can take lunch breaks.
Help us welcome Charity to the area. And we are sure you will enjoy meeting with her. |
| What is Eye Allergy? Eye Allergy, also known as Allergic Conjunctivitis, is a very common disorder affecting millions of people every year. The conjunctiva is the mucous membrane covering the whites of the eyes and the inner side of the eyelids. If something irritates this clear membrane, the eyes may water, itch, hurt, or become red and/or swollen. There are many causes of conjunctivitis, including viral and bacterial infections. However, 50% of conjunctivitis cases seen by primary care doctors are allergic in nature. Eye allergy can occur alone or along with nasal allergy symptoms such as sneezing and stuffy nose.
What causes Eye Allergy? In an allergic person, the immune system identifies common airborne materials as invaders, or allergens. On contact with these allergens, the immune system reacts and releases a variety of chemicals, including histamine, that cause the symptoms of allergies. In those with Eye Allergy, allergic triggers can be present indoors and outdoors. The most common outdoor allergens are grass, tree and weed pollens that will cause symptoms during particular times of the year. Indoor allergens are pet hair or dander, dust mites and mold and can cause year round symptoms.
What are the symptoms of Eye Allergy? The most common symptoms of Eye Allergy include redness, watery discharge, and itching of both eyes. Other symptoms include burning, sensitivity to light, and swelling of the eyelids. Both eyes are generally affected, although symptoms may be worse in one eye. Rubbing of the eyes can exacerbate symptoms. Many people will also have other allergy symptoms, such as sneezing and a runny nose.
Can Eye Allergy Harm my Eyesight? Eye Allergy can be very uncomfortable and may disrupt your day to day activities, but usually does not permanently harm your eyes. However, there are rare conditions associated with atopic dermatitis and other diseases that can cause inflammation that could affect the eyesight.
How is Eye Allergy treated? The first line of treatment to ward against developing Eye Allergy is to identify and then avoid allergy triggers. Allergen skin testing is a quick and accurate test that will identify the particular allergens that trigger eye allergies. Once these triggers are identified, you can take environmental control measures to minimize your exposure. This includes:
- staying indoors when pollen and mold counts are highest.
- showering after playing or working outside.
- keeping house and car windows closed and using air conditioning.
- don't allow pets in the bedroom.
- wash bedding and stuffed toys in hot water frequently.
In addition, your Allergy Partners physician can prescribe medications that will help soothe and alleviate Eye Allergy symptoms. Allergy injections, or immunotherapy, is very effective therapy to help protect against the allergens causing your Eye Allergy.
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| State laws protect students diagnosed with asthma and anaphylaxis. They have the right to carry and if needed, use prescribed lifesaving medications at school. They should be taught from a young age to keep these medications nearby everyday.
A growing number of states are strengthening anaphylaxis preparedness policies to protect students whose first severe reaction happens at school. Is your school ready? Are YOU ready?
What would YOU do if suddenly responsible for a student whose lips and tongue are red and swelling? Or when a student is covered in hives and gasping for air?
School policy and training programs should answer those questions before faced with the situations. You won't have time to run to the clinic and search for the student's health records. No time to second-guess the consequences of using another student's epinephrine auto-injector. No time to call 911 and the parents.
Allergy & Asthma Network Mothers of Asthmatics (AANMA) supports state laws requiring all schools to establish and enforce anaphylaxis preparedness programs consistent with the Guidelines for the Diagnosis and Management of Food Allergy in the US: Report of the NIAID-Sponsored Expert Panel.
AANMA encourages schools to stock emergency epinephrine auto-injectors. Check manufacturere websites for free and discount progrmas offered to schools that stock epi-pens for use in emergencies.
--Allergy & Asthma Today, 2013 Special Edition |
| Spring is on the way according to the groundhog!! And with that, we'll be out cleaning up our yards, and starting to enjoy the outdoors again. Our little insect friends will be waking up as well, so let's be ready with what to do if we are stung.
First of all, flick the insect away from your skin. Don't swat at it like you would a mosquito.
Walk (don't run) away from the area. Some bees will feel threatened by quick movements, but also, running increases your heartrate, which could in turn increase how quickly your body absorbs the venom.
If you notice a stinger still in your skin (teltale sign of a honey bee), use a credit card or some other flat surface to scrape it off your skin. Using tweezers of your fingers may only squeeze more venom into the sting site.
Apply ice to reduce the swelling. Expect to see redness and swelling at this site.
Watch for these symptoms indicating an anaphylactic reaction:
-hives or generalized itching other than at the sting site.
-swelling of the throat or tongue
-difficulty breathing
-dizziness
-severe headache
-stomach cramps, nausea or diarrhea
These symptoms indicate need for immediate use of your epinephrine auto-injector followed by medical assistance at the ER or Urgent Care.
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| Have you been wondering why we ask you to wait for 30 minutes after we give you your allergy shot?
Allergy shots can provide long-lasting relief for people with allergic asthma, allergic rhinits and stinging insect allergies. However, allergy shots can also lead to an anaphylactic reaction.
This is the reason that we ask you to wait for 30 minutes, to be sure that if you have a reaction, it can be treated safely and quickly. Your doctor may also prescribe an auto-injectible epinephrine in case you have a reaction after your office visit.
Some other recommendations that your doctor may make is to avoid any strenuous exercise for several hours after an allergy shot. Exercise speeds your body's absorption of the allergens in the shot, which increases your risk for anaphylaxis. |
| Sometimes anaphylaxis can show up as nonlife-threatening reactions such as itchy rashes, hives or local swelling. Typically, all that is needed to treat these mild reactions are antihistamines.
Other times, reactions can be somewhat more severe, and involve breathing, heart or even digestive system symptoms. It can also cause profuse sweating, dizziness, confusion or a feeling of 'impending doom'. If these types of symptoms occur, it is probably a full blown anapylaxis.
You should: Refer to your anaphylaxis action plan.
Use your Epi-pen auto-injector
Seek Emergency medical treatment or call 911
Epinephrine is the only medication that can reverese the symptoms of this life-threatening reaction. The average time to respiratory or cardiac arrest due to food allergy is 30 minutes, venom allergy is 15 minutes and for drug allergy it is 5 minutes. Take action - don't wait!! |
| Eosinophilic esophagitis (EE or EoE) is a relatively newly recognized disease that has been increasingly diagnosed in both adults and children since 2000. It is characterized by a large number of white blood cells called eosinohils that cause inflammation in the esophagus (the tube that connects the mouth and stomach).
This inflammation prevents the esophagus from functioning normally and leads to symptoms. EoE comonly occurs in people with other allergic diseases such as allergic rhinitis (hay fever), asthma and/or eczema.
Symptoms
Reflux that does not respond to usual therapy:
- Dysphagia (difficulty swallowing)
- Food impactions (food gets stuck in the esophagus)
- Nausea and vomiting
- Failure to thrive (poor growth, malnutrition or weight loss)
- Abdominal or chest pain
- Feeding refusal/intolerance or poor appetite
- Difficulty sleeping
Diagnosis
The only way to definitvely diagnose EoE is through endoscopy with biopsies, usually done by a gastroenterologist. The endoscopy is often performed after treatment with reflux medications have failed to relieve symptoms. During the endoscopy, the gastroenterologist looks at the esophagus, stomach and duodenum (the first part of the small bowel) through an endoscope (small tube inserted through the mouth) and takes multiple biopsies (small tissue samples) which a pathologist reviews under the microscope. A high number of eosinophils (>15 per high power field under the microscope) suggests a diagnosis of EoE.
Once EoE is confirmed, allergy testing is recommended as many patients with EoE have underlying food and possibly environmental allergies that are contributing to the abnormal inflammation seen in the esophagus. The most common type of allergy testing is skin prick tesing, but patch testing to certain foods can be useful as well. In patch testing, a small amount of the food is placed on the skin (usually the back) and covered with tape for 48-72 hours. At that point, the site is assessed for evidence of redness and inflammation indicating food allergy.
Treatment
At present, the two main treatments recommended are dietary management and topical corticosteroids.
Dietary Therapy
Elimination Diets - All "positive" foods on allergy testing are removed from the diet. Often this is the only treatment needed.
Six-food Elimination Diet - Patients eliminate the top 6 most allergenic foods (dairy, eggs, wheat, soy, peanuts/other nuts, fish/shellfish).
Elemental Diets - All sources of protein are eliminated from the diet except for an amino acid (building blocks of protein) formula. These diets are mostly used in young children with EoE.
Food Trials - This involves adding back one ingredient at a time to one's diet to determine specific foods causing a reaction. They begin after symptoms resolve and eosinophils have cleared.
Medications - Medications most commonly include steroids to control inflammation and suppress eosonophils. They can be taken orally ( a form of prednisone) or topically (swallowed asthma inhaled steroid such as fluticasone or budesonide).
How We Can Help
The diagnosis and treatment of eosinophilic esophagitis requires a multidisciplinary team approach involving gastroenterologists, allergists and nutritionists. As part of the nation's largest allergy practice, Allergy Partners' physicians provide the expertise needed to accurately diagnose underlying allergic triggers to EoE. With this information, a personalized and comprehensive treatment plan aimed at alleviating symptoms of EoE can be formulated. |
| Urticaria, or hives, is a common reason to see an allergist. It can be incredibly distressing to be covered with red welts, and the itching can disrupt sleep, school, and work. Hives appear quickly when special skin cells, calledmast cells, are triggered to release chemicals that cause the rash.
Most cases of hives last only a short time and are triggered by allergic reactions, medications or viral infections. Allergic reasctions are possible to foods, bee stings, medications or airborne substances. Hives can also be part of a severe, whole-body allergic reaction called anaphylaxis.
In some people, the skin mast cells can react and cause hives due to pressure, cold, heat, vibration and exposure to the sun or water. Dematographism (latin for "skin writing") refers to hives that pop up for only minutes after a scratch or irritation to the skin.
It is also possible to have hives lasting for weeks or months. This "chronic urticaria" is usually not due to a particular trigger, but instead it can result from abnormal immune reactions involving the mast cell. The severity of chronic hives can be affected by factors such as stress, medications, temperature and illnesses.
It is important to identify the cause of hives if possible, and the first step is a careful interview and physical exam with an experienced medical professional. Episodes of hives due to foods, be stings, medications or allergens can often be sorted out with allergy testing. A simple cause is not often found for chronic urticaria, but laboratory testing can help sort out any source of inflammation or infection that could lead to long-lasting hives.
Once the cause is determined, it is important to avoid the cause of your hives if possible. Hives usually respond to medications that block histamine -- the major chemical released by the mast cell. These "antihistamines" include the commonly used diphenhydramine (BenadrylR), but mild or ongoing cases of hives can also respond to longer-lasting and less sedating antihistamines, such as loratadine (ClaritinR), cetirizine (ZyrtecR) or fexofenadine (AllegraR).
Under the care of an allergist, severe or persistent cases of urticaria can be treated with high dose antihistamines, the addition of other histamine blockers (ranitidine or similar drugs) or the temporary use of corticosteroids (such as prednisone). In severe cases of chronic urticaria, it is sometimes necessary to use other drugs that act on the immune system.
The physicians at Allergy Partners are experts in evaluating and treating the many possible causes of hives and allergic reactions. The evaluation begins with a careful interview and physical exam, followed by any necessary tests. These may include skin testing, which can be done during the initial visit if the patient is not taking antihistamines. For more information on Urticaria and skin testing, please visit our Patient Education page on our website or contact our office.
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| Welcome to our Blog! Stay tuned to get the latest news about our practice. We will share tips for living with and managing Allergies & Asthma. We look forward to sharing with our patients! |
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