rhinitis, better known as hay fever, is one of the most common chronic
illnesses and is estimated to affect 20% or more individuals at some point in
time. An allergy can be considered an exaggerated immune response where the
body is trying so hard to keep the allergens out that undesirable symptoms such
as sneezing, rhinitis, congestion, and wheezing occur. Allergic
triggers include seasonal pollens and year-round allergens such as house dust
mites, mold, and animal dander.
sufferers also suffer from asthma. Upwards of 70% of all asthmatics have
underlying allergies. In children, the numbers are even more staggering as
80-90% of asthmatic children are allergic. Conversely, allergic children have a
40-60% risk of asthma. Allergies also can negatively impact quality of
life with malaise, fatigue, loss of sleep, and loss of school and work
days. The resulting expenses for treatment and lost wages are very
substantial, ranking high on the list with medical expenditures.
many allergy and asthma patients respond well to symptomatic treatment and
avoidance. Education about allergen avoidance and control and the ongoing
use of an effective medication can lead to excellent results for many.
patients for whom conservative treatment proves inadequate because of severity,
chronicity, and complications, an evaluation by a board certified allergist is
in order. An allergist will use a thorough history and exam to establish
the best available options for treatment. When indicated, allergy skin
tests identify specific sensitivities to seasonal and perennial
allergens. Such testing provides the most cost effective answers, which
can then be correlated with that particular patients’ history and physical
In a patient
with such severe chronic respiratory allergy, subcutaneous immunotherapy (SCIT)
or “allergy shots” may offer the best opportunity to modify, in a sustained
fashion, the underlying problems. SCIT helps up to 80% of pollen allergic
and 60-65% of environmentally allergic patients. By a variety of
mechanisms, SCIT teaches the body to “block” or decrease the exaggerated immune
In the office,
this process takes place by formulating an allergen vaccine targeted against a
person’s allergy triggers. Initial doses are very small and administered in
increasing doses. As the dose is increased, the immune response begins to
change. After a build- up period, immunotherapy is continued at a targeted
optimized dose every 2-4 weeks for a 3-5 year course.
have been shown to result in less symptoms, severity, and complications of both
asthma and allergies over time. Additionally, successful SCIT leads to less
need for medication and less need for medical attention.
medications for allergies and asthma are very effective in treating the
symptoms and preventing asthma flares. However, they do not alter the
underlying cause of asthma. When the medicines are stopped, allergy and asthma
This is one of
the key differences between immunotherapy and other treatments. By
fundamentally changing the immune process to underlying allergies and asthma,
immunotherapy can change the disease process. After 3-5 years of immunotherapy,
many patients are able to stop allergy shots and their symptoms remain
controlled without more medication.
children, allergy shots may also prevent the development of new allergies and
asthma. One study by DeRoches, et al showed that children on SCIT were much
less likely to develop new allergies after 3 years. The Prevention of Asthma by
Immunotherapy (PAT) study also showed that immunotherapy can prevent the
development of asthma in allergic, at-risk children. Children receiving
immunotherapy were 48% and 60% less likely to have developed asthma at 3 and 5
years respectively than the children who did not receive SCIT.
By its nature,
immunotherapy carries with it the risk of allergic reactions. While most
reactions are localized with some swelling, itching and pain, more severe
allergic reactions can occur. Immunotherapy, therefore, should always be
administered in a doctor’s office and patients should be monitored for 30
minutes after all injections. Fortunately, these reactions are rare and Allergy
Partners strives to ensure the safety of all patients.
Learn more about
immunotherapy by contacting your trusted Allergy Partners Allergist.
In the News:
Study shows second severe reactions can occur hours to days
after an initial allergic reaction and occurs in up to 15% of children.
We all know how scary an allergic reaction can be,
especially if it occurs in a child.
New research in children shows it is even more important to
be prepared to treat the initial reaction aggressively and to be prepared to
treat what is known as a secondary or delayed reaction. Delayed reactions occur
when the initial reaction is treated and the symptoms resolve but then return
hours to days later.
A recent study looked at records of children who were seen
in emergency departments for anaphylaxis (significant allergic reactions) to
find out how often a second reaction occurs.
In about 75 percent of the delayed reactions, the second
reaction occurred within 6 hours of the initial allergic reaction but could
occur up to days later. The children more likely to have a delayed reaction
usually had more severe initial reactions requiring more than one dose of
epinephrine. At least half of the delayed reactions were serious enough to
require another dose of epinephrine.
The take home messages: Be prepared with at least 2 doses of
epinephrine if you are your child are at risk for a serious allergic reaction.
Remember to use the epinephrine early. Do not wait for life threatening
symptoms to occur to use epinephrine as an allergic reaction can be fatal.
Don’t be afraid to give the second dose of epinephrine if symptoms are not
improving or progress on the way to the emergency department. If you are not
admitted to the hospital for your allergic reaction, be prepared for a
secondary reaction by having more epinephrine available.
Inspired by one of our
favorite television shows, Allergy Myth Busters looks at a number of popularly
held beliefs about allergy. But are these myths just urban legends or are they
The use of local grown
honey can help relieve symptoms of allergic rhino-conjunctivitis and
associated atopic (allergic) conditions including asthma.
What does the science say:
A literature search returns
very few articles specifically addressing and using locally grown honey. A
study published in the Annals of Allergy, Asthma and Immunology in February
2002 negates the benefits of local grown honey. The study followed a cohort of
64 people randomly assigned to one of three groups, with the first receiving
locally collected, unpasteurized, unfiltered honey,
the second nationally collected, filtered, and pasteurized honey, and the third, corn syrup with synthetic honey flavoring. They were asked to consume one
tablespoonful of honey or substitute daily and to follow their usual standard
care for the management of their symptoms. Neither honey
group experienced symptom relief when compared to the placebo group.
To the contrary, a study in
the International Archives of Allergy and Immunology in May 2011 appeared to
show a benefit. In this study, Forty-four patients with physician-diagnosed
birch pollen allergy consumed either no honey, regular honey or honey to which
birch pollen was added (birch pollen honey or BPH) in incremental amounts from
November 2008 to March 2009. At the conclusion, patients in the first 2 groups
experienced no improvement of symptoms but the BPH group experienced a
statistically significant improvement in symptoms scores.
So is the myth busted or
Essentially both articles are
supporting the same conclusion i.e. locally grown honey is not beneficial for
allergies. How so? Obviously in the first article there was no benefit obtained
in the group consuming locally grown honey but the same result was actually
shown in the second study. If the honey was not doctored with additional birch
pollen, symptom improvement DID NOT occur.
Despite this, the second
article is often cited as being beneficial in lay publications and websites
promoting organic or naturalistic methods for treating allergies. They appear
to ignore the fact that birch pollen HAD TO BE ADDED. The first article is cited
often as being outdated or old and therefore given no credence, which is
foolish. Otherwise most of what's available is purely anecdotal with little
factual evidence supporting the claim. Surprisingly, some websites purport the
benefit but contradict their own anecdotal evidence.
Remember that bees are in the
business of collecting a flower's nectar, not pollen to produce honey.
Therefore very little pollen is deposited in honey. Also, the pollen they
handle is produced by flowers that require cross pollination by insects unlike
the majority of allergy triggering tree, grass and weed plants that do not
require insects to carry pollen for fertilization. They produce huge amounts of
pollen and depend on the wind for distribution/pollination. They don't need the
bees. Yes some of the allergen inducing pollen grains end up in the honey but
they are in insignificant quantity.
Final thought :
Remember if you are
experiencing difficulty with allergy, your local Allergy Partners specialist is
available to administer immunotherapy which utilizes a natural pollen extract
to alleviate symptoms. It is the only modality proven to statistically reduce
the progression of atopy and potentially reverse the allergic IgE mediated
mechanism preventing asthma and the progression of allergy. Also, the
consumption of locally grown honey is fine, but should not be given to infants
under 12 months of age. Diabetics will likely have difficulty with blood
glucose control and if a person is allergic to bee venom they may be at an increased
risk of developing anaphylaxis to locally grown honey.
Was the death of a pharaoh the first report of an insect
In 1989, an article in Hospital Practice by Ovary
stated that the death of Pharaoh Menes after a wasp sting in 2600 BC was the
first reported account of an anaphylactic reaction to insect stings.
According to Krombach,
this was based on hieroglyphs found on his sarcophagus and tomb. Dynasties that
came after Menes believed him to be the first Pharaoh and he is credited with
many things, including the introduction of papyrus and writing. But Krombach and his fellow authors
argue that he was likely a mythical figure who may not have even lived.
Oh well -- so much for exotic origins. No matter when the first reaction
was, it is likely that insect sting allergy started a very long time ago.
A review article in the June
2015 Journal of Allergy and Clinical Immunology In Practice spoke about the
state of the art in treating stinging insect allergy. Reactions to stinging
insects account for 10% of all cases of anaphylaxis presenting to emergency
rooms and there are about 40 deaths per year in the US due to these reactions.
The estimate is that 0.4% to 0.8% of children and 2% to 3.5% of the general
adult population experience systemic reactions to insect stings at some point
in their lives.
The Hymenoptera are the most
studied stinging insects, with purified, commercial venoms for testing and
treatment in the United States. Hymenoptera include the Apidae (honeybee) and
Vespidae (aerial yellow jacket or New World hornets) which include Vespinae
(yellow jackets and aerial yellow jackets) and Polistinae (wasps). There are
also a number of types of stinging ants. The most common in the US and best
studied is the Imported Fire Ant (IFA), Solenopsis invicta. Since
inadvertent importation through Mobile, Alabama during 1930-1940, this fire ant
has spread throughout the Southeast of the US as far north as Maryland and even
into the arid southwest.
A new type of inhaler is now available to deliver albuterol
for patients with asthma or reversible COPD. The inhaler is called
ProairRespiclick and is available for patients 12 years or older to treat acute
symptoms of airway constriction (bronchospasm) or as prevention of exercise
induced asthma symptoms. Most patients refer to albuterol inhaler as the
“rescue” or “emergency” inhaler.
Current albuterol inhalers (Ventolin, Proventil, Proair HFA)
are all aerosol propelled meter dosed inhalers that most patients need a spacer
or holding chamber to deliver medicine effectively. Respiclick inhaler is
a dry powder inhaler and requires no spacer. The medicine is released and
delivered into your lungs by your own breath effort (breath-actuated).
This eliminates the need to coordinate dispensing the medicine with breathing
in the medicine. This step frequently results in poor delivery of the
medicine from traditional inhaler into your lungs.
There are 200 doses per inhaler with dose counter to track
doses remaining. No priming is required that would result in lost
doses. Respiclick must stay dry at all times. Patients with severe
cow’s milk allergy may not be candidate for this inhaler. Consult your
Allergist to see if dry powder albuterol inhaler is right for you. Dosing
directions and training on how to use this new style inhaler will be necessary
to discuss with your doctor. Opening the mouth piece guard will generate
a “click” and load the albuterol to inhale from the Respiclick. Educating
patients with asthma on how and when to use their inhalers is a critical
feature to a successful asthma management plan developed by Allergy Partners
physicians, nurses, and asthma educators.
Inspired by one
of our favorite television shows, Allergy Myth Busters looks at a number of
popularly held beliefs about allergy. But are these myths just urban legends or
are they true?
Myth: Some breeds of dogs are hypoallergenic,
so dog allergic patients can tolerate having these dogs in the home.
For many of us dog
allergies interfere with our love for these furry companions. Exposure to the
allergens from our beloved pets can lead to nasal, eye, skin and breathing
symptoms which can make life miserable. That makes the innovation of the
“hypoallergenic” dog an amazing breakthrough! Unfortunately what is well known
to allergists is that the existence of a hypoallergenic dog is a MYTH.
In a study
published in 2012, investigators from the Utrecht University in the Netherlands
compared Can f 1 levels (the major dog allergen) in the pet hair/coat samples
and the home environment of various alleged hypoallergenic (Labradoodle,
poodle, Spanish Waterdog, and Airedale terrier) and non-hypoallergenic dogs
(Labrador retriever and a control group composed of 47 different
non-hypoallergenic dog breeds and several crossbreeds.)They found that that Can
f 1 levels in hair and coat samples were related to the breed, BUT there was a
high variability within individual breeds. Can f 1 levels were significantly
higher in hair and coat samples in dog breeds considered hypoallergenic thus
they are not less allergenic than any other dogs. Similar findings were
published in another study from 2011 which examined dog allergen levels in
homes of hypoallergenic versus non-hypoallergenic dogs. It, too, showed that
there was no evidence of decreased shedding of allergens by dogs grouped as
The myth of the
hypoallergenic dog has been debunked. For those people who do suffer from dog
allergy, this does not mean that they have to get rid of their pet. Those
people who don’t want to give up “man’s best friends” can always try allergy
medications or be evaluated for immunotherapy/ allergy shots. If you
suffer from allergies to your pets, Allergy Partners can help you find relief.
Vredegoor DW, Willemse T, Chapman MD, Heederik DJJ, Krop EJM. Can f1 levels in
hair and homes of different dog breeds: lack of evidence to describeany dog
breed as hypoallergenic. J Allergy ClinImmunol 2012;130:904-9.
Nicholas CE, Wegienka GR, Havstad SL, Zoratti EM, Ownby DR, Johnson CC.Dog
allergen levels in homes with hypoallergenic compared with nonhypoallergenic
dogs. Am J Rhinol Allergy 2011;25:252-6.
Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?
Radiocontrast media reactions are related to shellfish allergy.
Patients with a history of allergy to shellfish are not at increased risk for anaphylaxis from iodinated contrast media. This myth stems from the false assumption that an iodine allergy is the common cause of contrast media and shellfish allergy. In fact, iodine is not an allergen and is structurally unrelated to the tropomyosin proteins which can cause anaphylactic reactions to shellfish. Although it is clear that contrast media can cause a variety of reactions, the mechanism of most of these is poorly understood and is not due to ‘iodine allergy’. Individuals with any allergic condition are at higher risk of contrast media reactions, regardless of a history of allergy to seafood. Fortunately, reactions to contrast media are quite low.
In some patients scheduled for procedures using contrast dye, precautions should be taken, such as premedication with antihistamines or steroids or using low osmolal contrast material (LOCM) agents. So who deserves these precautions? Empiric use of LOCM agents for all intravascular procedures has become widespread and has largely eliminated the need for premedication. In settings where LOCM agents are not routine, nonionic LOCMs or iso-osmolal agents should be considered for patients with asthma and patients taking beta-blockers, interleukin-2, or NSAIDS (eg. Aspirin, ibuprofen). In addition, nonionic LOCM agents should be considered in patients with a previous history of serious reactions to radiocontrast media, patients receiving contrast by power injector, or any other circumstance in which the clinician believes that it is indicated. In the absence of a history of immediate hypersensitivity reactions to contrast media in the past, empiric premedication with antihistamines and steroids is generally not indicated.
American College of Radiology Committee on Drugs and Contrast Media. ACR Manual on Contrast Media, 5th ed, American College of Radiology, Reston VA 2004. p.5.
Solensky R, Khan DA. Drug Allergy: an updated parameter. Ann Allergy Asthma Immunol. 2010 Oct;105(5):259-73.
Greenberger P. Prophylaxis against repeated radio contrast media reaction in 857 cases. Arch Intern Med. 1085;145:2197-200.
Lang DM, Alpern MB, Visintainer PF, Smith ST. Elevated risk for anaphylactoid reaction from radiographic contrast media associated with both beta blocker exposure and cardiovascular disorders. Arch Intern Med. 1993;153:2033-40.
Allergy immunotherapy, more commonly referred to as
allergy shots, is the most effective treatment available for environmental
allergies. By reducing your reactions to pollens, pet dander, molds and dust
mites, allergy shots reduce symptoms and your need for medication. While
it is a highly effective treatment, immunotherapy does not contain medication
and is composed of natural protein extracts from allergens. By giving gradually
increasing doses of the allergen, immunotherapy teaches your immune system to
tolerate exposure to the allergens in the environment. It is highly effective
in treating sinus and eye symptoms along with asthma, sinusitis and allergy
induced eczema. To assure that proper treatment is provided, immunotherapy
should always be prescribed by a board certified allergist. Certification by
the American Board of Allergy, Asthma and Immunology assures that your doctor
has received at least 2 years of additional training specifically in treating
allergic diseases. Only through this intense training can a doctor gain
full knowledge of immunotherapy treatment.
While immunotherapy is the cornerstone of the allergy
specialty, not all allergy shots are created equally. Allergy Partners strives
to provide the most effective, safe and cost effective care possible.
Allergy Partners was founded on a simple premise: by working together, allergists
can identify and implement best practices, which will result in improved
patient care. By following this premise we have grown to over 100 allergists
across the United States, and our shared knowledge and experience is
unsurpassed in allergy and asthma care. We have applied this knowledge to
create a state of the art immunotherapy program. To produce optimal results,
immunotherapy protocols must follow national guidelines which are based on the
latest research. These guidelines include proper patient selection, allergy
testing, and immunotherapy dosing. As the leader in allergy and asthma
care, Allergy Partners has compiled the largest collection of data and
information about allergy shots in the world. We are continually utilizing this
experience to further improve patient care. Furthermore, our Clinical
Excellence committee continually reviews the medical literature and assures
that our treatment program is state of the art.
The Allergy Partners immunotherapy protocols strictly
adhere to national practice guidelines and were developed in collaboration with
nationally recognized experts. To maintain the highest quality standards
throughout the immunotherapy treatment process, we compound our immunotherapy
extract at our centralized lab in Asheville, NC. Our lab was planned and
built in collaboration with industry experts and the FDA Center for Biologics
Evaluation and Research. Today we produce over a quarter of a million vials
annually of the highest quality allergy extract possible. Allergy
Partners extract labs strictly follows USP 797 guidelines for sterile
allergenic extract processing, and it is through this attention to detail that
we can provide you will be provided safe and effective treatment.
We invite you to learn more about
Allergy Partners, the conditions we treat and our immunotherapy treatment
program by browsing our website or contacting your local Allergy Partners
Previous research indicates that women tend to experience
more severe allergic reactions - anaphylaxis – than men. The reason behind this
has remained somewhat of a mystery, however, a new study published in The
Journal of Allergy and Clinical Immunology suggests estrogen could be to
blame. Researchers from the National Institute of Allergy and Infectious
Diseases have explored sex-dependent differences in a mouse model of
anaphylaxis to explore how female sex hormones, estrogen, may be involved.
In this study, anaphylaxis was induced in both female and
male mice by using histamine, as well as Immunoglobulin E (IgE) and
Immunoglobulin G (IgG) receptor aggregation. Anaphylaxis was assessed by
monitoring body temperature, release of mast cell mediators, and lung weight.
Researchers were able to observe that female mice experienced
anaphylaxis that was more severe and lasted longer compared to their male
counterparts. This enhanced severity was eliminated after pretreatment with an
estrogen receptor antagonist or ovariectomy. They found that estrogen
influenced blood vessels and enhanced the levels and activity of endothelial
nitric oxide synthase (eNOS), an enzyme that drives anaphylaxis. When eNOS
activity was blocked, the gender difference disappeared. When they blocked
estrogen in female mice, this decreased the severity of their allergic
This study demonstrates a link between estrogen and eNOS in
severe allergic reactions in female mice. The results may shed light on why
women have more severe allergic reactions than men, however, further research
is needed to determine whether there is a similar effect in humans.
Estrogen increases the severity of anaphylaxis in female mice
through enhanced endothelial nitric oxide synthase expression and nitric oxide
production, Valerie Hox, et.al.,The Journal of Allergy and Clinical
Immunology, doi:https://dx.doi.org/10.1016/j.jaci.2014.11.003, published 29
Partners physician would likely respond to the above statement with a cautious
“maybe.” Hives, like many of the responses of the body, can be caused by
many stimuli, not just allergies. Take, for instance, the similar example
of sneezing. Sneezing is a common allergic symptom; however, we all know
that non-allergic stimuli can cause sneezing, from infections due to the common
cold to irritants in the air (pepper, for example). In a likewise fashion,
hives can be due to allergic and non-allergic causes.
Partners doctor will take a careful history and perform a thorough examination
when considering whether your hives are due to an allergic reaction. Be
prepared to answer questions on how long your symptoms have lasted, any recent
exposures to new foods or medications, and whether you have experienced any
If you have had
hives almost daily for six weeks or more, your allergist may use the term
“chronic” to describe your condition. Hives lasting less than six weeks
are called “acute”. The distinction between “acute” and “chronic” is
important, as acute hives are more frequently associated with identifiable
causes. If supported by the details of your history, allergy testing may
be helpful in identifying causes of acute hives.
non-allergic conditions have been reported to be associated with chronic hives,
including various infections, connective tissue diseases, thyroid dysfunction,
and endocrine disorders. If your symptoms do not readily suggest one of
these conditions, extensive laboratory testing is not typically warranted or
necessary. Extensive testing is not cost-effective and does not appear to
improve patient outcomes. In light of an unremarkable clinical history
and physical examination, laboratory evaluation and allergy testing rarely identifies
a cause for chronic hives.
Hives can be
incredibly uncomfortable and frustrating. Hives typically improve with a
regimen of antihistamines, regardless of the cause. For cases of chronic
hives that do not respond to antihistamines, alternative treatments are
available. A newly approved approach to chronic hives utilizes the medication
Xolair (omalizumab). This medication was initially developed for patients
suffering from moderate to severe allergic asthma, but has shown to be
effective in chronic hives. With your input, your Allergy Partners physician
can decide what testing and treatment options are best for you.
Welcome to our blog site! Stay tuned to get the latest news. We will share tips and techniques for living with and managing your Allergies & Asthma. We look forward to sharing useful resources with our patients!