SLIT is an alternative method of allergen desensitization in the management of atopic conditions such as asthma and allergic rhinitis, which does not involve a series of injections. The protocol for SLIT involves an allergist determining a patient’s sensitizing allergens, typically by skin testing, followed by small doses of these allergens placed under the tongue daily in the form of tablets or drops. This causes a decrease in the body’s natural production of specific allergic antibody, called IgE.
Though SLIT is widely accepted and standard in Europe, not all SLIT therapy is approved in the US by the Food and Drug Administration (FDA). A tablet form of SLIT for patients with grass and ragweed allergy (GRASTEK, ORALAIR, RAGWITEK) has been FDA approved and is currently available for physicians to prescribe. While yet to be approved by the FDA, sublingual drop therapy formulated by your Allergy Partners physician is available for “off label” use.
Does it Work?
There is mounting evidence that SLIT is an effective treatment strategy in the management of allergic conditions. A recent systematic review in the Journal of the American Medical Association states: “The overall evidence provides a moderate grade level of evidence to support the effectiveness of sublingual immunotherapy for the treatment of allergic rhinitis and asthma, but high-quality studies are still needed to answer questions regarding optimal dosing strategies.”1Though evidence supports SLIT being more efficacious compared to some traditional treatment strategies, it is very clear that subcutaneous injection immunotherapy (allergy shots) is favorable to SLIT in reducing allergy symptoms.
What Are the Side Effects?
In general, SLIT is well tolerated. Patients may have oral itching or mild tongue swelling after the first 3-4 doses. However, these symptoms typically subside. Other potential side effects include: trouble breathing, throat tightness, throat swelling, dizziness, rapid heartbeat, severe stomach cramps, vomiting, diarrhea, and severe flushing of the skin. As there is risk for anaphylaxis, all patients on SLIT therapy should have access to an epinephrine pen and be trained on its use and the first dose of SLIT is administered in a physician’s office.
Is it For Me?
There are certainly advantages to SLIT. Published data does demonstrate clinical efficacy and you can expect to see improvement in your allergy symptoms. For patients with busy schedules, SLIT makes immunotherapy less cumbersome as treatment can be given at home. For children with “needle phobia,” SLIT provides an alternative option to avoid weekly injections. Although allergy shots are the most efficacious form of immunotherapy, there undoubtedly is a role for SLIT in the management of allergic disease. Talk to your Allergy Partners physician about whether SLIT is the best option for management of your allergy symptoms.
1. Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review. JAMA. 2013 Mar 27;309(12):1278-88.
Food allergy is estimated to affect 5 to 7% of infants and 1 to 2% of adults. Currently there is no cure for food allergy and patients must adhere to a strict regimen of dietary avoidance of foods to which they are allergic. Despite the best of intentions, accidental exposure to food allergens remains a significant cause of allergic reactions. To avoid such exposure, food allergic patients and their families rely on food package labels to identify possible triggers.
The Food Allergy Labeling and Consumer Protection Act of 2004 requires packaged foods sold in the United States to clearly list the eight primary food allergens in plain English on the ingredient label. These 8 foods are milk, egg, wheat, soybean, peanut, tree nuts, fish and shellfish. However, for foods that may accidentally contain small amounts of allergens- such as being produced in a factory that handles the allergen- precautionary labels may be applied to food products as well. Such precautionary labeling is neither consistent nor regulated. Food allergic patients have varying levels of tolerance to allergens and such precautionary labels could lead to confusion and unnecessary risk taking behavior.
In January, Medical News Today reported on a study published in the Journal of Allergy and Clinical Immunology (January 2015) by the research team led by Clare Mills, PhD of the Institute of Inflammation and Repair at the University of Manchester in the UK. Researchers sought to better define the threshold doses of 5 major food allergens (peanut, hazelnut, celery, fish and shrimp) in a European population. What researchers were able to demonstrate was that for these foods there is threshold dose below which only 10% of allergic subjects will react. Though more research is needed, such new data could help better identify allergen doses that are safe versus those doses which may trigger a reaction. This information would help improve patient safety through refined product labeling.
These new findings highlight how essential it is for patients with suspected food allergy to be evaluated by an allergist who will not only assess but help minimize the risk for future food reactions.
1. “Study identifies levels at which five foods may trigger allergic reactions” Medical News Today. January 2015.
2. Mills C et al. How much is too much?: Threshold dose distributions for 5 food allergens. J Allergy Clin Immunol 2014, published online January 2015, abstract.
Our office will be opeing at 10 am tomorrow 3/6/15, please continue to check our website and facebook page for any changes.
Due to inclement weather both our Fredericksburg and Stafford offices will be closing at 1pm today.
Peanut allergy can result in severe, and at times fatal, allergic reactions. Unfortunately, peanut allergy has become more and more common over the years. A new study, however, gives hope that early interventions may decrease the risk of developing peanut allergy.
A recent study published in the New England Journal of Medicine suggests that early exposure to peanuts helps to prevent peanut sensitization in high risk children. The study was performed in response to the significant increase in the incidence of peanut allergy worldwide, especially in westernized countries, such as the United States. The most recent recommendations by the American Academy of Pediatrics (AAP) came in 2000, in response to outcomes from infant feeding trials conducted in Europe and the United States. At that time, the AAP recommended refraining from introduction of peanuts to children until age 3. Despite this recommendation, the incidence of peanut allergy continues to rise, and in 2008, the AAP retracted its recommendation due to insufficient evidence. Since that time, multiple observational studies have found that early introduction of peanut protein, as well as cow's milk and egg, result in decreased incidence of these food allergies.
In a new study by Du Toit et al., Learning Early about Peanut Allergy (LEAP), investigators studied over 500 infants at high risk of peanut allergy (severe eczema, egg allergy, or both). Half of the children were randomly selected to consume peanuts and the other half, to avoid peanuts. At age 5, the children underwent peanut challenge to determine if they were allergic. Results indicated that the prevalence of peanut allergy in the peanut-avoidance group was significantly higher at 17.2%, compared to 3.2% in the group that consumed peanuts.
The trial went on to compare two groups: one group of infants with skin prick test (SPT) that was initially negative to peanut, and another with mildly positive results (wheal of 1-4mm). Infants with a wheal of >4mm were excluded from the study (about 10%). In infants with an initially negative SPT, prevalence of peanut allergy was 13.7% in the avoidance group and 1.9% in the consumption group. For infants with mildly positive SPT, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group.
Although many questions still remain, early testing of infants at high risk for peanut allergy in the first 4-8 months of life, along with early introduction of peanut protein or in-office peanut challenge may have the potential to prevent peanut allergy in the future.
Allergy Partners’ board certified allergists are experts in the diagnosis and treatment of food allergies. If you have questions regarding food allergies, contact your local Allergy Partners physician.
Asthma is a
condition due to airway inflammation often associated with an allergic
component. It is characterized by symptoms that can include chest tightness,
cough, shortness of breath and wheezing, which may be intermittent or
persistent. Proper diagnosis requires a thorough history, physical examination,
appropriate lung function testing and allergy testing.
Acute, or severe
asthma, can present as a rapid or gradual increase in symptoms resulting in an
acute attack or exacerbation. Chronic asthma, or persistent asthma, may present
with intermittent symptoms or even nocturnal awakening.
Control of asthma
is defined as an absence or decrease in asthmatic symptoms and improvement in
the quality of life. A 5-question survey known as the ACT defines uncontrolled
asthma on the basis of a score of less than 19 out of a possible 25.
The key to
controlling asthma is through the regular use of asthma controller medications
such as inhaled corticosteroids, antileukotrienes, or combination inhalers
containing inhaled corticosteroids and long-acting bronchodilators. These drugs
treat the underlying cause of asthma, namely airway inflammation. They are most
often delivered by inhalers with the exception of the antileukotrienes, which
are taken orally. Short-acting bronchodilators such as albuterol, are
considered relievers and are meant to be used on an as-needed basis or before
exercise. The need for a reliever inhaler more than 2 days a week or 2
nights a month is a sign of poorly controlled asthma.
have demonstrated adherence to asthma medications averages only 50%. In other
words, one-half of patients do not take their controller medicine regularly.
This is extremely important, as improved adherence is associated with less
asthma attacks and an improved quality of life and more symptom-free days. Thus
non-adherence is associated with a lack of asthma control, poor health outcomes
and increased costs.
The reasons for
the lack of regular use of asthma control drugs are varied. The cost, co-pays
and coverage for these drugs varies widely and high costs can be a barrier for
many people. Some patients are worried about ‘being dependent’ on daily
medications while many people simply find it hard to remember to take
medication once or twice a day. Additionally, correct inhaler technique is
vital to ensure that the medicine, when taken, is effective.
physician-patient relationship is vital in improving adherence. Understanding,
trust and mutual respect are absolutely necessary between a patient and
physician. For example, patients should understand the difference between an
oral steroid like prednisone and an inhaled corticosteroid in terms of
their safety and efficacy. Patients should feel confident in why they are
taking certain medications and in how they are taking it. Regular follow up
visits are vital. Asthma can have fluctuations that require adjusting therapy
up or down depending on the situation. Thus prescribing or changing an asthma
regime requires feedback to insure safety, efficacy and compliance. Adjustments
in dosing, if needed, can be made on subsequent visits, usually 4-6 weeks
apart, or as long as 90 days.
electronic monitoring devices have the potential to be a very important asset
to remind and reinforce with patients when to take their medication. Such
devices may even provide vocal reminders that the medicines are due.
Documenting the regular use of these medications is of great use to physicians
as well as to patients.
In addition to
devices that remind us to take medication, the future of asthma therapy will no
doubt include lung function peak flow monitoring via the smart phone. This will
allow both patients and physicians to get a much fuller picture of an
individual’s asthma and allow far greater individualized care.
successfully hinges upon using controller medications, such as inhaled steroid,
regularly. Regular use improves symptoms and quality of life and reduces the
risk of asthma exacerbations. For many, however, adherence can be challenging.
Effecting behavior change is quite difficult and time consuming. It requires
reinforcement and even such devices as peak expiratory flow meters to be used
by the patient at home. Technology should lead the way in helping patients and
physicians alike improve asthma control. In recent years we have all seen
tremendous advances in technology that have not only made our lives better, but
improved the quality of our lives. Such an outcome would be welcome in the care
of our asthmatic patients. As Leaders in Allergy and Asthma Care, Allergy
Partners is actively working to bring this technology to our patients.
Due to inclement weather both our Fredericksburg and Stafford offices will be opening at 1pm today 2/26/15, please continue to check our website and facebook page for any changes.
Due to inclement weather both our office's will be closing at 4pm today February 16, 2015, we are sorry for any inconvenience. Please continue to check our website and facebook page for up to date information.
Have you ever wondered what to make of those air quality warnings you hear on the news? These warnings are intended to help you take action to avoid harmful air, but it is not always clear what they really mean and what actions are reasonable and necessary. Here is a brief history of the system behind the Air Quality Index (AQI), and education regarding how these warnings can help you breathe better.
The AQI was developed by the Environmental Protection Agency in 1968. It measures the levels of 5 major air pollutants regulated by the Clean Air Act: particle pollution, ground-level ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide. Of these, ozone and particle pollution pose the greatest risk to your health.
The AQI is a number from 0-500 for each of these pollutants, and anything below 50 is considered good. From 50-100 only very sensitive people will be affected. Above 100 more people will begin to experience problems, especially people with allergies, asthma, COPD, heart disease, the elderly, and children. Above 150 even healthy people might begin to have problems.
Health effects of air pollution include irritation of the nose, throat, and lungs, worsening asthma, increased susceptibility to respiratory infections, and even long term damage to these areas if the exposure is high and prolonged.
So what action should you take when the AQI is elevated? The first step is to build awareness of how your own body reacts to air pollution, by keeping track of air quality (
www.airnow.gov or the AIRNow app), and seeing what symptoms you experience. You may find you need to take precautions in the Yellow or Orange range. Everybody should take precautions once levels are in the Red range or worse. Precautions include avoiding exercising outdoors when AQI is poor, and limiting your children’s outdoor play. Go to the gym or walk at the mall instead of jogging outdoors. Use the air conditioner in your home and auto to help filter the air. If you have asthma or allergies you may need to take extra precautions. Discuss this with your Allergy Partners physician and make a plan to maintain optimal health.
shelves are stocked with herbs and supplements that claim to improve health.
Such complementary and alternative medicines (CAM) are part of a group of
diverse medical and healthcare systems, practices, and products that are not
generally considered part of the conventional medical practices.
42 percent of people in the US (both adults and children) have used CAM for
their allergic disorders. Such treatments are perceived to be natural and safe
by patients, but reporting of adverse effects is largely inadequate. But do CAM
therapies really help with allergies and asthma? Importantly, are CAM therapies
Herbal Medicine has been used for centuries in Asia. However, lack of
standardization and controlled clinical trials have hampered their use as
conventional therapies in Western medicine. There is potential for developing
novel therapies for atopic diseases from Chinese herbs. Several herbal formulas
show early promise for the treatment of asthma, food allergies, and allergic
rhinitis in randomized trials. Work remains to determine the active components
of each herb and their mechanisms of action. In addition, issues with
consistency of herb quality and standardization still need to be addressed.
Herbal therapies like Ayurvedic mixes, butterbur, and Tinofend have
demonstrated some efficacy but these treatments may have side effects.
These products are not systematically monitored for safety by drug regulatory
bodies. Herbal remedies, including teas, made from plants can cause allergic
reactions, such as hives, or can induce asthma symptoms. Pregnant and nursing
patients should be advised to avoid these herbal therapies.
sprays consisting of dilute solutions of capsaicin or inert, micronized
cellulose powder have shown efficacy for allergic rhinitis. Nasal saline
lavage, commonly with a nettie pot can be effective in alleviating symptoms of
nasal congestion and drainage.
variety of other herbal preparations, homeopathic products, and miscellaneous
therapies have been suggested for the treatment of allergic rhinitis or
conjunctivitis. However, studies have either been of low quality or failed to
show benefit. Additionally, a number of herbs such as chamomile and Echinacea
can cause allergic reactions in people who are allergic to ragweed pollen.
D deficiency has been increasingly recognized as a health issue, particularly
in northern latitudes. Low Vitamin D levels have been associated with increased
rates of food allergy. It’s too early to say whether vitamin D can reverse food
allergies. Future research is needed to answer that question. However, research
is beginning to support the idea that vitamin D can protect against food
allergies and vitamin D is important for overall good health.
For most people, the best way to ensure you have enough vitamin D is a
combination between sensible sun exposure and adequate intake of foods
containing the vitamin. Your doctor can assess your vitamin D status with a
simple blood test and recommend a supplement if necessary
interventions such as Acupuncture and Acupressure (Stainless steel pellets in
adhesive discs are applied to specified points “acupoints” on the ear) show
modest benefit in the treatment of allergic rhinitis, although it is difficult
to estimate the size of the effect in most studies.
all CAM interventions, it is vitally important to discuss your use of these
therapies with your doctor. Additionally, CAM therapies should not be used in
place of conventional therapies without first talking to your doctor.
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!