Allergy Partners of Fredericksburg will be participating in Toys for Tots this year. We will be accepting new unwrapped toys, in both locations until Friday, December 11, 2015.
What is Sublingual
There has been a lot of press
recently as well as television and print advertisements touting the
availability of sublingual immunotherapy (SLIT). Unlike traditional
allergy shots (called Subcutaneous Immunotherapy or SCIT), SLIT is taken as
either drops or tablets under the tongue.
Does it Work?
A recent meta-analysis (a study
that statistically analyzes multiple other studies to identify trends and
confirm positive effects) of SLIT for seasonal allergies show that it may offer
only small benefit. Danilo Di Bona and colleagues looked at 13 studies
enrolling over 4000 patients and in 7 of 13 studies the group taking the
immunotherapy reported improved symptoms with decreased use of
medications. In six of the thirteen studies there was no more improvement
than in the placebo (no medication) group. The conclusion was that while
some patients will benefit, many may not, and it is not possible to identify
those that will respond prior to initiating therapy.
What Are the Side Effects?
Over half of the patients in the
treatment group reported either oral or GI/stomach side effects. Seven patients
had allergic reactions requiring epinephrine.
SCIT vs. SLIT
In the not so recent past,
immunotherapy or “allergy shots” was a fairly narrow topic for
discussion. Those patients with nasal allergy and allergic asthma who
were not well controlled on medications were offered subcutaneous immunotherapy
(SCIT) as a better alternative to medication and a potentially disease
modifying intervention. The injection therapy works directly on the
patient’s response to allergens which results in short term symptom control,
reduced medication requirement, and a durable long term improvement.
The downside was a significant commitment to receiving injections in a medical
setting on a regular basis.
Fast forward to the past few
years. Sublingual immunotherapy (SLIT) utilizes allergen as drops or
dissolving tablet under the tongue. This approach has been common in
Europe for a number of years for patients symptomatic from a single allergen.
It is also available off label in the United States for single or multiple
allergens using conventional allergen extracts. Tablets for grass and ragweed
have become available by prescription. These require at least pre-seasonal
therapy beginning three months prior to the pollen season and may be more
effective if continued all year. The major advantage of SLIT is that the
allergens can be self-administered at home with the availability of epinephrine
as the risk of serious systemic reactions is low.
immunotherapy allows the inclusion of multiple allergens in a single injection,
and in the large majority of studies, has been shown to be more or equally
efficacious when compared to the sublingual program. Since many of our
patients are allergic to multiple environmental allergens, this may be their
Fortunately, Allergy Partners physicians are able to offer sublingual and
injection therapy and select the type of immunotherapy that best serves your
For more information, visit: http://www.allergypartners.com/fredericksburg/SitePages/Treatment.aspx
Please refer to the Auvi-Q website for the latest information on the Auvi-Q Recall. Please contact our office if you or your child need a new prescription sent to the pharmacy.
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
IgG RAST testing is an
effective means to identify food allergies.
What does science
It is estimated that 15
million people in the United States have food allergies. This includes up to 1
in 13 children. Therefore, appropriate evaluation and treatment of these
allergies are essential. Various methods have been described to test for food
allergies since the 1970s. These include skin prick testing to possible
offending foods, ImmunoCAP IgE blood testing, and IgG RAST blood testing.
So is the myth busted or
Detection of IgG antibodies
has been discredited as a reliable diagnostic tool since the 1980s. Unlike IgE
antibodies, which are responsible for allergies, IgG antibodies can be found in
allergic and non-allergic people regardless of whether they are healthy or
sick. IgG antibodies are the normal antibodies made by the body to fight off
infections. Increase in levels of IgG antibodies present in the circulating
blood is thought to be a normal response to the ingestion of food. In fact, IgG
antibodies have actually been found to go up during successful research studies
on food immunotherapy. Also, allergy testing to foods using IgG RAST testing
has been shown to lack clinical relevance. These tests are not validated and
lack sufficient quality control.
These unproven tests may
lead to false diagnoses, increased anxiety, and a useless strict avoidance
diet. If a food allergy is suspected, evaluation, diagnosis, and treatment
should be performed by a board certified allergist. The evaluation should
include a thorough medical history and a physical exam. The allergist may
perform tests including skin prick tests and ImmunoCAP IgE blood tests to help
identify a food allergy. Both methods are highly sensitive and useful to help
exclude a diagnosis of food allergy. An oral food challenge or even a trial
elimination diet may be necessary. These tests have all been proven to be
effective diagnostic methods which the board certified allergist may use in
conjunction with the information from the clinical history and physical to
provide a diagnosis of a food allergy.
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.
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!