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August 26
Of Pharaohs and Bee Stings

Was the death of a pharaoh the first report of an insect sting reaction?  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.

                       

Statistics

 

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 Players
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.

 What are the different kinds of reactions to insect stings?

There are five types of reactions to insect stings, according to Koterba and Greenberger. These include:
·        A normal reaction with less than 2 inches of redness and swelling right around the sting and which subsides in less than a day.  For this, cold compresses and analgesics (pain medication) are sufficient treatment.
·        A large local reaction with extensive redness and swelling, generally more than 5 inches in size and lasting 1-10 days.  These reactions can involve large areas – for example, a whole arm. Analgesics, ice and sometimes prednisone is the usual treatment.
·         Anaphylaxis includes swelling that skips a joint area or occurs at areas of the body distant from the site of the sting.  Hives can also accompany this reaction.  The patient may have life threatening symptoms such as swelling of the larynx (which may cut off breathing) or cardiac involvement.  Treatment includes urgent use of epinephrine (generally administered by an automatic injector such as EpiPen or Auvi Q) and calling EMS for a trip to the emergency room. Patients who have these reactions should be skin tested and considered for desensitization to the venom or venoms to which they are shown to be allergic.  If the reaction is only hives in a child less than 16 years old, life threatening reactions usually do not develop on re-sting so desensitization may not be necessary in this case.
·        Rare reactions: These include serum sickness with hives, fever, malaise and joint pain that occurs 7 days after the sting.  Some of these patients may experience anaphylaxis on subsequent stings, so desensitization is suggested.
·        Toxic  reactions: These happen with multiple simultaneous stings such as may occur in an attack by Africanized honey bees. Hypotension, cardiovascular collapse and death may occur.

How can you tell which kind of insect stung you?

There are five types of stinging insects to which allergists test – Yellow Jacket, Honeybee, White Faced Hornet, Yellow-Faced Hornet,  and Wasp.  According to the American Academy of Asthma, Allergy and Immunology, here are some of the characteristics of these insects:
•    Yellow jackets are black with yellow markings, found in various climates. Their nests are usually located underground, but sometimes found in the walls of buildings, cracks in masonry or in woodpiles.
•    Honeybees have round, fuzzy bodies with dark brown and yellow markings. They can be found in honeycombs in trees, old tires or other partially protected sites. Honeybees are the only Hymenoptera insects that leave their stinger in the skin after a sting.
•    Paper wasps are slender with black, brown, red and yellow markings. They live in a circular comb under eaves, behind shutters or in shrubs and woodpiles.
•    Hornets are black or brown with white, orange or yellow markings. Their nests are gray or brown and are usually found in trees.
Why is it important for you to be able to identify the type of insect that stung you when you have had a reaction?  It is important because your allergist at Allergy Partners uses this information in conjunction with skin tests to determine which type of venom to use for desensitization.
It is very important for the doctor to get a good history, including what type of insect was involved and the details of the reaction. Identification of the type of insect that caused the reaction through history and skin testing as well as the nature of the reaction can be lifesaving.

Is there anything that can be done?

Skin tests to stinging insects can show false negatives in up to 20% of cases, and so blood tests may then be helpful.   In some cases, it is important to get a baseline tryptase level.  If elevated, it may make the sting reaction more severe.  If you are skin test positive to one or more venoms after you have had a systemic or anaphylactic reaction to an insect sting, your allergist can prescribe desensitization injections which will reduce the likelihood of a reaction to 3% from 60%. The exception is in children  under 16 who have only had skin reactions (usually hives) as these patients generally do not progress to more severe reactions with subsequent stings.  It takes about 15 injections, barring local or systemic reactions to the shots, to get to a “maintenance” dose.  Once maintenance is reached, injections can be given once per month during the first year and every 6-8 weeks during the subsequent years. Venom immunotherapy is typically given for 5 years, but may be continued for a longer duration in certain instances. Your Allergy Partners physician will work with you to determine the best course for you.

 

April 14
Do I Have Food Allergies?

Food allergy are an immune system reaction that occurs soon after eating a certain food. Food allergies affect about one in twenty Americans, with cases occurring at any age, but most commonly in babies and young children. While any food may cause an allergic reaction, eight types of food account for about 90 percent of food allergies: milk, egg, soy, wheat, peanuts, tree nuts, shellfish and fish.

 
Symptoms

Symptoms of a food allergy vary significantly from person to person, as does the amount of food needed to trigger an allergic reaction. While most food-related symptoms occur within two hours of ingestion, in some rare cases, the reaction may be delayed by four to six hours or even longer. Common symptoms of a food-related allergic reaction include: digestive problems, hives, or swollen airways. The most severe allergic reactions may result in anaphylaxis, which can impair breathing, cause a dramatic drop in blood pressure, and affect heart rate to a fatal degree.

 
Some patients may experience an itching and/or tingling feeling in their mouths after consuming certain fruits, which is referred to as pollen-food allergy syndrome or oral allergy syndrome. For example, patients allergic to birch pollen can have this reaction when eating an apple. In rare cases, pollen-food allergy syndrome can lead to anaphylaxis.
 
Diagnosis

The diagnosis of a food allergy generally requires a thorough medical history of the patient including what and how much was eaten, how long it took for symptoms to develop, what symptoms were experienced and how long it lasted. Your doctor may order skin and/or blood tests in making a diagnosis. However,a “positive” result on any one test is not an absolute indication of a food allergy. Allergists rely on their experience to properly interpret the results of tests within the overall context of the patient’s medical history. If you suspect you have a food allergy, talk to your Allergy Partners physician to determine what method of diagnosis is most suitable.

 
Skin Test

In this test, a tiny amount of liquid containing suspected food is placed on the skin of your arms or back. The skin is then pricked with a small sterile probe, allowing the liquid to seep under the skin. After about 20 minutes, a hive (a bump similar to a mosquito bite) may form and will be compared to the bump at the site of the control, where a liquid not containing any allergen is placed. We offer specific testing panels for foods to which patients are most commonly allergic, but we can also make a skin test using a small amount of any fresh food.
 

Blood test
A blood test (commonly known as RAST or ImmunoCAP) detects the presence of allergen-specific antibodies known as immunoglobulin E (IgE) antibodies. Additionally, a relatively new test, called a “component test” can be ordered to gain more specific information and is mostly used for peanut allergies. Blood tests have been used extensively but often are not specifically based on patients’ detailed diet diary. When not properly utilized, the results of a blood test can be very confusing and may lead to unnecessary food restriction. Allergy Partners allergists use their experience to determine when a blood test may be helpful and to properly interpret the results of the blood test.
 
Other Tests
There are a number of non-standardized tests that are advertised as helping diagnose food allergy. These tests include allergen-specific IgG blood tests, antigen leukocyte cellular antibody tests, hair analysis, and applied kinesiology. Their use in the diagnosis of food allergy is not advised.
 
Oral Food Challenge
In an oral food challenge, small increment amounts of food are fed to the patient over a period of a few hours to determine if a reaction occurs. Due to the possibility of a severe reaction, it must be conducted under medical supervision by an experienced doctor and in a facility with emergency medication and equipment on hand. The gold standard for a food challenge is one that is double-blind and placebo-controlled, though it may still have very good diagnostic value when lacking these conditions.
 
Conclusion
Food allergies can be challenging and stressful, so knowing what you or your child is eating is an important first step. If you have doubts about a possible food allergy, err on the side of caution until you have a chance to speak with an Allergy Partners physician.

February 27
For Asthma Patients: The Importance of Daily Controller Medicines

 

Asthma is a condition caused by airway inflammation, and it often has an allergic component. It is characterized by symptoms including chest tightness, cough, shortness of breath and wheezing, all of 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 or persistent asthma may present with intermittent symptoms including  nocturnal awakening.
 
Asthma control is defined as an absence or decrease in asthmatic symptoms and improvement in the quality of life. A five-question survey known as the ACT (Asthma Control Test) defines uncontrolled asthma on the basis of a score of less than 19 out of a possible 25.
 
The key to controlling asthma is 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: 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(or “rescue” inhalers) and are meant to be used on an as-needed basis or before exercise.  The need for a reliever inhaler more than two dayss a week or two nights a month is a sign of poorly controlled asthma.
 

Recent studies have demonstrated that adherence to asthma medications averages only 50%. In other words, one-half of asthma patients do not take their controller medicine regularly. This is extremely important, as improved adherence directly relates to fewer asthma attacks, more symptom-free days, and an improved quality of life. 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 insurance 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.

 
The 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. Prescribing or changing an asthma regime requires patient  feedback to insure safety, efficacy and compliance.
 
Newly developed electronic monitoring devices have the potential to be very important assets to remind and reinforce patients when to take their medication. Such devices may even provide vocal reminders that the medicines are due and may also document the regular use of medications.
 

In addition to devices that remind patients to take medications, 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 for greater individualized care. In recent years we have seen tremendous advances in technology that can help improve the quality of patients’ lives.  As the leaders in allergy and asthma care, Allergy Partners is actively working to bring this technology to our patients.

 

December 09
Winter Allergies

     As the calendar turns to the winter months, many allergy sufferers let out a sigh of relief. No more pollen means no more sneezing and itching, right? Unfortunately for New Mexicans, some pollens can be found in our air almost year-round, and  juniper can begin emitting pollen as soon as mid-January. In addition, there are "winter allergies." Winter allergies?

     With colder weather, we close up the house and get out our warm blankets and comforters. Pets come indoors to snuggle. And for those allergic to pets and dust mites, winter means more allergy symptoms.

    Dust mites are microscopic, eight legged creatures that feed on flakes of dead skin. They absorb moisture from the air as opposed to drinking. Therefore, they like to live where people are and where it is humid. Beds, bedding and carpets provide dust mites the perfect place to live. And no matter how clean your house is, you have dust mites.
 
    Fortunately for New Mexicans, dust mites thrive best in more humid environments than what we normally experience. However, dust mites are still an issue for many. 

  

    Allergy to dust mites is one of the most common allergies. Up to 25% of people are allergic to dust mites, and over 45% of homes have enough dust mite allergen to trigger asthma and allergies. Symptoms of dust mite allergy tend to be a bit different from pollen triggered allergies. As opposed to sudden fits of sneezing, clear watery runny nose and itchy eyes, dust mite allergy tends to cause more chronic nasal congestion that is worse first thing in the morning. People allergic to dust mites are more prone to ear and sinus infections. Dust mite allergy also worsens other underlying allergies.

 

    So what should you do? The first step is to find out if you are dust mite allergic. Allergen skin testing under the direction of your Board Certified Allergy Partners physician remains the best way to diagnose allergies. If you are dust mite allergic, the following can help limit your exposure:
 
1.     Limit dust collectors such as stuffed animals in the bedroom                    
 

2.     Wash bedding in hot water (130 degrees minimum) 

3.     Vacuum carpets regularly with a HEPA filter vacuum

4.     Consider steam cleaning your carpets yearly
 
5.     Invest in high quality allergen encasements for your mattress and pillows to put a barrier between you and the dust mites.
 

    Treatment of dust mite allergy symptoms can include the use of over the counter and prescription medicines. For those interested in preventing symptoms, allergen immunotherapy (allergy shots) can provide relief without having to take daily medications. Your Allergy Partners physician will work with you to determine the best options for you and your family.

 

To learn more about allergen encasements visit www.allergyguardian.com
 
To learn more about controlling your indoor air quality visit www.O2airpurifier.com
  
To learn more about allergies, asthma and our practice visit www.allergypartners.com/newmexico

 

 

 

September 18
Asthma webinars available on YouTube

Dr. Heather Gutekunst, Allergy Partners of Raleigh, hosted a great webinar this week on the symptoms and treatment options for Asthma.  Her colleagues, Dr. Vaishali Mankad, Allergy Partners of Raleigh, and Dr. Ananth Thyagarajan, Allergy Partners of Richmond, joined in for a live Q&A session after the presentation.  If you were not able to attend, please view the recording now on our YouTube Channel, www.youtube.com/MyAllergyPartners.  You can also watch many other useful webinar and ‘how-to’ videos on various topics as it relates to allergies and asthma.

 

 

 

September 02
Los Alamos Tuesday office hours extended to 5:30 PM

​We have added an hour at the end of the day in Los Alamos on Tuesdays so that we are now open until 5:30 PM.

July 14
Dr. Sussman interviewed on the radio

​Please tune in to KSFR radio at 101.1 on Tuesday August 12 and Tuesday August 19 at 6:30 PM for an interview with Dr. Sussman on the East-West Medicine program. After the show airs, a podcast will be available at this link: www.eastwestmedicine.libsyn.com<http://www.eastwestmedicine.libsyn.com/>  This is a great opportunity to learn more details about allergies from our senior physician!

March 24
Santa Fe office hours extended!

​Santa Fe clinic hours have been extended on Wednesdays and Fridays! New hours:

Monday through Thursday 8:30 AM-5:30 PM

Friday 8:30 AM-4:30 PM

March 05
Why Allergy Partners?

 

More than 20 years ago in Asheville, North Carolina, 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 that premise, we have grown to almost 100 allergists and 800 team members in 17 states. We are proud to provide care for more than a half-million patients. We are even more proud of the quality of care we provide.
 
All Allergy Partners physicians are certified by the American Board of Allergy, Asthma, and Immunology. That certification requires certification by the American Board of Internal Medicine or the American Board of Pediatrics followed by a minimum of two years of fellowship training. As a result, our physicians are uniquely qualified to manage conditions including:
 
• allergic rhinitis
• asthma
• allergic conjunctivitis
• chronic cough
• chronic sinusitis
• urticaria and angioedema
• atopic dermatitis
• contact dermatitis
• anaphylaxis(bee sting, drugs, food, or other causes)
• immune deficiencies
 
To make certain we remain on the cutting edge of our specialty, we created the Clinical Excellence Committee. Under the oversight of Dr. Spencer Atwater, our Chief Medical Officer, the Committee identifies opportunities for improvement, reviews pertinent medical literature and current standards, develops recommendations for optimal treatments, and engineers systems to make sure that treatment is delivered consistently. A perfect example of that is our state-of-the-art allergen immunotherapy program and extract lab. In many ways, immunotherapy is the cornerstone of the allergy specialty. To ensure that immunotherapy is as safe and effective as possible, we worked in conjunction with nationally recognized experts to develop our formulation processes and dosing recommendations. We invested in building our extract lab after seeking input from industry experts as well as the Center for Biologics Evaluation and Research. Today we produce over a quarter million vials of allergy extract annually following USP 797 guidelines for sterile allergenic extract processing. It is through this attention to detail that we can provide you assurance that the patients you entrust to us will be provided safe and effective therapy.
 
At Allergy Partners, we are committed to using the latest technology to improve patient outcomes. Each of our locations is not only using the same electronic health record, they are also configured as a single database. In this way, as opportunities to improve care become available, we can easily build and implement the forms that will encourage that care on an enterprise level. We can and do track the outcomes of that care delivery, and use that understanding to implement further change. We have published data in national allergy journals which we hope will help other practices with what we have learned.
 
We also use our information systems configuration to improve the quality of our consultations. We have an “All Doctors” listserv set up which enables our referring physicians to benefit from the expertise of not just one, but almost 100, practicing allergists. When any of our physicians confronts a particularly unusual or difficult case, he or she can immediately tap into the expertise of our entire network. With our current size, we see this oppor­tunity utilized once or twice every day. It not only provides access to much broader expertise for our patients, it also serves to educate our own physicians on a daily basis.
 
At Allergy Partners we are proud of our history and proud of the care we provide today. We are even more ex­cited about the future and the opportunities we have to deliver even better care. We have just implemented our patient portal, which increases our opportunities to interact with patients. We are in the process of developing more robust outcomes assessment capabilities. Additionally, we are exploring ways to integrate technology in ways that will help us work with our patients to make those outcomes even better. And most importantly, we are continuing to work as a group to build a patient-centered culture. As hard as we work behind the scenes to implement best practices and improve our specialty, we work just as hard to make sure our patients recognize that we care. We pledge to provide our shared patients the very best care and the best experience possible.

  
December 13
Tips for the Holidays!

Whether it's feasting on holiday meals, setting up your Christmas tree, or
visiting your pet-owning relatives, allergy triggers may be lurking.
Unfortunately, with busy schedules, travel time and the stress of the
holidays, it is easy to forget to take the proper care when dealing
with allergies and asthma.
  

Here are some tips to help keep allergies and asthma under control
this holiday season:
  
When attending holiday parties, inform the host about your food
allergy and ask about the ingredients used to prepare the meal.
  
Carry an auto-injectable dose of epinephrine when attending a holiday
party where unrecognized food allergens could be hiding. Homemade
items do not have ingredient lists and could be contaminated with
trace amounts of allergenic foods through contact with storage
containers or kitchen utensils.
  
Remind family members and friends that strict avoidance is the only
way to manage food allergies and that even one little bite can
trigger a dangerous reaction.
  
If visiting relatives' homes who own pets, take your allergy
medication before arriving in order to minimize a possible reaction.
  
Evergreens often carry microscopic mold spores. You might think you
are allergic to your Christmas tree, but it is likely that it is the
mold spores that are causing those symptoms.
  
Clean decorations and artificial trees outside before decorating.
They can gather mold and dust while in storage. Wash fabric
decorations in hot, soapy water before displaying them to remove mold
and dust.
  
When spraying artificial snow on windows or other surfaces, be sure
to follow directions. These sprays can irritate your lungs if you
inhale them.
  
Take along your own pillow with an allergen-proof cover and request
down-free pillows if staying in a hotel or at a relative's house.
Dust mites can be especially troublesome if traveling away from home.
  
Ask your relatives and friends to avoid burning wood in the
fireplace. The smoke can trigger an asthma attack.
 
The holidays can be a stressful time of year. Pay attention to your
stress level because stress can sometimes lead to asthma attacks. Deep
breathing and relaxation can help. Remember to enjoy this special season instead of trying to make everything perfect!

 

 

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 About this blog

 
 

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!