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 Allergy shots are commonly known in the medical community as immunotherapy. They are one of (if not the) most effective treatments for allergic rhinitis (hay fever), allergic asthma and flying insect allergy. There are some data indicating that immunotherapy might be effective for atopic dermatitis (eczema) when the patient’s disease is associated with environmental aeroallergen sensitivity (especially dust mite allergy). Treatment with allergy shots can reduce your need for medications, make asthma easier to control and give relief from allergy and sinus symptoms. In children, allergy shots may reduce the risk of developing asthma later in life and reduce the risk of developing additional allergies. So what does this mean in terms of health care costs? Are the medical benefits of shots outweighed by its expense?
In a 7-year retrospective analysis (looking back in time) of children newly diagnosed as having allergic rhinitis, investigators compared medical costs incurred during the 6 months before starting shots to the costs for these same children that were incurred during the 6 months after completion. The per-patient 6-month total health care costs were significantly lower in the 6-month period after completion compared to the time preceding the start of shots. Interestingly, in this study only 16% o f patients completed the recommended 3 years of treatment. Even with that low completion rate, a significant savings was seen.
The same investigators subsequently conducted a similar 10-year retrospective study. One of the main differences in this study is that they compared the 18 month health care costs of a group of patients receiving shots to a similar group that did not. Children who received shots incurred significantly lower per-patient health care costs compared to the children who were treated with medications alone. A parallel study has been conducted with adults and similar, significant reductions in 18-month health care costs have been reported. In these patients the cost savings was approximately 41%! Allergy shots are not only the most effective treatment for certain allergic diseases, but they are also more cost effective than medications alone. That is a win-win situation!
Dr. Ananth Thyagarajan (Dr. T.)
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| It makes sense that frequent consumption of fast food could lead to increased weight and obesity. Previous studies have already shown a link between asthma and obesity. Other studies have shown that increased weight decreases our body’s responses to asthma medications. Now, investigators have published evidence that increased fast food consumption is linked to an increased risk of severe asthma, rhinitis (runny nose that is frequently associated with allergies) and eczema .
A group of European researchers analyzed data from written questionnaires completed by over 500,000 participants or their parents. Adolescents aged 13-14 years old completed their own questionnaires while the parents/guardians of 6-7 year old children answered the queries. They answered questions on their symptom prevalence of asthma, rhinoconjunctivitis and eczema as well as types and frequency of food intake over the past 12 months. The participants included children from over 50 different countries from a range of socioeconomic backgrounds.
Eating fast food meals at least 3 times a week was linked to a 39% increased risk of severe asthma in teenagers and a 27% increased risk among children. Interestingly, consuming 3 or more servings of fruit per week was associated with an 11% decrease in severe symptoms in teens and a 14% decrease in children. These patterns were consistent regardless of gender, region of origin and socioeconomic status. As with many studies, we must all be careful to draw too many conclusions from this study that shows a correlation between fast food consumption and disease. Correlation does NOT mean causation. A great example of this is as ice cream sales increase, the rate of drowning deaths increases sharply. Therefore, ice cream consumption causes drowning, right? We all know that this is incorrect. Ice cream is much more popular during the hot summer season when people are more likely to go swimming. With more people swimming we see an increase in drowning. The ice cream had nothing to do with it.
It is incredibly difficult to prove causation, but if the above correlation between fast food and severe asthma is truly causal in nature then that has incredible public health implications. In the end, I believe that the investigators have done an incredibly thorough job that makes me believe that this association is strong enough to point to causation. In my opinion, decreased fast food consumption can’t hurt anyone. Fast food may be cheap and convenient, but the latest data suggests that the negative implications of eating it frequently are too high a price to pay.
Dr. Ananth Thyagarajan (Dr. T.)
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| Influenza is a serious disease that can lead to hospitalization and sometimes death. Each year the flu season is different, and even within the same season the flu affects individuals differently. Although the majority of deaths (about 90%) occur in individuals > 65 years old, even healthy people can get very sick from the flu and spread it to others. Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from 3,000 - 49,000 people. Flu season in the U.S. can begin as early as October and last until late May.
Influenza vaccines (both the shot and spray) cause antibodies to develop in the body about two weeks after vaccination. Antibodies are used by the immune system to identify and neutralize foreign objects such as bacteria and viruses. These antibodies provide protection against infection with the viruses that are in the vaccine.
The seasonal flu vaccine protects against three influenza viruses that research indicates will be most common during the upcoming season. The viruses in the vaccine can change each year based on international surveillance and scientists’ estimations about which types and strains of viruses will circulate in a given year. Three kinds of influenza viruses commonly circulate among people today: influenza B viruses, influenza A (H1N1) viruses, and influenza A (H3N2) viruses. Each year, one flu virus of each kind is used to produce seasonal influenza vaccine. This is the tricky part, based on available data experts from the Food and Drug Administration (FDA), World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and other institutions have to make their best educated guess as to which specific influenza types (or strains) to include in the vaccine. Sometimes they are right, sometimes they’re not…but we’ll get into that a little bit later. While the H1N1 virus used to make the 2012-2013 flu vaccine is the same virus that was included in the 2011-2012 vaccine, the recommended influenza H3N2 and B vaccine viruses are different from those in the 2011-2012 influenza vaccine. The H1N1 strain used is the same strain used in the 2009 flu pandemic vaccine.
There are multiple types of flu shots and one nasal spray available. We don’t use the nasal spray in our office because it is contraindicated in asthmatics. EVERYONE who is at least 6 months of age should get a flu vaccine this season. It’s especially important for some high risk individuals to get vaccinated, they include:
- People who have certain medical conditions including asthma, diabetes, and chronic lung disease
- Pregnant women
- People 65 years and older
- People who live with or care for others who are high risk of developing serious complications such as caregivers/household contacts of people with certain medical conditions listed above
Although there is a warning for those with severe egg allergy to not receive the influenza vaccine, there is an abundance of data that says that the risk of an allergic reaction to influenza vaccine in egg allergic individuals is very low. Any such risk is far outweighed by the very real risk of not receiving the vaccine. All patients with egg allergy of any severity, including anaphylaxis, should receive the flu shot or spray. Skin testing with the vaccine and dividing the dose are not necessary. For those with a history of hives only after egg ingestion, the vaccine can be administered in the primary care provider's office. For those with more serious reactions to egg ingestion, the vaccine should be administered in an allergist's office.
The ability of the influenza vaccine to prevent influenza illness can range widely from season to season. In part, this is due to the educated guesses made by experts on which strains of influenza to include (as I mentioned earlier). In recent years the match between the vaccine viruses and those actually seen during the flu season has usually been good. In 18 of the last 22 U.S. influenza seasons the viruses in the influenza vaccine have been well matched to the predominant circulating viruses. Preliminary data for the 2010-2011 influenza season indicate that influenza vaccine effectiveness was about 60% for all age groups combined (Unpublished CDC data). A randomized study looking at the 2007-2008 influenza season found that the flu shot protected 72% of people from influenza disease.
So what’s the take home point? Get vaccinated against influenza! At Allergy Partners of Northern Virginia, we have it available. If you are an existing patient (who has been seen in the last 3 years) just come in to any of our office locations to receive the vaccine. As always, you can also follow us on Facebook and Twitter for daily pollen counts, office information, patient education and more. If you enjoyed this post please “Like” us on Facebook.
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Reactions to food are common, and can be divided into two categories, those caused by food allergy and all other reactions. Food allergies develop when the body's immune system has an abnormal reaction to one or more proteins in a food. Food allergies can lead to serious or even life-threatening allergic reactions. Food allergies can be further divided into “classic” and “non-classic” types. Other food reactions are not caused by the immune system. These reactions cause unpleasant symptoms and are far more common than food allergies. Examples include lactose intolerance, heartburn (gastroesophageal reflux), bacterial food poisoning, and sensitivity to caffeine.
Although 20-30% of people report food allergies, only 6-8% of children and 3-4% of adults have “classic” food allergy. The most common foods causing allergy are cow’s milk, egg, peanuts, soy, wheat, tree nuts, fish, and shellfish.
Symptoms
In people with "classic" food allergies symptoms typically occurs quickly, within minutes to two hours after eating. The most common symptoms of food allergy include:
Skin: Itching, flushing, hives (urticaria), or swelling (angioedema)
Eyes: Itching, tearing, redness, or swelling of the skin around the eyes
Nose and mouth: Sneezing, runny nose, nasal congestion, swelling of the tongue, or a metallic taste
Lungs and throat: Difficulty getting air in or out, repeated coughing, chest tightness, wheezing, increased mucus production, throat swelling or itching, hoarseness, change in voice, or a sensation of choking
Heart and circulation: Dizziness, weakness, fainting, rapid, slow, or irregular heart rate, or low blood pressure
Digestive system: Nausea, vomiting, abdominal cramps, or diarrhea
Nervous system: Anxiety, confusion, or a sense of impending doom
Some individuals suffer from “non- classic” food allergies. The symptoms of this type of food allergy are usually slower to develop and longer lasting than those of classic food allergies. Symptoms commonly include vomiting, diarrhea, abdominal pain, and/or blood in the stool. Food protein-induced enterocolitis and proctitis/proctocolitis are common types of non-classic food allergy that are seen often in infancy.
Diagnosis
A complete and detailed medical history is essential for initiating the proper work up for food allergy. Specific skin and blood testing gives providers added information on determining the likelihood of “classic” food allergy. If a person had a reaction after eating peanuts, but has never reacted to wheat or eggs and eats them regularly, it is not necessary to test for allergy to wheat or eggs. The gold standard test for all food allergy is the oral food challenge, where the food is ingested by the patient in a controlled setting (clinic or hospital) to monitor for reaction. It is important to note that neither the size of the skin prick test nor the level on blood tests translate into severity of allergy. These tests only speak to the likelihood of any reaction.
Treatment
Once a food allergy is certain, the best treatment is to avoid the food. Patients must carefully check ingredient labels for all food products. The most important aspect of the treatment plan is to have emergency medications available at all times in case of an allergic reaction. In the case of a severe allergic reaction, timely administration of self-injectable adrenaline is the cornerstone of treatment.
How We Can Help
Your Allergy Partners board-certified provider can assist in determining whether or not a food allergy exists, what type of food allergy it is, and what treatment plan is appropriate. Your allergist will help you understand the potential testing options as well as directing you to helpful resources like special food allergy cookbooks, patient support groups, and registered dieticians.
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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, called mast 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 reactions 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. Dermatographism (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, bee 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 (Benadryl®), but mild or ongoing cases of hives can also respond to longer-lasting and less sedating antihistamines, such as loratadine (Claritin®), cetirizine (Zyrtec®), or fexofenadine (Allegra®).
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, is it 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 examination, 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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With the warmer weather of summer, we are enjoying more time outside. Along with the summer weather comes a dramatic rise in the number of stings from bees and fire ants. For many people these stings are painful and annoying but not dangerous. However, approximately 1 in 100 people has a potentially life-threatening allergy to insect stings. The insects most often responsible for serious allergic reactions are honey bees, wasps, hornets, yellow jackets, and fire ants. Although intimidating by virtue of their size, bumble bees rarely sting.
An allergic reaction can involve the entire body and advance rapidly after the sting. Common symptoms include itching, hives and swelling distant from the site of the sting. Dizziness, asthma symptoms, nausea, vomiting and a drop in blood pressure, shock and unconsciousness may also occur. Severe reactions may be fatal if medical treatment is not obtained immediately.
Once an individual has experienced a severe reaction, they have a 60-70% chance of experiencing a similar or more severe reaction with each future sting. Therefore, anyone who has experienced any of the above symptoms following a sting should carry an EpiPen at all times. However, with insect venom allergy, epinephrine is not enough. Using an EpiPen is critical for treating a severe reaction. However, it cannot prevent future reactions. Anyone with an allergic reaction to a sting should be evaluated by an allergist for testing and consideration of immunotherapy. Allergy shots to stinging insect venom are 98% effective in preventing future stings and are the standard of care treatment for venom allergy.
Stinging insect allergy is potentially fatal. Fortunately, current treatment is very safe and highly effective. Allergy shots to venom can be life-saving. Don’t let the fear of stings keep you indoors this summer. If you have a history of reactions to stings, see us for an evaluation.
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| What Is Asthma?
Asthma is a common lung disorder in which the inner lining of the small breathing tubes of the lungs, the bronchioles, becomes inflamed and swollen. At times this leads to spasms or narrowing of these tubes. This may cause wheezing, shortness of breath, and/or tightness in the chest. Cough, especially with exercise or in the middle of the night, is particularly common in asthma. In mild asthma, the only symptom may be cough. Wheezing may not occur, or may only be heard by your doctor listening with a stethoscope.
Who Develops Asthma?
Asthma may develop at any age, but most commonly does so in early childhood, or mid-adulthood. Most cases that occur in childhood improve greatly over time and with appropriate treatment. Many cases that occur in adulthood respond well to treatment, but remain chronic.
Approximately one person in ten has asthma. Many people with mild asthma may not even be aware they have it. The tendency in asthma is often inherited, and is often strongly related to allergies, particularly in childhood. The majority of children with asthma have allergies that cause or significantly aggravate their asthma.
What Causes Asthma?
As with many medical conditions, a combination of heredity and environment plays the biggest role in both causing and aggravating asthma. The most common triggers of asthma are allergies, respiratory infections, exercise, and cigarette smoke.
The allergens that most commonly trigger asthma are inhalants, such as house dust mites, pollens, molds, and animal danders. When the allergens are inhaled into the lungs, they directly provoke asthma by causing swelling of the lining of the bronchioles and mucus production. Asthma is indirectly worsened by allergies for two reasons: first, nasal congestion interferes with the normal filtering and humidification of inspired air; and second, the postnasal drainage from allergies aggravates the cough and wheeze associated with asthma.
Viral respiratory infections commonly cause asthma to flare temporarily, especially in young children, and account for some of the wintertime worsening seen in this age group. Smoldering sinus problems will worsen asthma as well.
Exercise, or any hyperventilation such that occurs with heavy laughing or emotional upset, will cause the bronchioles to tighten. This is because the asthmatic lung is overly sensitive to the sudden cooling and drying of the airway caused by rapid and deep breathing. For this reason, exercise in cooler weather often causes more trouble.
Cigarette smoking, both active and secondhand, is extremely harmful to patients with asthma. Smoke contains numerous toxic gases and particles that further irritate the already inflamed airway of the asthmatic. Cigarette smoking by asthmatics increases the severity of the asthma immediately, and further increases the likelihood of permanent lung damage.
How is Asthma Diagnosed?
Asthma is usually suspected when the characteristic symptoms occur, especially at nighttime, with exercise, with colds or with allergy flare-ups.
Definitive diagnosis and optimal treatment of each individual case requires not only periodic exams, but also measurements of lung function, starting by five or six years of age. This is done by measuring the amount and rate of air flow from your lungs. We often check to see how this changes after using an asthma inhaler. These results, along with your progress since your last visit, allow us to customize and update your treatment plan.
Since allergies are a common trigger in up to 85% of individuals with asthma, we will usually perform allergy testing as part of the initial evaluation in order to optimize your treatment. Chest x-rays, blood work, and other tests are rarely needed for the diagnosis and management of asthma, unless other medical problems are suspected.
How is Asthma Treated?
There are four general areas of asthma treatment. We will often recommend a combination of more than one, or even all, of these depending on your unique situation.
Avoidance of allergens and irritants: Depending on your history and the results of any allergy testing, we may recommend specific measures to reduce your exposure to the substances to which you are allergic. This will help reduce the amount of medication you need to control your asthma.
Treatment of underlying medical conditions: Chronic sinus problems, stomach acid reflux, obesity, and other conditions may cause or aggravate asthma. It is important that these problems be addressed in order to have ideal control of your asthma.
Medications: There are two basic categories of asthma medications- the first are bronchodilators, which temporarily relieve symptoms by relaxing constricted bronchial tubes. These are typically used only when needed. The second are anti-inflammatory medications, which prevent or heal the inflammation inside the bronchial tubes. These are generally used every day, even when you feel well.
Allergy immunotherapy: Allergy injections are the most effective long-term preventative strategy for allergy treatment. In the many cases of asthma where allergies are a significant trigger, injections help decrease asthma symptoms, reducing the amount of medications needed to control asthma.
Your Allergy Partners physician can help determine the cause of your asthma by combining a thorough medical history and physical examination with appropriate diagnostic testing. An allergist is an expert at managing asthma to ensure long-term health and well-being.
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Spring allergies are now in full bloom. The spring allergy season kicked off with tree pollen and in some parts of the country this has been joined by grass pollen. Many of you have already experienced that yearly increase in nasal and eye symptoms. While pollen allergies lead to the more obvious symptoms of runny nose, congestion and itchy eyes, allergic reactions to pollen often leads to some less obvious symptoms.
Allergies are one of the leading triggers for asthma. If you experience more coughing, bronchitis, chest tightness, shortness of breath or wheezing during the pollen season, these symptoms may be triggered by your allergies. Allergies also increase the rate of sinus and ear infections. Allergic inflammation can prevent the ears and sinuses from draining properly which in-turn makes you more likely to develop infections. Getting control of your spring allergies will not only provide relief from your nasal and eye symptoms, it often reduces your need for asthma medications and antibiotics.
Minimizing your exposure to spring pollens will reduce your allergy symptoms. Some basic avoidance tips include:
· Keep windows closed to prevent pollens from drifting into your home.
· Minimize early morning activity when pollen is usually emitted — between 5:00 and 10:00 a.m.
· Keep your car windows closed when traveling.
· Stay indoors when the pollen count is reported to be high.
· Machine dry bedding and clothing. Pollen may collect in laundry if it is hung outside to dry.
Of course, avoidance is not always practical. We want to be outdoors and enjoy the spring weather which means exposing ourselves to pollen. Regular use of your allergy medications such as nasal steroids and antihistamines will help control your allergy symptoms. If medications are not providing complete relief or if you prefer to avoid regular mediation use, consider allergy shots (allergy immunotherapy) to gain better control of your allergies. This non-medication treatment contains natural extracts of allergens and slowly reduces the severity of your allergic reactions. Over and over this has been shown to be the most effective treatment for pollen allergies. Allergy shots are effective for 85% of patients, reduce the need for medication and in the long run are less expensive than medication use.
You do not need to live with allergy symptoms and relief is available. If you are experiencing spring allergies, make an appointment with your local Allergy Partners office.
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| New Advances in Immunotherapy
Recent and exciting changes to our immunotherapy program include the development of a cluster immunotherapy program that allows patients to reach maintenance immunotherapy in as short as four weeks. Allergy Partners is also excited to offer sublingual immunotherapy to appropriate patients. Compared to traditional immunotherapy, sublingual immunotherapy has a reduced risk of reactions that allows patients to receive immunotherapy at home.
What is Cluster Immunotherapy?
Cluster immunotherapy is an accelerated version of traditional immunotherapy. Our standard immunotherapy build up schedule calls for 27 incremental doses given once or twice a week. In Cluster, this build up period is condensed into 8 ‘sessions’ held once or, ideally, twice a week. At each session, the patient will receive 2-3 doses of immunotherapy separated by a 30 minute waiting period. While sessions may last up to 90 minutes, a patient can reach maintenance dosages in as little as 4 weeks. Such a schedule is very appealing to patients desiring to see results more quickly or whose schedule is better suited to a more intensive initial phase of immunotherapy.
What is Sublingual Immunotherapy?
Sublingual immunotherapy utilizes allergens administered in a liquid or tablet form under the tongue to achieve immune changes as seen in traditional immunotherapy. Sublingual immunotherapy is currently not FDA approved in the United States, but research in both the US and abroad, demonstrate that sublingual immunotherapy can be a safe and effective treatment for allergic rhinitis. Allergy Partners physicians have been deeply involved in sublingual immunotherapy studies and development. After a careful review of all the current available data, Allergy Partners is pleased to announce that we will begin offering this form of immunotherapy to appropriate patients. Patients for whom this treatment may be a good option include those who are needle phobic, those who have not tolerated traditional immunotherapy well, and those with isolated seasonal symptoms. In addition, sublingual immunotherapy appears to be an exciting option for young children.
Talk with your Allergy Partners physician today to determine which method may be best suited for your individual situation. |
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Allergy Partners is the nation's largest single-specialty practice dedicated to the treatment of allergies, asthma, and allergic diseases. All Allergy Partners’ physicians are board-certified allergists who have years of training and experience in the treatment of allergies and asthma. Working together, our physicians are able to combine their expertise to ensure that each and every patient receives the very best care. Our physicians are dedicated to identifying clinical best practices that will ensure the very best outcomes for each patient. Such collaboration produces what we like to call the Allergy Partners Difference.
One example of the Allergy Partners Difference is our state-of-the-art allergen immunotherapy program and extract lab. To ensure that immunotherapy is as safe and effective as possible, it is imperative that the extract be made with the highest quality raw materials, that the dosage be optimized to ensure effectiveness and safety, and that the extract be individualized for the patient. Working with national organizations and extract manufacturers, Allergy Partners has developed a state-of-the-art immunotherapy program. Our centralized extract lab, located in Asheville, North Carolina, produces the highest quality allergen extract possible. Abiding by national immunotherapy standards, all Allergy Partners extract is designed to provide each patient an individualized vaccine that will provide the utmost clinical effectiveness while maintaining patient safety.
Allergy Partners is also committed to using the latest technology to improve patient outcomes. Allergy Partners has adopted electronic health records to improve patient safety and communication with referring physicians. All Allergy Partners physicians also employ a secure internal e-mail system that allows them to virtually discuss difficult cases with the entire group of allergists. This affords the patient with access to not just his or her allergist, but a network of over 60 board-certified allergists to help solve the problem.
Allergy Partners is dedicated to patient education. Our new website was built and designed by our physicians and contains a wealth of educational material to help families and patients manage their allergies and asthma. You can also find information about upcoming events and news, as well as local allergy and asthma information by ‘Liking’ us on Facebook and ‘Following’ us on Twitter.
We invite you to learn more about Allergy Partners, the conditions we treat, and the services we provide by browsing our website, visiting our social media pages or contacting the practice. Check back often for new updates and the latest information!
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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! |
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