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April 14
The Allergic (Atopic) March: What Is It And Who Gets It?

The Allergic March, also called the Atopic March, refers to the progression or development of various allergic conditions with age.  

  

 
What is Allergic March?
Being prone to develop allergic conditions is a genetically inherited trait; however, the conditions or environment a child grows up in also affects the development of allergic conditions.  The tendency to have an allergic condition, known as "atopy", makes one prone to develop other allergic condition which is one reason it is called the Allergic (Atopic) March. The 4 main allergic conditions are eczema (also called atopic dermatitis), food allergies, environmental allergies (also called allergic rhinoconjunctivitis or "hay fever" or just "allergies"), and asthma.  These conditions and their symptoms often appear in a particular sequence with age, hence another reason for the term "march".  BUT they can also overlap.  For example a child with a food allergy can go on to develop environmental allergies before they have outgrown their food allergy.  Although the term "march" also implies that there is a progression through each one of these allergic conditions, an individual may only manifest some of these allergic conditions through their lifetime.  It's just that the allergic conditions that do end up developing tend to appear at particular ages in a sequence.

What are the symptoms and when do they appear?
Typically the first allergic condition to manifest is eczema which is a skin condition characterized by itchy rashes which come and go.  Eczema most commonly develops between 2-12 months of age.  About 30% of children with moderate to severe eczema develop a food allergy and this condition is typically next to develop, often between 6 to 12 months of age.  Symptoms of food allergies include redness of the skin, rash or hives (welts), swelling of lips or eyes, vomiting, or breathing difficulty which occur in various combinations fairly quickly after eating the food (usually within 2 hours).  Food allergies most commonly are due to one or more of the following: milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish.  These foods account for 85% of food allergies in children.  In a child who has eczema, there is an 85% risk of developing environmental allergies (hay fever).  Environmental allergies can develop as early as 1 year of age to substances found indoors such as dust mites and pet dander.  Allergies to pollen typically develop between 3 to 5 years of age at the earliest (after exposure to a few pollen seasons). Symptoms of environmental allergies include runny nose, frequent sneezing, itchy nose, blocked nose, or itchy, red, watery eyes.  Finally, a child with eczema has a 50% risk of developing asthma which can manifest at 3 to 5 years of age or later.  Asthma is a chronic lung disease characterized by inflammation (swelling and mucous) in the airways (breathing tubes) AND "twitchiness" of the airways causing them to constrict (narrow).  When the airways constrict, symptoms of asthma occur and can include repeating coughing or wheezing (high pitched whistling noise with breathing) or chest tightness (a sensation where breathing seems constricted or difficult) or a combination of these.  The symptoms of asthma can be triggered by colds (illness) or allergies.  
 
 
When should treatment begin?
Doctors and other scientist are continually doing research to better understand the Allergic March.  Hopefully a better understanding of the Allergic March can help us develop strategies to prevent allergic conditions from occurring and put a "halt" to the march. For example, studies have shown that starting a young child with environmental allergies on immunotherapy (allergy shots) can reduce the child’s risk of developing asthma. Additionally, new studies suggest that introducing some highly allergenic foods such as peanut earlier in life may reduce the risk of developing food allergies in children with eczema. To learn more contact your local Allergy Partners physician or visit allergypartners.com.
 
By Dr. Vaishali Mankad
Allergy Partners of Raleigh

 

 

 

 
 

 

April 06
2016 Spring Allergy Capitals

2016 Spring Allergy Capitals

 

The Asthma and Allergy Foundation of America recently released their 2016 list of ‘the most challenging places to live with spring allergies’.  You might be wondering if you are suffering from allergies or have a cold with the fluctuating temperatures. The symptoms are similar-- runny noses and sneezing. Dr. Deogun, Allergy Partners of Raleigh, indicated in a recent interview the best way to tell the difference: It’s likely allergies if you’re suffering these symptoms for more than a week.
Published: March 24, 2016, 4:47 pm  Updated: March 24, 2016, 5:40 pm
 
DURHAM, N.C. (WNCN) – Two Triangle cities made a list that some people probably want no part of.
Durham and Raleigh are on the Asthma and Allergy Foundation of America list for worst places to live with Spring allergies.
As the first week of spring rolls in, color is popping across the Bull City. But so is another un-welcomed sight.
“My car is a mess,” Durham resident Regina Lynch said. “It’s supposed to be red but it looks green.”
“Mostly sneezing,” Lynch said. “Runny noses, runny eyes.” “Itchy throat, watery eyes, my son had to break out the inhaler, and the breathing treatments,” Tankard said,
Enough of a problem to land Durham on the list.
Durham is 51 on the list and Raleigh comes in at 93.
Results that don’t surprise Allergy Partners of Raleigh’s Dr. Geetu Deogun.
“Generally we’ve had a lot of pollen in this part of the country,” Deogun said.
If you’re suffering, Deogun said over the counter medicine works for most but you may need a shot if the problem lingers.
You might be wondering if you are suffering from allergies or have a cold with the fluctuating temperatures. The symptoms are similar with runny noses and sneezing. Experts said the best way to tell the difference: It’s likely allergies if you’re suffering these symptoms for more than a week.
El Niño is another allergy factor this year.
It created a warmer, wetter winter.
Experts say you’re out of luck if you were hoping for a shorter allergy season.
“It means that the trees will just start blooming sooner,” Deogun said. “They need their trigger from the warmth, sunlight and the rain, so they might start pollinating earlier and last longer.”
As for the worst place for spring allergies, the study shows it’s Jackson, Mississippi.
 
To find out if your area made the list, click here.

 

 

 

By Dr. Geetu Deogun
Allergy Partners of Raleigh
 

 

March 21
Are There Allergic Triggers To Eczema

Studies have indicated an increased rate of sensitization to food and environmental allergens in patients with eczema. Infants and young children less than 5 years of age are more likely to be sensitized to foods while older children and adults are more likely to be sensitized to aeroallergens, especially dust mites.

 

 
 
 
How to sort it out?
 
Allergic triggers for eczema may be identified through skin testing or blood testing for specific IgE antibodies. In allergic patients, the immune system makes IgE antibodies to foods or aeroallergens that lead to an allergic response. Testing can be done for both foods and environmental allergens. A careful history should guide allergen selection for testing. In small children, the most common food triggers are milk, egg, wheat, peanut and soy. Once the positive sensitizations are known, working with your Allergy Partners allergist is instrumental in determining whether a food should be eliminated from the diet or if a supervised food challenge is warranted. As a positive skin or blood test in and of itself does not indicate a food allergy, your allergist may suggest a food challenge to determine if a true food allergy exists. Subsequent follow up is also needed to determine if and when a food allergy resolves. Aeroallergens can also trigger eczema flares. Dust mite allergy is common and certain measures in controlling dust mite exposure, such as allergen proof bedding encasements, have improved patients’ eczema. Pollen and animal dander have also been implicated as eczema triggers.
What is the treatment?
A more recent indication for immunotherapy (allergy shots) is eczema. Dust mite immunotherapy in adults with chronic eczema improved both eczema severity scores as well as reduced the use of topical steroid creams. Unlike medications, allergy shots work to modify the course of disease rather than simply treating symptoms.
 
Patients with eczema also have higher rates of contact dermatitis. Contact dermatitis is a delayed type of allergic reaction to substances touching the skin, for example poison ivy. Common contact allergy triggers include metals, fragrances, preservative and neomycin. A different type of allergy testing called Patch Testing can be performed to determine if patients are allergic to these common products. If so, avoidance can lead to significant improvement of eczema.
 

 

Allergy Partners physicians are specially trained physicians who are experts in identifying allergic triggers to eczema and other allergic diseases. They offer skin testing, both to foods and aeroallergens, and patch testing and are experts in interpreting the results of all allergy tests. They perform food challenges and can provide patients and families with expert advice as to how best treat and manage eczema.

 

 
By Dr. Patrice Kirchoff
Allergy Partners of the Blue Ridge
 
 

 

March 15
Breaking News: LEAP- On Trial

The Early Introduction of Peanuts to Children’s Diets

 

In a pivotal trial, published last year in the New England Journal of Medicine, European researchers from the Learning Early About Peanut Allergy (LEAP) study team presented data which fundamentally shifted existing concepts surrounding peanut allergy.  Early dietary avoidance of peanut had previously been advocated as a method to delay the onset of peanut allergy.  Despite this, the incidence of allergies has continued to rise worldwide.  In LEAP, 640 infants at high risk for developing peanut allergy (those with eczema and/or egg allergy) were selected to either consume or avoid peanuts until they reached 5 years (60 months) of age.  Results from this study showed a 70-86% risk reduction in the future development of peanut allergy in children from the early consumption group.  One of the questions left answered by LEAP was what would happen if these same children stopped consuming peanut on a regular basis? 
The Study
Enter, LEAP-On.  556 participants from the initial LEAP study were observed from the 60 month mark for 12 months after being instructed to avoid peanuts.  Peanut allergy at 72 months was significantly more prevalent among children in the original peanut-avoidance group than those who had initially been consuming peanut on a regular basis.  Although three new cases of allergy did develop in the early peanut-consumers, there was no significant increase in the prevalence of allergy in this group after 12 months of not eating peanuts.  This indicates that after achieving tolerance to peanuts at age 5, children may not need to continue to eat them regularly to prevent development of allergy.
To peanut or not to peanut?
These findings provide insights into future strategies of preventing peanut allergies and clinical implications of maintaining immune tolerance.  Obvious questions that now arise are how long tolerance can potentially be maintained and the effects of “ad lib” peanut consumption.
Given that peanut-associated anaphylaxis can potentially lead to fatal reactions, none of the above interventions should be attempted without first consulting with your Allergy Partners allergist. 
 
By Dr. Nabeel Farooqui

 

Allergy Partners of Central Indiana

 

 

 

February 25
What is Recurrent Acute Sinusitis?

Acute sinusitis is one of the most common disorders seen in a primary care setting. Unfortunately, many individuals develop recurrent acute episodes. If a patient suffers 3 acute sinus infections in 1 year, they are considered to have recurrent sinusitis. This condition is very challenging for patients and providers alike, leading to lost work and school days, patient discomfort, and high medical costs.  It is recommended that these patients see an allergist/immunologist and have a workup including an evaluation of environmental allergy as well as a review of how well their immune system is functioning.

 

 
 
What Causes It?
The allergic workup is very import, as allergic rhinitis can lead to acute and chronic sinusitis. In one study of 200 patients with chronic sinusitis, more than half of patients had allergic rhinitis. When looking at recurrent sinusitis, significant sinus disease has been found to be associated with allergy in 78% of patients. In acute sinusitis, one study of patients with acute maxillary sinusitis found more than a third of the patients suffered from allergic rhinitis. Finding the allergic triggers and treating them effectively will reduce the inflammation and swelling in the nasal passages.  If untreated, the swelling can lead to poor clearance of nasal mucous that is already full of bacteria, leading to bacterial growth and infection. Secretions thicken and become more difficult to clear.  An allergist can help patients manage their allergies in many ways, including teaching them to avoid allergy triggers once they are known, and developing an immunotherapy program.  In patients with recurrent sinusitis, a study showed that immunotherapy resulted in a 61% improvement in sinus pain, a 49% reduction in nasal blockage, and 72% fewer days lost from school or work.
 
 
 
What is the Treatment?
Patients with 3 or more acute sinus infections a year or chronic sinusitis should receive a complete allergic workup as well as an evaluation for immunodeficiency. If abnormalities are found, many of these patients can be helped greatly with management. All Allergy Partners allergists are Board Certified or eligible in Allergy and Immunology and provide expert care for patients suffering from recurrent sinusitis.
 
By Dr. Mark Wenger
Allergy Partners of Fredericksburg

 

 

 

 
 

 

February 19
Allergy Myth Busters: Adults Cannot Develop Allergies

Our very own Allergy Myth Busters!

 

Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?
 
 
MYTH: Adults cannot develop allergies.
 
THE SCIENCE:
 
While allergies are often thought of as a pediatric issue, adults can clearly develop allergies of all sorts (environmental, food, venom, medication) even when they haven't been allergy sufferers as children.  In most instances, such adults likely had a genetic tendency towards allergy and may even have had allergic symptoms such as mild eczema or hay fever as children, but often the symptoms were so mild or long ago that they have no memory of being "allergic" as a child.
There are a number of reasons why adult patients might experience the onset of what appear to be new allergies:
 
1) Increasing pollen levels - For people with only mild seasonal allergies, the appearance of classical symptoms such as seasonal congestion, runny nose, and itchy/watery eyes might only occur during certain very high pollen seasons.  Thus, given that pollen levels have generally been on the rise, such a person might have only recently noticed allergy symptoms as an adult.
 
2) Move to a new climate or introduction of a new pet - For a patient with an underlying allergic tendency, moving to a new geographic location with vastly different pollens (a new "aerobiology") can precipitate the onset of allergy symptoms.  Typically, this takes several years to be noted, since one has to be first sensitized to the new allergens in a given location, and then in subsequent years the symptoms occur rapidly with the onset of the pollen seasons in that area.  Similarly, a person may not have been aware of a pet allergy, but after significant exposure to a dog or a cat after bringing an animal into the house, a cascade of allergy symptoms can begin.
 
3) Immune system alteration - There is emerging evidence that exposure to allergens (such as foods or environmental triggers) during times when the immune system is undergoing changes can cause the onset of allergy.  The best documented of such immune changes are during certain viral infections, or during pregnancy.
 
4) Air pollution - Air pollution does not directly cause allergies, but evidence suggests that certain pollutants found in smog might increase the potency of airborne allergens.  This effect can lower the threshold of an allergy sufferer who otherwise might not notice the symptoms.  More globally, climate change may be contributing to increasing pollen levels and longer pollen seasons, though this hasn't been definitively proven.
 
5) Foods - Overall, food allergy is significantly more common in children, with certain childhood allergens being very well-known such as peanut, milk, and egg.  However, shellfish is a good example of a food allergy that it is much more common in adults than kids.  The reasons for this difference are not well-understood, but a new allergy to crab or shrimp in an adult is not a surprising finding for an allergist.
 
 
So is the myth busted or true?
 
MYTH BUSTED!
Mainly the myth is busted, in the sense that individuals frequently develop allergy symptoms as adults.  However, in many instances, there was an underlying tendency towards allergy or even mild allergy symptoms that went unrecognized in childhood.
 
Dr. David Fitzhugh
Allergy Partners of Chapel Hill

 

 

 

 
 

 

February 10
Allergies, Treatment and Prevention

Dr. Friedman, Allergy Partners of Arizona, was featured on Wake Up! Tucson

 

 
Click to listen to Dr. David Friedman discuss allergies, treatment and prevention with callers on Wake Up! Tucson 1030 KVOI The Voice
 

 

 

 

 

 

February 10
Breaking News: Occupational or Workplace Asthma

 

 

Summary:

 

 
Patients that suffer from occupational asthma (asthma caused by breathing in hazardous substances in the workplace) may not realize their symptoms are work-related. It can also affect their ability to work, overall quality of life, and even threaten their lives.
 
Full Release:
 
What is Occupational Asthma?
Asthma caused by breathing in hazardous substances in the workplace is called "occupational asthma." Asthma can affect your ability to work and overall quality of life.  It can even threaten your life.
 
How Does it Work?
Patients suffering from occupational asthma often may not realize their symptoms are work-related. Symptoms of occupational asthma are the same as regular asthma and may include any or all these chest symptoms: cough, shortness of breath, wheezing and chest tightness. An asthmatic patient my fail to recognize the work relationship to their asthma as symptoms often begin several hours after exposure. Occupational asthma symptoms usually become worse during the workday and throughout the work week. Symptoms may be immediate (less than 1 hour), delayed (more commonly, 2 to 8 hours after exposure), or nocturnal. They usually decrease over the weekend, or days off and during vacations, but may take a week or more. However, workplace exposure to sensitizing chemicals or dusts can induce asthma often persisting after the exposure has stopped. Initial symptoms may occur after high-level exposure (spill).
 
What Causes It?
Several hundred substances found in the workplace have been found to be respiratory sensitizers with more being identified all the time. The list below is a broad indication of substances known to be respiratory sensitizers and their common work activities.  It is not exhaustive and many known sensitizers are not identified here:
Substance Groups                                                    Common Activities
Isocyanates                                                                        Vehicle spray painting, foam manufacture
Flour/grain/hay                                                          Handling grain at docks, milling, malting, baking
Electronic soldering flux                                           Soldering, electronic assembly, computer manufacturing
Latex rubber                                                      Gloves in health care, laboratories
Laboratory animals                                          Laboratory animal work
Wood dusts                                                                        Saw milling, woodworking, and furniture manufacture
Glues/resins                                                                      Curing glues and epoxy resins in joinery and construction
Gluteraldehyde                                                           Health Care
Hair dyes                                                                             Hairdressers
Penicillins/cephalosporins                                            Pharmaceutical industry
Chromium compounds                                  Welding stainless steel
Platinum salts                                                                    Catalyst manufacture
Cobalt                                                                                   Hard metal production, diamond polishing
Nickel sulphate                                                                 Electroplating
Subtilisin/enzymes                                                          Detergent manufacture
 
 
What Should I Do If I Have Occupational Asthma?
If you are having work-related air flow limitation make an appointment with your Allergy Partners Physician telling him/her your symptoms, where you work, what your job is and what chemicals and materials you work with daily. Take chemical fact sheets to your Allergy Partners Physician. Lung function monitoring may include serial charting with a peak flow meter for 2 to 3 weeks (2 weeks at work and up to 1week off work as needed to identify or exclude work-related changes in peak expiratory flow.) Record when symptoms and exposures occur and when a rescue inhaled bronchodilator is used. Measure and record peak flows every 2 hours at work and away from work.
 
What is the Treatment?
Allergy Partners Physicians are trained in additional, specialized evaluations to include immunologic testing and confirmatory evaluations such as detailed pulmonary function testing and bronchial challenges.
The patient is encouraged to work with on-site health providers or managers/supervisors discussing avoidance of the initiating agent, ventilation, respiratory protection, and tobacco smoke-free environments.
If your Allergy Partners Physician tells you that you have occupational asthma, you should be removed from the work area or job to prevent it from getting worse. Occupational asthma is a serious illness. Lack of appropriate treatment can lead to permanent disability.  Early recognition and treatment are paramount in keeping this illness from getting worse.
Patient confidentiality issues are particularly important in work-related asthma. As even general inquires about the potential adverse health effects of work exposures may occasionally result in reprisals such as job loss, occupational asthma patients need to be informed of this possibility and be full partners in the decision to approach management regarding the effects or control of workplace exposures.
 
 
Dr. Brian Dantzler
Allergy Partners of Charleston

 

 

 

 

 

January 26
Allergy Myth Busters: Children Under Four Can't Be Skin Tested

 

 

Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?

 

 
MYTH: Children less than 4 years of age can’t be skin tested for allergies.
 
THE SCIENCE:
First introduced in 1865, allergy skin testing remains the gold standard for diagnosing allergic sensitization. There are two types of skin testing. Skin prick testing involves placing a drop of a suspected allergen (or extract) on the skin and scratching or pricking the surface of the skin. Intradermal testing involves injecting a small amount of extract just under the skin, similar to how a Tuberculin skin test is performed. A positive reaction to either test will appear as a small, slightly raised red bump. Allergy skin testing has a number of positives:
·         Quick – Many allergens can be tested at the same time and results are read in 10-15 minutes.
·         Comfortable – Both skin prick and intradermal testing involve very minimal discomfort, although positive test can be itchy for several minutes.
·         Accurate – When performed with high quality extracts and by a trained technician, allergy skin testing is the most accurate test for allergy diagnosis.
 
Although the results of allergy tests are not affected by a person’s age, sex, or race independent, certain age (children younger than 2 years and adults older than 65 years) and racial (African American children) factors may affect their interpretation. This fact may explain why some people believe that children need to be a certain age before they can be skin tested. Generally speaking, skin testing can be performed even in infancy, and as young as one month of age. However, the skin of very young children may not be as reactive as older children and adults, and therefore the results need to be interpreted more carefully.
 
The reason for skin testing is probably more important than the age at which a child is tested.
 
In infants and toddlers, allergic disease most commonly occurs as food allergy and atopic dermatitis. In school-age children, allergic disease occurs more commonly as allergic rhinitis. Asthma can occur at any age, but occurs most commonly in adolescent boys and teenage girls. Because of this, skin testing should be aimed at identifying allergic triggers appropriate to the age of the child.
 
Skin testing, particularly prick skin testing, is virtually painless. There is no bleeding involved, as the needle only pricks the skin to the depth of a scratch. The worst part of skin testing is that the skin test sites may be quite itchy when positive results occur.
 
MYTH BUSTED!
Allergy skin testing is a safe, accurate and virtually painless means of diagnosing allergy at all ages. All Allergy Partners physicians are Board-Certified and experts in the diagnosis, treatment, and management of allergies and asthma at any age. Learn more at allergypartners.com.

 

 

 

January 19
Use of Asthma Medication in Pregnancy

Summary:

 

 
Maternal asthma during pregnancy has been associated with increased risks of several adverse outcomes, emphasizing the need for optimal asthma control during pregnancy.
 
Full Release:
 
The risks:

 

Maternal asthma in pregnancy has been associated with an increased risk of adverse outcomes, including preeclampsia, low birth weight, preterm birth and congenital abnormalities. This, compounded with the increasing prevalence of asthma in the general population, emphasizes the need for optimal asthma control during pregnancy. Of the associated adverse risks, there has not been a clear consensus as to whether the increased risk of congenital abnormalities is related to asthma itself or the medications used to treat asthma. A recent study in the Journal of Allergy and Clinical Immunology sought to identify whether this risk is associated with asthma medications in the first trimester.1

 

 
What is the underlying cause?
The study did find that there was an increased chance of congenital abnormalities including cleft palate and gastroschisis in those with exposure to inhaled B2 agonists (e.g. albuterol), the drug typically found in rescue inhalers. Though there is an increased risk, the individual risk remains low – less than 1 in 100 births. There was no increased risk seen with inhaled corticosteroids, which are often used in controller inhalers.
 
Conclusion.
Despite these findings, both maternal asthma and asthma exacerbations during the first trimester of pregnancy have been found to increase the risk of congenital anomalies as well. http://www.jacionline.org/article/S0091-6749(08)00521-6/pdf Furthermore, asthma exacerbations during pregnancy have been associated with other unfavorable pregnancy outcomes for both the mother and infant. The study highlights these facts as the risks of uncontrolled asthma might be much greater than the studied specific risks. Ultimately, the study suggests that the use of prophylactic inhaled steroids seems to be the best approach for treating asthma in pregnancy to prevent asthma exacerbations and to reduce the need for β2-agonists.  For this reason, both those pregnant or considering pregnancy that have asthma would benefit from being followed by an asthma specialist.
 
1.       Garne et al. Use of asthma medication during pregnancy and risk of specific congenital anomalies: A European case-malformed control study.  J Allergy Clin Imuno.  Vol 136, Number 6. pp 1496-1502.
By Dr. Michael Alvares
Allergy Partners of Dallas-Fort Worth

 

 

 

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