dermatitis or atopic eczema is a chronic inflammatory skin condition that
causes itching of the skin and chronic or recurrent skin lesions. Atopic
dermatitis can significantly impair quality of life due to sleep disturbance,
skin changes and scarring, and skin infections. Treatment may require
topical or oral steroids which have potential side effects. Studies that have
evaluated allergen avoidance measures as a means to PREVENT atopic dermatitis
have not shown much benefit. However, new studies indicate that using
inexpensive moisturizing emollients at a very young age may prevent eczema and
perhaps even allergies in at risk children.
dermatitis is now felt to result from skin barrier defects. Many people with
eczema have defects in a protein called filaggrin in the top layers of skin.
This protein and lipid layers together help maintain a healthy skin barrier.
The outer layers of skin are important to retain skin moisture and act as an
effective barrier to environmental allergens and irritants. The question
is whether or not enhancement of the defective skin barrier could prevent or
delay the onset of atopic dermatitis. Emollients (hydrating agents) improve the
skin barrier by providing extra lipids to the skin.
studies have evaluated the benefit of early application of emollients to the
skin of infants at high risk for developing atopic dermatitis and have shown positive
results. In a pilot study done in the United States and in the United
Kingdom, daily application of an emollient to the entire body surface, except
the scalp, beginning by 3 weeks of age showed a reduction in the incidence of
atopic dermatitis at 6 months of age. The emollients used in the US included
sunflower seed oil with a high ratio of linoleic acid/oleic acid, Cetaphil
cream, and Aquaphor ointment. Most parents preferred using a cream and
there were no adverse effects noted from applying the moisturizers.
sensitization can occur through skin that is not intact and preventing the
development of atopic dermatitis may reduce allergic sensitization. For
example, studies have identified peanut allergen in dust in homes where peanuts
are consumed and skin exposure to this allergen is believed to sensitize some
infants and children with eczema to peanut. Thus, applying an emollient
cream such as Cetaphil on a daily basis beginning shortly after an infant is
born may prevent the development of atopic dermatitis and sensitization to
allergens through the skin.
dermatitis is established, use of emollients remains a mainstay of treatment.
In addition, evaluation by an allergist and allergy testing can help identify
environmental or dietary allergic sensitivity that may be triggering symptoms.
Your Allergy Partners physician will work with you to develop an individualized
treatment plan that includes avoidance of allergens and irritants and other
skin care recommendations.
shelves are stocked with herbs and supplements that claim to improve health.
Such complementary and alternative medicines (CAM) are part of a group of
diverse medical and healthcare systems, practices, and products that are not
generally considered part of the conventional medical practices.
Over 42 percent of people in the US (both
adults and children) have used CAM for their allergic disorders. Such
treatments are perceived to be natural and safe by patients, but reporting of
adverse effects is largely inadequate. But do CAM therapies really help with
allergies and asthma? Importantly, are CAM therapies safe?
Chinese Herbal Medicine has been used for
centuries in Asia. However, lack of standardization and controlled clinical
trials have hampered their use as conventional therapies in Western medicine.
There is potential for developing novel therapies for atopic diseases from
Chinese herbs. Several herbal formulas show early promise for the treatment of
asthma, food allergies, and allergic rhinitis in randomized trials. Work
remains to determine the active components of each herb and their mechanisms of
action. In addition, issues with consistency of herb quality and
standardization still need to be addressed.
Herbal therapies like Ayurvedic mixes, butterbur, and Tinofend have
demonstrated some efficacy but these treatments may have side effects.
These products are not systematically monitored for safety by drug regulatory
bodies. Herbal remedies, including teas, made from plants can cause allergic
reactions, such as hives, or can induce asthma symptoms. Pregnant and nursing
patients should be advised to avoid these herbal therapies.
Nasal sprays consisting of dilute
solutions of capsaicin or inert, micronized cellulose powder have shown
efficacy for allergic rhinitis. Nasal saline lavage, commonly with a nettie pot
can be effective in alleviating symptoms of nasal congestion and drainage.
A variety of other herbal preparations, homeopathic
products, and miscellaneous therapies have been suggested for the treatment of
allergic rhinitis or conjunctivitis. However, studies have either been of low
quality or failed to show benefit. Additionally, a number of herbs such
as chamomile and Echinacea can cause allergic reactions in people who are
allergic to ragweed pollen.
Vitamin D deficiency has been
increasingly recognized as a health issue, particularly in northern latitudes.
Low Vitamin D levels have been associated with increased rates of food allergy.
It’s too early to say whether vitamin D can reverse food allergies. Future
research is needed to answer that question. However, research is beginning to
support the idea that vitamin D can protect against food allergies and vitamin
D is important for overall good health.
For most people, the best way to ensure you have enough vitamin D is a
combination between sensible sun exposure and adequate intake of foods
containing the vitamin. Your doctor can assess your vitamin D status with a simple
blood test and recommend a supplement if necessary
interventions such as Acupuncture and Acupressure (Stainless steel pellets in
adhesive discs are applied to specified points “acupoints” on the ear) show
modest benefit in the treatment of allergic rhinitis, although it is difficult
to estimate the size of the effect in most studies.
With all CAM interventions, it is vitally
important to discuss your use of these therapies with your doctor.
Additionally, CAM therapies should not be used in place of conventional
therapies without first talking to your doctor.
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. But, for others
winter time means winter allergies. Winter allergies? Yes, winter allergies.
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.
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.
to dust mites is one of the most common allergies. Up to 1 in 4 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.
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:
dust collectors such as stuffed animals in the bedroom
bedding in hot water (130 degrees)
carpets regularly with a HEPA filter vacuum
steam cleaning your carpets yearly
in high quality allergen encasements for your mattress and pillows to put a
barrier between you and the dust mites.
of dust mite allergy symptoms can include the use of over the counter and
prescription medicines. For those interested in preventing symptoms, allergen
immunotherapy (AKA 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.
learn more about allergies, asthma and our practice visit
The O2 Air Purifier attracts and eliminates not only allergens, but also mold,
bacteria, germs and odors.
Dr. Heather Gutekunst, Allergy Partners of Raleigh, hosted a great webinar last night 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.
Ahh, cooler weather. Ahh Ragweed? Ahh
CHOO! Yes, Fall has its own pollen season, and the important pollen is ragweed,
which pollinates from August to October. The main two varieties in our area are
Giant ragweed and Short ragweed.
There are other weeds whose pollen may provoke allergic reactions, but
ragweed produces pollen in quantities which put these other weeds to shame. Other weeds which produce allergenic pollen
in our area during the fall are:
Of these, English plantain has the longest pollinating
season. None of those minor weeds above
can match Ragweed's production, but are still important contributors to fall
think that they are allergic to goldenrod, which they see growing in large
quantities in open fields in the fall. In fact, the pollens of most flowering
plants do not provoke allergy for
the simple reason that flowering plants have flowers in order to attract bees
which are required to transfer the heavy, sticky pollen from the male to the
female plant. Since the pollen requires bees for transfer, it isn't blown aloft
where it can be inhaled into the respiratory tract or get into the eyes of
allergy sufferers. Those plants which are wind pollinated generally have small
and unspectacular flowers or florets, and light, aerodynamically shaped pollen.
So when you sneeze next to a field bursting with yellow flowers, it's probably
the ragweed, not the goldenrod.
comes in several varieties, but the important ones in our area are giant
ragweed and short ragweed. In the delta region of the Mississippi river, vast
stands of giant ragweed may grow to reach as much as 15 feet in height! Let
that be a warning to those who are ragweed-sensitive not to visit that area of
the country during the fall pollinating season! Many people ask if there is a
better place to live if they have ragweed allergies. Last year, the Asthma and Allergy Foundation
of America compiled a list of the worst cities to live for those
with ragweed allergies. Top on the list was Louisville, KY. But don’t think about moving right away. In general, studies have shown that when
people move to another city, 50% have worse allergy symptoms and only 50% get
In the past,
many ragweed-sensitive subjects have taken late summer or fall vacations in the
upper peninsula of Michigan or the northern tip of Maine because these areas
have traditionally been free of ragweed. People hiking in carrying pollen and
seeds on their clothing have unfortunately introduced some ragweed.
who are sensitive to ragweed will complain of itching of the throat and/or
nasal congestion after eating cantaloupe, watermelon or bananas. This is due to
a cross-reacting protein present in these foods and the syndrome is called oral
A publication from the United States Department of Agriculture found data that
indicate a significant increase in the length of the ragweed pollen season by
as much as 13–27 days at latitudes above 44°N since 1995 compared to before
that time (this latitude crosses states in the northern part of the U.S.)
This is not good news for those people who suffer from ragweed allergy.
The pollen is highest during the morning hours, on windy days or shortly after
a rainstorm when the plant is drying out. However, rain “washes the pollen out
of the air,” so going out during the rain generally causes fewer symptoms.
symptoms of allergic rhinitis are sneezing, runny nose and nasal congestion.
Eye symptoms include itchy, watery, red and, at times, swollen eyes. The ears
and roof of the mouth may itch as well. In asthmatic patients, allergen
exposure can trigger cough, wheeze and shortness of breath. Importantly, up to
70% of asthmatics have underlying allergies. People with allergies are also more
prone to ear and sinus infections.
other allergic conditions, the mainstays of treatment include avoidance,
medications and allergy shots. Some basic avoidance tips
- Keep windows closed to
prevent pollens from drifting into your home.
- Keep air conditioning on as
that filters out 95% of the pollen.
- Minimize early morning
activity when pollen is generally at its maximum -- between 5:00 and 10:00
- Keep your car windows closed
- Stay indoors during high
pollen counts (which are available on our home page) and
on windy days when pollen may be present in higher amounts in the air.
- Machine dry bedding and
clothing. Pollen may collect in laundry if it is hung outside to dry.
- When you come home for the
day, change your clothes and take a shower to remove the pollen that is
attached to your clothes and hair. Also consider washing out your eyes
with contact lens saline solution or artificial tears and rinsing out your
nose with saline nasal spray to wash the pollen out of those areas.
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 and “Share” the article.
S. Turner, MD
Interested in learning more
about the treatment and control of asthma or would you like the opportunity to ask a physician all of your
asthma related questions?
Join us September 9th
at 8:00 PM EST or September 16th at 10:00 PM EST for an interactive,
live webinar! Follow one of these links to register or scan the QR code
Feel free to share this link
with your family and friends so they can participate too!
Today’s blog post is the last installment in our annual series on going back to school with food allergies. Our previous posts have focused on:
Today I will focus on the federal and state legislation regarding this issue and what potential impact it can have on you and your family.
The Food Allergy and Anaphylaxis Management Act (FAAMA) was passed by Congress on December 21st, 2010 and was signed into law by President Obama on January 4th, 2011. The legislation called for (1) the creation of voluntary national guidelines to help schools manage students affected by food allergy and anaphylaxis and (2) providing of incentive grants to support implementation of food allergy management guidelines in public schools. The guidelines are voluntary which is very important because one size does NOT fit all when it comes to school based procedures to protect against food allergy. The CDC published these voluntary guidelines in late 2013. These guidelines serve as a framework to help families, school officials and medical providers take concrete actions to protect food allergic children in the school and early care/education setting.
On November 13, 2013 President Obama signed into law the School Access to Emergency Epinephrine Act, which encourages states to adopt laws requiring schools to have on hand “stock” epinephrine auto-injectors. The legislation was passed by the U.S. House of Representatives on July 30, 2013 and the Senate on October 31, 2013. In both cases the bills passed with strong bipartisan support. In addition to protecting those whose epinephrine auto-injector isn’t immediately accessible during a reaction, this legislation will help save the lives of those who experience an anaphylactic reaction and don’t have a prescribed epinephrine auto-injector. The federal legislation provides an incentive for states to enact their own laws allowing school personnel to keep and administer a non-student specific epinephrine auto-injector in case of an emergency. The Food Allergy Research and Education organization (FARE) was instrumental in getting this legislation passed, the hard working individuals at that organization deserve a lot of credit.
· Required local school boards to adopt and implement policies for the possession and administration of epinephrine in every school
· Importantly, a $200,000 budget was passed to support the purchase of epinephrine auto-injectors for Virginia public schools during that initial school year. For this upcoming school year, many of the replacement auto-injectors were provided by a program from Mylan Speciality called EpiPen4Schools that offers four FREE EpiPen or EpiPen Jr Auto-Injectors to qualifying public and private kindergarten, elementary, middle and high schools.
In my opinion, all of these pieces of legislation have tremendous potential to protect food allergic children in the school, but they are no substitute for parents and families taking on their own personal responsibility to make sure that the student and school staff are educated and prepared.
This is the last post in our special series on going back to school with food allergies. I hope you have found it educational and helpful. There is still a lot to learn, but with the proper education and preparation we can all be confident that our food allergic students can enjoy another healthy and safe school year.
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. If you have a loved one with food allergy, please “Share” the article.
Dr. Ananth Thyagarajan (Dr. T.)
Today’s post is the next installment in our series on going
back to school with food allergies and will focus on special situations (field
trips, teenagers and college). Our previous posts have focused on:
Ask that you be given advance notice about these
Determine who will be responsible for carrying
the epinephrine autoinjector (i.e. EpiPen® or Auvi-Q®)
Make sure your child can bring his/her own food,
Will the children eat at a restaurant or other
type of food service establishment? If so, special arrangements may be
What type of transportation will be involved
(bus, van, private automobile)?
Based on this information you can address any specific food
Teenagers and young adults represent a special age group
when talking about food allergy. In two studies investigators analyzed
fatal food allergy anaphylaxis cases reported to a national registry, which was
established by the American Academy of
Allergy, Asthma, and Immunology, with the assistance of FARE. They found
that “… it is clear that the greatest number of fatalities…occurs in
adolescents and young adults.” Besides
the age range, other recurring characteristics include individuals with known
food allergies consuming foods without asking
about ingredients and not having the proper treatment available.
As always, the most important step is to make sure that the
school has an up to date epinephrine autoinjector and Food Allergy Action Plan
as well as knowing what the ingredients are of any food that is ingested. This
piece of advice is true for a student of any age. Most teenagers should be able
to carry their own epinephrine autoinjector. Here are some other tips directed
at teenagers based on advice from FARE:
When traveling, make sure that any food that you
take stays in your possession. If the food gets lost, then it may be difficult
to obtain other safe food
Keep your epinephrine autoinjector in the same
place in your backpack. If you have a reaction, you won’t have to search for
it. Tell your friends beforehand where you keep it and other medicines
Make sure to room with friends who respect and
understand your food allergies when going on a class trip
If you experience any harassment, let an adult
know. This can be your parent and/or school official. Unfortunately, studies
have shown that “bullying, teasing and harassment of children with food allergy
seems to be common, frequent and repetitive”
Don’t be polite if you are having a reaction.
There is no need to raise your hand, just shout it out
FARE has some great
teenager focused tips and videos For those students who are college bound, this represents a
wonderful time for academic, social and emotional development. Food allergies do
not have to get in the way of this. Here are some tips aimed at college-aged
students, again, adapted from FARE:
Choose a school with a supportive food allergy
policy and Resident Life staff
Before deciding on a college, students and
families should be sure to visit the school. Ask questions of the staff and
learn how each college helps students to manage their food allergies
Make sure to tour the dining services and ask
the food service director how the ingredients of each meal can be verified and
if an unsafe entrée can be exchanged
Find out if bringing or renting a MicroFridge (a
combination refrigerator and microwave) is possible, which give options of
preparing foods in the room
Alcohol may increase the rate of food allergen
absorption which may lead to a quickened reaction AND it can impair judgment
thus leading to poor decision making
(i.e. eating a food where the ingredients are unknown)
In any scenario, the foundation of food allergy management
doesn’t change: (1) always ask about
ingredients and (2) make sure there is ready access to self-injectable
epinephrine. Hopefully , in addition to
this, the above tips will help in these special circumstances.
In the last post in this series I will focus on federal and
state legislation regarding this issue and what potential impact it can have on
you and your family.
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. If you have a loved one with food allergy, please
“Share” the article.
Dr. Ananth Thyagarajan (Dr. T.)
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!