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August 27
FREE Asthma Webinar

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 below.
 
September 9th
 
September 16th
 
Feel free to share this link with your family and friends so they can participate too!
 
 

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August 11
Back to School with Food Allergy (Part 4): Federal and State Legislation

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.
 
Currently, over 35 states have a law/guideline allowing schools to stock epinephrine. Five states have a law/guideline REQUIRING schools to stock epinephrine. Here in Virginia we have legislation requiring schools to stock epinephrine. The “Public schools; possession and administration of auto-injectable epinephrine” act (HB 1107 and SB 656) was signed into law by Governor McDonnell in April 2012. This legislation:
·         Required local school boards to adopt and implement policies for the possession and administration of epinephrine in every school
·         Dictated that the school nurse or a school board employee may administer the epinephrine to any student believed to be having an anaphylactic reaction and states that these individuals shall not be liable for any civil damages for ordinary negligence in acts or omissions resulting from the rendering of such treatment” (protects them from liability when giving the medication)
·         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.)

 

August 04
Back to School with Food Allergy (Part 3) – Special situations at school

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:
Your child’s food allergy should not prevent them from attending field trips and participating in extracurricular activities. Here are some tips and issues to consider for that situation (adapted from the Food Allergy Research and Education (FARE) organization’s “Managing Food Allergies in the School Setting: Guidance for Parents”):
·         Ask that you be given advance notice about these events
·         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, if not…
·         Will the children eat at a restaurant or other type of food service establishment? If so, special arrangements may be necessary
·         What type of transportation will be involved (bus, van, private automobile)?
Based on this information you can address any specific food allergy concerns.
 
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)
·         One study showed that peanut allergen would become undetectable in saliva for the majority of people several hours after they had eaten peanuts or peanut products. This is relevant for those people who have food allergies and are interested in dating. Be upfront with people you are interested in. If they care about you, they will understand and want to learn about how they can help keep you safe
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.)

 

July 29
Back to School with Food Allergy (Part 2) – Tips on staying safe

Today’s post is the next installment in our series regarding going back to school with food allergies. In the last post I discussed the available science on this subject. Today we will focus on practical tips to keep your children safe.
 
The most important step that you can take is to make sure that the school has an up to date epinephrine autoinjector (for example Epi-Pen® or Auvi-Q®) and Food Allergy Action Plan for your child. Regardless of what setting a reaction occurs, it should be treated in the same way. If the symptoms are isolated to the skin or gastrointestinal tract and mild in nature, then treating with an anti-histamine is sufficient. If the symptoms are more severe (like losing consciousness, throat constriction, wheezing/shortness of breath or repeated vomiting) then the epinephrine autoinjector should be administered immediately. Emergency services should then be notified for further possible treatment.  If there is any doubt as to whether or not the reaction is mild or severe, epinephrine should be given. The potential side effects of epinephrine are negligible compared to the consequences of an under treated allergic reaction.
 
In order to prevent reactions, you should emphasize to your child that he/she cannot eat foods from other kids. The only foods that can be ingested should come from you or a designated adult. There is no evidence that policies regarding tables and classrooms that are “peanut-free/allergy-free” decrease reaction rates. The same is true for policies that isolate food allergic children.  I advise my patients to place the least amount of restriction as possible on other children while offering adequate protection. I also advise my patient’s families to really emphasize “no food sharing” at school. In my opinion a “no food sharing” school wide policy would be more effective in keeping kids safe versus the so-called allergen free table or classroom.
 
In a published editorial from professionals at the University of Michigan and the Global Food Protection Institute, they stated that a more effective policy would be to reduce the presence of food items in the classroom.  There is data the shows the food allergy reactions most commonly occur in the classroom. If the presence of food items was decreased in this setting, that would likely lead to a decreased frequency of reactions at school. According to the editorial, “[s]chools would have to emphasize use of nonfood treats (eg, stickers or small trinket toys) or create designated celebration spaces away from learning areas, where selected safe treats could be consumed.” Hopefully more schools will pursue this strategy.
 
Here are some tips adapted from the Food Allergy Research and Education (FARE) organization:
·         See the allergist: Make sure to have an updated Food Allergy Action Plan
·         Be informed and educated: Learn about your child’s food allergy and their school’s approach to food allergic children
·         Prepare and provide information: As mentioned above, provide an up to date Food Allergy Action Plan as well as emergency medications (especially an epinephrine autoinjector) to the school
·         Build a team: Befriend the school nurse, talk with your child’s teacher and provide allergy-free snacks at the beginning of the school year so that your child won’t feel left out during parties and celebrations
·         Help ensure appropriate storage and administration of epinephrine: Make sure to know where the medication will be stored, who has access to it and who will administer the medication in an emergency
·         Help reduce food allergens in the classroom: Talk with your child’s teacher about possibly implementing strategies to help avoid exposure to food allergens (i.e. no food sharing, using nonfood items for projects)
·         Address transportation issues: Find out what the procedures are for managing food allergies on school transportation and determine whether they are appropriate for your child
·         Prepare for field trips: Ask that you be given advance notice about these events so that you can address any food allergy concerns
·         Prevent and stop bullying: Unfortunately, studies have shown that 31.5% of the children and 24.7% of the parents reported bullying specifically due to food allergy. Talk to your school about their anti-bullying policies and make sure they fit with your family’s priorities and comfort level
·         Keep records: Make sure all of your school forms are up to date with your current contact information. Keep copies of important documents
·         Offer to volunteer: If your schedule allows, consider volunteering to be the room parent so that you can be involved in classroom celebrations that may involve food, or can accompany the class on a field trip
·         Assist your child with self-management: This may be the most important point. Continuously talk to them about making good choices, advocating for themselves and recognizing potentially dangerous situations
In the next post in this series I will focus on special situations for students with food allergy.
 
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.)

 

July 23
Back to School with Food Allergy (Part 1) – What does the science tell us?

This is the first post in an annual series regarding students going back to school with food allergies. For families or patients living with food allergies, going back to school can be a stressful time. Especially for those kids going to school for the first time, there can be a great deal of concern over preventing accidental ingestions and reactions. My goal as a physician and allergist is to help create an environment for my patients to live their lives in a healthy and prosperous manner. For children, that means helping them be kids without being defined as “the kid with food allergies”. Growing up is hard enough without feeling different than everyone else. Over the next few weeks I will be writing about different aspects concerning this issue and what you can do to protect yourself or your children.

 

This week I want to focus on the science available that can help dictate our course of action.
 
  • Reactions occur at school and can be severe with certain conditions. However, their overall occurrence is still rare and there are no exact data on how often reactions occur in school. There is a growing trend of families choosing to home-school their food allergic children, but there is no data showing that this course of action reduces the risk of reaction.
  •  
  • The highest risk for any food-induced reaction stems from direct ingestion of the food. Severe reactions from contact or inhalation exposure to the allergen seem to be extremely low.  In a study from Johns Hopkins, researchers failed to detect measurable quantities of peanut in air filters around the necks of volunteers who danced on peanut shells scattered on the floor of a poorly ventilated room.  In the same study they found that peanut allergen was easily cleaned from hands and tabletops with common cleaning agents and did not appear to be widely distributed in preschools and schools. 
  •  
  • Contact with the allergen may lead to localized hives that will not result in a full body reaction in the overwhelming majority of food allergic individuals. Wiping down the skin area where there was contact with allergen often resolves the reaction. In summary, the greatest risk for a reaction at school or child care in a food-allergic child is from direct ingestion of the allergen and not from other routes of exposure.
 
In the next blog post in this series I will focus on tips to help families practically manage their child’s food allergy in school.
 
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.)

 

July 22
Dr. T was featured in the news

Dr. Thyagarajan was recently interviewed on WTVR CBS 6 News regarding summer time asthma. To watch the interview, click on the following link:

 

 

July 02
Upcoming Office Closings

There are some changes to our schedules in the coming weeks:

  • Friday, JULY 4th - ALL Offices will be closed
  • Friday, JULY 18th - Our Forest Avenue Office will close at 12:30 pm - last injection will be at Noon.

We apologize for any inconvenience.

 

June 03
What is An Allergist?

 

AAllergy doctor Richmond, VA Allergy testing Richmond, VA
An allergist/immunologist (commonly referred to as an allergist) is a physician specially trained to diagnose, treat, and manage allergies, asthma, and immunologic disorders including primary immune deficiency disorders. These conditions range from the very, very rare to the very common, span all ages, and encompass various organ systems.
 
In the United States, becoming an allergist/immunologist requires at least an additional nine years of training beyond a bachelor’s degree. After completing medical school, physicians undergo three years of training in internal medicine or pediatrics and pass the exam of either the American Board of Internal Medicine or the American Board of Pediatrics. Internist and pediatricians interested in becoming an allergist/immunologist have at least an additional two years of study, called fellowship, in an allergy/immunology training program. All allergists are trained to become both adult and pediatric allergists.
 
Allergists/immunologists listed as board-certified have successfully passed certifying examination of the American Board of Allergy and Immunology. Board certification ensures that the treating physician has successfully completed all of training to be expert in the management, treatment, and diagnosis of allergies, asthma, and other allergic diseases.

The allergist/immunologist is uniquely trained in:

  • Allergy testing (skin testing and in-vitro)
  • History-allergy test correlation
  • Bronchial provocation testing
  • Environmental control education
  • Inhalant immunotherapy
  • Immunomodulatory therapy (for example anti-IGE and IVIG)
  • Venom immunotherapy
  • Food and drug challenges and drug desensitization
  • Evaluation of immune competence
  • Education (disease, medications, monitoring)
  • Management of chronic or recurrent conditions where allergy may be playing a role

Conditions for which the allergist/immunologist is uniquely qualified to manage patients includes: 

  • Allergic rhinitis (hay fever)
  • Asthma
  • Allergic conjunctivitis
  • Chronic cough
  • Chronic sinusitis
  • Urticaria and angioedema
  • Atopic dermatitis (eczema)
  • Contact dermatitis
  • Anaphylaxis (bee sting, drugs, food or other causes)
  • Diagnosis, treatment, and management of immune deficiencies
 

 

May 23
Our Webinars are on YouTube

Our recent webinar on Allergic Rhinitis was a big hit!  Dr. Christopher Copenhaver with Allergy Partners discussed seasonal allergies, which included a review of causes, symptoms and treatment options. Drs. Bill McCann and Ananth Thyagarajan, also with Allergy Partners, joined Dr. Copenhaver after the initial presentation to host a live Q&A session with the audience.  There were a wealth of great questions which provided a lot of educational opportunities.
 
If you couldn’t attend but would like to enjoy the broadcast, you can find the recording on our Allergy Partners YouTube Channel, www.youtube.com/myallergypartners

 

Our channel also offers a variety of other videos on topics such as skin testing, inhaler use, food allergies, and more. 

 

May 12
Exercise and Asthma

Excercise and asthma.jpg

Exercise and Asthma

 

OK, you have trained for the big race, but you know that sometimes exercise makes you feel tight in the chest. Often you have a feeling of shortness of breath along with wheezing.  What is going on?  Are you going to be able to run in the race?  Is this bad?
 
Not to worry.  You most likely have Exercise Induced Bronchospasm or EIB, sometimes also called Exercise Induced Asthma (EIA).  Many famous athletes have had asthma or EIB, among them these Olympians:
          Bill Koch - First American to win World Cup in cross-country skiing
          Greg Louganis - Olympic diver-USA 4 golds, 1 silver
          Peter Maher - Olympic marathoner
          Tom Malchow - Olympic swimmer gold medalist
          Mark Spitz - 1972 Gold medalist in swimming - 7 golds at one Olympics, 9 overall.
          Curt Harnett - Olympic cyclist and silver medalist
          Jackie Joyner Kersee - ranked among the all-time greatest athletes in the women's heptathlon as well as in the women's long jump
 
Here are some statistics about EIB:
          It occurs in about 12% to 15% of the US general population and 10% of school children.
          Of patients with chronic asthma, 70% to 90% have an exercise component to their disease.
          Up to 40% of patients with allergic rhinitis without asthma at other times also have EIB.
          5% - 10% of patients with EIB have no concomitant respiratory or allergic disease.
          11% of US Olympians in the 1984 Olympic Summer Games met the criteria for EIB.
          17% Of the US Olympians in the 1998 Olympic Winter Games admitted the need for medication for their exercise-induced symptoms.
          Incidence of EIB in US Army recruits about 7%-- But no effect on physical performance during basic training.
 
What are the symptoms?
          Wheezing and/or tightness in the chest with shortness of breath.
          Symptoms start 5-10 minutes into vigorous exercise or, often, 5-10 minutes after stopping.
          If no medication is taken, it typically lasts 30-60 minutes and then goes away.
          In 50% of those with EIB, there is a “refractory period,” which begins 30 minutes to 4 hours after the start of exercise.  During this period, an individual can continue to exercise without being subject to wheezing or chest tightness.  These individuals can use this to their advantage to allow continued physical activity.
          Some individuals experience a late reaction in which symptoms recur 12 -16 hours after exercise and can last 24 hours.
 
So what is the cause of EIB?
 Most researchers feel that it is due to cooling and drying of the airways.  Those who have asthma have “twitchy airways.” When breathing in cold air, pollutants, irritants such as smoke or strong odors or allergens such as pollen -- the smooth muscles around the airways contract and the inside of the airways produce excess mucous.  When exercising, especially in cold air, the individual breathes through the mouth so that the nose does not have a chance to warm the air.  Also, the air is exchanged more rapidly, which means that the airways are subject to drying, just like if a wind was blowing over a moist surface.  This causes the airways to be irritable and the mucous membranes to swell and produce excess mucous. In short,  an asthmatic reaction occurs, producing the symptoms described above.
 
So what can be done about it? Here are some suggestions:
 When exercising in cold weather, put a scarf over your nose and mouth.  This will help to make the air warmer.  Avoid exercising on high pollution days or high pollen days (f you are allergic to pollen).  If that cannot be avoided, wear a pollen mask while exercising.  Some exercises may be easier for those subject to EIB, including swimming, biking , surfing or hiking.  Your doctor may prescribe a short acting bronchodilator medication, such as Proventil, ProAir or Ventolin, to take 2 puffs 10-15 minutes before exercise.  If the expected duration of exercise is going to be more than 2-3 hours, a longer-acting bronchodilator, such as Serevent or Foradil, may work better.  If you have already taken your inhaler and start to wheeze while exercising, then additional puffs may be taken.  There are other medications which may help, which include cromolyn sodium (Intal) taken 15 minutes before exercise or Singulair, taken 2 hours before exercise.  Of course, if there is chronic asthma, that needs to be controlled with regular corticosteroid inhalers or with dual-acting inhalers that have both an inhaled corticosteroid and a long-acting bronchodilator.
  
And now—off to the races!!
 
As always, you can also follow us on Facebook and Twitter for pollen counts, office information, patient education and more. If you enjoyed this post please “Like” us on Facebook and “Share” the article.

 

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