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January 20
Is There A Simple Way to Help Prevent the Onset of Atopic Dermatitis/Eczema in Children?

Atopic 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.

 

 
Atopic 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. 
 
Recent 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.
 
Allergen 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.
 

 

Once atopic 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.

 

January 12
Alternative Medicine and Allergy/Asthma: What Really Works

Pharmacy 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.
 
Other 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
 
Non-pharmacologic 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.

 

November 21
Winter Allergies

Winter Allergies
As the calendar turns to the winter months, many allergy sufferers let out a sigh of relief. No more pollen means no more sneezing and itching. But, for others winter time means winter allergies. Winter allergies? Yes, winter allergies.
 
With colder weather, we close up the house and get out our warm blankets and comforters. Pets come indoors to snuggle. And for those allergic to pets and dust mites, winter means more allergy symptoms.
 
Dust mites are microscopic, eight legged creatures that feed on flakes of dead skin. They absorb moisture from the air as opposed to drinking. Therefore, they like to live where people are and where it is humid. Beds, bedding and carpets provide dust mites the perfect place to live. And no matter how clean your house is, you have dust mites.
 
Allergy 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.
 
So what should you do? The first step is to find out if you are dust mite allergic. Allergen skin testing under the direction of your Board Certified Allergy Partners physician remains the best way to diagnose allergies. If you are dust mite allergic, the following can help limit your exposure:
 
1.    Limit dust collectors such as stuffed animals in the bedroom
2.    Wash bedding in hot water (130 degrees)
3.    Vacuum carpets regularly with a HEPA filter vacuum
4.    Consider steam cleaning your carpets yearly
5.    Invest in high quality allergen encasements for your mattress and pillows to put a barrier between you and the dust mites.
 
Treatment of dust mite allergy symptoms can include the use of over the counter and prescription medicines. For those interested in preventing symptoms, allergen immunotherapy (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.
 
To learn more about allergen encasements visit www.allergyguardian.com
 
To learn more about controlling your indoor air quality visit www.O2airpurifier.com
 

To learn more about allergies, asthma and our practice visit

 

September 23
O2 Air Purifier

                The O2 Air Purifier attracts and eliminates not only allergens, but also mold, bacteria, germs and odors.
                Learn more today about how you can truly breathe fresh air at home.  www.o2airpurifier.com/comprehensive

 

September 18
Don't miss out! Asthma webinar

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.

 

September 09
Fall Allergies

 

Ahh Fall. 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 allergy symptoms.
 
Many people 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.
 
Ragweed 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 better.
 
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.
 
Many people 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 allergy syndrome.
 
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.
 
Common 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.
 
As with other allergic conditions, the mainstays of treatment include avoidance, medications and allergy shots.  Some basic avoidance tips include:
  • 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 a.m.
  • Keep your car windows closed when traveling.
  • 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.
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 and “Share” the article.
  
Dr. Elaine S. Turner, MD

September 04
Dr. T was interviewed on CBS6's Virginia this Morning
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!
 
 

 AsthmaWebinar.jpg

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.)

 

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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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