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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 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
 

 

June 03
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:

 

 

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.

 

May 06
Thursday Hours - Henrico Office

Our office will be closing Thursday, May 8th at 3:30 pm

The last injections will be at 3pm.

We apologize for any inconvenience

April 23
Free Seasonal Allergies Webinar

Interested in learning more about the causes and treatments for allergies or would you like the opportunity to ask a physician all of your spring allergy related questions?  

Join us May 20th at 9:00 PM EST for an interactive, live webinar!  Follow this link to register or scan the QR code below.
  
Feel free to share this link with your family and friends so they can participate too!
 
WebinarAR.jpg

 

 

April 15
Dr. T. was featured again in the local news!

​Dr. T. was featured in a CBS6 news report about pollen season:

 

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 About this blog

 
 

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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