March, also called the Atopic March, refers to the progression or development
of various allergic conditions with age.
What is Allergic March?
Being prone to develop allergic conditions is a genetically
inherited trait; however, the conditions or environment a child grows up in
also affects the development of allergic conditions. The tendency to have
an allergic condition, known as "atopy", makes one prone to develop
other allergic condition which is one reason it is called the Allergic (Atopic)
March. The 4 main allergic conditions are eczema (also called atopic
dermatitis), food allergies, environmental allergies (also called
allergic rhinoconjunctivitis or "hay fever" or just
"allergies"), and asthma. These conditions and their
symptoms often appear in a particular sequence with age, hence another reason
for the term "march". BUT they can also overlap. For
example a child with a food allergy can go on to develop environmental
allergies before they have outgrown their food allergy. Although the term
"march" also implies that there is a progression through each one of
these allergic conditions, an individual may only manifest some of these allergic
conditions through their lifetime. It's just that the allergic conditions
that do end up developing tend to appear at particular ages in a sequence.
What are the symptoms and when do they appear?
Typically the first allergic
condition to manifest is eczema which is a skin condition characterized
by itchy rashes which come and go. Eczema most commonly develops between
2-12 months of age. About 30% of children with moderate to severe eczema
develop a food allergy and this condition is typically next to develop,
often between 6 to 12 months of age. Symptoms of food allergies include
redness of the skin, rash or hives (welts), swelling of lips or eyes, vomiting,
or breathing difficulty which occur in various combinations fairly quickly
after eating the food (usually within 2 hours). Food allergies most
commonly are due to one or more of the following: milk, egg, wheat, soy,
peanut, tree nuts, fish, and shellfish. These foods account for 85% of
food allergies in children. In a child who has eczema, there is an 85%
risk of developing environmental allergies (hay fever). Environmental
allergies can develop as early as 1 year of age to substances found indoors
such as dust mites and pet dander. Allergies to pollen typically develop
between 3 to 5 years of age at the earliest (after exposure to a few pollen
seasons). Symptoms of environmental allergies include runny nose, frequent
sneezing, itchy nose, blocked nose, or itchy, red, watery eyes. Finally,
a child with eczema has a 50% risk of developing asthma which can
manifest at 3 to 5 years of age or later. Asthma is a chronic lung
disease characterized by inflammation (swelling and mucous) in the airways
(breathing tubes) AND "twitchiness" of the airways causing them to
constrict (narrow). When the airways constrict, symptoms of asthma occur
and can include repeating coughing or wheezing (high pitched whistling noise
with breathing) or chest tightness (a sensation where breathing seems
constricted or difficult) or a combination of these. The symptoms of
asthma can be triggered by colds (illness) or allergies.
should treatment begin?
other scientist are continually doing research to better understand the
Allergic March. Hopefully a better understanding of the Allergic March
can help us develop strategies to prevent allergic conditions from occurring
and put a "halt" to the march. For example, studies have shown that
starting a young child with environmental allergies on immunotherapy (allergy
shots) can reduce the child’s risk of developing asthma. Additionally, new
studies suggest that introducing some highly allergenic foods such as peanut
earlier in life may reduce the risk of developing food allergies in children
with eczema. To learn more contact your local Allergy Partners physician or
Dr. Vaishali Mankad
Partners of Raleigh
2016 Spring Allergy Capitals
The Asthma and Allergy Foundation of America recently released
their 2016 list of ‘the most challenging places to live with spring
allergies’. You might be wondering if you are suffering from allergies or
have a cold with the fluctuating temperatures. The symptoms are similar-- runny
noses and sneezing. Dr. Deogun, Allergy Partners of Raleigh, indicated in a
recent interview the best way to tell the difference: It’s likely allergies if
you’re suffering these symptoms for more than a week.
Published: March 24, 2016, 4:47 pm Updated: March 24, 2016, 5:40 pm
DURHAM, N.C. (WNCN) – Two Triangle cities made a list that some
people probably want no part of.
Durham and Raleigh are on the Asthma and Allergy Foundation of
America list for worst places to live with Spring allergies.
As the first week of spring rolls in, color is popping across
the Bull City. But so is another un-welcomed sight.
“My car is a mess,” Durham resident Regina Lynch said. “It’s
supposed to be red but it looks green.”
“Mostly sneezing,” Lynch said. “Runny noses, runny eyes.” “Itchy
throat, watery eyes, my son had to break out the inhaler, and the breathing
treatments,” Tankard said,
Enough of a problem to land Durham on the list.
Durham is 51 on the list and Raleigh comes in at 93.
Results that don’t surprise Allergy Partners of Raleigh’s Dr.
“Generally we’ve had a lot of pollen in this part of the
country,” Deogun said.
If you’re suffering, Deogun said over the counter medicine works
for most but you may need a shot if the problem lingers.
You might be wondering if you are suffering from allergies or
have a cold with the fluctuating temperatures. The symptoms are similar with
runny noses and sneezing. Experts said the best way to tell the difference:
It’s likely allergies if you’re suffering these symptoms for more than a week.
El Niño is another allergy factor this year.
It created a warmer, wetter winter.
Experts say you’re out of luck if you were hoping for a shorter
“It means that the trees will just start blooming sooner,”
Deogun said. “They need their trigger from the warmth, sunlight and the rain,
so they might start pollinating earlier and last longer.”
As for the worst place for spring allergies, the study shows
it’s Jackson, Mississippi.
To find out if your area made the list, click
Dr. Geetu Deogun
Partners of Raleigh
indicated an increased rate of sensitization to food and environmental
allergens in patients with eczema. Infants and young children less than 5 years
of age are more likely to be sensitized to foods while older children and
adults are more likely to be sensitized to aeroallergens, especially dust
How to sort it out?
Allergic triggers for eczema may be identified through skin
testing or blood testing for specific IgE antibodies. In allergic patients, the
immune system makes IgE antibodies to foods or aeroallergens that lead to an
allergic response. Testing can be done for both foods and environmental
allergens. A careful history should guide allergen selection for testing. In
small children, the most common food triggers are milk, egg, wheat, peanut and
soy. Once the positive sensitizations are known, working with your Allergy
Partners allergist is instrumental in determining whether a food should be
eliminated from the diet or if a supervised food challenge is warranted. As a
positive skin or blood test in and of itself does not indicate a food allergy,
your allergist may suggest a food challenge to determine if a true food allergy
exists. Subsequent follow up is also needed to determine if and when a food
allergy resolves. Aeroallergens can also trigger eczema flares. Dust mite
allergy is common and certain measures in controlling dust mite exposure, such
as allergen proof bedding encasements, have improved patients’ eczema. Pollen
and animal dander have also been implicated as eczema triggers.
is the treatment?
A more recent indication for immunotherapy (allergy shots)
is eczema. Dust mite immunotherapy in adults with chronic eczema improved both
eczema severity scores as well as reduced the use of topical steroid creams.
Unlike medications, allergy shots work to modify the course of disease rather
than simply treating symptoms.
Patients with eczema also have higher rates of contact
dermatitis. Contact dermatitis is a delayed type of allergic reaction to
substances touching the skin, for example poison ivy. Common contact allergy
triggers include metals, fragrances, preservative and neomycin. A different
type of allergy testing called Patch Testing can be performed to determine if
patients are allergic to these common products. If so, avoidance can lead to
significant improvement of eczema.
Allergy Partners physicians are specially trained physicians
who are experts in identifying allergic triggers to eczema and other allergic
diseases. They offer skin testing, both to foods and aeroallergens, and patch
testing and are experts in interpreting the results of all allergy tests. They
perform food challenges and can provide patients and families with expert
advice as to how best treat and manage eczema.
Dr. Patrice Kirchoff
Partners of the Blue Ridge
The Early Introduction
of Peanuts to Children’s Diets
In a pivotal trial, published last year in the New England
Journal of Medicine, European researchers from the Learning Early About Peanut
Allergy (LEAP) study team presented data which fundamentally shifted existing
concepts surrounding peanut allergy. Early dietary avoidance of peanut
had previously been advocated as a method to delay the onset of peanut
allergy. Despite this, the incidence of allergies has continued to rise
worldwide. In LEAP, 640 infants at high risk for developing peanut allergy
(those with eczema and/or egg allergy) were selected to either consume or avoid
peanuts until they reached 5 years (60 months) of age. Results from this
study showed a 70-86% risk reduction in the future development of peanut
allergy in children from the early consumption group. One of the
questions left answered by LEAP was what would happen if these same children
stopped consuming peanut on a regular basis?
Enter, LEAP-On. 556 participants from the initial LEAP
study were observed from the 60 month mark for 12 months after being instructed
to avoid peanuts. Peanut allergy at 72 months was significantly more
prevalent among children in the original peanut-avoidance group than those who
had initially been consuming peanut on a regular basis. Although three
new cases of allergy did develop in the early peanut-consumers, there was no
significant increase in the prevalence of allergy in this group after 12 months
of not eating peanuts. This indicates that after achieving tolerance to
peanuts at age 5, children may not need to continue to eat them regularly to
prevent development of allergy.
peanut or not to peanut?
These findings provide insights into future strategies of
preventing peanut allergies and clinical implications of maintaining immune
tolerance. Obvious questions that now arise are how long tolerance can
potentially be maintained and the effects of “ad lib” peanut consumption.
Given that peanut-associated anaphylaxis can potentially lead to
fatal reactions, none of the above interventions should be attempted without
first consulting with your Allergy Partners allergist.
Dr. Nabeel Farooqui
Partners of Central Indiana
sinusitis is one of the most common disorders seen in a primary care setting.
Unfortunately, many individuals develop recurrent acute episodes. If a patient
suffers 3 acute sinus infections in 1 year, they are considered to have
recurrent sinusitis. This condition is very challenging for patients and
providers alike, leading to lost work and school days, patient discomfort, and
high medical costs. It is recommended that these patients see an
allergist/immunologist and have a workup including an evaluation of
environmental allergy as well as a review of how well their immune system is
What Causes It?
allergic workup is very import, as allergic rhinitis can lead to acute and
chronic sinusitis. In one study of 200 patients with chronic sinusitis, more
than half of patients had allergic rhinitis. When looking at recurrent
sinusitis, significant sinus disease has been found to be associated with
allergy in 78% of patients. In acute sinusitis, one study of patients with
acute maxillary sinusitis found more than a third of the patients suffered from
allergic rhinitis. Finding the allergic triggers and treating them effectively
will reduce the inflammation and swelling in the nasal passages. If
untreated, the swelling can lead to poor clearance of nasal mucous that is
already full of bacteria, leading to bacterial growth and infection. Secretions
thicken and become more difficult to clear. An allergist can help
patients manage their allergies in many ways, including teaching them to avoid
allergy triggers once they are known, and developing an immunotherapy
program. In patients with recurrent sinusitis, a study showed that
immunotherapy resulted in a 61% improvement in sinus pain, a 49% reduction in
nasal blockage, and 72% fewer days lost from school or work.
What is the Treatment?
Patients with 3 or more acute sinus infections a year or chronic
sinusitis should receive a complete allergic workup as well as an evaluation
for immunodeficiency. If abnormalities are found, many of these patients can be
helped greatly with management. All Allergy Partners allergists are Board
Certified or eligible in Allergy and Immunology and provide expert care for
patients suffering from recurrent sinusitis.
Dr. Mark Wenger
Partners of Fredericksburg
Our very own Allergy Myth Busters!
Inspired by one of our favorite television shows, Allergy
Myth Busters looks at a number of popularly held beliefs about allergy. But are
these myths just urban legends or are they true?
MYTH: Adults cannot develop allergies.
While allergies are often thought of as a pediatric issue,
adults can clearly develop allergies of all sorts (environmental, food, venom,
medication) even when they haven't been allergy sufferers as children. In
most instances, such adults likely had a genetic tendency towards allergy and
may even have had allergic symptoms such as mild eczema or hay fever as
children, but often the symptoms were so mild or long ago that they have no
memory of being "allergic" as a child.
There are a number of reasons why adult patients might
experience the onset of what appear to be new allergies:
1) Increasing pollen levels - For people with only mild
seasonal allergies, the appearance of classical symptoms such as seasonal
congestion, runny nose, and itchy/watery eyes might only occur during certain
very high pollen seasons. Thus, given that pollen levels have generally
been on the rise, such a person might have only recently noticed allergy
symptoms as an adult.
2) Move to a new climate or introduction of a new pet - For
a patient with an underlying allergic tendency, moving to a new geographic
location with vastly different pollens (a new "aerobiology") can
precipitate the onset of allergy symptoms. Typically, this takes several
years to be noted, since one has to be first sensitized to the new allergens in
a given location, and then in subsequent years the symptoms occur rapidly with
the onset of the pollen seasons in that area. Similarly, a person may not
have been aware of a pet allergy, but after significant exposure to a dog or a
cat after bringing an animal into the house, a cascade of allergy symptoms can
3) Immune system alteration - There is emerging evidence
that exposure to allergens (such as foods or environmental triggers) during
times when the immune system is undergoing changes can cause the onset of
allergy. The best documented of such immune changes are during certain
viral infections, or during pregnancy.
4) Air pollution - Air pollution does not directly cause
allergies, but evidence suggests that certain pollutants found in smog might
increase the potency of airborne allergens. This effect can lower the
threshold of an allergy sufferer who otherwise might not notice the
symptoms. More globally, climate change may be contributing to increasing
pollen levels and longer pollen seasons, though this hasn't been definitively
5) Foods - Overall, food allergy is significantly more
common in children, with certain childhood allergens being very well-known such
as peanut, milk, and egg. However, shellfish is a good example of a food
allergy that it is much more common in adults than kids. The reasons for
this difference are not well-understood, but a new allergy to crab or shrimp in
an adult is not a surprising finding for an allergist.
So is the myth busted or true?
Mainly the myth is busted, in the sense that individuals
frequently develop allergy symptoms as adults. However, in many
instances, there was an underlying tendency towards allergy or even mild
allergy symptoms that went unrecognized in childhood.
Dr. David Fitzhugh
Allergy Partners of Chapel Hill
Dr. Friedman, Allergy Partners of Arizona, was featured on Wake
Click to listen to Dr. David Friedman discuss allergies,
treatment and prevention with callers on Wake Up! Tucson 1030 KVOI The Voice
Patients that suffer from occupational asthma (asthma caused
by breathing in hazardous substances in the workplace) may not realize their
symptoms are work-related. It can also affect their ability to work, overall
quality of life, and even threaten their lives.
What is Occupational Asthma?
Asthma caused by breathing in hazardous substances in the
workplace is called "occupational asthma." Asthma can affect your
ability to work and overall quality of life. It can even threaten your
How Does it Work?
Patients suffering from occupational asthma often may not
realize their symptoms are work-related. Symptoms of occupational asthma are
the same as regular asthma and may include any or all these chest symptoms:
cough, shortness of breath, wheezing and chest tightness. An asthmatic patient
my fail to recognize the work relationship to their asthma as symptoms often
begin several hours after exposure. Occupational asthma symptoms usually become
worse during the workday and throughout the work week. Symptoms may be
immediate (less than 1 hour), delayed (more commonly, 2 to 8 hours after
exposure), or nocturnal. They usually decrease over the weekend, or days off
and during vacations, but may take a week or more. However, workplace exposure
to sensitizing chemicals or dusts can induce asthma often persisting after the
exposure has stopped. Initial symptoms may occur after high-level exposure
What Causes It?
Several hundred substances found in the workplace have been
found to be respiratory sensitizers with more being identified all the time.
The list below is a broad indication of substances known to be respiratory
sensitizers and their common work activities. It is not exhaustive and
many known sensitizers are not identified here:
Substance Groups Common
Vehicle spray painting, foam manufacture
grain at docks, milling, malting, baking
electronic assembly, computer manufacturing
Gloves in health care, laboratories
Laboratory animal work
Saw milling, woodworking, and furniture manufacture
Curing glues and epoxy resins in joinery and construction
Welding stainless steel
Hard metal production, diamond polishing
What Should I Do If I Have Occupational Asthma?
If you are having work-related air flow limitation make an
appointment with your Allergy Partners Physician telling him/her your symptoms,
where you work, what your job is and what chemicals and materials you work with
daily. Take chemical fact sheets to your Allergy Partners Physician. Lung
function monitoring may include serial charting with a peak flow meter for 2 to
3 weeks (2 weeks at work and up to 1week off work as needed to identify or
exclude work-related changes in peak expiratory flow.) Record when symptoms and
exposures occur and when a rescue inhaled bronchodilator is used. Measure and
record peak flows every 2 hours at work and away from work.
What is the Treatment?
Allergy Partners Physicians are trained in additional,
specialized evaluations to include immunologic testing and confirmatory
evaluations such as detailed pulmonary function testing and bronchial
The patient is encouraged to work with on-site health
providers or managers/supervisors discussing avoidance of the initiating agent,
ventilation, respiratory protection, and tobacco smoke-free environments.
If your Allergy Partners Physician tells you that you have
occupational asthma, you should be removed from the work area or job to prevent
it from getting worse. Occupational asthma is a serious illness. Lack of
appropriate treatment can lead to permanent disability. Early recognition
and treatment are paramount in keeping this illness from getting worse.
Patient confidentiality issues are particularly important in
work-related asthma. As even general inquires about the potential adverse
health effects of work exposures may occasionally result in reprisals such as
job loss, occupational asthma patients need to be informed of this possibility
and be full partners in the decision to approach management regarding the
effects or control of workplace exposures.
Dr. Brian Dantzler
Allergy Partners of Charleston
Inspired by one of our favorite television shows, Allergy
Myth Busters looks at a number of popularly held beliefs about allergy. But are
these myths just urban legends or are they true?
MYTH: Children less than 4 years of age can’t be skin tested
First introduced in 1865, allergy skin testing remains the
gold standard for diagnosing allergic sensitization. There are two types of
skin testing. Skin prick testing involves placing a drop of a suspected
allergen (or extract) on the skin and scratching or pricking the surface of the
skin. Intradermal testing involves injecting a small amount of extract just
under the skin, similar to how a Tuberculin skin test is performed. A positive
reaction to either test will appear as a small, slightly raised red bump.
Allergy skin testing has a number of positives:
Quick – Many allergens can be tested at the same
time and results are read in 10-15 minutes.
Comfortable – Both skin prick and intradermal
testing involve very minimal discomfort, although positive test can be itchy
for several minutes.
Accurate – When performed with high quality
extracts and by a trained technician, allergy skin testing is the most accurate
test for allergy diagnosis.
Although the results of allergy tests are not affected by a
person’s age, sex, or race independent, certain age (children younger than 2
years and adults older than 65 years) and racial (African American children)
factors may affect their interpretation. This fact may explain why some people
believe that children need to be a certain age before they can be skin tested.
Generally speaking, skin testing can be performed even in infancy, and as young
as one month of age. However, the skin of very young children may not be as
reactive as older children and adults, and therefore the results need to be
interpreted more carefully.
The reason for skin testing is probably more important than
the age at which a child is tested.
In infants and toddlers, allergic disease most commonly
occurs as food allergy and atopic dermatitis. In school-age children, allergic
disease occurs more commonly as allergic rhinitis. Asthma can occur at any age,
but occurs most commonly in adolescent boys and teenage girls. Because of this,
skin testing should be aimed at identifying allergic triggers appropriate to
the age of the child.
Skin testing, particularly prick skin testing, is virtually
painless. There is no bleeding involved, as the needle only pricks the skin to
the depth of a scratch. The worst part of skin testing is that the skin test
sites may be quite itchy when positive results occur.
Allergy skin testing is a safe, accurate and virtually
painless means of diagnosing allergy at all ages. All Allergy Partners
physicians are Board-Certified and experts in the diagnosis, treatment, and
management of allergies and asthma at any age. Learn more at
Maternal asthma during pregnancy has been associated with
increased risks of several adverse outcomes, emphasizing the need for optimal
asthma control during pregnancy.
Maternal asthma in pregnancy has been associated with an
increased risk of adverse outcomes, including preeclampsia, low birth weight,
preterm birth and congenital abnormalities. This, compounded with the
increasing prevalence of asthma in the general population, emphasizes the need
for optimal asthma control during pregnancy. Of the associated adverse risks,
there has not been a clear consensus as to whether the increased risk of
congenital abnormalities is related to asthma itself or the medications used to
treat asthma. A recent study in the Journal of Allergy and Clinical
Immunology sought to identify whether this risk is associated with asthma
medications in the first trimester.1
What is the underlying cause?
The study did find that there was an increased chance of
congenital abnormalities including cleft palate and gastroschisis in those with
exposure to inhaled B2 agonists (e.g. albuterol), the drug typically
found in rescue inhalers. Though there is an increased risk, the individual risk
remains low – less than 1 in 100 births. There was no increased risk seen with
inhaled corticosteroids, which are often used in controller inhalers.
Despite these findings, both maternal asthma and asthma exacerbations during the
first trimester of pregnancy have been found to increase the risk of congenital
anomalies as well. http://www.jacionline.org/article/S0091-6749(08)00521-6/pdf
asthma exacerbations during pregnancy have been associated with other
unfavorable pregnancy outcomes for both the mother and infant. The study
highlights these facts as the risks of uncontrolled asthma might be much
greater than the studied specific risks. Ultimately, the study suggests that
the use of prophylactic inhaled steroids seems to be the best approach for
treating asthma in pregnancy to prevent asthma exacerbations and to reduce the
need for β2-agonists. For this reason, both those pregnant or
considering pregnancy that have asthma would benefit from being followed by an
Garne et al. Use of asthma medication during pregnancy and risk
of specific congenital anomalies: A European case-malformed control study. J Allergy Clin Imuno.
Vol 136, Number 6. pp 1496-1502.
By Dr. Michael Alvares
Allergy Partners of Dallas-Fort Worth
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!