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June 11
Exercise-Induced Asthma

Exercise-Induced Asthma

Do you have problems with coughing, wheezing, or chest tightness when you exercise? Do you feel very tired and short of breath when you exert yourself? Some people wrongly believe that they are just out of shape when, in fact, they may have exercise-induced asthma. About 18 million Americans have asthma and, of those, 80% will have increased symptoms with exercise. In non-asthmatics, up to 15% experience asthma symptoms with exercise and 40% of people with nasal allergies may experience exercise-induced asthma symptoms.
 
What is Exercise-Induced Asthma?
Exercise-induced asthma (EIA) is a reaction of the lungs caused by exercise. The bronchial tubes become irritated and constrict, also known as bronchospasm. Excess mucus is also formed contributing to the blockage of the airway and congestion. It is thought that when you exercise the airway is cooled and dried rapidly which sets off the reaction in some people. Although chronic asthma sufferers are more likely to have EIA, the presence of EIA does not lead to chronic asthma.
 
Symptoms and Triggers
Symptoms of EIA include shortness of breath during or after exercise, coughing, wheezing, chest tightness or pain, and extreme fatigue. Symptoms usually start within 5-20 minutes after starting exercise and may last for 30-60 minutes. Sometimes symptoms start only after activity has stopped however. “Locker room cough”, or a cough that occurs after exercise, is a common form of exercise induced asthma. Shortness of breath, from poor conditioning, usually resolve within a few minutes of rest. People with EIA are overly sensitive to sudden changes in temperature and humidity. Colder, drier air is usually more of a problem. Nasal breathing helps warm and humidify the air you breathe so mouth-breathing with exercise reduces the moisture and humidity of the air that reaches your lungs. Air pollution, high pollen counts, and viral upper respiratory infections can also worsen wheezing with exercise.
 
Diagnosis
You should talk to your doctor if you think you may have EIA. You will need a good history and physical which often leads to the diagnosis. You may have a resting lung function test to make sure you have no chronic asthma. You may also have a breathing test after exercise, although this test may not be positive in everyone with EIA. A trial of bronchodilator therapy prior to exercise may be used to help determine whether you have EIA. Chest pain may be a symptom of EIA, but it is important for your doctor to rule out cardiovascular disease as well.
 
Treatment and Practical Tips
There are things that you can do to reduce the chance of having symptoms. Staying out of cold, dry air is a big fac­tor so train indoors if possible. If you do exercise in the cold, try to breathe through the nose as much as possible, wear a mask or scarf, and avoid exercise in the cold if you have a respiratory infection. Warming up 45-60 minutes before training or playing may help. Taking frequent, short breaks can help. Avoid training or playing outside on days with high pollution or pollen counts. Certain sports are tolerated more than others. Swimming is usually tolerated well due to the humidity of a pool. Lower intensity sports like golf, baseball, and weight lifting are better tolerated. Sports with short bursts of energy such as baseball, football, wrestling, gymnastics, and short-term tack events are better tolerated than soccer, basketball, hockey, skiing, and long-distance running. Always have your asthma medications with you!
 
The first step of treatment is the use of an inhaled short-acting bronchodilator medicine 15-20 minutes before exercise. These include albuterol, pirbuterol, and levalbuterol and are effective in 80-90% of patients, have a rapid onset of action, and last for 4-6 hours. If symptoms are not controlled by these short-acting medications, a daily medication may have to be used to prevent inflammation and responsiveness of the airway.
 
Most importantly, you should be evaluated and continue to exercise. Exercise and training will improve fitness, reduce the amount of breathing needed with exercise, and allow you to exert yourself at a higher intensity before symptoms begin.
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May 07
Thank you!

 In honor of Administrative Professional's Week last week and Nurse's Week this week, we would like to thank our staff at Allergy Partners of WNC for all the hard work, dedication, and love they put in to their jobs each and every day! On behalf of our physicians and our patients, we thank you!!!

April 26
Allergy Partners' Patient Portal
Introducing Allergy Partners' Patient Portal:  The new secure, private, easy and convenient way of interacting with us!  You now have free access anywhere, anytime! 
Features include:
  • Request Appointments
  • Pay Your Bill
  • View Statements
  • Review and Update Patient Information
  • Receive Appointment Reminders Electronically
AND MORE!
Go to https://allergypartners.myezyaccess.com to register today.  Or, ask our staff for more information.
April 25
Dr. Copenhaver's Interview on WLOS
March 19
Allergy-Immunology Glossary

Allergy-Immunology Glossary

Here are definitions of some of the words frequently encountered in literature on allergy and asthma.
 
Allergy
Allergies are inappropriate or exaggerated reactions of the immune system to substances that, in the majority of people, cause no symptoms. Symptoms of the allergic diseases may be caused by exposure of the skin to a chemical, of the respiratory system to particles of dust or pollen (or other substances), or of the stomach and intestines to a particular food.
 
Anaphylaxis
Anaphylaxis, or anaphylactic shock, is a severe, frightening and life-threatening allergic reaction. The reaction, although rare, can occur after an insect sting or as a reaction to an injected drug - for example, penicillin or antitetanus (horse) serum. Less commonly, the reaction occurs after a particular food or drug has been taken by mouth.
 
Antibody

An antibody is a protein (also called an immunoglobulin) that is manufactured by lymphocytes (a type of white blood cell) to neutralize an antigen or foreign protein. Bacteria, viruses and other microorganisms commonly contain many antigens, as do pollens, dust mites, molds, foods, and other substances. Although many types of antibodies are protective, inappropriate or excessive formation of antibodies may lead to illness. When the body forms a type of antibody called IgE (immunoglobulin E), allergic rhinitis, asthma or eczema may result when the patient is again exposed to the substance which caused IgE antibody formation (allergen).

 
Antigen
An antigen is a substance that can trigger an immune response, resulting in production of an antibody as part of the body's defense against infection and disease. Many antigens are foreign proteins (those not found naturally in the body). An allergen is a special type of antigen which causes an IgE antibody response.
 
Antihistamine drugs
Antihistamines are a group of drugs that block the effects of histamine, a chemical released in body fluids during an allergic reaction. In rhinitis, antihistamines reduce itching, sneezing, and runny nose.
 
Anti-inflammatory drugs
Anti-inflammatory drugs reduce the symptoms and signs of inflammation. Although not a drug, immunotherapy ("allergy shots") reduces inflammation in both allergic rhinitis and allergic asthma.
 
Asthma
Asthma is a chronic, inflammatory lung disease characterized by recurrent breathing problems. People with asthma have acute episodes or when the air passages in their lungs get narrower, and breathing becomes more difficult. Sometimes episodes of asthma are triggered by allergens, although infection, exercise, cold air and other factors are also important triggers.
 
Bronchitis
Bronchitis is an inflammation of the bronchi (lung airways), resulting in persistent cough that produces consideration quantities of sputum (phlegm). Bronchitis is more common in smokers and in areas with high atmospheric pollution.
 
Bronchodilator drugs
Bronchodilators are a group of drugs that widen the airways in the lungs.
 
Bronchus
Any of the larger air passages that connect the trachea (windpipe) to the lungs. The plural form of "bronchus" as "bronchi."
 
Contact dermatitis
Contact dermatitis is an inflammation of the skin or a rash caused by contact with various substances of a chemical, animal or vegetable nature. The reaction may be an immunologic response or a direct toxic effect of the substance. Among the more common causes of a contact dermatitis reaction are detergents left on washed clothes, nickel (in watch straps, bracelets and necklaces, and the fastenings on underclothes), chemicals in rubber gloves and condoms, certain cosmetics, plants such as poison ivy, and topical medications.
 
Corticosteroid drugs
Corticosteroids are a group of anti-inflammatory drugs similar to the natural corticosteroid hormones produced by the cortex of the adrenal glands. Among the disorders that often improve with corticosteroid treatment include asthma, allergic rhinitis, eczema and rheumatoid arthritis.
 
Digestive system
The digestive system is the group of organs that breaks down food into chemical components that the body can absorb and use for energy and for building and repairing cells and tissues.
 
Eczema
An inflammation of the skin, usually causing itching and sometimes accompanied by crusting, scaling or blisters. A type of eczema often made worse by allergen exposure is termed "atopic dermatitis".
 
Epinephrine
Epinephrine is a naturally occurring hormone, also called adrenaline. It is one of two chemicals (the other is norepinephrine) released by the adrenal gland. Epinephrine increases the speed and force of heart beats and thereby the work that can be done by the heart. It dilates the airways to improve breathing and narrows blood vessels in the skin and intestine so that an increased flow of blood reaches the muscles and allows them to cope with the demands of exercise. Epinephrine has been produced synthetically as a drug since 1900. It remains the drug of choice for treatment of anaphylaxis.
 
Extrinsic asthma
Extrinsic asthma is asthma that is triggered by an allergic reaction, usually something that is inhaled.
 
Hay fever
See Rhinitis.
 
Histamine
Histamine is a chemical present in cells throughout the body that is released during an allergic reaction. Histamine is one of the substances responsible for the symptoms on inflammation and is the major reason for running of the nose, sneezing, and itching in allergic rhinitis. It also stimulates production of acid by the stomach and narrows the bronchi or airways in the lungs.
 
Hives
See Urticaria.
 
Immune system
The immune system is a collection of cells and proteins that works to protect the body from potentially harmful, infectious microorganisms (microscopic life-forms), such as bacteria, viruses and fungi. The immune system plays a role in the control of cancer and other diseases, but also is the culprit in the phenomena of allergies, hypersensitivity and the rejection of transplanted organs, tissues and medical implants.
 
Immunoglobulins
Immunoglobulins, also known as antibodies, are proteins found in blood and in tissue fluids. Immunoglobulins are produced by cells of the immune system called B-lymphocytes. Their function is to bind to substances in the body that are recognized as foreign antigens (often proteins on the surface of bacteria and viruses). This binding is a crucial event in the destruction of the microorganisms that bear the antigens. Immunoglobulins also play a central role in allergies when they bind to antigens that are not necessarily a threat to health and provoke an inflammatory reaction.
 
Immunotherapy
Immunotherapy ("allergy shots") is a form of preventive and anti-inflammatory treatment of allergy to substances such as pollens, house dust mites, fungi, and stinging insect venom. Immunotherapy involves giving gradually increasing doses of the substance, or allergen, to which the person is allergic. The incremental increases of the allergen cause the immune system to become less sensitive to the substance, perhaps by causing production of a particular "blocking" antibody, which reduces the symptoms of allergy when the substances is encountered in the future.
 
Inflammation
Inflammation is the redness, swelling, heat and pain in a tissue due to chemical or physical injury, or to infection. It is a characteristic of allergic reactions in the nose, lungs, and skin.
 
Intrinsic asthma
Intrinsic asthma is asthma that has no apparent external cause.
 
Lymphocyte
A lymphocyte is any of a group of white blood cells of crucial importance to the adaptive part of the body's immune system. The adaptive portion of the immune system mounts a tailor-made defense when dangerous invading organisms penetrate the body's general defenses.
 
Mast cell
Mast cells play an important role in the body's allergic response. Mast cells are present in most body tissues, but are particularly numerous in connective tissue, such as the dermis (innermost layer) of skin. In an allergic response, an allergen stimulates the release of antibodies, which attach themselves to mast cells. Following subsequent allergen exposure, the mast cells release substances such as histamine (a chemical responsible for allergic symptoms) into the tissue.
 
RAST
RAST is an abbreviation for RadioAllergoSorbent Test, a trademark of Pharmacia Diagnostics, which originated the test. RAST is a laboratory test used to detect IgE antibodies to specific allergens.
 
Respiratory system
The respiratory system is the group of organs responsible for carrying oxygen from the air to the bloodstream and for expelling the waste product carbon dioxide.
 
Rhinitis
Rhinitis is an inflammation of the mucous membrane that lines the nose, often due to an allergy to pollen, dust or other airborne substances. Seasonal allergic rhinitis also is known as "hay fever," a disorder which causes sneezing, itching, a runny nose and nasal congestion.
 
Sinus
The sinuses (paranasal sinuses) are air cavities within the facial bones. They are lined by mucous membranes similar to those in other parts of the airways.
 
Sinusitis
Sinusitis is inflammation of the membrane lining the facial sinuses, often caused by bacterial or viral infection.
 
Theophylline
Theophylline is a bronchodilator drug, given by mouth, that widens the airways to the lung. It also is used to prevent attacks of apnea (cessation of breathing) in premature infants and to treat heart failure because it stimulates heart rate and increases urine excretion.
 
Urticaria
Urticaria is a skin condition, common known as hives, characterized by the development of itchy, raised white lumps surrounded by an area of red inflammation
 
March 11
FYI: Spring Closings

​FYI: 

*The Hendersonville office will be closing a few minutes early on Friday 3/22/13; The shot clinic and office will be closing at 4pm.

*Our Asheville, Hendersonville, and Clyde offices will be closed on Friday, 3/29/13, and our Long Shoals Road office will be closed on Saturday, 3/30/13 in observance of the Easter holiday.

*The Clyde office will close at 3:30p on 4/10/13.

February 27
New Study Shows Further Cost Savings with Allergy Shots

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Allergy shots are commonly known in the medical community as immunotherapy. They are one of (if not the) most effective treatments for allergic rhinitis (hay fever), allergic asthma and flying insect allergy. There are some data indicating that immunotherapy might be effective for atopic dermatitis (eczema) when the patient’s disease is associated with environmental aeroallergen sensitivity (especially dust mite allergy). Treatment with allergy shots can reduce your need for medications, make asthma easier to control and give relief from allergy and sinus symptoms.  In children, allergy shots may reduce the risk of developing asthma later in life and reduce the risk of developing additional allergies. So what does this mean in terms of health care costs? Are the medical benefits of shots outweighed by its expense?

I recently wrote about the current evidence showing significant cost savings for patients suffering from allergic disease and starting allergy shots. The same group of investigators have published a more extensive analysis of health care spending for both adults and children who have undergone treatment with allergy shots. They examined data on almost 25,000 patients with allergic rhinitis. About 5,000 of them were started on allergy shots. They then compared health care costs for those who received treatment versus those who did not. They found that the allergy shot treated patients incurred, on average, a 38% reduction in health care costs over the initial 18 month time frame after starting treatment. This translated into over $4,000 in decreased health care spending with significant savings observed within 3 months of starting treatment.  Health care savings for adults was similar to children ($4,397 versus $3,965 respectively). These are truly incredible findings. They add to the existing literature showing that allergy shots are not only the most effective treatment for certain allergic diseases, but they are also very cost effective. That is a win-win situation!
 
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.
 
Dr. Ananth Thyagarajan (Dr. T.) AP Richmond, VA

January 29
Patient Appreciation Day

Join us in our Asheville office on Thursday, Febuary 14th for our first annual Patient Appreciation Day!  Drop by between the hours of 8 AM and 5 PM for snacks, prizes, and more!  Also, one of our lucky patients will win one of our EdenPure O2 Air Purifiers! (A $250 value).  Even if you are not a patient, please stop by so we can share some valuable information with you regarding how we can relieve your allergy and/or asthma symptoms. 

 

We hope to see you there!

 

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January 22
Clinical Research Department-Asthma Study

Do you have trouble controlling your asthma?

We are currently conducting a research study testing the effectiveness and safety of an investigational steroid medication for asthma that is given in a nebulizer. Patient volunteers must be 18-70 years old, and have asthma that is partly controlled or uncontrolled asthma.

This study requires you to visit our Asheville office 6 times over 4 months. ...The study medication or placebo is provided to you at no cost, and you are compensated up to $300.00 if you complete the study. In addition, all study-related medical care, including physical exams, breathing tests, lab work and EKGs, is provided without cost. Patient volunteers do not have to be existing patients of Allergy Partners, so please feel free to pass this information along to family members and friends.

November 20
EOSINOPHILIC ESOPHAGITIS

 

 
Eosinophilic esophagitis (EE or EoE) is a relatively newly recognized disease that has been increasingly diagnosed in both adults and children since 2000.  It is characterized by a large number of white blood cells called eosinophils that cause inflammation in the esophagus (the tube that connects the mouth and stomach).
 
This inflammation prevents the esophagus from functioning normally and leads to symptoms. EE commonly occurs in people with other allergic diseases such as allergic rhinitis (hay fever), asthma and/or eczema.
Symptoms
Reflux that does not respond to usual therapy: 
  • Dysphagia (difficulty swallowing)
  • Food impactions (food gets stuck in esophagus)
  • Nausea and vomiting
  • Failure to thrive (poor growth, malnutrition or weight loss)
  • Abdominal or chest pain
  • Feeding refusal/intolerance or poor appetite
  • Difficulty sleeping
Diagnosis
The only way to definitively diagnose EE is through endoscopy with biopsies, usually done by a gastroenterologist.  The endoscopy is often performed after treatment with reflux medications have failed to relieve symptoms.  During the endoscopy, the gastroenterologist looks at the esophagus, stomach and duodenum (the first part of the small bowel) through an endoscope (small tube inserted through the mouth) and takes multiple biopsies (small tissue samples) which a pathologist reviews under the microscope.  A high number of eosinophils (>15 per high power field under the microscope) suggests a diagnosis of EE.
 
Once EE is confirmed, allergy testing is recommended as many patients with EE have underlying food and possibly environmental allergies that are contributing to the abnormal inflammation seen in the esophagus.  The most common type of allergy testing is skin prick testing, but patch testing to certain foods can be useful as well. In patch testing, a small amount of the foods is placed on the skin (usually the back) and covered with tape for 48-72 hours. At that point, the site is assessed for evidence of redness and inflammation indicating food allergy.
Treatment
At present the two main treatments recommended are dietary management and topical corticosteroids.
 
Dietary Therapy
Elimination Diets – All “positive” foods on allergy testing are removed from the diet.  Often this is the only treatment needed.
Six-food Elimination Diet – Patients eliminate the top 6 most allergenic foods (dairy, eggs, wheat, soy, peanuts/other nuts, fish/shellfish).
Elemental Diets – All sources of protein are eliminated from the diet except for an amino acid (building blocks of protein) formula.  These diets are mostly used in young children with EE.
Food Trials – This involves adding back one ingredient at a time to one’s diet to determine specific foods causing a reaction.  They begin after symptoms resolve and eosinophils have cleared. 
Medications - Medications most commonly include steroids to control inflammation and suppress eosinophils.  They can be taken orally (a form of prednisone) or topically (swallowed asthma inhaled steroid such as fluticasone or budesonide).
How We Can Help
The diagnosis and treatment of eosinophilic esophagitis requires a multidisciplinary team approach involving gastroenterologists, allergists, nutritionists.   As part of the nation’s largest allergy practice, Allergy Partners’ physicians provide the expertise needed to accurately diagnose underlying allergic triggers to EE. With this information, a personalized and comprehensive treatment plan aimed at alleviating symptoms of EE can be formulated.
 

 

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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!