Thanks Dr Benaroch for your insights from a pediatricians standpoint. We see patients everyday that have been told based on a “test” that their child has food allergy. The percentages vary, but a majority of children that are found to have a food allergy by testing, tolerate the food just fine after challenge. What are the exceptions? Peanut, tree nut, milk, and egg anaphylaxis should always be asked during patient histories. This is why meeting your patient and asking directed questions is so important!
People like tests. You get numbers, and maybe a printout, and there’s science and blood and things just feels more… serious, when testing is done. You can picture Marcus Welby (or perhaps a more modern physician), looking solemn, declaring “We’d better run some tests.”
Are medical tests magical and mysterious, and can they unlock the secrets of life? Usually, no. And among the worst and most misunderstood tests we do are food allergy tests.
A few recent studies illustrate this well. A review of about 800 patients referred to an allergy clinic found that almost 90% of children who had been told to avoid foods based on allergy testing could in fact eat them safely. The study, bluntly titled “Food allergen panel testing often results in misdiagnosis of food allergy” also found that the positive predictive value of food allergy blood…
At first glance, I thought to myself, do we really need another quick acting inhaler? As I thought about inhaler technique and how we use our Ventolin MDI’s, most of use suck on the end of the inhaler which is the wrong technique to use. (all of the medication deposits on the back of the throat) Why not use the appropriate inhaler that’s meant to actuate with your breath anyway? ie, sucking on the inhaler is what you’re supposed to do!
This article is in press and will be published in Annals from the College of Allergy, Asthma, and Immunology next month. I thought the study is very interesting given the “push” for oral desensitization. I just returned from the AAAAI annual meeting and it appears that patients with food allergy can become “desensitized” or cured, however, that comes with a cost of potential anaphylaxis during treatment. Think of it like the use of allergy shots which are very effective, but you can develop anaphylaxis after an allergy shot that will need additional treatment such as epinephrine. The question I have is, “should this therapy with foods be used at home where parents and patients don’t know much about giving epi?”
Here’s the summary–>Asthma patients are at risk for more severe reactions and less likely to reach full desensitization during milk oral immunotherapy, according to a study in Annals of Allergy, Asthma and Immunology. Researchers in Israel studied 194 subjects 6 years and older with IgE-mediated cow’s milk allergy, with and without asthma, undergoing milk oral immunotherapy. Regardless of severity, subjects with asthma had more reactions and injectable epinephrine use during induction, and more home treatments with immunotherapy. Moderate to severe asthma also was associated with a lower likelihood of reaching full desensitization
What does it mean for your doctor to be board certified? Let’s start from the beginning of how your doctor becomes educated in the first place. Believe me, it’s hard enough for your doctor to keep track of the next test to take, much less keep track as a patient. Medical education begins in college as wannabe doctors take prerequisite college courses to prove their mettle in hopes of securing a medical school interview. Successful applications for medical school require a competitive GPA, good scores on standardized tests (MCAT), glowing references, and a first-rate impression during interviews. You would think that would be grueling enough to become a doctor, but there’s more! Once you’re accepted into medical school, you must take a series of exams to demonstrate that you are competent to become “board-certified”. Continue reading Do You Care if Your Doctor is Board-Certified?→
Over-the-Counter Allergy Medications Warrant Caution for Some
Nasal allergy sprays can now be purchased without prescription.
The next time you’re at the local pharmacy, you may be surprised to see your prescribed allergy nasal spray available over-the-counter. Many drug manufacturers are pushing for this move to make finding relief easier for some of the 50 million Americans with allergies. But this warrants caution for some.
“Allergy sufferers may no longer need a prescription for certain allergy nasal sprays, but they might need an allergist’s advice. Some medications merely mask symptoms without tackling the root of the allergy. And often patients will find what medication once suppressed their symptoms, no longer does.”
The over the counter availability of this new nasal spray may lead to questions from local Tulsa allergy sufferers. To help eliminate confusion, Dr. Lynn Wiens, along with the American College of Allergy, Asthma and Immunology (ACAAI) have answered the seven most common questions. Continue reading Do you Pick Your Nose?→
Good health habits can only be achieved by our mental outlook on exercise, healthy diet, smoking cessation. Here’s where going to the doctor for a “pill” doesn’t work very well. BTW, do you know why most people have difficulty exercising? Because it hurts! (more on that later)
There is no doubt that it is tough to kick the habit when it comes to cigarette smoking. If you ask 100 people how they stopped, the odds are quite strong you will get 100 different answers. But there is usually one consistent comment that comes across. It goes something like this. ‘I was so frustrated with smoking that I finally said, ‘The heck with it. I’m quitting.” It is clear that to finally stop smoking, a person needs to take a mental order to do it. It doesn’t matter whether it’s the latest drugs, acupuncture, or whatever. You have to want to.
New Year’s resolutions, gotta lose weight, exercise more. It does get a bit annoying to read all of our good intentions and then we fall off the wagon one more time! As I look ahead to 2015, I begin my term (one year) as president of Tulsa County Medical Society (TCMS). No resolutions I can’t keep, just hard work and lots of meetings. The best way for me to share my thoughts and vision for 2015 is to let you in on my first newsletter of the year. (unabridged)
It’s Monday morning and I haven’t rested well from the weekend. With a full schedule at the office, I don’t have time for interruptions. I check my e-mail first thing in the morning and today I wish I hadn’t. I have four prior authorization phone calls to complete today, and two of them have already been denied. “What?” I asked as the insurance representative informed me that the patient in question didn’t qualify for the CT sinus study because they hadn’t been on antibiotics for 2 months. “Aren’t we supposed to use antibiotics judiciously?” I asked. But my troubles today were just beginning. Continue reading What Do Doctors Read?→
An apple a day might keep the doctor away, but what is modern hospital medicine really like? Follow Dr. Benjamin Kirkland - a Doctor working in Australia - through the pinnacles and pitfalls of everyday hospital medicine!