Please leave your questions or comments!

I need an outlet for my questions, comments, or we hope are a few complaints or improvements as I like to call them. I’m sure you would appreciate any opportunity to communicate with me as well. I have changed many things over the years based on recommendations and questions from patients and colleagues alike. Use the comments section below for your writing space and I’ll delete the old messages so this section will always remain at the top of the page.

New medications available for eosinophilic respiratory disease

When it comes to respiratory allergies, the role of eosinophils can be perplexing. But understanding how eosinophilic inflammation affects the immune response is essential in providing effective treatment for allergy sufferers. In this post, I’ll examine the science behind eosinophils and their influenza-like symptoms, as well as discuss how doctors might use medication and other strategies to effectively alleviate these uncomfortable episodes. With a better grasp on what’s going on inside an allergic patient’s body, both doctors and patients will have deeper insight into treating airway swelling and irritation that often results from airborne allergens like pollen or dust mites.

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#asthma, #biologicals, #oral-steroids

How Snowstorms May Affect Your Asthma

So we just missed the big one promised to dump 4-6 inches of snow in Tulsa. I call it the 2023 winter “dud”. My wife was really pissed that we didn’t have snow to disrupt all of our daily activities. No snow day for you! Even if we didn’t get snow this time around, what about the next unpredictable snowstorm for asthma patients?

For many people with asthma, cold weather can trigger an asthma attack. The air is colder and drier in winter, which can irritate the lungs and trigger asthma symptoms. But what about snowstorms specifically? Is there anything about a snowstorm that makes it more likely to trigger an asthma attack? Let’s take a closer look.

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#asthma, #cold-weather

Which allergy medication do you reach for first? | TulsaAllergyNews

Are you unsure which allergy medication to take when your symptoms start acting up? Read this article for a breakdown of the three most common types of treatments.

When it comes to allergies, there are a variety of medicines and treatments available to help manage them. However, with the broad range of choices available, choosing which medicine or treatment to take first can be difficult for patients and even doctors. Right now, we’re fortunate enough to have access to options such as antihistamines, decongestants and corticosteroids–but how do we make sure that our choice is continuing us down the right path? In this blog post we will explore these different medications and examine which one should come first when considering treating your allergies.

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#allergy, #allergy-shots-2, #american-college-of-allergy-asthma-immunology, #medications, #sneezing

I Can’t Get My Allergist to Diagnose Allergy!

If you’re an allergy patient or doctor managing allergies, you will likely come across situations where there is a discrepancy between the suspected allergens and skin test results. While this can be frustrating for both patients and doctors alike, it is important to understand why such discrepancies can occur, in order to make sure your patient receives the best possible care and treatment. In this blog post, we’ll discuss some of the potential reasons as to why negative skin testing results might not match a patient’s diagnosis or symptoms. We’ll also look at how to interpret these test results more accurately when they don’t reflect expected outcomes.

From Reddit–>This is a real patient comment and a real patient concern: My allergist told me to use Dymista nasal spray until allergy testing. However, I googled it and found out that Dymista should be stopped 5 days before allergy testing. In my allergy test, dust mites came back negative but I don’t believe it. I have obvious symptoms of dust mite allergy and I want to get allergy shots as soon as possible, before my allergies get worse and start ruining my life.

Should I find another allergist for allergy testing and allergy shots? Because my allergist made the mistake of prescribing me Dymista before my allergy test so I got false negatives on my skin and blood tests.

Credit to Reddit to find out what people really think and can join together to make changes in their daily lives. Anyone doubt that after GameStop and AMC? I have some concerns, however, with using Reddit as your source of medical information. Let’s take the issue of using Dymista prior to skin testing. Dymista indeed has antihistamines (azelastine) as well as topical corticosteroids and it recommended to stop this spray 3-5 days before skin testing. Topical antihistamines do not have the potency of ORAL antihistamines, and often the topical sprays with antihistamine do not interfere with the testing. How do you know for sure if Dymista has interfered with testing results? One of the quality controls I always use is a histamine control and saline control when testing for allergy. The positive histamine control should always be positive and the saline negative, guaranteeing accurate testing.

“I have been to so many allergist and my skin tests are all negative.  I cannot believe this is true.  Why has not anyone found a way to fix this?  Patients will even have a seasonal pattern to other allergy symptoms.”

You can feel the frustration of negative allergy testing, when clinical symptoms of allergy are so present. I myself have to explain why testing is negative when patients sneeze and cough during the pollen seasons of Spring & Fall. Here’s some insight into negative allergy testing with VERY positive clinical symptoms of allergy.

  • I wish our memories were 100%–it would be obvious if we messed up and took antihistamines or nasal sprays too close to testing and caused false negative allergy results. As mentioned previously, I can generally tell when skin testing is “suppressed” by comparing a positive histamine with negative saline prick testing. They should be wildly different.
  • There is a condition called local allergic rhinitis that occurs when all skin testing and blood testing for allergy is negative, but the body still responds right in the nose.  My problem is getting treatment for local allergic rhinitis in a convenient cost-effective manner.  Of course it is neither cost effective nor pleasant to have your allergist blow dust mite in your nose and record nasal congestion on a scale of 1-10– how would you like to do that?
  • You may not have IgE-mediated allergy as the cause of your symptoms. Believe it or not, not everybody has allergy in the sense of hypersensitivity that responds to allergy shots. Sometimes the culprit is an irritant such as dust, fumes, cigarette smoke, aerosols, all of which will cause “allergy” symptoms, but no positive skin tests.
  • Another strategy I will use for negative skin testing is to confirm results with blood tests. This is direct measurement of IgE and fortunately, is not suppressed by any medication you take, including antihistamines.

So here’s the conundrum–>Allergy symptoms, but no positive tests? ENTER Local Allergic Rhinitis. Simply put, LAR is allergy that’s limited to the nose, and not in the skin or blood, making skin testing/blood testing very unfruitful for diagnosis.

In order to perform testing to measure local allergic rhinitis, the clinician must by the equipment to perform nasal challenges and develop protocols that are only suited for research hospitals. (at least for now) Medical literature has been published regarding diagnosis and treatment of LAR, but not in the United States which always means an additional hurdle is the FDA.

  • I’ll summarize some published articles on LAR for those of you who want to know more.
  • Allergy symptoms are very common, up to 30% of the general population. No wonder everyone thinks they have allergy.
  • In Europe, allergists are using AIT (allergy immunotherapy) for treatment of LAR and it works! Knowing that dust mite accounts for 60% of local allergic rhinitis, it’s a very reasonable strategy to use dust mites and pollens in allergy extracts for LAR.
  • BTW, the article below is written by the guru or AIT, Dr. “Hal” Nelson; if nothing else, read the article to catch up on the latest in allergy shots.
  • And now for the “meat” of LAR–published by Dr. Campo who is the leading author for LAR diagnosis and treatment. Now you’ll understand why only 30% of rhinitis patients have IgE-mediated allergy. Fortunately, treatment is still available for LAR.
  • The second article in this block is also a review of LAR. It is interesting that despite adequate research on local allergic rhinitis, treatment and diagnosis of this condition hasn’t caught on here in the States. Perhaps the more we talk about it, the better treatment will evolve.

 If you are having allergy symptoms, but tests come back negative, it is still possible that you have Local Allergic Rhinitis. Now during the winter months, you are not going to have the typical sneezing postnasal drainage and coughing that you get during the spring or fall–but that does not mean you do not have allergy to dust mite. Treatment is available and can help improve your quality of life. If you find yourself experiencing symptoms of allergy but cannot get your allergist to diagnose allergic rhinitis, you may be dealing with local allergic rhinitis. Call us today @ 918-495-2636 and get your allergies controlled.

#allergy, #american-college-of-allergy-asthma-immunology, #local-allergic-rhinitis

Allergies on Friday the thirteenth

It’s that time of year again the weather is getting warmer, the flowers are blooming, and for many of us that means it is time to start sneezing. If you are one of the millions of Americans who suffer from seasonal allergies, you may have noticed your symptoms seem to get worse on Fridays. And if you are superstitious, you may be wondering if there is a connection between your allergies and Friday the 13th. For many people, Friday the 13th is a day to be avoided. But for those with allergies, it is just another day. Allergies are caused by an overreaction of the immune system to a usually harmless substance, such as pollen or dust. When these substances come into contact with the nose, eyes, or skin, they can cause symptoms such as sneezing, itching, and watery eyes.

Some common allergies include hay fever, pet allergies, food allergies, and drug allergies. Although there is no cure for allergies, there are ways to manage them. Avoidance is the best way to manage allergies. If you know you are allergic to something, try to avoid contact with it as much as possible, such as staying indoors on days when pollen counts are high and avoid petting animals that you know you are allergic to.

When an allergy suffer comes in contact with an allergen, there are body releases histamine in an attempt to get rid of the allergen. This release of histamine is what causes allergy symptoms like watery eyes, runny nose, and sneezing. So, what does all this have to do with Friday the 13th? Well according to some researchers there may actually be a connection between the 2. One theory is that because Fridays generally tend to be busier days than other weekdays, people are more likely to come in contact with allergens like pollen and pet dander. Additionally, stress has been shown to increase histamine levels in the body, so if you are feeling extra stressed on Fridays (perhaps because of work deadlines or family obligations, that could also contribute to worsening allergy symptom
Whether or not there is a real connection between allergies and Friday the 13th remains to be seen. But if you are someone who suffers from seasonal allergies, it might not hurt to take some extra precautions on days when your symptoms seem to be worse than usual. Stay indoors is much as possible, keep windows closed and avoid being outside during peak pollen hours (generally early morning and late afternoon. And if you know you will be spending time around pets or other allergens, be sure to take your allergy medication ahead of time. There are ways to manage allergies such as avoidance, medications, and allergy immunotherapy (allergy shots) so if you suffer from allergies do not let Friday the 13th stop you from living your life.

Allergens can change depending on the Food you Eat

Do you have allergies? Are there certain triggers that can make your allergy symptoms worse? One of the things to consider when it comes to managing your allergies is what you’re eating. From dairy products, to legumes and nuts, and even some vegetables – all these foods can cause allergic reactions in many people. Every person will react differently so it’s important to keep track of how specific items affect you. In this blog post, we’ll explore how different types of food can trigger or reduce allergic reactions in individuals with allergies.

It turns out one way to protect babies from developing bad allergies in life is to give them breast milk from Mennonite mothers who grew up on farms. Yes, that’s for real: a new (peer reviewed!) study published in Frontiers in Immunology found that breast milk from Mennonite moms has a greater abundance in the type of antibodies and other immune systems components that protect babies from common allergies.

“Our findings indicate that that breast milk from old order Mennonite mothers contains higher levels of beneficial antibodies, microbes and metabolites that help to ‘program’ the developing gut microbiota and immune system of their babies,” study coauthor Antti Seppo from the University of Rochester said in a statement. “These may protect infants against developing allergic diseases.”

What prompted the study? Allergy rates in Western societies have exploded in the early 20th century. One theory explaining this phenomenon argues that lately people have adopted cleaner and more sedentary lives that leave them less exposed to the outside world, which means the immune system is unable to prime itself to co-exist with a lot of foreign substances. A lot of immunity during infancy is passed down from mother to child via breast milk—so over several generations, that breast milk would contain fewer antibodies that tell the body certain airborne dust and certain foods are actually safe.

Mennonite mothers, on the other hand, live very traditional one-family farming lives with little modern technology. They are constantly exposed to pollen and animal dander, unpasteurized milk and other dairy products, and livestock. The research team compared the breast milk of 52 Mennonite women living in Western New York to 29 urban and suburban women living around the city of Rochester. Not only did Mennonite breast milk contain more allergy-associated antibodies, but it also contained a greater diversity of milk microbes that bolster the developing gut microbiota of babies.

The main takeaway here is that it might be good to get outside and touch some grass, at least for your future children’s sake. It is not suggesting you go out and find some Mennonite breast milk.

Seppo AE, Bu K, Jumabaeva M, Thakar J, Choudhury RA, Yonemitsu C, Bode L, Martina CA, Allen M, Tamburini S, Piras E, Wallach DS, Looney RJ, Clemente JC, Järvinen KM. Infant gut microbiome is enriched with Bifidobacterium longum ssp. infantis in Old Order Mennonites with traditional farming lifestyle. Allergy. 2021 Nov;76(11):3489-3503. doi: 10.1111/all.14877. Epub 2021 May 14. PMID: 33905556.

The prevalence of allergic diseases and asthma is increasing rapidly worldwide, with environmental and lifestyle behaviors implicated as a reason. Epidemiological studies have shown that children who grow up on farms are at lower risk of developing childhood atopic disease, indicating the presence of a protective “farm effect”. The Old Order Mennonite (OOM) community in Upstate New York have traditional, agrarian lifestyles, a low rate of atopic disease, and long periods of exclusive breastfeeding. Human milk proteins are heavily glycosylated, although there is a paucity of studies investigating the milk glycoproteome. In this study, we have used quantitative glycoproteomics to compare the N-glycoprotein profiles of 54 milk samples from Rochester urban/suburban and OOM mothers, two populations with different lifestyles, exposures, and risk of atopic disease. We also compared N-glycoprotein profiles according to the presence or absence of atopic disease in the mothers and, separately, the children. We identified 79 N-glycopeptides from 15 different proteins and found that proteins including immunoglobulin A1, polymeric immunoglobulin receptor, and lactotransferrin displayed significant glycan heterogeneity. We found that the abundances of 38 glycopeptides differed significantly between Rochester and OOM mothers and also identified four glycopeptides with significantly different abundances between all comparisons. These four glycopeptides may be associated with the development of atopic disease. The findings of this study suggest that the differential glycosylation of milk proteins could be linked to atopic disease.

Holm M, Saraswat M, Joenväärä S, Seppo A, Looney RJ, Tohmola T, Renkonen J, Renkonen R, Järvinen KM. Quantitative glycoproteomics of human milk and association with atopic disease. PLoS One. 2022 May 13;17(5):e0267967. doi: 10.1371/journal.pone.0267967. PMID: 35559953; PMCID: PMC9106177.

Background: Growing up on traditional, single-family farms is associated with protection against asthma in school age, but the mechanisms against early manifestations of atopic disease are largely unknown. We sought determine the gut microbiome and metabolome composition in rural Old Order Mennonite (OOM) infants at low risk and Rochester, NY urban/suburban infants at high risk for atopic diseases.

Methods: In a cohort of 65 OOM and 39 Rochester mother-infant pairs, 101 infant stool and 61 human milk samples were assessed by 16S rRNA gene sequencing for microbiome composition and qPCR to quantify Bifidobacterium spp. and B. longum ssp. infantis (B. infantis), a consumer of human milk oligosaccharides (HMOs). Fatty acids (FAs) were analyzed in 34 stool and human 24 milk samples. Diagnoses and symptoms of atopic diseases by 3 years of age were assessed by telephone.

Results: At a median age of 2 months, stool was enriched with Bifidobacteriaceae, Clostridiaceae, and Aerococcaceae in the OOM compared with Rochester infants. B. infantis was more abundant (p < .001) and prevalent, detected in 70% of OOM compared with 21% of Rochester infants (p < .001). Stool colonized with B. infantis had higher levels of lactate and several medium- to long/odd-chain FAs. In contrast, paired human milk was enriched with a distinct set of FAs including butyrate. Atopic diseases were reported in 6.5% of OOM and 35% of Rochester children (p < .001).

Conclusion: A high rate of B. infantis colonization, similar to that seen in developing countries, is found in the OOM at low risk for atopic diseases.

Seppo AE, Choudhury R, Pizzarello C, Palli R, Fridy S, Rajani PS, Stern J, Martina C, Yonemitsu C, Bode L, Bu K, Tamburini S, Piras E, Wallach DS, Allen M, Looney RJ, Clemente JC, Thakar J, Järvinen KM. Traditional Farming Lifestyle in Old Older Mennonites Modulates Human Milk Composition. Front Immunol. 2021 Oct 11;12:741513. doi: 10.3389/fimmu.2021.741513. PMID: 34707611; PMCID: PMC8545059.

Background: In addition to farming exposures in childhood, maternal farming exposures provide strong protection against allergic disease in their children; however, the effect of farming lifestyle on human milk (HM) composition is unknown.

Objective: This study aims to characterize the maternal immune effects of Old Order Mennonite (OOM) traditional farming lifestyle when compared with Rochester (ROC) families at higher risk for asthma and allergic diseases using HM as a proxy.

Methods: HM samples collected at median 2 months of lactation from 52 OOM and 29 ROC mothers were assayed for IgA1 and IgA2 antibodies, cytokines, endotoxin, HM oligosaccharides (HMOs), and targeted fatty acid (FA) metabolites. Development of early childhood atopic diseases in children by 3 years of age was assessed. In addition to group comparisons, systems level network analysis was performed to identify communities of multiple HM factors in ROC and OOM lifestyle.

Results: HM contains IgA1 and IgA2 antibodies broadly recognizing food, inhalant, and bacterial antigens. OOM HM has significantly higher levels of IgA to peanut, ovalbumin, dust mites, and Streptococcus equii as well TGF-β2, and IFN-λ3. A strong correlation occurred between maternal antibiotic use and levels of several HMOs. Path-based analysis of HMOs shows lower activity in the path involving lactoneohexaose (LNH) in the OOM as well as higher levels of lacto-N-neotetraose (LNnT) and two long-chain FAs C-18OH (stearic acid) and C-23OH (tricosanoic acid) compared with Rochester HM. OOM and Rochester milk formed five different clusters, e.g., butyrate production was associated with Prevotellaceae, Veillonellaceae, and Micrococcaceae cluster. Development of atopic disease in early childhood was more common in Rochester and associated with lower levels of total IgA, IgA2 to dust mite, as well as of TSLP.

Conclusion: Traditional, agrarian lifestyle, and antibiotic use are strong regulators of maternally derived immune and metabolic factors, which may have downstream implications for postnatal developmental programming of infant’s gut microbiome and immune system.

The food we eat can change the way our body reacts to form allergies. Our western culture is almost too clean, and this leads to changes in our microbiome that favors the development of allergies. There is research demonstrating that subcultures within the United States have very different breast feeding habits during infancy that actually decrease the incidence of allergy in that population. You can remember that probiotics are a good way to prevent allergies and please pay attention to your food–you are what you eat!

#allergy, #food

PEG Allergy and COVID-19

Are you an allergy patient? Are you worried about the effects of COVID-19 on your condition? You’re not alone. With the current pandemic that doesn’t seem to be going away, many people are facing unprecedented circumstances, and one area that is particularly vulnerable includes PEG allergies. But don’t panic – understanding what PEG allergy is, how it relates to COVID-19 and some tips to help manage your symptoms can make life easier during these challenging times. Read on for all the essential information you need to know about managing a PEG allergy in this time of crisis.

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#allergy, #anaphylaxis, #covid-19-vaccination, #peg

How Am I Doing?

It’s Only Skin Deep

Severe allergy and can’t find what’s causing it. Literally have tried EVERYTHING. Have been on 5 rounds of steroids in the past 2 months. Saw an allergist and having a patch test done so have to stop steroids and that’s the only thing giving me relief. I will try anything at this point.

After swelling goes down skin is dry, itchy, feels hot, and red. Nothing is helping. I want to crawl in a hole and never come out–I think I hear this story every day and definitely feel for those of you that suffer from CONTACT DERMATITIS. Click on the link if you want more information from American Contact Dermatitis Society. As this gal is appropriately pursuing, you must do patch testing for better answers.

Bailey E, Kroshinsky D. Cellulitis: diagnosis and management. Dermatol Ther. 2011 Mar-Apr;24(2):229-39. doi: 10.1111/j.1529-8019.2011.01398.x. PMID: 21410612.Cellulitis is an acute infection of the dermal and subcutaneous layers of the skin, often occurring after a local skin trauma. It is a common diagnosis in both inpatient and outpatient dermatology, as well as in the primary care setting. Cellulitis classically presents with erythema, swelling, warmth, and tenderness over the affected area. There are many other dermatologic diseases, which can present with similar findings, highlighting the need to consider a broad differential diagnosis. Some of the most common mimics of cellulitis include venous stasis dermatitis, contact dermatitis, deep vein thrombosis, and panniculitis. History, local characteristics of the affected area, systemic signs, laboratory tests, and, in some cases, skin biopsy can be helpful in confirming the correct diagnosis. Most patients can be treated as an outpatient with oral antibiotics, with dicloxacillin or cephalexin being the oral therapy of choice when methicillin-resistant Staphylococcus aureus is not a concern–and yes, sometimes you have to treat with the antibiotic and see if the condition improves. That’s why we call this the “practice of medicine”

Roy S, Chompunud Na Ayudhya C, Thapaliya M, Deepak V, Ali H. Multifaceted MRGPRX2: New insight into the role of mast cells in health and disease. J Allergy Clin Immunol. 2021 Aug;148(2):293-308. doi: 10.1016/j.jaci.2021.03.049. Epub 2021 May 4. PMID: 33957166; PMCID: PMC8355064.

Mast cells are getting lots of attention these days and many mystery diagnoses are labeled as “mastocytosis”. For the unfortunate few with true mastocytosis, your life will be filled with hives, flushing just like the above picture. At times, you may need chemotherapy if your tryptase levels get too high. But most patients (and doctors alike) who think they have mastocytosis really don’t.

Cutaneous mast cells (MCs) express Mas-related G protein-coupled receptor-X2 (MRGPRX2; mouse ortholog MrgprB2), which is activated by an ever-increasing number of cationic ligands. Antimicrobial host defense peptides (HDPs) generated by keratinocytes contribute to host defense likely by 2 mechanisms, one involving direct killing of microbes and the other via MC activation through MRGPRX2. However, its inappropriate activation may cause pseudoallergy and likely contribute to the pathogenesis of rosacea, atopic dermatitis, allergic contact dermatitis, urticaria, and mastocytosis. So here’s the link between normal cells in the body and disease of any kind: inappropriate activation causes a rash you don’t want to deal with. Gain- and loss-of-function missense single nucleotide polymorphisms in MRGPRX2 have been identified. The ability of certain ligands to serve as balanced or G protein-biased agonists has been defined. Small-molecule HDP mimetics that display both direct antimicrobial activity and activate MCs via MRGPRX2 have been developed. In addition, antibodies and reagents that modulate MRGPRX2 expression and signaling have been generated. In this article, we provide a comprehensive update on MrgprB2 and MRGPRX2 biology. We propose that harnessing MRGPRX2’s host defense function by small-molecule HDP mimetics may provide a novel approach for the treatment of antibiotic-resistant cutaneous infections. In contrast, MRGPRX2-specific antibodies and inhibitors could be used for the modulation of allergic and inflammatory diseases that are mediated via this receptor.

So for contact dermatitis, remember the following:

  • You can always have an infection that mimics contact dermatitis–don’t forget to at least ask about antibiotics.
  • Facial rosacea is treated with topical metronidazole among other creams, but it often hangs around for a long time. It will mimic contact dermatitis many times.
  • Patch testing is crucial for diagnosing the culprit causing contact dermatitis, and I would recommend having this procedure done at a clinic familiar with patch testing and even consider customizing your own patch test. We do this in our clinic with use of a Finn Chamber which allows you to test for anything in a semi-liquid or pasty consistency.
  • Autoimmunity can always cause a rash, especially on the face and upper body. Anyone see a butterfly rash that looks like this?

I hope she gets some answers and I’d love to hear about your stories re: facial rash and contact dermatitis.

#allergies, #american-contact-dermatitis-society, #contact-dermatitis

This Can’t Be Right

So what is going on with persistent allergy symptoms when the pollens are NOT very high? This patient is using the term “allergies” to describe “symptoms” of allergy that may not be IgE-mediated allergy at all. Doesn’t mention skin testing, but this testing can be completely negative in this scenario. How frustrating!

Positive skin tests look like this….

In fact, often I am tested for allergy and had no reactions even though I sneeze my head off during the fall season?
You cannot assume that pollens are the only cause of persistent rhinitis. Various conditions are called infectious rhinitis, vasomotor rhinitis, that have nothing to do with allergy but still because lots of nasal drainage and congestion.
In fact we are now entering into the time of year (late fall and winter) when many symptoms of sneezing, coughing, asthma are thought to be due to allergy but are really due to infection or cold air. Your body does not tell you when triggers change, but that is actually what is happening.
This writer from Reddit also complained of more symptoms that would suggest asthma during the fall pollen season, but yet low allergy counts.
Again, allergies are not the only cause of asthma even though the highest time of admissions for asthma occurred during the third week of September. Certainly, not all these patients have allergy. We have been inundated with COVID-19, and this virus shares many similarities with the common cold–do not be surprised if sneezing congestion, nasal drainage during the winter makes you think of Covid-19, but is actually rhinovirus induced asthma.

Look at the examples of sinus infection below. Slide a is the only normal CT scan as all of the others have some evidence of sinusitis. Any sinus infection is bound to cause problems with PND, congestion, and even sneezing–allergy can be involved, but many patients with chronic sinusitis have no allergy on skin testing. Asthma during the winter is often exacerbated by sinus infections just like the ones shown below.

What to do with this conundrum?

  1. Take your regular medications as prescribed by your doctor–do not stop using your inhaled corticosteroids just because the seasons change.
  2. It may even be beneficial to increase your dose of inhaled corticosteroids to 2 puffs 4 times a day when you are ill
  3. Always use a spacer device for your asthma
  4. Be open to “nonallergic” trigger for your nasal congestion sneezing, coughing. It is not unusual for patients to have both allergy and sinus infection for instance.
  5. Treating sinus infections may require oral corticosteroids and antibiotics for up to 1 month at a time. 10 days just won’t do it with chronic sinusitis
  6. Take your regular medications as prescribed by your doctor–do not stop using your inhaled corticosteroids just because the seasons change.
  7. It may even be beneficial to increase your dose of inhaled corticosteroids to 2 puffs 4 times a day when you are ill
  8. Always use a spacer device for your asthma
  9. Be open to “nonallergic” trigger for your nasal congestion sneezing, coughing. It is not unusual for patients to have both allergy and sinus infection for instance.
  10. Treating sinus infections may require oral corticosteroids and antibiotics for up to 1 month at a time. 10 days just won’t do it with chronic sinusitis

#allergies, #allergy, #respiratory-disorders