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!
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?
Take your regular medications as prescribed by your doctor–do not stop using your inhaled corticosteroids just because the seasons change.
It may even be beneficial to increase your dose of inhaled corticosteroids to 2 puffs 4 times a day when you are ill
Always use a spacer device for your asthma
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.
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
Take your regular medications as prescribed by your doctor–do not stop using your inhaled corticosteroids just because the seasons change.
It may even be beneficial to increase your dose of inhaled corticosteroids to 2 puffs 4 times a day when you are ill
Always use a spacer device for your asthma
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.
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
I have been telling patients for years that allergy immunotherapy (#allergy shots) are very helpful for controlling the sniffles, sneezing and coughing that patients experience particularly during the fall and spring. This is a very interesting market research report on allergy shots that analyzes marked growth of allergy immunotherapy, uses cost structures and various other statistical tools to make their predictions. If AIT does not work, my reasoning is why would the market increase over the next 5 years? I have referenced the research report if you are interested in pursuing a more detailed analysis. Just so you know, our clinic uses Greer extracts and they are one of the top companies in the report. I’ll provide some specific answers from a clinical standpoint to questions that this research report discusses. They are found at the bottom of the blog. Thanks to data analytics, many industries are now converting a “gut instinct” into mathematical equations–I do not know if this is really good, but “just the facts”
A2Z Market Research announces the release of Allergy Shots Market research report. The market is predictable to grow at a healthy pace in the coming years. Allergy Shots Market 2021 research report presents analysis of market size, share, and growth, trends, cost structure, statistical and comprehensive data of the global market.
As analytics have become an inherent part of every business activity and role, form a central role in the decision-making process of companies these days is mentioned in this report. In the next few years, the demand for the market is expected to substantially rise globally, enabling healthy growth of the Allergy Shots Market is also detailed in the report. This report highlights the manufacturing cost structure includes the cost of the materials, labor cost, depreciation cost, and the cost of manufacturing procedures. Price analysis and analysis of equipment suppliers are also done by the analysts in the report.
This research report represents a 360-degree overview of the competitive landscape of the Allergy Shots Market. Furthermore, it offers massive data relating to recent trends, technological advancements, tools, and methodologies. The research report analyzes the Allergy Shots Market in a detailed and concise manner for better insights into the businesses.
The report, with the assistance of nitty-gritty business profiles, project practicality analysis, SWOT examination, and a few different insights about the key organizations working in the Allergy Shots Market, exhibits a point-by-point scientific record of the market’s competitive scenario. The report likewise displays a review of the effect of recent developments in the market on market’s future development prospects.
The pandemic of COVID-19 has emerged in lockdown across regions, line limitations, and breakdown of transportation organizations. Furthermore, the financial vulnerability Allergy Shots Market is a lot higher than past flare-ups like the extreme intense respiratory condition (SARS), avian influenza, pig influenza, bird influenza, and Ebola, inferable from the rising number of contaminated individuals and the vulnerability about the finish of the crisis. With the rapid rising cases, the worldwide Allergy Shots refreshments market is getting influenced from multiple points of view.
The accessibility of the labor force is by all accounts disturbing the inventory network of the worldwide Allergy Shots market as the lockdown and the spread of the infection are pushing individuals to remain inside. The presentation of the Allergy Shots makers and the transportation of the products are associated. If the assembling movement is stopped, transportation and, likewise, the store network additionally stops. The stacking and dumping of the items, i.e., crude materials and results (fixings), which require a ton of labor, is likewise vigorously affected because of the pandemic. From the assembling plant entryway to the stockroom or from the distribution center to the end clients, i.e., application ventures, the whole Allergy Shots inventory network is seriously compromised because of the episode.
The research provides answers to the following key questions:
What is the projected market size of the Allergy Shots market by 2027? **As you probably guessed, it’s going up. One of the favorable features of AIT is the frequency of injections–once you complete the build-up phase, allergy shots are given once monthly and it’s hard to beat this “convenience factor”.
What will be the normal portion of the overall industry for impending years?
What is the significant development driving components and restrictions of the worldwide Allergy Shots market across different geographics? **This is more FYI than anything. I was very surprised that world-wide use of allergy shots is predicted to increase. In previous years, the use of allergy shots around the world had been decreasing–why? AIT involves some risk (albeit small) of anaphylaxis and even death from allergy immunotherapy. In recent years, we’ve been able to reduce this risk by better selection of patients for AIT, more standardized allergen extracts, and more appropriate clinical setting (minimize home shots) for giving shots in order to treat any anaphylaxis quickly with appropriate back-up (urgent care and ER in this case). It’s working as there have been zero deaths from AIT in the United States for the past number of years–wahoo, that’s progress!
Who are the key sellers expected to lead the market for the appraisal time frame 2021 to 2027? ** We’ll find out in 5 years. Obviously, this is a very profitable market for companies making allergy extracts. Twenty years ago a gallon of pure dust mite extracts sold for $10,000–I wonder what inflation has done to that cost today?
What are the moving and arising advances expected to influence the advancement of the worldwide Allergy Shots market? **Currently, we inject the entire allergen (say ragweed) under your skin to induce tolerance. Researchers have been looking for years at the possibility of injecting only the important parts of the allergen that retains immunogenicity, but reduces the risk of anaphylaxis. This “Holy Grail” is not far off.
What are the development techniques received by the significant market sellers to remain ahead on the lookout?
Click the link below for a message from Dr. Wiens himself!
Dr. Alan Khadavi from southern California.
I appreciate the blog from Dr. Khadavi as the question of “citrus acid allergy” often comes up in my daily allergy practice here in Tulsa. Tomato is just one more food that can cause an intolerance that often is confused with a food allergy. As listed below, mucosal irritation is an intolerance, while oral allergy syndrome and anaphylaxis represent two examples of “IgE-mediated” or true allergy.
Tomato allergy is not commonly reported, but it can cause adverse reactions. Hypersensitivity reactions to other fruits are commonly reported, particularly apples, stone fruits and bananas. Tomato (Solanum lycopersicum) is derived from two wild ancestor species, Solanum pimpinellifolium and Solanum cerasiforme. Tomato flavor is a balance of acid and sugar recognized by the tongue and the effect of volatile compounds within the fruit that cause aroma recognized by the nose. Tomato flavor is commonly described as sweet, tart, tangy or balanced.
Tomato is classified as a fruit because they contain seeds and grow from the flower of the tomato plant. But many people still classify it as a vegetable based on its culinary applications. (how we cook with it!)
Credits to Dr. Alan Khadavi
Types of reactions to Tomato:
Mucosal irritation-Tomato has been implicated in an array of adverse reactions, including uncomfortable mucosal irritation due to acidic pH. The tomato plant can also cause itching of the skin when touched which is a form of allergic contact dermatitis.
Oral allergy syndrome-symptoms typically occur with mouth itching and swelling of lips and tongue. Patients allergic to grass pollen can describe symptoms of oral allergy syndrome to tomato. This is not a true tomato allergy, but a cross reactivity of the proteins to the grass pollen. Treatment is heating the fruit or just avoiding it. Other foods in the same category are kiwi, melon, peach and celery.
Anaphylaxis-symptoms that occur are hives, swelling, wheezing, coughing, vomiting, diarrhea and low blood pressure. This is from IgE mast cell degranulation. Allergy skin testing, specific IgE lab testing and fresh food skin testing with tomato all can be used to test for tomato allergy.
Reactions to tomato can thus come in different forms. With a severe reaction to tomatoes, patients will often avoid altogether and the problematic reactions are usually the mucosal irritation or food intolerance. An allergy doctor can help decipher what type of reaction one is having to tomato and to do the appropriate tests for establishing or ruling out a diagnosis of clinical allergy.
In the news a couple of years ago, Ariana Grande was diagnosed with a true tomato allergy. She joked that there was “nothing more unfair than an Italian woman developing an allergy to tomatoes in her mid-twenties.” But food allergies are a serious matter and should be taken seriously. All precautions should be taken place and patients should carry around an injectable epinephrine in case of an accidental exposure.
Not only should patients be aware of tomato allergy, but doctors should also recognize that rare food allergies aren’t so rare if you have the sensitivity. What to do?
Make sure you have injectable epinephrine
Skin testing or blood testing can be performed to many foods that cause rare allergies.
Even if you don’t perform testing, please avoid the food (s) that cause problems, as the reaction may get worse with subsequent exposures.
It’s about time we as clinicians and “learners” can meet together to discuss asthma and new developments in the treatment of this very expensive and disruptive disease. Enter Dr. Mark Millard from Baylor in Dallas, TX who gave an excellent presentation on TSLP and the role this molecule plays in “causing asthma”. Allergists and pulmonologists have changed our approach to asthma many times in my practice lifetime. Here’s a few examples for you to ponder:
Prior to the development of albuterol (bronchodilator), medical doctors would administer strychnine for asthma. Obviously, that method didn’t work well and I wonder how many patients just died from the treatment.
In the early 1960’s epinephrine was the newest fad for asthma and you could actually go outside x 4 hours and not be home bound (the asthma curse). Why only 4 hours? That’s how long epinephrine lasts.
Next on the list of miracles for asthma was the development of bronchodilators such as albuterol. The MDI (metered dose inhaler) was born and to this day, we struggle with overuse of this quick acting treatment for asthma.
In the 1980’s, we began to understand that asthma is much more than bronchoconstriction and something had to be done about the INFLAMMATION that gives you asthma in the first place.
When inhaled corticosteroids were invented, I really thought this was the last frontier for asthma therapy. I was dead wrong, because some patients don’t respond well to the inhaled steroids as a class-specific treatment. ie, the severe asthma patient will often take every medication you prescribe and still have frequent visits to the ER and even hospitalization when recovering from a simple cold.
Our conference Monday night was focused on a novel Biologic therapy that may indeed be another target for asthma treatment: TSLP
We now have many biologicals that target novel molecules for asthma, so what’s the big deal about TSLP? Never thinking I would have to choose between biologics for asthma, when omalizumab (the first one) was released, I smugly said to myself, “this is too expensive, I’ll never use it!” Here’s the advantage of using a biological for asthma. Molecules such as IL-5, IL-4, IL-13 are very important in causing asthma, but if you block them, side effects are minimal. Steroids can block these molecules as well, but steroids affect many pathways of inflammation, and thus cause many side effects that nobody really wants. Most descriptions of asthma dissect pathways of signals from the airway epithelium down to the macrophage in the airway itself as the source of these inflammatory messengers. It’s way beyond the scope of this writing to explain every pathway as PubMed reveals 202,130 articles on asthma and 10,000 just in 2020!
With this writing, I’ll focus on TSLP which was last night’s topic presented by Dr. Millard. A great reference is American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2017;5:909-16) I’ll be happy to get you a copy–drop me a line.
TSLP originates from the airway epithelium which is unusual at best. But what a brilliant design as lung epithelial cells provide not only a physical barrier, but they produce mediators and cytokines that propagate innate and adaptive immune responses (keep you from infection). For our purposes today, the “alarmin” cytokines include TSLP, IL-25, and IL-33 which promote activation of TH2 cells and ILC2s. Who thinks of these abbreviations anyway? TSLP also promotes activation of mast cells, basophils, and dendritic cells all of which create inflammation; not good news if you have asthma. Studies now show that AMG 157 (once the product is released, the name will change to a sexy title, appropriate to catch the masses on TV!) can reduce early and late-phase allergen-induced bronchoconstriction and parameters of allergic airway inflammation.
And now some questions and discussion on asthma. Don’t be alarmed, this will give us a basis for understanding how asthma is triggered and the plethora of treatment options now available for asthma. Just use the “comments” section of this post for your answers and questions.
Asthma is a heterogenous disease that presents with multiple phenotypes and responds differently depending on which “type” of asthma you have. Can you list at least 3 triggers that cause asthma exacerbations in real life?
Fill in the blank with the appropriate molecule blocked by the following biologicals?
AMG 157 _______________
Biologicals, regardless of their specificity carry the potential of reducing exacerbations of asthma and in some cases may reduce the use of oral corticosteroids? T or F
Making the diagnosis of asthma is tough for both patient and doctor. As an asthma specialist, I can tell you that patients want to know, “doc, when can I stop my medications?” This is often the first question they ask! Ruth Holroyd takes a very candid look at natural treatments for allergic asthma and I appreciate her insights into her journey of asthma therapy. I would make some comments regarding asthma treatment with natural remedies:
Ruth is using a peak flow meter to determine the amount of airway obstruction that causes wheezing and shortness of breath. She is utilizing the first component of asthma care which is to monitor the degree of obstruction in the lungs. Unfortunately, worsening asthma is often undiagnosed because we don’t measure our lung capacity and instead rely on our symptoms. Time and time again, asthma can fool us by how much wheezing or shortness of breath we have. Always use your peak flow meter, or have your doctor order spirometry at least once per year to measure your airway capacity.
If you want to make changes in your asthma regimen, please let your doctor know before changing your medications on your own. If your doctor won’t endorse your desire to reduce your medications, get a different doctor. Shared decision making is a must with this condition.
We know that asthma has a strong component of anxiety, possible vocal cord dysfunction (from not breathing correctly), and respiratory muscle weakness. Many of the natural remedies for asthma that Ruth mentions are targeting better muscle control and eliminating the “anxiety” component of asthma. These techniques are helpful regardless of the medications you’re already on for asthma.
The most important part of asthma management doesn’t involve any medication–know your triggers! Whether allergens, perfumes, or stressful situations, if you know your triggers, you will do much better in staving off an asthma attack.
I’ve had allergic asthma all my life and used both reliever and preventative inhalers regularly for YEARS. This blog is about my journey to living with asthma naturally and no longer using any asthma medication.
I’ve always worried about this continued use of steroids for asthma and whether they were bad for me, causing side effects etc. Naturally when I began topical steroid withdrawal I looked into whether this was going to hinder my progress because the preventative asthma inhaler contains a steroid drug. It was hard to find any advice that I really trusted so I continued to use both.
Asthma can be life threatening.
Every day 3 people in the UK die because of their asthma.
“Asthma deaths in England and Wales were recorded at 1,320 in 2017 and 1,422 in 2018 giving us an increase of 7.7%. Asthma UK analysed asthma deaths data from the Office for National Statistics, Deaths registered in England and Wales 2018 .“
I believe many of these could be due to undiagnosed allergies, but I can’t substantiate this.
My asthma history
However during lockdown, purely by chance, the slower lifestyle and isolation, different pace of life, outlook, eating habits and daily routines, I realised I’d forgotten to use the preventative inhaler for months. I felt fine, so I kept on as I was, being very careful, avoiding my triggers and watching my peak flow.
I have a Smart Peak Flow device which was given to me free to review on Instagram. It links up to your phone and you can then easily track your readings, see peaks and troughs and monitor your asthma really quickly in the app. You can also share this with your medical professional so they have up to date information to see. You can buy a Smart Peak Flow unit on Amazon.
At my last asthma consultation I sought advice from my local asthma nurse who, whilst nervous to condone my choice of quitting the medication, admitted my peak flow was normal. She told me to keep an eye on it and get in touch if I needed to get back on the preventative inhalers. The other interesting advice I was given was to stop using the blue one before a run, as had been previously advised. Instead, I should take the inhaler with me and only use it as needed. I now find I rarely need the blue inhaler at all and actually couldn’t tell you the last time I used it.
I still get a little wheezy, I think caused by hay fever, dust and other triggers, but it seems to be very mild. A visit to a cafe can set me off on a wheeze attack due to air borne dairy particles, but this was still the case when I was using both reliever and preventer inhalers. Sitting outside and leaving cafes quickly when I get wheezy is a price I have to pay to stay safe .
Ban the bloody latte!
I’m not a doctor so would not for a moment suggest that anyone stop using their asthma medication. If you are using preventative inhalers and the blue relievers please continue to do so as directed by your doctor. If you are concerned please get an appointment with the asthma centre closest to you for a review.
Natural asthma treatments
Since not using my preventative inhaler I’ve been looking into how to ensure I remain drug free safely. Sometimes I do still get wheezy, on high pollen days and sometimes for no apparent reason that I can determine. Luckily these have been mild and I can manage it myself. Monitoring regularly by taking your peak flow is good practise so you can see any dips and deterioration. By far the best thing was one particular breathing technique that has helped so much and it got me thinking, what other research and things are out there that could help? What else am I missing?
Buteyko breathing – Buteyko (pronounced Bu-tay-ko) is a breathing technique which can ‘improve asthma symptoms, quality of life and reduce bronchodilator (blue reliever inhaler) requirement in adults with asthma’. To do Buteyko breathing, breathe in normally, hold your breathe by covering your nose with your finger and thumb and keep your mouth closed. Hold for 10 seconds or as long as you can. Let your breathe out slowly when you need to, or after ten seconds and now breathe in and out normally ten times. Every time I do this I find it shifts mucous after only one try, and always by the second cycle. I used to feel like my chest was restricted and that the mucous was stuck, dry and wouldn’t move, leaving me sort of breath. This simple technique works every time I feel a little shortness of breath of wheezy. You can read more about this in my blog about the Buteyko Breathing technique for asthma
Salt Therapy Inhaler – I’ve not used one of these before but a few of my contacts on Instagram have recommended them to me. I nearly bought one but at the moment I don’t have any asthma to test it on. Check out Saltair inhalers on Amazon.
Reduce anxiety – This is key, for me there is a direct link between being anxious and itching and wheezing or shortness of breath. It’s not always easy to just do something like cut out stress or reduce anxiety as it’s not simple. But do you what makes you stressed and anxious? Can you control it in any way? or work to make thing better and reduce that burden on your immune system. I have had counselling and continue to work on the things that worry and upset me. I have loads of tools that I’ve learnt over the years and learning what’s not good for me is really helping. Learning to say no when you need to and look after yourself first will start to show a difference in your health. It’s all those little things like maintaining good sleep, healthy screen time, self care, nature and exercise. Don’t under estimate the effect of a busy lifestyle with no time to rest, recharge and rewire.
Meditation – I’ve been learning to meditate now for a few years and I am by no means an expert. I don’t for a moment try to clear my mind or do anything clever, but what it does do for me is to help me slow my breathing down. So many of us are not learning to breathe properly. By taking just ten minutes out of my day to just sit and try to slow everything down I have noticed a huge difference in my mental health and my physical health. Learning to breath properly, deeply and plug into that part of your nervous system that helps you relax is something I think everyone should learn to do. Just try it for 30 seconds and you’ll notice a difference. Just sit with a straight back, feet planted firmly on the floor, try to relax your jaw, your tongue, your forehead and your shoulders and close your eyes and breath in deeply, hold your breath for few seconds and breath out slowly. There are loads of different breathing exercises so give it a go. It’s free, you can do it anywhere and I guarantee it will help. I have the Calm app and find that a guided meditation helps me to keep focus on the breath. If you would like a free month’s trial on Calm let me and I’ll send you a link.
Vitamin C – Vitamin C is involved in the metabolism of histamine and prostaglandins, which are involved in bronchoconstriction so it’s a natural antihistamine. It certainly isn’t going to do you any harm because the body doesn’t store it if you take too much. So if you have allergic asthma it should definitely help. Obviously a diet rich in vitamin C will help but you can boost your intake, particularly when wheezy. Get Vitamin C powder or pure ascorbic acid on Amazon.
Magnesium – The reason this mineral can help is because it’s a natural bronchodilator which means it opens up the airways and also helps reduce inflammation. It’s even used by doctors in emergencies either intravenously or in a nebulizer. You can try Liquid Magnesium from Floradix on Amazon.
Learn your triggers – My asthma is triggered by a number of things including dust, latex, mould, pollen and grass, airborne dairy particles, some dog and cat dander, horses, other animals etc. Even when I was using all the medication these triggers would still cause asthma. The only way to really manage it is to avoid these triggers as best you can. Really keep an eye on when you get wheezy and what’s happening each time. Keep a diary so you can work out what’s happening. Ie. is it in the bath, in the garden, when at a particular friend’s house, time of year, season of pollen. It takes time to piece it all together but by understanding your body and what it reacts to you can live your life to avoid them as much as possible. So for instance, I always sit outside in some cafes, even in winter, because sitting inside makes me too wheezy.
Detox your home – I’ve been doing this slowly now for a few years. As things run out I replace with a natural kinder solution. I’m talking about skin care, cleaning products, fragrances, everything. I love my new essential oil diffuser that helps me get calm and chilled for bedtime. I only use 100% pure essential oils now to fragrance my house, those plugin perfume things are awful, honestly really bad for your asthma and general health. Please everyone stop using them!
Diet – Soya triggers an asthma attack for me, immediately. Could a food type be giving you problems too? Keep a food diary if you think this is the case and request allergy testing from you doctor.
Dust mite and allergen bedding – This one is also really important if you have a dust allergy. I’ve used them in the past but am currently not as I find that if I stay somewhere else I really used to struggle. The mattress covers are quite a bother to fit, but if you have a serious dust allergy these could be a game changer. You can get Anti Allergen mattress and duvet covers from Allergy Best Buys. You’ll get 10% off if you sign up to their newsletter. They also do some lovely looking Bamboo bedlinen that I have my eye on!
Pillows – I have got the SleepAngel anti allergen pillow which I really love and take everywhere with me when I go on holiday. It goes with a carry bag so you can easily transport it. It is the only allergen free and waterproof pillow on the market and nothing gets inside it. It’s special coating means you can wipe it clean if you need to a disinfect also so there is no need to machine wash either. Although who ever washes pillows? Or is that just me who’s never washed a pillow? Check out the SleepAngel pillow here. Of course there are lots of pillows that say they are hypoallergenic but I’m getting on really well with my SleepAngel pillow.
Demystifying Atopic eczema and asthma course – I have just started a course to understand eczema better and some of these tips are from that. I will share a link when I have it so you can find out more too. If you’re interested contact Carolyne Akinyemi on Linkedin.
Disclaimer: By using any of the Amazon links above a small amount will be paid to me from Amazon as commission. It costs me money every month just to host and maintain this blog so these links help me keep the blog going.
I do want to stress here I am not suggesting that anyone stops using their asthma medication. I am not a doctor, just a patient sharing their experience. Please make an appointment with your GP or local asthma clinic if you need help or advise about managing your asthma.
How is your asthma? Do you use a preventive inhaler? What do you do to help you manage your asthma?
Back-to-school with peanut allergy: 6 steps for parents to consider
What families living with peanut allergy need to know to help care for their kids at school
For families living with peanut allergy, the most common food allergy among children in the U.S.1, managing the allergy can require constant vigilance and supervision. This includes diligently reading food labels and, for some, avoiding social gatherings, such as birthday parties and summer camp, in fear of accidental exposure. Practicing a strict peanut-free diet alone might not be enough, as even a small amount of exposure to the allergen can prompt an allergic reaction.2
With many schools reopening for in-person learning this fall, parents of children with peanut allergy may be feeling nervous to send their kids back to school. This may be particularly true for those with young children starting school in-person for the first time who are not accustomed to the independence and level of vigilance required.
Here are six proactive steps that parents can take when sending children with peanut allergy back into the classroom:
1. Speak to the child’s allergist
Before the school year begins, parents should make an appointment to speak to their child’s allergist. At this time, parents can work with the allergist to update their Emergency Care Plan, which details the child’s allergies and what to do in case of an allergic reaction. During this appointment, parents can also discuss treatment options with their allergist.
2. Inform the school
Parents should share their Emergency Care Plan with school administrators and explain how they can help prevent accidental exposure to peanut. Many schools have protocols in place, but it’s important to have open conversations to ensure comfort with those protocols and to put other protocols in place as needed. The school may even have information about a food allergy support group for parents whose children attend local schools, which could offer useful tips.
Parents should make a complete list of the foods their child is allergic to and share emergency contact information, along with how and where their child’s medication will be stored. Additionally, they should confirm that the school staff is trained to administer injectable epinephrine.
3. Educate, educate, educate
Parents may want to meet with teachers, health professionals, cafeteria staff and other parents to educate them about the child’s peanut allergy and what to do in case of an allergic reaction. An educational session, in collaboration with the child’s teacher, could be offered to classmates during which students can ask questions and better understand what it means to avoid even the tiniest traces of peanut.
4. Reduce transportation concerns
The school bus may pose a risk for accidental peanut exposure as buses are used for daily transportation and for class field trips. Parents should talk to their child’s school to understand school bus rules and protocols for food allergy management.
5. Prepare lunch or learn about substitute meal options
Preparing lunch at home may offer some parents assurance, while others may prefer that their child uses the school cafeteria. The U.S. Department of Agriculture (USDA) requires schools to offer substitute meals for students with life-threatening food allergies. This may require written instructions from the child’s healthcare provider and is another reason that speaking with the school’s food service director in advance of the school year is suggested.
Once thought to be a permanent condition, peanut allergy is now a treatable condition with the use of Oral Immunotherapy or desensitization to peanuts. Granted, this article is sponsored by the maker of Palforzia, Aimmune, but it is a good option for kids with peanut allergy.
Why should I consider the use of an “expensive” protocol for peanut desensitization? (Palforzia)
Using a FDA approved protocol simply means that researchers have agreed upon the dose escalation that minimizes adverse reactions such as anaphylaxis during the procedure. After all, you are giving your child a food that they are allergic to!
The amount of peanut protein is standardized between doses, meaning during the “up-days” and escalation phase, your child will always get the anticipated dose, making anaphylaxis less likely to occur.
In order to start using “peanut desensitization”, parents and physicians must verify that they have completed the appropriate education on how to use Palforzia and not “shoot from the hip.” If it were my child, I would always want to use a product that’s been tested and standardized for best results done safely.
6. Find out if treatment could be the right option
PALFORZIA® [Peanut (Arachis hypogaea) Allergen Powder-dnfp] is intended to gradually decrease your child’s sensitivity to small amounts of peanuts that may be hidden in foods. As children go back to school, parents may want to speak to their child’s allergist to see if PALFORZIA may be the right choice for them.
WHAT IS PALFORZIA?
PALFORZIA is a treatment for people who are allergic to peanuts. PALFORZIA can help reduce the severity of allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanut. PALFORZIA may be started in patients aged 4 through 17 years old. If you turn 18 years of age while on PALFORZIA treatment you should continue taking PALFORZIA unless otherwise instructed by your doctor.
Who doesn’t like to fish during this time of the year? Doesn’t matter if it’s catfish on the local pond, or trout at Roaring River, there’s nothing like feeling the tug on your line before you set the hook. And I have relatives that are experts at catching any type of fish you want. Fish allergy can be divided into 2 groups: the white fish and shellfish. You are usually not allergic to both groups and testing for sensitivity can be very helpful to avoid anaphylaxis and give you the tools to avoid the wrong kind of fish. Shellfish allergy to shrimp, crab, and lobster isn’t the focus of this writing, so we’ll discuss only allergy to “white fish” today. At times, I enjoy searching the medical literature for other allergist’s opinions on food allergy and this is no exception. What is most important for the white fish allergy, is can you outgrow this condition?
The data of whether someone can outgrow fish allergy is scarce. Fish allergy is one of the most common causes of food allergy, especially in children and young adults, with rates from 0.1 to 0.5%. The major fish allergen identified is beta-parvalbumin, it is resistant to heat and digestion. Many patients with an allergic reaction to one fish will also react upon ingestion of other fish. Sharks and rays mainly contain alpha-parvalbumin which has been shown to be less allergic.
Journal of Allergy and Clinical Immunology: In Practice.
Previous studies have shown that 15% of children can outgrow fish allergy within a period of 2-5 years, whereas telephone studies have shown it to be 3.5% in the United States.
A recent study called “Natural History of IgE-Mediated Fish Allergy in Children” published in The Journal of Allergy and Clinical Immmunology: In Practice, aimed to describe the natural history of fish allergy.
Children in the study ranged from 4 to 18 years who were previously diagnosed with fish allergy. The results showed:
22% of children tolerated all fish tested, the average timeframe was 8 years after their first reaction.
Complete tolerance to fish increased with age, from 3.4% in preschool children to over 45% in adolescents.
Most children were able to tolerate swordfish (94%) and tuna (95%).
The best predictor of fish allergy was the IgE test to cod greater than 4.87 kUA/L.
The study has shown that fish allergy in children starts early, mostly during the first 2 years of life and a considerable proportion of children will outgrow fish allergy. Particularly those with less sever reactions and a lower level of sensitization (skin prick and IgE testing). Those who continue being allergic may still tolerate several fish species, such as tuna and swordfish. This probably is a reflection of their parvalbumin content and/or composition.
Tolerance to at least 1 fish can be important for allergic children because fish has beneficial effects on health owing to the high omega-3 content and it is associated with a lower risk of coronary heart disease.
So what’s the take away from fish allergy, so you can fantasize what the “big fish” is doing underwater before you set the hook?
Most children will outgrow fish allergy and this applies particularly to swordfish and tuna. A definite must is to have testing performed to determine the level of IgE (or skin testing) to white fish that will prevent an allergic reaction that can spoil your next great fishing trip.
Tolerating fish to include at least one species can have clinical benefit due to omega-3 content to reduce heart disease and stroke.
Our hot topics and angry controversies about not only COVID infections but now COVID vaccinations reached the boiling point this past week, resulting in protests over COVID vaccination mandates all over the world. Organized medicine (ie, the AMA) has been accused of covering up the origins of the virus and now the side effects of taking the vaccine. To counter these false claims, I would invite you to examine a recent publication from the AMA discussing the side effects of the vaccine and steps to take in order to report unwanted side effects.
As the country continues to push for more people to get vaccinated against COVID-19, some remain concerned over rare cases of heart inflammation—myocarditis and pericarditis—linked to the Pfizer-BioNTech and Moderna mRNA vaccines. While some parents may be thinking twice about teen vaccination, medical experts reassure that the risk of myocarditis and pericarditis are far lower than the risks of serious illness or death from contracting COVID-19.
Since April, there have been more than 1,000 reports to the Vaccine Adverse Event Reporting System (VAERS) of cases of myocarditis and pericarditis occurring after mRNA COVID-19 vaccination in the U.S. with more than 300 cases confirmed. Myocarditis is inflammation of the heart muscle and pericarditis is inflammation of the lining outside the heart. In both cases, according to the Centers for Disease Control and Prevention (CDC), the body’s immune system is causing inflammation in response to an infection or other trigger.
“As physicians, nurses, pharmacists, public health and health care professionals, and, for many of us, parents, we understand the significant interest many Americans have in the safety of the COVID-19 vaccines, especially for younger people,” the nation’s leading doctors, nurses, pharmacists and public health leaders, including the AMA, said in a joint release.
Here is what physicians should share with patients about incidents of myocarditis and pericarditis after Pfizer or Moderna mRNA vaccination.
These are rare cases
Confirmed cases have occurred mostly in male adolescents and young adults aged 16 years or older. But given the hundreds of millions of vaccine doses administered, says the CDC, reports of myocarditis and pericarditis are rare.
“The CDC’s Advisory Committee on Immunization Practices, or ACIP, met to discuss this issue last week,” AMA Chief Health and Science Officer Mira Irons, MD, said during an episode of “AMA COVID-19 Update” on vaccination challenges and masking guidance. “While the CDC did determine the mRNA COVID-19 vaccines can, in rare instances, be linked to myocarditis or pericarditis, the majority of patients have recovered.”
“This is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination,” the joint release says. “Importantly, for the young people who do, most cases are mild, and individuals recover often on their own or with minimal treatment.
“In addition, we know that myocarditis and pericarditis are much more common if you get COVID-19,” the release adds, emphasizing that “the risks to the heart from COVID-19 infection can be more severe.”
Symptoms appear after second dose
Severity of myocarditis and pericarditis cases can vary, but “reports have increased since April, mostly in young males 16 and older, several days after vaccination, and more often after the second vaccine dose. Symptoms include chest pain, shortness of breath and palpitations,” Sandra Fryhofer, MD, an Atlanta general internist who serves as the AMA’s liaison to the CDC’s Advisory Committee on Immunization Practices, said during an episode of “AMA COVID-19 Update” about COVID-19 vaccines and variants. Dr. Fryhofer also is a member of ACIP’s COVID-19 Vaccine Work Group.
Sandra Fryhofer, MD
While these cases are rare, “ACIP agreed that a warning about the potential risks should be added to the FDA’s official fact sheets on the vaccine so that people would not ignore symptoms,” explained Dr. Irons.
If a parent or their child has any of these symptoms within a week after COVID-19 vaccination, it is important to seek medical care. For instances of myocarditis and pericarditis after mRNA COVID-19 vaccination, most who received medical care have responded well to medications and rest.
Vaccination far outweighs risk
“The benefits of COVID-19 vaccination far outweigh the risks of heart inflammation in young people,” said Dr. Irons, adding that “it’s important to remember that the risk for COVID is far higher.”
“Teens and young adults account for the largest proportion of new cases in the United States,” she said. “And we know that COVID infection itself can affect the heart, so myocarditis after COVID vaccination is still a rare event and the vast majority have recovered.”
COVID-19 vaccines “will help protect you and your family and keep your community safe. We strongly encourage everyone age 12 and older who are eligible to receive the vaccine under Emergency Use Authorization to get vaccinated, as the benefits of vaccination far outweigh any harm,” the joint release said. “Especially with the troubling Delta variant increasingly circulating, and more readily impacting younger people, the risks of being unvaccinated are far greater than any rare side effects from the vaccines.”
For physicians who have “a patient with myocarditis … or anything else unusual after COVID vaccination, please send a report to VAERS … so they can check it out,” urged Dr. Fryhofer. “Without this reporting, CDC can’t know the scope of a potential issue, investigate it and provide communication.”
“If you do report a case and CDC asks for medical records, send them ASAP—it’s not a HIPAA violation,” she said, adding that “anyone can submit a report to VAERS—it’s not just limited to health care” professionals.
Today, I had the opportunity to review a patient satisfaction survey from our allergy office. Now that COVID-19 pandemic isn’t at the top of everyone’s agenda (but may be changing soon with delta variant), I expect you’ll be asked to complete more surveys and as doctors, we’ll be asked to review more of your responses. This raises several questions for me and I hope you as well– I’ll share with you some “science” about answering survey questions, and you might just be surprised at the results.
Do you even answer medical survey questions?
How honest are you with your responses? Are you confident that changes will be made based on your survey responses?
Do you think doctors/providers really read their individual surveys?
Should compensation depend on your survey results?
Can I sue you if you have good patient satisfaction surveys? Does it matter?
Yes, we have to do something about our medical system, and hopefully, we’ll all do our part. As promised, there is actually information on what patients like or don’t like about their physician interaction that shows up in physician surveys. I’ll see if I can’t relate this to an allergy visit with surveys included.
WhatPatientsValueinPhysicians: Analyzing Drivers of Patient Satisfaction Using Physician-Rating Website Background: Customer-oriented health care management and patient satisfaction have become important for physicians to attract patients in an increasingly competitive environment. Satisfaction influences patients‘ choice of physician and leads to higher patient retention and higher willingness to engage in positive word of mouth. In addition, higher satisfaction has positive effects on patients‘ willingness to follow the advice given by the physician. In recent years, physician-rating websites (PRWs) have emerged in the health care sector and are increasingly used by patients. Patients‘ usage includes either posting an evaluation to provide feedback to others about their own experience with a physician or reading evaluations of other patients before choosing a physician. Methods: We analyzed large-scale survey data from a German PRW containing 84,680 surveys of patients rating a total of 7038 physicians on 24 service attributes and 4 overall evaluation measures. Results: The proposed approach revealed new insights into what patients value when visiting physicians and what they take for granted. Improvements in the physicians‘ pleasantness and friendliness have increasing returns to the publicly available overall evaluation (b=1.26). The practices’ cleanliness (b=1.05) and the communication behavior of a physician during a visit (b level between .97 and 1.03) have constant returns. Indiscretion in the waiting rooms, extended waiting times, and a lack of modernity of the medical equipment (b level between .46 and .59) have the strongest diminishing returns to overall evaluation. Conclusions: The categorization of the service attributes supports physicians in identifying potential for improvements and prioritizing resource allocation to improve the publicly available overall evaluation ratings on PRWs. Thus, the study contributes to patient-centered health care management and, furthermore, promotes the utility of PRWs through large-scale data analysis.
J Med Internet Res 2020; 22(2):e13830
How about that? If you like your doctor, you are more willing to follow provider directions on the care prescribed. In allergy & asthma, this means using your inhaler as soon as you feel shortness of breath or wheezing, not just when you’re so sick the ER is the next logical decision. Or how about using a biological that takes care of your asthma by 1-2 shots per month?
Physician-rating websites can be very helpful if you’re choosing a physician. But buyer beware, some patients have used these PRW’s to “vent” their frustration with a medical office visit that reflects more of an emotional dislike for some aspect of the visit, rather than bad medical advice. On a personal note, I try and implement “shared decision making” with every patient that I see, but sometimes, I don’t end up on the same page as what meets patient’s expectation. For instance, I can tell you that you probably have asthma, and some are not ready to hear that. My advice: just let your doctor know about your concerns and 99% of the time, your questions are answered and life is good again. I can tell you from personal experience that doctors go to school for >10+ years to make patients happy and provide the best possible outcome for any medical condition.
So what will cause a “bad” rating on physician-rating websites? (or diminishing returns to the overall evaluation)
Indiscretion in the waiting rooms. Unfortunately, I’ve seen this too many times when health care providers or staff talk without discretion outside of the waiting room. Doors are never sound proof and no one wants to be “that guy” that feels embarrassed at what the office staff is saying about HIM. Never once did I think I’d have to say this, but social media doesn’t help with our lack of discretion. You can say what you want and when you want to on your favorite platform, whether it’s Facebook, Twitter, or even LinkedIn. Give some respect to even those that irritate you or you don’t agree with. My favorite sign I saw recently in a medical office: “viewer discretion advised!”
Extended waiting times will always hurt your P-RW. Nobody likes to wait, but it’s even worse if you don’t think the office or doctor cares about your time as well as theirs. From the outside looking in, it’s a challenge to get patients in when needed and at the same time, keep on schedule. I do try to apologize for making anyone wait > 15 minutes, but even that isn’t good enough at times. I understand your dilemma, and maybe that’s just a good reason to have surveys and pay attention to the results by changing schedule demands.
Lack of a clean office environment and modern equipment/facility is also a deterrent to favorable reviews according to the above study. This one is almost a “no-brainer” but even old chairs in the waiting room and otoscopes falling off the walls, probably don’t make you feel comfortable with the level of medical expertise in your doctors’ office. Granted, the medical advice you receive may still be correct even if the upholstery is ripped in the waiting room, or the exam tables were possibly used by your grandmother; you still want to hear medical advice in a clean, modern facility. As an example, medical offices are now “open” with large nursing stations rather than the old model of small exam rooms and nursing staff hidden in obscure corners, trying to hide from patients to not be bothered; the change is somewhat like our new kitchens!
So what have I really said so far? First of all, medical surveys are becoming another part of our health care system. Like it or not, patients will be asked for their opinion about medical care they received and doctors will be paid based in part on their performance. As expected, this can create some unintended consequences that I will talk about below. One of the positive benefits from patient interaction, which definitely includes patient satisfaction surveys is better relationships with your doctor and less conflict which has to be resolved by formal intervention such as lawsuits or arbitration. The best way to prevent malpractice claims is not perfection, but rather an improved physician-patient relationship.
A Survey of Sued and Nonsued Physicians and Suing Patients
Shapiro, Robyn S. Simpson, Deborah E. Lawrence, Steven L. Talsky, Anne Marie Sobocinski, Kathleen A. Schiedermayer, David L.
Archives of Internal Medicine; October 1989, Vol. 149 Issue: 10 p2190-2196, 7p
• To systematically assess the impact of malpractice litigation on the doctor-patient relationship and to collect data that might suggest effective tort reform, we surveyed 642 sued physicians, nonsued physicians, and suing patients in Wisconsin. Parallel forms of survey instruments obtained information regarding changes in physicians’ practices, changes in attitudes toward patients or physicians, and changes in physical and emotional well-being as a result of malpractice litigation or the threat of the same. In addition, opinions regarding causes and deterrents of malpractice litigation were obtained. Results suggested that claims or threats of malpractice suits had a negative impact on physicians’ practices and emotional well-being; that this negative impact was more pronounced when the sued physician had been more personally involved with his patient prior to the malpractice claim; and that suing patients’ and sued physicians’ understanding of their relationship before the malpractice claim significantly differed. All respondents viewed improved physician-patient communication as the most effective method of preventing malpractice claims. Informal, alternative dispute resolution mechanisms in hospitals and clinics and improved peer review may decrease litigation and its deleterious effects.(Arch Intern Med. 1989;149:2190-2196)
“As physicians, we want our patients to have not only better outcomes but also a positive experience of care,” gastroenterologist Shivan J. Mehta, MD, MBA, wrote in the AMA Journal of Medical Ethics® (@JournalofEthics). “If we care about the experience of our patients, why shouldn’t we measure it and strive to improve our performance?”
The answer is a complicated one, wrote Dr. Mehta, assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania and director of operations at the Penn Medicine Center for Innovation.
On the one hand, patient-experience scores can help physicians think more broadly about outcomes. They can also carry huge financial stakes, such as through the incentives and public disclosures that are Centers for Medicare & Medicaid Services’ efforts to improve quality through value-based purchasing.
But patient-experience measures aren’t infallible in their collection or their application. Following are three concerns about surveys for physicians, hospital administrators and policymakers to consider. Reference: https://www.ama-assn.org/delivering-care/ethics/3-legitimate-concerns-about-patient-experience-surveys
Patients may seek low-value treatments
Physicians often spend less time than they would like with their patients, and can feel pressure to expedite selection and explanation of treatment plans. When confronted with low patient-satisfaction scores—or even the threat of them—some doctors may assent to requests for low-value or unnecessary treatments that patients have come to expect.
One large study even showed that high patient satisfaction was associated with higher utilization, expenditure and mortality—the very opposite of high value.
What could this possibly mean for an allergy practice? Take for instance, a patient who comes in to the office with a chief complaint of headaches and wants to be tested for food allergy. The correct answer is most food allergy (ie, anaphylaxis) doesn’t cause isolated headaches and testing for foods won’t give you any clues about which foods to suspect anyway. A satisfaction survey would “ding” you because you didn’t provide something the patient was looking for, but wasn’t medically necessary.
Gains could concentrate at the top
It’s typical for safety-net hospitals to score lower on patient satisfaction than hospitals that provide less care to underserved populations—not surprising given the challenges of caring for sicker populations with fewer resources—so it follows that one-size-fits-all financial incentives could produce even wider disparities in care and satisfaction.
In addition, concerns over penalties for low satisfaction scores could cause physicians to avoid caring for more challenging patients, such as poorer people and persons with mental illness.
Responses can be suspect
Patients’ expectations and perceptions may not lend themselves to technical or objective measures of quality.
Also, voluntary surveys can be long and may not be filled out immediately following consultation or recovery, producing selection and recall biases in those with experiences at the extremes, and limited sample sizes can similarly skew results. There may even be a crowding-out effect of surveys on other, more reliable quality metrics.
“Physicians can no longer choose not to participate in, but they can decide how best to engage with, incentive programs,” Dr. Mehta wrote. “Patient experience scores should also be evaluated in the context of other clinician incentives, whether productivity or quality metrics.”
So what can we do together to improve our physician-patient relationships and avoid the dread of patient surveys?
Be honest with your doctor….if you don’t agree on an issue, let them know in a courteous and respectful manner. You may even want to write a letter or e-mail at a different time to avoid a disruption in the medical office “flow”.
Options are always a plus. Working with your doctor to find a solution is often called “shared decision-making” and just like it says, you should have input regarding the medications you’re on and the concerns you have about your condition should be expressed in a friendly, open manner.
Unfortunately, blowing off steam at your doctor’s office through a practice survey is just that–hot air! Medical offices don’t usually change their protocols following angry criticism because this is usually an outlier on the scale meant to improve working relationships.
Do unto others as you would have them do unto you–this mantra has worked in the past, and should definitely improve our task of answering those pesky surveys!
Here’s the full update and thank-you Alan for sharing
Capsaicin nasal spray may be an effective treatment for patients who have nonallergic rhinitis. A significant proportion (25-30%) of patients suffering from rhinitis have nasal symptoms without an infection or allergies, this is referred to nonallergic rhinitis. Up to 50% of these patients have idiopathic #rhinitis after excluding work, elderly, gustatory, hormonal and drug induced rhinitis. Nasal steroid sprays are ineffective for this condition. Astelin, Atrovent are nasal sprays that have also been used for this condition and they have showed some improvement. But for others, these treatment options have failed. Capsaicin is the active ingredient of chili peppers. It is available as an over-the-counter nasal spray (ei, Sinus Buster, Sinus Plumber, others).
Capsaicin is another treatment option available for patients with idiopathic rhinitis. This treatment has limitations though, it can be uncomfortable, time consuming and incompletely understood in terms of its working mechanism. Research for better capsaicin treatment is needed.
A recent study looked at 2 different dosing of #capsaicin nasal sprays to see if it could suppress nasal symptoms. Daily nasal administration of low-dose capsaicin was well tolerated and reduced nasal symptoms. The study also evaluated the levels of Substance P which has been shown to be higher in patients with idiopathic rhinitis.
Symptom reduction was seen between 70-80% of patients with idiopathic rhinitis. Daily administration of low dose capsaicin was well tolerated and reduced nasal symptoms. Levels of Substance P were reduced and there was a positive correlation between Substance P and nasal obstruction, suggesting that rhinitis symptoms result from abnormally increased Substance P levels. As Substance P increases mucus secretion, suppressing it might represent a novel approach.
This study looked at different concentrations of Capsaicin nasal spray. There are various different manufacturers of Capsaicin spray, although the exact concentration isn’t well defined. As always speak to your doctor before beginning any treatment. Patients who participated in this study were excluded from any allergies or infections prior to beginning treatment.
In conclusion, capsaicin low dose is effective in suppressing nasal symptoms and it may be a good, novel option for patients with non-allergic rhintis.
I have several reasons to write about “non-allergic” rhinitis.
Granted, this is the allergy season, but not everything that sneezes is allergy. Patients are always confused when skin testing is negative, yet they have consistent “allergy symptoms”. Heck, I even use the term “allergy” when I’m writing about non-allergic rhinitis.
Allergy has to have IgE (that’s the molecule binding to both allergens and subsequently to the mast cell causing histamine release). No IgE, no allergies and unfortunately, no allergy shots will work.
As Alan has mentioned, the typical nasal sprays such as Flonase and other nasal steroids don’t work well for this condition. Much of what you see advertised on TV is designed to encourage you to buy intranasal steroids, but many of those conditions are “non-allergic” rhinitis and listening to the TV ads won’t do you a bit of good.
I would disagree with the incidence of “non-allergic” rhinitis @ 30%–it’s more like the majority of rhinitis sufferers at ~70% and maybe more during the winter.
It is true that treatment of “non-allergic” rhinitis is frustrating because of lack of good nasal sprays, but PLEASE don’t give yourself capsaicin or hot pepper sauce in the nose before getting a prescription to dilute those hot babies down or you’ll be swearing at me all the way to the ER. Pepper spray will reduce that runny nose only if you compound the formula by an experienced pharmacist and deliver it into the nose carefully. Police grade pepper spray will get you into a whole lot of trouble!
As a research project, I’m looking into using nasal challenges for patients who have local allergic rhinitis and this may provide some additional use of desensitization even though skin testing and blood work is all negative for IgE. More on that later.
Bottom line: Not all that sneezes is allergy and a significant number of patients have runny nose, sneezing and sinus infections without having the opportunity to use allergy shots for desensitization.
If this is you, there is hope. See your local allergist for discussion about Astelin, Atrovent (hardly ever used), and if needed, I can work in conjunction with a local compounding pharmacy to get some capscaicin spray to help with that sneezing.