Last month, I shared several videos with you that pertained to treatment of #asthma with biologicals. I hope you listened to the lives of patients just like you who can now “do life” with their family and friends not having to fear the next asthma attack. But it’s not so easy to change our habits on treating asthma. We’ve been trying for years to get patients to use preventative care (ie, inhaled steroids) and that method even in clinical studies is no more than ~50% effective. So what’s next?Continue reading
The first video reflects one of our first biologicals to date, that being mepolizumab or (Nucala). As you will hear, before Nucala, we had nothing to use for asthma except the dreaded steroids. Here’s what I like about Nucala:
1. One of the first anti-IL 5 medications to hit the market to reduce asthma exacerbations.
2. Dosing is easy: 100mg every month and it’s not based on weight
What I don’t like about Nucala:
1. Maybe we should be dosing on weight. Several studies that are now looking at Nucala for treatment of EoE find the 300 mg dose works better than the current 100mg.
2. Blocking IL-5 molecule only may not work as well as blocking the receptor itself or blocking other cytokines (IL-4; IL-13)
I will verify that responses you’re about to hear do happen all the time with mepolizumab (Nucala) and it’s been a great addition to our asthma treatment.
What is the magic bullet of medical treatment? How about a biological that treats two or more diseases at one time? Dupilumab (Dupixent) is one such medication and I agree with Dr. Castro’s interpretation of the data on dupilumab–after all, he wrote the study. Here’s what I like about Dupixent:
- Blocks 2 cytokines, both IL-4 and IL-13
- Treats 3 different diseases: asthma, nasal polyps, and atopic dermatitis.
- If you can’t get approved through your insurance, the company has a very good patient assistance program that makes Dupixent affordable for most patients.
Xolair, xolair, xolair. This biological has been around since my days back in Kansas. I have to admit, when Xolair was first released 20 years ago, I thought “who would use this type of medication?” Not only was I wrong, but Xolair has now set the standard for the use of monoclonal treatment of allergic disease, asthma, and urticaria. But I can’t compete with the video on Xolair….enjoy!
The last biological I mention is one that wasn’t the first on the scene, but has made it’s impression with a unique mechanism for getting rid of allergic inflammation: why not block the eosinophil IL-5 receptor directly? What do I like about Fasenra?
- Gets rid of eosinophils quickly–you notice within several weeks many times when Fasenra makes you feel better.
- After the first 3 doses, you only have to use Fasenra every OTHER month–pretty cool schedule compared to a daily inhaler.
- Reduces both exacerbations of asthma AND the need for corticosteroids.
Ok..it’s time we learn the “why” of using spacers, because most patients don’t use them on a regular basis. Spacers do several things for your pocketbook and your asthma:
- This spacer below can be purchased for < $10 on-line at Amazon. That’s almost better than a used toilet roll cardboard! Yes, we used to use and recommend I might add this “makeshift” spacer for patients because the others were too expensive.
- Your asthma inhaler is much more effective when you use a spacer, because the aerosol is delivered deep into the lungs where you need it–in the small airways. Make sure you don’t use a spacer with dry powder –not needed here. For example, Advair has both dry powder and aerosol; the choice is yours, but no spacer for the dry powder.
- If you’re using an aerosol or MDI, you may find that only 1 puff is needed–you save money with similar results, but check with your doctor first before making that kind of switch.
- Now you know why we harp on you to use your spacer–saves money and better results.
Go out (or order from home) and get you one today! Leave me a note on how it works. Happy breathing–Dr. Wiens
We’ve been so caught up with the #Coronavirus pandemic, that we’ve missed two important developments in the field of allergy:
- The FDA has now approved the use of Palforzia for taking care of peanut allergy. Guess when this was released? January 2020, about one month prior to the outbreak of COVID-19; the affect on our practice and most other medical clinics across the country was predictable. Nothing happened except to try and avoid COVID-19 as long as possible. Hopefully, our efforts will pay off, but the viral pandemic isn’t over yet, even though the panic has appeared to lessen.
- I won’t talk more about COVID-19 because many of us (including myself) are suffering from Corona fatigue and plenty of good information about COVID exists on YouTube channels such as MedCram and ZDogg. Be prepared to devote some time to listen to these experts, because they won’t give you just a brief summary. They drill down to the ever evolving truth about COVID-19. (definitely worth your time)
- Back to the peanut story. #Palforzia is designed to give minute (very small) powder of peanut protein a little bit at a time so you don’t develop anaphylaxis with every ingestion. The company making this product spent large amounts of money to train professionals such as allergists with Zoom! conferences and field representatives to make sure we launched the program of desensitization without a hitch. Then came Coronavirus and knocked that one out of the park. So where does that leave us:
- Palforzia or peanut desensitization still works and is available to those patients who make good candidates. And who wouldn’t be a good candidate?
- Palforzia is associated with some risk and a consultation just to focus on this new treatment is required before starting the process. Can you believe, patients have to pass a certification as well?
- For more information, call our office at 918-495-2636 to schedule a consultation for peanut desensitization.
What else did we miss because of COVID-19?
IT’S THE SPRING POLLEN SEASON!
In years past, everyone lived their life (or especially free time) outdoors because we live in Tulsa for the Spring & Fall, right? Well, this year, it was hard to live outside when you’re quarantined. Hopefully, you avoided exposure to the Coronavirus, but you also avoided exposure to the outdoor Spring allergens (good for you). What you’ll find when we relax the “stay-at-home” rules is more sneezing, runny nose, and typical allergy symptoms. Just a great case in point at how exposure really plays a significant role in your allergy symptoms. So don’t make fun of me when I tell you to cover your mattress and pillows with a substance that isolates the dust mites! Let’s review how allergies work, because a “pollen grain” and IgE look a lot like COVID-19. the video below is a pollen grain that attaches to IgE and the process of “allergy” begins. Notice that whatever process happens in the body occurs because a receptor (suction cup on the cell) binds to a virus or IgE. Every reaction (both good and bad) happens because of this union between body cells and external molecules. Listen to the video below to see how this actually works–and BTW, infection with COVID-19 works the same way.
So how do I tell if I’m having allergy or a nasty virus?
- As is usual for me, I like to give you academic information on topics that I really want you to understand–don’t just take my word for it. Too many hits come up searching for “corona virus or allergy,” so I will make it simple and give you the best video to watch.
- Patients with allergy are always sneezing and coughing, and many stories this year involve allergy patients who were suspected of having “the virus”. One patient said, “the isle cleared at Wal-Mart when I sneezed”. Another patient found she was ostracized at a friendly get together because of her runny nose and cough–it wasn’t Corona, only spring allergies. She told me later, that she felt embarrassed and wanted to leave the party immediately. You shouldn’t have to experience this rejection and embarrassment if you know what separates virus (any type) from allergy.
- Viral infections will often have fever, sore muscles/joints, and in the case of COVID-19, significant shortness of breath. Most likely, this is your first experience with rhinitis, whereas allergy patients have sneezing, coughing, and runny nose year after year.
- If you have any questions, please ask your doctor if you need further testing. Testing for both allergies and viral infections (not just Corona) are readily available and you should take advantage of knowing how best to treat your symptoms by correctly diagnosing your problem. Now, don’t show up at your allergists’ office if you think you have COVID-19 before calling first! Don’t take my word alone, watch the video from Dr. Skoner at West Virginia — 3 minutes long and will give you the peace of mind to know “is this allergy or virus.” Your health depends on it!
Jane (fictitious name, of course because of HIPPA regulations) is now 56 years old and just last year was diagnosed with #asthma. She thought, “no big deal, there are plenty of inhalers for me to use so I don’t wheeze”. Little did she know that 2019 would put her in the hospital 3 times and multiple visits to the emergency room because of asthma. In fact, she even missed her grandson’s graduation from kindergarten because of her asthma. Now if that doesn’t motivate you, nothing will! Continue reading
As #Christmas time approaches, it’s clear that Americans want choice. When I ask patients what they would like for Christmas, “I don’t know” is usually not their answer. Children’s eyes filled with sparkles at Santa’s coming, parents’ smiling at me and thankful I haven’t ruined their stories about Santa dominate our discussions about the holidays. Of course, I’ll always review medications and made sure that #asthma won’t ruin a perfectly good Christmas.
As an allergist in Tulsa, the myths that surround asthma, food allergy, hives, hay fever abound and patients often come in to the office telling ME what they are allergic to or how to fix the problem. Let me give you some examples:
Flying home from San Francisco spending some time at the AAAAI (American Academy of Allergy, Asthma, and Immunology) was a powerful reminder of how thankful I am for the opportunity to practice allergy here in the Midwest. National meetings give you updates of new procedures, opportunities to meet colleagues, and just a general good time getting out of the routine. What’s new for allergy here in Tulsa is more use of #biologicals (for #asthma), more #food challenges/treatment, and more aggressive treatment of #hives. I’m excited to get started, so let’s go!