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

For Medical Students and Residents: Some Study and Interaction on your own time!

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?
  • Omalizumab _____________
  • Mepolizumab _____________
  • Dupilumab ______________
  • Benralizumab ____________
  • 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

What question do patients ask even during their first visit with me?

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.

Natural treatments for allergic asthma

07/09/2021 by Ruth Holroyd 1 Comment

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 UK

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.

Smart Peak Flow Meter
Smart 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!

PUBLIC ANNOUNCEMENT

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?

  1. 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
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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!
  9. 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.
  10. 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!
  11. 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.
  12. 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.
SleepAngel anti allergen pillow – wipe clean and doesn’t allow any allergens to get inside.

References and further reading

Magnesium and Asthma on asthma.net

Asthma and pathogenesis and novel drugs for treatment (the vitamin c link) from the British Medical Journal

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 montjust 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?

#asthma

Why Don’t More Patients with Asthma Use Biologicals?

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

#american-academy-of-allergy-asthma-and-immunology, #american-college-of-allergy-asthma-immunology, #biologics

New Biologicals are unknown

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:

  1. Blocks 2 cytokines, both IL-4 and IL-13
  2. Treats 3 different diseases: asthma, nasal polyps, and atopic dermatitis.
  3. 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?

  1. Gets rid of eosinophils quickly–you notice within several weeks many times when Fasenra makes you feel better.
  2. After the first 3 doses, you only have to use Fasenra every OTHER month–pretty cool schedule compared to a daily inhaler.
  3. Reduces both exacerbations of asthma AND the need for corticosteroids.

Time for correct use of spacers

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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

Is This Really Corona virus? 

We’ve been so caught up with the #Coronavirus pandemic, that we’ve missed two important developments in the field of allergy:

  1.  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.
  2. 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 ZDoggBe 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)
  3. 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:
  4. Palforzia or peanut desensitization still works and is available to those patients who make good candidates. And who wouldn’t be a good candidate?
  5. 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?
  6. For more information, call our office at 918-495-2636 to schedule a consultation for peanut desensitization.

FDA Gives OK to Peanut Allergy Oral Immunotherapy

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?

  1. 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.
  2. 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.
  3. 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.
  4. 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!

 

#allergy-symptoms, #asthma, #tulsa-oklahoma

New medications for Asthma–are we at the end of the line?

Watch my FOX 23 interview about new asthma meds

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

#allergies, #tulsa-oklahoma

Do I really want that? Shared decision making and how this applies to allergy.

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.


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Myth-busters in Medicine

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:

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#allergies, #asthma, #board-certified-allergist, #dave-stukus, #food-allergy, #lynn-wiens, #tulsa-oklahoma, #zdogg