Ever notice how everyone has #allergies these days? I kid you not, almost everyday, a patient will tell me that #Tulsa (where I practice) has more allergies than any other place in the country. The irony of it all, is so did patients in Kansas, and patients say the same thing in Virginia and Texas. You get my point–we all love to be known as the Allergy Capital of the World! Maybe it’s because allergies make us feel so miserable, and we love to hear stories about how to deal with the nemesis. Or maybe we want some “inside information” to share with our friends & family who also suffer from allergy. Whatever the reason for our obsession with allergy, you can’t argue with the fact that good allergy advise is not only helpful for better quality of life, but it’s crucial in making sure that allergy sufferers avoid heeding the WRONG advice for treating #hay fever. This is the passion I experienced in order to complete a fellowship training in allergy– I wanted to be able to interact with patients about their #allergic symptoms on their journey to good health. But wait, why practice a specialty that has so much incorrect information on-line and no doubt, “everyone’s an expert in allergy” when you could be doing real medicine to treat someone’s heart attack? Here are four reasons I still practice allergy for your consideration: Continue reading Four reasons I still practice Allergy in the Information Age
The following YouTube video describes a process called “Rush Immunotherapy” conducted in Ohio. It’s now a more common way to deliver #allergy shots and reduces the total number of shots required to achieve clinical relief from your #allergies. Some caveats about #RUSH Immunotherapy need to be included and your bullet list is below the video.
I would make the following corrections to this video:
1. Unfortunately, you can’t answer all questions about immunotherapy (allergy shots) in a 3 minute news clip.
Believe it or not the pollen season is just around the corner–6 weeks to be exact.
Want to know how to improve your make-up skills during allergy season? Look at this YouTube:
Here’s the article link. Early allergy in Tulsa! Look at Tulsa which is in the “high” range for this Spring’s pollen count!
Sinus pressure can be a real problem during the cold, winter months. Do I take decongestants or antihistamines? Sudafed or Zyrtec? Are my allergies acting up?
Here are some pointers on dealing with sinus infections and sinus pressure with some really cool slides at the end:
- Most allergens are gone in December-January, so the statement “my allergies are bothering me” is actually misplaced. You are meaning to say that sinus pressure is causing congestion and runny nose. Inflammation and swelling definitely exist in your sinuses, it’s just that your symptoms during the winter are not caused by allergy, but rather sinus infection.
- Treatment of a sinus infection is “all or nothing”. In other words, if you only remove 50% of the infection, it is likely your symptoms will quickly recur. Your body requires a mucociliary blanket in the sinuses to gradually remove bacteria and excessive snot. This protective blanket is destroyed during any infection, and won’t grow back until the inflammation subsides. Often it takes 30 days of antibiotics and prednisone to restore the sinuses back to their original condition.
- One of the pictures in your slide set (slide 3 of 15) shows what normal mucociliary blanket looks like under the microscope. If this giant vacuum sweeper was operating normally all of the time, you wouldn’t have to use all your medication.
Here are some suggestions on how to treat your sinuses better:
- Make sure you eliminate nasal congestion. For the short term, use Afrin or similar equivalent (OTC) if you limit to < 1 week per month. This allows the nasal airflow to drive away the excessive mucous in your nose which would otherwise become a great meal for hungry bacteria. Sick but true!
- Find out if you have allergy! The winter season gives you a reprieve from outdoor allergens, but during the spring, summer, and fall, tree pollen, Bermuda grass, and ragweed are more than willing to invade your sinuses and cause irreparable damage to your mucous membranes and make you always sick.
- Use your prescribed nasal spray EVERYDAY as prescribed by your doctor. I know, Americans hate to put anything in their nose (except your finger), but regular use of nasal steroids and antihistamines will reduce the swelling in your sinuses and guess what? You got it, fewer infections.
- Get smart! Go through the slides below, and if you don’t learn anything new, I’ll buy your favorite drink at Starbucks.
This question comes up in my office almost everyday….should I do skin testing or blood work? As you can see from the response of national experts, it depends. There is NO test that can boast 100% accuracy to predict whether or not you will react to a food. In fact, the gold standard if you will, is still the oral food challenge. Here is some food for thought (really, do you have to pun)
- Clinical history is very important in determining food allergy. If you can eat a food without difficulty breathing, rash, or hives, you are most likely not allergic. You may have a positive test, but that only means you’ve had previous exposure to the food.
- I will often obtain both skin testing and ImmunoCap (blood work) to clarify the presence of IgE-mediated allergy. If both tests are negative, you may have an adverse reaction to a food, not the severe life-threatening anaphylaxis. Very important distinction!
- If in doubt, a food challenge is always a procedure to consider. Here’s why.
- Sometimes the food in question just isn’t worth the trouble to challenge. No one says you have to eat strawberries!
- If you challenge peanuts for example, in the doctor’s office and experience anaphylaxis, better there than at home. Epinephrine is more readily available and in many cases, IV access and full resuscitation is available within minutes of your reaction.
- This is another reason why a single test or treating allergy without experience is not a good idea. Read the link below and tell me just how complicated things can become!
Everyday I teach patients the difference between “allergy” and “irritant” reaction. TV ads are overloaded with allergy advertisements in an attempt to sell antihistamines, so why wouldn’t you think that everyone has allergy of some kind. The link below is a question about allergy (anaphylaxis in this case) to chemicals. Consider the following:
- Adverse reactions to pollen, food, chemicals can be divided into “allergy” or “intolerance/irritants“.
- Allergy is defined as the production of IgE to the substance in question. This is why you have positive skin tests and blood testing. Why does this matter?
- You can only be “desensitized” to allergens, not chemicals. IgE can be decreased and if you don’t have IgE to begin with you can’t delete its effect.
- The only treatment for irritants is to avoid them, regardless of whether the substance is a food or chemical.
- For chemical reactions or food intolerance, there’s not much to say except to stay away. Click on the link below just to make sure!
It’s not unusual for a doctor to refer a patient to our allergy clinic to answer the question, “what pain medications am I allergic to?” Surgery of any kind is a bit frightening, but add to that an adverse reaction to one of your pain medications and you know what hits the fan! Reactions can include hives, difficulty breathing, headaches and a whole lot more. So what can I do if I’m in a car accident or emergency surgery and I receive a pain medication I’m allergic to? Will it kill me?
Consider the following:
- Most effective pain meds are opioids and release histamine from the body when taken as pain meds. We can’t skin test to medications in this category, so we rely on previous history. That works well for the most part, but “there’s a first time for everything”
- The one exception to the above rule is fentanyl. With this medication, skin testing and treatment for tolerance have been published and offer a good alternative.
- Often a procedure called “drug provocation testing (DPT)” is necessary to determine what you can and cannot take for pain medication. Fortunately, most patients can tolerate the standard protocols used by most hospitals, so no need to worry. If in doubt, DPT will give you VERY small amounts of medication making sure you can tolerate the drug before moving to a higher dose. With a little patience & a long afternoon in the doctor’s office, we can usually find a medication that will work.
- But don’t take my word for it….the American Academy of Allergy Asthma & Immunology has several references on the subject of allergy to pain meds. Check it out with the link below:
I want to be an expert. Always have and always will, but now it’s a little easier than 30 years ago. In fact, all you need now to become an expert is a little fame, a published book or memoir, and Shazam! you’re an authority on any subject you want to write on. So where’s the beef on my book?
Well, that’s not exactly how an allergist becomes an expert. I won’t bore you with the details, but doctors are trained by experience in the clinic (office) and reading about the medical conditions you have to treat….over and over again. Eventually your training ends and what do you do then? No more residency programs, no more allergy fellowships, and no more mentors. I have found a valuable resource through the American Academy of Allergy, Asthma, and Immunology (AAAAI) entitled “Ask the Expert” (hey they get paid for content, not the title). Here’s an example of a conversation about hives. (click on the link at the end) Patients all hate hives and just from this discussion alone I propose the following take home messages:
1. Hives are caused by allergy only 20% of the time. We usually want an easy answer, but if that were the case you would never show up in the allergy office. It’s important to look for the underlying cause of the hives, but in up to 50% of cases, the hives are due to autoimmunity….more on that later.
2. Once hives are identified, change your mindset to 6-12 months of treatment. Hives can resolve spontaneously, but it doesn’t happen quickly.
3. Hives that bruise should be evaluated ASAP….no exceptions.
4. The usual dose of antihistamines prescribed by your doctor is usually for treating hay fever. The effective dose for treating hives may be 4 times as high; beware of feeling sleepy for several days, but that side effect will usually improve.
5. I try to avoid steroids because of long-term side effects, but sometimes steroids are necessary to get the itching under control. Limit your use and look for alternative medications. But I will warn you, it’s not always allergy!
Yes, you too, can become an expert with your health—you’ll spend a lot less time in the doctor’s office if you do!