Tag Archives: American Academy of Allergy Asthma & Immunology

Blood work can be a problem

Normally, I like to include lab studies for evaluation of patients with chronic infections.  It’s very important to find out if your body can make the right amount of antibodies to fight infection.  But…there’s always the exception.  In this case, IgA can be absent from your bloodstream and not cause a problem because it’s gone.  In short, I call this asymptomatic IgA deficiency (you should see the long version).  The link below comes from the American Academy of Allergy, Asthma, and Immunology–good stuff and easy to understand if you’re interested.

Low IgA with elevated IgE in a relatively asymptomatic.

How You Can Be an Expert

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!

Acute urticaria resistant to therapy.

Oral food challenge to peanut

Food allergy is a very common and even popular disease to have.  This results in some predictable patient behavior such as:

1.       I have allergy based on a blood test only, and I tolerate this food all the time.  This may not be allergy at all, but simply a condition called “asymptomatic hypersensitivity”.  Relax, some foods you can eat without allergy symptoms even though a blood or skin test is positive. 

2.       It is fashionable nowadays to have gluten sensitivity.  Many patients will perform gluten challenges at home to see if bread or starches make abdominal cramping, skin rashes, or even concentration problems improve or worsen with the offending food.  This practice becomes a problem if you are concerned with anaphylaxis (difficulty breathing, low blood pressure) to foods such as peanut, milk, or eggs to name a few.  It’s one thing to experience more abdominal bloating after a gluten challenge and a much more dangerous situation to lose consciousness after ingesting peanut. 

3.       I’m grateful to be a member of the American Academy of Allergy, Asthma, and Immunology (AAAAI) in part because they help me as an allergist to stay current of all the thousands of recommendations published every year on my specialty.   One such service is “Ask the Expert” forum and I’d like to share a recent post with you about food challenges.

Here’s the take-home message and the full answer is available if you click on the link below:

1.       Food anaphylaxis can be related to the total amount of food ingested.  In other words, don’t assume that tolerating a very small amount of peanut will guarantee that you can tolerate peanuts ad lib!  Food challenges are performed under close supervision in order to determine HOW sensitive you are. 

2.       Oral desensitization to foods is still in the research stage and the experts on treating food allergy do not recommend this procedure be performed outside of a research protocol.  It only takes one bad outcome to taint any progress made with treatment of food anaphylaxis.

Anyway, it’s lunchtime, and talking about food does make me hungry!

Oral food challenge to peanut.