October 28, 2015
by johnoverholt

OTC Decongestant Found To Be Ineffective

Back in the day there were three main options for over-the-counter oral decongestants: phenylpropanolamine (PPA), pseudoephedrine (PSE), and phenyephrine (PHE).  PPA was removed from the market after it was associated with several cases of stroke, probably from people abusing it as a “diet aid”.  PSE is still available, but has been moved behind the counter and the amount available for purchase is limited due to its use in illicit methamphetamine production.  This leaves us with PHE which has been included in an increasing number of OTC medications since the restrictions on PSE went in to effect.  Unfortunately, a new study suggests that oral PHE is not effective as a decongestant.

Researchers looked at several different doses of oral PHE, from 10-40mg every four hours, and compared them to placebo.  While there were some short-term increases in heart rate and blood pressure with PHE, there was no improvement in nasal congestion from PHE compared to placebo.

So what should you do with this information?  First- you need to be a label reader.  All OTC medications will contain a list of their active ingrediants.  If one you are using or considering contains PHE, you should consider an alternate preparation.  Second, for control of nasal congestion, consider switching from oral medications to nasal sprays.  Nasal decongestant sprays such as Afrin, Neosynephrine, etc. are very effective for short term relief of severe nasal congestion.  However,  if they are used for more than a few days they will cause rebound nasal congestion-making your problem worse than when you started.  Nasal steroid spays such as Flonase, Nasacort, etc are also very effective at controlling nasal congestion without causing rebound.  They do take some time to work, though.  A good strategy is to start by combining both types of sprays.  After three days, drop the nasal decongestant spray and continue the nasal steroid.  This provides good immediate relief, minimizes rebound, and gives the nasal steroid some time to work.

Finally, if all of this isn’t helpful, if you are on year round medications or if you are having complications from your allergies, contact a board-certified allergist for help.


Dr O.

October 26, 2015
by johnoverholt

Why Can’t I Give My Allergy Shots At Home?


Immunotherapy should be administered in a setting that permits the prompt recognition and management of adverse reactions. The preferred location for such administration is the prescribing physician’s office. However, patients can receive immunotherapy injections at another health care facility if the physician and staff at that location are trained and equipped to recognize and manage immunotherapy reactions, particularly anaphylaxis.– Allergen Immunotherapy: A Practice Parameter 3rd update- Joint Task Force on Practice Parameters, AAAAI and ACAAI

Allergy shots are the most effective therapy for treating nasal allergies and their attendant complications.  My patients often call them life changing.  Despite their effectiveness, many patients who would benefit from them choose not to utilize this therapy.  The most common reason they choose  not to do so is not money, since insurance coverage is generally very good, or fear of needles, since the injections are relatively painless.  The biggest reason is time.  Allergy shots must be administered in a medically supervised setting where the provider and staff are familiar with the shot process and have the means to diagnose and manage acute allergic reactions.  This means coming to the doctor’s office to receive injections.  Given the busy modern lifestyle, this can be a significant time commitment.  So why does it have to be this way?  The answer is safety.

Allergy shots are generally a safe procedure, but, like all medical procedures, there is risk involved.  Overall, systemic allergic reactions happen in about 1 out of every 500 injections.  From 1980-1990, about 5% of patients experienced a systemic reaction.  From 1990-2000, this rate fell to about 1% of patients.  The tremendous drop in reaction rates is attributable in part to better standardization of allergen extracts and to the widespread implementation of computerized immunotherapy monitoring systems, which drastically reduced dosing errors.  Indeed, the most recent data suggests that only 25% of systemic reactions are due to dosing errors, while almost half are due to receiving injections during a severe allergy flare.  Fortunately, most reactions to allergy shots are mild to moderate, but severe reactions, even fatalities, do occur.  Fatality rates have remained fairly constant at 1:2.5 million injections, about the same risk as being in a commercial airline crash, 1:2.5 million flights.

Those numbers should be reassuring to patients but also might lead some to conclude that allergy shots are indeed safe enough for home administration.  They’re not, and here’s why: Allergy shots are as safe as they are because the vast majority are given in a medically supervised setting.  All of the above data looking at safety come from patients who received shots at the office of their allergist or another physician.  We don’t know what the reaction rates or safety outcomes would have been if the same patient population had been allowed to receive injections at home, but I can’t imagine that they would be better.

Allergen immunotherapy is a complex process that requires careful monitoring of doses, frequent dose adjustment, and clinical training to evaluate if patients are well enough to receive their shots.  Allergists have years of training and experience in this regard as well as in the diagnosis and management of acute allergic reactions.  We have dedicated staff whose sole job is to administer injections and computer managed protocols designed to reduce error.  All of this helps the allergist deliver the most effective therapies with the highest degree of safety.  You should accept no less.

Dr. O

October 16, 2015
by Megan Stauffer

Is there more pollen in the air than there used to be?

Every year in the allergy clinic, we hear from our patients that this is “the worst pollen season ever.” But is this true? Is there more pollen now than there used to be? According to a study recently presented at the World Allergy Organization, there actually is more pollen now than there was in the 1990s. The study found that from 1994 to 2010 the “average peak value and annual total of daily counted airborne pollen have increased by 42.4%  and 46.0%, respectively.” Wow! That is a big increase! Also, the pollen season is now starting 3 days earlier than it did in the 1990s. So not only do we have more pollen in the air, we’re also exposed to the pollen for a longer period of time. The study concluded that “these changes are likely due to recent climate change and particularly the enhanced warming and precipitation at higher latitudes in the [continental United States].”  Unfortunately, this trend of more pollen and longer seasons is likely to continue.

If you are feeling the impact of the higher pollen counts and longer seasons, come see one of our Board-Certified Allergists, who can help you find a way to survive these increasingly heavy pollen seasons.

-Dr. Megan

September 4, 2015
by Megan Stauffer

Fall Allergies

Do you have a cold that lasts most of the fall? Are your eyes itchy, does your nose get stuffy and runny, or do you just feel plain exhausted? If so, you may have fall allergies.

During the fall the most prominent allergens are weeds and molds. Ragweed is the most likely weed to trigger symptoms of allergy, but other weeds such as plantain, lamb’s quarter, kochia and mugwort can cause the same misery. Ragweed is found predominantly in the east and midwest of the United States. One plant can produce 1 MILLION grains of pollen a day, and the pollen can travel more than 100 miles!!! Ragweed typically begins pollinating during mid-August, with pollen levels peaking in mid-September and dying down after the first hard frost. Pollen counts tend to be highest on warm, dry and windy days and between the hours of 10am-3pm. Therefore, all we have to do is walk outside to get exposed to this pollen.

Exposure can be increased by raking leaves, which is a common activity in the fall. Raking not only stirs up pollen that has settled on the dead leaves, but it also stirs up mold, the other common fall-time allergen. Mold exposure can trigger allergy symptoms and is also a common trigger for asthma. In fact, the worst time of year for people with asthma is the fall due to the combination of fall allergens (weed and mold) and the onset of viral illnesses, particularly respiratory viruses.

Symptoms of fall allergies include runny/stuffy/itchy nose, sneezing, itchy eyes, coughing, wheezing and headache. Some people with ragweed allergy will also notice itching of their mouth after eating fresh banana, cantaloupe, watermelon or honeydew melons. These symptoms called Oral Allergy Syndrome are triggered when the body sees a similar protein found in ragweed and in these fresh fruits.

If you think you might have fall allergies, make an appointment with a Board Certified Allergist for testing and treatment. Happy Fall!

-Dr. Megan

August 12, 2015
by Megan Stauffer

Nasal sprays

Nasal sprays are commonly used to treat sinus and allergy issues, and they generally fall into one of three categories.

The most commonly used nasal spray to treat nasal allergies is the intranasal steroid. It works over several days to decrease swelling of the nasal/sinus tissue and mucous production, but it must be used every day to really work. Examples of intranasal steroid sprays include: Flonase, Nasacort AQ, Qnasl and Nasonex.

Nasal antihistamines work in a different way to decrease swelling and mucous production. Symptomatic improvement can occur within about 30 minutes, and this class of medications can be used as needed in many cases. Examples include: Patanase and azelastine.

The third class of nasal sprays are the over-the-counter nasal decongestants, like Afrin. These are a blessing and a curse for patients (and allergists!). They work very rapidly to decrease stuffiness, but if used more than three days in a row they have the potential to cause “rebound congestion.” When this happens the patient feels they need more and more of the spray to attain the same results and essentially become “addicted” to their nose spray. This happens only with the nasal decongestants, and we often have to use the nasal steroids (like Flonase) to get patients off these nasal decongestants. As much as nasal decongestants are a lifesaver during a cold, they can stir up many more problems if not used correctly.

Kids and adults alike are generally hesitant to use nasal sprays. Reasons for the hesitancy to use nasal sprays include: patients just don’t like spraying something up their nose, they are afraid of “rebound congestion,” they don’t like the way the spray tastes or smells, they dislike the spray dripping down the back of their throat, or they get nosebleeds. Although some patients are really unable to use nasal sprays, we can typically come up with something that works with minimal symptoms.

So as the fall allergy season starts, keep in mind that the right nasal spray can help make the season tolerable, but the wrong one can end up making it even more miserable!

-Dr. Megan


June 24, 2015
by Megan Stauffer

“I am so itchy!”

“I am so itchy!” is a common complaint in the allergy clinic. Chronic itching can be very bothersome and can significantly affect a person’s quality of life. It is typically defined as itching lasting longer than six weeks. By the time a patient gets to the allergy clinic, they are frustrated, often sleep deprived and looking for answers.

The causes of chronic itching are vast, and although we see many of these patients in the allergy clinic, allergy is often not the cause of chronic itching. Causes of itching may be divided into those associated with a rash and those without a rash. Itching with a rash may be caused by conditions such as ezcema, contact dermatitis, medications, psoriasis, insect bites or chronic hives. Itching without a rash is more likely related to an underlying systemic issue, such as a liver, kidney or blood disorder. Dry skin is a common cause of itching, particularly in the winter. On occasion, the chronic itching will eventually result in a rash typically sparing the back and often triggered by an underlying neurological or psychological cause.

Testing will depend on the results of history and physical exam findings, but it may include blood work, allergy testing by prick skin testing or patch testing, and X-ray studies. Treatment also depends on the underlying cause of the rash. Antihistamines, cool baths, nonfragrant moisturizers and topical steroids may be recommended. Often times the primary care physician must work together with an Allergist and/or a Dermatologist to diagnose and manage this frustrating condition.

-Dr. Megan Continue Reading →

June 3, 2015
by Megan Stauffer

Summertime allergies

Spring is over. Summer is here! For many people with springtime allergies, this is a relief. Unfortunately, the summer offers allergy issues of its own.

While tree pollen is mostly gone, grass pollen is here and can cause all the same symptoms triggered by tree pollen: itchy/watery eyes, sneezing and stuffy/runny nose. In the late summer, weed pollen (ragweed) blooms and can cause similar allergy issues.

Pollen can also trigger a specific type of food allergy called Oral Allergy Syndrome (OAS). OAS is a reaction to the fresh fruits and vegetables that we love to eat during the summer. It is caused by a cross reaction between proteins found in pollen that are similar to proteins in specific fruits and vegetables. For instance, people with a birch tree allergy may get an itchy mouth after eating fresh apples, peaches and cherries, but they are able to tolerate cooked forms of these foods.

Since we are spending more time outdoors during the summer months, we are more likely to come in contact with a stinging insect, such as a wasp or a bee. Fortunately, most people only have local reactions to insect stings, typically swelling, redness and pain at the site. However, less than 5% of the population will have a severe allergic reaction to a bee sting, which can be life threatening. Allergists are able to test for a bee sting allergy and can offer allergy shots that are 98% effective in preventing a severe reaction to a future sting.

For all these reasons, if you suspect summertime is giving you allergy issues, see one of our Board Certified Allergists for evaluation and management.
-Dr. Megan


May 19, 2015
by johnoverholt

Should Children With Asthma Be Tested For Peanut Allergy?

During the recent American Thoracic Society meeting a study was presented that has caused a bit of a stir in the press. Headlines have included: “Many children with asthma have reaction to peanuts but don’t know it,” “The connection between peanut allergies(sic) and asthma,” and “Asthma symptoms in children may be a sign of peanut allergies(sic).” The authors of the study suggest that children with asthma should be routinely tested for peanut allergy. I think this is a bad idea and the ACAAI agrees with me. Let’s look a bit at the study and the author’s incorrect conclusion.

This study, conducted by Dr. Robert Cohn from Mercy Children’s in Toledo, Ohio, looked at about 1,500 children who were actively followed in their clinic for asthma. They did a chart review and found that about 11% of the kids had a “documented history” of peanut allergy. They then looked at the 650 or so kids who had peanut tests and found that 22% of them had positive tests. They go on to say that 50% of the families were unaware of the peanut sensitivity and that, “We speculate that children with asthma might benefit from peanut sensitivity screening especially when control is difficult to achieve.”

This conclusion is wrong for several reasons.

  • First, a positive peanut test does NOT indicate peanut allergy. Peanut testing has a high false positive rate, especially in children who are otherwise allergic. Indeed, some studies have suggested that 80% of positive peanut tests are false positives. A positive test indicates sensitization, which is not the same as allergy.
  • Second, food allergies do not play a role in asthma. Though food allergies can cause respiratory symptoms, usually in conjunction with hives and swelling, these symptoms occur within minutes of exposure to the offending food. They do not cause chronic, ongoing symptoms as found in asthma. Furthermore, they do not have any role in the ongoing inflammation that underlies asthma.
  • Finally, routine testing for foods is never indicated without a history that is consistent with food allergy. This sort of “fishing expedition” leads to incorrect diagnoses, false positive tests, and unnecessary anxiety and lifestyle modification. It causes more questions than it answers.

Though food allergy testing is not useful in asthma, testing for aeroallergens like pollen, animals and dust mites can be very helpful in guiding avoidance of specific triggers and, in some cases, utilizing specific immunotherapy. If you or your child has allergies and asthma, contact a board-certified allergist in your area.

May 12, 2015
by johnoverholt

On the Importance of Breathing Tests in Managing Asthma

Imagine you are cooking dinner for a big family get-together at Thanksgiving. Roast turkey with stuffing, green bean casserole, rolls and pie for dessert. It’s a big undertaking. Now imagine doing it without an oven thermometer.

Think about playing a round on your favorite golf course ever. You’ve got a long shot over the water to a tiny green. Now imagine that shot without yard markers or a range finder. Golf is hard enough already.

Numbers are important. Data and objective information help guide us through our daily lives. They let us know the true measure of things so we do not have to rely on intuition or guesswork.

Numbers are important in asthma, too. Often there is a large disconnect between how people perceive their asthma severity and what the objective numbers tell us. Lung function in asthma is measured with a test called spirometry. Spirometry measures the bellows function of the lungs- how well we move air in and out. Spirometry can be used to diagnose asthma, to help us gauge asthma severity, and to monitor response to asthma therapy. Spirometry is critical to the diagnosis and management of asthma. It is so important that the AAAAI lists it as one of their most important recommendations to physicians in their Choosing Wisely initiative.

At The Allergy, Asthma & Sinus Center, all of our locations have the ability to perform spirometry and all of our board-certified physicians are trained in using it to diagnose and manage asthma. If you have asthma or have symptoms such as cough, chest tightness, wheezing or shortness of breath, a simple spirometry test might provide you with valuable information to help improve or maintain your health.

Dr. O

April 15, 2015
by Megan Stauffer

At what age can my child get tested for allergies?

“At what age can my child get tested for allergies?” This is a question I often get asked by parents of young children.  Many parents and some healthcare providers believe that allergy testing cannot be done until 3 years of age. This is not true. This belief comes from the fact that most children begin developing seasonal allergies around age 3. However, many children have already developed allergies to other things (ie. indoor allergens and/or foods) by then.

Allergy skin testing is a technique that can detect allergic antibodies present in the blood by placing a small amount of the allergen on the skin and monitoring the response. Allergic antibodies can develop at any age. So if symptoms are consistent with an allergic process, allergy testing can be done. Although I prefer to wait to do a skin test around 1 year of age, many infants particularly those with severe eczema or a possible food allergy need to have some form of allergy testing done much earlier-and it can be done!

Many parents (myself included!) have found it very helpful to know what specifically their child is allergic to, even if they aren’t ready to start on allergy shots.  This information can help clarify what time of year it is critical to give allergy medications daily, and when they may used on an as needed basis. Also, if a child is allergic to indoor allergens (ie. dust mite or dog) we can work on ways to decrease exposure to those allergens, thereby decreasing symptoms, which may then decrease the need for allergy medications- which is always desirable, especially for little ones!

-Dr. Megan