In recent years it has been discovered that a tick bite can lead to a delayed food allergy to mammalian meat products (meat from any kind of mammal). Red meat typically includes beef, pork, goat, and lamb, but patients can still tolerate chicken, turkey, and fish. In contrast to other food allergies, which are typically immediate (5-30 minutes), red meat allergy usually occurs 3 to 6 hours after ingestion. Another common name for this is Alpha-gal allergy. The Lone Star tick, Amblyomma americanum, is thought to be the sensitizing tick in the United States. Typical symptoms include hives, angioedema (swelling of the soft tissues), upset stomach, or anaphylaxis. Several patients report waking in the middle of the night with symptoms. This often makes diagnosis very difficult. History, along with blood work and/or a skin test, is key for making a diagnosis. Treatment consists of ALL red meat avoidance and carrying an epinephrine auto injector. If you think you might be allergic to red meat, contact us. We can help!
An allergist (allergy/immunology physician) is an expert trained to take a detailed medical history and appropriately interpret allergy/immunology test results. After completing medical school and graduating with a medical degree, these physicians go through an additional three years of training in either internal medicine or pediatrics and have passed the certification exam of either the American Board of Internal Medicine (ABIM) or the American Board of Pediatrics (ABP). With that foundation, they complete subsequent specialized training of at least two more years in an allergy/immunology fellowship program. Board certification in allergy/immunology is awarded by the American Board of Allergy and Immunology (ABAI) only after successful completion of another rigorous certification exam. Patients who see a board-certified allergist can rest assured that he or she has the necessary medical knowledge, judgment, professionalism and clinical skills to provide safe, effective patient care. – Jeana S. Bush, MD
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.
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.
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.
September 4, 2015
by Dr. Megan Stauffer 0 comments
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!
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!
“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.
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.
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.