aasc

Understanding and Managing Eczema and Chronic Hives

Wed, 22 Apr 2026 19:05:17 GMT

Eczema & Urticaria: What They Are, How They're Treated

Eczema and hives (urticaria) represent two of the most frustrating skin conditions encountered in clinical practice. While their causes and appearances differ, both share a defining characteristic: a debilitating itch that can significantly decrease a patient’s quality of life.

Eczema: The "Itch That Rashes"

Atopic dermatitis, commonly known as eczema, is frequently described as "the itch that rashes" because the act of scratching triggers visible inflammatory changes in the skin. While some people may suspect childhood vaccines are responsible for eczema, clinical studies have shown otherwise. Vaccines can, however, stimulate the immune system upon initial injection and trigger a mild but brief flare.

Clinical Presentation: Eczema typically appears as scaly, dry skin that can ooze and crust during severe flares.
Duration: Unlike other skin conditions, an eczema flare does not resolve in hours; it typically persists for days, weeks, or longer.
Distribution: Due to a defect in the skin barrier, eczema can appear anywhere on the body from head to toe.

Clinical Management of Eczema

Effective management is built upon a foundation of rigorous skin care designed to break the itch-scratch cycle.

The "Soak and Smear" Technique: This involves hydrating the skin in a warm bath and immediately applying a thick emollient, such as Cetaphil®, CeraVe ® , or Eucerin ® , to lock in moisture.
Physical Protection: Especially for pediatric patients, keeping fingernails short and smooth or using cotton or silk gloves can prevent skin damage during sleep.
Topical Therapies: Options include varying potencies of steroids, calcineurin inhibitors (Protopic ® or Elidel ® ), phosphodiesterase inhibitors, and newer JAK inhibitors. (Janus kinase inhibitors are a class of targeted, small molecule medications that treat autoimmune and inflammatory diseases. By interrupting signaling pathways, they reduce inflammation and help manage certain conditions, like eczema.)
Advanced Biologics: For severe cases, injectable biologics like Dupixent ® and NEMLUVIO ® have proven life-changing by targeting specific inflammatory pathways.

Hives: Transient and Mobile

Urticaria, or hives, is distinguished by the rapid appearance and disappearance of welts.

Clinical Presentation: Individual hives are fleeting, typically lasting less than 24 hours before moving to a different location.
Acute vs. Chronic: Acute hives often have an identifiable allergic trigger. However, chronic urticaria—hives occurring daily for six weeks or more—is rarely caused by an allergy.
Underlying Causes: Chronic cases are often autoimmune or idiopathic, though rare cases may involve urticarial vasculitis, marked by systemic symptoms like fever and bruising.
Physical Triggers: Hives can be induced by physical stimuli such as heat, cold, pressure, vibration, or scratching the skin.

Treatment Pathways for Hives

Antihistamines: High-dose second-generation antihistamines serve as the primary treatment.
Targeted Therapies: When antihistamines are insufficient, medications such as Rhapsido ® or the biologics Xolair or Dupixent are utilized.

The Role and Safety of Biologics

The biologics used to treat eczema and hives have revolutionized patient care. Unlike traditional immunosuppressants used for conditions like rheumatoid arthritis, these medications are not broadly immunosuppressive. Instead, they disrupt specific inflammatory pathways (targeting IgE or eosinophils) to control the disease without increasing the general risk of infection.

Common side effects are typically manageable and may include mild headaches, joint aches, or conjunctivitis. For many patients, these advanced treatments provide the necessary relief to end social isolation and restore a normal quality of life.

(This blog post is an adaptation of a Let's Clear the Air! podcast episode airing on April 20, 2026.)

Ready To Say Goodbye To Needles?

Thu, 09 Apr 2026 14:57:07 GMT

Is Sublingual Immunotherapy right for you?

For many allergy sufferers, the road to relief often feels like a choice between two extremes: managing symptoms with daily medications or committing to a long-term schedule of allergy shots. But what if an easier route was available to patients that didn't involve needles?

What is Sublingual Immunotherapy (SLIT)?

Sublingual immunotherapy is a needle-free alternative to traditional allergy shots. Instead of an injection, the same allergens used in shots are formulated into a liquid droplet. These drops are placed under the tongue for a short period before being swallowed.

The Key Benefits of Allergy Drops

Why would patients choose drops over traditional injections?

Convenience: Unlike shots, which require weekly office visits during the initial stages, allergy drops can be administered at home. This is a game-changer for frequent travelers or people with busy work schedules.
Safety: The risk of a systemic reaction or anaphylaxis is significantly lower with drops compared to shots. While the risk with shots is already low (around 0.2% to 1%), drops offer an even higher safety profile.
Child-friendly: Because there are no needles involved, drops are an excellent option for young children who may have an inherent fear of injections.
Minimal Side Effects: The most common side effect is minor itching in the mouth, which occurs because the allergen is being introduced directly to those tissues.

Are Drops as Effective as Shots?

A common concern for patients is whether "skipping the needle" means sacrificing results. In a 2023 meta-analysis that included 50 studies and 10,000 children, SLIT was shown to be equally as effective as the traditional shots. ¹

The study used metrics such as symptom scores and medication usage to determine that patients on drops saw improvements nearly identical to patients on shots.

Important Considerations

While SLIT offers many advantages, a few logistical hurdles should be kept in mind:

Cost and Insurance: Unlike allergy shots, custom-mixed allergy drops are not currently FDA-approved. This means they are typically not covered by insurance and require out-of-pocket payment.

Mixing Restrictions: Not all allergens "play well" together. For example, molds have enzyme activity that can degrade other extracts like pollen. To remain effective, mold extract must often be kept in a separate vial.

FDA-approved Tablets: FDA-approved allergy tablets are available for specific triggers like grass or ragweed, but they are often more expensive than drops and target only one specific allergy at a time.

The Bottom Line

If you have struggled to stay consistent with allergy shots or simply want to avoid needles, allergy drops are a science-backed alternative worth discussing with your doctor. The best first step is to visit a board-certified allergist for skin testing to accurately identify your triggers and build a customized treatment plan that fits your lifestyle.

Yang J, Lei S. Efficacy and safety of sublingual versus subcutaneous immunotherapy in children with allergic rhinitis: a systematic review and meta-analysis. Front Immunol. 2023 Dec 15;14:1274241. doi: 10.3389/fimmu.2023.1274241. PMID: 38162647; PMCID: PMC10757840. https://pubmed.ncbi.nlm.nih.gov/38162647/

(This blog post is an adaptation of a Let's Clear the Air! podcast episode airing on Jan. 30, 2026.)

Why Does Fresh Fruit Make My Mouth Itch?

Fri, 03 Apr 2026 13:53:23 GMT

Understanding Oral Allergy Syndrome

If you’ve noticed your mouth itching after eating a fresh apple or peach during peak pollen season, you aren't alone. It may be a common but often misunderstood condition known as Oral Allergy Syndrome (OAS) .

What is Oral Allergy Syndrome (OAS)?

Oral Allergy Syndrome, also known as Pollen-Food Allergy Syndrome , is a reaction that occurs because of "conserved proteins" found throughout nature. Essentially, the proteins found in certain tree, grass, or weed pollens are very similar to the proteins found in specific fruits, vegetables, and nuts.

When you have a pollen allergy, your immune system becomes sensitized to a specific protein in that pollen. Because the proteins in some fresh foods look almost identical, your immune system can't tell the difference. It essentially asks, "Why are you eating pollen?" and triggers an allergic response.

Common Triggers and Symptoms

The condition is particularly bothersome in the spring and summer when pollen counts are high and fresh produce is in season. A classic example is the link between birch pollen and fresh apples .

Common symptoms include:

An itchy or burning sensation in the mouth.
Itching or irritation in the throat.
Occasional coughing or "weird sensations" immediately after eating raw produce.

While these symptoms are frustrating, OAS is rarely life-threatening . It typically does not cause the throat or tongue to swell shut, so most patients with OAS will not require an EpiPen for.

The "Apple Pie" Solution: Why Cooking Helps

If you have OAS but love fruit, you may find that cooking the fruit provides an easy "fix."

Why It Works: Heating a fruit or vegetable changes the physical shape of the problematic protein.
The Result: Once the protein is "denatured" by heat, the immune system no longer recognizes it as a threat.
An Example: A patient who gets an itchy mouth from a raw apple can often eat a baked apple pie with no symptoms at all.

Managing Your Allergies

If you suspect you have OAS, it's helpful to look at cross-reactivity charts that link specific pollens (like birch, grass, or ragweed) to their corresponding food triggers. Seeking help from a board-certified allergist can give you definite answers about which pollens can trigger OAS. For example, birch tree pollen has a cross-reactivity with kiwi. So, if you're allergic to birch and you see a high pollen count, you know to avoid eating fresh kiwi!

If you experience an itchy mouth, lips, or tongue during pollen season, you may have Oral Allergy Syndrome. Schedule an appointment to learn more about your allergic triggers.

Summer Grass Pollen

Wed, 05 Jun 2024 15:17:05 GMT

By Dr. Ben Gaudin, II

School is out and summer has begun. Summertime brings the return of rapidly growing grass. Grass pollens in Louisiana peak during May and June. In February, grass pollenates and continues to do so until the first frost in the fall. Of course this means the return of grass pollen and frequent grass mowing. For the allergic person this means increased sinus allergy symptoms.

If you are like me and are outside this summer grilling and swimming, grass pollen can be bothersome to enjoying precious time outdoors. Grass pollen can also affect allergy sufferers who are out at the ballpark or children at camp this summer.

M anaging respiratory allergy involves 3 key steps:

Avoiding allergy triggers as able.
Allergy medications.
Allergy shots.

Trigger Avoidance

Although it is impossible to avoid pollen completely, here are some steps to help decrease exposure to this common allergen:

Wearing a mask when mowing the grass.
Keep windows closed in your home and automobile .
Change clothes and shower after being outside to remove any pollen attached to your hair, body and clothing.
Bathe any pets that have spent time outside. Fur traps outdoor pollen, carrying it into your home.
Monitor local pollen counts and avoid outdoor activities on days with higher levels of pollen.

Medications

Medication options include:

Antihistamine pills to help with sneeze, runny nose, itchy nose and itchy eyes.
Antihistamine nasal sprays to help with similar symptoms.
Steroid nasal sprays to help treat nasal congestion.

Many of these medications are now available over-the-counter.

Allergy Shots

An excellent, long-term treatment option involves allergy shots, which are a useful intervention for anyone whose allergy symptoms are not controlled with medications or who are tired of requiring daily medications to control symptoms. These small injections help your immune system buildup a resistance to your triggers , slowly turning off your allergic response. This effective therapy can lead to a reduction in allergy symptoms, allowing less need for medications.

Schedule an appointment with us today to seek expert care for, not only your grass pollen allergy, but all your allergy triggers in-between!

The Proper Use of Nasal Sprays

Wed, 05 Jan 2022 20:16:23 GMT

Correct Nasal Spray Technique

Are you using your nasal sprays correctly? Dr. Nicholas Kolinsky explains what the proper technique is and why it matters.

Nasal sprays are a great treatment option, second only to allergy shots, for patients with allergies. Believe it or not, it's not just a squirt up each nostril and you're done! Here's a technique to ensure you get the most from your sprays.

How to:

While seated or standing, lean forward and tuck your chin into your chest. Be sure to aim the nasal spray towards the outer ear. In the left nostril, spray towards the left ear, and in the right nostril, spray towards the right ear. When you spray, do not aggressively sniff. This will drag the medication to the back of the throat and lose some off your nasal passages, which is where we want it to be. Instead, lightly breathe in. After you spray 1 to 2 sprays in each nostril (follow your physician's recommended dosage), pinch and hold your nose for 15 seconds while remaining in position (leaned forward with chin to chest). This will allow the medication to stay in your nose and not drip down the back of your throat. You can release your nose and breathe in through your nose and out through your mouth to help dry up the medication. Congratulations, now you know!

Environmental Control Measures to Decrease Allergy Symptoms

Mon, 20 Dec 2021 18:27:06 GMT

Indoor Allergen Exposure

What can be done to decrease allergen exposure inside your home or office? Dr. Nicholas Kolinsky has some great tips and tricks to share!

Environmental control measures are a key part of any allergy action plan. Here are some helpful things you can do at home to decrease your exposure to allergens in your environment.

Dust Mites:

In order to decrease your exposure to dust and dust mites, we recommend you use specially designed dust mite covers for your pillows and mattress. You can find these at our offices or online via Amazon.com , Allergy Control Products or Mission: Allergy . D ust regularly with dusting products and wear a mask while cleaning. Sheets and pillowcases should be washed on the hot cycle (130 degrees or greater) and also dried in the dryer as opposed to hang drying. Try and keep pillows off the floor. Keeping the humidity level as low as possible with a dehumidifier is also helpful. The target is to have the humidity level below 50%, b ut levels below 50% may be difficult to reach during certain times of the year. If you have children, frequently was h stuffed animals or place them in a bag in the freezer for a couple of days to help kill off dust mites. Ideally, d o not have carpet in the bedroom. HEPA air filters may be beneficial; however, they can be expensive and may not be very effective depending on the filter's size and location in the room. These measures will greatly reduce your exposure to dust and dust mites , but only allergy shots and appropriate medications can decrease or eliminate symptoms from dust mite allergy.

Mold:

Mold grows in areas of increased humidity, low light and cool temperatures. Areas where mold grows best are the basement, the area around the clothes dryer, and bathrooms. In addition, potted plants, mulch, leaves and other decaying matter have high levels of mold. If your carpet has ever been wet, you will have heavy mold growth under the carpet for the life of the carpet (which is why you should not steam clean your carpets). Placement of a dehumidifier can be helpful (ideal humidity level is below 40%-50%).

Pets:

Since pets are most often beloved members of the family, we do not recommend you get rid of them! Instead, you can take steps to help minimize your allergic responses. Rinsing your cat or dog will temporarily remove animal dander. It is best to do this at least once a week if possible. Keeping your pets out of your bedroom or AT LEAST off upholstered furniture is also a good idea. If possible, keep your pets in rooms without carpets. Dog and cat allergens can stay in a room for up to 6 months, even after the animal has been removed. There is also no such thing as a hypoallergenic dog/cat. Unfortunately, this is a common misconception . All ergy i mmunotherapy ( allergy shots ) will decrease and possibly eliminate your pet allergies.

Trees/Grass/Weeds:

Trees and grass pollinate in the spring and into summer. Ragweed pollinates from mid-summer until the first hard freeze of winter. Some of these pollens blow for up to 400 miles and are very difficult to avoid outdoors. Please keep your windows and doors shut at all times and filter your air through a high efficiency filter placed in your central health and air system. Change the filter monthly or according to the manufacturer's recommendations. Here, too, allergy immunotherapy can decrease or eliminate your pollen allergies.

Blood Testing for Allergies

Thu, 07 Nov 2019 21:01:04 GMT

Why Not to Get a Blood Test for Allergies

If you’re wondering whether you have allergies, you can be tested two ways: a skin test and a blood test. Most allergists prefer skin tests – the results are immediately available, they are easier to interpret and may be more clinically relevant. That’s not to say that blood tests are bad. In the hands of someone who knows how to properly select the appropriate tests and how to interpret the data, they are an excellent tool. Unfortunately, some practitioners continue to order 1) unnecessary tests or 2) the wrong type of tests in an effort to diagnose allergies in their patients. To better explain this, a little background is necessary.

The immune system makes proteins called antibodies (Ab) or immunoglobulins (Ig) that are designed to help fight off infections. There are four main types and each has a letter name: IgA, IgG, IgM, and IgE. IgA and IgG each have different sub-types: two for IgA and four for IgG. Each of the different types of Ig has a different job. IgA is found on the lining of the airways where it helps to keep bacteria and viruses at bay. IgG circulates in the blood stream where it helps to fight bacteria and viruses that have slipped past the first lines of defense. It is the most important Ig in the overall defense from infection. IgE is the allergy antibody. It sits on the surface of allergy cells, like mast cells and basophils if you really must know, and when it comes into contact with allergens it causes the allergy cells to explode and release all of their nasty contents that make you sneeze and wheeze and blow your nose.

Igs do their work by binding to things like a bacterial cell wall, a viral capsule, or a grain of ragweed pollen. Ig binding is very selective. Each individual Ig will only bind to a very specific 3-dimensional protein structure, much like a lock and key. However, just like there are master keys that can open several locks, there are Igs that can bind to a few very different things. This is called cross-reactivity and it can often cause confusion when trying to interpret blood tests.

If your provider wants to do blood tests for allergies, make sure it's IgE testing and ask them what you're being tested for and why. Or better yet, see a board-certified allergist.

What does all of this have to do with allergy blood tests? Well, when you are doing blood tests for allergies, you are measuring the amount of IgE floating around in the blood that will bind to a specific allergen: ragweed, cat, peanut, etc. Note that I said the amount of IgE , not IgG. IgG does not play a role in the allergy response, measuring the amount of IgG that binds to molds or foods will not tell you one way or the other if you have an allergy to these things. This goes for IgG sub-types such as IgG4 as well. This is a distressingly common mistake – ordering the wrong type of test. Indeed, the AAAAI saw fit to address this specifically as item number one in their Choosing Wisely initiative.

The second common mistake is indiscriminate testing: ordering unnecessary tests. The big problem with this, apart from wasting money, is that blood tests, and particularly blood tests for foods, have a fair degree of false positive tests. Often this is due to cross-reactivity, where people who are very pollen allergic will have positive blood tests to certain foods but will be able to tolerate those foods just fine. In medical parlance, this is called being sensitized but not allergic. The selection of tests should always flow from the patient history. So, if a patient’s history is not consistent with food allergies, then a provider should never order food tests. The use of food tests ordered as part of a “routine allergy panel” when the patient is being evaluated for non-food related problems, such as asthma or hay fever, is a prime example of indiscriminate testing.

So, in summary, IgE testing is the only meaningful allergy blood test and you should only be tested to things that fit with your history. If your provider wants to do blood tests for allergies, make sure it's IgE testing and ask them what you're being tested for and why. Or better yet, see a board-certified allergist.

The Teal Pumpkin Project

Wed, 30 Oct 2019 18:36:49 GMT

Creating a Safe Halloween for All

F ood allergies can be difficult to manage on a daily basis. Add in Halloween, with its mayhem, mischief and mad supply of candy and sweets, and the holiday can be the most mentally and emotionally taxing time of the year for young children and their parents. Show your support and help food-allergy families join in the spirit(s) of Halloween by participating in the Teal Pumpkin Project. Simply display a teal pumpkin on your front porch or wherever trick or treaters can see it and provide non-food or food-allergy safe options for your trick or treaters.

Visit foodallergy.org for more information about #TealPumpkinProject!

Food Allergy Research & Education (FARE) began the Teal Pumpkin Project "to promote safety, inclusion and respect of individuals managing food allergies – and to keep Halloween a fun, positive experience for all.” Visit foodallergy.org for more information about #TealPumpkinProject and a list of candy alternatives. By participating in the Teal Pumpkin Project, you can make Halloween safe and fun for everyone!

Nasal Saline Rinse

Wed, 18 Sep 2019 20:12:25 GMT

To Rinse or Not to Rinse?

Flushing out the nose with a large volume of salt water is a great treatment for allergy symptoms. It removes allergens and irritants from the nose and also helps remove thick, sticky secretions that may be clogging the nose or leading to drainage.

This method has been around for a long time. You may have heard of the neti pot method. It uses gravity to force the liquid through the nose. Modern technology has given us simple plastic squeeze bottles that can provide a bit more force and flow through the nose. You can find one at any pharmacy.

Be sure to not use plain tap water to irrigate the nose. It is too dilute and will irritate the lining of the nose. To make a proper saline solution, add a teaspoon of salt to 8 ounces of lukewarm tap water. If you like you can use a half-teaspoon of salt and a half-teaspoon of baking soda instead. Some people prefer one over the other, but either way is fine.

Next, tilt the head forward and slightly sideways and place the nozzle in the upper nostril. Do not plug up the other side of the nose, simply let the solution drain out of the lower nostril. Obviously, one would do this over the sink or in the shower. Flush til the secretions clear. Once or twice a day is usually sufficient.

If you have had sinus surgery, this method may not work so well. The solution can pool in the sinuses and run out at very inopportune moments. (I’m speaking from experience here.)

Also, despite warnings in the commercially available squeeze bottles, you do not need to buy a fancy expensive mix. Whatever you have in your pantry will work just fine, including iodinated salt.

Fall Allergies

Wed, 04 Sep 2019 19:40:04 GMT

Autumn Signs and Symptoms

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 to 3pm. Therefore, all we have to do is walk outside to get exposed to this pollen.

Pollen counts tend to be highest on warm, dry and windy days and between the hours of 10am to 3 pm.

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!

Back to School and Food Allergies

Thu, 08 Aug 2019 04:00:00 GMT

Staying Safe at School

It’s that time of year again, when we pack our children’s backpacks and start a new school year. For parents of children with food allergies it can be a particularly stressful time, as they worry about their children having a reaction while at school. Food allergies have become more common in the past 20 years. Most of us grew up not knowing anyone with a food allergy. That’s not true these days. It seems most classrooms have at least one food allergic child.

What can parents do to prepare for the upcoming school year? It is very important to meet with the school nurse and the child’s teacher to review his or her food allergy. You should find out what protocols are already in place at the school to prevent and to treat accidental exposures. Fortunately, most schools already have protocols in place. You should also have a Food Allergy Action Plan on file at the school that tells the staff about the child’s food allergy, what symptoms he or she might develop, what treatment to give, and contact information on whom to call after treatment has been initiated.

Be aware of field trips or other times your child might be exposed to an allergen, such as a class party or class project. Discuss with the teacher how these activities will be handled.

It’s also important to teach your child how to talk about symptoms he or she might experience during an allergic reaction and what to do if he/she has a reaction. Help your child get in the habit of asking if the food allergen is in the food before taking any food from an adult or other child.

More information on sending your food allergic child to school can be found on the FARE website under “Tools and Resources” for parents.

Have a safe year!

Local Honey for Allergies: Sweet Relief or Just Sweet?

Sat, 01 Jun 2019 04:00:00 GMT

The Pollen Counts

Local honey is very tasty. I love it on a bagel with peanut butter or in a good marinade. But should it be on your menu of allergy treatments, too?

The notion that local honey can be utilized to treat allergies is not new. In fact, it has been a common topic of conversation with my patients since my days as an allergy fellow. The idea is that a small amount of pollen carried by bees makes its way into the honey and that regular ingestion of the pollen leads to desensitization. It’s a tempting notion, to think that you could treat your allergies with a natural, sweet treat, but the reality is slightly bitter.

What if there's something about honey itself that is beneficial for allergies? This final question was answered over a decade ago....

First, the pollens that bees carry are not significant allergens. To make honey, bees collect nectar from flowering plants and in the process become coated with the pollen from these plants. As they buzz from plant to plant, they spread the pollen, which allows the flowering plants to reproduce. Since these pollens are carried largely by bees and not the wind, the pollens rarely come into contact with the human nose and eyes and, hence, do not cause allergy symptoms. Conversely, plants whose pollens cause allergies are wind-pollenated and are not major sources for nectar and bee pollen.

Second, oral immunotherapy doesn’t work for nasal allergies. Numerous clinical trials have looked at oral immunotherapy (swallowed allergens) as a possible treatment for this problem. These trials used large doses of purified allergens, far more than would ever be found in bee pollen, and still failed to show a benefit. (Note: this is different from sublingual immunotherapy where the allergen is held under the tongue). So, even if allergy-causing pollens are found in honey, the act of swallowing them is unlikely to improve allergies.

What if there’s something about honey itself that is beneficial for allergies? This final question was answered over a decade ago by researchers in Connecticut who did a blind, randomized trial comparing the effects of local, unfiltered, unpasteurized honey, commercial honey, and honey-flavored corn syrup on seasonal allergies. They found no benefit for either honey group compared to the corn syrup group. In other words, honey is, literally and figuratively, a simple sugar pill.

Spring Allergies

Wed, 10 Apr 2019 12:28:16 GMT

Blooming with Allergens

S pring can be one of the worst times of year for allergy sufferers due to warm, wet weather and high tree pollen counts. Pollen allergy leads to sneezing, itching, watery eyes, drippy noses, congestion, coughing and wheezing. Many allergy sufferers choose to just stay indoors and miss many of the fun spring events, like the Annual Cherry Blossom Festival in Macon! Don’t let this year be miserable. We can help! Our allergists are all board certified with expertise in properly diagnosing and treating your allergies and asthma. While over-the-counter medications are quick fixes for allergy symptoms, these drugs have many side effects and do nothing to address the root of the problem. They are essentially bandages on an allergic immune system. Our physicians can prescribe safe, effective, more natural options that address the source of the problem rather than simply covering up the symptoms.

Spring can be one of the worst times of year for allergy sufferers due to warm, wet weather and high tree pollen counts.

- Dr. Jeana Bush

How Mild Winters Bring Early Spring Allergy Symptoms

Mon, 25 Mar 2019 18:49:35 GMT

Let It Snow

A mild winter can mean trouble for Central Georgians who suffer from allergies. Lack of cold weather means the plants pollinate earlier in the year, and a rainy spring will mean faster plant growth and higher mold counts. Anyone with pollen or mold allergies will probably feel the symptoms early in the year!

Pollen and mold are just a few of the many allergens that can lead to the symptoms of allergy. Symptoms may include sneezing, itching, watery eyes, drippy noses, congestion, swelling, coughing or wheezing. Normally the immune system protects our bodies from harmful invaders like bacteria and viruses. In people with allergies, the immune system is distracted by an otherwise harmless substance (also called an “allergen”).

Allergists can discuss alternative treatment options that actually fix the problem, rather than putting a 'band-aid' over the symptoms.

Allergens such as pollen from trees, grasses and weeds, house dust mite particles, pet dander and mold spores often enter our bodies by inhalation. If you have allergies to any of these particles, your immune system responds by causing inflammation in the skin, sinuses, nasal passages, digestive systems and the lungs – leading to symptoms of cough, wheezing and shortness of breath. If these symptoms go untreated for a long time, aside from being miserable, you may also develop lasting effects of chronic sinusitis or even asthma.

If you or your loved ones suffer from any of the above symptoms, it is important to be seen by a doctor board-certified in Allergy/Immunology. Allergists have years of advanced training and experience to properly diagnose the condition and prescribe an appropriate treatment plan to help you or your loved ones feel better and live better. While there are many medications on the market to treat symptoms of allergy, it can be difficult to know which one is right for you depending on your age, overall health, comorbidities, etc. Some of these medications may even cause problems such as drowsiness, high blood pressure and other harmful side effects. In addition, many people often find that these medications stop working after long-term use. Allergists can discuss alternative treatment options that actually fix the problem, rather than putting a “band-aid” over the symptoms.

Don’t waste any time in beautiful Central Georgia hiding indoors. Call and schedule an appointment with one of our board-certified allergists today!

The Post-Antibiotic Era: Sinusitis

Mon, 03 Dec 2018 05:00:00 GMT

Appropriate Antibiotic Use: Part III

This post will deal with one of the most common diagnoses seen by allergists: sinusitis. Here are some staggering statistics.

Sinusitis remains one of the top reasons for seeing a doctor in the U.S., accounting for almost 14 million physician visits annually.

Overall, 1 in 5 antibiotic prescriptions in the U.S. are written for presumed sinusitis, and most of these are unnecessary.

Despite studies showing that antibiotics don’t help for acute sinusitis, 86% of patients who sought treatment for acute sinusitis received antibiotics.

...if you're having persistent sinus symptoms or have required antibiotics three or more times in a year, it's time to see an allergist.

So what is sinusitis? Sinusitis is usually taken to mean infection of the sinus cavities. It is broadly divided into acute sinusitis and chronic sinusitis. Acute sinusitis is mostly due to the common cold virus (rhinovirus) and can present with low-grade fever, pain, pressure, and discolored secretions. It usually lasts 7-10 days and resolves on its own. Bacterial infections complicate less than 5% of cases of acute sinusitis. Chronic sinusitis can present with similar symptoms, though they are usually less severe, and also may cause significant fatigue, cough and occasionally drainage. Unlike acute sinusitis, it is frequently bacterial.

The biggest problem in managing chronic sinusitis is making a diagnosis. The symptoms are non-specific and don’t correlate well with the gold standard diagnostic test, a sinus CT. Indeed, the exact same symptoms can be infectious, allergic, both or neither. This illustrates the importance of allergy testing and sinus imaging in the management of chronic sinusitis. In general, if you’re having persistent sinus symptoms or have required antibiotics three or more times in a year, it’s time to see an allergist. They can find out precisely what’s wrong with you and come up with a treatment plan to get you better.

The Post-Antibiotic Era: Bronchitis

Wed, 21 Nov 2018 05:00:00 GMT

Appropriate Antibiotic Use: Part II

Part II of the when-not-to-use-antibiotics post deals with another common ailment: Bronchitis. We’ll be talking about acute bronchitis, not chronic bronchitis due to long-term smoking, which is a different animal altogether.

The term bronchitis is fairly non-specific. It simply means inflammation of the bronchial tubes or airways. This inflammation can occur for several different reasons, most commonly viruses or irritants, but rarely from bacteria. Viruses that cause bronchitis include influenza, parainfluinza, adenovirus and respiratory syncitial virus (RSV). Non-infectious causes of bronchitis include pollutants, chemicals, second-hand cigarette smoke and the like.

The hallmark of bronchitis is a cough, with or without mucus production. Depending on the cause, there may be fever, aches, headache and sore throat as well. The acute symptoms typically last less than two weeks, but the cough may linger for several weeks after. You should call your healthcare provider for high fever, thick or bloody mucus, or trouble breathing, but otherwise seek simple symptomatic treatment. Lots of great ideas are on this CDC web page .

Treating bronchitis with antibiotics simply adds to the cost, exposes people to the potential for adverse reactions, and adds to the growing rotes of antibiotic resistance.

Note that I did not mention antibiotics as a treatment. Since the vast majority of acute bronchitis is viral-or irritant-induced, antibiotics will not improve symptoms or shorten the duration of illness. (Anti-viral treatments for influenza can help if started early). Treating bronchitis with antibiotics simply adds to the cost, exposes people to the potential for adverse reactions, and adds to the growing rates of antibiotic resistance.

The one exception is pertussis, aka whooping cough. It is bacterial and responds to certain antibiotics. It also has an excellent vaccine that you and your children should all be up-to-date on. It had virtually disappeared from the U.S., but recent drops in vaccination rates and changes in vaccine composition have led to its reemergence. It causes a very characteristic, severe cough that can last for months, hence its old name, the 100-day cough.

So what can you do to prevent bronchitis? Avoid smoking and second-hand smoke for you and your kids, practice good hand hygiene, and stay current on your vaccinations, including pertussis and the yearly influenza vaccination.

I’ve borrowed liberally from the CDC website in writing this post. They have a ton of great information for the interested reader. I highly recommend it.

The Post-Antibiotic Era: Adult Upper Respiratory Infections

Tue, 13 Nov 2018 05:00:00 GMT

Appropriate Antibiotic Use: Part I

It’s no secret that antibiotics are becoming less and less effective. The Centers for Disease Control launched a campaign to educate both doctors and the general public about antibiotic use and to cajole them into actually doing the right thing. I think this is a hugely important issue, so I’m going to devote a few posts to it. I’ll start with the one I see most: upper respiratory infections, or URIs.

In the general population, virtually all sporadic infections of the upper respiratory tract are self-limited viral infections, usually the common cold. Since antibiotics don’t treat viruses, you’d think doctors wouldn’t prescribe them for such problems, but they do. Alot. In fact, doctors prescribed $1.1 billion worth of antibiotics for URIs last year, and nearly all of those were unnecessary. Aside from the waste of money, the biggest problem for overprescribing antibiotics is resistance. The more we use antibiotics, the more bacteria become resistant to them. So, if we want them to work when we need them, we need to use them only when needed.

Even though nothing will get rid of or shorten the duration of a cold, medications and other strategies can give symptomatic relief.

Here are some helpful facts about URIs and antibiotics.

More than 200 different viruses can cause the common cold.
Cold symptoms include runny nose, sneezing, sore throat and cough.
Cold symptoms typically last ten days to two weeks.
When nasal discharge turns yellow or green, it does not mean there is a bacterial infection. It simply means the immune system is fighting the virus.
Bacterial infections only complicate 1 out of every 50 colds.
Call your doctor if symptoms last more than 10 days or if you have a fever of greater than 100.4.
If you go to the doctor, let them know you’re ok with not taking antibiotics. Doctors are ten times more likely to prescribe antibiotics if they feel that’s what the patient wants.

Even though nothing will get rid of or shorten the duration of a cold, medications and other strategies can give symptomatic relief.

Take acetaminophen, ibuprofen or naproxen to relieve pain or fever. Always use these as directed.

Soothe a sore throat with ice chips, lozenges or a sore throat spray.

For sinus pain and pressure, use a decongestant or saline nasal spray, or breath in steam from a bowl of hot water or shower.

For a cough, try a cool mist vaporizer or humidifier.

Next time, I’ll discuss some other common infections like bronchitis and sinusitis.

"I'm so itchy!"

Mon, 25 Jun 2018 04:00:00 GMT

Scratching Out the Causes of Itchy Skin

" I am so itchy!” It's 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.

The causes of chronic itching are vase, and although we see many of these patients in the allergy clinic, allergy is often not the cause....

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.

On the Importance of Breathing Tests in Managing Asthma

Sat, 12 May 2018 04:00:00 GMT

The More You Know....

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.

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.

At what age can my child be tested for allergies?

Sun, 15 Apr 2018 04:00:00 GMT

In the Child's Best Interest

I 'm often asked by parents of young children when their child can get tested for allergies. 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 (i.e., 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 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 (i.e., 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!

"Is there more pollen in the air?"

Mon, 16 Oct 2017 04:00:00 GMT

More pollen, longer seasons

E very 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.

Unfortunately this trend of more pollen and longer seasons is likely to continue.

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.

Nasal Sprays

Sat, 12 Aug 2017 04:00:00 GMT

The Benefits and Risks of Nasal Antihistamines

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.

As much as nasal decongestants are a lifesaver during a cold, they can stir up many more problems if not used correctly.

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!

Summertime Allergies

Sat, 03 Jun 2017 04:00:00 GMT

A pollen-free season? Afraid not.

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.

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.

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.

Exercise Induced Asthma

Sat, 25 Feb 2017 05:00:00 GMT

When is asthma to blame for being out of breath?

W ho remembers Shaun T’s Insanity® DVD set released back in 2009? Now who tried and who completed the entire set?

Bored with my early morning fitness routines, I started working through this DVD set with a good friend after finding these videos packed away. I very quickly started questioning if I had exercise-induced asthma with just the “fit test!”

In the spring my daughter had begun training 2-3 times a week for her soccer team, and after talking with several of our patients, I knew for sure that cheer, softball, baseball, tee ball, track, golf and swimming had all been starting up around the same time (if they actually ever ended for some of my competitive patients and parents).

The combination of exercise and seasonal allergies has long been associated with what is often called “exercise-induced bronchospasm” or “exercise-induced asthma.” Are you or your child experiencing shortness of breath, chest tightness or cough associated with exercise? Should we be pushing ourselves (or our children) harder because we are “just out of shape”? Or could we be pushing children to do more than what their lungs will allow because they have asthma, eventually pushing them out of sports altogether because they “just don’t like sports”?

The only way to know if you or your child’s symptoms are related to asthma/allergies or if you’re just out of shape is to be seen by a board certified allergist.

The only way to know if you or your child’s symptoms are related to asthma/allergies or if you’re just out of shape is to be seen by a board certified allergist. At The Allergy, Asthma and Sinus Center, Dr. Jeana Bush and I are both board certified in pediatric and adult allergies (sinuses) and asthma. If you would like to be evaluated or have us talk with your school or organization on this subject, please call. We can help!

As for me, I realized that I fell into the category of being out of shape. I often tell my patients that I love blaming things on allergies and asthma; but in this case, I just need to “push harder, dig deeper!”

Have a great season, everyone, and “push harder, dig deeper!”

Over-the-counter Medicines for Nasal Symptoms

Fri, 16 Dec 2016 05:00:00 GMT

What to Buy for Allergic Rhinitis Relief

Let's talk for a bit about common allergy medications. In the interest of time, I’ll focus on medicines used to treat nasal symptoms, what doctors call rhinitis.

The most common medications used for rhinitis are antihistamines. Antihistamines work, as their name suggests, by blocking the effects of the chemical histamine. They are particularly good for controlling symptoms of nasal itching, sneezing, runny nose, and itchy eyes. They are not very good at controlling nasal congestion and drainage. Older antihistamines like diphenhydramine (benadryl), chlorpheniramine (chlor-trimeton) , and hydroxyzine (atarax, vistaril) are very potent, but they are also very sedating. Newer antihistamines such as cetirizine (zyrtec), fexofenadine (allegra), and loratidine (claritin) are classified as low- or non-sedating and still have adequate potency. I generally recommend one of the newer medications. Cetirizine and loratidine are available over-the-counter and as store brands.

Decongestants also do what their name suggests: help control nasal congestion. Some people find they help with symptoms of pressure and pain as well. They work by constricting the blood vessels in the nose which, in turn, shrinks the lining of the nasal passage. Since they are oral medications, they will also constrict the blood vessels in the rest of the body, which can worsen blood pressure, In guys, they can also worsen prostate problems. They cause insomnia in a number of people as well. Because of all these side effects, I avoid decongestants as much as possible and limit their use to short periods of time.

Plain table salt is fine and could never make the nose a dirtier place than it already is.

Over-the-counter nasal sprays are a double-edged sword. They are sold under a variety of names, but most contain the drug oxymetazoline. They will open your nose like nothing else, but if used improperly can lead to dependence so be very careful with them and always follow the instructions. Never use them for more than 3 days in a row or more than twice a day. If you do, when you try to stop, your nose will be worse than when it started- a phenomenon called rebound. I see patients every week who have become dependent on these medications to breathe through their nose. Don’t become one of them.

Finally, I’ll talk about saline rinse. This is a great treatment for most nasal symptoms, including drainage. It’s essentially free and devoid of side effects. I’m not referring to “ocean spray” that simply moistens the nose, but rather forcing a large volume of saline through the nose. This can be done with gravity (a neti pot) or with force (a plastic squeeze bottle). Either way, make sure you don’t use plain tap water- it’s too dilute and will irritate the lining of the nose. A simple mix involves using a teaspoon of salt in 8 ounces of water. Some companies try to sell you their mix, claiming that they have “pharmaceutical grade NaCl”. This is ridiculous. Plain table salt is fine and could never make the nose a dirtier place than it already is.

Hope this is helpful.

What is a Board-Certified Allergist?

Wed, 07 Dec 2016 05:00:00 GMT

Certification Matters

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.

Allergies and the Ear

Mon, 17 Oct 2016 04:00:00 GMT

The Ins and Outs of Ears and Allergies

When people think of allergy problems, what comes to mind most often are the classic symptoms of sneezing, runny nose, and itchy eyes. Many people don’t realize that the ears can be affected by allergies, too.

The ear can be divided into three sections: outer, middle and inner.

The outer ear is made up of the ear we see, called the pinna, and the ear canal. The pinna and canal help catch and funnel sound vibrations toward the middle ear. The middle ear begins with the eardrum or tympanic membrane and contains the auditory bones-hammer, anvil, and stapes(STAY-peas)- which transmit sound vibrations to the inner ear or cochlea (COKE-lee-uh). The cochlea converts those vibrations into nerve impulses which can be interpreted by the brain as sound. The cochlea also contains the body’s balance apparatus- the vestibular (ves-TIB-you-luhr) system.

Allergies primarily affect the middle ear. As you can see, the middle ear has a drainage tube or pressure release valve called the eustachian (you-STAY-shun) tube. If this tube is clogged with mucus or its opening is blocked by allergy swelling, then pressure and fluid can build up in the middle ear. This gives us the sensation of being down a well, having the need to “pop” our ears frequently, and can result in diminished hearing. Fluid build-up also creates a good environment for infection to occur. Middle ear infections, called otitis media or OM, occur commonly in early childhood and are a frequent reason for antibiotic treatment and missed school days. Allergies are a well recognized cause for recurrent OM and kids who have more than their share of middle ear infections should be allergy tested.

Disorders affecting the inner ear, such as Meniere’s disease, may have an allergic component as well. Patients who fail to respond to conservative therapy may benefit from allergy desensitization, though evidence to support this comes largely from case series and anecdotal evidence.

External ear infection, otits externa (OE) or swimmer’s ear, is usually caused by a water loving bacterium called pseudomonas (soo-duh-MOAN-us). It is usually not related to allergies.

Finally, a word about itchy ears. You really want to scratch them, don’t you? Well, remember what your mom said: Never put anything in your ear smaller than your elbow! The skin in the ear canal is paper thin and very easy to irritate. Although sticking a Q-tip in there might feel good for a few seconds, it will just make the ears itch more afterward.

Is there such a thing as a red meat allergy?

Tue, 26 Jan 2016 05:00:00 GMT

Ticks and Red Meat Allergy

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!

Ineffective OTC Decongestants

Wed, 28 Oct 2015 04:00:00 GMT

Avoid Wasting Time, Money and Treatment

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.

First, you need to be a label reader. All OTC medications will contain a list of their active ingredients.

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.

Allergy Shots at Home

Sun, 25 Oct 2015 04:00:00 GMT

Safety First

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.

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.

Should children with asthma be tested for peanut allergy?

Tue, 19 May 2015 04:00:00 GMT

Forging a False Connection

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 American College of Allergy, Asthma and Immunology (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 sort of 'fishing expedition' leads to incorrect diagnoses, false positive tests, and unnecessary anxiety and lifestyle modifications.

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.

Stress and Allergies

Tue, 14 Apr 2015 04:00:00 GMT

In case if you weren't stressed enough....

W e all know stress isn’t good for our health. It increases the risk of developing high blood pressure and diabetes and contributes to increased levels of anxiety and depression.

A study in the Annals of Allergy, Asthma and Immunology shows that people who are experiencing stress are more likely to have a flare of their allergies. Many of the patients in the study reported an allergic flare within days of the increased stress. Additionally, allergy suffers with more chronic stress experienced allergy flares more often.

Five Tips to Manage Stress:
Take a break.

Exercise.

Smile and laugh.

Get social support.

Meditate.

Source: The American Psychological Association

The authors recommend ways to alleviate stress, such as meditating, making time for relaxing and adopting a healthy lifestyle. Certainly decreasing stress is good for your overall health, but be sure to see a board-certified allergist to get a comprehensive plan for managing your allergies.

The Science of a Sneeze

Fri, 02 May 2014 04:00:00 GMT

Gesundheit, Fellow Science Geeks!

I love science: chemistry, physics, engineering, math. It’s a big reason I became a doctor. So when scientists at Massachusetts Institute of Technology published a paper in the Journal of Fluid Mechanics on sneezing, I got pretty excited. How nerdy is that? Anyway, regardless of your level of nerd-cred, the article had some important and interesting new findings — and it has a high-speed video of a sneeze.

What you’re seeing there is not just a simple sneeze, it’s a multiphase turbulent buoyant cloud. That means that when you sneeze, the gasses you emit mix with the surrounding air (“multiphase”) in a violent, roiling fashion (“turbulent”) that results in a floating (“buoyant”) cloud. We used to think that the distance a germ could travel in a sneeze was limited to the distance the large droplet particles could travel, essentially the spray that you can see and feel from a sneeze. We also thought that larger particles traveled the farthest due to their greater momentum. The new gas cloud model turns that understanding on its ear. It tells us that the smaller particles travel the farthest because the cloud keeps them suspended in the air while the larger particles fall out. In fact, these small particles can travel five to 200 times farther than we previously thought! Some very small particles even had the potential to reach air ventilation intakes that could then circulate them elsewhere in an indoor environment.

In practical terms, this might change the way ventilation systems are designed, especially for higher risk locales like hospitals, schools and airplanes. Better air systems with less germ transmission could result in real gains in public health: fewer cases of hospital-acquired pneumonia, fewer influenza outbreaks in schools, and less anxiety about the guy three rows behind you on the plane coughing his head off. For now, though, the CDC still recommends that we sneeze into our elbow and wash our hands after sneezing — very good recommendations.

If you want to dig a little deeper and read about it from the people who really know what they are talking about, try this press release from MIT . If you read it, let me know what you think, and I'll put your official nerd certificate in the mail.

A New Treatment for Hives

Tue, 08 Apr 2014 04:00:00 GMT

Relief for Chronic Hive Sufferers

C hronic hives make people miserable. They affect all facets of life — work, sleep, relationships, mood — and they can be relentless. Most folks who suffer from persistent hives can get adequate relief with simple, long-acting antihistamines like cetirizine (Zyrtec) or fexofenadine (Allegra) if taken in adequate doses (sometimes two to three times the usual daily dose). If these don’t work, then super-potent antihistamines like hydroxyzine or doxepin are the next step, but both are very sedating.

Sometimes even these very strong medications don’t work or the side effects are just intolerable. In the past, severe patients had very limited treatment options, usually potent immune suppressants like cyclosporine; but now there’s a new option in the form of a not-so-new medication: omalizumab (Xolair).

The important message here is this: you needn't be miserable from chronic hives.

In simplest terms, omalizumab disarms the body’s allergy cells, making it nearly impossible for them to mount an allergic reaction. Because these cells are responsible in large part for causing hives, it makes sense that omalizumab would work in such cases, and now there are good studies to show that it is, indeed, effective when antihistamines fail.

So how effective is it? I would say moderately effective. Studies show that only about a third of folks who took omalizumab injections once a month got total relief and about two-thirds had a good response. It took up to two weeks to see improvement, and once they stopped taking omalizumab, the hives came back. On the good side, omalizumab is very well tolerated.

The important message here is this: you needn’t be miserable from chronic hives. Numerous good treatment options exist. To find which is most appropriate for you, go see your local board-certified allergist and get better.

Universal Allergies in the U.S.

Thu, 13 Mar 2014 04:00:00 GMT

No matter where you go, there you are. -- Buckaroo Banzai

Allergies: Nature or ...?

Spring allergy season is upon us, and in Middle Tennessee it’s the time of year with the most acute allergy misery. All the sneezy, itchy, runny noses drive many patients to the allergist where they often wonder aloud, “I never had problems like this until I moved here. Would it simply be better for me to move somewhere else?” One recent study suggests the answer to that question is “No.”

No one is born with allergies. Whether people develop them, like most medical problems, depends on the combination of genetics and environment, nature and nurture. Certain people are born with a tendency – the genetic component – to develop allergies. At some point they become exposed to allergens like tree pollen, cat dander or peanuts – the environmental component. If a person’s genetic tendency is strong and the exposure has the right amount, timing and route of administration, then a clinical allergy may develop.

If your body has an allergic tendency, it's going to find an allergen to react to no matter where you live or what you try to avoid.

The genetic side of this formula is set in stone. You can’t pick your parents. The exposure side, however, is variable. Tennessee has more tree pollen than Phoenix. Humid areas (Mississippi) have more dust mites than arid climates (Colorado). Urban areas (Baltimore) have more cockroaches and cat dander than rural areas (Beaver Dam, KY). So you would think that the prevalence of allergies would be higher in areas with a greater environmental allergy loads. But, you’d be wrong.

A recent study looked at the prevalence of positive allergy tests in all areas of the U.S. and found that the numbers were pretty much the same wherever you live. A whopping 44.6%(!) of U.S. adults are sensitive to at least one allergen. In kids ages 1-5, that number is 36%. Interestingly, the rates didn’t vary from region to region, though they were a little higher in urban areas, 50%, vs. rural areas, 40%. Rates of sensitization to individual allergens did differ. For example, the South had more dust mite allergy and the West had more pollen allergy, but the overall rates remained constant.

So what does this all mean? It suggests that the genetic component of allergies is much more important than the environment. If your body has an allergic tendency, it’s going to find an allergen to react to no matter where you live or what you try to avoid. You can avoid specific allergens, but you can’t avoid all of them, and you can’t run from your genetics.

This is where the allergist comes in. We actually have the tools to make you less allergic to your specific allergens. We can teach your immune system to ignore your triggers, which will shut off your allergies at the source and give you systemic relief, fewer symptoms and fewer complications while using fewer or no medications. So before you pack up for Denver, try giving you local, board-certified allergist a visit first.

Allergy Shots Reduce Sinus Infections, Sore Throats

Wed, 05 Mar 2014 05:00:00 GMT

Additional Benefits of Immunotherapy

Allergies are much more than just a runny nose. We all know they can cause the acute misery of sneezing, itchy eyes and nasal congestion, but they affect people in numerous other ways. One of the most common complications of allergies is an increase in upper respiratory infections. URIs include sinusitis, pharyngitis (sore throat), tonsillitis, and the common cold.

Multiple studies have shown that allergy shots will reduce the direct symptoms of allergies, and now a recent study has helped quantify exactly how much we can expect them to help with the complications.

Multiple studies have shown that allergy shots will reduce the direct symptoms of allergies....

Data presented at this year's AAAAI meeting show that patients who take allergy shots are overall three times as likely to have fewer URIs than patients who do not. The study used a large Medicare database from Florida and compared several thousand allergy shot patients with matched controls. The study found that allergy shot patients were:

twice as likely to have fewer sinus infections

four times as likely to have fewer episodes of tonsillitis

eight times as likely to have fewer sore throats, and

35 times as likely to have improvement in nasal polyps.

These findings confirm what we’ve been saying all along — If you’re having complications from allergies, you need to see a board certified allergist so that you can get tested, get treated, and get better.

Preventing Food Allergy During Pregnancy

Tue, 14 Jan 2014 05:00:00 GMT

Early Exposure to Foods

Can a pregnant woman do something to prevent her child from having food allergies? There has been much debate surrounding this question over the years. In the past, allergists recommended pregnant women try to avoid nuts during pregnancy; however, current recommendations are that maternal avoidance diets are unsuccessful in preventing the development of an allergy and are therefore not recommended.

A new Harvard study published in JAMA Pediatrics provides some new insight. This study examined the association between maternal comsumption of nuts and the risk of having children with a nut allergy. They found that mothers who were not allergic and who ate nut products more than five times per month were significantly less likely to have a child with a nut allergy. This finding is consistent with new recommendations about introducing highly allergenic foods earlier in life as a way to help prevent the development of food allergies, and it suggests that early exposure to allergens may help promote tolerance to these allergens.

In a Lather Over Soaps

Tue, 17 Dec 2013 05:00:00 GMT

The FDA and Soap

Doctor:

What is it she does now? Look how she rubs her hands.

Gentlewoman:

It is an accustom’d action with her, to seem thus washing her hands. I have known her continue in this a quarter of an hour.

Lady Macbeth:

Yet here’s a spot.

Doctor:

Hark, she speaks. I will set down what comes from her, to satisfy my remembrance the more strongly.

Lady Macbeth:

Out, damn’d spot! out, I say!

-Macbeth, Act V, Scene I

Germophobes rejoice! Or revolt! I’m not sure which, but the FDA is now going to require that manufacturers of anti-bacterial soaps prove that their products are safe over time and that they work better than plain soap and water. (Your hand sanitizer is still safe, for now.) A bit more from Jeff Bezo's Washington Post article .

Acetaminophen and Asthma

Wed, 13 Nov 2013 05:00:00 GMT

Pain Relief Precautions for Children with Asthma

N o parents want their child to suffer. When your child is sick, especially with a fever, he or she can feel miserable, which in turn makes you feel miserable, too! Fever-reducing medications, such as acetaminophen (Tylenol) and ibuprofen (Motrin) have long been known to improve symptoms associated with infections. Pediatricians recommend, however, that these medications only be used if the fever is affecting the child's behavior (except in young infants) or if the fever is really high. The fever itself is not harmful and is in fact a way the immune system fights infection.

A study published in the Annals of Allergy, Asthma & Immunology by Kang et al examined the association between acetaminophen exposure in the first year of life and the risk of developing asthma. The researchers found that preschool children (3-7 year olds) who used acetaminophen for more than three days during the first year of life, especially if they have a family history of asthma, were significantly more likely to have asthma. Similar results have been seen in other studies, but this study controlled for lung infections associated with an increased risk of asthma. At this point, these are only associations, and the results cannot clarify cause and effect. Also, it is unknown whether or not this risk remained as the children got older. More studies are needed to help clarify this risk, but the results are quite intriguing and would certainly lead me to recommend that those families with a history of asthma should limit the use of acetaminophen during the first year of life.

Gluten and Allergy

Fri, 27 May 2011 04:00:00 GMT

Concerns about Gluten

Gluten is a protein found in wheat, barley and rye. In persons with celiac disease (formerly celiac sprue, aka gluten sensitive enteropathy), eating gluten causes an inflammatory response in the bowel leading to abdominal pain, diarrhea, and malabsorption. The latter may cause anemia. The presenting symptoms can vary, but GI symptoms are the most common form of presentation. Celiac disease may affect up to 1% of the population. Simple blood tests are very good at screening for celiac disease. In celiac disease, the reaction to gluten is not an allergy, so allergy testing is not a part of the diagnostic workup.

Allergy to wheat should not be confused with gluten sensitivity. As with all food allergies, individuals with wheat allergy can have GI symptoms but will lack the small bowel inflammation and malabsorption found in celiac disease. Most commonly, individuals with wheat allergy will present with a rash.

Lastly, there is nothing inherently bad about gluten. I have seen many patients who tried to remove gluten from their diets thinking it would help their allergy symptoms. There is no evidence to support a connection between eating gluten and allergies.

If you have questions about gluten sensitivity or celiac disease, your primary care doc is a good starting point.

aasc

Understanding and Managing Eczema and Chronic Hives

Eczema & Urticaria: What They Are, How They're Treated ﻿

Eczema: The "Itch That Rashes"

Clinical Management of Eczema

Hives: Transient and Mobile

Treatment Pathways for Hives

The Role and Safety of Biologics

Ready To Say Goodbye To Needles?

Is Sublingual Immunotherapy right for you?

What is Sublingual Immunotherapy (SLIT)?

The Key Benefits of Allergy Drops

Are Drops as Effective as Shots?

Important Considerations

The Bottom Line

Why Does Fresh Fruit Make My Mouth Itch?

Understanding Oral Allergy Syndrome

What is Oral Allergy Syndrome (OAS)?

Common Triggers and Symptoms

The "Apple Pie" Solution: Why Cooking Helps

Managing Your Allergies

Summer Grass Pollen

By Dr. Ben Gaudin, II

The Proper Use of Nasal Sprays

Correct Nasal Spray Technique

How to:

Environmental Control Measures to Decrease Allergy Symptoms

Indoor Allergen Exposure

Dust Mites:

Mold:

Pets:

Trees/Grass/Weeds:

Blood Testing for Allergies

Why Not to Get a Blood Test for Allergies

If your provider wants to do blood tests for allergies, make sure it's IgE testing and ask them what you're being tested for and why. Or better yet, see a board-certified allergist.

The Teal Pumpkin Project

Creating a Safe Halloween for All

Visit foodallergy.org for more information about #TealPumpkinProject!

Nasal Saline Rinse

To Rinse or Not to Rinse?

Fall Allergies

Autumn Signs and Symptoms

Pollen counts tend to be highest on warm, dry and windy days and between the hours of 10am to 3 pm.

Back to School and Food Allergies

Staying Safe at School

Local Honey for Allergies: Sweet Relief or Just Sweet?

The Pollen Counts

What if there's something about honey itself that is beneficial for allergies? This final question was answered over a decade ago....

Spring Allergies

Blooming with Allergens

Spring can be one of the worst times of year for allergy sufferers due to warm, wet weather and high tree pollen counts.

How Mild Winters Bring Early Spring Allergy Symptoms

Let It Snow

Allergists can discuss alternative treatment options that actually fix the problem, rather than putting a 'band-aid' over the symptoms.

The Post-Antibiotic Era: Sinusitis

Appropriate Antibiotic Use: Part III

...if you're having persistent sinus symptoms or have required antibiotics three or more times in a year, it's time to see an allergist.

The Post-Antibiotic Era: Bronchitis

Appropriate Antibiotic Use: P﻿art II

Treating bronchitis with antibiotics simply adds to the cost, exposes people to the potential for adverse reactions, and adds to the growing rotes of antibiotic resistance.

The Post-Antibiotic Era: Adult Upper Respiratory Infections

Appropriate Antibiotic Use: Part I

Even though nothing will get rid of or shorten the duration of a cold, medications and other strategies can give symptomatic relief.

"I'm so itchy!"

Scratching Out the Causes of Itchy Skin

The causes of chronic itching are vase, and although we see many of these patients in the allergy clinic, allergy is often not the cause....

On the Importance of Breathing Tests in Managing Asthma

The More You Know....

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.

At what age can my child be tested for allergies?

In the Child's Best Interest

...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!

"Is there more pollen in the air?"

More pollen, longer seasons

Unfortunately this trend of more pollen and longer seasons is likely to continue.

Nasal Sprays

The Benefits and Risks of Nasal Antihistamines

As much as nasal decongestants are a lifesaver during a cold, they can stir up many more problems if not used correctly.

Summertime Allergies

A pollen-free season? Afraid not.

Eczema & Urticaria: What They Are, How They're Treated

Appropriate Antibiotic Use: Part II

Avoid Wasting Time, Money and Treatment

Five Tips to Manage Stress:
Take a break.

Exercise.

Smile and laugh.

Get social support.

Meditate.

Source: The American Psychological Association